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Has the Legalisation of Medical and Recreational Cannabis Use in the USA Affected the Prevalence of Cannabis Use and Cannabis Use Disorders? CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0224-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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152
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Hockenberry JM, Wen H. Opioid Death Rate Acceleration in Jurisdictions Legalizing Marijuana Use-Reply. JAMA Intern Med 2018; 178:1282. [PMID: 30193248 DOI: 10.1001/jamainternmed.2018.3894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jason M Hockenberry
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia.,National Bureau of Economic Research, Cambridge, Massachusetts
| | - Hefei Wen
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington
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153
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Older marijuana users' marijuana risk perceptions: associations with marijuana use patterns and marijuana and other substance use disorders. Int Psychogeriatr 2018; 30:1311-1322. [PMID: 29223184 DOI: 10.1017/s1041610217002794] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED ABSTRACTBackground:Compared to their non-using age peers, older marijuana users are known to have lower marijuana risk perceptions. We examined associations of older marijuana users' risk perceptions with their marijuana use patterns and substance use disorders. METHODS Data are from 2013 to 2015 National Survey of Drug Use and Health (N = 24,057 respondents aged 50+ years). Bivariate logistic regression was used to compare risk perceptions among never users, former users, and past-year users aged 50+ years. Multivariable logistic regression was used to test associations between risk perception and marijuana use status and between risk perception and marijuana use patterns. RESULTS Among the total sample, former (AOR = 0.30, 95% CI = 0.27-0.32) and past-year (AOR = 0.05, 95% CI = 0.04-0.06) marijuana users had significantly lower odds of moderate/great risk perception (as opposed to no/slight risk perception) than never users. Among past-year users, odds of moderate/great risk perception were lower among those who used marijuana more frequently (AOR = 0.14, 95% CI = 0.07-0.28 for 300+ days of use compared to 1-11 days of use) and who reported any medical marijuana use (AOR = 0.27, 95% CI = 0.14-0.51). However, those who had marijuana use disorder were 3.5 times more likely to report moderate/great risk perception (AOR = 3.50, 95% CI = 1.62-7.58). Those who had a college education, had higher incomes, and resided in states with medical marijuana laws also had lower risk perceptions. CONCLUSIONS Public health education on scientific evidence about marijuana's benefits and harms and age-appropriate treatment for older adults with substance use problems are needed. Research on risk perception formation using longitudinal data among older adults is also needed.
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154
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Anderson DM, Rees DI, Tekin E. Medical marijuana laws and workplace fatalities in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 60:33-39. [PMID: 30092547 DOI: 10.1016/j.drugpo.2018.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/13/2018] [Accepted: 07/15/2018] [Indexed: 11/25/2022]
Abstract
AIMS The aim of this research was to determine the association between legalizing medical marijuana and workplace fatalities. DESIGN Repeated cross-sectional data on workplace fatalities at the state-year level were analyzed using a multivariate Poisson regression. SETTING To date, 29 states and the District of Columbia have legalized the use of marijuana for medicinal purposes. Although there is increasing concern that legalizing medical marijuana will make workplaces more dangerous, little is known about the relationship between medical marijuana laws (MMLs) and workplace fatalities. PARTICIPANTS All 50 states and the District of Columbia for the period 1992-2015. MEASUREMENTS Workplace fatalities by state and year were obtained from the Bureau of Labor Statistics. Regression models were adjusted for state demographics, the unemployment rate, state fixed effects, and year fixed effects. FINDINGS Legalizing medical marijuana was associated with a 19.5% reduction in the expected number of workplace fatalities among workers aged 25-44 (incident rate ratio [IRR], 0.805; 95% CI, .662-.979). The association between legalizing medical marijuana and workplace fatalities among workers aged 16-24, although negative, was not statistically significant at conventional levels. The association between legalizing medical marijuana and workplace fatalities among workers aged 25-44 grew stronger over time. Five years after coming into effect, MMLs were associated with a 33.7% reduction in the expected number of workplace fatalities (IRR, 0.663; 95% CI, .482-.912). MMLs that listed pain as a qualifying condition or allowed collective cultivation were associated with larger reductions in fatalities among workers aged 25-44 than those that did not. CONCLUSIONS The results provide evidence that legalizing medical marijuana improved workplace safety for workers aged 25-44. Further investigation is required to determine whether this result is attributable to reductions in the consumption of alcohol and other substances that impair cognitive function, memory, and motor skills.
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Affiliation(s)
- D Mark Anderson
- Department of Agricultural Economics and Economics, Montana State University, P.O. Box 172920, Bozeman, MT, 59717-2920, United States.
| | - Daniel I Rees
- Department of Economics, University of Colorado Denver, United States.
| | - Erdal Tekin
- School of Public Affairs, American University, United States.
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155
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Meinhofer A, Witman AE. The role of health insurance on treatment for opioid use disorders: Evidence from the Affordable Care Act Medicaid expansion. JOURNAL OF HEALTH ECONOMICS 2018; 60:177-197. [PMID: 29990675 DOI: 10.1016/j.jhealeco.2018.06.004] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 05/26/2023]
Abstract
We estimate the effect of health insurance coverage on opioid use disorder treatment utilization and availability by exploiting cross-state variation in effective dates of Medicaid expansions under the Affordable Care Act. Using a difference-in-differences design, we find that aggregate opioid admissions to specialty treatment facilities increased 18% in expansion states, most of which involved outpatient medication-assisted treatment (MAT). Opioid admissions from Medicaid beneficiaries increased 113% without crowding out admissions from individuals with other health insurance. These effects appeared to be driven by market entry of select MAT providers and by greater acceptance of Medicaid payments among existing MAT providers. Moreover, effects were largest in expansion states with comprehensive MAT coverage. Our findings suggest that Medicaid expansions resulted in substantial utilization and availability gains to clinically efficacious and cost-effective pharmacological treatments, implying potential benefits of expanding Medicaid to non-expansion states and extending MAT coverage.
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Affiliation(s)
- Angélica Meinhofer
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, United States.
| | - Allison E Witman
- University of North Carolina Wilmington, 601 S. College Road, Wilmington, NC 28043-5920, United States.
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Abstract
Cannabis (marijuana) is a drug product derived from the plant Cannabis sativa. Cannabinoid is a general term for all chemical constituents of the cannabis plant. Legalization of marijuana in numerous US states, the availability of cannabis of higher potency, and the emergence of synthetic cannabinoids may have contributed to increased demand for related medical services. The most effective available treatments for cannabis use disorder are psychosocial approaches. There is no pharmacotherapy approved treatment. This article reviews the current state of knowledge regarding effective treatments for cannabis use disorder.
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Affiliation(s)
- Annie Lévesque
- Department of Psychiatry, Mount Sinai West Hospital, 1000 10th Avenue, Suite 8C-02, New York, NY 10019, USA.
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Addiction Division, Addiction Medicine Service, Centre for Addiction and Mental Health, Toronto, Ontario M6J 1H4, Canada; Department of Pharmacology and Toxicology, Institute of Medical Sciences, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Department of Family and Community Medicine, Institute of Medical Sciences, University of Toronto, Toronto, Ontario M5S 1A8, Canada
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157
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Abstract
Legislative reforms have legalized use of cannabis for medical and recreational purposes. Efforts to evaluate the public health impact of these changes have predominantly focused on determining whether liberalizing cannabis policies has increased cannabis use patterns. Co-use of cannabis and other licit substances, namely tobacco and alcohol, is common during the developmental period of adolescence, which is generally characterized by an increase in risk-taking and novelty-seeking. However, limited research has sought to evaluate the potential implications of reforms to medical and recreational cannabis laws on concurrent and simultaneous use of cannabis, tobacco, and alcohol during adolescence. The current report reviews the extant literature detailing the prevalence and outcomes associated with concurrent and simultaneous cannabis-tobacco and cannabis-alcohol use, including recent work that has examined how concurrent and simultaneous use may be influenced by cannabis reform. This review details how the cannabis landscape and cannabis retail marketplace have evolved and briefly summarizes the corresponding policy and regulatory challenges that have emerged. The report concludes with a focused cannabis co-use research agenda that adopts different strategies including behavioural economic, self-administration, and survey research methods.
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Affiliation(s)
- Nicolas J. Schlienz
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dustin C. Lee
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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158
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Sarvet AL, Wall MM, Fink DS, Greene E, Le A, Boustead AE, Pacula RL, Keyes KM, Cerdá M, Galea S, Hasin DS. Medical marijuana laws and adolescent marijuana use in the United States: a systematic review and meta-analysis. Addiction 2018; 113:1003-1016. [PMID: 29468763 PMCID: PMC5942879 DOI: 10.1111/add.14136] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/14/2017] [Accepted: 12/01/2017] [Indexed: 12/14/2022]
Abstract
AIMS To conduct a systematic review and meta-analysis of studies in order to estimate the effect of US medical marijuana laws (MMLs) on past-month marijuana use prevalence among adolescents. METHODS A total of 2999 papers from 17 literature sources were screened systematically. Eleven studies, developed from four ongoing large national surveys, were meta-analyzed. Estimates of MML effects on any past-month marijuana use prevalence from included studies were obtained from comparisons of pre-post MML changes in MML states to changes in non-MML states over comparable time-periods. These estimates were standardized and entered into a meta-analysis model with fixed-effects for each study. Heterogeneity among the study estimates by national data survey was tested with an omnibus F-test. Estimates of effects on additional marijuana outcomes, of MML provisions (e.g. dispensaries) and among demographic subgroups were abstracted and summarized. Key methodological and modeling characteristics were also described. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS None of the 11 studies found significant estimates of pre-post MML changes compared with contemporaneous changes in non-MML states for marijuana use prevalence among adolescents. The meta-analysis yielded a non-significant pooled estimate (standardized mean difference) of -0.003 (95% confidence interval = -0.012, +0.007). Four studies compared MML with non-MML states on pre-MML differences and all found higher rates of past-month marijuana use in MML states pre-MML passage. Additional tests of specific MML provisions, of MML effects on additional marijuana outcomes and among subgroups generally yielded non-significant results, although limited heterogeneity may warrant further study. CONCLUSIONS Synthesis of the current evidence does not support the hypothesis that US medical marijuana laws (MMLs) until 2014 have led to increases in adolescent marijuana use prevalence. Limited heterogeneity exists among estimates of effects of MMLs on other patterns of marijuana use, of effects within particular population subgroups and of effects of specific MML provisions.
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Affiliation(s)
- Aaron L. Sarvet
- Department of Psychiatry, College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- New York State Psychiatric InstituteNew YorkNYUSA
| | - Melanie M. Wall
- Department of Psychiatry, College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- New York State Psychiatric InstituteNew YorkNYUSA
- Department of Biostatistics, Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - David S. Fink
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Emily Greene
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Aline Le
- New York State Psychiatric InstituteNew YorkNYUSA
| | - Anne E. Boustead
- School of Government and Public PolicyUniversity of ArizonaTucsonAZUSA
| | | | - Katherine M. Keyes
- Department of Psychiatry, College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Magdalena Cerdá
- Department of Emergency MedicineUniversity of California, DavisSacramentoCAUSA
| | - Sandro Galea
- Boston School of Public HealthBoston UniversityBostonMAUSA
| | - Deborah S. Hasin
- Department of Psychiatry, College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- New York State Psychiatric InstituteNew YorkNYUSA
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
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159
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Chu YWL. Commentary on Sarvet et al. (2018): What do we still need to know about the impacts of medical marijuana laws in the United States? Addiction 2018; 113:1017-1018. [PMID: 29732703 DOI: 10.1111/add.14167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Yu-Wei Luke Chu
- School of Economics and Finance, Victoria University of Wellington, Wellington, New Zealand
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160
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Dutra LM, Parish WJ, Gourdet CK, Wylie SA, Wiley JL. Medical cannabis legalization and state-level prevalence of serious mental illness in the National Survey on Drug Use and Health (NSDUH) 2008-2015. Int Rev Psychiatry 2018; 30:203-215. [PMID: 30010452 DOI: 10.1080/09540261.2018.1467385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although research has established a link between cannabis legalization and use, and cannabis use and mental health, the relationship between medical cannabis legalization and mental health remains uncharacterized. This analysis investigated the relationship between state medical cannabis laws (restrictive, i.e. covering a narrow set of medical conditions; or liberal, i.e. covering a broad range of medical conditions), whether the law permits patients to petition their physician to approve medical cannabis use for specific medical conditions, and state prevalence of serious mental illness (SMI) in the National Survey of Drug Use and Health 2008-2015. In a covariate-adjusted meta-regression, liberal laws were significantly associated with higher prevalence of SMI (Coeff = 0.003, SE = 0.001, p < .001). Restrictive laws (Coeff = 0.001, SE = 0.001, p = .285) and the ability to petition physician approval (Coeff = -0.001, SE = 0.001, p = .140) were non-significant. When added to the model, state past-year cannabis use was significantly associated with higher prevalence of SMI (Coeff = 0.037, SE = 0.015, p = .018), liberal laws remained significant (Coeff = 0.002, SE = 0.001, p = .015), and restrictive laws (Coeff = -0.0001, SE = 0.001, p = .945) and the ability to petition a physician (Coeff = 0.001, SE = 0.001, p = .290) remained non-significant. Medical cannabis laws are likely related to state mental health, and a higher prevalence of cannabis use partially explains this relationship.
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Affiliation(s)
| | | | | | - Sarah A Wylie
- c Oregon Public Health Division, Oregon Health Authority , Portland , OR , USA
| | - Jenny L Wiley
- b RTI International , Research Triangle Park , NC , USA
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161
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Choi NG, DiNitto DM, Marti CN. A longitudinal assessment of change in marijuana use with other substance use problems. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 44:642-652. [DOI: 10.1080/00952990.2018.1461879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Diana M. DiNitto
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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162
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Impact of E-Cigarette Minimum Legal Sale Age Laws on Current Cigarette Smoking. J Adolesc Health 2018; 62:532-538. [PMID: 29422436 PMCID: PMC5930073 DOI: 10.1016/j.jadohealth.2017.11.302] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/03/2017] [Accepted: 11/30/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to use individual-level data to examine the relationship between e-cigarette minimum legal sale age (MLSA) laws and cigarette smoking among U.S. adolescents, adjusting for e-cigarette use. METHODS In 2016 and 2017, we regressed (logistic) current (past 30-day) cigarette smoking (from 2009-2014 National Youth Tobacco Surveys [NYTS]) on lagged (laws enacted each year counted for the following year) and unlagged (laws enacted January-June counted for that year) state e-cigarette MLSA laws prohibiting sales to youth aged <18 or <19 years (depending on the state). Models were adjusted for year and individual- (e-cigarette and other tobacco use, sex, race/ethnicity, and age) and state-level (smoke-free laws, cigarette taxes, medical marijuana legalization, income, and unemployment) covariates. RESULTS Cigarette smoking was not significantly associated with lagged MLSA laws after adjusting for year (odds ratio [OR] = .87, 95% confidence interval [CI]: .73-1.03; p = .10) and covariates (OR = .85, .69-1.03; p = .10). Unlagged laws were significantly and negatively associated with cigarette smoking (OR = .84, .71-.98, p = .02), but not after adjusting for covariates (OR = .84, .70-1.01, p = .07). E-cigarette and other tobacco use, sex, race/ethnicity, age, and smoke-free laws were associated with cigarette smoking (p <.05). Results unadjusted for e-cigarette use and other tobacco use yielded a significant negative association between e-cigarette MLSA laws and cigarette smoking (lagged: OR = .78, .64-.93, p = .01; unlagged: OR = .80, .68-.95, p = .01). CONCLUSIONS After adjusting for covariates, state e-cigarette MLSA laws did not affect youth cigarette smoking. Unadjusted for e-cigarette and other tobacco use, these laws were associated with lower cigarette smoking.
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163
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Sarvet AL, Wall MM, Keyes KM, Cerdá M, Schulenberg JE, O'Malley PM, Johnston LD, Hasin DS. Recent rapid decrease in adolescents' perception that marijuana is harmful, but no concurrent increase in use. Drug Alcohol Depend 2018; 186:68-74. [PMID: 29550624 PMCID: PMC6134844 DOI: 10.1016/j.drugalcdep.2017.12.041] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/22/2017] [Accepted: 12/24/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND National trends in adolescent's marijuana risk perceptions are traditionally used as a predictor of concurrent and future trends in adolescent marijuana use. We test the validity of this practice during a time of rapid marijuana policy change. METHODS Two repeated cross-sectional U.S. nationally-representative surveys of 8th, 10th, and 12th-graders: Monitoring the Future (MTF) (1991-2015; N = 1,181,692) and National Survey on Drug Use and Health (NSDUH) (2002-2014; N = 113,317). We examined trends in the year-to-year prevalence of perceiving no risk of harm in using marijuana regularly, and prevalence of regular marijuana use within the previous month. A piecewise linear regression model tested for a change in the relationship between trends. Similar analyses examined any past-month use and controlled for demographic characteristics. RESULTS Among MTF 12th-graders, the prevalence of regular marijuana use and risk perceptions changed similarly between 1991 and 2006 but diverged sharply afterward. The prevalence of regular marijuana use increased by ∼1 percentage point to 6.03% by 2015. In contrast, the proportion of 12th-graders that perceived marijuana as posing no risk increased over 11 percentage points to 21.39%. A similar divergence was found among NSDUH 12th-graders and other grades, for any past month marijuana use, and when controlling demographic characteristics. CONCLUSIONS An increase in adolescent marijuana use has not accompanied recent rapid decreases in marijuana risk perceptions. Policy makers may consider broader prevention strategies in addition to targeting marijuana risk perceptions. Further monitoring of predictors of marijuana use trends is needed as states legalize recreational marijuana use.
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Affiliation(s)
- Aaron L Sarvet
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Melanie M Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Katherine M Keyes
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Magdalena Cerdá
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA
| | - John E Schulenberg
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Patrick M O'Malley
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Lloyd D Johnston
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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164
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Sarvet AL, Wall MM, Keyes KM, Olfson M, Cerdá M, Hasin DS. Self-medication of mood and anxiety disorders with marijuana: Higher in states with medical marijuana laws. Drug Alcohol Depend 2018; 186. [PMID: 29525698 PMCID: PMC5911228 DOI: 10.1016/j.drugalcdep.2018.01.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Self-medication with drugs or alcohol is commonly reported among adults with mood or anxiety disorders, and increases the risk of developing substance use disorders. Medical marijuana laws (MML) may be associated with greater acceptance of the therapeutic value of marijuana, leading individuals to self-medicate. METHODS The study utilized data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005). Participants were sampled from households in the general population and included adults with a mood or anxiety disorder in the past 12 months (n = 7418), and the subset of those who used marijuana and no other drug (n = 314). Weighted logistic regression models predicted the prevalence of self-medication with drugs in U.S. states with and without MML, adjusting for individual and state-level covariates. As a negative control, analyses were repeated for self-medication with alcohol. RESULTS Overall, self-medication with drugs was 3.73 percentage points higher (95% confidence interval [CI]: 0.93-6.53) among those living in MML states (p = 0.01). For the subpopulation that only used marijuana, self-medication with drugs was 21.22 percentage points higher (95% CI: 3.91-38.53) among those living in MML states (p = 0.02). In contrast, self-medication with alcohol had nearly identical prevalence in MML and non-MML states, overall and for drinkers. CONCLUSIONS Among adults with mood or anxiety disorders, living in a medical marijuana law state is associated with self-medication with marijuana. While additional research is needed to determine the reasons for this association, clinical screening for self-medication with marijuana may be particularly important in states with medical marijuana laws.
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Affiliation(s)
- Aaron L. Sarvet
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 722 W 168th St, New York, New York 10032, USA,New York State Psychiatric Institute, 722 W 168th St, New York, New York 10032, USA
| | - Melanie M. Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 722 W 168th St, New York, New York 10032, USA,New York State Psychiatric Institute, 722 W 168th St, New York, New York 10032, USA,Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, New York 10032, USA
| | - Katherine M. Keyes
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 722 W 168th St, New York, New York 10032, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, New York 10032, USA
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 722 W 168th St, New York, New York 10032, USA,New York State Psychiatric Institute, 722 W 168th St, New York, New York 10032, USA
| | - Magdalena Cerdá
- Department of Emergency Medicine, University of California, Davis, 2315 Stockton Blvd., Sacramento, California 95817, USA
| | - Deborah S. Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 722 W 168th St, New York, New York 10032, USA,New York State Psychiatric Institute, 722 W 168th St, New York, New York 10032, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, New York 10032, USA
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165
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Trends in and correlates of medical marijuana use among adults in the United States. Drug Alcohol Depend 2018; 186:120-129. [PMID: 29567626 DOI: 10.1016/j.drugalcdep.2018.01.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 01/09/2018] [Accepted: 01/13/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Trends in and correlates of medical marijuana use are important to inform ongoing clinical, research, policy, and programmatic efforts. This study assessed trends in and correlates of medical marijuana use among U.S. adults. METHODS We analyzed data from approximately 147,200 U.S. civilians aged 18 or older who participated in the 2013-2015 National Surveys on Drug Use and Health. Descriptive analyses, multivariable logistic regressions, and zero-truncated native binomial regressions were applied. RESULTS Among U.S. adults, the prevalence of medical marijuana use increased from 1.2% in 2013 to 1.6% in 2015 (p = 0.0007). After adjusting for covariates, adults residing in medical marijuana states (states with legalized medical marijuana use) were 1.3 times more likely to use marijuana medically in 2015 than in 2013 (adjusted odds ratio (AOR) = 1.3, 95% confidence interval (CI) = 1.03-1.61), and adults in nonmedical marijuana states were 1.4 times more likely to report medical marijuana use in 2015 than in 2013 (AOR = 1.4, 95% CI = 1.05-1.90). Among adults who used marijuana exclusively for medical purposes in the past 12 months, trends in 12-month cannabis use disorders, daily or near daily use, and the number of days of marijuana use remained unchanged during 2013-2015. We identified how correlates of medical marijuana use among adults in medical marijuana states differed from their counterparts in nonmedical marijuana states. CONCLUSIONS Adults were more likely to use marijuana medically in 2015 than in 2013 in both medical and nonmedical marijuana states. Clinicians need to learn about and address evolving patterns of medical marijuana use in patients.
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Bradford AC, Bradford WD, Abraham A, Bagwell Adams G. Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population. JAMA Intern Med 2018; 178:667-672. [PMID: 29610897 PMCID: PMC6145794 DOI: 10.1001/jamainternmed.2018.0266] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/12/2018] [Indexed: 12/13/2022]
Abstract
Importance Opioid-related mortality increased by 15.6% from 2014 to 2015 and increased almost 320% between 2000 and 2015. Recent research finds that the use of all pain medications (opioid and nonopioid collectively) decreases in Medicare Part D and Medicaid populations when states approve medical cannabis laws (MCLs). The association between MCLs and opioid prescriptions is not well understood. Objective To examine the association between prescribing patterns for opioids in Medicare Part D and the implementation of state MCLs. Design, Setting, and Participants Longitudinal analysis of the daily doses of opioids filled in Medicare Part D for all opioids as a group and for categories of opioids by state and state-level MCLs from 2010 through 2015. Separate models were estimated first for whether the state had implemented any MCL and second for whether a state had implemented either a dispensary-based or a home cultivation only-based MCL. Main Outcomes and Measures The primary outcome measure was the total number of daily opioid doses prescribed (in millions) in each US state for all opioids. The secondary analysis examined the association between MCLs separately by opioid class. Results From 2010 to 2015 there were 23.08 million daily doses of any opioid dispensed per year in the average state under Medicare Part D. Multiple regression analysis results found that patients filled fewer daily doses of any opioid in states with an MCL. The associations between MCLs and any opioid prescribing were statistically significant when we took the type of MCL into account: states with active dispensaries saw 3.742 million fewer daily doses filled (95% CI, -6.289 to -1.194); states with home cultivation only MCLs saw 1.792 million fewer filled daily doses (95% CI, -3.532 to -0.052). Results varied by type of opioid, with statistically significant estimated negative associations observed for hydrocodone and morphine. Hydrocodone use decreased by 2.320 million daily doses (or 17.4%) filled with dispensary-based MCLs (95% CI, -3.782 to -0.859; P = .002) and decreased by 1.256 million daily doses (or 9.4%) filled with home-cultivation-only-based MCLs (95% CI, -2.319 to -0.193; P = .02). Morphine use decreased by 0.361 million daily doses (or 20.7%) filled with dispensary-based MCLs (95% CI, -0.718 to -0.005; P = .047). Conclusions and Relevance Medical cannabis laws are associated with significant reductions in opioid prescribing in the Medicare Part D population. This finding was particularly strong in states that permit dispensaries, and for reductions in hydrocodone and morphine prescriptions.
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Affiliation(s)
- Ashley C. Bradford
- Department of Public Administration & Policy, University of Georgia, Athens
| | - W. David Bradford
- Department of Public Administration & Policy, University of Georgia, Athens
| | - Amanda Abraham
- Department of Public Administration & Policy, University of Georgia, Athens
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167
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Paschall MJ, Grube JW, Biglan A. Medical Marijuana Legalization and Marijuana Use Among Youth in Oregon. J Prim Prev 2018; 38:329-341. [PMID: 28484894 DOI: 10.1007/s10935-017-0476-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
While the legalization of marijuana for medical and recreational use has raised concerns about potential influences on marijuana use and beliefs among youth, few empirical studies have addressed this issue. We examined the association between medical marijuana patients and licensed growers per 1000 population in 32 Oregon counties from 2006 to 2015, and marijuana use among youth over the same period. We obtained data on registered medical marijuana patients and licensed growers from the Oregon Medical Marijuana Program and we obtained data on youth marijuana use, perceived parental disapproval, and demographic characteristics from the Oregon Healthy Teens Survey. Across 32 Oregon counties, the mean rate of marijuana patients per 1000 population increased from 2.9 in 2006 to 18.3 in 2015, whereas the grower rate increased from 3.8 to 11.9. Results of multi-level analyses indicated significant positive associations between rates of marijuana patients and growers per 1000 population and the prevalence of past 30-day marijuana use, controlling for youth demographic characteristics. The marijuana patient and grower rates were also inversely associated with parental disapproval of marijuana use, which decreased from 2006 to 2015 and acted as a mediator. These findings suggest that a greater number of registered marijuana patients and growers per 1000 population in Oregon counties was associated with a higher prevalence of marijuana use among youth from 2006 to 2015, and that this relationship was partially attributable to perceived norms favorable towards marijuana use.
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Affiliation(s)
- Mallie J Paschall
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue, Suite 1200, Oakland, CA, 94612, USA.
| | - Joel W Grube
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue, Suite 1200, Oakland, CA, 94612, USA
| | - Anthony Biglan
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR, 97403, USA
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168
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Parnes JE, Smith JK, Conner BT. Reefer madness or much ado about nothing? Cannabis legalization outcomes among young adults in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 56:116-120. [PMID: 29626630 DOI: 10.1016/j.drugpo.2018.03.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/24/2018] [Accepted: 03/13/2018] [Indexed: 11/15/2022]
Abstract
In 2012, Colorado became one of the first two U.S. States to legalize cannabis for recreational use for adults 21 and older. Given that cannabis use holds potential physical and mental health risks, particularly among adolescent users, concerns have grown regarding changes in use following this change in policy. Studies examining medical cannabis legalization have found inconsistent changes in cannabis use and prevalence of dependence following medical implementation. However, recreational legalization holds potential unique changes, such as increased availability and social acceptance, as well as decreased price and perceived harm of use. There also may be increased interest in moving to Colorado related to the changes in cannabis laws. Based on past literature, two hypotheses were made for this study. First, college student cannabis use would increase after recreational legalization, however just for those 21 years old and older. Second, there would be a positive relation between the influence of cannabis legislation on out-of-State student's decision to attend a Colorado university and their cannabis use. Data from 5241 undergraduate students was available to test study hypotheses using Pearson's Chi-square, negative binomial regressions, and path analysis. Results indicated that cannabis use increased since recreational legalization for all students, but more so for those over 21 years. No differences in past month use frequency were found between pre- and post-legalization. Influence of cannabis laws on non-resident student's decision to attend a Colorado college predicted lifetime and past 30-day use. Additionally, out-of-State students reported higher past 30-day use than in-State students. These findings may help inform other States considering recreational legalization of potential outcomes, as well as potential interventions.
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Affiliation(s)
- Jamie E Parnes
- Department of Psychology, Colorado State University, 1876 Campus Delivery, Fort Collins, CO 80523, USA.
| | - Joey K Smith
- Department of Psychology, Colorado State University, 1876 Campus Delivery, Fort Collins, CO 80523, USA.
| | - Bradley T Conner
- Department of Psychology, Colorado State University, 1876 Campus Delivery, Fort Collins, CO 80523, USA.
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169
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Nasr SZ, Nasrallah AI, Abdulghani M, Sweet SC. The impact of conventional and nonconventional inhalants on children and adolescents. Pediatr Pulmonol 2018; 53:391-399. [PMID: 29084362 DOI: 10.1002/ppul.23836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 01/16/2023]
Abstract
AIM Inhalant abuse in the adolescent population is a growing concern for care givers, communities, physicians, and medical providers. The aim of this article is to provide a review of the literature about this new challenge. In addition, it raises awareness about recent health policy rulings. METHODS Review of the literature was done. RESULTS In this review article, the prevalence of different modes of inhalant use and abuse in children and young adults and their potential health implications will be examined: Cigarettes, ENDS (E Cigarettes), Hookah, Marijuana, and Huffing. Additionally, marketing and advertising tactics will be reviewed to understand how they target this population. A review of current health policy recommendations from the FDA, American Thoracic Society, and the American Academy of Pediatrics will also be discussed. CONCLUSION The rapid rise in e-cigarette and hookah use in school aged children should trigger a call to action in the medical and public health communities. Health policy recommendations need to be made to reduce the level of adolescent substance abuse.
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Affiliation(s)
- Samya Z Nasr
- Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan
| | | | | | - Stuart C Sweet
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St. Louis, Missouri
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170
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Abstract
State-level marijuana liberalization policies have been evolving for the past five decades, and yet the overall scientific evidence of the impact of these policies is widely believed to be inconclusive. In this review we summarize some of the key limitations of the studies evaluating the effects of decriminalization and medical marijuana laws on marijuana use, highlighting their inconsistencies in terms of the heterogeneity of policies, the timing of the evaluations, and the measures of use being considered. We suggest that the heterogeneity in the responsiveness of different populations to particular laws is important for interpreting the mixed findings from the literature, and we highlight the limitations of the existing literature in providing clear insights into the probable effects of marijuana legalization.
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Affiliation(s)
- Rosalie Liccardo Pacula
- RAND Corporation, Santa Monica, California 90407; , .,National Bureau of Economic Research, Cambridge, Massachusetts 02138
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171
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Kristman-Valente AN, Hill KG, Epstein M, Kosterman R, Bailey JA, Steeger CM, Jones TM, Abbott RD, Johnson RM, Walker D, David Hawkins J. The Relationship Between Marijuana and Conventional Cigarette Smoking Behavior from Early Adolescence to Adulthood. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 18:428-438. [PMID: 28349235 DOI: 10.1007/s11121-017-0774-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Longitudinal analyses investigated (a) the co-occurrence of marijuana use and conventional cigarette smoking within time and (b) bidirectional associations between marijuana and conventional cigarette use in three developmental periods: adolescence, young adulthood, and adulthood. A cross-lag model was used to examine the bidirectional model of marijuana and conventional cigarette smoking frequency from ages 13 to 33 years. The bidirectional model accounted for gender, school-age economic disadvantage, childhood attention problems, and race. Marijuana use and conventional cigarette smoking were associated within time in decreasing magnitude and increased cigarette smoking predicted increased marijuana use during adolescence. A reciprocal relationship was found in the transition from young adulthood to adulthood, such that increased conventional cigarette smoking at age 24 years uniquely predicted increased marijuana use at age 27 years, and increased marijuana use at age 24 years uniquely predicted more frequent conventional cigarette smoking at age 27 years, even after accounting for other factors. The association between marijuana and cigarette smoking was found to developmentally vary in the current study. Results suggest that conventional cigarette smoking prevention efforts in adolescence and young adulthood could potentially lower the public health impact of both conventional cigarette smoking and marijuana use. Findings point to the importance of universal conventional cigarette smoking prevention efforts among adolescents as a way to decrease later marijuana use and suggest that a prevention effort focused on young adults as they transition to adulthood would lower the use of both cigarette and marijuana use.
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Affiliation(s)
- Allison N Kristman-Valente
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave. NE, Suite, 401, Seattle, WA, 98115, USA.
| | - Karl G Hill
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave. NE, Suite, 401, Seattle, WA, 98115, USA
| | - Marina Epstein
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave. NE, Suite, 401, Seattle, WA, 98115, USA
| | - Rick Kosterman
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave. NE, Suite, 401, Seattle, WA, 98115, USA
| | - Jennifer A Bailey
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave. NE, Suite, 401, Seattle, WA, 98115, USA
| | - Christine M Steeger
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave. NE, Suite, 401, Seattle, WA, 98115, USA
| | - Tiffany M Jones
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave. NE, Suite, 401, Seattle, WA, 98115, USA
| | - Robert D Abbott
- College of Education, University of Washington, Seattle, WA, USA
| | - Renee M Johnson
- Bloomberg School of Public Health, Johns Hopkins University, Seattle, WA, USA
| | - Denise Walker
- School of Social Work, University of Washington, Seattle, WA, USA
| | - J David Hawkins
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave. NE, Suite, 401, Seattle, WA, 98115, USA
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172
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Powell D, Pacula RL, Jacobson M. Do medical marijuana laws reduce addictions and deaths related to pain killers? JOURNAL OF HEALTH ECONOMICS 2018; 58:29-42. [PMID: 29408153 PMCID: PMC7867411 DOI: 10.1016/j.jhealeco.2017.12.007] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 08/15/2017] [Accepted: 12/30/2017] [Indexed: 05/19/2023]
Abstract
Recent work finds that medical marijuana laws reduce the daily doses filled for opioid analgesics among Medicare Part-D and Medicaid enrollees, as well as population-wide opioid overdose deaths. We replicate the result for opioid overdose deaths and explore the potential mechanism. The key feature of a medical marijuana law that facilitates a reduction in overdose death rates is a relatively liberal allowance for dispensaries. As states have become more stringent in their regulation of dispensaries, the protective value generally has fallen. These findings suggest that broader access to medical marijuana facilitates substitution of marijuana for powerful and addictive opioids.
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Affiliation(s)
| | | | - Mireille Jacobson
- NBER Cambridge, MA, United States; University of California, Irvine, United States
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173
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Chadi N, Weitzman ER, Levy S. Understanding the Impact of National and State Medical Marijuana Policies on Adolescents. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0191-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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174
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Cerdá M, Sarvet AL, Wall M, Feng T, Keyes KM, Galea S, Hasin DS. Medical marijuana laws and adolescent use of marijuana and other substances: Alcohol, cigarettes, prescription drugs, and other illicit drugs. Drug Alcohol Depend 2018; 183:62-68. [PMID: 29227839 PMCID: PMC5803452 DOI: 10.1016/j.drugalcdep.2017.10.021] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/13/2017] [Accepted: 10/14/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Historical shifts have taken place in the last twenty years in marijuana policy. The impact of medical marijuana laws (MML) on use of substances other than marijuana is not well understood. We examined the relationship between state MML and use of marijuana, cigarettes, illicit drugs, nonmedical use of prescription opioids, amphetamines, and tranquilizers, as well as binge drinking. METHODS Pre-post MML difference-in-difference analyses were performed on a nationally representative sample of adolescents in 48 contiguous U.S. states. Participants were 1,179,372U.S. 8th, 10th, and 12th graders in the national Monitoring the Future annual surveys conducted in 1991-2015. Measurements were any self-reported past-30-day use of marijuana, cigarettes, non-medical use of opioids, amphetamines and tranquilizers, other illicit substances, and any past-two-week binge drinking (5+ drinks per occasion). RESULTS Among 8th graders, the prevalence of marijuana, binge drinking, cigarette use, non-medical use of opioids, amphetamines and tranquilizers, and any non-marijuana illicit drug use decreased after MML enactment (0.2-2.4% decrease; p-values:<0.0001-0.0293). Among 10th graders, the prevalence of substance use did not change after MML enactment (p-values: 0.177-0.938). Among 12th graders, non-medical prescription opioid and cigarette use increased after MML enactment (0.9-2.7% increase; p-values: <0.0001-0.0026). CONCLUSIONS MML enactment is associated with decreases in marijuana and other drugs in early adolescence in those states. Mechanisms that explain the increase in non-medical prescription opioid and cigarette use among 12th graders following MML enactment deserve further study.
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Affiliation(s)
- Magdalena Cerdá
- Department of Emergency Medicine, University of California, Davis, 2315 Stockton Blvd., 95817 Sacramento, CA, United States.
| | - Aaron L Sarvet
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States
| | - Melanie Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Tianshu Feng
- New York State Psychiatric Institute, New York, NY, United States
| | - Katherine M Keyes
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Sandro Galea
- Boston School of Public Health, Boston University, Boston, MA, United States
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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175
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Kim J, Coors ME, Young SE, Raymond KM, Hopfer CJ, Wall TL, Corley RP, Brown SA, Sakai JT. Cannabis use disorder and male sex predict medical cannabis card status in a sample of high risk adolescents. Drug Alcohol Depend 2018; 183:25-33. [PMID: 29223914 PMCID: PMC6043896 DOI: 10.1016/j.drugalcdep.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 11/21/2017] [Accepted: 11/25/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To examine if a substance use disorder (SUD), especially cannabis use disorder in adolescence, predicts future medical cannabis card status among high-risk youth. METHODS Data collection occurred in Denver and San Diego. We recruited adolescents, with or at high risk for SUD and conduct problems (hereafter probands) and their siblings (n=654). Baseline (Wave 1) assessments took place between 1999 and 2008, and follow-up (Wave 2) took place between 2010 and 2013. In initial bivariate analyses, we examined whether baseline DSM-IV cannabis abuse/dependence (along with other potential predictors) was associated with possessing a medical cannabis card in young adulthood (Wave 2). Significant predictors were then included in a multiple binomial regression. Self-reported general physical health was also evaluated at both time points. Finally, within Wave 2, we tested whether card status was associated with concurrent substance dependence. RESULTS About 16% of the sample self-reported having a medical cannabis card at follow-up. Though bivariate analyses demonstrated that multiple predictors were significantly associated with Wave 2 card status, in our multiple binomial regression only cannabis abuse/dependence and male sex remained significant. At Wave 2, those with a medical cannabis card were significantly more likely to endorse criteria for concurrent cannabis dependence. There was no significant difference in self-reported general physical health. CONCLUSIONS Cannabis abuse/dependence and male sex positively predicted future medical cannabis card holder status among a sample of high risk adolescents. Physicians conducting evaluations for medical cannabis cards should carefully evaluate and consider past and concurrent cannabis addiction.
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Affiliation(s)
- Janet Kim
- University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO, United States, 80045-2559
| | - Marilyn E. Coors
- University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO, United States, 80045-2559
| | - Susan E. Young
- University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO, United States, 80045-2559
| | - Kristen M. Raymond
- University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO, United States, 80045-2559
| | - Christian J. Hopfer
- University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO, United States, 80045-2559
| | - Tamara L. Wall
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA, United States, 92093-0001
| | - Robin P. Corley
- University of Colorado, Boulder, I.B.G. 447 UCB, 1480 30th St, Boulder CO, United States, 80309-0447
| | - Sandra A. Brown
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA, United States, 92093-0001
| | - Joseph T. Sakai
- University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO, United States, 80045-2559
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176
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Choi NG, DiNitto DM, Marti CN. Marijuana use among adults: Initiation, return to use, and continued use versus quitting over a one-year follow-up period. Drug Alcohol Depend 2018; 182:19-26. [PMID: 29120860 DOI: 10.1016/j.drugalcdep.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study examined factors associated with marijuana use initiation among never users, prior-to-past year user who return to use, and users who continue use over a 12-month follow-up period. METHODS Two waves (W1 and W2) of the Population Assessment of Tobacco and Health (PATH) Study provided data (N=26,204 aged 18+). Multivariable logistic regression models were used to examine associations of W1 sociodemographic, health/mental health, and other substance use characteristics with W2 use status. As applicable, marijuana initiation age, use frequency, and use problems were also examined. RESULTS At W2, 2.36% and 10.42% of W1 never users and prior-to-past year users, respectively, reported having used marijuana, and 72.54% of W1 past-year users reported continued use. Those in the 18-24 age group were most likely to initiate, resume, or continue use. Among never and prior-to-past year users, those who reported more mental health problems at W1 also had greater odds of use at W2. Marijuana initiation and return to use were significantly associated with movement from nonuse to use of other substances. Continued marijuana use, as opposed to quitting, was also associated with other substance use, initiation of marijuana use prior to age 18, weekly or more frequent use (AOR=2.34, 95% CI=1.87-2.93), and use problems (AOR=1.40, 95% CI=1.05-1.85) reported at W1. CONCLUSIONS Movement between marijuana nonuse and use was substantial during the 12-month follow-up period. Early intervention to prevent initiation of, return to, and continued marijuana and other substance use, especially among young adults, is needed.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712, United States.
| | - Diana M DiNitto
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712, United States.
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712, United States.
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177
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Hasin DS. US Epidemiology of Cannabis Use and Associated Problems. Neuropsychopharmacology 2018; 43:195-212. [PMID: 28853439 PMCID: PMC5719106 DOI: 10.1038/npp.2017.198] [Citation(s) in RCA: 378] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 12/12/2022]
Abstract
This review provides an overview of the changing US epidemiology of cannabis use and associated problems. Adults and adolescents increasingly view cannabis as harmless, and some can use cannabis without harm. However, potential problems include harms from prenatal exposure and unintentional childhood exposure; decline in educational or occupational functioning after early adolescent use, and in adulthood, impaired driving and vehicle crashes; cannabis use disorders (CUD), cannabis withdrawal, and psychiatric comorbidity. Evidence suggests national increases in cannabis potency, prenatal and unintentional childhood exposure; and in adults, increased use, CUD, cannabis-related emergency room visits, and fatal vehicle crashes. Twenty-nine states have medical marijuana laws (MMLs) and of these, 8 have recreational marijuana laws (RMLs). Many studies indicate that MMLs or their specific provisions did not increase adolescent cannabis use. However, the more limited literature suggests that MMLs have led to increased cannabis potency, unintentional childhood exposures, adult cannabis use, and adult CUD. Ecological-level studies suggest that MMLs have led to substitution of cannabis for opioids, and also possibly for psychiatric medications. Much remains to be determined about cannabis trends and the role of MMLs and RMLs in these trends. The public, health professionals, and policy makers would benefit from education about the risks of cannabis use, the increases in such risks, and the role of marijuana laws in these increases.
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Affiliation(s)
- Deborah S Hasin
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
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178
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Abouk R, Adams S. Examining the relationship between medical cannabis laws and cardiovascular deaths in the US. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 53:1-7. [PMID: 29227828 DOI: 10.1016/j.drugpo.2017.11.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 11/02/2017] [Accepted: 11/23/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Several countries and many U.S. states have allowed, for cannabis to be used as therapy to treat chronic conditions or pain., This has increased the use of cannabis, particularly among older people.Because cannabis has been linked to adverse cardiac events in the medical literature, there may be unintended consequences on increased use among older people. METHODS We analyze cardiac-related mortality data from the U.S. National Vital Statistics System for 1990-2014. We use difference-in-difference fixed-effects models to assess whether there are increased rates of cardiac-related mortality following passage of medical cannabis programs. We also analyze whether states with more liberal rules on dispensing cannabis show higher mortality rates. RESULTS For men, there is a statistically significant 2.3% increase in the rate of cardiac death following passage. For women, there is a 1.3% increase that is also statistically significant. he effects increase or both men and women with age. The effects are also stronger in states with more a lax approach to cannabis dispensing. CONCLUSION Policymakers should be aware of a potential unintended consequence of allowing broader use of cannabis, specifically for those more at risk of cardiovascular events.
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Affiliation(s)
- Rahi Abouk
- Department of Economics, Finance and Global Business, William Paterson University, United States
| | - Scott Adams
- Department of Economics, University of Wisconsin-Milwaukee, United States.
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179
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Effects of the 2009 Medical Cannabinoid Legalization Policy on Hospital Use for Cannabinoid Dependency and Persistent Vomiting. Clin Gastroenterol Hepatol 2017; 15:1876-1881. [PMID: 28711691 DOI: 10.1016/j.cgh.2017.06.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In 2009, the U.S. Department of Justice issued a memo stating that it would not prosecute users and sellers who complied with the state laws allowing for medical use of marijuana. There are growing concerns about legalization of marijuana use and its related public health effects. We performed an interrupted time series analysis to evaluate these effects. METHODS We collected a representative sample of hospital discharge data from the Healthcare Cost and Utilization Project, from January 1993 to December 2014. We divided the data in to 3 groups: the prelegalization period (1993-2008), the legalization period (2009), and the postlegalization period (2010-2014). The disease variables were International Classification of Disease-Ninth Revision-Clinical Modification 304.30 cannabinoid dependency unspecified (CDU), 536.2 persistent vomiting, and an aggregate of CDU and persistent vomiting. We performed interrupted time series and Poisson-Gamma regression analysis to calculate each year's incidence rate of unspecified and persistent vomiting and CDU per 100,000 hospital discharges. CDU, persistent vomiting, and aggregate of CDU and persistent vomiting were modeled separately to estimate average incidence rate ratio and 95% confidence interval for each study phase. RESULTS We observed an increasing trend of CDU or an aggregate of CDU and persistent vomiting during the prelegalization period. The legalization of marijuana significantly increased the incidence rate during the legalization period (by 17.9%) and the yearly average increase in rate by 6% after policy implementation, compared to the prelegalization period. The increase in rate of persistent vomiting after policy implementation increased significantly (by about 8%), although there were no significant trends in increase prior to or during marijuana legalization in 2009. CONCLUSIONS In an interrupted time series analysis of before, during, and after medical marijuana legalization, we estimated levels and rate changes in CDU and persistent vomiting. We found persistent increases in rates of CDU and persistent vomiting during and after legalization of marijuana.
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180
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Klieger SB, Gutman A, Allen L, Pacula RL, Ibrahim JK, Burris S. Mapping medical marijuana: state laws regulating patients, product safety, supply chains and dispensaries, 2017. Addiction 2017; 112:2206-2216. [PMID: 28696583 PMCID: PMC5725759 DOI: 10.1111/add.13910] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/17/2017] [Accepted: 06/13/2017] [Indexed: 02/03/2023]
Abstract
AIMS (1) To describe open source legal data sets, created for research use, that capture the key provisions of US state medical marijuana laws. The data document how state lawmakers have regulated a medicine that remains, under federal law, a Schedule I illegal drug with no legitimate medical use. (2) To demonstrate the variability that exists across states in rules governing patient access, product safety and dispensary practice. METHODS Two legal researchers collected and coded state laws governing marijuana patients, product safety and dispensaries in effect on 1 February 2017, creating three empirical legal data sets. We used summary tables to identify the variation in specific statutory provisions specified in each state's medical marijuana law as it existed on 1 February 2017. We compared aspects of these laws to the traditional Federal approach to regulating medicine. Full data sets, codebooks and protocols are available through the Prescription Drug Abuse Policy System (http://www.pdaps.org/; Archived at http://www.webcitation.org/6qv5CZNaZ on 2 June 2017). RESULTS Twenty-eight states (including the District of Columbia) have authorized medical marijuana. Twenty-seven specify qualifying diseases, which differ across states. All states protect patient privacy; only 14 protect patients against discrimination. Eighteen states have mandatory product safety testing before any sale. While the majority have package/label regulations, states have a wide range of specific requirements. Most regulate dispensaries (25 states), with considerable variation in specific provisions such as permitted product supply sources number of dispensaries per state and restricting proximity to various types of location. CONCLUSIONS The federal ban in the United States on marijuana has resulted in a patchwork of regulatory strategies that are not uniformly consistent with the approach usually taken by the Federal government and whose effectiveness remains unknown.
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Affiliation(s)
- Sarah B. Klieger
- Center for Health Law, Policy and Practice, Beasley School of Law, Temple University
| | - Abraham Gutman
- Center for Health Law, Policy and Practice, Beasley School of Law, Temple University
| | | | | | - Jennifer K. Ibrahim
- Center for Health Law, Policy and Practice, Beasley School of Law, Temple University,College of Public Health, Temple University
| | - Scott Burris
- Center for Health Law, Policy and Practice, Beasley School of Law, Temple University
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181
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Johnson JK, Johnson RM, Hodgkin D, Jones AA, Matteucci AM, Harris SK. Heterogeneity of state medical marijuana laws and adolescent recent use of alcohol and marijuana: Analysis of 45 states, 1991-2011. Subst Abus 2017; 39:247-254. [PMID: 28991522 PMCID: PMC5891387 DOI: 10.1080/08897077.2017.1389801] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess associations between enactment of state medical marijuana laws (MMLs), MML restrictiveness, and past-30-day youth alcohol use overall, and in relation to marijuana use. METHOD This quasi-experimental difference-in-difference designed study used state-level Youth Risk Behavior Survey data of 9th-12th grade students in 45 states from 1991-2011 (N D 715,014). We conducted bivariate (unadjusted) and multivariable (adjusted for state, year, individual characteristics) logistic regression analyses to examine the effect of MML enactment (yes/no) and less restrictive vs. more restrictive MMLs on five varying measures of past 30-day alcohol use (i.e., any use or binge) and alcohol and marijuana use behaviors. RESULTS In the final adjusted analyses, MML enactment was associated with lower odds of adolescent past 30-day (1) alcohol use (OR D 0.92, [0.87, 0.97], p < .01) and (2) use of both alcohol and marijuana (OR D 0.93, [0.87, 0.99], p < .05). States with less restrictive MMLs had lower odds of past 30-day (1) alcohol use (OR D 0.94, [0.92, 0.97], p < .001), (2) binge drinking (OR D 0.96, [0.93, 0.97], p < .05), (3) alcohol use without any marijuana use (OR D 0.96, [0.93, 0.99], p < .01), and (4) use of both alcohol and marijuana (OR D 0.96, [0.92, 0.99], p < .05). CONCLUSIONS This study found that enactment of any MML, and of less restrictive MMLs, was associated with lower odds of past 30-day adolescent alcohol use among adolescents. With continued change in state marijuana laws, it is important to monitor the effect of their enactment and implementation, as well as their specific provisions (e.g. dispensaries, home cultivation), which may differentially affect adolescent behaviors.
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Affiliation(s)
- Julie K. Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland, USA
- The Center for Adolescent Substance Abuse Research (CeASAR), Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Renee M. Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland, USA
| | - Dominic Hodgkin
- Institute for Behavioral Health, Heller School of Social Policy and Management, Brandeis University Brandeis University, Waltham, Massachusetts, USA
| | - Abenaa A. Jones
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland, USA
| | - Ann Marie Matteucci
- Department of Health Management and Policy, University of New Hampshire, Durham, New Hampshire, USA
| | - Sion K. Harris
- Institute for Behavioral Health, Heller School of Social Policy and Management, Brandeis University Brandeis University, Waltham, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
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182
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Borodovsky JT, Budney AJ. Legal cannabis laws, home cultivation, and use of edible cannabis products: A growing relationship? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 50:102-110. [PMID: 29102847 DOI: 10.1016/j.drugpo.2017.09.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 09/16/2017] [Accepted: 09/26/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Over half of U.S. states have enacted legal cannabis laws (LCL). In parallel, edible cannabis products (i.e., edibles) have presented new regulatory challenges. LCL provisions that dictate access to cannabis (e.g., home cultivation (HC) or dispensaries (DSP)) may impact edible production and use. This study examined relationships among HC and DSP provisions, cannabis cultivation, and edible use. METHODS An online cannabis use survey was distributed using Facebook. Data were collected from 1813 cannabis-using adults. U.S. states were classified as states without LCL (Non-LCL) or LCL states that: (1) only permit DSP (LCL DSP-only), (2) only permit HC (LCL HC-only), or (3) permit HC and DSP (LCL HC+DSP). Analyses tested associations among these classifications, cannabis growing, and edible use and procurement. RESULTS Individuals in LCL HC-only and LCL HC+DSP states were more likely to report currently growing cannabis at home (OR: 3.3, 95% CI: 1.7, 6.2; OR: 3.9, 95% CI: 2.4, 6.3, respectively) and past-month edible use (OR: 2.1, 95% CI: 1.4, 3.4; OR: 2.9, 95% CI: 2.2, 3.9, respectively) than individuals in LCL DSP-only states. Regardless of state, those who had grown cannabis were more likely to have made edibles than those who had never grown cannabis (OR: 2.2, 95% CI: 1.8, 2.6). Individuals in LCL HC-only states were more likely to have made edibles in the past month than individuals from Non-LCL (OR: 2.75, 95% CI: 1.5, 5.3) and DSP-only states (OR: 2.1, 95% CI: 1.0, 4.4). Individuals in LCL HC+DSP states were more likely to have purchased edibles in the past month than individuals from Non-LCL (OR: 3.7, 95% CI: 2.4, 5.6) and DSP-only states (OR: 3.2, 95% CI: 1.8, 5.5). CONCLUSION Specific LCL provisions may differentially affect individuals' propensity to grow cannabis and make, buy, and use edible cannabis products. Permitting home cultivation contributes to a greater likelihood of growing cannabis. Those who grow cannabis economize the plant by creating homemade edible cannabis products. Conversely, permitting dispensaries increases the likelihood of purchasing edibles. The psychoactive effects of edibles with unknown and variable cannabinoid content will be unpredictable. Policymakers should carefully consider how specific LCL provisions can affect patterns of cannabis edible product access and quality.
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Affiliation(s)
- Jacob T Borodovsky
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States; The Dartmouth Institute for Health Policy and Clinical Practice, 74 College St., Hanover, NH 03755, United States.
| | - Alan J Budney
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States
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183
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Williams AR, Santaella-Tenorio J, Mauro CM, Levin FR, Martins SS. Loose regulation of medical marijuana programs associated with higher rates of adult marijuana use but not cannabis use disorder. Addiction 2017; 112:1985-1991. [PMID: 28600874 PMCID: PMC5735415 DOI: 10.1111/add.13904] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/27/2017] [Accepted: 06/06/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Most US states have passed medical marijuana laws (MMLs), with great variation in program regulation impacting enrollment rates. We aimed to compare changes in rates of marijuana use, heavy use and cannabis use disorder across age groups while accounting for whether states enacted medicalized (highly regulated) or non-medical mml programs. DESIGN Difference-in-differences estimates with time-varying state-level MML coded by program type (medicalized versus non-medical). Multi-level linear regression models adjusted for state-level random effects and covariates as well as historical trends in use. SETTING Nation-wide cross-sectional survey data from the US National Survey of Drug Use and Health (NSDUH) restricted use data portal aggregated at the state level. PARTICIPANTS Participants comprised 2004-13 NSDUH respondents (n ~ 67 500/year); age groups 12-17, 18-25 and 26+ years. States had implemented eight medicalized and 15 non-medical MML programs. MEASUREMENTS Primary outcome measures included (1) active (past-month) marijuana use; (2) heavy use (> 300 days/year); and (3) cannabis use disorder diagnosis, based on DSM-IV criteria. Covariates included program type, age group and state-level characteristics throughout the study period. FINDINGS Adults 26+ years of age living in states with non-medical MML programs increased past-month marijuana use 1.46% (from 4.13 to 6.59%, P = 0.01), skewing towards greater heavy marijuana by 2.36% (from 14.94 to 17.30, P = 0.09) after MMLs were enacted. However, no associated increase in the prevalence of cannabis use disorder was found during the study period. Our findings do not show increases in prevalence of marijuana use among adults in states with medicalized MML programs. Additionally, there were no increases in adolescent or young adult marijuana outcomes following MML passage, irrespective of program type. CONCLUSIONS Non-medical marijuana laws enacted in US states are associated with increased marijuana use, but only among adults aged 26+ years. Researchers and policymakers should consider program regulation and subgroup characteristics (i.e. demographics) when assessing for population level outcomes. Researchers and policymakers should consider program regulation and subgroup characteristics (i.e. demographics) when assessing for population level outcomes.
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184
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The potential impact of cannabis legalization on the development of cannabis use disorders. Prev Med 2017; 104:31-36. [PMID: 28668544 PMCID: PMC5735001 DOI: 10.1016/j.ypmed.2017.06.034] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/24/2017] [Accepted: 06/26/2017] [Indexed: 01/21/2023]
Abstract
Specific provisions of legal cannabis legislation and regulation could influence cannabis initiation, frequency and quantity of use, and progression to cannabis use disorder. This brief essay highlights scientifically based principles and risk factors that underlie substance use and addiction that can be leveraged to inform policies that might mitigate the development and consequences of cannabis use disorder. Specifically, pharmacologic, access/availability, and environmental factors are discussed in relation to their influence on substance use disorders to illustrate how regulatory provisions can differentially affect these factors and risk for addiction. Relevant knowledge from research and experience with alcohol and tobacco regulation are also considered. Research designed to inform regulatory policy and to evaluate the impact of cannabis legislation on cannabis use and problems is progressing. However, definitive findings will come slowly, and more concerted efforts and resources are needed to expedite this process. In the meantime, policymakers should take advantage of the large body of scientific literature on substance use to foster empirically-guided, common sense approaches to cannabis policy that focus on prevention of addiction.
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185
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Carliner H, Brown QL, Sarvet AL, Hasin DS. Cannabis use, attitudes, and legal status in the U.S.: A review. Prev Med 2017; 104:13-23. [PMID: 28705601 PMCID: PMC6348863 DOI: 10.1016/j.ypmed.2017.07.008] [Citation(s) in RCA: 351] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/27/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
Abstract
Cannabis is widely used among adolescents and adults. In the U.S., marijuana laws have been changing, and Americans increasingly favor legalizing cannabis for medical and recreational uses. While some can use cannabis without harm, others experience adverse consequences. The objective of this review is to summarize information on the legal status of cannabis, perceptions regarding cannabis, prevalence and time trends in use and related adverse consequences, and evidence on the relationship of state medical (MML) and recreational (RML) marijuana laws to use and attitudes. Twenty-nine states now have MMLs, and eight of these have RMLs. Since the early 2000s, adult and adolescent perception of cannabis use as risky has decreased. Over the same time, the prevalence of adolescent cannabis use has changed little. However, adult cannabis use, disorders, and related consequences have increased. Multiple nationally representative studies indicate that MMLs have had little effect on cannabis use among adolescents. However, while MML effects have been less studied in adults, available evidence suggests that MMLs increase use and cannabis use disorders in adults. While data are not yet available to evaluate the effect of RMLs, they are likely to lower price, increase availability, and thereby increase cannabis use. More permissive marijuana laws may accomplish social justice aims (e.g., reduce racial disparities in law enforcement) and generate tax revenues. However, such laws may increase cannabis-related adverse health and psychosocial consequences by increasing the population of users. Dissemination of balanced information about the potential health harms of cannabis use is needed.
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Affiliation(s)
- Hannah Carliner
- Columbia University, Department of Psychiatry, United States; Columbia University Mailman School of Public Health, Department of Epidemiology, United States; New York State Psychiatric Institute, United States
| | - Qiana L Brown
- Columbia University Mailman School of Public Health, Department of Epidemiology, United States; Nathan Kline Institute for Psychiatric Research, New York State Office of Mental Health, United States; New York University School of Medicine, Department of Psychiatry, United States
| | | | - Deborah S Hasin
- Columbia University, Department of Psychiatry, United States; Columbia University Mailman School of Public Health, Department of Epidemiology, United States; New York State Psychiatric Institute, United States.
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186
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Kerr DCR, Bae H, Phibbs S, Kern AC. Changes in undergraduates' marijuana, heavy alcohol and cigarette use following legalization of recreational marijuana use in Oregon. Addiction 2017; 112:1992-2001. [PMID: 28613454 DOI: 10.1111/add.13906] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/23/2017] [Accepted: 06/02/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Recreational marijuana legalization (RML) went into effect in Oregon in July 2015. RML is expected to influence marijuana use by adolescents and young adults in particular, and by those with a propensity for substance use. We sought to quantify changes in rates of marijuana use among college students in Oregon from pre- to post-RML relative to college students in other states across the same time period. DESIGN Repeated cross-sectional survey data from the 2012-16 administrations of the Healthy Minds Study. SETTING Seven 4-year universities in the United States. PARTICIPANTS There were 10 924 undergraduate participants. One large public Oregon university participated in 2014 and 2016 (n = 588 and 1115, respectively); six universities in US states where recreational marijuana use was illegal participated both in 2016 and at least once between 2012 and 2015. MEASUREMENTS Self-reported marijuana use in the past 30 days (yes/no) was regressed on time (pre/post 2015), exposure to RML (i.e. Oregon students in 2016) and covariates using mixed-effects logistic regression. Moderation of RML effects by recent heavy alcohol use was examined. FINDINGS Rates of marijuana use increased from pre- to post-2015 at six of the seven universities, a trend that was significant overall. Increases in rates of marijuana use were significantly greater in Oregon than in comparison institutions, but only among students reporting recent heavy alcohol use. CONCLUSIONS Rates of Oregon college students' marijuana use increased (relative to that of students in other states) following recreational marijuana legislation in 2015, but only for those who reported recent heavy use of alcohol. Such alcohol misuse may be a proxy for vulnerabilities to substance use or lack of prohibitions (e.g. cultural) against it.
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Affiliation(s)
| | - Harold Bae
- Oregon State University, Corvallis, OR, USA
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187
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Ullman DF. The Effect of Medical Marijuana on Sickness Absence. HEALTH ECONOMICS 2017; 26:1322-1327. [PMID: 27416978 DOI: 10.1002/hec.3390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 06/02/2016] [Accepted: 06/22/2016] [Indexed: 06/06/2023]
Abstract
Utilizing the Current Population Survey, the study identifies that absences due to sickness decline following the legalization of medical marijuana. The effect is stronger in states with 'lax' medical marijuana regulations, for full-time workers, and for middle-aged males, which is the group most likely to hold medical marijuana cards. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Darin F Ullman
- Department of Economics, University of Wisconsin-Milwaukee, Milwaukee, USA
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188
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Kilmer B, MacCoun RJ. How Medical Marijuana Smoothed the Transition to Marijuana Legalization in the United States. ANNUAL REVIEW OF LAW AND SOCIAL SCIENCE 2017; 13:181-202. [PMID: 34045931 PMCID: PMC8152576 DOI: 10.1146/annurev-lawsocsci-110615-084851] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Public support for legalizing marijuana use increased from 25% in 1995 to 60% in 2016, rising in lockstep with support for same-sex marriage. Between November 2012 and November 2016, voters in eight states passed ballot initiatives to legalize marijuana sales for nonmedical purposes-covering one-fifth of the US population. These changes are unprecedented but are not independent of the changes in medical marijuana laws that have occurred over the past 20 years. This article suggests five ways in which the passage and implementation of medical marijuana laws smoothed the transition to nonmedical legalization in the United States: (a) They demonstrated the efficacy of using voter initiatives to change marijuana supply laws, (b) enabled the psychological changes needed to destabilize the "war on drugs" policy stasis, (c) generated an evidence base that could be used to downplay concerns about nonmedical legalization, (d) created a visible and active marijuana industry, and (e) revealed that the federal government would allow state and local jurisdictions to generate tax revenue from marijuana.
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Affiliation(s)
- Beau Kilmer
- RAND Drug Policy Research Center, Santa Monica, California 90407-2138
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189
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Cannabis use patterns and motives: A comparison of younger, middle-aged, and older medical cannabis dispensary patients. Addict Behav 2017; 72:14-20. [PMID: 28340421 DOI: 10.1016/j.addbeh.2017.03.006] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/16/2017] [Accepted: 03/08/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Medical cannabis is increasingly being used for a variety of health conditions as more states implement legislation permitting medical use of cannabis. Little is known about medical cannabis use patterns and motives among adults across the lifespan. METHODS The present study examined data collected at a medical cannabis dispensary in San Francisco, California. Participants included 217 medical cannabis patients who were grouped into age-defined cohorts (younger: 18-30, middle-aged: 31-50, and older: 51-72). The age groups were compared on several measures of cannabis use, motives and medical conditions using one-way ANOVAs, chi-square tests and linear regression analyses. RESULTS All three age groups had similar frequency of cannabis use over the past month; however, the quantity of cannabis used and rates of problematic cannabis use were higher among younger users relative to middle-aged and older adults. The association between age and problematic cannabis use was moderated by age of regular use initiation such that earlier age of regular cannabis use onset was associated with more problematic use in the younger users, but not among older users. Middle-aged adults were more likely to report using medical cannabis for insomnia, while older adults were more likely to use medical cannabis for chronic medical problems such as cancer, glaucoma and HIV/AIDS. Younger participants reported cannabis use when bored at a greater rate than middle-aged and older adults. CONCLUSIONS Findings suggest that there is an age-related risk for problematic cannabis use among medical cannabis users, such that younger users should be monitored for cannabis use patterns that may lead to deleterious consequences.
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190
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Okafor CN, Cook RL, Chen X, Surkan PJ, Becker JT, Shoptaw S, Martin E, Plankey MW. Prevalence and correlates of marijuana use among HIV-seropositive and seronegative men in the Multicenter AIDS Cohort Study (MACS), 1984-2013. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 43:556-566. [PMID: 27808576 PMCID: PMC5415427 DOI: 10.1080/00952990.2016.1245738] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Marijuana use is common among HIV+ individuals, but few studies have examined long-term trends in prevalence and correlates of use. METHODS We evaluated trends (1984-2013) in the annual prevalence of current (past 6-month use) and daily (among current users) marijuana use and determined correlates of use among 2742 HIV-seropositive (HIV+) and 3172 HIV-seronegative (HIV-) men who have sex with men in the Multicenter AIDS Cohort Study (MACS). Poisson regression models were used to estimate prevalence ratios of marijuana use separately for the men who were enrolled before 2001 (early-cohort) and after 2001 (late-cohort). RESULTS Over the 29 years of the study, the prevalence of current marijuana use declined significantly, whereas daily use among users increased among all men in the early and late-cohorts. A HIV+ status was associated with higher prevalence of marijuana use among the men in the early-cohort (adjusted prevalence ratio [aPR] = 1.53, 95% confidence interval [CI]:1.42, 1.64, p = <0.0001), but not in the men in the late-cohort (aPR = 0.90, 95% CI: 0.79, 1.03, p = 0.1424). Alcohol use and cigarette smoking were being positively associated with marijuana use. CONCLUSIONS Although the annual prevalence of current marijuana use decreased significantly over time in the MACS, daily use among users increased significantly. Further, among the HIV+ men, our study did not show clinically significant adverse effects of marijuana use on highly active antiretroviral therapy use, CD4+ count, or HIV viral load.
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Affiliation(s)
- Chukwuemeka N Okafor
- a Department of Epidemiology, College of Public Health and Health Professions, College of Medicine , University of Florida , Gainesville , FL , USA
| | - Robert L Cook
- a Department of Epidemiology, College of Public Health and Health Professions, College of Medicine , University of Florida , Gainesville , FL , USA
| | - Xinguang Chen
- a Department of Epidemiology, College of Public Health and Health Professions, College of Medicine , University of Florida , Gainesville , FL , USA
| | - Pamela J Surkan
- b Social and Behavioral Interventions Program, Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - James T Becker
- c Departments of Psychiatry, Neurology and Psychology , University of Pittsburgh , Pittsburgh , PA , USA
| | - Steve Shoptaw
- d David Geffen School of Medicine , Department of Family Medicine at University of California , Los Angeles , USA
| | - Eileen Martin
- e Department of Psychiatry , Rush University Medical Center , Chicago , IL USA
| | - Michael W Plankey
- f Georgetown University Medical Center , Department of Medicine, Division of Infectious Diseases , Washington , DC , USA
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191
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Choi NG, DiNitto DM, Marti CN. Nonmedical versus medical marijuana use among three age groups of adults: Associations with mental and physical health status. Am J Addict 2017; 26:697-706. [DOI: 10.1111/ajad.12598] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/01/2017] [Accepted: 07/15/2017] [Indexed: 01/24/2023] Open
Affiliation(s)
- Namkee G. Choi
- University of Texas at Austin School of Social Work; 1925 San Jacinto Blvd; Austin Texas
| | - Diana M. DiNitto
- University of Texas at Austin School of Social Work; 1925 San Jacinto Blvd; Austin Texas
| | - Carl Nathan Marti
- University of Texas at Austin School of Social Work; 1925 San Jacinto Blvd; Austin Texas
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192
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Hasin DS, Sarvet AL, Cerdá M, Keyes KM, Stohl M, Galea S, Wall MM. US Adult Illicit Cannabis Use, Cannabis Use Disorder, and Medical Marijuana Laws: 1991-1992 to 2012-2013. JAMA Psychiatry 2017; 74:579-588. [PMID: 28445557 PMCID: PMC5539836 DOI: 10.1001/jamapsychiatry.2017.0724] [Citation(s) in RCA: 266] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/01/2017] [Indexed: 12/24/2022]
Abstract
Importance Over the last 25 years, illicit cannabis use and cannabis use disorders have increased among US adults, and 28 states have passed medical marijuana laws (MML). Little is known about MML and adult illicit cannabis use or cannabis use disorders considered over time. Objective To present national data on state MML and degree of change in the prevalence of cannabis use and disorders. Design, Participants, and Setting Differences in the degree of change between those living in MML states and other states were examined using 3 cross-sectional US adult surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013). Early-MML states passed MML between NLAES and NESARC ("earlier period"). Late-MML states passed MML between NESARC and NESARC-III ("later period"). Main Outcomes and Measures Past-year illicit cannabis use and DSM-IV cannabis use disorder. Results Overall, from 1991-1992 to 2012-2013, illicit cannabis use increased significantly more in states that passed MML than in other states (1.4-percentage point more; SE, 0.5; P = .004), as did cannabis use disorders (0.7-percentage point more; SE, 0.3; P = .03). In the earlier period, illicit cannabis use and disorders decreased similarly in non-MML states and in California (where prevalence was much higher to start with). In contrast, in remaining early-MML states, the prevalence of use and disorders increased. Remaining early-MML and non-MML states differed significantly for use (by 2.5 percentage points; SE, 0.9; P = .004) and disorder (1.1 percentage points; SE, 0.5; P = .02). In the later period, illicit use increased by the following percentage points: never-MML states, 3.5 (SE, 0.5); California, 5.3 (SE, 1.0); Colorado, 7.0 (SE, 1.6); other early-MML states, 2.6 (SE, 0.9); and late-MML states, 5.1 (SE, 0.8). Compared with never-MML states, increases in use were significantly greater in late-MML states (1.6-percentage point more; SE, 0.6; P = .01), California (1.8-percentage point more; SE, 0.9; P = .04), and Colorado (3.5-percentage point more; SE, 1.5; P = .03). Increases in cannabis use disorder, which was less prevalent, were smaller but followed similar patterns descriptively, with change greater than never-MML states in California (1.0-percentage point more; SE, 0.5; P = .06) and Colorado (1.6-percentage point more; SE, 0.8; P = .04). Conclusions and Relevance Medical marijuana laws appear to have contributed to increased prevalence of illicit cannabis use and cannabis use disorders. State-specific policy changes may also have played a role. While medical marijuana may help some, cannabis-related health consequences associated with changes in state marijuana laws should receive consideration by health care professionals and the public.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York3Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Aaron L Sarvet
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York
| | - Magdalena Cerdá
- Department of Emergency Medicine, University of California, Davis, Sacramento
| | - Katherine M Keyes
- Department of Psychiatry, Columbia University Medical Center, New York, New York3Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Malka Stohl
- New York State Psychiatric Institute, New York
| | - Sandro Galea
- School of Public Health, Boston University, Boston, Massachusetts
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York6Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
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193
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Maier SL, Mannes S, Koppenhofer EL. The Implications of Marijuana Decriminalization and Legalization on Crime in the United States. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/0091450917708790] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Shana L. Maier
- College of Arts and Sciences, Widener University, Chester, PA, USA
| | - Suzanne Mannes
- College of Arts and Sciences, Widener University, Chester, PA, USA
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194
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Bradford AC, Bradford WD. Medical Marijuana Laws May Be Associated With A Decline In The Number Of Prescriptions For Medicaid Enrollees. Health Aff (Millwood) 2017; 36:945-951. [PMID: 28424215 DOI: 10.1377/hlthaff.2016.1135] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the past twenty years, twenty-eight states and the District of Columbia have passed some form of medical marijuana law. Using quarterly data on all fee-for-service Medicaid prescriptions in the period 2007-14, we tested the association between those laws and the average number of prescriptions filled by Medicaid beneficiaries. We found that the use of prescription drugs in fee-for-service Medicaid was lower in states with medical marijuana laws than in states without such laws in five of the nine broad clinical areas we studied. If all states had had a medical marijuana law in 2014, we estimated that total savings for fee-for-service Medicaid could have been $1.01 billion. These results are similar to those in a previous study we conducted, regarding the effects of medical marijuana laws on the number of prescriptions within the Medicare population. Together, the studies suggest that in states with such laws, Medicaid and Medicare beneficiaries will fill fewer prescriptions.
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Affiliation(s)
- Ashley C Bradford
- Ashley C. Bradford is a master of public administration student in the Department of Public Administration and Policy at the University of Georgia, in Athens
| | - W David Bradford
- W. David Bradford is the George D. Busbee Chair in Public Policy in the Department of Public Administration and Policy, University of Georgia
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195
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Shi Y. Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever. Drug Alcohol Depend 2017; 173:144-150. [PMID: 28259087 PMCID: PMC5385927 DOI: 10.1016/j.drugalcdep.2017.01.006] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Twenty-eight states in the U.S have legalized medical marijuana, yet its impacts on severe health consequences such as hospitalizations remain unknown. Meanwhile, the prevalence of opioid pain reliever (OPR) use and outcomes has increased dramatically. Recent studies suggested unintended impacts of legalizing medical marijuana on OPR, but the evidence is still limited. This study examined the associations between state medical marijuana policies and hospitalizations related to marijuana and OPR. METHODS State-level annual administrative records of hospital discharges during 1997-2014 were obtained from the State Inpatient Databases (SID). The outcome variables were rates of hospitalizations involving marijuana dependence or abuse, opioid dependence or abuse, and OPR overdose in 1000 discharges. Linear time-series regressions were used to assess the associations of implementing medical marijuana policies to hospitalizations, controlling for other marijuana- and OPR-related policies, socioeconomic factors, and state and year fixed effects. RESULTS Hospitalizations related to marijuana and OPR increased sharply by 300% on average in all states. Medical marijuana legalization was associated with 23% (p=0.008) and 13% (p=0.025) reductions in hospitalizations related to opioid dependence or abuse and OPR overdose, respectively; lagged effects were observed after policy implementation. The operation of medical marijuana dispensaries had no independent impacts on OPR-related hospitalizations. Medical marijuana polices had no associations with marijuana-related hospitalizations. CONCLUSION Medical marijuana policies were significantly associated with reduced OPR-related hospitalizations but had no associations with marijuana-related hospitalizations. Given the epidemic of problematic use of OPR, future investigation is needed to explore the causal pathways of these findings.
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Affiliation(s)
- Yuyan Shi
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA.
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196
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Kaskie B, Ayyagari P, Milavetz G, Shane D, Arora K. The Increasing Use of Cannabis Among Older Americans: A Public Health Crisis or Viable Policy Alternative? THE GERONTOLOGIST 2017; 57:1166-1172. [DOI: 10.1093/geront/gnw166] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/06/2017] [Indexed: 11/15/2022] Open
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197
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Johnson J, Hodgkin D, Harris SK. The design of medical marijuana laws and adolescent use and heavy use of marijuana: Analysis of 45 states from 1991 to 2011. Drug Alcohol Depend 2017; 170:1-8. [PMID: 27855317 PMCID: PMC5183555 DOI: 10.1016/j.drugalcdep.2016.10.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 10/17/2016] [Accepted: 10/22/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the association between U.S. state medical marijuana laws (MML), the most liberal category of marijuana policies before legalization, their specific provisions, and adolescent past-30-day use and heavy marijuana use. METHODS This quasi-experimental study used state Youth Risk Behavior Survey (YRBS) data collected during 1991-2011 from 45 states (N=715,014) to examine MML effects, taking advantage of heterogeneity across states in MML status and design. Multiple logistic regression modeling was used to adjust for state and year effects, and youth demographics. RESULTS Unadjusted analyses found that MMLs were associated with higher rates of adolescent past-30-day marijuana use (odds ratio [OR]=1.08, 95% confidence interval, [(CI)=1.03,1.13]) and heavy marijuana use (OR=1.12, [CI=1.05,1.21]). However, analyses adjusting for state/year effects found a 7% lower odds of use (OR=0.99, [CI=0.98,0.999]) and no difference in heavy use. In the adjusted models, years since MML enactment (OR=0.93, [CI=0.86,0.99]) and MML inclusion of more liberalized provisions (OR=0.98, [CI=0.96,0.998]) were associated with slightly lowered odds of past-30-day marijuana use. Conversely, allowance for ≥2.5 usable marijuana ounces was associated with higher past-30-day marijuana use odds (OR=1.21, [CI=1.09,1.34]) and a voluntary vs. mandatory patient registration with higher odds of both past-30-day use (OR=1.41, [CI=1.28,1.56]) and heavy use (OR=1.23, [CI=1.08,1.40]). CONCLUSIONS MML enactment, years since enactment, and inclusion of more liberalized provisions were not associated with increased adolescent marijuana use in this dataset after adjusting for state and year effects; however, higher possession limits and a voluntary registration were. It is possible that state norms are the impetus for MML enactment.
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Affiliation(s)
- Julie Johnson
- Institute for Behavioral Health, Heller School of Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, USA; Center for Adolescent Substance Abuse Research (CeASAR), Boston Children's Hospital, 300 Longwood, Boston, MA 02115, USA.
| | - Dominic Hodgkin
- Institute for Behavioral Health, Heller School of Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, USA.
| | - Sion Kim Harris
- Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Center for Adolescent Substance Abuse Research (CeASAR), Boston Children's Hospital, 300 Longwood, Boston, MA 02115, USA.
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198
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Martins SS, Mauro CM, Santaella-Tenorio J, Kim JH, Cerda M, Keyes KM, Hasin DS, Galea S, Wall M. State-level medical marijuana laws, marijuana use and perceived availability of marijuana among the general U.S. population. Drug Alcohol Depend 2016; 169:26-32. [PMID: 27755989 PMCID: PMC5140747 DOI: 10.1016/j.drugalcdep.2016.10.004] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known on how perceived availability of marijuana is associated with medical marijuana laws. We examined the relationship between medical marijuana laws (MML) and the prevalence of past-month marijuana use, with perceived availability of marijuana. METHODS Data were from respondents included in the National Survey of Drug Use and Health restricted use data portal 2004-2013. Multilevel logistic regression of individual-level data was used to test differences between MML and non-MML states and changes in prevalence of past-month marijuana use and perceived availability from before to after passage of MML among adolescents, young adults and older adults controlling for demographics. RESULTS Among adults 26+, past-month prevalence of marijuana use increased from 5.87% to 7.15% after MML passage (Adjusted Odds Ratio (AOR): 1.24 [1.16-1.31]), but no change in prevalence of use was found for 12-17 or 18-25 year-olds. Perceived availability of marijuana increased after MML was enacted among those 26+ but not in younger groups. Among all age groups, prevalence of marijuana use and perception of it being easily available was higher in states that would eventually pass MML by 2013 compared to those that had not. Perceived availability was significantly associated with increased risk of past-month marijuana use in all age groups. CONCLUSION Evidence suggests perceived availability as a driver of change in use of marijuana due to MML. To date, this has only occurred in adults 26+ and different scenarios that could explain this change need to be further explored.
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Affiliation(s)
| | | | | | - June H Kim
- Columbia University, New York, United States
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199
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Keyes KM, Wall M, Cerdá M, Schulenberg J, O’Malley PM, Galea S, Feng T, Hasin DS. How does state marijuana policy affect US youth? Medical marijuana laws, marijuana use and perceived harmfulness: 1991-2014. Addiction 2016; 111:2187-2195. [PMID: 27393902 PMCID: PMC5222836 DOI: 10.1111/add.13523] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/13/2016] [Accepted: 07/05/2016] [Indexed: 11/26/2022]
Abstract
AIMS To test, among US students: (1) whether perceived harmfulness of marijuana has changed over time, (2) whether perceived harmfulness of marijuana changed post-passage of state medical marijuana laws (MML) compared with pre-passage; and (3) whether perceived harmfulness of marijuana statistically mediates and/or modifies the relation between MML and marijuana use as a function of grade level. DESIGN Cross-sectional nationally representative surveys of US students, conducted annually, 1991-2014, in the Monitoring the Future study. SETTING Surveys conducted in schools in all coterminous states; 21 states passed MML between 1996 and 2014. PARTICIPANTS The sample included 1 134 734 adolescents in 8th, 10th and 12th grades. MEASUREMENTS State passage of MML; perceived harmfulness of marijuana use (perceiving great or moderate risk to health from smoking marijuana occasionally versus slight or no risk); and marijuana use (prior 30 days). Data were analyzed using time-varying multi-level regression modeling. FINDINGS The perceived harmfulness of marijuana has decreased significantly since 1991 (from an estimated 84.0% in 1991 to 53.8% in 2014, P < 0.01) and, across time, perceived harmfulness was lower in states that passed MML [odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.75-0.97]. In states with MML, perceived harmfulness of marijuana increased among 8th graders after MML passage (OR = 1.21, 95% CI = 1.08-1.36), while marijuana use decreased (OR = 0.81, 95% CI = 0.72-0.92). Results were null for other grades, and for all grades combined. Increases in perceived harmfulness among 8th graders after MML passage was associated with ~33% of the decrease in use. When adolescents were stratified by perceived harmfulness, use in 8th graders decreased to a greater extent among those who perceived marijuana as harmful. CONCLUSIONS While perceived harmfulness of marijuana use appears to be decreasing nationally among adolescents in the United States, the passage of medical marijuana laws (MML) is associated with increases in perceived harmfulness among young adolescents and marijuana use has decreased among those who perceive marijuana to be harmful after passage of MML.
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Affiliation(s)
- Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA,Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Melanie Wall
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Magdalena Cerdá
- Department of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento, CA
| | - John Schulenberg
- Department of Psychology University of Michigan, Ann Arbor, Michigan, USA,Institute for Social Research, University of Michigan, Ann Arbor, USA
| | | | - Sandro Galea
- Boston School of Public Health, Boston University, Boston, MA, USA
| | - Tianshu Feng
- Research Foundation of Mental Hygiene, New York, New York, USA
| | - Deborah S. Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA,Department of Psychiatry, Columbia University Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
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200
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Plunk AD, Agrawal A, Harrell PT, Tate WF, Will KE, Mellor JM, Grucza RA. The impact of adolescent exposure to medical marijuana laws on high school completion, college enrollment and college degree completion. Drug Alcohol Depend 2016; 168:320-327. [PMID: 27742490 PMCID: PMC5123757 DOI: 10.1016/j.drugalcdep.2016.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is concern that medical marijuana laws (MMLs) could negatively affect adolescents. To better understand these policies, we assess how adolescent exposure to MMLs is related to educational attainment. METHODS Data from the 2000 Census and 2001-2014 American Community Surveys were restricted to individuals who were of high school age (14-18) between 1990 and 2012 (n=5,483,715). MML exposure was coded as: (i) a dichotomous "any MML" indicator, and (ii) number of years of high school age exposure. We used logistic regression to model whether MMLs affected: (a) completing high school by age 19; (b) beginning college, irrespective of completion; and (c) obtaining any degree after beginning college. A similar dataset based on the Youth Risk Behavior Survey (YRBS) was also constructed for confirmatory analyses assessing marijuana use. RESULTS MMLs were associated with a 0.40 percentage point increase in the probability of not earning a high school diploma or GED after completing the 12th grade (from 3.99% to 4.39%). High school MML exposure was also associated with a 1.84 and 0.85 percentage point increase in the probability of college non-enrollment and degree non-completion, respectively (from 31.12% to 32.96% and 45.30% to 46.15%, respectively). Years of MML exposure exhibited a consistent dose response relationship for all outcomes. MMLs were also associated with 0.85 percentage point increase in daily marijuana use among 12th graders (up from 1.26%). CONCLUSIONS Medical marijuana law exposure between age 14 to 18 likely has a delayed effect on use and education that persists over time.
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Affiliation(s)
- Andrew D. Plunk
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Paul T. Harrell
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
| | - William F. Tate
- Department of Education, Washington University in St. Louis, St. Louis, MO, USA
| | - Kelli England Will
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jennifer M. Mellor
- Department of Economics, College of William and Mary, Williamsburg, VA, USA
| | - Richard A. Grucza
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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