101
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Bruce D, Brady JP, Foster E, Shattell M. Preferences for Medical Marijuana over Prescription Medications Among Persons Living with Chronic Conditions: Alternative, Complementary, and Tapering Uses. J Altern Complement Med 2017; 24:146-153. [PMID: 28945457 DOI: 10.1089/acm.2017.0184] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Despite expanded legalization and utilization of medical cannabis (MC) internationally, there is a lack of patient-centered data on how MC is used by persons living with chronic conditions in tandem with or instead of prescription medications. This study describes approaches to use of MC vis-à-vis prescription medications in the treatment of selected chronic conditions. DESIGN Participants completed semistructured telephone interviews with open-ended questions. Content analysis of qualitative data identified themes and subthemes relating to patient approaches to using MC products. PARTICIPANTS Thirty persons (mean age = 44.6 years) living with a range of chronic conditions (e.g., rheumatoid arthritis, Crohn's disease, spinal cord injury/disease, and cancer) who had qualified for and used MC in Illinois. RESULTS Participants described a range of approaches to using MC, including (1) as alternatives to using prescription or over-the-counter medications; (2) complementary use with prescription medications; and (3) as a means for tapering off prescription medications. Motives reported for reducing or eliminating prescription medications included concerns regarding toxicity, dependence, and tolerance, and perceptions that MC improves management of certain symptoms and has quicker action and longer lasting effects. CONCLUSIONS MC appears to serve as both a complementary method for symptom management and treatment of medication side-effects associated with certain chronic conditions, and as an alternative method for treatment of pain, seizures, and inflammation in this population. Additional patient-centered research is needed to identify specific dosing patterns of MC products associated with symptom alleviation and produce longitudinal data assessing chronic disease outcomes with MC use.
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Affiliation(s)
- Douglas Bruce
- 1 Department of Health Sciences, DePaul University , Chicago, IL
| | - John P Brady
- 2 Department of Psychology, DePaul University , Chicago, IL
| | - Elissa Foster
- 3 Health Communication Program, College of Communication, DePaul University , Chicago, IL
| | - Mona Shattell
- 4 Department of Community, Systems, and Mental Health Nursing, College of Nursing, Rush University , Chicago, IL
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102
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Stith SS, Vigil JM, Adams IM, Reeve AP. Effects of Legal Access to Cannabis on Scheduled II-V Drug Prescriptions. J Am Med Dir Assoc 2017; 19:59-64.e1. [PMID: 28899660 DOI: 10.1016/j.jamda.2017.07.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/17/2017] [Accepted: 07/26/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Co-prescribing of scheduled drugs is endemic in the United Sates, increasing health risks to patients and the burden on healthcare systems. PURPOSE We conducted a pragmatic historical cohort study to measure the effect of enrollment in a state-authorized United States' Medical Cannabis Program (MCP) on scheduled II-V drug prescription patterns. PROCEDURES Eighty-three chronic pain patients, who enrolled in the New Mexico MCP between April 1, 2010 and October 3, 2015, were compared with 42 nonenrolled patients over a 24-month period (starting 6 months before enrollment for the MCP patients) using the Prescription Monitoring Program. The outcome variables include baseline levels and pre- and postenrollment monthly trends in the number of drug prescriptions, distinct drug classes, dates prescription drugs were filled, and prescribing providers. FINDINGS Twenty-eight MCP patients (34%) and 1 comparison group patient (2%) ceased the use of all scheduled prescription medications by the last 6 months of the observation period. Age- and sex-adjusted regressions show that, although no statistically significant differences existed in pre-enrollment levels and trends, the postenrollment trend among MCP patients is statistically significantly negative for all 4 measures (decreases in counts of -0.02 to -0.04, P values between <.001 and .017), whereas the postenrollment trend is 0 among the comparison group. Controlling for time-invariant patient characteristics suggested that MCP patients showed statistically significantly lower levels across all 4 measures by 10 months postenrollment. CONCLUSIONS Legal access to cannabis may reduce the use of multiple classes of dangerous prescription medications in certain patient populations.
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Affiliation(s)
- Sarah S Stith
- Department of Economics, University of New Mexico, Albuquerque, NM
| | - Jacob M Vigil
- Department of Psychology, University of New Mexico, Albuquerque, NM.
| | - Ian Marshall Adams
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM; Industrial Rehabilitation Clinics, Albuquerque, NM
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103
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Park JY, Wu LT. Prevalence, reasons, perceived effects, and correlates of medical marijuana use: A review. Drug Alcohol Depend 2017; 177:1-13. [PMID: 28549263 PMCID: PMC5542049 DOI: 10.1016/j.drugalcdep.2017.03.009] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/10/2017] [Accepted: 03/12/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND The use of marijuana for medical purposes is now legal in some U.S. states and other jurisdictions, such as Canada, and Israel. Despite the widespread legalization of medical marijuana globally, there is limited information on patterns and correlates of medical marijuana use (MMU). We conducted a literature review to assess prevalence, reasons, perceived effects, and correlates of MMU among adolescents and adults. METHODS We searched peer-reviewed articles in English between January 1996 and August 2016 from several databases (PubMed, Google Scholar, Embase, CINAHL, and PsycINFO) using different combinations of keywords. RESULTS A total of 25 articles met the inclusion criteria. In the U.S., national survey estimates of prescribed MMU was 1.1% among 12th graders and 17% among adults who reported past-year marijuana use. The reported prevalence of prescribed MMU ranged from <1.7% in Israeli cancer patients to 17.4% in American health care patients. The reported prevalence of self-medication with marijuana ranged from 15% in Canadian patients with chronic pain to 30% in British patients with multiple sclerosis. Pain was the most frequently endorsed reason for use. MMU appeared to provide symptom relief for a range of pain conditions, sleep disturbance, and anxiety symptoms, but it did not appear to provide sufficient relief of cluster headache symptoms. Non-medical marijuana use was a common factor associated with MMU across studies. CONCLUSION Either MMU or self-medication with marijuana was common, mainly due to pain management. Additional research is needed to evaluate temporal and causal associations of non-medical marijuana use with MMU.
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Affiliation(s)
- Ji-Yeun Park
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, BOX 3903, Durham, NC, USA.
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, BOX 3903, Durham, NC, USA; Department of Medicine, School of Medicine, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham NC, USA.
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104
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Baumgartner P, Peiper N. Utilizing Big Data and Twitter to Discover Emergent Online Communities of Cannabis Users. Subst Abuse 2017; 11:1178221817711425. [PMID: 28615950 PMCID: PMC5462814 DOI: 10.1177/1178221817711425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/06/2017] [Indexed: 01/15/2023]
Abstract
Large shifts in medical, recreational, and illicit cannabis consumption in the United States have implications for personalizing treatment and prevention programs to a wide variety of populations. As such, considerable research has investigated clinical presentations of cannabis users in clinical and population-based samples. Studies leveraging big data, social media, and social network analysis have emerged as a promising mechanism to generate timely insights that can inform treatment and prevention research. This study extends a novel method called stochastic block modeling to derive communities of cannabis consumers as part of a complex social network on Twitter. A set of examples illustrate how this method can ascertain candidate samples of medical, recreational, and illicit cannabis users. Implications for research planning, intervention design, and public health surveillance are discussed.
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Affiliation(s)
| | - Nicholas Peiper
- Behavioral Health and Criminal Justice Research Division, RTI International, Durham, NC, USA
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105
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Reiman A, Welty M, Solomon P. Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report. Cannabis Cannabinoid Res 2017; 2:160-166. [PMID: 28861516 PMCID: PMC5569620 DOI: 10.1089/can.2017.0012] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Prescription drug overdoses are the leading cause of accidental death in the United States. Alternatives to opioids for the treatment of pain are necessary to address this issue. Cannabis can be an effective treatment for pain, greatly reduces the chance of dependence, and eliminates the risk of fatal overdose compared to opioid-based medications. Medical cannabis patients report that cannabis is just as effective, if not more, than opioid-based medications for pain. Materials and Methods: The current study examined the use of cannabis as a substitute for opioid-based pain medication by collecting survey data from 2897 medical cannabis patients. Discussion: Thirty-four percent of the sample reported using opioid-based pain medication in the past 6 months. Respondents overwhelmingly reported that cannabis provided relief on par with their other medications, but without the unwanted side effects. Ninety-seven percent of the sample "strongly agreed/agreed" that they are able to decrease the amount of opiates they consume when they also use cannabis, and 81% "strongly agreed/agreed" that taking cannabis by itself was more effective at treating their condition than taking cannabis with opioids. Results were similar for those using cannabis with nonopioid-based pain medications. Conclusion: Future research should track clinical outcomes where cannabis is offered as a viable substitute for pain treatment and examine the outcomes of using cannabis as a medication assisted treatment for opioid dependence.
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Affiliation(s)
- Amanda Reiman
- School of Social Welfare, University of California, Berkeley, Berkeley, California
| | - Mark Welty
- School of Lifespan Development and Educational Services, Kent State University, Kent, Ohio
| | - Perry Solomon
- Chief Medical Officer, HelloMD, San Francisco, California
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106
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Piper BJ, DeKeuster RM, Beals ML, Cobb CM, Burchman CA, Perkinson L, Lynn ST, Nichols SD, Abess AT. Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. J Psychopharmacol 2017; 31:569-575. [PMID: 28372506 DOI: 10.1177/0269881117699616] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A prior epidemiological study identified a reduction in opioid overdose deaths in US states that legalized medical cannabis (MC). One theory to explain this phenomenon is a potential substitution effect of MC for opioids. This study evaluated whether this substitution effect of MC for opioids also applies to other psychoactive medications. New England dispensary members ( n = 1,513) completed an online survey about their medical history and MC experiences. Among respondents that regularly used opioids, over three-quarters (76.7%) indicated that they reduced their use since they started MC. This was significantly ( p < 0.0001) greater than the patients that reduced their use of antidepressants (37.6%) or alcohol (42.0%). Approximately two-thirds of patients decreased their use of anti-anxiety (71.8%), migraine (66.7%), and sleep (65.2%) medications following MC which significantly ( p < 0.0001) exceeded the reduction in antidepressants or alcohol use. The patient's spouse, family, and other friends were more likely to know about their MC use than was their primary care provider. In conclusion, a majority of patients reported using less opioids as well as fewer medications to treat anxiety, migraines, and sleep after initiating MC. A smaller portion used less antidepressants or alcohol. Additional research is needed to corroborate these self-reported, retrospective, cross-sectional findings using other data sources.
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Affiliation(s)
- Brian J Piper
- 1 Department of Basic Sciences, Geisinger Commonwealth School of Medicine, Scranton, PA, USA.,2 Department of Basic Pharmaceutical Sciences, Husson University School of Pharmacy, Bangor, ME, USA.,3 Neuroscience Program, Bowdoin College, Brunswick, ME, USA
| | - Rebecca M DeKeuster
- 4 Wellness Connection of Maine, Gardiner, ME, USA.,12 Calyx Concepts LLC, Sidney, ME, USA
| | - Monica L Beals
- 5 Department of Psychologcal Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Catherine M Cobb
- 4 Wellness Connection of Maine, Gardiner, ME, USA.,6 Center for Wellness Leadership, Portland, ME, USA
| | - Corey A Burchman
- 7 Department of Anesthesiology and Perioperative Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,8 Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | - Stephanie D Nichols
- 10 Department of Pharmacy Practice, Husson University School of Pharmacy, Bangor, ME, USA
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107
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Lankenau SE, Ataiants J, Mohanty S, Schrager S, Iverson E, Wong CF. Health conditions and motivations for marijuana use among young adult medical marijuana patients and non-patient marijuana users. Drug Alcohol Rev 2017; 37:237-246. [PMID: 28434211 DOI: 10.1111/dar.12534] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/18/2016] [Accepted: 12/30/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION While marijuana has been legal for medical purposes in California since 1996, little is known about the health histories of young adult medical marijuana patients who are a significant proportion of medical marijuana patients. We examined whether young adult medical marijuana patients reported health conditions and motivations for use that were consistent with medical use of marijuana in California. METHODS Young adults (N = 366) aged 18 to 26 years were sampled in Los Angeles in 2014-2015 and segmented into medical marijuana 'patients' (n = 210), marijuana users with a current recommendation, and non-patient users or 'non-patients' (n = 156), marijuana users who never had a medical marijuana recommendation. Differences between patients and non-patients regarding self-reported health histories and past/current motivations for marijuana use were expressed as unadjusted risk ratios. RESULTS Compared with non-patients, patients were significantly more likely to report a range of lifetime health problems, such as psychological, physical pain and gastrointestinal. In the past 90 days, patients were significantly more likely to report motivations for marijuana use than non-patients concerning sleep, anxiety, physical pain and focusing. Psychological and pain problems were the most common health conditions reported to receive a medical marijuana recommendation. Patients were significantly less likely than non-patients to report any privacy concerns about obtaining a medical marijuana recommendation. CONCLUSIONS Patients were significantly more likely to report a range of health conditions and motivations associated with medical use than non-patients. A great majority of patients reported obtaining a medical marijuana recommendation for health problems in accordance with the California law. [Lankenau SE, Ataiants J,Mohanty S, Schrager S, Iverson E, Wong CF.Health conditions and motivations for marijuana use among young adultmedical marijuana patients and non-patient marijuana users. Drug Alcohol Rev 2017;00:000-000].
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Affiliation(s)
- Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, USA.,Rory Meyers College of Nursing, New York University, New York, USA
| | - Salini Mohanty
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Sheree Schrager
- Children's Hospital Los Angeles, Division of Hospital Medicine, Los Angeles, USA
| | - Ellen Iverson
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA.,Division of Adolescent Medicine, Children's Hospital Los Angeles, Los Angeles, USA
| | - Carolyn F Wong
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA.,Division of Adolescent Medicine, Children's Hospital Los Angeles, Los Angeles, USA.,Division of Research on Children, Youth, & Families, Children's Hospital Los Angeles, Los Angeles, USA
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108
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Subbaraman MS, Metrik J, Patterson D, Swift R. Cannabis use during treatment for alcohol use disorders predicts alcohol treatment outcomes. Addiction 2017; 112:685-694. [PMID: 27865015 PMCID: PMC5339049 DOI: 10.1111/add.13693] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/15/2016] [Accepted: 11/15/2016] [Indexed: 02/04/2023]
Abstract
AIMS To compare post-treatment alcohol use between those who use cannabis and those who abstain during treatment for alcohol use disorders (AUD); and to examine potential cannabis use thresholds by comparing post-treatment alcohol use between four frequency groups of cannabis users relative to abstainers. DESIGN Secondary analyses of the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) Study, a randomized control trial of AUD treatments. The current study compares longitudinal drinking data between those who used cannabis versus those who abstained during COMBINE treatment. SETTING The COMBINE Study treatments were delivered on an out-patient basis for 16 weeks. The current analyses include 206 cannabis users and 999 cannabis abstainers. PARTICIPANTS All participants met diagnosis of primary alcohol dependence (n = 1383). MEASUREMENTS Primary exposures were any cannabis use and quartiles of cannabis use (Q1: 1-4 use days during treatment, Q2: 5-9 days, Q3: 10-44 days, Q4: 45-112 days). Outcomes were percentage of days abstinent from alcohol (PDA), drinks per drinking day (DPDD) and percentage of heavy drinking days (PHD), all measured at treatment end and 1 year post-treatment. FINDINGS Compared with no cannabis use, any cannabis use during treatment was associated with 4.35% [95% confidence interval (CI) = -8.68, -0.02], or approximately 4 fewer alcohol abstinent days at the end of treatment. This association weakened by 1 year post-treatment (95% CI = -9.78, 0.54). Compared with no cannabis use, only those in the second quartile of cannabis use (those who used once or twice per month during treatment) had 8.81% (95% CI = -17.00, -0.63), or approximately 10 fewer days alcohol abstinent at end of treatment, and 11.82% (95% CI = -21.56, -2.07), or approximately 13 fewer alcohol abstinent days 1 year post-treatment. Neither any cannabis use nor quartiles were associated with DPDD or PHD at either time-point. CONCLUSIONS Among individuals in alcohol treatment, any cannabis use (compared with none) is related to a significantly lower percentage of days abstinent from alcohol post-treatment, although only among those who used cannabis once or twice per month.
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Affiliation(s)
- Meenakshi Sabina Subbaraman
- Alcohol Research Group, Public Health Institute, Emeryville, CA 94608,Corresponding author: Address: Alcohol Research Group, 6001 Shellmound Ave, Emeryville, CA 94608, USA, Phone: (510) 898-5854, Fax: (510) 985-6459,
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903,Providence Veterans Affairs Medical Center, Providence, RI, 02908
| | - Deidre Patterson
- Alcohol Research Group, Public Health Institute, Emeryville, CA 94608
| | - Robert Swift
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903,Providence Veterans Affairs Medical Center, Providence, RI, 02908
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109
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Lucas P, Walsh Z. Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 42:30-35. [PMID: 28189912 DOI: 10.1016/j.drugpo.2017.01.011] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/15/2016] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND In 2014 Health Canada replaced the Marihuana for Medical Access Regulations (MMAR) with the Marihuana for Medical Purposes Regulations (MMPR). One of the primary changes in the new program has been to move from a single Licensed Producer (LP) of cannabis to multiple Licensed Producers. This is the first comprehensive survey of patients enrolled in the MMPR. METHODS Patients registered to purchase cannabis from Tilray, a federally authorized Licenced Producer (LP) within the MMPR, were invited to complete an online survey consisting of 107 questions on demographics, patterns of use, and cannabis substitution effect. The survey was completed by 271 respondents. RESULTS Cannabis is perceived to be an effective treatment for diverse conditions, with pain and mental health the most prominent. Findings include high self-reported use of cannabis as a substitute for prescription drugs (63%), particularly pharmaceutical opioids (30%), benzodiazepines (16%), and antidepressants (12%). Patients also reported substituting cannabis for alcohol (25%), cigarettes/tobacco (12%), and illicit drugs (3%). A significant percentage of patients (42%) reported accessing cannabis from illegal/unregulated sources in addition to access via LPs, and over half (55%) were charged to receive a medical recommendation to use cannabis, with nearly 25% paying $300 or more. CONCLUSION The finding that patients report its use as a substitute for prescription drugs supports prior research on medical cannabis users; however, this study is the first to specify the classes of prescription drugs for which cannabis it is used as a substitute, and to match this substitution to specific diagnostic categories. The findings that some authorized patients purchase cannabis from unregulated sources and that a significant percentage of patients were charged for medical cannabis recommendations highlight ongoing policy challenges for this federal program.
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Affiliation(s)
- Philippe Lucas
- Tilray, 1100 Maughan Rd., Nanaimo, BC V9X1J2, Canada; Social Dimensions of Health, University of Victoria, 3800 Finnerty Rd., Victoria, BC V8P 5C2, Canada; Centre for Addictions Research of British Columbia, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada.
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Okanagan, 3333 University Way, Kelowna, BC V1V 1V7, Canada; Centre for the Advancement of Psychological Science and Law, University of British Columbia, Okanagan, 3333 University Way, Kelowna, BC V1V 1V7, Canada
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110
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Walsh Z, Gonzalez R, Crosby K, S. Thiessen M, Carroll C, Bonn-Miller MO. Medical cannabis and mental health: A guided systematic review. Clin Psychol Rev 2017; 51:15-29. [DOI: 10.1016/j.cpr.2016.10.002] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 10/06/2016] [Accepted: 10/10/2016] [Indexed: 12/28/2022]
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111
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Lankenau SE, Fedorova EV, Reed M, Schrager SM, Iverson E, Wong CF. Marijuana practices and patterns of use among young adult medical marijuana patients and non-patient marijuana users. Drug Alcohol Depend 2017; 170:181-188. [PMID: 27987475 PMCID: PMC6540119 DOI: 10.1016/j.drugalcdep.2016.10.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 10/07/2016] [Accepted: 10/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about young adult medical marijuana patients (MMP) and their marijuana using patterns and practices, which includes frequency of use, sourcing of marijuana products, forms/modes of administration, and patterns of illicit/prescription drug misuse, compared to non-patient marijuana users (NPU). METHODS Young adults (N=366) aged 18-26 years old were sampled in Los Angeles in 2014-15 and segmented into NPU (n=156), marijuana users who never had a medical marijuana (MM) recommendation, and MMP (n=210), marijuana users with a current, verified MM recommendation. Differences regarding self-reported marijuana and other drug use during the past 90days are expressed as unadjusted risk ratios or differences in means. RESULTS MMP reported significantly greater mean days of use (76.4 vs. 59.2, p<0.001) and mean dollars spent on marijuana products (564.5 vs. 266.9, p<0.001) than NPU. Approximately one-quarter (22.6%) of both MMP and NPU report selling marijuana obtained from a dispensary to someone else in the past 90days. MMP were more likely to report vaporization modalities for concentrates (URR=1.5, 95% C.I.=1.2, 2.0) and for marijuana (URR=1.5, 95% C.I.=1.1, 2.1) than NPU. Though not significant, trends toward lower misuse of prescription drugs in the past 90days were observed among MMP compared to NPU. CONCLUSION MMP reported greater access to marijuana via dispensaries, more frequent and intensive use of marijuana, and greater use of non-combustible forms of marijuana compared to NPU. MMP reported less recent misuse of prescription drugs compared to NPU.
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Affiliation(s)
- Stephen E Lankenau
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA 19104, United States.
| | - Ekaterina V Fedorova
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA 19104, United States.
| | - Megan Reed
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA 19104, United States.
| | - Sheree M Schrager
- Children's Hospital Los Angeles, Division of Hospital Medicine, 4650 Sunset Blvd., MS #94, Los Angeles, CA 90027, United States.
| | - Ellen Iverson
- University of Southern California, Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, United States; Children's Hospital Los Angeles, Division of Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United States.
| | - Carolyn F Wong
- University of Southern California, Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, United States; Children's Hospital Los Angeles, Division of Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United States; Children's Hospital Los Angeles, Division of Research on Children, Youth, & Families, 4650 Sunset Blvd., MS #2, Los Angeles, CA, United States.
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112
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Fischer B, Ialomiteanu AR, Aeby S, Rudzinski K, Kurdyak P, Rehm J. Substance Use, Health, and Functioning Characteristics of Medical Marijuana Program Participants Compared to the General Adult Population in Ontario (Canada). J Psychoactive Drugs 2016; 49:31-38. [DOI: 10.1080/02791072.2016.1264648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Benedikt Fischer
- Senior Scientist, Institute for Mental Health Policy Research, Centre for Addiction & Mental Health, Toronto, Canada
- Professor, Department of Psychiatry, Institute of Medical Science, Centre for Criminology & Socio-legal Studies, University of Toronto, Toronto, Canada
| | - Anca R. Ialomiteanu
- Research Methods Specialist, Institute for Mental Health Policy Research, Centre for Addiction & Mental Health, Toronto, Canada
| | - Samantha Aeby
- Graduate Research Assistant, Institute for Mental Health Policy Research, Centre for Addiction & Mental Health, Toronto, Canada
| | - Katherine Rudzinski
- Graduate Research Assistant, Institute for Mental Health Policy Research, Centre for Addiction & Mental Health, Toronto, Canada
| | - Paul Kurdyak
- Director, Health Outcomes and Performance Evaluation Research Unit, Institute for Mental Health Policy Research, Centre for Addiction & Mental Health, Toronto, Canada
- Core Senior Scientist and Lead, Mental Health and Addictions Research Program, Institute for Clinical Evaluative Sciences, Toronto, Canada
- Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jürgen Rehm
- Senior Director, Institute for Mental Health Policy Research, Centre for Addiction & Mental Health, Toronto, Canada
- Professor and Chair, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Professor, Department of Psychiatry, University of Toronto, Toronto, Canada
- Head, Research Unit, Technische Universität Dresden, Dresden, Germany
- Faculty Member, Institute of Medical Science, University of Toronto, Toronto, Canada
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113
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Santaella-Tenorio J, Mauro CM, Wall MM, Kim JH, Cerdá M, Keyes KM, Hasin DS, Galea S, Martins SS. US Traffic Fatalities, 1985-2014, and Their Relationship to Medical Marijuana Laws. Am J Public Health 2016; 107:336-342. [PMID: 27997245 DOI: 10.2105/ajph.2016.303577] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the association of medical marijuana laws (MMLs) with traffic fatality rates. METHODS Using data from the 1985-2014 Fatality Analysis Reporting System, we examined the association between MMLs and traffic fatalities in multilevel regression models while controlling for contemporaneous secular trends. We examined this association separately for each state enacting MMLs. We also evaluated the association between marijuana dispensaries and traffic fatalities. RESULTS On average, MML states had lower traffic fatality rates than non-MML states. Medical marijuana laws were associated with immediate reductions in traffic fatalities in those aged 15 to 24 and 25 to 44 years, and with additional yearly gradual reductions in those aged 25 to 44 years. However, state-specific results showed that only 7 states experienced post-MML reductions. Dispensaries were also associated with traffic fatality reductions in those aged 25 to 44 years. CONCLUSIONS Both MMLs and dispensaries were associated with reductions in traffic fatalities, especially among those aged 25 to 44 years. State-specific analysis showed heterogeneity of the MML-traffic fatalities association, suggesting moderation by other local factors. These findings could influence policy decisions on the enactment or repealing of MMLs and how they are implemented.
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Affiliation(s)
- Julian Santaella-Tenorio
- Julian Santaella-Tenorio, June H. Kim, Katherine M. Keyes, Deborah S. Hasin, and Silvia S. Martins are with Columbia University, Epidemiology Department, Mailman School of Public Health, New York, NY. Christine M. Mauro and Melanie M. Wall are with Columbia University, Biostatistics Department, Mailman School of Public Health. Magdalena Cerdá is with University of California at Davis, Davis, CA. Sandro Galea is with Boston University School of Public Health, Boston, MA
| | - Christine M Mauro
- Julian Santaella-Tenorio, June H. Kim, Katherine M. Keyes, Deborah S. Hasin, and Silvia S. Martins are with Columbia University, Epidemiology Department, Mailman School of Public Health, New York, NY. Christine M. Mauro and Melanie M. Wall are with Columbia University, Biostatistics Department, Mailman School of Public Health. Magdalena Cerdá is with University of California at Davis, Davis, CA. Sandro Galea is with Boston University School of Public Health, Boston, MA
| | - Melanie M Wall
- Julian Santaella-Tenorio, June H. Kim, Katherine M. Keyes, Deborah S. Hasin, and Silvia S. Martins are with Columbia University, Epidemiology Department, Mailman School of Public Health, New York, NY. Christine M. Mauro and Melanie M. Wall are with Columbia University, Biostatistics Department, Mailman School of Public Health. Magdalena Cerdá is with University of California at Davis, Davis, CA. Sandro Galea is with Boston University School of Public Health, Boston, MA
| | - June H Kim
- Julian Santaella-Tenorio, June H. Kim, Katherine M. Keyes, Deborah S. Hasin, and Silvia S. Martins are with Columbia University, Epidemiology Department, Mailman School of Public Health, New York, NY. Christine M. Mauro and Melanie M. Wall are with Columbia University, Biostatistics Department, Mailman School of Public Health. Magdalena Cerdá is with University of California at Davis, Davis, CA. Sandro Galea is with Boston University School of Public Health, Boston, MA
| | - Magdalena Cerdá
- Julian Santaella-Tenorio, June H. Kim, Katherine M. Keyes, Deborah S. Hasin, and Silvia S. Martins are with Columbia University, Epidemiology Department, Mailman School of Public Health, New York, NY. Christine M. Mauro and Melanie M. Wall are with Columbia University, Biostatistics Department, Mailman School of Public Health. Magdalena Cerdá is with University of California at Davis, Davis, CA. Sandro Galea is with Boston University School of Public Health, Boston, MA
| | - Katherine M Keyes
- Julian Santaella-Tenorio, June H. Kim, Katherine M. Keyes, Deborah S. Hasin, and Silvia S. Martins are with Columbia University, Epidemiology Department, Mailman School of Public Health, New York, NY. Christine M. Mauro and Melanie M. Wall are with Columbia University, Biostatistics Department, Mailman School of Public Health. Magdalena Cerdá is with University of California at Davis, Davis, CA. Sandro Galea is with Boston University School of Public Health, Boston, MA
| | - Deborah S Hasin
- Julian Santaella-Tenorio, June H. Kim, Katherine M. Keyes, Deborah S. Hasin, and Silvia S. Martins are with Columbia University, Epidemiology Department, Mailman School of Public Health, New York, NY. Christine M. Mauro and Melanie M. Wall are with Columbia University, Biostatistics Department, Mailman School of Public Health. Magdalena Cerdá is with University of California at Davis, Davis, CA. Sandro Galea is with Boston University School of Public Health, Boston, MA
| | - Sandro Galea
- Julian Santaella-Tenorio, June H. Kim, Katherine M. Keyes, Deborah S. Hasin, and Silvia S. Martins are with Columbia University, Epidemiology Department, Mailman School of Public Health, New York, NY. Christine M. Mauro and Melanie M. Wall are with Columbia University, Biostatistics Department, Mailman School of Public Health. Magdalena Cerdá is with University of California at Davis, Davis, CA. Sandro Galea is with Boston University School of Public Health, Boston, MA
| | - Silvia S Martins
- Julian Santaella-Tenorio, June H. Kim, Katherine M. Keyes, Deborah S. Hasin, and Silvia S. Martins are with Columbia University, Epidemiology Department, Mailman School of Public Health, New York, NY. Christine M. Mauro and Melanie M. Wall are with Columbia University, Biostatistics Department, Mailman School of Public Health. Magdalena Cerdá is with University of California at Davis, Davis, CA. Sandro Galea is with Boston University School of Public Health, Boston, MA
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Kim JH, Santaella-Tenorio J, Mauro C, Wrobel J, Cerdà M, Keyes KM, Hasin D, Martins SS, Li G. State Medical Marijuana Laws and the Prevalence of Opioids Detected Among Fatally Injured Drivers. Am J Public Health 2016; 106:2032-2037. [PMID: 27631755 PMCID: PMC5055785 DOI: 10.2105/ajph.2016.303426] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To assess the association between medical marijuana laws (MMLs) and the odds of a positive opioid test, an indicator for prior use. METHODS We analyzed 1999-2013 Fatality Analysis Reporting System (FARS) data from 18 states that tested for alcohol and other drugs in at least 80% of drivers who died within 1 hour of crashing (n = 68 394). Within-state and between-state comparisons assessed opioid positivity among drivers crashing in states with an operational MML (i.e., allowances for home cultivation or active dispensaries) versus drivers crashing in states before a future MML was operational. RESULTS State-specific estimates indicated a reduction in opioid positivity for most states after implementation of an operational MML, although none of these estimates were significant. When we combined states, we observed no significant overall association (odds ratio [OR] = 0.79; 95% confidence interval [CI] = 0.61, 1.03). However, age-stratified analyses indicated a significant reduction in opioid positivity for drivers aged 21 to 40 years (OR = 0.50; 95% CI = 0.37, 0.67; interaction P < .001). CONCLUSIONS Operational MMLs are associated with reductions in opioid positivity among 21- to 40-year-old fatally injured drivers and may reduce opioid use and overdose.
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Affiliation(s)
- June H Kim
- June H. Kim, Julian Santaella-Tenorio, Katherine M. Keyes, Deborah Hasin, Silvia S. Martins, and Guohua Li are with the Department of Epidemiology and Christine Mauro and Julia Wrobel are with the Department of Biostatistics, Columbia University, New York, NY. Magdalena Cerdà is with the Department of Emergency Medicine, University of California, Davis
| | - Julian Santaella-Tenorio
- June H. Kim, Julian Santaella-Tenorio, Katherine M. Keyes, Deborah Hasin, Silvia S. Martins, and Guohua Li are with the Department of Epidemiology and Christine Mauro and Julia Wrobel are with the Department of Biostatistics, Columbia University, New York, NY. Magdalena Cerdà is with the Department of Emergency Medicine, University of California, Davis
| | - Christine Mauro
- June H. Kim, Julian Santaella-Tenorio, Katherine M. Keyes, Deborah Hasin, Silvia S. Martins, and Guohua Li are with the Department of Epidemiology and Christine Mauro and Julia Wrobel are with the Department of Biostatistics, Columbia University, New York, NY. Magdalena Cerdà is with the Department of Emergency Medicine, University of California, Davis
| | - Julia Wrobel
- June H. Kim, Julian Santaella-Tenorio, Katherine M. Keyes, Deborah Hasin, Silvia S. Martins, and Guohua Li are with the Department of Epidemiology and Christine Mauro and Julia Wrobel are with the Department of Biostatistics, Columbia University, New York, NY. Magdalena Cerdà is with the Department of Emergency Medicine, University of California, Davis
| | - Magdalena Cerdà
- June H. Kim, Julian Santaella-Tenorio, Katherine M. Keyes, Deborah Hasin, Silvia S. Martins, and Guohua Li are with the Department of Epidemiology and Christine Mauro and Julia Wrobel are with the Department of Biostatistics, Columbia University, New York, NY. Magdalena Cerdà is with the Department of Emergency Medicine, University of California, Davis
| | - Katherine M Keyes
- June H. Kim, Julian Santaella-Tenorio, Katherine M. Keyes, Deborah Hasin, Silvia S. Martins, and Guohua Li are with the Department of Epidemiology and Christine Mauro and Julia Wrobel are with the Department of Biostatistics, Columbia University, New York, NY. Magdalena Cerdà is with the Department of Emergency Medicine, University of California, Davis
| | - Deborah Hasin
- June H. Kim, Julian Santaella-Tenorio, Katherine M. Keyes, Deborah Hasin, Silvia S. Martins, and Guohua Li are with the Department of Epidemiology and Christine Mauro and Julia Wrobel are with the Department of Biostatistics, Columbia University, New York, NY. Magdalena Cerdà is with the Department of Emergency Medicine, University of California, Davis
| | - Silvia S Martins
- June H. Kim, Julian Santaella-Tenorio, Katherine M. Keyes, Deborah Hasin, Silvia S. Martins, and Guohua Li are with the Department of Epidemiology and Christine Mauro and Julia Wrobel are with the Department of Biostatistics, Columbia University, New York, NY. Magdalena Cerdà is with the Department of Emergency Medicine, University of California, Davis
| | - Guohua Li
- June H. Kim, Julian Santaella-Tenorio, Katherine M. Keyes, Deborah Hasin, Silvia S. Martins, and Guohua Li are with the Department of Epidemiology and Christine Mauro and Julia Wrobel are with the Department of Biostatistics, Columbia University, New York, NY. Magdalena Cerdà is with the Department of Emergency Medicine, University of California, Davis
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Abstract
BACKGROUND Whether alcohol and cannabis are used as substitutes or complements remains debated, and findings across various disciplines have not been synthesized to date. OBJECTIVE This article is a first step towards organizing the interdisciplinary literature on alcohol and cannabis substitution and complementarity. METHOD Electronic searches were performed using PubMed and ISI Web of Knowledge. Behavioral studies of humans with "alcohol" (or "ethanol") and "cannabis" (or "marijuana") and "complement(*)" (or "substitut(*)") in the title or as a keyword were considered. Studies were organized according to sample characteristics (youth, general population, clinical and community-based). These groups were not set a priori, but were informed by the literature review process. RESULTS Of the 39 studies reviewed, 16 support substitution, ten support complementarity, 12 support neither and one supports both. Results from studies of youth suggest that youth may reduce alcohol in more liberal cannabis environments (substitute), but reduce cannabis in more stringent alcohol environments (complement). Results from the general population suggest that substitution of cannabis for alcohol may occur under more lenient cannabis policies, though cannabis-related laws may affect alcohol use differently across genders and racial groups. CONCLUSIONS Alcohol and cannabis act as both substitutes and complements. Policies aimed at one substance may inadvertently affect consumption of other substances. Future studies should collect fine-grained longitudinal, prospective data from the general population and subgroups of interest, especially in locations likely to legalize cannabis.
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116
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Sexton M, Cuttler C, Finnell JS, Mischley LK. A Cross-Sectional Survey of Medical Cannabis Users: Patterns of Use and Perceived Efficacy. Cannabis Cannabinoid Res 2016; 1:131-138. [PMID: 28861489 PMCID: PMC5549439 DOI: 10.1089/can.2016.0007] [Citation(s) in RCA: 201] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The political climate around Cannabis as a medicine is rapidly changing. Legislators are adopting policies regarding appropriate medical applications, while the paucity of research may make policy decisions around conditions for which Cannabis is an effective medicine difficult. Methods: An anonymous online survey was developed to query medical Cannabis users about the conditions they use Cannabis to treat, their use patterns, perception of efficacy, and physical and mental health. Participants were recruited through social media and Cannabis dispensaries in Washington State. Results: A total of 1429 participants identified as medical Cannabis users. The most frequently reported conditions for which they used Cannabis were pain (61.2%), anxiety (58.1%), depression (50.3%), headache/migraine (35.5%), nausea (27.4%), and muscle spasticity (18.4%). On average, participants reported an 86% reduction in symptoms as a result of Cannabis use; 59.8% of medical users reported using Cannabis as an alternative to pharmaceutical prescriptions. Global health scores were on par with the general population for mental health and physical health. Conclusions: While patient-reported outcomes favor strong efficacy for a broad range of symptoms, many medical users are using Cannabis without physician supervision and for conditions for which there is no formal research to support the use of Cannabis (e.g., depression and anxiety). Future research and public policy should attempt to reduce the incongruence between approved and actual use.
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Affiliation(s)
- Michelle Sexton
- Department of Medical Research, Center for the Study of Cannabis and Social Policy, Seattle, Washington
| | - Carrie Cuttler
- Department of Psychology, Washington State University, Pullman, Washington
| | - John S. Finnell
- Graduate School of Integrative Medicine, AOMA, Austin, Texas
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Morabito D, Soyster P, Ramey-Wright S, Belendiuk KA, Bonn-Miller MO. A Review of Recent Advances in the Therapeutic Uses of Secondary Cannabinoids. CURRENT ADDICTION REPORTS 2016. [DOI: 10.1007/s40429-016-0096-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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118
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Guttmannova K, Lee CM, Kilmer JR, Fleming CB, Rhew IC, Kosterman R, Larimer ME. Impacts of Changing Marijuana Policies on Alcohol Use in the United States. Alcohol Clin Exp Res 2016; 40:33-46. [PMID: 26727520 PMCID: PMC4700545 DOI: 10.1111/acer.12942] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Marijuana policies are rapidly evolving. In the United States, recreational use of marijuana is now legal in 4 states and medical marijuana is legal in 23 states. Research evaluating such policies has focused primarily on how policies affect issues of price, access to, use, and consequences of marijuana. Due to potential spillover effects, researchers also need to examine how marijuana policies may impact use and consequences of alcohol. METHODS The current paper is a critical review of articles evaluating alcohol outcomes associated with marijuana decriminalization, medical marijuana legalization, and nonmedical or recreational marijuana legalization. We identified articles and reports through (1) online searches of EBSCO host database including Academic Search Premier, Econlit, Legal Collection, Medline, PsycARTICLES, and PsycINFO, as well as PubMed and Google Scholar databases; (2) review of additional articles cited in papers identified through electronic searches; and (3) targeted searches of state and local government records regarding marijuana law implementation. We reviewed studies with respect to their data sources and sample characteristics, methodology, and the margin of alcohol and marijuana use, timing of policy change, and the aspects of laws examined. RESULTS The extant literature provides some evidence for both substitution (i.e., more liberal marijuana policies related to less alcohol use as marijuana becomes a substitute) and complementary (i.e., more liberal marijuana policies related to increases in both marijuana and alcohol use) relationships in the context of liberalization of marijuana policies in the United States. CONCLUSIONS Impact of more liberal marijuana policies on alcohol use is complex, and likely depends on specific aspects of policy implementation, including how long the policy has been in place. Furthermore, evaluation of marijuana policy effects on alcohol use may be sensitive to the age group studied and the margin of alcohol use examined. Design of policy evaluation research requires careful consideration of these issues.
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Affiliation(s)
- Katarina Guttmannova
- Katarina Guttmannova, Charles B. Fleming, Isaac C. Rhew, Rick Kosterman, Social Development Research Group, School of Social Work, University of Washington, 9725 3 Ave NE, Suite 401, Seattle, WA 98115
| | - Christine M. Lee
- Christine M. Lee, Jason R. Kilmer, Isaac C. Rhew, and Mary E. Larimer, Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE 45 St., Suite 300, Seattle, WA 98105
| | - Jason R. Kilmer
- Christine M. Lee, Jason R. Kilmer, Isaac C. Rhew, and Mary E. Larimer, Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE 45 St., Suite 300, Seattle, WA 98105
| | - Charles B. Fleming
- Katarina Guttmannova, Charles B. Fleming, Isaac C. Rhew, Rick Kosterman, Social Development Research Group, School of Social Work, University of Washington, 9725 3 Ave NE, Suite 401, Seattle, WA 98115
| | - Isaac C. Rhew
- Katarina Guttmannova, Charles B. Fleming, Isaac C. Rhew, Rick Kosterman, Social Development Research Group, School of Social Work, University of Washington, 9725 3 Ave NE, Suite 401, Seattle, WA 98115
- Christine M. Lee, Jason R. Kilmer, Isaac C. Rhew, and Mary E. Larimer, Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE 45 St., Suite 300, Seattle, WA 98105
| | | | - Mary E. Larimer
- Christine M. Lee, Jason R. Kilmer, Isaac C. Rhew, and Mary E. Larimer, Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE 45 St., Suite 300, Seattle, WA 98105
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Lau N, Sales P, Averill S, Murphy F, Sato SO, Murphy S. A safer alternative: Cannabis substitution as harm reduction. Drug Alcohol Rev 2015; 34:654-9. [PMID: 25919477 PMCID: PMC10840418 DOI: 10.1111/dar.12275] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/15/2015] [Indexed: 01/27/2023]
Abstract
INTRODUCTION AND AIMS Substitution is operationalised as a conscious choice made by users to use one drug instead of, or in conjunction with another based on: perceived safety, level of addiction potential, effectiveness in relieving symptoms, access and level of acceptance. Harm reduction is a set of strategies that aim to minimise problems associated with drug use while recognising that for some users, abstinence may be neither a realistic nor a desirable goal. In this paper, we aim for deeper understandings of older adult cannabis users' beliefs and substitution practices as part of the harm reduction framework. DESIGN AND METHODS We present selected findings from our qualitative study of Baby Boomer (born 1946-1964) marijuana users in the San Francisco Bay Area. Although the sample consisted of primary cannabis users, many had personal experience with other drugs throughout their lifetimes. Data collection consisted of an audio-recorded, semi-structured in-depth life history interview followed by a questionnaire and health survey. Qualitative interviews were analysed to discover users' harm reduction beliefs and cannabis substitution practices. RESULTS Study participants described using cannabis as a safer alternative for alcohol, illicit drugs and pharmaceuticals based on their perceptions of less adverse side effects, low-risk for addiction and greater effectiveness at relieving symptoms, such as chronic pain. DISCUSSION AND CONCLUSIONS Cannabis substitution can be an effective harm reduction method for those who are unable or unwilling to stop using drugs completely. More research is needed on cannabis as a safer alternative.
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Affiliation(s)
- Nicholas Lau
- Centre for Substance Abuse Studies, Institute for Scientific Analysis, San Francisco, USA
| | - Paloma Sales
- Centre for Substance Abuse Studies, Institute for Scientific Analysis, San Francisco, USA
| | - Sheigla Averill
- Centre for Substance Abuse Studies, Institute for Scientific Analysis, San Francisco, USA
| | - Fiona Murphy
- Centre for Substance Abuse Studies, Institute for Scientific Analysis, San Francisco, USA
| | - Sye-Ok Sato
- Centre for Substance Abuse Studies, Institute for Scientific Analysis, San Francisco, USA
| | - Sheigla Murphy
- Centre for Substance Abuse Studies, Institute for Scientific Analysis, San Francisco, USA
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Lucas P, Walsh Z, Crosby K, Callaway R, Belle-Isle L, Kay R, Capler R, Holtzman S. Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors. Drug Alcohol Rev 2015; 35:326-33. [PMID: 26364922 DOI: 10.1111/dar.12323] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 07/06/2015] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND AIMS Recent years have witnessed increased attention to how cannabis use impacts the use of other psychoactive substances. The present study examines the use of cannabis as a substitute for alcohol, illicit substances and prescription drugs among 473 adults who use cannabis for therapeutic purposes. DESIGN AND METHODS The Cannabis Access for Medical Purposes Survey is a 414-question cross-sectional survey that was available to Canadian medical cannabis patients online and by hard copy in 2011 and 2012 to gather information on patient demographics, medical conditions and symptoms, patterns of medical cannabis use, cannabis substitution and barriers to access to medical cannabis. RESULTS Substituting cannabis for one or more of alcohol, illicit drugs or prescription drugs was reported by 87% (n = 410) of respondents, with 80.3% reporting substitution for prescription drugs, 51.7% for alcohol, and 32.6% for illicit substances. Respondents who reported substituting cannabis for prescription drugs were more likely to report difficulty affording sufficient quantities of cannabis, and patients under 40 years of age were more likely to substitute cannabis for all three classes of substance than older patients. DISCUSSION AND CONCLUSIONS The finding that cannabis was substituted for all three classes of substances suggests that the medical use of cannabis may play a harm reduction role in the context of use of these substances, and may have implications for abstinence-based substance use treatment approaches. Further research should seek to differentiate between biomedical substitution for prescription pharmaceuticals and psychoactive drug substitution, and to elucidate the mechanisms behind both. [Lucas P, Walsh Z, Crosby K, Callaway R, Belle-Isle L, Kay B, Capler R, Holtzman S. Substituting cannabis for prescription drugs, alcohol, and other substances among medical cannabis patients: The impact of contextual factors. Drug Alcohol Rev 2016;35:326-333].
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Affiliation(s)
- Philippe Lucas
- Centre for Addictions Research of British Columbia, University of Victoria, Victoria, Canada
| | - Zach Walsh
- Psychology, The University of British Columbia, Kelowna, Canada
| | - Kim Crosby
- Psychology, The University of British Columbia, Kelowna, Canada
| | - Robert Callaway
- Medical Cannabis Advocate, Vancouver, British Columbia, Canada
| | - Lynne Belle-Isle
- Centre for Addictions Research of British Columbia, University of Victoria, Victoria, Canada.,Canadian AIDS Society, Ottawa, Canada
| | - Robert Kay
- GreenLeaf Technologies, Kelowna, British Columbia, Canada
| | - Rielle Capler
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, Canada
| | - Susan Holtzman
- Department of Psychology, University of British Columbia, Kelowna, Canada
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Troutt WD, DiDonato MD. Medical Cannabis in Arizona: Patient Characteristics, Perceptions, and Impressions of Medical Cannabis Legalization. J Psychoactive Drugs 2015; 47:259-66. [DOI: 10.1080/02791072.2015.1074766] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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122
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Grella CE, Rodriguez L, Kim T. Patterns of Medical Marijuana Use Among Individuals Sampled from Medical Marijuana Dispensaries in Los Angeles. J Psychoactive Drugs 2014; 46:267-75. [DOI: 10.1080/02791072.2014.944960] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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123
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Janero DR. Medications development for substance-use disorders: contextual influences (dis)incentivizing pharmaceutical-industry positioning. Expert Opin Drug Discov 2014; 9:1265-79. [PMID: 25162124 DOI: 10.1517/17460441.2014.951631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The significant contribution of substance-use disorders (SUDs) to the global-disease burden and associated unmet medical needs has not engendered a commensurate level of pharma-industry research and development (R&D) for novel SUD therapeutics invention. Analysis of contextual factors shaping this position suggests potential routes toward incentivizing R&D commitment for that purpose. AREAS COVERED This article considers multiple primary factors that have consorted to disincentivize pharma industry's operating in the SUD space: ill-understood pathology; variegated treatments and patient profiles; involved clinical trials; and - with particular reference to SUDs-negative cultural/business stigmas and shallow commercial precedent. Industry incentivization for SUD drug innovation requires progress on several fronts, including: translational experimental data and systems; personalized, holistic SUD treatment approaches; interactions among pharma, nonindustry constituencies, and the medical profession with vested interests in countering negative stereotypes and expanding SUD treatment options; and public-private alliances focused on improving SUD pharmacotherapy. EXPERT OPINION Given the well-entrenched business stance whereby the prospect of future profits in major markets largely determines drug-company R&D investment trajectory, strategic initiatives offering substantial reductions in the risks and opportunity (i.e., time and money) costs associated with SUD drug discovery are likely to be the most potent drivers for encouraging mainstream industry positioning in this therapeutic area. Such initiatives could originate from front-loaded R&D operational and back-loaded patent, regulatory, marketing and health-care policy reforms. These may be too involved and protracted for the turbulent pharmaceutical industry to entertain amid its recent retrenchment from psychiatric/CNS diseases and intense pressures to increase productivity and shareholder value.
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Affiliation(s)
- David R Janero
- Northeastern University, Bouvé College of Health Sciences, Center for Drug Discovery, Department of Pharmaceutical Sciences, Health Sciences Entrepreneurs , 360 Huntington Avenue, 116 Mugar Life Sciences Hall, Boston, MA 02115-5000 , USA +1 617 373 2208 ; +1 617 373 7493 ;
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McKetin R, Chalmers J, Sunderland M, Bright DA. Recreational drug use and binge drinking: Stimulant but not cannabis intoxication is associated with excessive alcohol consumption. Drug Alcohol Rev 2014; 33:436-45. [DOI: 10.1111/dar.12147] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/31/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Rebecca McKetin
- Centre for Research on Ageing, Health and Well-Being; The Australian National University; Canberra Australia
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
| | - Jenny Chalmers
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
| | - Matthew Sunderland
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
| | - David A. Bright
- School of Social Sciences; University of New South Wales; Sydney Australia
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Boeri M, Gibson D, Boshears P. Conceptualizing Social Recovery: Recovery Routes of Methamphetamine Users. JOURNAL OF QUALITATIVE CRIMINAL JUSTICE & CRIMINOLOGY : JQCJC 2014; 2:5-38. [PMID: 25574504 PMCID: PMC4283845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The goal of our qualitative study was to gain a phenomenological understanding of routes to recovery from problematic drug use. In-depth interviews and drug histories were collected from 50 former methamphetamine users recruited from a U.S. metropolitan suburb who identified as having had problematic use of this drug in the past. Transcripts of the audio-recorded interviews were coded for common themes regarding types of recovery strategies or tools employed on the route to recovery. The common strategies used for recovery from problematic methamphetamine use in all routes were social in nature and did not necessarily include cessation of all substances. Based on our findings, we suggest a conceptualization of social recovery that focuses on reducing the social harms caused by problematic drug use rather than focusing primarily on cessation of all drug use. Social recovery may be employed as both a treatment strategy and analytical tool. More research is needed to advance the concept of social recovery for intervention, drug policy, and criminal justice implications.
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Affiliation(s)
- Miriam Boeri
- Kennesaw State University, Department of Sociology and Criminal Justice, Kennesaw, GA
| | - David Gibson
- Bentley University, Department of Sociology. Waltham, MA
| | - Paul Boshears
- Europäische Universität für Interdisziplinäre Studien/The European Graduate School (CH)
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Abstract
AIMS Substituting cannabis for alcohol may reduce drinking and related problems among alcohol-dependent individuals. Some even recommend prescribing medical cannabis to individuals attempting to reduce drinking. The primary aim of this review is to assess whether cannabis satisfies the seven previously published criteria for substitute medications for alcohol [e.g. 'reduces alcohol-related harms'; 'is safer in overdose than alcohol'; 'should offer significant health economic benefits'; see Chick and Nutt ((2012) Substitution therapy for alcoholism: time for a reappraisal? J Psychopharmacol 26:205-12)]. METHODS Literature review. RESULTS All criteria appear either satisfied or partially satisfied, though studies relying on medical cannabis patients may be limited by selection bias and/or retrospective designs. Individual-level factors, such as severity of alcohol problems, may also moderate substitution. CONCLUSIONS There is no clear pattern of outcomes related to cannabis substitution. Most importantly, the recommendation to prescribe alcohol-dependent individuals cannabis to help reduce drinking is premature. Future studies should use longitudinal data to better understand the consequences of cannabis substitution.
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Bonn-Miller MO, Boden MT, Bucossi MM, Babson KA. Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2013; 40:23-30. [DOI: 10.3109/00952990.2013.821477] [Citation(s) in RCA: 192] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Marcel O. Bonn-Miller
- Center of Excellence for Substance Abuse Treatment and Education, Philadelphia VA Medical Center
Philadelphia, PAUSA
- National Center for PTSD, VA Palo Alto Health Care System
Menlo Park, CAUSA
- Center for Health Care Evaluation, VA Palo Alto Health Care System
Menlo Park, CAUSA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
Philadelphia, PAUSA
| | - Matthew Tyler Boden
- Center for Health Care Evaluation, VA Palo Alto Health Care System
Menlo Park, CAUSA
| | - Meggan M. Bucossi
- National Center for PTSD, VA Palo Alto Health Care System
Menlo Park, CAUSA
| | - Kimberly A. Babson
- Center for Health Care Evaluation, VA Palo Alto Health Care System
Menlo Park, CAUSA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
Stanford, CAUSA
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128
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Ritter C, Broers B, Elger BS. Cannabis use in a Swiss male prison: qualitative study exploring detainees' and staffs' perspectives. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:573-8. [PMID: 23773686 DOI: 10.1016/j.drugpo.2013.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/27/2013] [Accepted: 05/06/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several studies suggest a high prevalence of cannabis use before and during imprisonment, but subjective perspectives of detainees and staff towards its use in prison are lacking. This issue was explored in the framework of an observational study addressing tobacco use in three Swiss prisons in 2009 and 2010 that involved multiple strands (quantitative and qualitative components). This article presents qualitative data on cannabis use collected in one of the settings. METHODS We used in-depth semi-structured interviews with both detainees and staff to explore their attitudes towards cannabis in one post-trial male Swiss prison. We performed specific coding and thematic analysis for cannabis with the support of ATLAS.ti, compared detainees' and staff's opinions, and considered the results with regard to drug policy in prison in general. RESULTS 58 participants (31 male offenders, mean age 35 years, and 27 prison staff, mean age 46 years, 33% female) were interviewed. Detainees estimated the current use of cannabis use to be as high as 80%, and staff 50%. Participants showed similar opinions on effects of cannabis use that were described both at individual and institutional levels: analgesic, calming, self-help to go through the prison experience, relieve stress, facilitate sleep, prevent violence, and social pacifier. They also mentioned negative consequences of cannabis use (sleepiness, decreased perception of danger and social isolation), and dissatisfaction regarding the ongoing ambiguous situation where cannabis is forbidden but detection in the urine was not sanctioned. However, the introduction of a more restrictive regulation induced fear of violence, increased trafficking and a shift to other drug use. CONCLUSION Although illegal, cannabis use is clearly involved in daily life in prison. A clearer and comprehensive policy addressing cannabis is needed, including appropriate measures tailored to individual users. To sustain a calm and safe environment in prison, means other than substance or medication use are required.
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Affiliation(s)
- Catherine Ritter
- University Centre of Legal Medicine of Geneva and Lausanne, 9, av. de Champel, 1211 Geneva 4, Switzerland.
| | - Barbara Broers
- Unit for Dependency in Primary Care at the Department of Community Health and Primary Care, University Hospitals of Geneva, Faculty of Medicine, 1211 Geneva 4, Switzerland
| | - Bernice S Elger
- Head of the Institute of Biomedical Ethics at the University of Basel, Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
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129
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Lee D, Karschner EL, Milman G, Barnes AJ, Goodwin RS, Huestis MA. Can oral fluid cannabinoid testing monitor medication compliance and/or cannabis smoking during oral THC and oromucosal Sativex administration? Drug Alcohol Depend 2013; 130:68-76. [PMID: 23146820 PMCID: PMC3612560 DOI: 10.1016/j.drugalcdep.2012.10.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 10/01/2012] [Accepted: 10/16/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVES We characterize cannabinoid disposition in oral fluid (OF) after dronabinol, synthetic oral Δ(9)-tetrahydrocannabinol (THC), and Sativex, a cannabis-extract oromucosal spray, and evaluate whether smoked cannabis relapse or Sativex compliance can be identified with OF cannabinoid monitoring. METHODS 5 and 15 mg synthetic oral THC, low (5.4 mg THC, 5.0 mg cannabidiol (CBD)) and high (16.2 mg THC, 15.0 mg CBD) dose Sativex, and placebo were administered in random order (n=14). Oral fluid specimens were collected for 10.5 h after dosing and analyzed for THC, CBD, cannabinol (CBN), and 11-nor-9-carboxy-THC (THCCOOH). RESULTS After oral THC, OF THC concentrations decreased over time from baseline, reflecting residual THC excretion from previously self-administered smoked cannabis. CBD and CBN also were rarely detected. After Sativex, THC, CBD and CBN increased greatly, peaking at 0.25-1 h. Median CBD/THC and CBN/THC ratios were 0.82-1.34 and 0.04-0.06, respectively, reflecting cannabinoids' composition in Sativex. THCCOOH/THC ratios within 4.5 h post Sativex were ≤ 1.6 pg/ng, always lower than after oral THC and placebo. THCCOOH/THC ratios increased throughout each dosing session. CONCLUSIONS Lack of measurable THC, CBD and CBN in OF following oral THC, and high OF CBD/THC ratios after Sativex distinguish oral and sublingual drug delivery routes from cannabis smoking. Low THCCOOH/THC ratios suggest recent Sativex and smoked cannabis exposure. These data indicate that OF cannabinoid monitoring can document compliance with Sativex pharmacotherapy, and identify relapse to smoked cannabis during oral THC medication but not Sativex treatment, unless samples were collected shortly after smoking.
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Affiliation(s)
- Dayong Lee
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD
| | - Erin L. Karschner
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD
- Aegis Sciences Corporation, Nashville, TN
| | - Garry Milman
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD
| | - Allan J. Barnes
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD
| | - Robert S. Goodwin
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD
- Physician in Private Practice, Catonsville, MD
| | - Marilyn A. Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD
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130
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Karila L, Petit A, Zarmdini R, Coscas S, Lowenstein W, Reynaud M. [Tobacco use and illicit substance use disorders: what should we have to do?]. Presse Med 2013; 42:795-805. [PMID: 23528335 DOI: 10.1016/j.lpm.2012.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 11/03/2012] [Accepted: 11/08/2012] [Indexed: 02/04/2023] Open
Abstract
UNLABELLED Tobacco use is a commonplace phenomenon in our society. Its use is responsible for more death and disease than any other noninfectious cause. More deaths are caused each year by tobacco use than by all deaths from HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined. Tobacco remains responsible for greater morbidity than alcohol and all other drugs combined. Tobacco dependence is highly prevalent among drug-dependent patients. Substance abuse patients smoke more and are more vulnerable to the effects of smoking than general populations. Traditional substance abuse therapeutic programs too frequently focus only on treatment of alcohol or other drugs rather than including treatment for tobacco dependence. Currently, there are no official medical recommendations for the treatment of tobacco addiction in illicit polysubstance users. METHODS A comprehensive literature search from a range of electronic databases (PubMed, Embase, PsycInfo, Google Scholar) was conducted for the period from 1988 to September 2012, using the following keywords alone or in combination: tobacco, nicotine, cocaine, cannabis, amphetamines, opiates, substance abuse, substance dependence, addiction, treatment. There were no restrictions on the identification or inclusion of studies in terms of publication status, language and design type. RESULTS Our literature review will focus on epidemiological, neurobiological, clinical interactions between tobacco, alcohol and other illicit drugs. It will also focus on therapeutic programs in this dual addictive disorder. The aim of this literature review is to make proposals for the treatment of tobacco addiction in polysubstance users entering in specific therapeutic programs.
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Affiliation(s)
- Laurent Karila
- AP-HP, université Paris-Sud 11, hôpital universitaire Paul-Brousse, centre d'enseignement, de recherche et de traitement des addictions, CEA-Inserm U1000, 94800 Villejuif, France.
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131
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Lucas P. Cannabis as an Adjunct to or Substitute for Opiates in the Treatment of Chronic Pain. J Psychoactive Drugs 2012; 44:125-33. [DOI: 10.1080/02791072.2012.684624] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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132
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Janichek JL, Reiman A. Clinical service desires of medical cannabis patients. Harm Reduct J 2012; 9:12. [PMID: 22414074 PMCID: PMC3337824 DOI: 10.1186/1477-7517-9-12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 03/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical cannabis dispensaries following the social or hybrid model offer supplementary holistic services in addition to dispensing medical cannabis. Historically, alternative physical health services have been the norm for these dispensaries, including services such as yoga, acupuncture, or chiropractor visits. A clinical service dearth remains for medical cannabis patients seeking substance use, misuse, dependence, and mental health services. This study examined patient desires for various clinical services and level of willingness to participate in specific clinical services. METHODS Anonymous survey data (N = 303) were collected at Harborside Health Center (HHC), a medical cannabis dispensary in Oakland, CA. The sample was 70% male, 48% Caucasian and 21% African American. The mean male age was 38 years old and female mean age was 30. Sixty two percent of the male participants and 44% of the female participants are single. Sixteen percent of the population reported having a domestic partner. Forty six percent of the participants are employed full time, 41% have completed at least some college, and 49% make less than $40,000 a year. RESULTS A significant portion of the sample, 62%, indicated a desire to participate in free clinical services at HHC, 34% would like more information about substances and use, and 41% want to learn more about reducing harms from substance use. About one quarter of the participants marked "would" or "likely would" participate in individual services such as consultation. Approximately 20% indicated "would" or "likely would" participate in psycho-educational forums, harm reduction information sharing sessions, online support groups, and coping, life, and social skills group. There was little interest in traditional NA/AA 12-step groups or adapted 12-step groups. CONCLUSIONS Desired clinical services can be qualified as a combination of harm reduction, educational, skills-based, peer support and therapeutic individual and group services. Results suggest that medical cannabis patients seek more information about various substances, including cannabis. Dispensaries can help to decrease gaps in substance education and clinical services and fulfill unmet clinical desires. More research is necessary in additional medical cannabis dispensaries in different geographic settings with different service delivery models.
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133
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Bostwick JM. Blurred boundaries: the therapeutics and politics of medical marijuana. Mayo Clin Proc 2012; 87:172-86. [PMID: 22305029 PMCID: PMC3538401 DOI: 10.1016/j.mayocp.2011.10.003] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 10/20/2011] [Accepted: 10/24/2011] [Indexed: 01/09/2023]
Abstract
For 5 millennia, Cannabis sativa has been used throughout the world medically, recreationally, and spiritually. From the mid-19th century to the 1930s, American physicians prescribed it for a plethora of indications, until the federal government started imposing restrictions on its use, culminating in 1970 with the US Congress classifying it as a Schedule I substance, illegal, and without medical value. Simultaneous with this prohibition, marijuana became the United States' most widely used illicit recreational drug, a substance generally regarded as pleasurable and relaxing without the addictive dangers of opioids or stimulants. Meanwhile, cannabis never lost its cachet in alternative medicine circles, going mainstream in 1995 when California became the first of 16 states to date to legalize its medical use, despite the federal ban. Little about cannabis is straightforward. Its main active ingredient, δ-9-tetrahydrocannabinol, was not isolated until 1964, and not until the 1990s were the far-reaching modulatory activities of the endocannabinoid system in the human body appreciated. This system's elucidation raises the possibility of many promising pharmaceutical applications, even as draconian federal restrictions that hamstring research show no signs of softening. Recreational use continues unabated, despite growing evidence of marijuana's addictive potential, particularly in the young, and its propensity for inducing and exacerbating psychotic illness in the susceptible. Public approval drives medical marijuana legalization efforts without the scientific data normally required to justify a new medication's introduction. This article explores each of these controversies, with the intent of educating physicians to decide for themselves whether marijuana is panacea, scourge, or both. PubMed searches were conducted using the following keywords: medical marijuana, medical cannabis, endocannabinoid system, CB1 receptors, CB2 receptors, THC, cannabidiol, nabilone, dronabinol, nabiximols, rimonabant, marijuana legislation, marijuana abuse, marijuana dependence, and marijuana and schizophrenia. Bibliographies were hand searched for additional references relevant to clarifying the relationships between medical and recreational marijuana use and abuse.
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Affiliation(s)
- J Michael Bostwick
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
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134
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Lucas P. It can't hurt to ask; a patient-centered quality of service assessment of health canada's medical cannabis policy and program. Harm Reduct J 2012; 9:2. [PMID: 22214382 PMCID: PMC3285527 DOI: 10.1186/1477-7517-9-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 01/03/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2001 Health Canada responded to a series of Ontario court decisions by creating the Marihuana Medical Access Division (MMAD) and the Marihuana Medical Access Regulations (MMAR). Although Health Canada has conducted a small number of stakeholder consultations, the federal government has never polled federally authorized cannabis patients. This study is an attempt to learn more about patient needs, challenges and experiences with the MMAD. METHODS Launched in the spring of 2007, Quality of Service Assessment of Health Canada's Medical Cannabis Policy and Program pairs a 50 question online survey addressing the personal experiences of patients in the federal cannabis program with 25 semi-guided interviews. Data gathering for this study took place from April 2007 to Jan. 2008, eventually garnering survey responses from 100 federally-authorized users, which at the time represented about 5% of the patients enrolled in Health Canada's program. This paper presents the results of the survey portion of the study. RESULTS 8% of respondents report getting their cannabis from Health Canada, while 66% grow it for themselves. >50% report that they frequent compassion clubs or dispensaries, which remain illegal and unregulated in Canada. 81% of patients would chose certified organic methods of cultivation; >90% state that not all strains are equally effective at relieving symptoms, and 97% would prefer to obtain cannabis from a source where multiple strains are available. Of the 48 patients polled that had tried the Health Canada cannabis supply, >75% rank it as either "1" or "2" on a scale of 1-10 (with "1" being "very poor", and 10 being "excellent"). DISCUSSION 72% of respondents report they are either "somewhat" or "totally unsatisfied" with Canada's medical cannabis program. These survey results and relevant court decisions suggest that the MMAR are not meeting the needs of most of the nation's medical cannabis patient community. It is hoped this research will help inform policy changes that will better address the needs of Canada's critically and chronically ill medical cannabis patient population, including the integration of community-based dispensaries into this novel healthcare delivery model.
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Affiliation(s)
- Philippe Lucas
- Center for Addictions Research of BC, University of Victoria, Technology Enterprise Facility, Room 273, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada.
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135
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Collen M. Prescribing cannabis for harm reduction. Harm Reduct J 2012; 9:1. [PMID: 22208773 PMCID: PMC3295721 DOI: 10.1186/1477-7517-9-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 01/01/2012] [Indexed: 12/16/2022] Open
Abstract
Neuropathic pain affects between 5% and 10% of the US population and can be refractory to treatment. Opioids may be recommended as a second-line pharmacotherapy but have risks including overdose and death. Cannabis has been shown to be effective for treating nerve pain without the risk of fatal poisoning. The author suggests that physicians who treat neuropathic pain with opioids should evaluate their patients for a trial of cannabis and prescribe it when appropriate prior to using opioids. This harm reduction strategy may reduce the morbidity and mortality rates associated with prescription pain medications.
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Affiliation(s)
- Mark Collen
- PainExhibit,com, 9008 El Cajon Way, #4, Sacramento, CA, 95826, USA.
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136
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An Analysis of Applicants Presenting to a Medical Marijuana Specialty Practice in California. ACTA ACUST UNITED AC 2011; 4. [PMID: 23750291 DOI: 10.2202/1941-2851.1017] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
For more than a decade, medical marijuana has been at the forefront of the marijuana policy debate in the United States. Fourteen states allow physicians to recommend marijuana or provide a legal defense for patients and physicians if prosecuted in state courts; however, little is known about those individuals using marijuana for medicinal purposes and the symptoms they use it for. This study provides descriptive information from 1,655 patients seeking a physician's recommendation for medical marijuana, the conditions for which they seek treatment, and the diagnoses made by the physicians. It conducts a systematic analysis of physician records and patient questionnaires obtained from consecutive patients being seen during a three month period at nine medical marijuana evaluation clinics belonging to a select medical group operating throughout the State of California. While this study is not representative of all medical marijuana users in California, it provides novel insights about an important population being affected by this policy.
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Mogensen M, Jemec GB. The potential carcinogenic risk of tanning beds: clinical guidelines and patient safety advice. Cancer Manag Res 2010; 2:277-82. [PMID: 21188119 PMCID: PMC3004589 DOI: 10.2147/cmr.s7403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In 2009, the WHO listed ultraviolet (UV) radiation as a group 1 carcinogen. In spite of this, each year, millions of people tan indoor in Western countries. The aim of this review is to summarize evidence of tanning bed carcinogenesis and to present guidelines for use of tanning beds and patient safety advice. METHODS A narrative review of the literature was conducted based on both PubMed and Medline searches and on literature review of the retrieved papers. RESULTS Use of indoor tanning beds represents a significant and avoidable risk factor for the development of both melanoma and nonmelanoma skin cancers. Frequent tanners are more often adolescent females. Tanning beds have additional potential adverse effects such as burns, solar skin damage, infection, and possibly also addictive behavior. DISCUSSION The effort in preventing UV light-induced carcinogenesis should currently be aimed at developing new strategies for public health information. Tanning beds are one preventable source of UV radiation. In the majority of people solar UV radiation continues to be the major factor and therefore anti-tanning campaigns must always include sunbathers.
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Affiliation(s)
- Mette Mogensen
- Department of Dermatology, Gentofte Hospital, Hellerup, Denmark
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