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Schaffrick M, Perreault ML, Jones AMP, Illes J. Understanding and Rebalancing: A Rapid Scoping Review of Cannabis Research Among Indigenous People. Cannabis Cannabinoid Res 2022. [DOI: 10.1089/can.2022.0251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Miles Schaffrick
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melissa L. Perreault
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - A. Maxwell P. Jones
- Department of Plant Agriculture, University of Guelph, Guelph, Ontario, Canada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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152
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Le A, Khoo E, Palamar JJ. Associations between Oral Health and Cannabis Use among Adolescents and Young Adults: Implications for Orthodontists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15261. [PMID: 36429978 PMCID: PMC9691037 DOI: 10.3390/ijerph192215261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Cannabis use is prevalent among adolescents and young adults in the US. Virtually all modes of cannabis consumption involve the oral cavity, and previous studies have linked cannabis use with poorer oral health. We sought to identify associations between cannabis use and various oral health outcomes and behaviors among individuals 12-25 years of age, and to discuss implications for orthodontists who largely interact with this age group over an extended period of treatment time. We examined data from patient electronic health records (N = 14,657) obtained between 2015 and 2021. Associations between lifetime and current self-reported cannabis use and several oral health outcomes or related behaviors that reflect periodontal health, caries status, oral lesions, and physical integrity of tooth structure and restorations were examined in a bivariable and multivariable manner, controlling for patient age, sex, and self-reported tobacco and alcohol use. Reporting lifetime cannabis use was associated with higher risk for having oral lesions (aPR = 1.41, 95% CI: 1.07-1.85), bruxism (aPR = 1.31, 95% CI: 1.09-1.58), and frequent consumption of sugary beverages and snacks (aPR = 1.27, 95% CI: 1.12-1.41). Reporting current cannabis use was associated with higher risk for oral lesions (aPR = 1.45, 95% CI: 1.03-2.06) and frequent consumption of sugary beverages and snacks (aPR = 1.26, 95% CI: 1.07-1.48). Cannabis users aged 12-25 are at increased risk for bruxism, oral lesions, and frequent consumption of sugary beverages and snacks. Orthodontists and other dental professionals should probe for drug use and be cognizant of increased risk for oral health problems in patients that report actively using cannabis.
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Affiliation(s)
- Austin Le
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
- Department of Orthodontics and Dentofacial Orthopedics, New York University College of Dentistry, New York, NY 10010, USA
| | - Edmund Khoo
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, Indianapolis, IN 46202, USA
- Eastman Institute of Oral Health, University of Rochester, Rochester, NY 14620, USA
| | - Joseph J. Palamar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
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153
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Chandy M, Obal D, Wu JC. Elucidating effects of environmental exposure using human-induced pluripotent stem cell disease modeling. EMBO Mol Med 2022; 14:e13260. [PMID: 36285490 PMCID: PMC9641419 DOI: 10.15252/emmm.202013260] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 11/15/2022] Open
Abstract
Induced pluripotent stem cells (iPSCs) are a powerful modeling system for medical discovery and translational research. To date, most studies have focused on the potential for iPSCs for regenerative medicine, drug discovery, and disease modeling. However, iPSCs are also a powerful modeling system to investigate the effects of environmental exposure on the cardiovascular system. With the emergence of e-cigarettes, air pollution, marijuana use, opioids, and microplastics as novel cardiovascular risk factors, iPSCs have the potential for elucidating the effects of these toxins on the body using conventional two-dimensional (2D) arrays and more advanced tissue engineering approaches with organoid and other three-dimensional (3D) models. The effects of these environmental factors may be enhanced by genetic polymorphisms that make some individuals more susceptible to the effects of toxins. iPSC disease modeling may reveal important gene-environment interactions that exacerbate cardiovascular disease and predispose some individuals to adverse outcomes. Thus, iPSCs and gene-editing techniques could play a pivotal role in elucidating the mechanisms of gene-environment interactions and understanding individual variability in susceptibility to environmental effects.
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Affiliation(s)
- Mark Chandy
- Stanford Cardiovascular InstituteStanford University School of MedicineStanfordCAUSA
- Department of MedicineWestern UniversityLondonONCanada
- Department of Physiology and PharmacologyWestern UniversityLondonONCanada
| | - Detlef Obal
- Stanford Cardiovascular InstituteStanford University School of MedicineStanfordCAUSA
- Department of Anesthesiology, Perioperative, and Pain MedicineStanford UniversityStanfordCAUSA
| | - Joseph C Wu
- Stanford Cardiovascular InstituteStanford University School of MedicineStanfordCAUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford University School of MedicineStanfordCAUSA
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154
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Macha V, Abouk R, Drake C. Association of Recreational Cannabis Legalization With Alcohol Use Among Adults in the US, 2010 to 2019. JAMA HEALTH FORUM 2022; 3:e224069. [PMID: 36399353 PMCID: PMC9675003 DOI: 10.1001/jamahealthforum.2022.4069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/16/2022] [Indexed: 11/19/2022] Open
Abstract
Importance In the US, cannabis use has nearly doubled during the past decade, in part because states have implemented recreational cannabis laws (RCLs). However, it is unclear how legalization of adult-use cannabis may affect alcohol consumption. Objective To estimate the association between implementation of state RCLs and alcohol use among adults in the US. Design, Settings, and Participants This was a cross-sectional study of 4.2 million individuals who responded to the Behavioral Risk Factor Surveillance System in 2010 to 2019. A difference-in-differences approach with demographic and policy controls was used to estimate the association between RCLs and alcohol use, overall and by age, sex, race and ethnicity, and educational level. Data analyses were performed from June 2021 to March 2022. Exposures States with RCLs, as reported by the RAND-University of Southern California Schaeffer Opioid Policy Tools and Information Center. Main Outcomes and Measures Past-month alcohol use, binge drinking, and heavy drinking. Results Of 4.2 million respondents (median age group, 50-64 years; 2 476 984 [51.7%] women; 2 978 467 [58.3%] non-Hispanic White individuals) in 2010 through 2019, 321 921 individuals lived in state-years with recreational cannabis laws. Recreational cannabis laws were associated with a 0.9 percentage point (95% CI, 0.1-1.7; P = .02) increase in any alcohol drinking but were not significantly associated with binge or heavy drinking. Increases in any alcohol use were primarily among younger adults (18-24 years) and men, as well as among non-Hispanic White respondents and those without any college education. A 1.4 percentage point increase (95% CI, 0.4-2.3; P = .006) in binge drinking was also observed among men, although this association diminished over time. Conclusions and Relevance This cross-sectional study and difference-in-differences analysis found that recreational cannabis laws in the US may be associated with increased alcohol use, primarily among younger adults and men.
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Affiliation(s)
- Vandana Macha
- Department of Economics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rahi Abouk
- Department of Economics, Finance, and Global Business, William Patterson University, Wayne, New Jersey
| | - Coleman Drake
- Department of Economics, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
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155
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Cannabis and Intentional Self-injury: a Narrative Review. CURRENT ADDICTION REPORTS 2022. [DOI: 10.1007/s40429-022-00453-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Purpose of Review
Observational studies assessing the association of cannabis use with subsequent intentional self-injury have reported mixed findings. Longitudinal studies examining the association of cannabis use with subsequent suicide death are notably rare. Our objective was to review longitudinal studies examining cannabis use and subsequent self-harm, suicide attempt, or suicide death.
Recent Findings
Few population-based studies have focused on self-harm with considerable variability across studies in how this outcome has been operationalized. Studies assessing the association between cannabis use and suicide attempt are equivocal in their conclusions and heterogenous in terms of samples utilized and assessment of confounding bias. The results of one meta-analysis were suggestive of dose dependency. For suicide death, the findings are inconsistent, and there is reason for concern of selection bias.
Summary
The existing evidence base on these associations is not yet rigorous enough to allow drawing conclusions on causality. However, cannabis might be seen as an adverse prognostic marker for intentional self-injury.
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156
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Struble CA, Borodovsky JT, Habib MI, Hasin DS, Shmulewitz D, Livne O, Walsh C, Aharonovich E, Budney AJ. Cannabis Practices Among a Gender-Diverse Sample of Young Adults. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100113. [PMID: 36741544 PMCID: PMC9894216 DOI: 10.1016/j.dadr.2022.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background Gender is an important factor in understanding cannabis patterns, yet few studies have explored cannabis patterns among gender minority (GM) individuals - particularly among high-risk age groups including young adults. The evolving cannabis market is reshaping typical patterns of cannabis use in the U.S. The combination of these factors warrants increased efforts to examine cannabis practices in gender-diverse samples. Methods Online survey participants between 18-34 years (N=2377) from the U.S. provided information on cannabis practices from May - July 2021. Gender differences across several cannabis outcomes (onset, methods of consumption, product potency, frequency, and quantity) were assessed. Bivariate tests and multiple regression models examined associations between gender (cisgender men: n=1020; cisgender women: n=1178; and GM: n=179) and cannabis outcomes adjusting for sociodemographic characteristics. Results In regression models adjusted for sociodemographic characteristics, GM identity was associated with later age of onset and lower likelihood of daily use compared to cisgender men and women. Identifying as GM or cisgender woman was associated with fewer lifetime methods of consumption and lower plant and concentrate potency usage. Conclusions Findings provide initial insights into potential gender differences in cannabis practices from a sample of heavy cannabis users. GM young adults report use patterns indicative of lower risk compared to cisgender men and women in our sample. Future investigations of gender differences in cannabis use that explore specific gender minority categories and that include alternative sampling strategies are needed to better understand differential risks associated with gender.
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Affiliation(s)
- Cara A. Struble
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Lebanon, NH, United States of America
- Corresponding author.
| | - Jacob T. Borodovsky
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Lebanon, NH, United States of America
| | - Mohammad I. Habib
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Lebanon, NH, United States of America
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States of America
- New York State Psychiatric Institute, New York, NY, United States of America
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States of America
- New York State Psychiatric Institute, New York, NY, United States of America
| | - Ofir Livne
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States of America
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Claire Walsh
- New York State Psychiatric Institute, New York, NY, United States of America
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States of America
- New York State Psychiatric Institute, New York, NY, United States of America
| | - Alan J. Budney
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Lebanon, NH, United States of America
- Department of Psychiatry, Dartmouth Geisel School of Medicine, Lebanon, NH, United States of America
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157
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Kowitt SD, Yockey RA, Lee JGL, Jarman KL, Gourdet CK, Ranney LM. The Impact of Cannabis Packaging Characteristics on Perceptions and Intentions. Am J Prev Med 2022; 63:751-759. [PMID: 35835626 PMCID: PMC9588761 DOI: 10.1016/j.amepre.2022.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION As cannabis increasingly becomes a consumer product in the U.S., its product packaging has become critically important to regulators. This study examined the influence of recreational cannabis packaging characteristics. METHODS Five online between-subjects experiments were conducted in April 2021, and data were analyzed in May 2021-July 2021. Experiments randomized participants to view different (1) types of cannabis, (2) visual displays of tetrahydrocannabinol content, (3) cannabis packages designed around brand personality research, (4) health warnings, and (5) health claims. Outcomes included cognitive, affective, and behavioral responses. RESULTS A total of 841 adults from the U.S. (49% male, 50% young adults, 44% White, 17% Hispanic) were included in the study. Edible gummies were perceived as healthier (β=0.32, 95% CI=0.03, 0.62), less grown up (β= -0.58, 95% CI= -0.86, -0.28), and more socially acceptable to consume (β=0.30, 95% CI=0.01, 0.59) than cannabis concentrate in a medical dropper. Participants also had more interest in trying edible gummies (β=1.33, 95% CI=1.04, 1.62) and trying a free sample (β=1.30, 95% CI=1.01, 1.60) than trying cannabis concentrate. Cannabis packages with a helps-you-relax health claim elicited more happy (β=0.34, 95% CI=0.04, 0.64) and good (β=0.37, 95% CI=0.07, 0.67) feelings than cannabis packages without this claim. Minimal effects were found for visual displays of tetrahydrocannabinol content and health warnings. CONCLUSIONS Edibles are a unique type of cannabis that should be given special consideration under state laws, and lawmakers should consider limiting and governing the use of both implicit and explicit health claims on recreational cannabis packages when implementing laws.
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Affiliation(s)
- Sarah D Kowitt
- Department of Family Medicine, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - R Andrew Yockey
- Department of Biostatistics and Epidemiology, The University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas
| | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina
| | - Kristen L Jarman
- Department of Family Medicine, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Leah M Ranney
- Department of Family Medicine, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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158
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Sharif A, Bombay K, Murphy MSQ, Murray RK, Sikora L, Cobey KD, Corsi DJ. Canadian Resources on Cannabis Use and Fertility, Pregnancy, and Lactation: Scoping Review. JMIR Pediatr Parent 2022; 5:e37448. [PMID: 36260396 PMCID: PMC9631170 DOI: 10.2196/37448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cannabis use among reproductive-aged Canadians is increasing, but our understanding of its impacts on fertility, pregnancy, and breast milk is still evolving. Despite the availability of many web-based resources, informed decision-making and patient counseling are challenging for expectant families and providers alike. OBJECTIVE We aimed to conduct a scoping review of publicly available web-based Canadian resources to provide information on the effects of cannabis on fertility, pregnancy, and breast milk. METHODS Following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), we systematically searched 8 databases between January 1, 2010, and November 30, 2020, and web pages of 71 Canadian obstetrical, government, and public health organizations. We included English resources discussing the effects of cannabis on fertility, pregnancy, breastfeeding, or the exposed fetus and infant. Epidemiological characteristics, readability, and content information were extracted and summarized. RESULTS A total of 183 resources met our inclusion criteria. Resources included content for public audiences (163/183, 89.1%) and health care providers (HCPs; 31/183, 16.9%). The resources were authored by national-level (46/183, 25.1%), provincial or territorial (65/183, 35.5%), and regional (72/183, 39.3%) organizations. All provinces and territories had at least one resource attributed to them. The majority (125/183, 68.3%) were written at a >10 grade reading level, and a few (7/183, 3.8%) were available in languages other than English or French. The breadth of content on fertility (55/183, 30.1%), pregnancy (173/183, 94.5%), and breast milk or breastfeeding (133/183, 72.7%) varied across resources. Common themes included citing a need for more research into the effects of cannabis on reproductive health and recommending that patients avoid or discontinue cannabis use. Although resources for providers were consistent in recommending patient counseling, resources targeting the public were less likely to encourage seeking advice from HCPs (23/163, 14.1%). CONCLUSIONS Canadian resources consistently identify that there is no known safe amount of cannabis that can be consumed in the context of fertility, pregnancy, and breastfeeding. Areas of improvement include increasing readability and language accessibility and encouraging bidirectional communication between HCPs and patients. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-045006.
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Affiliation(s)
- Ayni Sharif
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kira Bombay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Malia S Q Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Rebecca K Murray
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | - Kelly D Cobey
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Daniel J Corsi
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Boakye E, El Shahawy O, Obisesan O, Dzaye O, Osei AD, Erhabor J, Uddin SMI, Blaha MJ. The inverse association of state cannabis vaping prevalence with the e-cigarette or vaping product-use associated lung injury. PLoS One 2022; 17:e0276187. [PMID: 36251673 PMCID: PMC9576092 DOI: 10.1371/journal.pone.0276187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/30/2022] [Indexed: 11/28/2022] Open
Abstract
The e-cigarette or vaping product-use-associated lung injury (EVALI) epidemic was primarily associated with the use of e-cigarettes containing tetrahydrocannabinol (THC)- the principal psychoactive substance in cannabis, and vitamin-E-acetate- an additive sometimes used in informally sourced THC-containing e-liquids. EVALI case burden varied across states, but it is unclear whether this was associated with state-level cannabis vaping prevalence. We, therefore, used linear regression models to assess the cross-sectional association between state-level cannabis vaping prevalence (obtained from the 2019 behavioral Risk Factor Surveillance System) and EVALI case burden (obtained from the Centers for Disease Control and Prevention) adjusted for state cannabis policies. Cannabis vaping prevalence ranged from 1.14%(95%CI, 0.61%-2.12%) in Wyoming to 3.11%(95%CI, 2.16%-4.44%) in New Hampshire. EVALI cases per million population ranged from 1.90(0.38-3.42) in Oklahoma to 59.10(19.70-96.53) in North Dakota. There was no significant positive association but an inverse association between state cannabis vaping prevalence and EVALI case burden (Coefficient, -18.6; 95%CI, -37.5-0.4; p-value, 0.05). Thus, state-level cannabis vaping prevalence was not positively associated with EVALI prevalence, suggesting that there may not be a simple direct link between state cannabis vaping prevalence and EVALI cases, but rather the relationship is likely more nuanced and possibly reflective of access to informal sources of THC-containing e-cigarettes.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States of America
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America
| | - Omar El Shahawy
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
| | - Olufunmilayo Obisesan
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, United States of America
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States of America
| | - Albert D. Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, United States of America
| | - John Erhabor
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States of America
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America
| | - S. M. Iftekhar Uddin
- Department of Medicine, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States of America
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America
- * E-mail:
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160
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Gunadi C, Zhu B, Shi Y. Recreational cannabis legalization and transitions in cannabis use: findings from a nationally representative longitudinal cohort in the United States. Addiction 2022; 117:2651-2659. [PMID: 35618659 PMCID: PMC11147131 DOI: 10.1111/add.15895] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
AIMS This study estimated the likelihoods of individuals transitioning to different cannabis use status following recreational cannabis legalization (RCL) in the United States. DESIGN Secondary analysis of a nationally representative longitudinal cohort in the United States. We used propensity score matching to balance individual characteristics between RCL and comparison states and generalized mixed regressions to estimate behavioral transitions in matched samples. PARTICIPANTS A longitudinal cohort of 21 863 individuals (6925 youths and 14 938 adults) participating in the Population Assessment of Tobacco and Health waves 3 and 4. SETTING Four RCL states that implemented RCL between waves 3 and 4 (California, Massachusetts, Nevada and Maine) and comparison states in the United States. MEASUREMENTS Transitions in cannabis use over the two waves: (1) from non-users to users; (2) from non-users to weekly users; (3) from users to non-users. Individuals in RCL states were compared with matched individuals in (1) states with medical cannabis legalization (MCL), (2) states not legalizing cannabis (non-legalizing) and (3) MCL and non-legalizing states combined. FINDINGS Among youths, the association between RCL and greater odds of transition from non-users to users was seen in comparison with non-legalizing states [odds ratio (OR) = 2.18, 95% confidence interval (CI) = 1.37-3.45] and combined states (OR = 1.73, 95% CI = 1.23-2.42). Evidence was lacking regarding the associations between RCL and transitions from non-users to weekly users and from users to non-users. Among adults, RCL was associated with greater odds of transitions from non-users to users and non-users to weekly users if RCL states were compared with non-legalizing states (OR = 1.68, 95% CI = 1.15-2.46; OR = 1.82, 95% CI = 1.00-3.31, respectively) or combined states (OR = 1.51, 95% CI = 1.11-2.07; OR = 2.09, 95% CI = 1.19-3.66, respectively). RCL was also associated with lower odds of transition from users to non-users if RCL states were compared with non-legalizing states (OR = 0.54, 95% CI = 0.35-0.81). CONCLUSIONS There appears to be some evidence that recreational cannabis legalization in the United States is associated with elevated odds of transition to cannabis use among both youths and adults.
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Affiliation(s)
- Christian Gunadi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, CA, USA
| | - Bin Zhu
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, CA, USA
- School of Public Health and Emergency Management, Southern University of Science and Technology, Guangdong, China
| | - Yuyan Shi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, CA, USA
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161
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Hasin DS, Saxon AJ, Malte C, Olfson M, Keyes KM, Gradus JL, Cerdá M, Maynard CC, Keyhani S, Martins SS, Fink DS, Livne O, Mannes Z, Wall MM. Trends in Cannabis Use Disorder Diagnoses in the U.S. Veterans Health Administration, 2005-2019. Am J Psychiatry 2022; 179:748-757. [PMID: 35899381 PMCID: PMC9529770 DOI: 10.1176/appi.ajp.22010034] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE In the United States, adult cannabis use has increased over time, but less information is available on time trends in cannabis use disorder. The authors used Veterans Health Administration (VHA) data to examine change over time in cannabis use disorder diagnoses among veterans, an important population subgroup, and whether such trends differ by age group (<35 years, 35-64 years, ≥65 years), sex, or race/ethnicity. METHODS VHA electronic health records from 2005 to 2019 (range of Ns per year, 4,403,027-5,797,240) were used to identify the percentage of VHA patients seen each year with a cannabis use disorder diagnosis (ICD-9-CM, January 1, 2005-September 30, 2015; ICD-10-CM, October 1, 2015-December 31, 2019). Trends in cannabis use disorder diagnoses were examined by age and by race/ethnicity and sex within age groups. Given the transition in ICD coding, differences in trends were tested within two periods: 2005-2014 (ICD-9-CM) and 2016-2019 (ICD-10-CM). RESULTS In 2005, the percentages of VHA patients diagnosed with cannabis use disorder in the <35, 35-64, and ≥65 year age groups were 1.70%, 1.59%, and 0.03%, respectively; by 2019, the percentages had increased to 4.84%, 2.86%, and 0.74%, respectively. Although the prevalence of cannabis use disorder was consistently higher among males than females, between 2016 and 2019, the prevalence increased more among females than males in the <35 year group. Black patients had a consistently higher prevalence of cannabis use disorder than other racial/ethnic groups, and increases were greater among Black than White patients in the <35 year group in both periods. CONCLUSIONS Since 2005, diagnoses of cannabis use disorder have increased substantially among VHA patients, as they have in the general population and other patient populations. Possible explanations warranting investigation include decreasing perception of risk, changing laws, increasing cannabis potency, stressors related to growing socioeconomic inequality, and use of cannabis to self-treat pain. Clinicians and the public should be educated about the increases in cannabis use disorder in general in the United States, including among patients treated at the VHA.
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Affiliation(s)
- Deborah S Hasin
- Department of Epidemiology (in Psychiatry) (Hasin), Department of Epidemiology (Olfson, Keyes, Martins, Livne, Mannes), and Department of Psychiatry (Olfson), Columbia University, New York; New York State Psychiatric Institute, New York (Hasin, Olfson, Fink, Wall); VA Puget Sound Health Care System, Seattle (Saxon, Malte, Maynard); Department of Psychiatry and Behavioral Sciences (Saxon) and Department of Health Systems and Population Health (Maynard), University of Washington, Seattle; Department of Epidemiology, Boston University, Boston (Gradus); Department of Population Health, New York University, New York (Cerdá); San Francisco VA Health System and Division of General Internal Medicine, University of California at San Francisco (Keyhani); Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York (Wall)
| | - Andrew J Saxon
- Department of Epidemiology (in Psychiatry) (Hasin), Department of Epidemiology (Olfson, Keyes, Martins, Livne, Mannes), and Department of Psychiatry (Olfson), Columbia University, New York; New York State Psychiatric Institute, New York (Hasin, Olfson, Fink, Wall); VA Puget Sound Health Care System, Seattle (Saxon, Malte, Maynard); Department of Psychiatry and Behavioral Sciences (Saxon) and Department of Health Systems and Population Health (Maynard), University of Washington, Seattle; Department of Epidemiology, Boston University, Boston (Gradus); Department of Population Health, New York University, New York (Cerdá); San Francisco VA Health System and Division of General Internal Medicine, University of California at San Francisco (Keyhani); Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York (Wall)
| | - Carol Malte
- Department of Epidemiology (in Psychiatry) (Hasin), Department of Epidemiology (Olfson, Keyes, Martins, Livne, Mannes), and Department of Psychiatry (Olfson), Columbia University, New York; New York State Psychiatric Institute, New York (Hasin, Olfson, Fink, Wall); VA Puget Sound Health Care System, Seattle (Saxon, Malte, Maynard); Department of Psychiatry and Behavioral Sciences (Saxon) and Department of Health Systems and Population Health (Maynard), University of Washington, Seattle; Department of Epidemiology, Boston University, Boston (Gradus); Department of Population Health, New York University, New York (Cerdá); San Francisco VA Health System and Division of General Internal Medicine, University of California at San Francisco (Keyhani); Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York (Wall)
| | - Mark Olfson
- Department of Epidemiology (in Psychiatry) (Hasin), Department of Epidemiology (Olfson, Keyes, Martins, Livne, Mannes), and Department of Psychiatry (Olfson), Columbia University, New York; New York State Psychiatric Institute, New York (Hasin, Olfson, Fink, Wall); VA Puget Sound Health Care System, Seattle (Saxon, Malte, Maynard); Department of Psychiatry and Behavioral Sciences (Saxon) and Department of Health Systems and Population Health (Maynard), University of Washington, Seattle; Department of Epidemiology, Boston University, Boston (Gradus); Department of Population Health, New York University, New York (Cerdá); San Francisco VA Health System and Division of General Internal Medicine, University of California at San Francisco (Keyhani); Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York (Wall)
| | - Katherine M Keyes
- Department of Epidemiology (in Psychiatry) (Hasin), Department of Epidemiology (Olfson, Keyes, Martins, Livne, Mannes), and Department of Psychiatry (Olfson), Columbia University, New York; New York State Psychiatric Institute, New York (Hasin, Olfson, Fink, Wall); VA Puget Sound Health Care System, Seattle (Saxon, Malte, Maynard); Department of Psychiatry and Behavioral Sciences (Saxon) and Department of Health Systems and Population Health (Maynard), University of Washington, Seattle; Department of Epidemiology, Boston University, Boston (Gradus); Department of Population Health, New York University, New York (Cerdá); San Francisco VA Health System and Division of General Internal Medicine, University of California at San Francisco (Keyhani); Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York (Wall)
| | - Jaimie L Gradus
- Department of Epidemiology (in Psychiatry) (Hasin), Department of Epidemiology (Olfson, Keyes, Martins, Livne, Mannes), and Department of Psychiatry (Olfson), Columbia University, New York; New York State Psychiatric Institute, New York (Hasin, Olfson, Fink, Wall); VA Puget Sound Health Care System, Seattle (Saxon, Malte, Maynard); Department of Psychiatry and Behavioral Sciences (Saxon) and Department of Health Systems and Population Health (Maynard), University of Washington, Seattle; Department of Epidemiology, Boston University, Boston (Gradus); Department of Population Health, New York University, New York (Cerdá); San Francisco VA Health System and Division of General Internal Medicine, University of California at San Francisco (Keyhani); Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York (Wall)
| | - Magdalena Cerdá
- Department of Epidemiology (in Psychiatry) (Hasin), Department of Epidemiology (Olfson, Keyes, Martins, Livne, Mannes), and Department of Psychiatry (Olfson), Columbia University, New York; New York State Psychiatric Institute, New York (Hasin, Olfson, Fink, Wall); VA Puget Sound Health Care System, Seattle (Saxon, Malte, Maynard); Department of Psychiatry and Behavioral Sciences (Saxon) and Department of Health Systems and Population Health (Maynard), University of Washington, Seattle; Department of Epidemiology, Boston University, Boston (Gradus); Department of Population Health, New York University, New York (Cerdá); San Francisco VA Health System and Division of General Internal Medicine, University of California at San Francisco (Keyhani); Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York (Wall)
| | - Charles C Maynard
- Department of Epidemiology (in Psychiatry) (Hasin), Department of Epidemiology (Olfson, Keyes, Martins, Livne, Mannes), and Department of Psychiatry (Olfson), Columbia University, New York; New York State Psychiatric Institute, New York (Hasin, Olfson, Fink, Wall); VA Puget Sound Health Care System, Seattle (Saxon, Malte, Maynard); Department of Psychiatry and Behavioral Sciences (Saxon) and Department of Health Systems and Population Health (Maynard), University of Washington, Seattle; Department of Epidemiology, Boston University, Boston (Gradus); Department of Population Health, New York University, New York (Cerdá); San Francisco VA Health System and Division of General Internal Medicine, University of California at San Francisco (Keyhani); Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York (Wall)
| | - Salomeh Keyhani
- Department of Epidemiology (in Psychiatry) (Hasin), Department of Epidemiology (Olfson, Keyes, Martins, Livne, Mannes), and Department of Psychiatry (Olfson), Columbia University, New York; New York State Psychiatric Institute, New York (Hasin, Olfson, Fink, Wall); VA Puget Sound Health Care System, Seattle (Saxon, Malte, Maynard); Department of Psychiatry and Behavioral Sciences (Saxon) and Department of Health Systems and Population Health (Maynard), University of Washington, Seattle; Department of Epidemiology, Boston University, Boston (Gradus); Department of Population Health, New York University, New York (Cerdá); San Francisco VA Health System and Division of General Internal Medicine, University of California at San Francisco (Keyhani); Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York (Wall)
| | - Silvia S Martins
- Department of Epidemiology (in Psychiatry) (Hasin), Department of Epidemiology (Olfson, Keyes, Martins, Livne, Mannes), and Department of Psychiatry (Olfson), Columbia University, New York; New York State Psychiatric Institute, New York (Hasin, Olfson, Fink, Wall); VA Puget Sound Health Care System, Seattle (Saxon, Malte, Maynard); Department of Psychiatry and Behavioral Sciences (Saxon) and Department of Health Systems and Population Health (Maynard), University of Washington, Seattle; Department of Epidemiology, Boston University, Boston (Gradus); Department of Population Health, New York University, New York (Cerdá); San Francisco VA Health System and Division of General Internal Medicine, University of California at San Francisco (Keyhani); Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York (Wall)
| | - David S Fink
- Department of Epidemiology (in Psychiatry) (Hasin), Department of Epidemiology (Olfson, Keyes, Martins, Livne, Mannes), and Department of Psychiatry (Olfson), Columbia University, New York; New York State Psychiatric Institute, New York (Hasin, Olfson, Fink, Wall); VA Puget Sound Health Care System, Seattle (Saxon, Malte, Maynard); Department of Psychiatry and Behavioral Sciences (Saxon) and Department of Health Systems and Population Health (Maynard), University of Washington, Seattle; Department of Epidemiology, Boston University, Boston (Gradus); Department of Population Health, New York University, New York (Cerdá); San Francisco VA Health System and Division of General Internal Medicine, University of California at San Francisco (Keyhani); Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York (Wall)
| | - Ofir Livne
- Department of Epidemiology (in Psychiatry) (Hasin), Department of Epidemiology (Olfson, Keyes, Martins, Livne, Mannes), and Department of Psychiatry (Olfson), Columbia University, New York; New York State Psychiatric Institute, New York (Hasin, Olfson, Fink, Wall); VA Puget Sound Health Care System, Seattle (Saxon, Malte, Maynard); Department of Psychiatry and Behavioral Sciences (Saxon) and Department of Health Systems and Population Health (Maynard), University of Washington, Seattle; Department of Epidemiology, Boston University, Boston (Gradus); Department of Population Health, New York University, New York (Cerdá); San Francisco VA Health System and Division of General Internal Medicine, University of California at San Francisco (Keyhani); Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York (Wall)
| | - Zachary Mannes
- Department of Epidemiology (in Psychiatry) (Hasin), Department of Epidemiology (Olfson, Keyes, Martins, Livne, Mannes), and Department of Psychiatry (Olfson), Columbia University, New York; New York State Psychiatric Institute, New York (Hasin, Olfson, Fink, Wall); VA Puget Sound Health Care System, Seattle (Saxon, Malte, Maynard); Department of Psychiatry and Behavioral Sciences (Saxon) and Department of Health Systems and Population Health (Maynard), University of Washington, Seattle; Department of Epidemiology, Boston University, Boston (Gradus); Department of Population Health, New York University, New York (Cerdá); San Francisco VA Health System and Division of General Internal Medicine, University of California at San Francisco (Keyhani); Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York (Wall)
| | - Melanie M Wall
- Department of Epidemiology (in Psychiatry) (Hasin), Department of Epidemiology (Olfson, Keyes, Martins, Livne, Mannes), and Department of Psychiatry (Olfson), Columbia University, New York; New York State Psychiatric Institute, New York (Hasin, Olfson, Fink, Wall); VA Puget Sound Health Care System, Seattle (Saxon, Malte, Maynard); Department of Psychiatry and Behavioral Sciences (Saxon) and Department of Health Systems and Population Health (Maynard), University of Washington, Seattle; Department of Epidemiology, Boston University, Boston (Gradus); Department of Population Health, New York University, New York (Cerdá); San Francisco VA Health System and Division of General Internal Medicine, University of California at San Francisco (Keyhani); Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York (Wall)
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162
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Rhee TG, Rosenheck RA. Admissions to substance use treatment facilities for cannabis use disorder, 2000-2017: Does legalization matter? Am J Addict 2022; 31:423-432. [PMID: 35368113 DOI: 10.1111/ajad.13286] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A growing number of US states have legalized marijuana use in the past decade. We examined if marijuana legalization is associated with increased marijuana-related admissions to substance use treatment facilities between 2000 and 2017. METHODS Data from the Treatment Episode Data Set-Admissions were used to examine the relationship between marijuana-related admissions among adults aged ≥18 by year and legalization status (i.e., fully legalized, medical use only [partially legalized], and illegal) (N = 35,457,854). Using interaction analyses, we further examined whether certain patient characteristics were associated with residence in states that legalized marijuana use as compared to those in which marijuana remained illegal. RESULTS Overall, the proportion of marijuana-related admissions in states with legalization decreased by 2.3% from 31.7% in 2000-2005 to 29.4% in 2012-2017 (odds ratio [OR], 0.90; 95% confidence intervals [CI], 0.89-0.90) with little difference from states where marijuana use remained illegal, in which marijuana use as any reason for admissions decreased by 0.3% from 39.8% in 2000-2005 to 39.5% in 2012-2017 (OR, 0.99; 95% CI, 0.98-0.99). We did not find any striking patient characteristics (e.g., referral by the police) associated with admissions in states that legalized compared to those that had not. DISCUSSION AND CONCLUSIONS While earlier studies suggested that marijuana legalization is associated with increased levels of use, emergency department visits, and traffic fatalities, our findings suggest that marijuana legalization did not increase marijuana-related treatment use in the United States. SCIENTIFIC SIGNIFICANCE This is the first study to examine the association of marijuana legalization with marijuana-related treatment use.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, Connecticut, USA.,Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA.,VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Robert A Rosenheck
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA.,VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, Connecticut, USA
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163
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Saran SK, Salinas KZ, Foulds J, Kaynak Ö, Hoglen B, Houser KR, Krebs NM, Yingst JM, Allen SI, Bordner CR, Hobkirk AL. A Comparison of Vaping Behavior, Perceptions, and Dependence among Individuals Who Vape Nicotine, Cannabis, or Both. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10392. [PMID: 36012024 PMCID: PMC9408799 DOI: 10.3390/ijerph191610392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
Background: Electronic delivery systems (e.g., vapes, e-cigarettes) are now popular modes of cannabis and nicotine administration that are often used by the same individuals; however, we still know little about dual nicotine and cannabis vaping. Materials & Methods: An online convenience sample of adult nicotine and/or cannabis vape users residing in the United States completed a 60 min survey on sociodemographic characteristics, cannabis and/or nicotine vape use behaviors and dependence, reasons for vape use, and perceptions of benefits and harms. After data cleaning, we compared dual vs. nicotine-only and cannabis-only vape users with univariate statistics and step-wise hierarchical linear regression analyses. Additionally, we assessed the factor structure, internal consistency, and criterion and convergent validity of the Penn State Cannabis Vaping Dependence Index (PSCVDI). Results: The final sample included 357 dual, 40 cannabis, and 106 nicotine vape users. Compared to nicotine- and cannabis-only vapers, dual vapers started using their nicotine and cannabis vapes at a younger age (p < 0.001), used them for more years (p < 0.001), and were less likely to use their nicotine vape to replace combustible cigarettes (p = 0.047). Dual users vs. single-substance users did not have significantly higher nicotine or cannabis vape dependence scores after controlling for sociodemographic and use behaviors. The PSCVDI showed adequate validity for measuring cannabis vape dependence. Conclusions: This survey is the first to highlight important differences in vape use behaviors and reasons for use between dual vs. cannabis- and nicotine-only vape users.
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Affiliation(s)
- Savreen K. Saran
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Kalin Z. Salinas
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Jonathan Foulds
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
- Department of Public Health Sciences & Penn State Center for Research on Tobacco and Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Övgϋ Kaynak
- School of Behavioral Sciences & Education, Penn State Harrisburg, 777 West Harrisburg Pike, Middletown, PA 17057, USA
| | - Brianna Hoglen
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Kenneth R. Houser
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Nicolle M. Krebs
- Department of Public Health Sciences & Penn State Center for Research on Tobacco and Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Jessica M. Yingst
- Department of Public Health Sciences & Penn State Center for Research on Tobacco and Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Sophia I. Allen
- Department of Public Health Sciences & Penn State Center for Research on Tobacco and Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Candace R. Bordner
- Department of Public Health Sciences & Penn State Center for Research on Tobacco and Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Andrea L. Hobkirk
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
- Department of Public Health Sciences & Penn State Center for Research on Tobacco and Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
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164
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Wang Y, Duan Z, Self-Brown SR, Weaver SR, Spears CA, Zheng P, Eriksen MP, Huang J. Longitudinal associations between e-cigarette use and onset of multiple modes of cannabis use among US adolescents. Addict Behav 2022; 131:107316. [PMID: 35364398 PMCID: PMC9086173 DOI: 10.1016/j.addbeh.2022.107316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/10/2022] [Accepted: 03/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the prospective associations between e-cigarette use and subsequent onset of various modes of cannabis use during a 12-month follow-up period among US adolescents. METHODS Data were from the Wave 4 (2017, baseline) and Wave 4.5 (12-month follow-up) surveys of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study. Study population was cannabis-naïve US adolescents (12-16 years) at baseline who reported cannabis use status at follow-up (N = 9,692). Outcomes were modality-specific past-12-month cannabis use (vaping, blunting, smoking with hookah) and any cannabis use (past-12-month and past-30-day) at follow-up. Multivariate logistic regressions were used to estimate the weighted association between baseline past-30-day e-cigarette use and each outcome. RESULTS Baseline e-cigarette use was significantly associated with onset of cannabis vaping (aOR = 4.00, 95% CI = 2.25-7.10), blunting (aOR = 5.30, 95% CI = 2.82-9.94), any cannabis use (aOR = 3.94, 95% CI = 2.35-6.62), and past-30-day cannabis use (aOR = 4.47, 95%CI = 2.64-7.58) at follow-up. Non-Hispanic blacks were more likely to report past-12-month blunting (aOR = 1.55, 95% CI = 1.07-2.24) and smoking cannabis with hookah (aOR = 3.13, 95% CI = 1.14-8.63) compared with non-Hispanic whites. Other tobacco use, alcohol use, perceiving e-cigarette use as having little or some harm, older age, high severity of externalizing mental health problems, and living in states legalized adult recreational cannabis use were significantly associated with future onset of cannabis vaping, blunting, and any cannabis use. CONCLUSIONS The association of e-cigarette use with cannabis vaping was not stronger than its association with other modes of cannabis use. Future studies are needed to explain the mechanisms linking e-cigarettes and cannabis use.
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165
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Ginley MK, Kelly LM, Pfund RA, Rash CJ, Alessi SM, Zajac K. The impact of marijuana use on cocaine use outcomes among patients in methadone maintenance treatment across five trials of contingency management. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2022; 36:526-536. [PMID: 34553964 PMCID: PMC8940730 DOI: 10.1037/adb0000735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cocaine use is prevalent among patients in methadone maintenance and a risk factor for poor treatment outcomes. Contingency management (CM) decreases cocaine use in this population, but little is known about its efficacy when marijuana use is present prior to or during treatment. METHOD Data from five randomized CM trials (N = 557) were used to evaluate whether: (a) marijuana frequency (none, low, or high) prior to or during treatment impacts cocaine use outcomes and (b) marijuana use differentially impacts cocaine outcomes with standard care (SC) + CM versus SC alone. RESULTS Relative to no marijuana use, low (β = .28, p < .01) and high marijuana use (β = .32, p < .05) during treatment were associated with roughly 1 week shorter duration of cocaine abstinence on average. Low marijuana use (β = .71, p < .05) during treatment was associated with a lower proportion of negative cocaine samples during treatment relative to no marijuana use. Treatment group by marijuana use (before or during treatment) interactions on duration and proportion of cocaine abstinence during treatment were not significant. For longer term outcomes, in SC + CM, marijuana use during treatment did not impact cocaine abstinence 6 months post-baseline. In SC, low (OR = .44, p < .05) and high (OR = .26, p < .001) marijuana use during treatment decreased odds of cocaine abstinence at 6 months post-baseline relative to no use. CONCLUSIONS Findings highlight the benefits of SC + CM and abstaining from marijuana use during active treatment. At 6 months postbaseline, SC + CM evidenced similar cocaine abstinence regardless of marijuana use levels during treatment, while those with low and high marijuana use showed decreased abstinence rates in SC only. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Meredith K. Ginley
- University of Connecticut School of Medicine
- East Tennessee State University
| | | | - Rory A. Pfund
- Center on Alcohol, Substance Use, and Addictions, The University of New Mexico
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166
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Trull TJ, Freeman LK, Fleming MN, Vebares TJ, Wycoff AM. Using ecological momentary assessment and a portable device to quantify standard tetrahydrocannabinol units for cannabis flower smoking. Addiction 2022; 117:2351-2358. [PMID: 35293047 DOI: 10.1111/add.15872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 02/23/2022] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate the feasibility and validity of a new method of quantifying cannabis flower use, integrating the amount of cannabis flower smoked, and the potency of the cannabis flower. DESIGN Ecological momentary assessment (EMA) for 14 days. SETTING Participants' daily lives in Columbia, Missouri, USA. PARTICIPANTS A total of 50 community participants, who were regular cannabis flower smokers (48% female). MEASUREMENTS Momentary subjective intoxication ratings following cannabis flower smoking; momentary quantity of cannabis flower smoked; potency of cannabis flower smoked in terms of percentage of tetrahydrocannabinol (THC) concentration assessed with a portable device, the Purpl Pro; and time since finished smoking. FINDINGS Participants completed our field testing of their cannabis flower (96.2%) and were compliant with our 2-week EMA protocol (73% for random prompts and 91% for morning reports). Momentary subjective intoxication ratings trended down as a function of time since smoking (r = -0.10, P = 0.004, 95% CI, [-0.17, -0.03]). Multi-level model (MLM) results indicated the momentary standard THC units (mg THC) were positively associated with momentary subjective intoxication ratings (b = 0.01, P = 0.03, 95% CI, [0.01, 0.012]). CONCLUSIONS There is evidence to support the feasibility and initial validity of a new method of quantifying cannabis flower use into standard tetrahydrocannabinol units. Researchers investigating the effects of cannabis flower use on a range of outcomes (e.g. neurobehavioral effects, emotional sequelae, and driving impairment) as well as in clinical treatment trials might adopt this method to provide estimates of cannabis flower use.
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Affiliation(s)
- Timothy J Trull
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Lindsey K Freeman
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Megan N Fleming
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Tayler J Vebares
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Andrea M Wycoff
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
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167
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Cao Y, Jankowska MM, Yang JA, Shi Y. Spatial and temporal pattern of cannabis use disorder in California 2010-2019. Spat Spatiotemporal Epidemiol 2022; 42:100520. [PMID: 35934327 DOI: 10.1016/j.sste.2022.100520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 05/16/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
As cannabis use is being legalized in an increasing number of states, it is important to understand the changing dynamic of the risk in cannabis use disorder (CUD). Shape-based time-series clustering was used to identify ZIP Code Tabulation Areas (ZCTAs) with similar changing pattern in CUD over time. We conducted a cross-sectional logistic regression analysis to investigate the most recent ZCTA socio-demographic characteristics in relation to the changing CUD rates. The emergency discharge rates generally increased during 2010-2016. Increase during 2017-2019 was found in Sacramento and Santa Barbara County. Approximately 13% of ZCTAs showed an increasing trend of hospitalization discharge during 2017-2019. Males and non-Hispanic Black had larger increase than other groups during 2017-2019. The recent growing trend was found associated with greater racial diversity and rural ZCTAs. The findings from this study hold promise for local public health officials to adjust the cannabis intervention strategies in target districts and improve overall health outcomes.
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Affiliation(s)
- Yanjia Cao
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, La Jolla, CA 92093, United States; Population Sciences, Beckman Research Institute, City of Hope, 1500 E Duarte Rd, Duarte, CA 91010, United States; Department of Geography, The University of Hong Kong.
| | - Marta M Jankowska
- Population Sciences, Beckman Research Institute, City of Hope, 1500 E Duarte Rd, Duarte, CA 91010, United States
| | - Jiue-An Yang
- Population Sciences, Beckman Research Institute, City of Hope, 1500 E Duarte Rd, Duarte, CA 91010, United States
| | - Yuyan Shi
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, La Jolla, CA 92093, United States
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168
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Keyes KM, Kreski NT, Ankrum H, Cerdá M, Chen Q, Hasin DS, Martins SS, Olfson M, Miech R. Frequency of adolescent cannabis smoking and vaping in the United States: Trends, disparities and concurrent substance use, 2017-19. Addiction 2022; 117:2316-2324. [PMID: 35588004 PMCID: PMC10037679 DOI: 10.1111/add.15912] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/07/2022] [Indexed: 01/24/2023]
Abstract
AIM To quantify the trends in frequent and occasional cannabis vaping, demographic differences and concurrent nicotine and alcohol use. DESIGN Observational study. Survey-weighted multinomial logistic regression models assessed trends and disparities in past 30-day cannabis use. Trends were assessed overall and by sex, race/ethnicity, parental education and urbanicity. Multinomial logistic regression models also estimated associations of cannabis use (none, use without vaping, use with vaping) with past 2-week binge drinking and past 30-day nicotine/tobacco use. SETTING United States, 2017-19. PARTICIPANTS Participants in the national Monitoring the Future (n = 51 052) survey. MEASUREMENTS Past 30-day frequent cannabis use (six or more times/30 days) and past 30-day occasional use (one to five times/30 days), with and without vaping. FINDINGS Past 30-day frequent cannabis use with vaping and occasional use with vaping rose from 2017 to 2019. Past 30-day frequent and occasional cannabis use without vaping declined. Certain groups, such as Hispanic/Latino or lower socio-economic status adolescents, experienced particularly notable increases in frequent cannabis use with vaping (e.g. prevalence among Hispanic/Latino adolescents). Adolescents who reported smoking and vaping nicotine, and 10+ occasions of binge drinking, were 42.28 [95% confidence interval (CI) = 33.14-53.93] and 10.09 (95% CI = 4.51-22.53) times more likely to report past 30-day cannabis use with vaping, respectively, compared with no use. DISCUSSION Cannabis use without vaping appears to be declining among adolescents in the United States, while cannabis use with vaping is accelerating; frequent cannabis vaping is especially increasing, with consistent increases across almost all adolescent demographic groups. Cannabis use among US adolescents remains highly associated with other substance use.
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Affiliation(s)
- Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Noah T. Kreski
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Hadley Ankrum
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Qixuan Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Deborah S. Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Psychiatry, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Silvia S. Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mark Olfson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Psychiatry, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Richard Miech
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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169
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Montgomery BW, Roberts MH, Margerison CE, Anthony JC. Estimating the effects of legalizing recreational cannabis on newly incident cannabis use. PLoS One 2022; 17:e0271720. [PMID: 35862417 PMCID: PMC9302774 DOI: 10.1371/journal.pone.0271720] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022] Open
Abstract
Liberalized state-level recreational cannabis policies in the United States (US) fostered important policy evaluations with a focus on epidemiological parameters such as proportions [e.g., active cannabis use prevalence; cannabis use disorder (CUD) prevalence]. This cannabis policy evaluation project adds novel evidence on a neglected parameter–namely, estimated occurrence of newly incident cannabis use for underage (<21 years) versus older adults. The project’s study populations were specified to yield nationally representative estimates for all 51 major US jurisdictions, with probability sample totals of 819,543 non-institutionalized US civilian residents between 2008 and 2019. Standardized items to measure cannabis onsets are from audio computer-assisted self-interviews. Policy effect estimates are from event study difference-in-difference (DiD) models that allow for causal inference when policy implementation is staggered. The evidence indicates no policy-associated changes in the occurrence of newly incident cannabis onsets for underage persons, but an increased occurrence of newly onset cannabis use among older adults (i.e., >21 years). We offer a tentative conclusion of public health importance: Legalized cannabis retail sales might be followed by the increased occurrence of cannabis onsets for older adults, but not for underage persons who cannot buy cannabis products in a retail outlet. Cannabis policy research does not yet qualify as a mature science. We argue that modeling newly incident cannabis use might be more informative than the modeling of prevalences when evaluating policy effects and provide evidence of the advantages of the event study model over regression methods that seek to adjust for confounding factors.
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Affiliation(s)
- Barrett Wallace Montgomery
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
- * E-mail:
| | - Meaghan H. Roberts
- Department of Economics, College of Social Science, Michigan State University, East Lansing, MI, United States of America
| | - Claire E. Margerison
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
| | - James C. Anthony
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
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170
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Carnide N, Lee H, Landsman V, Frone MR, Furlan AD, Smith PM. Cannabis use and workplace cannabis availability, perceptions and policies among Canadian workers: a comparison before and after the legalisation of non-medical cannabis. Occup Environ Med 2022; 79:oemed-2022-108316. [PMID: 35851324 PMCID: PMC9685684 DOI: 10.1136/oemed-2022-108316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Little data exist examining the impact of non-medical (recreational) cannabis legalisation among a working population. The objective was to compare cannabis use patterns and workplace risk perceptions, cannabis availability and workplace use policies before and almost 1 year after legalisation in Canadian workers. METHODS Two overlapping cross-sectional samples of Canadian workers were surveyed 4 months before legalisation (time 1 (T1), n=2011) and 9-11 months after legalisation (time 2 (T2), n=4032), gathering information on cannabis use (overall and workplace use), workers' perceptions regarding risks of workplace use, availability of cannabis at work and awareness of workplace substance use policies. The marginal distributions of these variables at T1 and T2 were compared, adjusting for sociodemographic, work and health and lifestyle factors. RESULTS Cannabis use status changed from prelegalisation to postlegalisation (p<0.0001), with fewer respondents reporting former use (ie, more than 1 year ago; 40.4% at T1, 33.0% at T2) and a greater proportion of workers reporting past-year use (30.4% at T1, 39.3% at T2). Never use remained stable (29.2% at T1, 27.6% at T2). Workplace cannabis use also remained stable (9.4% at T1, 9.1% at T2; p=0.4580). At T1, 62.7% of respondents reported being aware of their workplace having a substance use policy, increasing to 79.0% at T2 (p<0.0001). Small magnitude changes occurred in perceptions of risk and workplace availability. CONCLUSIONS Results point to a lack of substantive changes in the short-term from prelegalisation to postlegalisation. Longer-term data among workers are needed given the evolving nature of this legislative policy.
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Affiliation(s)
- Nancy Carnide
- Institute for Work and Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hyunmi Lee
- Institute for Work and Health, Toronto, Ontario, Canada
| | - Victoria Landsman
- Institute for Work and Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael R Frone
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Andrea D Furlan
- Institute for Work and Health, Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter M Smith
- Institute for Work and Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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171
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Fleming CB, Ramirez JJ, Rhew IC, Hultgren BA, Hanson KG, Larimer ME, Dilley JA, Kilmer JR, Guttmannova K. Trends in Alcohol, Cigarette, E-Cigarette, and Nonprescribed Pain Reliever Use Among Young Adults in Washington State After Legalization of Nonmedical Cannabis. J Adolesc Health 2022; 71:47-54. [PMID: 35550333 PMCID: PMC9232986 DOI: 10.1016/j.jadohealth.2022.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Liberalization of cannabis laws may be accompanied by changes in the use of substances other than cannabis and changes in associations of cannabis use with other types of substance use. This study assessed (1) trends in alcohol, nicotine, and nonprescribed pain reliever use and (2) changes in associations of cannabis use with these other substances among young adults in Washington State after nonmedical cannabis legalization. METHODS Regression models stratified by age (18-20 vs. 21-25) were used to analyze six annual waves of cross-sectional survey data from a statewide sample from 2014 through 2019 (N = 12,694). RESULTS Prevalence of past-month alcohol use, heavy episodic drinking (HED), and cigarette use and prevalence of past-year pain reliever misuse decreased, while the prevalence of past-month e-cigarette use increased since 2016 (the first year assessed). Across years and age groups, the prevalence of substance use other than cannabis was higher among occasional and frequent cannabis users compared to cannabis nonusers. However, associations between both occasional (1-19 days in the prior month) and frequent (20+ days) cannabis use and pain reliever misuse and between frequent cannabis use and HED weakened over time among individuals ages 21-25. DISCUSSION Contrary to concerns about spillover effects, implementation of legalized nonmedical cannabis coincided with decreases in alcohol and cigarette use and pain reliever misuse. The weakening association of cannabis use with the use of other substances among individuals ages 21-25 requires further research but may suggest increased importance of cannabis-specific prevention and treatment efforts.
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Affiliation(s)
- Charles B Fleming
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
| | - Jason J Ramirez
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Isaac C Rhew
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Brittney A Hultgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Koren G Hanson
- School of Social Work, University of Washington, Seattle, Washington
| | - Mary E Larimer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Julia A Dilley
- Multnomah County Health Department and Oregon Health Authority Public Health Division, Portland, Oregon
| | - Jason R Kilmer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Katarina Guttmannova
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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172
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Dellazizzo L, Potvin S, Giguère S, Dumais A. Evidence on the acute and residual neurocognitive effects of cannabis use in adolescents and adults: a systematic meta-review of meta-analyses. Addiction 2022; 117:1857-1870. [PMID: 35048456 DOI: 10.1111/add.15764] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cannabis is among the most consumed psychoactive substances world-wide. Considering changing policy trends regarding the substance, it is crucial to understand more clearly its potential acute and residual adverse effects from a public health viewpoint. Cognitive function is one of the targeted areas with conflicting findings. This meta-review measured the magnitude of acute and residual effects of cannabis on cognition in adolescents and adults provided by meta-analyses and evaluated quality of evidence. METHODS A systematic search was performed in PubMed, PsycINFO, Web of Science and Google Scholar. Meta-analyses were included if they quantitatively examined the performances of users from the general population on cognitive tasks. RESULTS The search retrieved 10 eligible meta-analyses (71 effects sizes, n = 43 761) with evidence ranging from low to moderate quality, which were categorized into domains of cognitive functions: executive functions (k = 7), learning and memory (k = 5), attention (k = 4), processing speed (k = 5), perceptual motor function (k = 2) and language (k = 2). Verbal learning and memory displayed the most robust evidence and were most impaired by acute cannabis intoxication that persisted after intoxication passed. Small-to-moderate acute and residual adverse effects were reported for executive functioning. Cannabis use led to small deficits in inhibitory processes and flexibility, whereas small-to-moderate deficits were reported for working memory and decision-making. Evidence regarding processing speed and attention has shown that cannabis administration induced small-to-moderate adverse effects and residual neurocognitive deficits were observed in heavy cannabis-using youths. Results showed no significant difference between cannabis users and non-users on language, and small-to-moderate effects for simple motor skills. CONCLUSION Meta-analytical data on the acute effects of cannabis use on neurocognitive function have shown that cannabis intoxication leads to small to moderate deficits in several cognitive domains. These acute impairments accord with documented residual effects, suggesting that the detrimental effects of cannabis persist beyond acute intake.
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Affiliation(s)
- Laura Dellazizzo
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.,Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Stéphane Potvin
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.,Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Sabrina Giguère
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.,Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Alexandre Dumais
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.,Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada
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173
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Correlates of cannabis use disorder in the United States: A comparison of logistic regression, classification trees, and random forests. J Psychiatr Res 2022; 151:590-597. [PMID: 35636037 DOI: 10.1016/j.jpsychires.2022.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
Although several recent studies have examined psychosocial and demographic correlates of cannabis use disorder (CUD) in adults, few, if any, recent studies have evaluated the performance of machine learning methods relative to standard logistic regression for identifying correlates of CUD. The present study used pooled data from the 2015-2018 National Survey on Drug Use and Health to evaluate psychosocial and demographic correlates of CUD in adults. In addition, we compared the performance of logistic regression, classification trees, and random forest methods in classifying CUD. When comparing the performance of each method on the test data set, classification trees (AUC = 0.84, 95%CI: 0.82, 0.85) and random forest (AUC = 0.83, 95%CI: 0.82, 8.05) performed similarly and superior to logistic regression (AUC = 0.77, 95%CI: 0.74, 0.79). Results of the random forests reveal that marital status, risk propensity, age, and cocaine dependence variables contributed most to node purity, whereas model accuracy would decrease significantly if county type, income, race, and education variables were excluded from the model. One possible approach to improving the efficiency, interpretability, and clinical insights of CUD correlates is the employment of machine learning techniques.
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174
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Wilkins C, Rychert M, Queirolo R, Lenton SR, Kilmer B, Fischer B, Decorte T, Hansen P, Ombler F. Assessing options for cannabis law reform: A Multi-Criteria Decision Analysis (MCDA) with stakeholders in New Zealand. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103712. [DOI: 10.1016/j.drugpo.2022.103712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
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175
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Macario E, Thomas RM. Reasons Washington State Women Use Marijuana During Pregnancy/Breastfeeding, Their Trusted Information Sources, and Communication Strategies for Informed Decision-Making. J Perinat Neonatal Nurs 2022; 36:243-255. [PMID: 35894721 DOI: 10.1097/jpn.0000000000000663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand reproductive-aged women's marijuana use beliefs and attitudes. METHODS Qualitative research (10 focus groups and 2 bulletin boards) with 95 Washington State women, aged 18 to 44 years, segmented by marijuana-using pregnant/breastfeeding; marijuana-using not-pregnant/breastfeeding; and nonmarijuana users. Participants completed up to 10 survey questions. We used deductive and inductive coding to analyze findings. RESULTS Marijuana-using pregnant/breastfeeding participants use marijuana to manage physical/mental pain and because of stigma, feel guilty, and sometimes hide use. Medicines have failed to address symptoms. Participants perceived marijuana safer than alcohol, tobacco, and illicit substances. Participants believed in the legitimacy of marijuana for health maintenance and want others to take their personally experienced benefits seriously. Participants interpreted lack of conclusive research as marijuana use not being unsafe. They want more information. All segments preferred hearing from other women about marijuana use experiences, with the marijuana-using pregnant/breastfeeding segment feeling strongest about this. CONCLUSIONS Personal experiences with, and anecdotes from family/friends about, the effects of marijuana use during pregnancy/breastfeeding influence marijuana-using participants' decision making. NURSING IMPLICATIONS It is important to speak with perinatal patients in a nonjudgmental/nonthreatening manner that acknowledges why reproductive-aged women may use marijuana and that conveys validation of patients' positive experiences with marijuana and a harm-reduction goal.
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Affiliation(s)
- Everly Macario
- Thomas Opinion Research, Chicago, Illinois (Dr Macario); and Thomas Opinion Research, Woodbridge, Virginia (Dr Thomas)
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176
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Nelson EUE. Consumption, not decriminalization: How Nigerian drug dealers/users account for cannabis harms. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103763. [PMID: 35717716 DOI: 10.1016/j.drugpo.2022.103763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Studies have shown that support for cannabis decriminalization and legalization is highest among users, but there is little research on constructions of cannabis decriminalization in the narratives of users who are also dealers. The aim of this study was to explore discursive constructions of cannabis consumption and decriminalization in dealers'/users' accounts of the drug's harms. METHODS A qualitative study was undertaken in which in-depth interviews were conducted with 31 commercially oriented Nigerian men drug dealers who also use drugs. They were recruited through snowball sampling. Data analysis was based on a social constructionist approach to grounded theory, which emphasizes the role of language and discourse in the construction of reality. RESULTS While harms from cannabis use were recognized, these were constructed as being relative to consumption practices and user's ability to manage drug effects. Accounts used different discourses and rhetorical strategies to deconstruct popular views of cannabis as a dangerous drug, including minimizing harms by juxtaposing them with harms from more potent drugs as well as with benefits from use. Harms were, however, amplified in relation to decriminalization to delegitimize the policy approach due to concerns about potential increase in consumption and harms to inexperienced consumers. CONCLUSIONS Constructions of cannabis-related harms in the participants' accounts served discursively to delegitimize cannabis decriminalization, without stigmatizing its use and the users. There exists a need to raise awareness on cannabis decriminalization and legalization as part of measures to bolster support for policy reforms among stakeholder groups (e.g., consumers).
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Affiliation(s)
- Ediomo-Ubong E Nelson
- Global Drug Policy Observatory, Swansea University, United Kingdom; Centre for Research and Information on Substance Abuse, Nigeria.
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177
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Wang LX, Wilson NJ. U.S. State approaches to cannabis licensing. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103755. [PMID: 35691088 DOI: 10.1016/j.drugpo.2022.103755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
U.S. states have taken varied approaches to licensing cannabis businesses under federal prohibition, but up to now there is limited research on cross-state licensing approaches. This paper provides a systematic analysis of the current licensing strategies taken by all states that have passed medical cannabis laws (MCLs)/recreational cannabis laws (RCLs). We construct comprehensive data on cannabis business licenses offered in each state, as well as metrics for license categories, cost, and issuance volume. We then analyze patterns between these metrics, also considering how long ago states implemented MCLs/RCLs, qualitative licensing aspects, state ideology and voting preference, and state cannabis taxation data. We observe that states tend to license medical cannabis more restrictively than adult-use cannabis: i.e., by offering licenses in fewer categories, at higher cost, in lower issuance volume, and more often mandating vertical integration. Additionally, states that implemented MCLs/RCLs earlier tend to offer licenses in more categories, at lower cost, and in greater volumes. Further, though states that implemented MCLs recently lean conservative and Republican, we do not observe clear relationships between ideology or voting preference and licensing policy. In our supporting results, we observe that a greater share of states with complex licensing structures impose non-retail price cannabis taxes than states overall, and we discuss how states have changed their licensing policies over time.
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Affiliation(s)
- Lucy Xiaolu Wang
- Department of Resource Economics, University of Massachusetts Amherst, Amherst MA 01002, United States; Max Planck Institute for Innovation and Competition, Marstallplatz 1, Munich 80539, Germany; Canadian Centre for Health Economics, 155 College Street, Toronto, ON M5T 3M6, Canada.
| | - Nicholas J Wilson
- Max Planck Institute for Innovation and Competition, Marstallplatz 1, Munich 80539, Germany; Department of Economics, Ludwig Maximilian University of Munich, Ludwigstraße 28, Munich 80539, Germany.
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178
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Weinberger AH, Wyka K, Kim JH, Smart R, Mangold M, Schanzer E, Wu M, Goodwin RD. A difference-in-difference approach to examining the impact of cannabis legalization on disparities in the use of cigarettes and cannabis in the United States, 2004-17. Addiction 2022; 117:1768-1777. [PMID: 34985165 DOI: 10.1111/add.15795] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
AIMS To estimate the impact of recreational and medical cannabis laws (RCL, MCL) on the use of cannabis and cigarettes in the United States. DESIGN A difference-in-difference approach was applied to data from the 2004-17 National Survey on Drug Use and Health (NSDUH). SETTING United States. PARTICIPANTS Nationally representative cross-sectional survey of Americans aged 12 years and older (combined analytical sample for 2004-17, n = 783 663). MEASUREMENTS Data on past-month use of (1) cigarettes and (2) cannabis were used to classify respondents into four groups: cigarette and cannabis co-use, cigarette-only use, cannabis-only use or no cigarette or cannabis use. State of residence was measured by self-report. MCL/RCL status came from state government websites. FINDINGS Difference-in-difference analyses suggest that MCL was associated with an increase in cigarette-cannabis co-use overall [adjusted odds ratio (aOR) = 1.09; 95% confidence interval (CI) = 1.02-1.16], with the greatest increases among those aged 50 years and above (aOR = 1.60; CI = 1.39-1.84), married (aOR = 1.19; CI = 1.07-1.31), non-Hispanic (NH) black (aOR = 1.14; CI = 1.02-1.07) and with a college degree or above (aOR = 1.15; CI = 1.06-1.24). MCL was associated with increases in cigarette-only use among those aged 50 years and above (aOR = 1.07; CI = 1.01-1.14) and NH black (aOR = 1.16; CI = 1.06-1.27) and increases in cannabis-only use among those aged 50 years and above (aOR = 1.24; CI = 1.07-1.44) and widowed/divorced/separated (aOR = 1.18; CI = 1.01-1.37). RCL was associated with an increase in cannabis-only use overall (aOR = 1.21; 95% CI = 1.09-1.34), a decline in cigarette-only use overall (aOR = 0.89; 95% CI = 0.81-0.97) and increases in co-use among those who were married (aOR = 1.24; CI = 1.02-1.50) and aged 50 years and above (aOR = 1.37; CI = 1.03-1.84). CONCLUSIONS Recreational and medical cannabis legalization have had a varying impact on the use, and co-use, of cannabis and cigarettes in the United States.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.,Department of Epidemiology and Population Health, Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
| | - June H Kim
- Institute for Implementation Science in Population Health, The City University of New York, New York, NY, USA
| | | | - Michael Mangold
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Ellen Schanzer
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Melody Wu
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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179
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Dawes C, Quinn D, Bickerdike A, O'Neill C, Granger KT, Pereira SC, Mah SL, Haselgrove M, Waddington JL, O'Tuathaigh C, Moran PM. Latent inhibition, aberrant salience, and schizotypy traits in cannabis users. Schizophr Res Cogn 2022; 28:100235. [PMID: 35028297 PMCID: PMC8738960 DOI: 10.1016/j.scog.2021.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Declan Quinn
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Andrea Bickerdike
- Department of Sport, Leisure, and Childhood Studies, Munster Technological University, Bishopstown, Cork, Ireland
| | - Cian O'Neill
- Department of Sport, Leisure, and Childhood Studies, Munster Technological University, Bishopstown, Cork, Ireland
| | - Kiri T Granger
- School of Psychology, University of Nottingham, NG7 2RD, UK
- Monument Therapeutics Ltd, Alderley Park, Congleton Road, Macclesfield SK10 4TG, UK
| | - Sarah Carneiro Pereira
- Psychological Sciences Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Sue Lynn Mah
- School of Psychology, University of Nottingham, NG7 2RD, UK
| | | | - John L Waddington
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, St Stephen's Green, Dublin 2, Ireland
| | - Colm O'Tuathaigh
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Paula M Moran
- School of Psychology, University of Nottingham, NG7 2RD, UK
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Abstract
PURPOSE OF REVIEW In recent years, an increasing number of states have legalized marijuana, also known as cannabis, for recreational use. As marijuana becomes more accessible, adolescent use and accidental pediatric exposures are likely to become broad public health concerns. Edible marijuana products, which are consumable foods or beverages that contain cannabis extract, are particularly enticing to youth, as they come in appealing forms such as candies, cookies, and drinks. The purpose of this review is to provide pediatricians with an overview of the different types and potential dangers associated with edible marijuana products. RECENT FINDINGS Edible marijuana products are often indistinguishable in appearance from normal food items and lack the smell and visible smoke associated with inhaled marijuana. Because they are inconspicuous, palatable, and easily accessible, they are increasingly popular among adolescents. Additionally, the packaging of edible baked goods, candies, and drinks is often purposefully very similar to that of mainstream foods, increasing the risk of accidental ingestion by children. An edible marijuana product must be digested before Δ9-tetrahydrocannabinol can enter the bloodstream, so there is a delayed onset of effects when consuming edibles compared with inhaling marijuana. This also predisposes users to accidental overconsumption. SUMMARY Greater knowledge of edible marijuana product consumption by pediatric populations will allow pediatricians to more effectively help patients and advise caregivers in cases of overconsumption, dependence, or accidental ingestion. It is important for parents, guardians, and educators to be able to successfully identify edible marijuana products and recognize signs of cannabis use.
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181
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Drabble LA, Munroe C, Mericle AA, Zollweg S, Trocki KF, Karriker-Jaffe KJ. Impact of the policy environment on substance use among sexual minority women. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3. [PMID: 35813352 PMCID: PMC9262325 DOI: 10.1016/j.dadr.2022.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Sexual minority women (SMW) are at greater risk for heavy episodic drinking, frequent marijuana use, and tobacco use than heterosexual women. Because past research has suggested the political and social environment may influence disparities in substance use by sexual orientation, this study examined associations of the U.S. state-level policy environment on substance use by SMW. Methods: A total of 732 SMW participants were recruited from two national online panels: a general population panel (n = 333) and a sexual minority-specific panel (n = 399). Past year substance use was defined by number of days of heavy episodic drinking (HED; 4+ drinks in a day), weekly tobacco use (once a week or more vs. less or none), and weekly marijuana use (once a week or more vs. less or none). Comprehensive state policy protection was defined by enactment of five policies protecting rights of sexual minorities. Regression models compared substance use outcomes for SMW living in states with comprehensive policy protections to SMW living in states with fewer or no protections. Models also assessed the impact of state policies related to alcohol (state monopoly on alcohol wholesale or retail sales), tobacco (state enactment of comprehensive smoke-free workplace laws) and marijuana (legalization of purchase, possession, or consumption of marijuana for recreational use). Results: Comprehensive policy protections were associated with fewer HED days. Recreational marijuana legalization was associated with higher odds of weekly use. Conclusions: Findings underscore the importance of policy protections for sexual minorities in reducing substance use, particularly HED, among SMW.
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Affiliation(s)
- Laurie A. Drabble
- San Jose State University College of Health and Human Sciences, San Jose, CA, USA
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
- Corresponding author.
| | - Cat Munroe
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Amy A. Mericle
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | | | - Karen F. Trocki
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
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182
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Lachance A, Bélanger RE, Riva M, Ross NA. A Systematic Review and Narrative Synthesis of the Evolution of Adolescent and Young Adult Cannabis Consumption Before and After Legalization. J Adolesc Health 2022; 70:848-863. [PMID: 35246363 DOI: 10.1016/j.jadohealth.2021.11.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To systematically review evidence assessing the evolution of cannabis consumption before and after the implementation of non-medical cannabis legislation. METHODS MEDLINE, PubMED, PsycINFO, Scopus, and Web of Science were systematically searched for studies that examined change in cannabis consumption before and after nonmedical cannabis legislation. Data were tabulated by study design, levels of consumption, and individual subgroups. Data were analyzed using a narrative synthesis approach, considering study quality. RESULTS 32 studies were included (11 higher quality and 21 lower quality). 40% of higher quality evidence supported an increase in postlegalization consumption (55% did not report a change and 5% reported a decrease). The increase was most evident for young adults (42% of higher quality evidence) and in the consumption in the past month (37% of higher quality evidence). There was limited supporting evidence for new users having grown in response to legalization. Based on subgroup analysis, the increase in postlegalization consumption was higher among women and those who engage in binge-drinking. CONCLUSIONS Higher quality evidence suggests an increase in adolescent past-month consumption of cannabis following legalization in several geographical jurisdictions. Consumption evolution prelegalization and postlegalization differed by age group and for young women and for binge drinkers. Consumption evolution differences suggest a variety of strategies might be required in efforts to lower public health impacts of cannabis consumption following legalization.
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Affiliation(s)
- Antoine Lachance
- Department of Geography, McGill University, Montreal, Quebec, Canada; Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada
| | - Richard E Bélanger
- Department of Pediatrics, Université Laval, Quebec city, Quebec, Canada; CHU de Quebec Research Center - Université Laval, Quebec city, Quebec, Canada.
| | - Mylène Riva
- Department of Geography, McGill University, Montreal, Quebec, Canada; Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada
| | - Nancy A Ross
- Department of Geography, McGill University, Montreal, Quebec, Canada
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183
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Cabral Barata P, Ferreira F, Oliveira C. Non-medical cannabis use: international policies and outcomes overview. An outline for Portugal. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2022; 44:e20210239. [PMID: 34898143 PMCID: PMC9490937 DOI: 10.47626/2237-6089-2021-0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/20/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Cannabis is probably the most commonly used illicit drug. It is often regarded as a relatively nonharmful experience, even though evidence indicates otherwise. Legalization of non-medical cannabis, which has already taken place in several countries, is currently a controversial issue. OBJECTIVE To provide an up-to-date overview of current models and policies and their outcomes that can inform future political decisions regarding non-medical cannabis use. METHODS PubMed/MEDLINE and Google Scholar scientific databases were searched for articles written in English, Spanish, and Portuguese published between 1990 and December 2020. The reference lists of these articles were similarly used as bibliography sources. Gray literature was also included. RESULTS While non-medical cannabis has been decriminalized in many countries, it has only been legalized in Uruguay, Canada, and some U.S. states. Several benefits of legalization were identified: decreases in cannabis-related crimes, law-enforcement and judicial costs; reduction in synthetic cannabis supply; decline in black economies and possible diminution of other illegal drug buying; and tax revenue increases. Reported legalization problems included: increases in cannabis use; cannabis-related disorders; and cannabis-related accidents and hospitalizations. Harm-reduction strategies are available in the scientific literature. CONCLUSION Growing, although incomplete, evidence exists to guide policy makers, minimize cannabis-related harm, and positively contribute to public health, if the legalization path is to be followed. Dialogue between legislators and science should be encouraged. There are more than a few legalization pathways, with diverse economic, social and health wellbeing effects. Public health-driven, instead of profit-driven models, seem to offer the most benefits regarding non-medical cannabis legalization. Most of the true public health effects of cannabis legalization are still unknown, for we are still in the early stages of these policies and their implications. Future studies should address the medium-to-long-term social, economic, and health consequences of legalization policies.
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Affiliation(s)
- Pedro Cabral Barata
- Regionspsykiatrien VestHerningDenmarkRegionspsykiatrien Vest, Herning, Denmark.
| | - Filipa Ferreira
- Departamento de Psiquiatria e Saúde MentalHospital Prof. Dr. Fernando FonsecaAmadoraPortugalDepartamento de Psiquiatria e Saúde Mental, Hospital Prof. Dr. Fernando Fonseca, Amadora, Portugal.
| | - Catarina Oliveira
- Departamento de Psiquiatria e Saúde MentalUnidade Local de Saúde de Castelo BrancoCastelo BrancoPortugalDepartamento de Psiquiatria e Saúde Mental, Unidade Local de Saúde de Castelo Branco, Castelo Branco, Portugal.
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184
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Klein RJ, Gyorda JA, Jacobson NC. Anxiety, depression, and substance experimentation in childhood. PLoS One 2022; 17:e0265239. [PMID: 35609016 PMCID: PMC9129013 DOI: 10.1371/journal.pone.0265239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
Previous research has demonstrated that adults with comorbid depressive and anxiety disorders are significantly more likely to show pathological use of drugs or alcohol. Few studies, however, have examined associations of this type in children. A better understanding of the relationships between affective disorders and substance experimentation in childhood could help clarify the complex ways in which pathological substance use symptoms develop early in life. The present study included 11,785 children (Mage = 9.9) participating in the Adolescent Brain Cognitive Development (ABCD) study. Depressive and anxiety disorder diagnoses were evaluated as concurrent predictors of experimentation with alcohol and tobacco. A series of linear regressions revealed that children with either depressive or anxiety disorders were significantly more likely to experiment with alcohol or tobacco. However, children with both depressive and anxiety diagnoses were not more likely to experiment than children without a diagnosis. These results suggest that anxiety or depressive diagnoses in childhood may be associated with a greater likelihood of substance experimentation, but severe psychological distress may suppress these effects.
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Affiliation(s)
- Robert J. Klein
- Geisel School of Medicine at Dartmouth College, Hanover, NH, United States of America
| | - Joseph A. Gyorda
- Geisel School of Medicine at Dartmouth College, Hanover, NH, United States of America
| | - Nicholas C. Jacobson
- Geisel School of Medicine at Dartmouth College, Hanover, NH, United States of America
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185
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Twenty Years of Addiction and Mental Illness in Alaska: Using the National Survey on Drug Use and Health to Understand Addiction in a Low Population and Rural State. J Community Health 2022; 47:680-686. [PMID: 35567711 DOI: 10.1007/s10900-022-01098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
Understanding changes in substance use in a small population state is challenging. Many national datasets restrict data to reduce the probability of identifying persons. Alaska is a small population state (731,000 residents) with a large geographic region (25% the size of the lower 48), a diverse population, and highly variable seasons, with fewer than 10% of the state being road accessible. Given the uniqueness of Alaska, this project sought to understand what could be learned about addiction and its relationships with unemployment and median income in Alaska. National Survey on Drug Use and Health, State and Small Area Estimates (1999-2020) data were analyzed to measure prevalence changes. Outcome prevalence were independently correlated with median income and annual unemployment rate as the annual collection periods varied. Analyses were limited to simple bivariate analyses due to the data restrictions. Median income was found to have stronger correlational relationships and significant relationships with more negative outcomes compared to unemployment. While annual unemployment rates had statistically significant relationships with substance use outcomes, negative mental health outcomes appeared more related to unemployment than median income. Alcohol use in the past month, cigarette and tobacco use, and pain reliever misuse declined while binge drinking in the past month and illicit drug use increased. More people reported depression, serious mental illness, and suicidal ideation and planning over time peaking in the last year of data collection. While NSDUH data provide some idea of the changes in drug use over time, their effectiveness in Alaska is unknown. Many data sources claim they are nationally representative, but these statements cannot be objectively measured. We will use these outcomes and data as a baseline for future studies where we will explore state specific data sources.
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186
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Wei TT, Chandy M, Nishiga M, Zhang A, Kumar KK, Thomas D, Manhas A, Rhee S, Justesen JM, Chen IY, Wo HT, Khanamiri S, Yang JY, Seidl FJ, Burns NZ, Liu C, Sayed N, Shie JJ, Yeh CF, Yang KC, Lau E, Lynch KL, Rivas M, Kobilka BK, Wu JC. Cannabinoid receptor 1 antagonist genistein attenuates marijuana-induced vascular inflammation. Cell 2022; 185:1676-1693.e23. [PMID: 35489334 PMCID: PMC9400797 DOI: 10.1016/j.cell.2022.04.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 02/01/2022] [Accepted: 04/04/2022] [Indexed: 12/16/2022]
Abstract
Epidemiological studies reveal that marijuana increases the risk of cardiovascular disease (CVD); however, little is known about the mechanism. Δ9-tetrahydrocannabinol (Δ9-THC), the psychoactive component of marijuana, binds to cannabinoid receptor 1 (CB1/CNR1) in the vasculature and is implicated in CVD. A UK Biobank analysis found that cannabis was an risk factor for CVD. We found that marijuana smoking activated inflammatory cytokines implicated in CVD. In silico virtual screening identified genistein, a soybean isoflavone, as a putative CB1 antagonist. Human-induced pluripotent stem cell-derived endothelial cells were used to model Δ9-THC-induced inflammation and oxidative stress via NF-κB signaling. Knockdown of the CB1 receptor with siRNA, CRISPR interference, and genistein attenuated the effects of Δ9-THC. In mice, genistein blocked Δ9-THC-induced endothelial dysfunction in wire myograph, reduced atherosclerotic plaque, and had minimal penetration of the central nervous system. Genistein is a CB1 antagonist that attenuates Δ9-THC-induced atherosclerosis.
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Affiliation(s)
- Tzu-Tang Wei
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305, USA; Department and Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan; Chemical Biology and Molecular Biophysics, Taiwan International Graduate Program in Chemical Biology and Molecular Biophysics (TIGP-CBMB), Academia Sinica, Taipei, Taiwan
| | - Mark Chandy
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305, USA; Greenstone Biosciences, Palo Alto, CA 94304, USA
| | - Masataka Nishiga
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305, USA
| | - Angela Zhang
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305, USA
| | - Kaavya Krishna Kumar
- Department of Molecular and Cellular Physiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Dilip Thomas
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305, USA
| | - Amit Manhas
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305, USA
| | - Siyeon Rhee
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305, USA; Greenstone Biosciences, Palo Alto, CA 94304, USA
| | - Johanne Marie Justesen
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA 94305, USA; Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Ian Y Chen
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305, USA
| | - Hung-Ta Wo
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305, USA; Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Saereh Khanamiri
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305, USA
| | - Johnson Y Yang
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305, USA
| | | | - Noah Z Burns
- Department of Chemistry, Stanford University, Stanford, CA, USA
| | - Chun Liu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305, USA
| | - Nazish Sayed
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305, USA
| | - Jiun-Jie Shie
- Institute of Chemistry, Academia Sinica, Taipei, Taiwan
| | - Chih-Fan Yeh
- Department and Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kai-Chien Yang
- Department and Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Edward Lau
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Manuel Rivas
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Brian K Kobilka
- Department of Molecular and Cellular Physiology, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305, USA; Greenstone Biosciences, Palo Alto, CA 94304, USA.
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187
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Padwa H, Huang D, Mooney L, Grella CE, Urada D, Bell DS, Bass B, Boustead AE. Medical conditions of primary care patients with documented cannabis use and cannabis use disorder in electronic health records: a case control study from an academic health system in a medical marijuana state. Subst Abuse Treat Prev Policy 2022; 17:36. [PMID: 35527269 PMCID: PMC9080201 DOI: 10.1186/s13011-022-00467-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Approximately 3.8% of adults worldwide have used cannabis in the past year. Understanding how cannabis use is associated with other health conditions is crucial for healthcare providers seeking to understand the needs of their patients, and for health policymakers. This paper analyzes the relationship between documented cannabis use disorders (CUD), cannabis use (CU) and other health diagnoses among primary care patients during a time when medical use of marijuana was permitted by state law in California, United States of America. METHODS The study utilized primary care electronic health record (EHR) data from an academic health system, using a case-control design to compare diagnoses among individuals with CUD/CU to those of matched controls, and those of individuals with CUD diagnoses with individuals who had CU otherwise documented. Associations of documented CU and CUD with general medical conditions and health conditions associated with cannabis use (both medical and behavioral) were analyzed using conditional logistic regression. RESULTS Of 1,047,463 patients with ambulatory encounters from 2013-2017, 729 (0.06%) had CUD diagnoses and 3,731 (0.36%) had CU documented in their EHR. Patients with documented CUD and CU patients had significantly (p < 0.01) higher odds of most medical and behavioral diagnoses analyzed. Compared to matched controls, CUD-documented patients had highest odds of other substance use disorders (OR = 21.44: 95% CI 9.43-48.73), any mental health disorder (OR = 6.99; 95% CI 5.03-9.70) social anxiety disorder (OR = 13.03; 95% CI 2.18-77.94), HIV/AIDS (OR = 7.88: 95% CI 2.58-24.08), post-traumatic stress disorder (OR = 7.74: 95% CI 2.66-22.51); depression (OR = 7.01: 95% CI 4,79-10.27), and bipolar disorder (OR = 6.49: 95% CI 2.90-14.52). Compared to matched controls, CU-documented patients had highest odds of other substance use disorders (OR = 3.64; 95% CI 2.53-5.25) and post-traumatic stress disorder (OR = 3.41; 95% CI 2.53-5.25). CUD-documented patients were significantly more likely than CU-documented patients to have HIV/AIDS (OR = 6.70; 95% CI 2.10-21.39), other substance use disorder (OR = 5.88; 95% CI 2.42-14.22), depression (OR = 2.85; 95% CI 1.90-4.26), and anxiety (OR = 2.19: 95% CI 1.57-3.05) diagnoses. CONCLUSION The prevalence of CUD and CU notation in EHR data from an academic health system was low, highlighting the need for improved screening in primary care. CUD and CU documentation were associated with increased risk for many health conditions, with the most elevated risk for behavioral health disorders and HIV/AIDS (among CUD-documented, but not CU-documented patients). Given the strong associations of CUD and CU documentation with health problems, it is important for healthcare providers to be prepared to identify CU and CUD, discuss the pros and cons of cannabis use with patients thoughtfully and empathically, and address cannabis-related comorbidities among these patients.
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Affiliation(s)
- Howard Padwa
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA.
| | - David Huang
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Larissa Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Christine E Grella
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Darren Urada
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Douglas S Bell
- Division of General Internal Medicine, Department of Medicine, University of California, Los Angeles, USA
- Clinical and Translational Science Institute, University of California, Los Angeles, USA
| | - Brittany Bass
- Department of Psychiatry and Biobehavioral Sciences, University of California, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA
| | - Anne E Boustead
- School of Government & Public Policy, University of Arizona, Tucson, USA
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188
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Firth CL, Carlini B, Dilley J, Guttmannova K, Hajat A. Retail cannabis environment and adolescent use: The role of advertising and retailers near home and school. Health Place 2022; 75:102795. [PMID: 35344691 PMCID: PMC9189000 DOI: 10.1016/j.healthplace.2022.102795] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 02/06/2023]
Abstract
Youth cannabis use is influenced by overlapping environmental contexts. We examined the associations between proximity to cannabis retailers and seeing cannabis advertisements and cannabis use behaviors in Oregon, a state with adult cannabis legalization. We used 2017 anonymous survey data from 24,154 Oregon 8th and 11th grade students. After adjustments for student and school district characteristics, advertising for 8th graders and presence of a retailer within a mile from school for 11th graders were associated with cannabis use and perceived harm. Additional policy efforts may further reduce youth exposure to cannabis.
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Affiliation(s)
- Caislin L Firth
- Addictions, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA; Program Design & Evaluation Services, Multnomah County Health Department & Oregon Public Health Division, Portland, OR, USA.
| | - Beatriz Carlini
- Addictions, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA.
| | - Julia Dilley
- Program Design & Evaluation Services, Multnomah County Health Department & Oregon Public Health Division, Portland, OR, USA.
| | - Katarina Guttmannova
- Center for the Study of Health and Risk Behaviors, University of Washington, Seattle, WA, USA.
| | - Anjum Hajat
- Epidemiology Department, University of Washington, Seattle, WA, USA.
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189
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Jordan A, Sherazi A, Flewelling AJ, Northrup V, Naseemuddin A, Shea JL. Identification of cannabinoids in post-mortem blood samples from the province of New Brunswick before and after recreational cannabis legalization. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103629. [DOI: 10.1016/j.drugpo.2022.103629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
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190
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The Liberalization of Cannabis Possession Laws and Birth Outcomes: A State-Level Fixed Effects Analysis, 2003–2019. POPULATION RESEARCH AND POLICY REVIEW 2022. [DOI: 10.1007/s11113-022-09714-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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191
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Duan Z, Wang Y, Weaver SR, Spears CA, Zheng P, Self-Brown SR, Eriksen MP, Huang J. Effect modification of legalizing recreational cannabis use on the association between e-cigarette use and future cannabis use among US adolescents. Drug Alcohol Depend 2022; 233:109260. [PMID: 35152099 PMCID: PMC8957562 DOI: 10.1016/j.drugalcdep.2021.109260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many states have legalized recreational cannabis use for adults. However, no study has examined how this policy may interact with youth vaping to influence cannabis use among US adolescents. This study investigates whether the association between baseline e-cigarette use and subsequent cannabis use differs by state recreational cannabis legalization status. METHODS This study analyzed data from the first four waves (2013-2018) of the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal survey. The study sample included adolescents (aged 12-17) who reported never used cannabis at baseline. Generalized estimating equations were used to analyze the effect modification of state recreational cannabis law on the association between baseline e-cigarette use and cannabis use at 12-month follow-up, controlling for individual characteristics. RESULTS Among adolescents who have never used cannabis at baseline, baseline past-30-day e-cigarette use was significantly associated with past-30-day cannabis use at 12-month follow-up (aOR=5.92, 95% CI: 3.52-9.95). This association was different by state recreational cannabis legalization status, as indicated by the significant interaction term. Subgroup analysis showed that the aOR was 18.39 (95% CI: 4.25-79.68) for adolescents living in states that legalized adult recreational cannabis use and 5.09 (95% CI: 2.86-9.07) for adolescents living in states without such laws. CONCLUSIONS E-cigarette use is associated with cannabis initiation among youth. This association is stronger among those living in states that legalized adult recreational cannabis use. Further examination of the impact of e-cigarette use on cannabis initiation in relation to state cannabis laws is warranted.
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Affiliation(s)
- Zongshuan Duan
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
| | - Yu Wang
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Scott R. Weaver
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Claire A. Spears
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Pinpin Zheng
- School of Public Health, Fudan University, Shanghai 200433, China
| | | | - Michael P. Eriksen
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Jidong Huang
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA.
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192
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Chaffee BW. National Surveillance of Youth Substance Use: Keeping Up With Changing Times. Am J Public Health 2022; 112:564-566. [PMID: 35319923 PMCID: PMC8961856 DOI: 10.2105/ajph.2022.306716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Benjamin W Chaffee
- Benjamin W. Chaffee is with the Center for Tobacco Control Research and Education, University of California, San Francisco
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193
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Kilmer JR, Rhew IC, Guttmannova K, Fleming CB, Hultgren BA, Gilson MS, Cooper RL, Dilley J, Larimer ME. Cannabis Use Among Young Adults in Washington State After Legalization of Nonmedical Cannabis. Am J Public Health 2022; 112:638-645. [PMID: 35319936 PMCID: PMC8961820 DOI: 10.2105/ajph.2021.306641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To examine changes in prevalence of cannabis use and of cannabis use disorder symptomatology among young adults from 2014 to 2019 in Washington State, where nonmedical (or "recreational") cannabis was legalized in 2012 and retail stores opened in July 2014. Methods. We used 6 years of cross-sectional data collected annually from 2014 (premarket opening) to 2019 from 12 963 (∼2000 per year) young adults aged 18 to 25 years residing in Washington. Logistic regression models estimated yearly change in prevalence of cannabis use at different margins and related outcomes. Results. Prevalence of past-year, at least monthly, at least weekly, and daily use of cannabis increased for young adults, although increases were driven by changes among those aged 21 to 25 years. There was also a statistically significant increase in prevalence of endorsing at least 2 of 5 possible symptoms associated with cannabis use disorder. Conclusions. Among young adults in Washington, particularly those of legal age, prevalences of cannabis use and cannabis use disorder symptomatology have increased since legalization. This trend may require continued monitoring as the nonmedical cannabis market continues to evolve. (Am J Public Health. 2022;112(4):638-645. https://doi.org/10.2105/AJPH.2021.306641).
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Affiliation(s)
- Jason R Kilmer
- Jason R. Kilmer, Isaac C. Rhew, Katarina Guttmannova, Charles B. Fleming, Brittney A. Hultgren, Michael S. Gilson, Rachel L. Cooper, and Mary E. Larimer are with the Center for the Study of Health & Risk Behaviors, Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle. Julia Dilley is with Program Design and Evaluation Services, Multnomah County Health Department and Oregon Health Authority Division of Public Health, Portland
| | - Isaac C Rhew
- Jason R. Kilmer, Isaac C. Rhew, Katarina Guttmannova, Charles B. Fleming, Brittney A. Hultgren, Michael S. Gilson, Rachel L. Cooper, and Mary E. Larimer are with the Center for the Study of Health & Risk Behaviors, Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle. Julia Dilley is with Program Design and Evaluation Services, Multnomah County Health Department and Oregon Health Authority Division of Public Health, Portland
| | - Katarina Guttmannova
- Jason R. Kilmer, Isaac C. Rhew, Katarina Guttmannova, Charles B. Fleming, Brittney A. Hultgren, Michael S. Gilson, Rachel L. Cooper, and Mary E. Larimer are with the Center for the Study of Health & Risk Behaviors, Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle. Julia Dilley is with Program Design and Evaluation Services, Multnomah County Health Department and Oregon Health Authority Division of Public Health, Portland
| | - Charles B Fleming
- Jason R. Kilmer, Isaac C. Rhew, Katarina Guttmannova, Charles B. Fleming, Brittney A. Hultgren, Michael S. Gilson, Rachel L. Cooper, and Mary E. Larimer are with the Center for the Study of Health & Risk Behaviors, Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle. Julia Dilley is with Program Design and Evaluation Services, Multnomah County Health Department and Oregon Health Authority Division of Public Health, Portland
| | - Brittney A Hultgren
- Jason R. Kilmer, Isaac C. Rhew, Katarina Guttmannova, Charles B. Fleming, Brittney A. Hultgren, Michael S. Gilson, Rachel L. Cooper, and Mary E. Larimer are with the Center for the Study of Health & Risk Behaviors, Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle. Julia Dilley is with Program Design and Evaluation Services, Multnomah County Health Department and Oregon Health Authority Division of Public Health, Portland
| | - Michael S Gilson
- Jason R. Kilmer, Isaac C. Rhew, Katarina Guttmannova, Charles B. Fleming, Brittney A. Hultgren, Michael S. Gilson, Rachel L. Cooper, and Mary E. Larimer are with the Center for the Study of Health & Risk Behaviors, Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle. Julia Dilley is with Program Design and Evaluation Services, Multnomah County Health Department and Oregon Health Authority Division of Public Health, Portland
| | - Rachel L Cooper
- Jason R. Kilmer, Isaac C. Rhew, Katarina Guttmannova, Charles B. Fleming, Brittney A. Hultgren, Michael S. Gilson, Rachel L. Cooper, and Mary E. Larimer are with the Center for the Study of Health & Risk Behaviors, Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle. Julia Dilley is with Program Design and Evaluation Services, Multnomah County Health Department and Oregon Health Authority Division of Public Health, Portland
| | - Julia Dilley
- Jason R. Kilmer, Isaac C. Rhew, Katarina Guttmannova, Charles B. Fleming, Brittney A. Hultgren, Michael S. Gilson, Rachel L. Cooper, and Mary E. Larimer are with the Center for the Study of Health & Risk Behaviors, Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle. Julia Dilley is with Program Design and Evaluation Services, Multnomah County Health Department and Oregon Health Authority Division of Public Health, Portland
| | - Mary E Larimer
- Jason R. Kilmer, Isaac C. Rhew, Katarina Guttmannova, Charles B. Fleming, Brittney A. Hultgren, Michael S. Gilson, Rachel L. Cooper, and Mary E. Larimer are with the Center for the Study of Health & Risk Behaviors, Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle. Julia Dilley is with Program Design and Evaluation Services, Multnomah County Health Department and Oregon Health Authority Division of Public Health, Portland
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194
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The Association of Cannabis Use Disorder and Perioperative Complications After Primary Total Knee Arthroplasty. J Am Acad Orthop Surg 2022; 30:313-320. [PMID: 35171881 DOI: 10.5435/jaaos-d-21-00703] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/09/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Although studies have shown the implications of substance use on total joint arthroplasty, studies investigating the association of patients exclusively who have cannabis use disorder (CUD) after primary total knee arthroplasty (TKA) are sparse. As such, this study analyzed a private payor database to assess the relationship of CUD after primary TKA. METHODS Data from the Mariner data set were used to identify patients who have CUD undergoing primary TKA. Patients with CUD were ratio matched 1:5 to a comparison population by age, sex, and comorbidities, yielding 55,553 patients in the study (n = 9,260) and case-matched (n = 46,293) population. Variables compared included in-hospital length of stay, complications, and costs. A P value of less than 0.003 was considered statistically significant. RESULTS Patients with CUD were found to have longer in-hospital length of stay (3.61 versus 2.07 days, P < 0.0001), in addition to higher frequency and odds ratio (OR) of medical (28.08 versus 12.5; OR, 1.50, P < 0.0001) and prostheses-related complications (9.63 versus 5.16%; OR, 1.56, P < 0.0001). Patients with CUD also incurred significantly higher episode of care costs ($29,025.34 versus $24,258.17, P < 0.0001). CONCLUSION With the continued legalization of cannabis use across the United States, studies investigating the association of cannabis on outcomes after primary TKA are limited. The current study helps to expand the current literature on outcomes of substance abuse after total joint arthroplasty and can serve to help educate patients of potential complications after their TKA.
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Kumar N, Janmohamed K, Nyhan K, Martins SS, Cerda M, Hasin D, Scott J, Sarpong Frimpong A, Pates R, Ghandour LA, Wazaify M, Khoshnood K. Substance, use in relation to COVID-19: A scoping review. Addict Behav 2022; 127:107213. [PMID: 34959077 PMCID: PMC8684053 DOI: 10.1016/j.addbeh.2021.107213] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/24/2021] [Accepted: 12/11/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND We conducted a scoping review focused on various forms of substance use amid the pandemic, looking at both the impact of substance use on COVID-19 infection, severity, and vaccine uptake, as well as the impact that COVID-19 has had on substance use treatment and rates. METHODS A scoping review, compiling both peer-reviewed and grey literature, focusing on substance use and COVID-19 was conducted on September 15, 2020 and again in April 15, 2021 to capture any new studies. Three bibliographic databases (Web of Science Core Collection, Embase, PubMed) and several preprint servers (EuropePMC, bioRxiv, medRxiv, F1000, PeerJ Preprints, PsyArXiv, Research Square) were searched. We included English language original studies only. RESULTS Of 1564 articles screened in the abstract and title screening phase, we included 111 research studies (peer-reviewed: 98, grey literature: 13) that met inclusion criteria. There was limited research on substance use other than those involving tobacco or alcohol. We noted that individuals engaging in substance use had increased risk for COVID-19 severity, and Black Americans with COVID-19 and who engaged in substance use had worse outcomes than white Americans. There were issues with treatment provision earlier in the pandemic, but increased use of telehealth as the pandemic progressed. COVID-19 anxiety was associated with increased substance use. CONCLUSIONS Our scoping review of studies to date during COVID-19 uncovered notable research gaps namely the need for research efforts on vaccines, COVID-19 concerns such as anxiety and worry, and low- to middle-income countries (LMICs) and under-researched topics within substance use, and to explore the use of qualitative techniques and interventions where appropriate. We also noted that clinicians can screen and treat individuals exhibiting substance use to mitigate effects of the pandemic. FUNDING Study was funded by the Institution for Social and Policy Studies, Yale University and The Horowitz Foundation for Social Policy. DH was funded by a NIDA grant (R01DA048860). The funding body had no role in the design, analysis, or interpretation of the data in the study.
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Affiliation(s)
- Navin Kumar
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT, USA.
| | | | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Magdalena Cerda
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Deborah Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jenny Scott
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | | | - Richard Pates
- Institute of Health and Society, University of Worcester, Worcester, UK
| | - Lilian A Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Mayyada Wazaify
- Department of Biopharmaceuticals and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, Jordan
| | - Kaveh Khoshnood
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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196
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Cannabis Use Disorder in the Setting of Primary Total Hip Arthroplasty: Understanding the Epidemiology, Demographic Characteristics, and Inpatient Postoperative Outcomes. J Am Acad Orthop Surg 2022; 30:321-328. [PMID: 35213453 DOI: 10.5435/jaaos-d-21-00976] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/21/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Cannabis use is expected to increase in the context of its decriminalization and legalization in several states. The purpose of this study was to report on the epidemiologic and demographic characteristics and inpatient postoperative outcomes of patients with cannabis use disorder (CUD) undergoing primary total hip arthroplasty (THA). METHODS The National Inpatient Sample registry was used to identify patients undergoing THA between 2006 and 2015. Patients were stratified into groups with and without CUD. Epidemiology, comorbidity, and outcomes data were comparatively analyzed between these two groups. RESULTS A total of 2,838,742 THAs were performed during the study period. The prevalence of CUD significantly increased from 0.10% in 2006 to 0.39% in 2015 (P < 0.0001). Patients with CUD were significantly younger, more likely to be male, had higher rates of Medicaid insurance and were more likely to be non-Hispanic Black and less likely to be non-Hispanic White when compared with the control group. When comparing patients with and without CUD, there was no significant difference in the composite any complication variable and no significant difference in seven of eight individual in-hospital complications assessed, with the exception being higher genitourinary complications in the CUD group. There were no significant differences in discharge disposition or length of stay. DISCUSSION Although CUD is significantly associated with various demographic, comorbidity, and hospital characteristics, it is not significantly associated with in-hospital complications, discharge disposition, and length of stay outcomes in the immediate in-hospital, postoperative period. It is critical for clinicians and public health professionals to understand the characteristics and expected inpatient outcomes of this evolving population of patients with CUD undergoing THA, particularly in the context of widespread legalization. LEVEL OF EVIDENCE Level III.
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197
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Rotering T, Apollonio DE. Cannabis industry lobbying in the Colorado state legislature in fiscal years 2010-2021. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103585. [PMID: 35085854 PMCID: PMC9632648 DOI: 10.1016/j.drugpo.2022.103585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The cannabis industry has an interest in creating a regulatory environment which maximizes profits at the cost of public health, similar to the tobacco, alcohol, and food industries. This study sought to describe the cannabis industry's lobbying activities in the Colorado State Legislature over time. METHODS This retrospective observational study analyzed publicly available lobbying expenditures data from fiscal years (FY) 2010-2021. Measures included inflation-adjusted monthly lobbying expenditures by funder and lobbyist, origin of funding, and lobbyist descriptions of cannabis industry clients. This dataset was supplemented with business license documentation, legislative histories, and public testimony. RESULTS The cannabis industry spent over $7 million (inflation adjusted) from FY 2010-2021 to lobby the Colorado legislature on 367 bills. Over $800,000 (11% of total cannabis spending) was from out-of-state clients. In 48% of lobbyist reports lobbyists did not disclose their funder's cannabis affiliation, and cannabis organizations used strategies that may have obscured the true amount and source of funding. Lobbyists and agencies concurrently represented the alcohol, tobacco, and cannabis industries, possibly facilitating inter-industry alliances when interests align. CONCLUSION The cannabis industry dedicated significant resources towards lobbying the Colorado State Legislature on behalf of policies intended to increase cannabis use. Creating transparency about the relationships between the cannabis industry, related industries, and policymakers is essential to ensure appropriate regulation of cannabis products.
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Affiliation(s)
- Thomas Rotering
- Department of Clinical Pharmacy, University of California, UCSF Clinical Sciences Box 0622, 521 Parnassus Avenue, Floor 3 Room 3303, San Francisco, CA 94143, USA
| | - Dorie E Apollonio
- Department of Clinical Pharmacy, University of California, UCSF Clinical Sciences Box 0622, 521 Parnassus Avenue, Floor 3 Room 3303, San Francisco, CA 94143, USA.
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198
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Walia P, Ghosh A, Singh S, Dutta A. Portable Neuroimaging-Guided Noninvasive Brain Stimulation of the Cortico-Cerebello-Thalamo-Cortical Loop—Hypothesis and Theory in Cannabis Use Disorder. Brain Sci 2022; 12:brainsci12040445. [PMID: 35447977 PMCID: PMC9027826 DOI: 10.3390/brainsci12040445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/06/2022] [Accepted: 03/22/2022] [Indexed: 12/22/2022] Open
Abstract
Background: Maladaptive neuroplasticity-related learned response in substance use disorder (SUD) can be ameliorated using noninvasive brain stimulation (NIBS); however, inter-individual variability needs to be addressed for clinical translation. Objective: Our first objective was to develop a hypothesis for NIBS for learned response in SUD based on a competing neurobehavioral decision systems model. The next objective was to develop the theory by conducting a computational simulation of NIBS of the cortico-cerebello-thalamo-cortical (CCTC) loop in cannabis use disorder (CUD)-related dysfunctional “cue-reactivity”—a construct closely related to “craving”—that is a core symptom. Our third objective was to test the feasibility of a neuroimaging-guided rational NIBS approach in healthy humans. Methods: “Cue-reactivity” can be measured using behavioral paradigms and portable neuroimaging, including functional near-infrared spectroscopy (fNIRS) and electroencephalogram (EEG) metrics of sensorimotor gating. Therefore, we conducted a computational simulation of NIBS, including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) of the cerebellar cortex and deep cerebellar nuclei (DCN) of the CCTC loop for its postulated effects on fNIRS and EEG metrics. We also developed a rational neuroimaging-guided NIBS approach for the cerebellar lobule (VII) and prefrontal cortex based on a healthy human study. Results: Simulation of cerebellar tDCS induced gamma oscillations in the cerebral cortex, while transcranial temporal interference stimulation induced a gamma-to-beta frequency shift. A preliminary healthy human study (N = 10) found that 2 mA cerebellar tDCS evoked similar oxyhemoglobin (HbO) response in the range of 5 × 10−6 M across the cerebellum and PFC brain regions (α = 0.01); however, infra-slow (0.01–0.10 Hz) prefrontal cortex HbO-driven phase–amplitude-coupled (PAC; 4 Hz, ±2 mA (max)) cerebellar tACS evoked HbO levels in the range of 10−7 M that were statistically different (α = 0.01) across these brain regions. Conclusion: Our healthy human study showed the feasibility of fNIRS of cerebellum and PFC and closed-loop fNIRS-driven ctACS at 4 Hz, which may facilitate cerebellar cognitive function via the frontoparietal network. Future work needs to combine fNIRS with EEG for multi-modal imaging for closed-loop NIBS during operant conditioning.
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Affiliation(s)
- Pushpinder Walia
- Neuroengineering and Informatics for Rehabilitation Laboratory, University at Buffalo, Buffalo, NY 14228, USA;
| | - Abhishek Ghosh
- Postgraduate Institute of Medical Education & Research, Chandigarh 700020, India; (A.G.); (S.S.)
| | - Shubhmohan Singh
- Postgraduate Institute of Medical Education & Research, Chandigarh 700020, India; (A.G.); (S.S.)
| | - Anirban Dutta
- Neuroengineering and Informatics for Rehabilitation Laboratory, University at Buffalo, Buffalo, NY 14228, USA;
- Correspondence:
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Kendzor DE, Ehlke SJ, Kharazi Boozary L, Smith MA, Cohn AM. Characteristics of adults with a medical cannabis license, reasons for use, and perceptions of benefit following medical cannabis legalization in Oklahoma. Prev Med Rep 2022; 27:101777. [PMID: 35392181 PMCID: PMC8980491 DOI: 10.1016/j.pmedr.2022.101777] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 03/11/2022] [Accepted: 03/20/2022] [Indexed: 01/13/2023] Open
Abstract
Little is known about the risks and benefits associated with medical cannabis legalization. The current study was an online panel survey of adult Oklahomans recruited between September and October 2020 (N = 1898). Respondents with and without a medical cannabis license were compared on sociodemographic, substance use and health characteristics, and sub-analyses focused on the characteristics of licensed and unlicensed past 30-day cannabis users. Among all participants, 19.34% (n = 367) reported that they had a medical cannabis license, and 35.73% (n = 676) reported past 30-day cannabis use. Licensees were more likely to be younger (i.e., 18-35 years of age; p = 0.001), identify as a sexual minority (p < 0.001), and report past 30-day cannabis, cigarette, alcohol, and prescription opiate use (all p's ≤ 0.003). Licensed participants most commonly reported medically-recommended cannabis use for anxiety (42.51%), depression (33.24%), sleep problems (26.98%), chronic pain (24.25%), and arthritis (12.81%). The likelihood of medically-recommended cannabis use for anxiety, depression, and chronic pain differed by age group (all p's ≤ 0.028). Licensees were most likely to perceive that cannabis delivered "very much/extreme" relief from anxiety (78.57%), sleep problems (76.30%), nausea/vomiting (70.00%), and depression (67.05%). Compared to licensed past 30-day cannabis users (n = 308), unlicensed users (n = 368) were more likely to be non-White, to have ≤ high school education, to report an annual household income <$30,000, and to report current smoking (all p's ≤ 0.027). Findings provide initial information about the personal characteristics associated with having a medical cannabis license in Oklahoma, the reasons for medical cannabis use, and the perceived medical benefits.
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Affiliation(s)
- Darla E. Kendzor
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, 900 N.E. 10th Street, Oklahoma City, OK 73104, USA,TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA,Corresponding author at: TSET Health Promotion Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA.
| | - Sarah J. Ehlke
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA
| | - Laili Kharazi Boozary
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA,Department of Psychology, Cellular and Behavioral Neurobiology, The University of Oklahoma, 455 W. Lindsey Street, Dale Hall Tower, Room 705, Norman, OK 73019, USA
| | - Michael A. Smith
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA,Hudson College of Public Health, The University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA
| | - Amy M. Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA,Department of Pediatrics, The University of Oklahoma Health Sciences Center, 800 Stanton L. Young Boulevard, Oklahoma City, OK 73117, USA
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Thomasius R. Gesundheitliche Risiken einer Cannabislegalisierung für Kinder und Jugendliche. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2022; 50:162-164. [PMID: 35274571 DOI: 10.1024/1422-4917/a000861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Rainer Thomasius
- Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie e. V., Berlin
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