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Armour M, Sinclair J, Noller G, Girling J, Larcombe M, Al-Dabbas MA, Hollow E, Bush D, Johnson N. Illicit Cannabis Usage as a Management Strategy in New Zealand Women with Endometriosis: An Online Survey. J Womens Health (Larchmt) 2020; 30:1485-1492. [PMID: 33275491 DOI: 10.1089/jwh.2020.8668] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Endometriosis affects around 10% of women worldwide. Many women with endometriosis struggle with finding adequate pain management, and data from other countries suggest that women use cannabis, either legal or illicit, to help manage their endometriosis symptoms. The aim of this study was to determine use of cannabis where endometriosis was self-identified as a condition that was being treated with cannabis, as well as the impact of cannabis use on the usage on other pharmaceuticals. Materials and Methods: A cross-sectional online survey of those using cannabis for health-related conditions run between May and July 2019. This article reports on the subset of this larger data set for those reporting they had a diagnosis of endometriosis and/or polycystic ovary syndrome. Data were collected on demographics, modes of cannabis administration, symptoms treated, changes in pharmaceutical usage, and adverse events. Results: Two hundred thirteen valid responses were analyzed. Mean age of respondents was 32 years and 79.8% were current cannabis users. The most common outcomes that cannabis was used for were to improve pain relief (95.5%) and to improve sleep (95.5%). Respondents reported that their symptom was "much better" for pain (81%), sleep (79%), and nausea or vomiting (61%). Over three-quarters (81.4%) indicated cannabis had reduced their normal medication usage. Over half (59%) were able to completely stop a medication, most commonly (66%) analgesics. Opioids (40%) were the most common class of analgesic stopped. Conclusions: Cannabis is reported as an effective intervention for pain and other endometriosis symptoms with potential substitution effects on opioid usage.
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Affiliation(s)
- Mike Armour
- NICM Health Research Institute, Western Sydney University, Sydney, Australia.,Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
| | - Justin Sinclair
- NICM Health Research Institute, Western Sydney University, Sydney, Australia
| | - Geoff Noller
- Department of General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jane Girling
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Maria Larcombe
- Department of General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Mahmoud A Al-Dabbas
- NICM Health Research Institute, Western Sydney University, Sydney, Australia
| | - Erika Hollow
- Coastal Health, Greymouth, Aotearoa, New Zealand
| | - Deborah Bush
- Endometriosis New Zealand, Auckland, New Zealand
| | - Neil Johnson
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia.,Auckland Gynaecology Group and Repromed Auckland, Auckland, New Zealand.,Department of Obstetrics & Gynaecology, University of Auckland, Auckland, New Zealand
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153
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Lee CR, Lee A, Goodman S, Hammond D, Fischer B. The Lower-Risk Cannabis Use Guidelines' (LRCUG) recommendations: How are Canadian cannabis users complying? Prev Med Rep 2020; 20:101187. [PMID: 33083205 PMCID: PMC7554648 DOI: 10.1016/j.pmedr.2020.101187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/19/2020] [Indexed: 12/19/2022] Open
Abstract
Canada, alongside other jurisdictions, implemented non-medical cannabis legalization in 2018, partly towards improving public health. Evidence-based 'Lower-Risk Cannabis Use Guidelines' (LRCUG), including recommendations for cannabis users on how to decrease risk-behaviors for harms, have been developed and widely disseminated in Canada since 2017. However, knowledge on users' compliance with the LRCUG is limited. We identified four major Canadian (three national, one provincial) population surveys presenting key data on cannabis-related behaviors: the National Cannabis Survey, Canadian Cannabis Survey, Canadian Tobacco, Alcohol & Drugs Survey, and CAMH Monitor. We scanned each survey for indicator data mapping onto either of the LRCUG's recommendations for the years 2017 to 2019. Relevant indicator data, albeit with varying operationalizations, were found for six of the ten LRCUG's recommendation clusters in at least some of the surveys, and were extracted and summarized. For results, substantial -- but declining -- majorities of users consumed cannabis by smoking, yet with shifts towards other use modes. Between one- to two-in-five users engaged in the risk-behaviors of using high-potency cannabis products, frequent cannabis use and cannabis-impaired driving, respectively. A small proportion of pregnant or breastfeeding women continued cannabis use during the study period. The data identified found suggested a heterogeneous picture regarding cannabis users' compliance with the LRCUG's recommendations. Non-compliance is highest for recommendations regarding modes-of-use, and applies to minorities of users for other risks factors. These sub-groups are at elevated risk for acute (e.g., accidents) or long-term (e.g., dependence) cannabis-related harms contributing to the public health burden. Appropriate targeted interventions in these areas require improvement.
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Affiliation(s)
- Chae-Rim Lee
- Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Angelica Lee
- Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Samantha Goodman
- School of Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - David Hammond
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Benedikt Fischer
- Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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154
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Callaghan RC, Sanches M, Kish SJ. Quantity and frequency of cannabis use in relation to cannabis-use disorder and cannabis-related problems. Drug Alcohol Depend 2020; 217:108271. [PMID: 32977043 DOI: 10.1016/j.drugalcdep.2020.108271] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND In almost all of the literature examining the relation between cannabis use and cannabis-related harms, researchers have neglected to include quantity measures of cannabis use. The study aims to assess whether cannabis: (1) quantity predicts harms; and (2) quantity might interact with other key variables (age, gender, and frequency of use) vis-à-vis the outcomes. METHOD Using the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), the current study (n = 36,309; n = 3,339 past-year cannabis users) employed a logistic-regression approach to assess the cross-sectional relations between the continuous variables of cannabis-use quantity and frequency and two Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5) DSM-5-based outcomes: past-year cannabis-use disorder (CUD) and past-year cannabis-related problems (CRP). RESULTS In the CUD model, the key variables log quantity [OR = 1.98 (95 % CI, 1.64;2.39), p < 0.001], log frequency [OR = 1.78 (95 % CI, 1.62;1.96), p < 0.001] and the log-quantity-by-log-frequency interaction [OR = 0.83 (95 % CI, 0.75;0.93), p = 0.002] were statistically significant. The final CRP model included the following main predictors: log quantity [OR = 2.13 (95 % CI, 1.70;2.66), p = <0.001], log frequency [OR = 1.50 (95 % CI, 1.36;1.65), p = <0.001], and a log-quantity-by-log-frequency interaction [OR = 0.82 (95 % CI, 0.73;0.93), p = 0.002]. CONCLUSIONS The quantity-by-frequency interactions in both models showed that the relative effect of quantity on cannabis-use disorders and cannabis-related problems decreased as frequency increased, and vice versa.
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Affiliation(s)
- Russell C Callaghan
- University of Northern British Columbia, Northern Medical Program, 3333 University Way, Prince George, British Columbia, V2N 4Z9, Canada; Centre for Addiction and Mental Health (CAMH), Human Brain Laboratory, 250 College Street, Toronto, Ontario, M5T 1L8, Canada; University of Victoria, Canadian Institute for Substance Use Research (CISUR), 2300 McKenzie Avenue, Victoria, British Columbia, V8N 5M8, Canada.
| | - Marcos Sanches
- Centre for Addiction and Mental Health (CAMH), Krembil Centre for Neuroinformatics, 250 College Street, Toronto, Ontario, M5T 1L8, Canada
| | - Stephen J Kish
- Centre for Addiction and Mental Health (CAMH), Human Brain Laboratory, 250 College Street, Toronto, Ontario, M5T 1L8, Canada
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155
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Lower-Risk Cannabis Use Guidelines: Adherence in Canada and the U.S. Am J Prev Med 2020; 59:e211-e220. [PMID: 33158644 DOI: 10.1016/j.amepre.2020.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION This study examines the prevalence of risky cannabis use based on adherence to the Lower-Risk Cannabis Use Guidelines. METHODS Respondents aged 16-65 years in Canada and the U.S. (N=27,024) completed the online 2018 International Cannabis Policy Study. Participants completed measures corresponding to the Lower-Risk Cannabis Use Guidelines and Alcohol, Smoking and Substance Involvement Screening Test. Analyses were conducted in 2019. RESULTS More than half of the respondents (57.3%, n=15,489) had ever used cannabis, and 28.1% (n=7,584) had used it in the past 12 months (current use). The majority of current consumers (88.8%) reported nonadherence to ≥1 guideline other than ever use. These behaviors included smoking ≥50% of all cannabis consumed (69.8%), using high-tetrahydrocannabinol products (44.9%), initiating cannabis use before age 16 years (35.9%), daily/near-daily use (32.2%), driving after cannabis use (26.1%), cannabis use during pregnancy or with a history of psychosis or substance abuse (17.3%), and synthetic cannabis use (5.9%). More respondents in U.S. legal recreational cannabis states reported nonadherence than those in jurisdictions where recreational cannabis remained illegal. Specifically, consumers in U.S. legal states were significantly more likely to use high-tetrahydrocannabinol products than consumers in U.S. illegal states or Canada and more likely to drive after cannabis use than consumers in Canada (p<0.001 for all). Adherence to Lower-Risk Cannabis Use Guidelines was strongly associated with Alcohol, Smoking and Substance Involvement Screening Test scores. CONCLUSIONS Lower-Risk Cannabis Use Guideline adherence differed by jurisdiction and sociodemographic profile. As more jurisdictions legalize nonmedical cannabis, targeted interventions for key risk behaviors (e.g., using high-potency cannabis, early initiation age, driving after cannabis use) are warranted.
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156
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Conde K, Nesoff ED, Peltzer RI, Cremonte M. A Multilevel Model of Alcohol Outlet Density, Individual Characteristics and Alcohol-Related Injury in Argentinean Young Adults. CANADIAN JOURNAL OF ADDICTION 2020; 11:32-39. [PMID: 33585673 PMCID: PMC7880044 DOI: 10.1097/cxa.0000000000000097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Previous research from high-income countries has consistently shown an association between alcohol-related harms and neighborhood characteristics such as alcohol outlet density, but this research has not been extended to middle- and low-income countries. We assessed the role of neighborhood characteristics such as alcohol outlet density, overcrowding and crime rates, and individual characteristics including gender, age, alcohol and marijuana use, and geographic mobility associated with alcohol-related injuries in university students in Argentina. METHODS Data were collected from a randomized sample of students attending a national public university (n = 1346). Descriptive, bivariable, and multilevel logistic regression analyses were performed. RESULTS In the final model, on-premises alcohol outlet density-but not off-premises outlet density, overcrowding or crime-was associated with past-year and lifetime alcohol-related injury (median odds ratio=1.16). At the individual level, quantity (odds ratio (OR)=1.05, 95% CI=(1.01, 1.10)) and frequency (OR=1.66, 95% CI=(1.41,1.97)) of alcohol consumption and age (OR=0.81, 95% CI=(0.74, 0.88)) were associated with past-year and lifetime alcohol-related injury. CONCLUSIONS This study contributes to an area with a paucity of information from non-high-income countries, finding differences with previous literature.
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Affiliation(s)
- Karina Conde
- Institute of Basic, Applied Psychology and Technology (IPSIBAT-CONICET-UNMDP-CIC), Mar del Plata, Buenos Aires, Argentina
- National University of Mar del Plata, Mar del Plata, Buenos Aires, Argentina
| | - Elizabeth D. Nesoff
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W168th St, 5th floor, New York, NY
| | - Raquel I. Peltzer
- Institute of Basic, Applied Psychology and Technology (IPSIBAT-CONICET-UNMDP-CIC), Mar del Plata, Buenos Aires, Argentina
- National University of Mar del Plata, Mar del Plata, Buenos Aires, Argentina
| | - Mariana Cremonte
- Institute of Basic, Applied Psychology and Technology (IPSIBAT-CONICET-UNMDP-CIC), Mar del Plata, Buenos Aires, Argentina
- National University of Mar del Plata, Mar del Plata, Buenos Aires, Argentina
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157
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McClure EA, Rabin RA, Lee DC, Hindocha C. Treatment Implications Associated with Cannabis and Tobacco Co-Use. CURRENT ADDICTION REPORTS 2020; 7:533-544. [PMID: 33777645 PMCID: PMC7992053 DOI: 10.1007/s40429-020-00334-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE OF THE REVIEW The goal of this article is to summarize the treatment-focused literature on cannabis and tobacco co-use and the treatment implications of co-use. This review will focus on: 1) the impact of co-use on cessation outcomes, 2) compensatory use/substitution of the non-treated substance among co-users, and 3) treatment interventions to address co-use. This article will highlight the limitations to co-use captured in the literature and offer considerations and directives for co-use research and treatment moving forward. RECENT FINDINGS The degree to which co-use affects cessation for a single, targeted substance remains in question, as the literature is largely mixed. Cannabis treatment trials are better equipped to answer these questions given that they do not typically exclude tobacco users. While the relationship between tobacco use and poorer cannabis outcomes appears to have some evidence, the reverse relationship (cannabis use affecting tobacco outcomes) is not consistently supported. SUMMARY The co-use of cannabis and tobacco and its impact on single substance cessation and/or compensatory substance use during cessation is generally overlooked in treatment trials, while interventions to address both substances are rare. Capturing co-use adds burden for researchers, clinicians, and participants, but is warranted given the prevalence of co-use and a rapidly changing cannabis and tobacco regulatory environment, which may further complicate co-occurring substance use. Co-users are a heterogeneous population; trials focused on co-users, in addition to better data capture and consistent terminology, will aid in an understanding of nuanced patterns of co-use critical to inform treatment interventions.
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Affiliation(s)
- Erin A. McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Rachel A. Rabin
- Department of Psychiatry, McGill University and The Douglas Mental Health Institute, Montreal, Canada
| | - Dustin C. Lee
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, Department of Clinical, Educational & Health Psychology, University College London, Faculty of Brain Sciences, University College London
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London
- University College Hospital National Institute of Health Research (NIHR) Biomedical Research Centre
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158
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Nasser Y, Woo M, Andrews CN. Cannabis in Gastroenterology: Watch Your Head! A Review of Use in Inflammatory Bowel Disease, Functional Gut Disorders, and Gut-Related Adverse Effects. ACTA ACUST UNITED AC 2020; 18:519-530. [PMID: 33250629 PMCID: PMC7680210 DOI: 10.1007/s11938-020-00323-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 12/22/2022]
Abstract
Purpose of review To review recent clinical evidence surrounding the use of cannabinoids and cannabis in gastrointestinal diseases, particularly inflammatory bowel disease (IBD) and functional gut disorders. A second aim is to evaluate the current status of gastrointestinal related adverse effects which have been linked to cannabis use, specifically cannabis hyperemesis syndrome (CHS) and acute pancreatitis. Recent findings Observational and prospective studies suggest that cannabinoids improve IBD symptoms. Small prospective clinical trials have not shown any effects on objective inflammatory findings, other than one recent paper in ulcerative colitis, in abstract form only, which suggests endoscopic improvement. Short duration mechanistic studies in functional gut disorders suggest cannabinoids may attenuate gastric emptying and slow colonic motility but appear to have less effect on sensory thresholds in the gut. Summary In general, while mostly uncontrolled data suggests cannabis may improve symptoms in IBD (and to a lesser degree functional gut disorders), this is not likely due to any substantial anti-inflammatory effect. Much remains unknown about CHS etiology and complete abstinence from cannabinoids remains the generally accepted treatment strategy. Population-based studies do not suggest that cannabis use is related to acute pancreatitis. Further research is certainly warranted.
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Affiliation(s)
- Yasmin Nasser
- Department of Medicine, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Matthew Woo
- Department of Medicine, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Christopher N. Andrews
- Department of Medicine, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
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159
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Meacham MC, Vogel EA, Thrul J. Vaping-Related Mobile Apps Available in the Google Play Store After the Apple Ban: Content Review. J Med Internet Res 2020; 22:e20009. [PMID: 33185565 PMCID: PMC7695530 DOI: 10.2196/20009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/01/2020] [Accepted: 09/24/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In response to health concerns about vaping devices (eg, youth nicotine use, lung injury), Apple removed 181 previously approved vaping-related apps from the App Store in November 2019. This policy change may lessen youth exposure to content that glamorizes vaping; however, it may also block important sources of information and vaping device control for adults seeking to use vaping devices safely. OBJECTIVE Understanding the types of nicotine and cannabis vaping-related apps still available in the competing Google Play Store can shed light on how digital apps may reflect information available to consumers. METHODS In December 2019, we searched the Google Play Store for vaping-related apps using the keywords "vape" and "vaping" and reviewed the first 100 apps presented in the results. We reviewed app titles, descriptions, screenshots, and metadata to categorize the intended substance (nicotine or cannabis/tetrahydrocannabinol) and the app's purpose. The most installed apps in each purpose category were downloaded and evaluated for quality and usability with the Mobile App Rating Scale. RESULTS Of the first 100 apps, 79 were related to vaping. Of these 79 apps, 43 (54%) were specific to nicotine, 3 (4%) were specific to cannabis, 1 (1%) was intended for either, and for the remaining 31 (39%), the intended substance was unclear. The most common purposes of the apps were making do-it-yourself e-liquids (28/79, 35%) or coils (25/79, 32%), games/entertainment (19/79, 24%), social networking (16/79, 20%), and shopping for vaping products (15/79, 19%). Of the 79 apps, at least 4 apps (5%) paired with vaping devices to control temperature or dose settings, 8 apps (10%) claimed to help people quit smoking using vaping, and 2 apps (3%) had the goal of helping people quit vaping. CONCLUSIONS The majority of vaping-related apps in the Google Play Store had features either to help users continue vaping, such as information for modifying devices, or to maintain interest in vaping. Few apps were for controlling device settings or assisting with quitting smoking or vaping. Assuming that these Google Play Store apps were similar in content to the Apple App Store apps that were removed, it appears that Apple's ban would have a minimal effect on people who vape with the intention of quitting smoking or who are seeking information about safer vaping via mobile apps.
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Affiliation(s)
- Meredith C Meacham
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Erin A Vogel
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, United States
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160
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Wilson M, Klein T, Bindler RJ, Kaplan L. Shared Decision-Making for Patients Using Cannabis for Pain Symptom Management in the United States. Pain Manag Nurs 2020; 22:15-20. [PMID: 33139204 DOI: 10.1016/j.pmn.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/14/2020] [Accepted: 09/17/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Gaps in research evidence and inconsistent policies regarding use of cannabis for pain and associated symptoms result in confusion for healthcare providers and patients. The objective of this review was to synthesize information on cannabis use for pain with legal and policy implications to create a shared decision-making model that can be used to guide patient care interactions. APPROACH Current cannabis policies, state laws, research, and patient care practices related to medical and recreational cannabis in the United States were reviewed, along with best practices in shared decision-making. Reviewed literature was then synthesized to create a model that can be used by registered nurses and others to address cannabis use, where legal, for pain and related symptoms. RESULT AND CONCLUSIONS Cannabis is a legal option for many patients with pain. To minimize harms and optimize benefits, nurses can play a key role when authorized by law in assisting with decision-making surrounding cannabis use.
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Affiliation(s)
- Marian Wilson
- College of Nursing, Washington State University, Spokane, Washington, USA.
| | - Tracy Klein
- College of Nursing, Washington State University, Vancouver, Washington, USA
| | - Ross J Bindler
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Louise Kaplan
- College of Nursing, Washington State University, Vancouver, Washington, USA
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161
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Lloyd SL, Lopez-Quintero C, Striley CW. Sex differences in driving under the influence of cannabis: The role of medical and recreational cannabis use. Addict Behav 2020; 110:106525. [PMID: 32711286 DOI: 10.1016/j.addbeh.2020.106525] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Existing evidence suggest that cannabis may impair driving and is the most prevalent drug identified in drivers. Males exhibit an excess risk for driving under the influence of drugs or alcohol compared to females. We assessed sex differences in the association between the reason for cannabis use (medical, recreational, or both) and driving under the influence of cannabis (DUIC). METHODS A sample of 17,405 past 12-month cannabis users (18 + years old) were analyzed from the 2016-17 National Survey on Drug Use and Health. Multivariable logistic regression was used to assess the interaction of sex and reason for cannabis use on DUIC using predicted probabilities. RESULTS Among cannabis users in the sample, 88.1% used for recreational reasons, 7.8% used for medical reasons, and 4.1% used for medical and recreational reasons. The probability of DUIC was as low as 20% among female medical only users, and as high as 40% among male combined medical and recreational users. Females showed more similar probabilities of DUIC across reasons of use (range 20% to 25%s) than males (range 28% to 40%). The difference in the probability of DUIC between combined medical and recreational users and recreational only users was significantly greater among males than among females (Δ 0.1, p < 0.05). CONCLUSIONS The observed effects of sex and reasons for cannabis use on DUIC suggests a need for targeted educational interventions, particularly among males reporting combined medical and recreational marijuana use.
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162
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The Lower-Risk Cannabis Use Guidelines (LRCUG): A ready-made targeted prevention tool for cannabis in New Zealand. PUBLIC HEALTH IN PRACTICE 2020; 1:100046. [PMID: 36101675 PMCID: PMC9461312 DOI: 10.1016/j.puhip.2020.100046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/10/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022] Open
Abstract
Cannabis use is common, especially among young people, and associated with risks for select acute and chronic adverse health and social outcomes. New Zealand features overall high cannabis use levels, yet may soon follow other jurisdictions and implement legalization of non-medical cannabis use and supply towards public health objectives. While existing cannabis-oriented interventions mainly focus on primary prevention and treatment (e.g., for dependence), key harms from use are crucially influenced by risk factors that can be modified by the user. On this basis, and similar to other health behavior-oriented interventions, ‘Lower-Risk Cannabis Use Guidelines’ (LRCUG), consisting of 10 recommendation clusters for lower-risk use, were systematically developed in Canada as an evidence-based, targeted prevention tool towards reducing adverse outcomes among cannabis users. We briefly summarize the concept of and experiences with implementation of the LRCUG elsewhere, and describe how their adoption as a population health intervention may serve public health goals of possible cannabis legalization in New Zealand and elsewhere. Cannabis is common, but involves risks for acute and chronic adverse outcomes. Many adverse outcomes are influenced by user-modifiable risk factors. Cannabis use and supply legalization may be implemented in New Zealand. Evidence-based ‘Lower-Risk Cannabis Use Guidelines’ are a targeted prevention tool. LRCUG may serve a valuable intervention towards legalization’s public health outcomes.
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163
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Manthey J, Kalke J, Rehm J, Rosenkranz M, Verthein U. Controlled administration of cannabis to mitigate cannabis-attributable harm among recreational users: a quasi-experimental study in Germany. F1000Res 2020; 9:201. [PMID: 32789008 PMCID: PMC7400698 DOI: 10.12688/f1000research.22612.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 12/05/2022] Open
Abstract
Background: New approaches are required to slow down or reverse increasing trends of levels of delta-9-tetrahydrocannabinol (THC) and cannabis-attributable hospitalizations in Germany. Legal access to cannabis may constitute one viable effective policy response; however, available evidence does not suffice to inform a regulation model for Germany. The proposed study aims to reduce harm for cannabis users through legal access to herbal cannabis through pharmacies. Protocol: A quasi-experimental study comparing cannabis users with legal access to herbal cannabis (Berlin, intervention group) to those without legal access (Hamburg, control group) (total N=698). As the primary outcome, we hypothesize that: 1) illegal THC consumption will reduce by at least 50% in the intervention group and 2) total THC exposure in the intervention group will be reduced by at least 10% lower than that of the control group, taking into account baseline values. Secondary outcomes comprise measures of frequency of use, THC-impaired driving, and mode of administration. Paired t-tests and multilevel regression models will be performed for statistical analyses. Discussion: This study proposal is currently being reviewed by the ‘Federal Institute for Drugs and Medical Devices’ – the body responsible for approving research studies on classified substances, including cannabis. Upon approval and prior to the start of the study, a full ethical review will be undertaken. Results may inform a regulation model for Germany and other jurisdictions and are expected to deepen the understanding of the effects of legal access to cannabis. Pre-registration: German Clinical Trials Register (DRKS), DRKS00020829
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Affiliation(s)
- Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Centre for Interdisciplinary Addiction Research, Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Kalke
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Centre for Interdisciplinary Addiction Research, Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute for Mental Health Policy Research and Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Moritz Rosenkranz
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Verthein
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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164
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Ramadan MM, Banta JE, Bahjri K, Montgomery SB. Frequency of cannabis use and alcohol-associated adverse effects in a representative sample of U.S. adolescents and youth (2002-2014) a cross-sectional study. J Cannabis Res 2020; 2:38. [PMID: 33526136 PMCID: PMC7819326 DOI: 10.1186/s42238-020-00043-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/25/2020] [Indexed: 02/08/2023] Open
Abstract
Background While the link between frequent cannabis use and alcohol use disorders is well documented, it is not clear whether alcohol drinkers who use cannabis less frequently are also vulnerable to alcohol use disorders. We estimate the association of frequency of past 12-months cannabis use with alcohol-associated adverse effects variables in the same time frame: alcohol dependence, heavy drinking, driving under alcohol influence, alcohol-related interpersonal problems, use after interpersonal problems, alcohol-related risky behaviors, and alcohol-related legal problems. Methods We analyzed data from U.S. individuals aged 12 to 25 years who participated in annual, cross-sectional U.S. National Surveys on Drug Use and Health from 2002 to 2014. Logistic regression models were used to examine the association of cannabis use with six alcohol-associated adverse effects variables. Frequency of cannabis use served as the primary independent variable, and were divided into four categories: frequent use (21–30 days per month), less frequent use (1–20 days per month), no use over the past 12 months, and no lifetime cannabis use. Alcohol dependence and six alcohol-associated adverse effects variables served as our primary outcomes. Results The study included 465,090 respondents aged 12 to 25 years, among all past-year cannabis users, (47.5%) were less frequent (1–20 days/month) users. Less frequent cannabis use was highest among male, 15–25-year-olds, and non-Hispanic white 11.8, 84 and 10.6%, respectively. In adjusted models, past-year less frequent cannabis use (1–20 days/month) was significantly associated with past-year alcohol dependence (adjusted odds ratio aOR 5.57, 95% confidence interval (CI) 5.5–6.4); heavy drinking in the past-year (aOR 3.41, 95% CI 3.2–3.5); alcohol-related interpersonal problems in the past-year (aOR 7.33, 95% CI 7.0–7.5); use after interpersonal problems (aOR 5.17, 95% CI 4.8–5.5); alcohol-related risky behaviors (aOR 7.29, 95% CI 7.0–7.5), and, driving under influence of alcohol (aOR 7.19, 95% CI 6.9–7.4). No cannabis use past-year were more likely to report alcohol dependence (aOR 2.81, 95% CI 2.6–3) compared with no lifetime cannabis use. Conclusion These findings indicated that within the general population, not only frequent cannabis user (21–30 days per month) but even less frequent cannabis use (1–20 days/month) was significantly associated with past-year alcohol dependence and alcohol-associated adverse effects than no lifetime cannabis use. These adverse alcohol-related outcomes associated with less frequent cannabis use, should be taken under careful consideration in alcohol use disorder treatment setting and policy planning.
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Affiliation(s)
- Majed M Ramadan
- Department of Health Policy and Leadership, School of Public Health, University of Loma Linda, 24951 North Circle Drive, Nichol Hall 1107, Loma Linda, CA, 92350, USA.
| | - Jim E Banta
- Center for Leadership in Health Systems, School of Public Health, Loma Linda University, 24951 North Circle Drive, Nichol Hall 1107, Loma Linda, CA, 92350, USA
| | - Khaled Bahjri
- Pharmaceutical & Administrative Sciences, School of Pharmacy, Loma Linda University, 24745 Stewart Street, Shryock Hall, Room 227, Loma Linda, CA, 92350, USA
| | - Susanne B Montgomery
- Research Loma Linda University
- School of Behavioral Health and Research, Behavioral Health Institute, Griggs Hall, 224, 11065 Campus Street, Loma Linda, CA, 92350, USA
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165
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Mihretu A, Fekadu A, Habtamu K, Nhunzvi C, Norton S, Teferra S. Exploring the concept of problematic khat use in the Gurage community, South Central Ethiopia: a qualitative study. BMJ Open 2020; 10:e037907. [PMID: 33046468 PMCID: PMC7552831 DOI: 10.1136/bmjopen-2020-037907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study aimed to explore how problematic khat use is characterised in the Gurage community in South Central Ethiopia. DESIGN Qualitative study. SETTING Gurage community in South Central Ethiopia. PARTICIPANTS We conducted indepth interviews with 14 khat users and 5 non-khat users, and three focus group discussions with khat users. METHODS All participants were selected purposively based on their exposure to khat or khat use. We used an interview guide to explore the perceptions of participants about khat use and problematic khat use. We analysed the data thematically using OpenCode V.4.03 software. We used iterative data collection and analysis, triangulation of methods, and respondent validation to ensure scientific rigour. FINDINGS We identified three major themes: sociocultural khat use, khat suse (khat addiction) and negative consequences of khat use. Sociocultural khat use included a broad range of contexts and patterns, including use of khat for functional, social, cultural and religious reasons. Khat addiction was mainly explained in terms of associated khat withdrawal experiences, including harara/craving and inability to quit. We identified mental health, sexual life, physical health, social and financial negative consequences of khat use. The local idiom jezba was used to label a subgroup of individuals with khat suse (khat addiction). CONCLUSION The study has identified what constitutes normative and problematic khat use in the Gurage community in South Central Ethiopia. Problematic khat use is a broad concept which includes frequency, reasons, contexts, negative consequences and addiction to khat. Insights generated can be used to inform future studies on the development of tools to measure problematic khat use.
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Affiliation(s)
- Awoke Mihretu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Social Sciences, College of Natural and Social Sciences, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kassahun Habtamu
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Clement Nhunzvi
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Sam Norton
- Psychology Department, Institute of Psychiatry, King's College London, London, UK
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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166
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Calling for Openness to the Study of Cannabis Use in Chronic Pelvic Pain. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:611-613. [PMID: 33132057 DOI: 10.1016/j.jogc.2020.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 11/20/2022]
Abstract
Chronic pelvic pain affects women across all demographics. Its management is complex and requires a multimodal approach. Cannabis has been legal for medical purposes for many years; however, its pharmacokinetics are just beginning to be understood, as are its analgesic effects and other benefits, such as improved sleep quality and reduced nausea and vomiting. Given the recent Canada-wide legalization of cannabis for non-medical use, patients may be more willing to disclose cannabis use and use it for pain management. Given the complexity of chronic pain management, physicians must be open to cannabis as an analgesic option. Cannabis use may decrease the need for opioids, a phenomenon that could reduce opioid dependency. Now is the ideal time to study patients' use of and perspectives on cannabis for pain relief in order to establish its effectiveness and safety. Cannabis shows potential to be a key player in a multimodal approach to chronic pelvic pain.
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167
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Kruger DJ, Moffet IM, Seluk LC, Zammit LA. A content analysis of internet information sources on medical cannabis. J Cannabis Res 2020; 2:29. [PMID: 33526127 PMCID: PMC7819301 DOI: 10.1186/s42238-020-00041-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/11/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Medical cannabis users report that their knowledge regarding cannabis is predominantly from their own personal experiences and the Internet. OBJECTIVE We summarize and describe information found through Internet searches on medical cannabis in English language websites. METHODS We used terms related to medical cannabis in the Google search engine between November and December 2019. Resulting websites were catalogued and coded for content, including mentions of health and medical conditions, pharmacology, dosage, harmful or adverse effects, harm reduction techniques, cautions or warnings, products for sale, and credentials. RESULTS We coded 344 web pages on 179 unique websites. Cannabis was mentioned for the treatment of 151 different medical and health conditions, only four of the twenty most frequently mentioned conditions have received substantial empirical support for cannabis or cannabinoid treatment. Information content varied widely across sites, only a small proportion of sites included information on pharmacology, dosage, risks, and other aspects that are requirements for pharmaceutical drugs. Information provided was only moderately related to conclusions in the emerging scientific literature. CONCLUSIONS Given the rise in cannabis use within the U.S. and the reliance on the Internet as a source of information, considerable efforts are needed to provide accurate on-line cannabis education to minimize harms and maximize benefits for individuals and society.
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Affiliation(s)
- Daniel J. Kruger
- Population Studies Center, Institute for Social Research, University of Michigan, 426 Thompson St, Ann Arbor, MI 48109-1248 USA
| | - Ilana M. Moffet
- Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI USA
- Undergraduate Research Opportunities Program, University of Michigan, Ann Arbor, MI USA
| | - Liliah C. Seluk
- Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI USA
- Undergraduate Research Opportunities Program, University of Michigan, Ann Arbor, MI USA
| | - Lara A. Zammit
- Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI USA
- Undergraduate Research Opportunities Program, University of Michigan, Ann Arbor, MI USA
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168
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Abstract
As is the case for most drugs, cannabis use has costs and benefits, and so do the policies that attempt to minimize the first and maximize the second. This article summarizes what we know about the harmful effects of recreational cannabis use and the benefits of medical cannabis use under the policy of prohibition that prevailed in developed countries until 2012. It outlines three broad ways in which cannabis prohibition may be relaxed, namely, the depenalization of personal possession and use, the legalization of medical use, and the legalization of adult recreational use. It reviews evidence to date on the impacts of each of these forms of liberalization on the costs and benefits of cannabis use. It makes some plausible conjectures about the future impacts of the commercialization of cannabis using experience from the commercialization of the alcohol, tobacco, and gambling industries. Cannabis policy entails unavoidable trade-offs between competing social values in the face of considerable uncertainty about the effects that more liberal cannabis policies will have on cannabis use and its consequences for better or worse.
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Affiliation(s)
- Wayne Hall
- The National Centre for Youth Substance Use Research; The Queensland Alliance for Environmental Health Sciences; The University of Queensland, Australia
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169
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Weisbeck SJ, Bright KS, Ginn CS, Smith JM, Hayden KA, Ringham C. Perceptions about cannabis use during pregnancy: a rapid best-framework qualitative synthesis. Canadian Journal of Public Health 2020; 112:49-59. [PMID: 32754880 DOI: 10.17269/s41997-020-00346-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/14/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE A rapid review was conducted in order to produce a streamlined and time-limited systematic evidence review to understand women's perceptions, beliefs, and knowledge of the risks associated with cannabis use during pregnancy. METHODS MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, EMBASE, PsycINFO (OVID interface), and CINAHL (Ebsco interface) databases were searched from inception to March 2019. Qualitative and descriptive studies, and reviews that addressed pregnant women's perceptions, beliefs, and attitudes about personal cannabis use were included. The methodological quality of the included studies was appraised using valid tools and data extraction was guided by suitable checklists. Full text of 18 citations was retrieved and reviewed, and 5 studies met the inclusion criteria. SYNTHESIS Women who continued to use cannabis during pregnancy often perceived less risk compared with nonusers. Their uncertainty regarding adverse consequences, perceived therapeutic effects, and lack of communication with health care providers contributed to cannabis use. Women perceived this lack of counselling as an indication that outcomes of cannabis use while pregnant were not significant. CONCLUSION This synthesis highlights important factors in women's decision-making processes regarding use or cessation of cannabis during pregnancy. In addition, the importance of health care providers providing information, education, and appropriate counselling to childbearing women is highlighted as these conversations may influence women's perceptions of risk and help them make informed choices.
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Affiliation(s)
- Sarah J Weisbeck
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB, T2N 1N4, Canada
| | - Katherine S Bright
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB, T2N 1N4, Canada
| | - Carla S Ginn
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB, T2N 1N4, Canada.
| | - Jacqueline M Smith
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB, T2N 1N4, Canada
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, 2500 University Dr. N.W, Calgary, AB, T2N 1N4, Canada
| | - Catherine Ringham
- Faculty of Nursing, Alberta Health Services, University of Calgary, 2500 University Dr. N.W, Calgary, AB, T3N 1N4, Canada
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170
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Carrara L, Giroud C, Concha-Lozano N. Development of a Vaping Machine for the Sampling of THC and CBD Aerosols Generated by Two Portable Dry Herb Cannabis Vaporisers. Med Cannabis Cannabinoids 2020; 3:84-93. [PMID: 34676343 PMCID: PMC8489338 DOI: 10.1159/000505027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022] Open
Abstract
Cannabis sativa is known for its recreational use, but also for its therapeutic potential. There has been wide discussion over the use of cannabis for medical purposes in recent years, especially because a consensus has not been reached regarding its risk/benefit balance. Among the more common modes of administration, vaping with a vaporiser is most frequently used for self-medication. Vaping seems to be a better alternative to preventing adverse health effects due to toxic compounds produced during combustion when cannabis is smoked. However, the delivery kinetics and efficiency of most portable vaporisers are not fully characterised with an appropriate vaping regime. This determination requires a specific vaping machine operating under realistic puffing conditions. In this study, a vaping machine was conceived to fit with the common uses of portable vaporisers that requires conditions different from those used for electronic cigarettes. The experimental setup in this study was optimised to sample aerosolised cannabinoids. The delivery kinetics, efficiency, and decarboxylation yields of two commercially available vaporisers (DaVinci® and Mighty Medic®) were evaluated for delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Among all tested sampling supports, the glass fibre filter is the most efficient medium to collect mixed THC and CBD aerosols. From the delivery kinetics of cannabinoids, a single-parameter model was used to calculate the extraction coefficient of each vaporiser. The results show that the Mighty Medic® vaporiser had a higher extraction coefficient (0.39) and a more immediate release of cannabinoids than the DaVinci® vaporiser (0.16), which had a gradual and slower rate of vaporisation. This parameter could be a quantitative input in pharmacokinetic models of administration of volatile compounds using vaporisers and a useful tool for the comparison of vaporisers.
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Affiliation(s)
| | | | - Nicolas Concha-Lozano
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine Lausanne, Lausanne, Switzerland
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171
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Fischer B, Daldegan‐Bueno D, Boden JM. Facing the option for the legalisation of cannabis use and supply in New Zealand: An overview of relevant evidence, concepts and considerations. Drug Alcohol Rev 2020; 39:555-567. [PMID: 32436274 PMCID: PMC7383663 DOI: 10.1111/dar.13087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/18/2022]
Abstract
ISSUES Non-medical cannabis policies are changing, including towards legalisation-with-regulation frameworks. New Zealand will hold a public referendum on cannabis legalisation in 2020. We reviewed data on cannabis use and health/social harms; policy reform options; experiences with and outcomes of reforms elsewhere; and other relevant considerations towards informing policy choices in the upcoming referendum. APPROACH Relevant epidemiological, health, social, criminal justice and policy studies and data were identified and comprehensively reviewed. KEY FINDINGS Cannabis use is common (including in New Zealand) and associated with risks for health and social harms, mainly concentrated in young users; key harms are attributable to criminalisation. 'Decriminalisation' reforms have produced ambivalent results. Existing cannabis legalisation frameworks vary considerably in main parameters. Legalisation offers some distinct advantages, for example regulated use, products and user education, yet outcomes depend on essential regulation parameters, including commercialisation, and policy ecologies. While major changes in use are not observed, legalisation experiences are inconclusive to date, including mixed health and social outcomes, with select harms increasing and resilient illegal markets. It is unclear whether legalisation reduces cannabis exposure or social harms (e.g. from enforcement) for youth. IMPLICATIONS/CONCLUSIONS No conclusive overall evidence on the outcomes of legalisation elsewhere exists, nor is evidence easily transferable to other settings. Legalisation offers direct social justice benefits for adults, yet overall public health impacts are uncertain. Legalisation may not categorically improve health or social outcomes for youth. Legalisation remains a well-intended, while experimental policy option towards more measured and sensible cannabis control and overall greater policy coherence, requiring close monitoring and possible adjustments depending on setting-specific outcomes.
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Affiliation(s)
- Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
- Department of PsychiatryUniversity of TorontoTorontoCanada
- Centre for Applied Research in Mental Health and AddictionSimon Fraser UniversityVancouverCanada
- Department of PsychiatryFederal University of Sao PauloSao Paulo, Brazil
| | - Dimitri Daldegan‐Bueno
- Schools of Population Health and Pharmacy, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Joseph M. Boden
- Department of Psychological MedicineUniversity of OtagoChristchurchNew Zealand
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172
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Freeman TP, Lorenzetti V. 'Standard THC units': a proposal to standardize dose across all cannabis products and methods of administration. Addiction 2020; 115:1207-1216. [PMID: 31606008 DOI: 10.1111/add.14842] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/18/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Cannabis products are becoming increasingly diverse, and vary considerably in concentrations of ∆9 -tetrahydrocannabinol (THC) and cannabidiol (CBD). Higher doses of THC can increase the risk of harm from cannabis, while CBD may partially offset some of these effects. Lower Risk Cannabis Use Guidelines currently lack recommendations based on quantity of use, and could be improved by implementing standard units. However, there is currently no consensus on how units should be measured or standardized among different cannabis products or methods of administration. ARGUMENT Existing proposals for standard cannabis units have been based on specific methods of administration (e.g. joints) and these may not capture other methods, including pipes, bongs, blunts, dabbing, vaporizers, vape pens, edibles and liquids. Other proposals (e.g. grams of cannabis) cannot account for heterogeneity in THC concentrations among different cannabis products. Similar to alcohol units, we argue that standard cannabis units should reflect the quantity of primary active pharmacological constituents (dose of THC). On the basis of experimental and ecological data, public health considerations and existing policy, we propose that a 'standard THC unit' should be fixed at 5 mg THC for all cannabis products and methods of administration. If supported by sufficient evidence in future, consumption of standard CBD units might offer an additional strategy for harm reduction. CONCLUSIONS Standard ∆9 -tetrahydrocannabinol (THC) units can potentially be applied among all cannabis products and methods of administration to guide consumers and promote safer patterns of use.
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Affiliation(s)
- Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK.,National Addiction Centre, King's College London, London,, UK.,Clinical Psychopharmacology Unit, University College London, London, UK
| | - Valentina Lorenzetti
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
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173
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Song A, Myung NK, Bogumil D, Ihenacho U, Burg ML, Cortessis VK. Incident testicular cancer in relation to using marijuana and smoking tobacco: A systematic review and meta-analysis of epidemiologic studies. Urol Oncol 2020; 38:642.e1-642.e9. [PMID: 32409200 DOI: 10.1016/j.urolonc.2020.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent epidemiologic studies identified credible associations between marijuana smoking and risk of nonseminomatous testicular germ cell tumors (TGCTs), but did not distinguish exposure to cannabinoid compounds from exposure to other constituents of smoke. METHODS We implemented a systematic review of scholarly literature followed by random effects meta-analysis to quantitatively synthesize published data relating incident TGCT to each of 2 exposure histories: ever using marijuana, and ever smoking tobacco. RESULTS We identified four epidemiologic studies of marijuana use and 12 of tobacco smoking. Summary data concur with earlier reports of a specific association of marijuana use with nonseminoma, summary odds ratio [sOR] = 1.71 (95% confidence interval [CI] 1.12-2.60), and identify a positive association, sOR = 1.18 (95% CI 1.05-1.33), between tobacco smoking and all TGCT. CONCLUSIONS Available data accord with positive associations between incident TGCT and each exposure, implicating both cannabinoid compounds and other constituents of smoke. Etiologic interpretation awaits epidemiologic studies that assess associations between tobacco smoking and nonseminomatous TGCT, investigating not only these exposures but also both co-use of tobacco and marijuana and smoke-free sources of cannabinoids, while adequately evaluating potential confounding among all of these exposures.
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Affiliation(s)
- Ashley Song
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA
| | - No Kang Myung
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA
| | - David Bogumil
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA
| | - Ugonna Ihenacho
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA; Department of Obstetrics and Gynecology, Keck School of Medicine of USC, Los Angeles, CA
| | - Madeleine L Burg
- Institute of Urology, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Victoria K Cortessis
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA; Department of Obstetrics and Gynecology, Keck School of Medicine of USC, Los Angeles, CA.
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174
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Fischer B, Russell C, Rehm J, Leece P. Assessing the public health impact of cannabis legalization in Canada: core outcome indicators towards an 'index' for monitoring and evaluation. J Public Health (Oxf) 2020; 41:412-421. [PMID: 29860521 DOI: 10.1093/pubmed/fdy090] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/13/2018] [Accepted: 05/02/2018] [Indexed: 12/31/2022] Open
Abstract
The legalization of non-medical cannabis use and supply is impending in Canada. This constitutes a major policy change with the declared objective of improving public health outcomes, which requires rigorous monitoring and evaluation. While numerous different aspects associated with legalization will be examined, a focused perspective is required for effective policy evaluation purposes. To these ends, we have identified a set of 10 core indicators associated with cannabis-related risk/harm outcomes-based on current best evidence-that are expected to measure the primary impacts of legalization on public health outcomes. We briefly review these indicators, and their respective data availability in Canada. As ideally an integrated outcome assessment of cannabis legalization's impact on public health will be available, we further propose options to merge the individual indicators into an integrated, weighted 'index', considering their expected relative impact for public health. One possible approach to undertake this is 'multi-criteria decision analysis' as a method to weight the relative indicator impact on public health; alternative approaches are proposed. The integrated 'public health index' for cannabis legalization will allow for scientifically comprehensive, while focused, monitoring and evaluation of the effects of legalization in Canada for the benefits of science and evidence-based policy alike.
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Affiliation(s)
- Benedikt Fischer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Canada.,Centre for Criminology & Sociolegal Studies, University of Toronto, Toronto, Canada.,Department of Psychiatry, Federal University of São Paulo (UNIFESP), 785 05403-903 São Paulo, Brazil
| | - Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
| | - Pamela Leece
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
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175
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Brubacher JR, Chan H, Staples JA. Cannabis-impaired driving and Canadian youth. Paediatr Child Health 2020; 25:S21-S25. [PMID: 32581627 DOI: 10.1093/pch/pxaa017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023] Open
Abstract
Acute cannabis use results in inattention, delayed information processing, impaired coordination, and slowed reaction time. Driving simulator studies and epidemiologic analyses suggest that cannabis use increases motor vehicle crash risk. How much concern should we have regarding cannabis associated motor vehicle collision risks among younger drivers? This article summarizes why young, inexperienced drivers may be at a particularly high risk of crashing after using cannabis. We describe the epidemiology of cannabis use among younger drivers, why combining cannabis with alcohol causes significant impairment and why cannabis edibles may pose a heightened risk to traffic safety. We provide recommendations for clinicians counselling younger drivers about cannabis use and driving.
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Affiliation(s)
- Jeff R Brubacher
- Faculty of Medicine, Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia
| | - Herbert Chan
- Faculty of Medicine, Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia
| | - John A Staples
- Faculty of Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia
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176
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Cannabis Use as a Risk Factor for Depression, Anxiety, and Suicidality: Epidemiological Associations and Implications for Nurses. J Addict Nurs 2020; 31:92-101. [PMID: 32487935 DOI: 10.1097/jan.0000000000000334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Psychiatric disorders and substance use disorders commonly co-occur and are major public health concerns given the morbidity and mortality associated with them. Globally, cannabis is among the most commonly used drugs, and cannabis use frequently begins in adolescence or emerging adulthood, both important periods of development and periods in which psychiatric symptoms and disorders frequently emerge. Thus, the relationships between cannabis use and mental illnesses are essential for nurses and other healthcare professionals and researchers to explore and understand. This literature review examines the relationships between cannabis use and depression, anxiety, and suicide. It includes a primer on the neurobiology of cannabis effects; an overview on the epidemiological evidence on the associations between cannabis use and depression, anxiety, and suicide; and a discussion of implications for nurses, particularly important given changes in the medical and recreational cannabis legislation in North America. Overall, this review found consistent evidence showing a cross-sectional association between recreational cannabis use and depression, anxiety, and suicide, despite some limitations and conflicts in the literature. In addition, most evidence from longitudinal or case control studies suggested cannabis use preceded the development of depressive symptoms and suicidal behaviors, although the quality of this evidence was mixed. Implications for future research and nursing practice are discussed.
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177
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Maloney-Hall B, Wallingford SC, Konefal S, Young MM. Psychotic disorder and cannabis use: Canadian hospitalization trends, 2006-2015. Health Promot Chronic Dis Prev Can 2020; 40:176-183. [PMID: 32529977 PMCID: PMC7367424 DOI: 10.24095/hpcdp.40.5/6.06] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Given the recent and impending changes to the legal status of nonmedical cannabis use in Canada, understanding the effects of cannabis use on the health care system is important for evaluating the impact of policy change. The aim of this study was to examine pre-legalization trends in hospitalizations for mental and behavioural disorders due to the use of cannabis, according to demographics factors and clinical conditions. METHODS We assessed the total number of inpatient hospitalizations for psychiatric conditions with a primary diagnosis of a mental or behavioural disorder due to cannabis use (ICD-10-CA code F12) from the Hospital Mental Health Database for ten years spanning 2006 to 2015, inclusive. We included hospitalizations from all provinces and territories except Quebec. Rates (per 100 000 persons) and relative proportions of hospitalizations by clinical condition, age group, sex and year are reported. RESULTS Between 2006 and 2015, the rate of cannabis-related hospitalizations in Canada doubled. Of special note, however, is that hospitalizations during this time period for those with the clinical condition code "mental and behavioural disorders due to use of cannabinoids, psychotic disorder" (F12.5) tripled, accounting for almost half (48%) of all cannabis-related hospitalizations in 2015. CONCLUSION Further research is required to investigate the reasons for the increase in hospitalizations for cannabis-related psychotic disorder. The introduction of high-potency cannabinoid products and synthetic cannabinoids into the illicit market are considered as possible factors.
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Affiliation(s)
| | | | - Sarah Konefal
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Matthew M Young
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
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Williams AR. Cannabis as a Gateway Drug for Opioid Use Disorder. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:268-274. [PMID: 32631185 PMCID: PMC7359408 DOI: 10.1177/1073110520935338] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cannabis use in some individuals can meaningfully introduce de novo risk for the initiation of opioid use and development of opioid use disorder. These risks may be particularly high during adolescence when cannabis use may disrupt critical periods of neurodevelopment. Current research studying the combination of genetic and environmental factors involved in substance use disorders is poorly understood. More research is needed, particularly to identify which adolescents are most at risk and to develop effective interventions addressing contributing factors such as trauma and psychiatric comorbidity.
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Affiliation(s)
- Arthur Robin Williams
- Arthur Robin Williams, M.D., M.B.E., is an Assistant Professor, Division on Substance Use Disorders, Columbia University Department of Psychiatry and a Research Scientist, New York State Psychiatric Institute
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179
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Hall W, Lynskey M. Assessing the public health impacts of legalizing recreational cannabis use: the US experience. World Psychiatry 2020; 19:179-186. [PMID: 32394566 PMCID: PMC7215066 DOI: 10.1002/wps.20735] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The sale of cannabis for adult recreational use has been made legal in nine US states since 2012, and nationally in Uruguay in 2013 and Canada in 2018. We review US research on the effects of legalization on cannabis use among adults and adolescents and on cannabis-related harms; the impact of legalizing adult recreational use on cannabis price, availability, potency and use; and regulatory policies that may increase or limit adverse effects of legalization. The legalization of recreational cannabis use in the US has substantially reduced the price of cannabis, increased its potency, and made cannabis more available to adult users. It appears to have increased the frequency of cannabis use among adults, but not so far among youth. It has also increased emergency department attendances and hospitalizations for some cannabis-related harms. The relatively modest effects on cannabis use to date probably reflect restrictions on the number and locations of retail cannabis outlets and the constraints on commercialization under a continued federal prohibition of cannabis. Future evaluations of legalization should monitor: cannabis sales volumes, prices and content of tetrahydrocannabinol; prevalence and frequency of cannabis use among adolescents and adults in household and high school surveys; car crash fatalities and injuries involving drivers who are cannabis-impaired; emergency department presentations related to cannabis; the demand for treatment of cannabis use disorders; and the prevalence of regular cannabis use among vulnerable young people in mental health services, schools and the criminal justice system. Governments that propose to legalize and regulate cannabis use need to fund research to monitor the impacts of these policy changes on public health, and take advantage of this research to develop ways of regulating can-nabis use that minimize adverse effects on public health.
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Affiliation(s)
- Wayne Hall
- University of Queensland Centre for Youth Substance Abuse Research, Brisbane, Australia
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Michael Lynskey
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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180
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Fischer B, Bullen C, Elder H, Fidalgo TM. Considering the health and social welfare impacts of non-medical cannabis legalization. World Psychiatry 2020; 19:187-188. [PMID: 32394558 PMCID: PMC7214954 DOI: 10.1002/wps.20736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auck-land, New Zealand
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Chris Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Hinemoa Elder
- Rangahau Roro Aotearoa, Brain Research NZ, Starship Children's Hospital, University of Auckland, Auckland, New Zealand
| | - Thiago M Fidalgo
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
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181
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Cheng P, Zagaran A, Rajabali F, Turcotte K, Babul S. Setting the baseline: a description of cannabis poisonings at a Canadian pediatric hospital prior to the legalization of recreational cannabis. Health Promot Chronic Dis Prev Can 2020; 40:193-200. [PMID: 32529979 PMCID: PMC7367428 DOI: 10.24095/hpcdp.40.5/6.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION This study describes the events and circumstances preceding children aged 16 years or younger being treated for cannabis poisoining in the emergency department (ED) of a Canadian pediatric hospital. METHODS We extracted cannabis poisoning treated in the ED at British Columbia Children's Hospital (BCCH) between 1 January, 2016 and 31 December, 2018, from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database. The poisonings were distinguished by the inadvertent or intentional ingestion of cannabis. We reviewed the hospital's electronic health information system and the patients' health records to obtain additional information on the context, including spatial and temporal characteristics. RESULTS Of the 911 poisonings treated at BCCH, 114 were related to intentional cannabis use (12.5%). Fewer than 10 poisonings resulted from inadvertent ingestions by children and the median age for these was 3 years. All inadvertent ingestion occurred at home and involved cannabis belonging to the patient's family. The vast majority of poisonings resulted from the intentional use of cannabis only (28.9%) or cannabis use with other psychoactive substances (co-ingestions; 71.1%). The median patient age was 15 years. Most patients reported consuming cannabis through inhalation with peers. Cannabis and co-ingestion poisonings were more often reported on weekdays than weekends. The consumption of cannabis leading to poisoning more often occurred in private residences. Patients with cannabis poisoning more often sought medical treatment themselves or were helped by their family. CONCLUSION The characteristics of cannabis poisonings among children are described for the three-year period prior to recreational cannabis legalization in Canada in order to set a baseline for future comparisons. Implications for improving injury prevention initiatives and policies are discussed.
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Affiliation(s)
- Phoebe Cheng
- Canadian Hospitals Injury Reporting and Prevention Program, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Atousa Zagaran
- Canadian Hospitals Injury Reporting and Prevention Program, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Fahra Rajabali
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Kate Turcotte
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Shelina Babul
- Canadian Hospitals Injury Reporting and Prevention Program, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
From a public health perspective, gambling shares many of the same characteristics as alcohol. Notably, excessive gambling is associated with many physical and emotional health harms, including depression, suicidal ideation, substance use and addiction and greater utilization of health care resources. Gambling also demonstrates a similar 'dose-response' relationship as alcohol-the more one gambles, the greater the likelihood of harm. Using the same collaborative, evidence-informed approach that produced Canada's Low-Risk Alcohol Drinking and Lower Risk Cannabis Use Guidelines, a research team is leading the development of the first national Low-Risk Gambling Guidelines (LRGGs) that will include quantitative thresholds for safe gambling. This paper describes the research methodology and the decision-making process for the project. The guidelines will be derived through secondary analyses of several large population datasets from Canada and other countries, including both cross-sectional and longitudinal data on over 50 000 adults. A scientific committee will pool the results and put forward recommendations for LRGGs to a nationally representative, multi-agency advisory committee for endorsement. To our knowledge, this is the first systematic attempt to generate a workable set of LRGGs from population data. Once validated, the guidelines inform public health policy and prevention initiatives and will be disseminated to addiction professionals, policy makers, regulators, communication experts and the gambling industry. The availability of the LRGGs will help the general public make well-informed decisions about their gambling activities and reduce the harms associated with gambling.
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Affiliation(s)
- Shawn R Currie
- Addiction and Mental Health, 10101 Southport Rd SW, Calgary, AB T2W 3N2, Canada
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183
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Brief Motivational Interventions: Strategies for Successful Management of Complex, Nonadherent Dental Patients. Dent Clin North Am 2020; 64:559-569. [PMID: 32448459 DOI: 10.1016/j.cden.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Motivational interviewing (MI) is an evidence-based approach to resolving patient ambivalence to change. MI techniques can be effectively used by dentists in assessing and managing substance use risk and may add minimal time to the patient interview. Although MI's greatest utility has been in the area of improving general oral hygiene in order to reduce caries and other preventable conditions, its use in addressing controlled substance risk is well established in other health care disciplines. These techniques do not require special training in mental health assessment and can be effectively used by dentists and dental hygienists.
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184
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Fischer B, Bullen C, Hall W. A call for greater policy and regulatory coherence for an expanding menu of legal psychoactive substances. Drug Alcohol Rev 2020; 39:737-742. [PMID: 32420658 DOI: 10.1111/dar.13071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/20/2020] [Accepted: 03/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Benedikt Fischer
- School of Population Health, University of Auckland, Auckland, New Zealand.,School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, Canada.,Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Chris Bullen
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia.,National Addiction Centre, Kings College London, London, UK
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185
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Wolfrom B, Ng VK. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:e140-e141. [PMID: 32404465 PMCID: PMC7219799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Brent Wolfrom
- Directeur du programme postdoctoral au Département de médecine familiale de l'Université Queen's à Kingston (Ontario), et observateur des soins de santé des anciens combattants pour le Groupe d'intérêt des membres sur la médecine du travail du Collège des médecins de famille du Canada.
| | - Victor K Ng
- Médecin conseiller auprès de la division Développement professionnel et Soutien à la pratique, et professeur adjoint en médecine familiale et d'urgence à l'Université de Toronto (Ontario) et à l'Université Western à London (Ontario)
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186
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Wolfrom B, Ng VK. Cannabis in the workplace: What physicians need to know. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:317-318. [PMID: 32404448 PMCID: PMC7219804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Brent Wolfrom
- Postgraduate Program Director in the Department of Family Medicine at Queen's University in Kingston, Ont, and Veterans' Health Observer for the Occupational Medicine Community of Practice of the College of Family Physicians of Canada.
| | - Victor K Ng
- Physician advisor in the Professional Development and Practice Support division of the College of Family Physicians of Canada and Assistant Professor in family and emergency medicine at the University of Toronto in Ontario and at Western University in London, Ont
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187
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Ayonrinde OA. Cannabis and psychosis: revisiting a nineteenth century study of 'Indian Hemp and Insanity' in Colonial British India. Psychol Med 2020; 50:1164-1172. [PMID: 31131781 DOI: 10.1017/s0033291719001077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND In nineteenth-century British India, concern regarding large numbers of asylum patients with 'Indian Hemp Insanity' led to establishment of the Indian Hemp Drugs Commission. The exotic cannabis plant was widely used in pharmacopeia and a source of government revenue. The Commission was tasked with determining the public health risks of cannabis use, particularly mental illness. This analysis of the Commission report seeks to highlight the status of 1892 cannabis research and compare it with current evidence for medical and recreational cannabis use. METHODS Detailed historiographic review of the Indian Hemp Drugs Commission Report (1892). RESULTS In 1892, heavy cannabis use was considered to have been associated with severe mental illness (7.3% of asylum patients; 12.6% of patients with diagnoses). About two-thirds were children and young adults with higher relapse rates. Risk increased with early cannabis use and a family history of mental illness. Cannabis psychosis was found to have a shorter trajectory and better prognosis than other mental illnesses in the asylums. Different cannabis potency and modes of consumption had different effects. Occasional cannabis use was felt to have medicinal benefits for some. Appendices provided symptoms and demographic characteristics of cannabis-induced mental illness. CONCLUSION This important nineteenth-century study observed frequency and dose-related effects of cannabis on mental health, particularly psychotic symptoms in young people with a previous or hereditary risk of mental illness. Pathophysiological observations were consistent with current knowledge. As one of the most systematic and detailed studies of the effects of cannabis of the time it foreshadowed contemporary cannabis issues.
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188
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O'Donnell S, Scott-Storey K, Wuest J, Malcolm J, Taylor P, Vincent CD. Patterns and correlates of cannabis use by cumulative lifetime violence severity as target and/or perpetrator in a community sample of eastern Canadian men. J Cannabis Res 2020; 2:14. [PMID: 33526113 PMCID: PMC7819289 DOI: 10.1186/s42238-020-00021-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 02/26/2020] [Indexed: 11/29/2022] Open
Abstract
Background Recent Canadian legalization of cannabis for non-medical use underscores the need to understand patterns and correlates of cannabis use among men who may be more likely than women to become problematic cannabis users. Evidence supporting an association between substance use and violence is accumulating. Current knowledge of relationships among patterns of cannabis use, violence, gender and health is limited by dichotomous measurement of cannabis use and a focus on individual types of violence rather than lifetime cumulative violence. Methods We collected online survey data between April 2016 and Septermber 2017 from a community convenience sample of 589 Eastern Canadian men ages 19 to 65 years and explored how socio-demographic characteristics, gender, and health varied by past-year patterns of cannabis use (i.e., daily, sometimes, never) in the total sample and by higher and lower cumulative lifetime violence severity (CLVS) measured by a 64-item CLVS scale score (1 to 4). Results Overall prevalence of cannabis use was 46.6% and differed significantly between lower (38.1%) and higher (55.3%) CLVS groups (χ2 (1) = 17.42, p = .000). Daily cannabis use was more likely in the higher (25.1%) than the lower group (11.9%, χ2 (2) = 31.53, p < .001). In the total sample, daily use was significantly associated with being single, less education, lower income, some gender norms, health problems, and use of other substances. Significant associations were found for sometimes cannabis use with age group 19 to 24 years, being single, some gender norms, and hazardous and binge drinking. Never use was associated with being married, more education, higher income, being older, not using other substances, and not having mental health problems. Associations between cannabis use patterns and many variables were found in both CLVS groups but effect sizes were frequently larger in the higher group. Conclusions These results add substantively to knowledge of relationships among lifetime cumulative violence, patterns of cannabis use, gender, socio-demographic indicators and health problems and may inform theoretical models for future testing. Additionally, findings provide critical information for the design of health promotion strategies targeted towards those most at risk in the current climate of cannabis legalization.
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Affiliation(s)
- Sue O'Donnell
- Faculty of Nursing, University of New Brunswick, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada.
| | - Kelly Scott-Storey
- Faculty of Nursing, University of New Brunswick, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada
| | - Judith Wuest
- Faculty of Nursing, University of New Brunswick, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada
| | - Jeannie Malcolm
- Faculty of Nursing, University of New Brunswick, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada
| | - Petrea Taylor
- Faculty of Nursing, University of New Brunswick, Moncton, Canada
| | - Charlene D Vincent
- Faculty of Nursing, University of New Brunswick, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada
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Lake S, Kerr T, Werb D, Haines-Saah R, Fischer B, Thomas G, Walsh Z, Ware MA, Wood E, Milloy MJ. Guidelines for public health and safety metrics to evaluate the potential harms and benefits of cannabis regulation in Canada. Drug Alcohol Rev 2020; 38:606-621. [PMID: 31577059 DOI: 10.1111/dar.12971] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 01/20/2023]
Abstract
ISSUES Canada recently introduced a public health-based regulatory framework for non-medical cannabis. This review sought to identify a comprehensive set of indicators to evaluate the public health and safety impact of cannabis regulation in Canada, and to explore the ways in which these indicators may be expected to change in the era of legal non-medical cannabis. APPROACH Five scientific databases were searched to compile a list of cannabis-related issues of interest to public health and safety. A set of indicators was developed based on topics and themes that emerged. Preliminary evidence from other jurisdictions in the USA and Canada that have legalised medical and/or non-medical cannabis (e.g. Colorado, Washington) was summarised for each indicator, wherever possible. KEY FINDINGS In total, 28 indicators were identified under five broad themes: public safety; cannabis use trends; other substance use trends; cardiovascular and respiratory health; and mental health and cognition. Preliminary trends from other legalised jurisdictions reveal little consensus regarding the effect of cannabis legalisation on public health and safety harms and an emerging body of evidence to support potential benefits (e.g. reductions in opioid use and overdose). IMPLICATIONS In addition to indicators of commonly discussed challenges (e.g. cannabis-related hospitalisations, cannabis-impaired driving), this review led to the recommendation of several indicators to monitor for possible public health and safety improvements. CONCLUSION In preparing a comprehensive public health and safety monitoring and evaluation system for cannabis regulation, this review underscores the importance of not only measuring the possible risks but also the potential benefits.
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Affiliation(s)
- Stephanie Lake
- British Columbia Centre on Substance Use, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - Dan Werb
- Department of Medicine, University of California San Diego, La Jolla, USA.,International Centre for Science in Drug Policy, St. Michael's Hospital, Toronto, Canada
| | - Rebecca Haines-Saah
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Benedikt Fischer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Canada.,Centre for Criminology and Sociolegal Studies, University of Toronto, Toronto, Canada.,Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Gerald Thomas
- Alcohol, Tobacco, Cannabis and Gambling Policy and Prevention, British Columbia Ministry of Health, Victoria, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, Canada
| | - Mark A Ware
- Departments of Family Medicine and Anesthesia, McGill University, Montréal, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
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190
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Vaillancourt R, Moreno M, Pouliot A, Sell E. Cannabis Use for Therapeutic Purposes by Children and Youth at a Tertiary Teaching Hospital in Canada: A Retrospective Chart Review. Can J Hosp Pharm 2020; 73:105-115. [PMID: 32362667 PMCID: PMC7182376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The study of the use of cannabis for therapeutic purposes in the pediatric population is increasing, yet data on efficacy and safety are limited. Characterization of pediatric cannabis use for therapeutic purposes will improve understanding of the circumstances under which it occurs and the associated outcomes. OBJECTIVE To describe the use of cannabis for therapeutic purposes, regardless of authorization, in a pediatric tertiary teaching hospital. METHODS A retrospective chart review was completed for patients 18 years of age or younger who used cannabis for therapeutic purposes, regardless of authorization, between May 1, 2014, and May 1, 2017. Patients whose cannabis use was documented as recreational were excluded. RESULTS In total, 300 patients were identified, of whom 37 met the inclusion criteria. Of these, 30 patients had documentation of medically supervised cannabis use. Most were using cannabis for seizures (n = 28), and many of these (n = 23) were patients with seizures described as intractable or refractory. Of the 27 patients who were experiencing seizures at initiation of medical cannabis, 21 had documentation of a decrease in seizure frequency. This decrease was transient for 16 patients, with a mean duration of 130.4 days (standard deviation 99.1 days). Seven patients self-medicated with cannabis. They obtained cannabis without authorization and used it for chronic pain (n = 5) and/or anxiety (n = 5). CONCLUSIONS Medically supervised cannabis use occurred most often in patients with intractable or refractory seizures. According to these data, seizure response is variable, and initial decreases may be transient for pediatric patients using cannabis. To ensure greater consistency and rigour in the conduct of prospective research and thus to generate better-quality research on the therapeutic effects of medical cannabis, development of a standardized care record is needed.
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Affiliation(s)
- Régis Vaillancourt
- , OMM, CD, BPharm, PharmD, FCSHP, is with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, PharmD, is with the Leslie Dan School of Pharmacy, University of Toronto, Toronto, Ontario, PhD, was, at the time this study was conducted, with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, MD, is with the Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Maria Moreno
- , OMM, CD, BPharm, PharmD, FCSHP, is with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, PharmD, is with the Leslie Dan School of Pharmacy, University of Toronto, Toronto, Ontario, PhD, was, at the time this study was conducted, with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, MD, is with the Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Annie Pouliot
- , OMM, CD, BPharm, PharmD, FCSHP, is with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, PharmD, is with the Leslie Dan School of Pharmacy, University of Toronto, Toronto, Ontario, PhD, was, at the time this study was conducted, with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, MD, is with the Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Erick Sell
- , OMM, CD, BPharm, PharmD, FCSHP, is with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, PharmD, is with the Leslie Dan School of Pharmacy, University of Toronto, Toronto, Ontario, PhD, was, at the time this study was conducted, with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, MD, is with the Faculty of Medicine, University of Ottawa, Ottawa, Ontario
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191
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Hammond D, Goodman S, Wadsworth E, Rynard V, Boudreau C, Hall W. Evaluating the impacts of cannabis legalization: The International Cannabis Policy Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 77:102698. [PMID: 32113149 DOI: 10.1016/j.drugpo.2020.102698] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 01/30/2023]
Abstract
An increasing number of jurisdictions have legalized non-medical cannabis use, including Canada in October 2018 and several US states starting in 2012. The policy measures implemented within these regulated markets differ with respect to product standards, labelling and warnings, public education, retail policies, marketing, and price/taxation. The International Cannabis Policy Study (ICPS) seeks to evaluate the impacts of these policy measures as well as the broader population-level impact of cannabis legalization using a quasi-experimental research design. The objective of this paper is to describe the ICPS conceptual framework, methods, and baseline estimates of cannabis use. The ICPS is a prospective cohort survey conducted with national samples of 16-65-year-olds in Canada and the US. Data are collected via an online survey using the Nielsen Consumer Insights Global Panel. Primary survey domains include: prevalence and patterns of cannabis use; purchasing and price; consumption and product types; commercial retail environment; problematic use and risk behaviours; cannabis knowledge and risk perceptions; and policy-relevant outcomes including exposure to health warnings, public educational campaigns, and advertising and promotion. The first annual wave was conducted in Aug-Oct 2018 with 27,169 respondents in three geographic 'conditions': Canada (n = 10,057), US states that had legalized non-medical cannabis (n = 7,398) and US states in which non-medical cannabis was prohibited (n = 9,714). The ICPS indicates substantial differences in cannabis use in jurisdictions with different regulatory frameworks for cannabis. Future waves of the study will examine changes over time in cannabis use and its effects associated with legalization in Canada and additional US states.
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Affiliation(s)
- David Hammond
- School of Public Health & Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Samantha Goodman
- School of Public Health & Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Elle Wadsworth
- School of Public Health & Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Vicki Rynard
- School of Public Health & Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Christian Boudreau
- Department of Statistics and Actuarial Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Wayne Hall
- Centre for Youth Substance Abuse, University of Queensland, 17 Upland Road, St Lucia, Queensland 4067, Australia.
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192
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Prevalence and forms of cannabis use in legal vs. illegal recreational cannabis markets. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 76:102658. [DOI: 10.1016/j.drugpo.2019.102658] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/12/2019] [Accepted: 12/29/2019] [Indexed: 11/18/2022]
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193
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Fischer B, Bullen C. Emerging prospects for non-medical cannabis legalisation in New Zealand: An initial view and contextualization. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 76:102632. [DOI: 10.1016/j.drugpo.2019.102632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 01/25/2023]
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194
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Schuster RM, Potter K, Vandrey R, Hareli M, Gilman J, Schoenfeld D, Evins AE. Urinary 11-nor-9-carboxy-tetrahydrocannabinol elimination in adolescent and young adult cannabis users during one month of sustained and biochemically-verified abstinence. J Psychopharmacol 2020; 34:197-210. [PMID: 31535597 PMCID: PMC6989351 DOI: 10.1177/0269881119872206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite adolescents and young adults being the most frequent users of cannabis, all information on cannabis drug testing interpretation is based on data from adults. AIMS This study aimed to define the time course of urinary 11-nor-9-carboxy-tetrahydrocannabinol (THCCOOH) excretion among 70 adolescent and young adult cannabis users during 1 month of biochemically-verified cannabis abstinence. METHODS Urine specimens were collected at non-abstinent baseline and after 2, 3, 8, 15, 21 and 28 days of abstinence. Specimens were tested for THCCOOH with a 'rapid' immunoassay drug test and a confirmatory assay using liquid chromatography-tandem mass spectrometry, with a 5 ng/mL limit of quantitation. Elimination rate was tested using a population pharmacokinetics model. RESULTS/OUTCOMES Participants had an average of 26 days of abstinence (SD = 6). Initial creatinine-adjusted THCCOOH concentration (CN-THCCOOH) was 148 ng/mg (SD = 157). Half-life was 2 days (SD = 5), with a 10-day window of detection (estimated range: 4-80 days). At the final timepoint and among those with > 25 days of abstinence (n = 62), 40% (n = 25) had THCCOOH concentrations > 5 ng/mL (i.e. detectable on confirmatory assay) and 19% (n = 12) were 'positive' per federal drug testing guidelines (i.e. values greater than 50 ng/mL on the screening immunoassay and 15 ng/mL on the confirmatory assay). More frequent past month cannabis use was associated with higher baseline CN-THCCOOH concentrations, but not with rate of elimination. Nested five-fold cross-validation suggested high model reliability and predictive validity. CONCLUSIONS/INTERPRETATION Findings underscore that, as with adults, detectable cannabinoid metabolites do not necessarily indicate recent use in adolescents and young adults. Algorithms that account for THCCOOH levels, assessed longitudinally and time between specimen collections are best equipped to confirm abstinence. CLINICAL TRIAL REGISTRATION NCT03276221; https://clinicaltrials.gov/ct2/show/NCT03276221?term=Randi+Schuster&rank=1.
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Affiliation(s)
- Randi Melissa Schuster
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Kevin Potter
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Ryan Vandrey
- Johns Hopkins University School of Medicine, Boston, MA
| | - Maya Hareli
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Jodi Gilman
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - David Schoenfeld
- Harvard Medical School, Boston, MA,Department of Biostatistics, Massachusetts General Hospital, Boston, MA
| | - A. Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
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195
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Vulfsons S, Minerbi A, Sahar T. Cannabis and Pain Treatment-A Review of the Clinical Utility and a Practical Approach in Light of Uncertainty. Rambam Maimonides Med J 2020; 11:RMMJ.10385. [PMID: 32017678 PMCID: PMC7000155 DOI: 10.5041/rmmj.10385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Over the past decade the phenomenon of cannabis as a legitimate form of treatment for pain has overwhelmed the medical community, especially in the field of pain. From a status of a schedule 1 substance having no currently accepted medical use and being considered to have high potential for abuse, its use has mushroomed to over 50,000 legal medical users per year in Israel alone. There appear to be many reasons behind this phenomenon-medical, sociological, and economical. Thus, what is cannabis? An abusive substance or a medication? Should it be incorporated into current biomedical practice, and how should it be administered? Finally, what is the evidence for the beneficial and detrimental effects of cannabis? This article reviews and discusses the current literature regarding the beneficial and the detrimental effects of medical cannabis in the treatment of pain. We further discuss the problems and challenges facing the medical community in this domain and offer a practical approach to deal with these challenges.
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Affiliation(s)
- Simon Vulfsons
- Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel
- Rappaport School of Medicine, Technion Institute of Technology, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Amir Minerbi
- Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel
- Alan Edwards Centre for Research on Pain, Montreal, Quebec, Canada
| | - Tali Sahar
- Pain Relief Unit, Department of Anesthesia, Hadassah Medical Center, Jerusalem, Israel
- Supportive Care & Pain Relief Clinic, Clalit Health Services, Jerusalem District, Israel
- Department of Family Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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196
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Staples JA, Merchant K, Erdelyi S, Lund A, Brubacher JR. Emergency department visits during the 4/20 cannabis celebration. Emerg Med J 2019; 37:187-192. [PMID: 31831590 DOI: 10.1136/emermed-2019-208947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Annual '4/20' cannabis festivals occur around the world on April 20 and often feature synchronised consumption of cannabis at 4:20 pm. The relationship between these events and demand for emergency medical services has not been systematically studied. METHODS We conducted a population-based retrospective cohort study in Vancouver, Canada, using 10 consecutive years of data (2009-2018) from six regional hospitals. The number of emergency department (ED) visits between 4:20 pm and 11:59 pm on April 20 were compared with the number of visits during identical time intervals on control days 1 week earlier and 1 week later (ie, April 13 and April 27) using negative binomial regression. RESULTS A total of 3468 ED visits occurred on April 20 and 6524 ED visits occurred on control days. A non-significant increase in all-cause ED visits was observed on April 20 (adjusted relative risk: 1.06; 95% CI 1.00 to 1.12). April 20 was associated with a significant increase in ED visits among prespecified subgroups including a 5-fold increase in visits for substance misuse and a 10-fold increase in visits for intoxication. The hospital closest to the festival site experienced a clinically and statistically significant 17% (95% CI 5.1% to 29.6%) relative increase in ED visits on April 20 compared with control days. INTERPRETATION Substance use at annual '4/20' festivals may be associated with an increase in ED visits among key subgroups and at nearby hospitals. These findings may inform harm reduction initiatives and festival medical care service planning.
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Affiliation(s)
- John A Staples
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada .,Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, British Columbia, Canada
| | - Ketki Merchant
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon Erdelyi
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Lund
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, British Columbia, Canada.,Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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197
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Balneaves LG, Alraja AA. "Guarding their practice": a descriptive study of Canadian nursing policies and education related to medical cannabis. BMC Nurs 2019; 18:66. [PMID: 31827392 PMCID: PMC6902327 DOI: 10.1186/s12912-019-0390-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background In Canada, federal regulations allow Nurse Practitioners (NPs) to authorize medical cannabis. Nursing regulatory bodies, however, have been hesitant to include medical cannabis within NPs' scope of practice. As the interest in cannabis increases, NPs have the potential to play a pivotal role in promoting the safe and appropriate use of cannabis. This study aimed to: summarize nursing policies in Canada related to medical cannabis; explore the perspective of nursing regulatory bodies regarding practice and policy issues related to medical cannabis; and examine the inclusion of medical cannabis content within Canadian NP curricula. Methods A descriptive study was conducted that comprised three phases. The first phase reviewed nursing regulatory bodies' existing policies related to medical cannabis. In the second phase, practice consultants from nursing regulatory bodies were interviewed regarding policies and practices issues related to medical cannabis. The interviews were analyzed using thematic analysis. The third phase was a national survey of NP program coordinators regarding inclusion of cannabis in curricula. Descriptive statistics summarized survey responses. Results Of the 12 nursing regulatory bodies in Canada, only 7 had policies or statements related to cannabis, with only Ontario allowing NPs to authorize medical cannabis. There was confusion among practice consultants regarding the role of nurses in the administration of medical cannabis and several barriers were identified regarding nursing engagement in care related to medical cannabis, including lack of knowledge and clinical guidelines. 60% of NP programs included cannabis in their curricula, however, less than half addressed the risks and benefits of medical cannabis and dosing and administration protocols. Limited faculty expertise was a barrier to including cannabis content in NP curricula. Conclusion Nursing regulatory bodies must be proactive in developing policies and educational resources that will support nurses in providing safe and informed care related to cannabis. To ensure patients using medical cannabis receive consistent and safe care from nurses, harmonized regulations and policies are needed across all jurisdictions. Education programs must also provide updated knowledge and training for both registered nurses and NPs that will support them in providing non-judgemental and evidence-based care to the growing number of individuals using cannabis.
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Affiliation(s)
- Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2 Canada
| | - Abeer A Alraja
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2 Canada
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198
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Caulkins JP, Kilborn ML. Lower-Risk Cannabis Use Guidelines: Will Users Listen? Am J Public Health 2019; 110:71-72. [PMID: 31800288 DOI: 10.2105/ajph.2019.305420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jonathan P Caulkins
- Jonathan P. Caulkins is with the Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA. Michelle L. Kilborn is with Population, Public, and Indigenous Health at Alberta Health Services, Edmonton, AB, Canada
| | - Michelle L Kilborn
- Jonathan P. Caulkins is with the Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA. Michelle L. Kilborn is with Population, Public, and Indigenous Health at Alberta Health Services, Edmonton, AB, Canada
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199
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Callaghan RC, Sanches M, Benny C, Stockwell T, Sherk A, Kish SJ. Who consumes most of the cannabis in Canada? Profiles of cannabis consumption by quantity. Drug Alcohol Depend 2019; 205:107587. [PMID: 31600617 DOI: 10.1016/j.drugalcdep.2019.107587] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 10/25/2022]
Abstract
AIM To establish whether the population-level pattern of cannabis use by quantity is similar to the distributions previously reported for alcohol, in which a small subset of drinkers accounts for a majority of total population alcohol consumption. METHOD The current study pooled Waves 1-3 of the 2018 National Cannabis Survey (n = 18,900; 2584 past-three-month cannabis users), a set of stratified, population-based surveys designed to assess cannabis consumption and related behaviors in Canada. Each survey systematically measured self-reported cannabis consumption by quantity across seven of the major cannabis-product types. In order to enable the conversion of self-reported consumption of non-flower cannabis products into a standard joint equivalent (SJE: equal to 0.5 g of dried cannabis), we created conversion metrics for physical production equivalencies across cannabis products. RESULTS Similar to the findings in the alcohol literature, study results show that cannabis consumption is highly concentrated in a small subset of users: the upper 10% of cannabis users accounted for approximately two-thirds of all cannabis consumed in the country. Males reported consuming more cannabis by volume than females (approximately 60% versus 40%), with young males (15-34 years old) being disproportionately represented in the heaviest-using subgroups. CONCLUSIONS Most of the cannabis used in Canada is consumed by a relatively small population of very heavy cannabis users. Future research should attempt to identify the characteristics of the heaviest-using groups, as well as how population-level cannabis consumption patterns relate to the calculus of cannabis-related harms in society.
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Affiliation(s)
- Russell C Callaghan
- University of Northern British Columbia, Northern Medical Program, 3333 University Way, Prince George, British Columbia, V2N 4Z9, Canada; Centre for Addiction and Mental Health (CAMH), Human Brain Laboratory, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; University of Victoria, Canadian Institute for Substance Use Research (CISUR), 2300 McKenzie Avenue, Victoria, British Columbia, V8N 5M8, Canada.
| | - Marcos Sanches
- Centre for Addiction and Mental Health (CAMH), Biostatistical Consulting Unit, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Claire Benny
- University of British Columbia, School of Population and Public Health, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Tim Stockwell
- University of Victoria, Canadian Institute for Substance Use Research (CISUR), 2300 McKenzie Avenue, Victoria, British Columbia, V8N 5M8, Canada
| | - Adam Sherk
- University of Victoria, Canadian Institute for Substance Use Research (CISUR), 2300 McKenzie Avenue, Victoria, British Columbia, V8N 5M8, Canada
| | - Stephen J Kish
- Centre for Addiction and Mental Health (CAMH), Human Brain Laboratory, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
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200
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Kahan M, Srivastava A, Clarke S. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:873-878. [PMID: 31831485 PMCID: PMC6907373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Meldon Kahan
- Professeur agrégé au Département de médecine familiale et communautaire de l'Université de Toronto, et directeur médical au Service des toxicomanies de l'Hôpital Women's College à Toronto, (Ontario)
| | - Anita Srivastava
- Professeure agrégée au Département de médecine familiale et communautaire de l'Université de Toronto, et médecin de famille et de la dépendance au St Joseph's Health Centre à Toronto
| | - Sarah Clarke
- Courtière du savoir au sein du projet Mentoring, Education, and Clinical Tools for Addictions : Primary Care-Hospital Integration de l'Hôpital Women's College.
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