Characterizing marijuana concentrate users: A web-based survey

Risk Factors for Quantity of Cannabis Use Per Day among College Students Who Violated Their University Drug Use Policy

Background

Cannabis use among college students represents a continued public health issue. The objective was to assess risk factors and reasons for cannabis use among students who violated their university's drug use policy, and whether risk factors influenced cannabis use quantity.

Methods

This cross-sectional survey study included 99 college students enrolled at a large U.S. public university. Descriptive statistics were calculated, and an ordinary least squares regression analysis was conducted.

Results

Students reported using cannabis an average of 7.4 (SD = 10.2) days in the past month, with 8% reporting daily use. On average, students consumed slightly over 0.25 (SD = 0.25) grams per day, with 40% reporting greater than one gram per day. The average age of onset of cannabis use was 16.8 (SD = 1.8) years old. The top reasons for cannabis use were to: relax or relieve tension (75.8%), feel good or get high (62.6%), and have a good time with friends (60.6%). Students perceived an average of 47% of their peers engaged in past-month cannabis use and only slight risk was associated with regular use. Students perceived their loved ones would mostly approve of a reduction in their cannabis use. Regression results indicated past-month cannabis frequency (p = .002) and being of racial/ethnic minority descent (p = .05) were positively associated with quantity of cannabis per day, while perceived risk of regular cannabis use (β = -0.21) was negatively associated.

Conclusion

Evidence-based cannabis interventions for students who violate their university's drug use policies are critically needed that aim to reduce cannabis use and mitigate its associated negative consequences.

Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map

Background

Globally, cannabis laws and regulations are rapidly changing. Countries are increasingly permitting access to cannabis under various decriminalization, medicalization, and legalization laws. With strong economic, public health, and social justice incentives driving these domestic cannabis policy reforms, liberalization trends are bound to continue. However, despite a large and growing body of interdisciplinary research addressing the policy-relevant health, safety, and socioeconomic consequences of cannabis liberalization, there is a lack of robust primary and systematic research that comprehensively investigates the consequences of these reforms.

Objectives

This evidence and gap map (EGM) summarizes the empirical evidence on cannabis liberalization policies. Primary objectives were to develop a conceptual framework linking cannabis liberalization policies to relevant outcomes, descriptively summarize the empirical evidence, and identify areas of evidence concentration and gaps.

Search Methods

We comprehensively searched for eligible English-language empirical studies published across 23 academic databases and 11 gray literature sources through August 2020. Additions to the pool of potentially eligible studies from supplemental sources were made through November 2020.

Selection Criteria

The conceptual framework for this EGM draws upon a legal epidemiological perspective highlighting the causal effects of law and policy on population-level outcomes. Eligible interventions include policies that create or expand access to a legal or decriminalized supply of cannabis: comprehensive medical cannabis laws (MCLs), limited medical cannabidiol laws (CBDLs), recreational cannabis laws (RCLs), industrial hemp laws (IHLs), and decriminalization of cultivations laws (DCLs). Eligible outcomes include intermediate responses (i.e., attitudes/behaviors and markets/environments) and longer-term consequences (health, safety, and socioeconomic outcomes) of these laws.

Data Collection and Analysis

Both dual screening and dual data extraction were performed with third person deconfliction. Primary studies were appraised using the Maryland Scientific Methods Scale and systematic reviews were assessed using AMSTAR 2.

Main Results

The EGM includes 447 studies, comprising 438 primary studies and nine systematic reviews. Most research derives from the United States, with little research from other countries. By far, most cannabis liberalization research focuses on the effects of MCLs and RCLs. Studies targeting other laws-including CBDLs, IHLs, and DCLs-are relatively rare. Of the 113 distinct outcomes we documented, cannabis use was the single most frequently investigated. More than half these outcomes were addressed by three or fewer studies, highlighting substantial evidence gaps in the literature. The systematic evidence base is relatively small, comprising just seven completed reviews on cannabis use (3), opioid-related harms (3), and alcohol-related outcomes (1). Moreover, we have limited confidence in the reviews, as five were appraised as minimal quality and two as low quality.

Authors’ Conclusions

More primary and systematic research is needed to better understand the effects of cannabis liberalization laws on longer-term-and arguably more salient-health, safety, and socioeconomic outcomes. Since most research concerns MCLs and RCLs, there is a critical need for research on the societal impacts of industrial hemp production, medical CBD products, and decriminalized cannabis cultivation. Future research should also prioritize understanding the heterogeneous effects of these laws given differences in specific provisions and implementation across jurisdictions.

Theory-based correlates of cannabis use and intentions among US and Israeli adults: a mixed methods study

BACKGROUND

In the US and Israel, non-medical ('recreational') cannabis use is illegal at the national level; however, use rates are high and decriminalization and legalization is spreading. Thus, theory-based intervention efforts, especially for youth prevention, are crucial.

METHODS

This mixed-methods study of adults in the US (n = 1,128) and Israel (n = 1,094) analyzed: 1) cross-sectional survey data (Fall 2021) to identify theory-based correlates (risk perceptions, social norms) of past-month cannabis use, next-year use intentions, and intentions to use in the home or among children if non-medical cannabis was legal, using multivariable regression; and 2) qualitative interviews regarding perceptions of cannabis policies and use (US n = 40, Israel n = 44).

RESULTS

16.7% reported past-month use; 70.5%, 56.3%, and 82.6% indicated "not at all likely" regarding next-year use and use in the home and among children if legal. Lower perceived risk and greater social norms were associated with past-month use, greater use intentions, and greater intentions to use in the home or among children. Past-month use was more prevalent among US (vs. Israeli) participants (22.0% vs. 11.2%); however, in multivariable regression controlling for past-month use, being from Israel was associated with greater use intentions (next-year; in the home/among children). Qualitative themes indicated: concerns about use (e.g., increasing use, health risks, driving-related risks) and legalization (e.g., impact on society/economy, marketing), and perceived benefits of use (e.g., medical) and legalization (e.g., access/safety, economic, individual rights).

CONCLUSIONS

Despite differences in cannabis perceptions and use across countries, perceived risk and social norms are relevant intervention targets regardless of sociopolitical context.

Momentary Craving, Craving Variability, and Cannabis Use: Associations With THC Concentrates and Sex

OBJECTIVE

Ecological momentary assessment (EMA) studies are well positioned to assess the impact of craving on cannabis use in real time and may better capture its time-varying nature. The goal of this exploratory study was to examine whether momentary craving and craving variability predict subsequent use of cannabis and how baseline concentrate use status and male sex might affect these relationships.

METHOD

College students residing in a state with legal recreational cannabis use who used cannabis twice a week or more completed a baseline interview and signal-contingent EMA for 2 weeks using a smartphone application. Hierarchical (multi-level) regression was used to examine time-lagged associations between craving, craving variability, and subsequent cannabis use. Baseline concentrate use and male sex were examined as moderators.

RESULTS

Participants (N = 109) included 59% women, with an average age of 20.2 years, and most using cannabis near-daily or daily. A main effect for craving (within-level effect) on the likelihood of cannabis use at the next EMA instance was found (odds ratio = 1.292, p < .001), although this effect was moderated by concentrate use status. For men, between-level increases in craving led to a greater likelihood of cannabis use at the next instance, but greater craving variability led to a lower likelihood of use. Greater variability in craving was associated with a greater likelihood of cannabis use among those using concentrates.

CONCLUSIONS

The experience of craving may differ based on important participant characteristics. More research examining the fluctuating nature of craving and the role of cannabis potency on craving is warranted.

Behavioral economic relationship between cannabis flower and concentrates: Evidence from simulated purchase tasks

Cannabis users use different forms of cannabis, which are associated with distinct public health concerns. Policies that aim to regulate one specific form may have unintended impacts on other forms. This study examined the behavioral economic relationship between flower and concentrates, the two most common forms of cannabis. We surveyed 605 adult cannabis users (21+) who lived in one of the U.S. states that had legalized recreational cannabis by the time of interview in 2019. The participants completed simulated purchase tasks, which asked how much cannabis flower and concentrates they would purchase in the next 30 days at escalating prices. We estimated (a) demand indices and own-price elasticities using nonlinear exponential demand models and (b) group- and individual-level cross-price elasticities using log-linear demand models. The estimated rate of change in demand elasticity (α) was 0.00066 for cannabis flower (SE = 0.00002, p < .001) and 0.00058 for cannabis concentrate (SE = 0.00002, p < .001). Group-level cross-price elasticity estimate (slope = -0.075, SE = 0.0135, p < .001) indicated that cannabis flower and concentrates were weak complements. Individual-level cross-price elasticity estimates showed that flower and concentrates were treated as independent by 76.2% of the users, as complements by 19.0% of the users, and as substitutes by 4.8% of the users. The findings suggested that cannabis flower and concentrates were overall weak complements and for most adult cannabis users were treated as independent of each other. Price and tax policies regulating either cannabis form may have minimal impacts on the other form. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cognitive test performance in chronic cannabis flower users, concentrate users, and non-users

Extremely high-potency cannabis concentrates are becoming increasingly available and popular among consumers. While prior research indicates these products are perceived to have greater detrimental effects relative to cannabis flower, few studies have examined their relative objective effects, and no existing studies have compared the cognitive test performance of sober flower users, concentrate users, and non-users. A total of 198 healthy adults (98 non-users, 46 exclusive flower users, and 54 concentrate users) were administered a battery of tests of memory, psychomotor speed, attention, and executive functioning under sober laboratory-controlled conditions. Significant group differences were detected on tests of verbal free recall and episodic prospective memory, with both the flower users and concentrate users demonstrating significantly worse performance than non-users. Concentrate (but not flower) users performed worse than non-users on a measure of source memory, but contrary to our hypothesis, there were no significant differences between flower and concentrate users on any of the cognitive tests. Results indicate that, under sober conditions, individuals who regularly use concentrates are no more cognitively impacted than those who exclusively use flower. These null findings may reflect the tendency for concentrate users to self-titrate and use significantly lower quantities of concentrates than flower.

Adult use of highly-potent Δ9-THC cannabis concentrate products by U.S. state cannabis legalization status, 2021

BACKGROUND

Compared to plant/flower cannabis products, cannabis concentrates have higher average potency of delta-9-tetrahydrocannabinol (Δ9-THC), which may be associated with greater likelihood of cannabis-related harms. Information on factors associated with use of cannabis concentrates is needed.

METHODS

Respondents were 4,328 adult past-7-day cannabis users from all 50 U.S. states and Washington DC (DC) who participated in an online 2021 survey. Using logistic regression to generate adjusted odds ratios (aOR), we investigated whether participants in states that enacted recreational cannabis laws (RCL, 12 states plus DC [treated as a state], n = 1,236) or medical cannabis laws (MCL-only, 23 states, n = 2,030) by December 31, 2020 were more likely than those in states without cannabis laws (no-CL, 15 states, n = 1,062) to use cannabis concentrate products in the prior 7 days.

RESULTS

Most participants (92.4%) used plant material in the prior 7 days; 57.0% used cannabis concentrates. In RCL, MCL and no-CL states, concentrate use was reported by 61.5%, 56.6%, and 52.5%, respectively. Compared to participants in no-CL states, odds of using cannabis concentrate products were greater among those in RCL states (aOR = 1.47; CI = 1.17-1.84) and MCL-only states (aOR = 1.29; CI = 1.08-1.55). Whether states had legally-authorized dispensaries had little effect on results.

CONCLUSION

Results suggest that individuals in MCL-only and RCL states are more likely to use cannabis concentrate products. Determining mechanisms underlying these results, e.g., commercialization, could provide important information for prevention. Clinicians should be alert to patient use of concentrates, especially in MCL-only and RCL states. Continued monitoring is warranted as additional states legalize cannabis use.

Perceptions and Practices of Cannabis Use Among Emergency Department Patients

BACKGROUND

Nationally, in states where cannabis has been legalized, increases in cannabis-related hospitalizations and emergency department (ED) visits have also been observed.

OBJECTIVES

This study aims to: 1) Describe the sociodemographic characteristics of cannabis users presenting to two academic EDs in California; 2) Assess cannabis-related behaviors; 3) Assess perceptions of cannabis; 4) Identify and describe reasons for cannabis-related ED utilization.

METHODS

This is a cross-sectional study of patients visiting one of two academic EDs between February 16, 2018 and November 21, 2020. Eligible participants completed a novel questionnaire developed by the authors. Basic descriptive statistics, Pearson correlation coefficients, and logistic regression were used for statistical analysis of responses.

RESULTS

The questionnaire was completed by 2577 patients. A quarter were categorized as Current Users (n = 628, 24.4%). Current, Regular Users were evenly divided across gender, were relatively younger (18-34 years, 48.1%), and were largely non-Hispanic Caucasian. Over half of all respondents believed that the use of cannabis was less harmful than tobacco or alcohol use (n = 1537, 59.6%). One in five Current Users (n = 123, 19.8%) reported driving while using cannabis in the past month. A small proportion (n = 24, 3.9%) of Current Users reported ever visiting the ED for a cannabis-related chief complaint.

CONCLUSIONS

Overall, many ED patients are currently using cannabis; few report utilizing the ED due to cannabis-related problems. Current, Irregular Users may represent the ideal target group for ED-based educational efforts aimed at improving knowledge of safe cannabis use.

Social Media Marketing Practices of Illinois Recreational Cannabis Dispensaries in the First Year of Legal Sales: Product Promotions, Branding, and Price Promotions

Research from tobacco suggests that the recreational cannabis industry will use aggressive tactics, including product innovation and mass-marketing and advertising, to increase demand for their products. The purpose of this study is to examine product promotions, branding, and promotional pricing on recreational dispensary social media pages in the state of Illinois in the first year of legal sales. Data were collected from all recreational cannabis dispensary Facebook and Twitter accounts and a quantitative content analysis was used to analyze the data. Differences in marketing practices were assessed by neighborhood race/ethnicity and income and dispensary type. Results of the study revealed that flower and edibles were the two most heavily promoted products; promotions for vaporizers and concentrates were also promoted frequently. Posts with branded promotions and price promotions increased substantially over the year. Research suggests that this trend in marketing practices will lead to greater initiation and intensity of cannabis use.

A First-Tier Framework for Assessing Toxicological Risk from Vaporized Cannabis Concentrates

Vaporization is an increasingly prevalent means to consume cannabis, but there is little guidance for manufacturers or regulators to evaluate additive safety. This paper presents a first-tier framework for regulators and cannabis manufacturers without significant toxicological expertise to conduct risk assessments and prioritize additives in cannabis concentrates for acceptance, elimination, or further evaluation. Cannabinoids and contaminants (e.g., solvents, pesticides, etc.) are excluded from this framework because of the complexity involved in their assessment; theirs would not be a first-tier toxicological assessment. Further, several U.S. state regulators have provided guidance for major cannabinoids and contaminants. Toxicological risk assessment of cannabis concentrate additives, like other types of risk assessment, includes hazard assessment, dose-response, exposure assessment, and risk characterization steps. Scarce consumption data has made exposure assessment of cannabis concentrates difficult and variable. Previously unpublished consumption data collected from over 54,000 smart vaporization devices show that 50th and 95th percentile users consume 5 and 57 mg per day on average, respectively. Based on these and published data, we propose assuming 100 mg per day cannabis concentrate consumption for first-tier risk assessment purposes. Herein, we provide regulators, cannabis manufacturers, and consumers a preliminary methodology to evaluate the health risks of cannabis concentrate additives.

Trends and Socio-Demographic Differences of Cannabis Vaping in the USA and Canada

Given the rise in cannabis vaping, it is important to highlight the heterogeneity in vaping different cannabis product because of the potential differences in their health risks. This study aims to estimate the trends and socio-demographic correlates of the use of various cannabis vaping products across jurisdiction with different legal status. Data from the 2018 (n = 27,169) and 2019 (n = 47,747) waves of the International Cannabis Policy Study (ICPS) were used. Respondents aged 16-65 completed web-based surveys. In 2019, proportions of past year vaping of cannabis oil, dried flower and concentrates in the overall sample were highest in U.S. jurisdictions where cannabis was legalized for non-medical use (17.4%, 6.0%, 4.9%), followed by U.S. jurisdiction where non-medical cannabis use is illegal (13.7%, 5.8%, 2.9%), and lowest in Canada (8.1%, 4.4%, 2.1%). Vaping dried flower decreased from 2019 to 2018 in U.S. legal jurisdictions and Canada, while vaping cannabis oil and concentrates increased in all jurisdictions (p < 0.001). The odds of vaping all forms of products were higher among younger respondents (16-55 years), males, respondents with some college education, and persons with low-risk perceptions on daily cannabis vaping. In both ICPS surveys (2018 and 2019), cannabis oil was the most frequently vaped products, followed by dried flower, and concentrates. Detailed measures of product forms for cannabis vaping should be considered in future surveys.

Medical cannabis dimethyl ether, ethanol and butane extracts inhibit the in vitro growth of bacteria and dermatophytes causing common skin diseases

Cannabis preparations are gaining popularity among patients with various skin diseases. Due to the lack of scientific evidence, dermatologists remain cautious about their prescriptions. So far, only a few studies have been published about the effects of high-potency cannabis extracts on microorganisms (especially dermatophytes) causing skin problems that affect more than 25% of the worldwide population. Even though, the high-potency cannabis extracts prepared by cold extraction are mostly composed of non-psychoactive tetrahydrocannabinolic acid (THCA) and only low amount of THC, their use in topical treatment can be stigmatized. The in vitro antimicrobial and antifungal activity of two high potent cannabis strains extracted by three solvents traditionally or currently used by cannabis users (ethanol; EtOH, butane; BUT, dimethyl ether; DME) was investigated by broth dilution method. The chemical profile of cannabis was determined by high-performance liquid chromatography with ultraviolet detection and gas chromatography with mass spectrometer and flame ionization detector. The extraction methods significantly influenced chemical profile of extracts. The yield of EtOH extracts contained less cannabinoids and terpenes compared to BUT and DME ones. Most of the extracts was predominantly (>60%) composed of various cannabinoids, especially THCA. All of them demonstrated activity against 18 of the 19 microorganisms tested. The minimal inhibitory concentrations (MICs) of the extracts ranged from 4 to 256 μg/mL. In general, the bacteria were more susceptible to the extracts than dermatophytes. Due to the lower content of biologically active substances, the EtOH extracts were less effective against microorganisms. Cannabis extracts may be of value to treat dermatophytosis and other skin diseases caused by various microorganisms. Therefore, they could serve as an alternative or supportive treatment to commonly used antibiotics.

Identifying risk profiles for marijuana vaping among U.S. young adults by recreational marijuana legalization status: A machine learning approach

INTRODUCTION

This study attempted to identify risk profiles of marijuana vaping by state-level recreational marijuana legalization (RML) status among U.S. young adults (YA).

METHODS

Data were drawn from the most recent two waves of restricted use files of the Population Assessment of Tobacco and Health Study with state identifiers. We analyzed 6155 young adult (18-24 years) respondents who were naïve to marijuana vaping at Wave 4 and had matched data at Wave 5. We employed a two-stage machine learning approach to predict marijuana vaping initiation at Wave 5 with predictors measured at Wave 4.

RESULTS

Among YA who had never vaped marijuana at Wave 4, 19% of those who lived in the states with RML and 15% of those who lived in the states without RML reported marijuana vaping at Wave 5. Substance-use-related predictors were rarely found as leading predictors in the states with RML. In the states without RML, substance use behaviors, including electronic nicotine delivery systems and smokeless tobacco use, and the presence of externalizing symptoms emerged as predictors for marijuana vaping. Results also revealed that nonlinear interactions between the predictors of marijuana vaping.

CONCLUSIONS

Our results highlight the importance of accounting for the RML status in developing risk profiles of marijuana vaping. Externalizing symptoms may be a behavioral endophenotype of marijuana vaping in the states without RML. Machine learning appears to be a promising analytical approach to identify complex interactions between factors in predicting an emerging risk behavior such as marijuana vaping.

A gas chromatography-mass spectrometry method for quantifying squalane and squalene in aerosol emissions of electronic cigarette, or vaping, products

Numerous chemicals of unknown inhalational toxicity have been measured in electronic cigarette, or vaping, products (EVPs). In addition, little is known about the liquid-to-aerosol transmission and deliveries of these chemicals, including oil-like terpenes such as squalene (SQE) and squalane (SQA). To provide information on the aerosol deliveries of these compounds from EVPs, we developed and validated a quantitative method to measure squalene and squalane in EVP aerosol emissions. Validation parameters include measurement repeatability (SQA and SQE %RSD <6%), intermediate precision (SQA: %RSD 11%, SQE: %RSD 17%), accuracy (SQA: 86-107%, SQE: 104-113%), matrix effects, method robustness, and analyte stability. Limits of detection were 6.06 ng/mL puffed air volume for both squalene and squalane. The method was used to measure squalene and squalane in aerosol emissions of 153 EVPs associated with case patients from a recent outbreak of e-cigarette, or vaping, product use associated lung injury (EVALI). The EVPs analyzed were organized into nicotine, cannabidiol, and tetrahydrocannabinol products by the percentage of nicotine, cannabidiol, and tetrahydrocannabinol in total particulate matter after vaping. In case-associated tetrahydrocannabinol products the detection rates and mean concentrations were 82.4% and 33.0 ng/mL puffed air for squalene and 4.41% and 7.80 ng/mL puffed air for squalane.

Changes in Cannabis Consumption Among College Students During COVID-19

OBJECTIVE

College campuses closed in March 2020 because of the COVID-19 pandemic, disrupting the lives of students. The goal of the present study was to examine whether cannabis use changed from before campus departures prompted by COVID-19 to after campus departures and after the semester ended--and if living situation explained observed changes. We also examined changes in specific formulations of cannabis and self-reported reasons for perceived changes in use frequency.

METHOD

A sample of 223 college student cannabis users (61% female) from three universities completed two online surveys (one in May 2020 assessing cannabis use pre-campus closure [pre-closure] and since campus closed [post-closure-1], and another in September 2020 assessing cannabis use since remote classes ended [post-closure-2]).

RESULTS

Any use of cannabis and use of each specific formulation (leaf, edibles, concentrates) declined from pre-closure to post-closure-1, whereas the frequency of use did not change. Any cannabis use declined for those who stayed living dependently or moved to dependent living. Leaf use declined for all groups, concentrate use declined only for those who moved from independent to dependent living, and edible use declined only for those who stayed living dependently or moved to dependent living. Cannabis use did not change between post-closure-1 and post-closure-2, regardless of living situation stability or transition.

CONCLUSIONS

Overall, among a sample of cannabis-using college students, the prevalence of any cannabis use, but not frequency of use, was reduced during the pandemic. Living with parents appears to be protective against frequent cannabis use.

Social Media, Marijuana and Sex: An Exploratory Study of Adolescents' Intentions to Use and College Students' Use of Marijuana

Recreational marijuana continues to be legalized in U.S. states, with popular media discussing connections between cannabis and the facilitation of sexual activity. We conducted two surveys with adolescents and college students in Washington state to examine the role of viewing social media and pro-marijuana content on sex-related marijuana expectancies and intentions to use. In Study 1, among adolescents (N = 350), we found connections between social media use, exposure to pro-marijuana content, and sex-related marijuana expectancies, with boys' sex-related marijuana expectancies predicting intentions to use marijuana. In Study 2, we expanded this research to college students (N = 966), with the addition of frequency of marijuana use as an outcome. For men, sex-related marijuana expectancies were negatively associated with marijuana use. Sex-related marijuana expectancies were not associated with intentions to use or use of marijuana among adolescent girls and college women. Our findings highlight how social media use is associated with increased exposure to pro-marijuana content for adolescents and college students, and how such content is associated with sex-related marijuana expectancies. The mixed relationships in our data between sex-related marijuana expectancies and intentions and use highlight potential gender and developmental differences.

Changes in Cannabis Consumption Among College Students During COVID-19

OBJECTIVE

College campuses closed in March 2020 because of the COVID-19 pandemic, disrupting the lives of students. The goal of the present study was to examine whether cannabis use changed from before campus departures prompted by COVID-19 to after campus departures and after the semester ended--and if living situation explained observed changes. We also examined changes in specific formulations of cannabis and self-reported reasons for perceived changes in use frequency.

METHOD

A sample of 223 college student cannabis users (61% female) from three universities completed two online surveys (one in May 2020 assessing cannabis use pre-campus closure [pre-closure] and since campus closed [post-closure-1], and another in September 2020 assessing cannabis use since remote classes ended [post-closure-2]).

RESULTS

Any use of cannabis and use of each specific formulation (leaf, edibles, concentrates) declined from pre-closure to post-closure-1, whereas the frequency of use did not change. Any cannabis use declined for those who stayed living dependently or moved to dependent living. Leaf use declined for all groups, concentrate use declined only for those who moved from independent to dependent living, and edible use declined only for those who stayed living dependently or moved to dependent living. Cannabis use did not change between post-closure-1 and post-closure-2, regardless of living situation stability or transition.

CONCLUSIONS

Overall, among a sample of cannabis-using college students, the prevalence of any cannabis use, but not frequency of use, was reduced during the pandemic. Living with parents appears to be protective against frequent cannabis use.

Use of highly-potent cannabis concentrate products: More common in U.S. states with recreational or medical cannabis laws

BACKGROUND

Highly-potent cannabis products, e.g., concentrates, entail greater risks of cannabis-related harms than lower-potency products such as plant or flower material. However, little information is available on whether individuals in U.S. states with recreational cannabis laws (RCL) or medical cannabis laws (MCL) are more likely than individuals in U.S. states without cannabis legalization (no-CL) to use highly-potent forms of cannabis.

METHODS

Cannabis-using adults in a 2017 online survey (N = 4064) provided information on state of residence and past-month cannabis use, including types of products used, categorized as low-potency (smoked or vaped plant cannabis) or high-potency (vaping or dabbing concentrates). Multivariable logistic regression models generated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for use of high-potency cannabis products by state cannabis legalization status (RCL, MCL, no-CL).

RESULTS

Compared to participants in no-CL states, participants in RCL states had greater odds of using high-potency concentrate products (aOR=2.61;CI=1.77-3.86), as did participants in MCL-only states (aOR=1.55;CI=1.21-1.97). When participants in RCL states and MCL states were directly compared, those in RCL states had greater odds of using high-potency concentrate products (aOR=1.69;CI=1.27-2.42).

DISCUSSION

Although the sample was not nationally representative and the cross-sectional data precluded determining the direction of effect, results suggest that use of high-potency cannabis concentrates is more likely among those in RCL states. Clinicians in RCL states should screen cannabis users for harmful patterns of use. Policymakers in states that do not yet have RCL should consider these findings when drafting new cannabis laws, including the specific products permitted and how best to regulate them.

Persistent Exposure to Δ9-Tetrahydrocannabinol during Adolescence Does Not Affect Nociceptive Responding in Adult Mice

Evidence suggests that Δ9-tetrahydrocannabinol (Δ9-THC), the intoxicating component of cannabis, causes enduring changes in the structure and function of adolescent brain circuits implicated in nociceptive responding. However, whether such changes might persistently disrupt nociceptive behaviors remains unknown. In the present study, we subjected C57BL6/J mice of both sexes to once-daily injections of Δ9-THC (5 mg-kg-1, i.p.) or vehicle throughout adolescence (PND 30-43) and, when the animals had reached adulthood (PND 70), assessed nociceptive behavior using the formalin and chronic constriction injury tests. We also investigated, using the tail immersion test, the antinociceptive effects of morphine and the development of tolerance to such effects. The results show that adolescent Δ9-THC exposure does not significantly impair nociceptive responding or morphine-related antinociception and tolerance. The findings suggest that frequent exposure to a moderate dose of Δ9-THC during adolescence does not permanently alter nociceptive circuits in male or female mice. SIGNIFICANCE STATEMENT: The endocannabinoid system serves critical functions in the central and peripheral nervous systems, including regulation of pain, and can be modified by prolonged exposure to the intoxicating constituent of cannabis, Δ9-tetrahydrocannabinol (Δ9-THC). This raises the possibility that regular use of Δ9-THC-containing cannabis during adolescence might cause changes in nociception that persist into adulthood. This study found that frequent early-life exposure to a moderate dose of Δ9-THC does not permanently alter nociceptive function in male or female mice.

Advancing the science on cannabis concentrates and behavioural health

ISSUES

The Cannabis sativa L. plant contains hundreds of phytocannabinoids, but putatively of highest importance to public health risk is the psychoactive cannabinoid delta-9-tetrahydrocannabinol (THC), which is associated with risk for cannabis use disorder, affective disturbance, cognitive harm and psychomotor impairment. Recently, there has been an increase in the use and availability of concentrated cannabis products (or 'concentrates') that are made by extracting cannabinoids from the plant to form a product with THC concentrations as high as 90-95%. These products are increasingly popular nationwide. The literature on these widely available high potency concentrates is limited and there are many unknowns about their potential harms.

APPROACH

This review covers the state of the research on cannabis concentrates and behavioural health-related outcomes and makes recommendations for advancing the science with studies focused on accurately testing the risks in relation to critical public and behavioural health questions.

KEY FINDINGS

Data point to unique behavioural health implications of concentrate use. However, causal, controlled and representative research on the effects of cannabis concentrates is currently limited.

IMPLICATIONS

Future research is needed to explore chronic, acute and developmental effects of concentrates, as well as effects on pulmonary function. We also highlight the need to explore these relationships in diverse populations.

CONCLUSION

While the literature hints at the potential for these highly potent products to increase cannabis-related behavioural health harms, it is important to carefully design studies that more comprehensively evaluate the impact of concentrates on THC exposure and short- and long-term effects across user groups.

Correlates of the use of electronic devices to vape cannabis in a cohort of young Swiss male reporting current cannabis use

BACKGROUND

Information about correlates of cannabis vaping in Europe is scarce.

METHODS

In a cohort of 1613 Swiss young males currently using cannabis, we used logistic regression, adjusting for age, linguistic region and education to assess the association between sensation seeking, substance use and sociodemographic variables with cannabis vaping.

RESULTS

Mean age was 25.38 years, 60.4% had post-secondary education and 57.3% lived in French-speaking cantons; 26.3% met criteria for nicotine dependence, 16.0% met criteria for alcohol use disorder and 34.9% used illicit drugs other than cannabis; 27.4% used cannabis at least twice a week and 27.8% met criteria for cannabis use disorder (CUD). Ninety-four participants (5.8%) reported cannabis vaping (of them 87.4% reported infrequent cannabis vaping). In the adjusted analysis, using joints with no tobacco {adjusted odds ratio (aOR) [95% confidence interval (CI)] = 1.45 (1.02-1.76)}, water pipe with [aOR (95% CI) = 1.70 (1.29-2.24)] and without tobacco [aOR (95% CI) = 2.15 (1.60-2.87)], cannabis mixed with food [aOR (95% CI) = 1.61 (1.29-2.02)], using cannabis >2 times a week [aOR (95% CI) = 3.73 (2.40-5.81)], meeting criteria for CUD [aOR (95% CI) = 4.19 (2.70-6.50)], using illicit drugs other than cannabis [aOR (95% CI) = 1.88 (1.23-2.87)], weekly number of alcohol drinks [aOR (95% CI) = 1.01 (1.00-1.03)] and living in the German-speaking area of Switzerland [aOR (95% CI) = 2.70 (1.71-4.25)] were associated with higher odds of cannabis vaping; post-secondary schooling [aOR (95% CI) = 0.37 (0.16-0.86)] and vocational training [aOR (95% CI) = 0.41 (0.17-0.99)] (as opposed to primary schooling) were associated with lower odds of cannabis vaping.

CONCLUSION

Cannabis vaping might be a marker of riskier behaviours among cannabis users.

Changes in Medical Cannabis Patient Status before and after Cannabis Legalization in California: Associations with Cannabis and Other Drug Use

It is unknown how patterns of cannabis and other drug use changed among young adult cannabis users as they became, exited or stayed medical cannabis patients (MCPs) after California legalized cannabis for adult use in 2016. A cohort of 18-26 year-old cannabis users was recruited in Los Angeles in 2014-15 (64.8% male; 44.1% Hispanic/Latinx). Based on wave 1 (pre-legalization) and wave 4 (post-legalization) MCP status, four transition groups emerged: MCP, Into MCP, Out of MCP and NPU (non-patient user). Relationships between self-reported medical cannabis use, transition group membership, and cannabis/other drug use outcomes were examined. Changes in cannabis practices were consistent with changes in MCP status. Cannabis days, concentrate use, self-reported medical cannabis use and driving under influence of cannabis were highest among MCP, increased for Into MCP, and decreased for Out of MCP in wave 4. A majority of drug use outcomes decreased significantly by wave 4. Self-reported medical cannabis use was associated with more frequent cannabis use but less problematic cannabis and other drug use. Future studies should continue to monitor the impact of policies that legalize cannabis for medical or recreational use, and medical motivations for cannabis use on young adults' cannabis and other drug use.

Age-Related Differences in Cannabis Product Use

Cannabis use varies with age and gender, but less is known regarding specific product choices. Previous work suggests that older adults are inclined to stick to the more "classic" and familiar, while "novel" products are more likely to appeal to younger populations. We examined cross-sectional, retrospective data to determine whether the type of cannabis products used varied according to participant age (N = 1406, 71.3% female). The extensive list of products included: loose flower, pre-rolled joints, edibles, concentrates, oil vaporizers (vape pens), dry vaporizers, tinctures, topicals, and ingestible oils. Overall, rates of use for cannabis-infused ingestible oils, topicals, and tinctures are the lowest and show no age or gender-related differences. In contrast, the use of pre-rolled joints, vape pens, and edibles tends to decrease with age. Loose flower and dry vaporizer use also decrease with age, although less consistently. These age-related differences in product choices can facilitate prevention and treatment efforts toward specific populations. While harm-reduction efforts targeting loose flower and edible products would benefit all age groups, those targeting concentrates might focus only on younger users. On the other hand, learning about concentrates might be beneficial for older medical users due to their larger THC doses and rapid onset.

College students' using marijuana to sleep relates to frequency, problematic use, and sleep problems

OBJECTIVE

Given the rising rates of insufficient sleep and the popularity of marijuana, we investigated using marijuana as a sleep aid, marijuana use frequency, problematic marijuana use, and sleep problems. Participants: Participants included a convenience sample of college students who endorsed using marijuana in the past year from May to December 2013 (N = 354; 68% female, 57% White). Methods: Path analyses investigated if using marijuana to sleep predicted: (1) marijuana use outcomes and (2) sleep problems; and if sleep problems predicted marijuana use outcomes. Results: Using marijuana to sleep was related to increased use and problematic use, as well as worse sleep efficiency. Daytime dysfunction related to sleepiness was associated with elevated levels of marijuana use and problematic use. Similar associations were found across sex and race. Conclusions: College students should be informed of the potential misconceptions between marijuana and improved sleep and provided with evidence-based alternatives to improve their sleep.

‘Cannabis’ ontologies I: Conceptual issues with Cannabis and cannabinoids terminology

Objective

Identify a coherent nomenclature for Cannabis sativa L. derived products and their analogues.

Design

Research undertaken in parallel to the three-year assessment of Cannabis derivatives by the World Health Organisation. The scope is limited to Cannabis products intended for human incorporation (internal and topical consumption). Primarily embedded in pharmacognosy, the study incorporates a wide range of scholarly and grey literature, folk knowledge, archives, pharmacopœias, international law, field pharmacy, clinical and herbal medicine data, under a philosophical scrutiny. Generic and Cannabis-specific nomenclatural frames are compared to determine the extent to which they coincide or conflict.

Results

All lexica reviewed use weak, ambiguous, or inconsistent terms. There is insufficient scientific basis for terms and concepts related to Cannabis at all levels. No sound classification exists: current models conflict by adopting idiosyncratic, partial, outdated, or utilitarian schemes to arrange the extraordinarily numerous and diverse derivatives of the C. sativa plant. In law and policy, no clear or unequivocal boundary between herbal and non-herbal drugs, nor natural and synthetic cannabinoids was found; current nomenclatures need updates. In science, the botanical Cannabis lexicon overlooks parthenocarpy, and wide disagreement remains as to the taxonomy and systematics of the plant; chemical research should address differences in kinds between synthetic cannabinoids; pharmacopœias include little information related to Cannabis, and disagree on broader classes of herbal medicines, virtually failing to embrace many known Cannabis medicines. Since existing products and compounds fail to be categorised in an evidence-based manner, confusions will likely increase as novel cannabinoid compounds, genetic and biotechnological modifications surge.

Conclusions

The lack of clarity is comprehensive: for patients, physicians, and regulators. This study proposes an update of terms at several levels. It points at gaps in morphological descriptions in botany and pharmacognosy and a need for a metaphysical address of cannabinoids. Methods of obtention are identified as a common criterion to distinguish products; the way forward suggests a mutually exclusive nomenclatural pattern based on the smallest common denominator of obtention methods. In the context of a swelling number of Cannabis products being consumed (be it via medical prescription, adult-use, ‘hemp’ foodstuff and cosmetics, or other purposes), this study can assist research, contribute to transparent labelling of products, consumer safety and awareness, pharmacovigilance, medical standards of care, and an update of prevention and harm reduction approaches. It can also better inform regulatory policies surrounding C. sativa, its derivatives, and other cannabinoid-containing products.

Characterizing the predictive validity of measures of susceptibility to future use of combustible, vaporized and edible cannabis products in adolescent never-users

BACKGROUND AND AIMS

The construct of susceptibility to substance use initiation (i.e. cognitive proclivity to future use) is critical for prevention efforts in adolescent populations. This study aimed to provide empirical evidence for the validity of the susceptibility construct for different cannabis products (i.e. combustible, edible or vaporized cannabis), and evaluate whether susceptibility measures are predictive of subsequent initiation.

DESIGN

Prospective cohort study including baseline data (Spring 2015) and four follow-up surveys administered every 6 months through Spring 2017.

SETTING

Ten schools in the Los Angeles, California metropolitan area.

PARTICIPANTS

Adolescents [n = 2100; mean age = 16.1; standard deviation (SD) = 0.41; 54% female] who reported never having used any cannabis product at baseline.

MEASUREMENTS

We assessed five indices of a susceptibility to use cannabis composite index at baseline, adapted from a validated tobacco use index (intention to use, willingness, curiosity and positive/negative cannabis use outcome expectancies, with four response categories, definitely not [1] to definitely yes [4]), by cannabis product (combustible, edible or vaporized). A composite index was created for each product by averaging responses across the five susceptibility items. Subsequent initiation of use of each cannabis product was assessed at each follow-up wave.

FINDINGS

Factorial validity for unidimensionality for each five-item index (by product) was confirmed. The composite index for susceptibility to cannabis use was greatest for combustible (mean = 1.44; SD = 0.58), moderate for edible (mean = 1.37; SD = 0.53) and lowest for vaporized cannabis (mean = 1.30; SD = 0.44). The associations of each composite susceptibility index with subsequent initiation of that product and each of the other cannabis products over follow-up (i.e. cross-product associations) were statistically significant, with hazard ratios ranging from 2.30 to 2.80 across 24 months of follow-up (all Ps < 0.05).

CONCLUSIONS

A five-item susceptibility to cannabis use composite index (by product) appears to be useful for characterizing and predicting youth at risk for cannabis use initiation across a spectrum of cannabis products.

Predictors of marijuana vaping onset and escalation among young adults

BACKGROUND

Little is known about factors that influence marijuana vaping among young people. We examined cigarette, e-cigarette and marijuana use experiences, social network characteristics and exposure to direct e-cigarette marketing as predictors of marijuana vaping initiation and escalation.

METHODS

One-year prospective data were collected between 2017 and 2019 from 2327 young adults (Mean age = 21.2; SD = 2.1; 54 % women) attending 2-year and 4-year colleges in Hawaii.

RESULTS

Among participants who were never marijuana users at baseline, being a dual user of cigarette and e-cigarette at baseline was the strongest predictor of marijuana vaping initiation, followed by baseline cigarette-only and e-cigarette-only use. Higher prevalence of regular marijuana users in one's social networks, but not e-cigarette users or cigarette smokers, significantly predicted marijuana vaping initiation a year later. Among baseline current e-cigarette users and lifetime marijuana users, higher presence in social networks of individuals who frequented vape shops at baseline was a significant predictor of increased current marijuana vaping at one-year follow-up.

CONCLUSIONS

Dual use of cigarette and e-cigarette and greater presence in social networks of marijuana users and people who frequent vape shops appear to be robust predictors of marijuana vaping onset and escalation among young adults. In addition to promoting e-cigarette use prevention/cessation, efforts to control marijuana vaping may need to consider promoting smoking prevention/cessation and the effects of increasing prevalence of marijuana use.

Association of Naturalistic Administration of Cannabis Flower and Concentrates With Intoxication and Impairment

IMPORTANCE

The rapidly growing legal cannabis market includes new and highly potent products, the effects of which, to our knowledge, have not previously been examined in biobehavioral research studies because of federal restrictions on cannabis research.

OBJECTIVE

To use federally compatible, observational methods to study high-∆9-tetrahydrocannabinol (THC) legal market forms of cannabis.

DESIGN, SETTING, AND PARTICIPANTS

In this cohort study with a between-groups design that was conducted in a community and university setting, cannabis flower users and concentrate users were randomly assigned to higher- vs lower-THC products within user groups. Participants completed a baseline and an experimental mobile laboratory assessment that included 3 points: before, immediately after, and 1 hour after ad libitum legal market flower and concentrate use. Of the 133 individuals enrolled and assessed, 55 regular flower cannabis users (41.4%) and 66 regular concentrate cannabis users (49.6%) complied with the study's cannabis use instructions and had complete data across primary outcomes.

EXPOSURES

Flower users were randomly assigned to use either 16% or 24% THC flower and concentrate users were randomly assigned to use either 70% or 90% THC concentrate that they purchased from a dispensary.

MAIN OUTCOMES AND MEASURES

Primary outcome measures included plasma cannabinoids, subjective drug intoxication, and neurobehavioral tasks testing attention, memory, inhibitory control, and balance.

RESULTS

A total of 121 participants completed the study for analysis: 55 flower users (mean [SD] age, 28.8 [8.1] years; 25 women [46%]) and 66 concentrate users (mean [SD] age, 28.3 [10.4] years; 30 women [45%]). Concentrate users compared with flower users exhibited higher plasma THC levels and 11-hydroxyΔ9-THC (THC's active metabolite) across all points. After ad libitum cannabis administration, mean plasma THC levels were 0.32 (SE = 0.43) μg/mL in concentrate users (to convert to millimoles per liter, multiply by 3.18) and 0.14 (SE = 0.16) μg/mL in flower users. Most neurobehavioral measures were not altered by short-term cannabis consumption. However, delayed verbal memory (F1,203 = 32.31; P < .001) and balance function (F1,203 = 18.88; P < .001) were impaired after use. Differing outcomes for the type of product (flower vs concentrate) or potency within products were not observed.

CONCLUSIONS AND RELEVANCE

This study provides information about the association of pharmacological and neurobehavioral outcomes with legal market cannabis. Short-term use of concentrates was associated with higher levels of THC exposure. Across forms of cannabis and potencies, users' domains of verbal memory and proprioception-focused postural stability were primarily associated with THC administration.

Complex cannabis use patterns: Associations with cannabis consequences and cannabis use disorder symptomatology

BACKGROUND

Historically, cannabis researchers have assumed a single mode and product of cannabis (e.g., smoking plant). However, patterns of use, products (e.g., concentrates, edibles), and modes (e.g. blunts, vaporizers) are diversifying. This study sought to: 1) classify cannabis users into groups based on their use of the full range of cannabis products, and 2) examine user group differences on demographics, cannabis consequences and cannabis use disorder (CUD) symptomatology.

METHODS

In a sample of college students (data collected in Fall 2017), who used cannabis in the past year (N = 1390), latent class analysis (LCA) was used to characterize cannabis users. We then added demographic characteristics, cannabis consequences, and CUD symptomatology scores separately to LCA models to examine class differences.

RESULTS

Five unique classes emerged: high-frequency all-product users, high-frequency plant/moderate-frequency edible and concentrate users, low-frequency plant users, moderate-frequency plant and edible users, and low-frequency edible users. Demographic characteristics, cannabis consequences, and CUD symptomatology differed across classes characterized by frequency as well as product.

CONCLUSIONS

Results reflect the increasing variety of cannabis products, modes, and use patterns among college students. In this sample, frequency of use remains a strong predictor of cannabis-related consequences, in addition to type of product. As variation in cannabis use patterns continue to evolve, it is essential for researchers to conduct comprehensive assessments.

Acute Effects of Cannabis Concentrate on Motor Control and Speed: Smartphone-Based Mobile Assessment

Background: The use of cannabis concentrate is dramatically rising and sparking major safety concerns. Cannabis concentrate contains tetrahydrocannabinol (THC) potencies up to 90%, yet there has been little research on motor impairment after concentrate use (commonly referred to as "dabbing"). This study measured postural control and motor speed after the use of high potency concentrates in males and females. Methods: Experienced concentrate users (N = 65, Female: 46%, 17 ± 11 days/month of concentrate use) were assessed for motor performance in a mobile laboratory before, immediately after, and 1 h after ad-libitum cannabis concentrate use. Plasma levels of THC were obtained via venipuncture at each timepoint. We used a remotely deployable motor performance battery to assess arm and leg movement speed, index finger tapping rate, and balance. The sensors on a smart device (iPod Touch) attached to the participant provided quantitative measures of movement. Results: Arm speed slowed immediately after concentrate use and remained impaired after 1 h (p < 0.001), leg speed slowed 1 h after use (p = 0.033), and balance decreased immediately after concentrate use (eyes open: p = 0.017, eyes closed: p = 0.013) but not at 1 h post-use. These effects were not different between sexes and there was no effect of concentrate use on finger tapping speed. Acute changes in THC plasma levels after use of concentrates were minimally correlated with acute changes in balance performance. Conclusions: Use of cannabis concentrates in frequent users impairs movement speed and balance similarly in men and women. The motor impairment is largely uncorrelated with the change in THC plasma levels. These results warrant further refinement of cannabis impairment testing and encourage caution related to use of cannabis concentrates in work and driving settings.

Is the Adolescent Brain at Greater Vulnerability to the Effects of Cannabis? A Narrative Review of the Evidence

Cannabis use during the critical neurodevelopmental period of adolescence, may lead to brain structural, functional, and histological alterations that may underpin some of the longer-term behavioral and psychological harms associated with it. The endocannabinoid system performs a key regulatory and homeostatic role, that undergoes developmental changes during adolescence making it potentially more susceptible to the effects of exposure to cannabis during adolescence. Here, we synthesize evidence from human studies of adolescent cannabis users showing alterations in cognitive performance as well as in brain structure and function with relevant preclinical evidence to summarize the current state of knowledge. We also focus on the limited evidence that speaks to the hypothesis that cannabis use during adolescence, may pose a greater risk than use during adulthood, identify gaps in current evidence and suggest directions for new research. Existing literature is consistent with the association of cannabis use during adolescence and neurological changes. Adolescence cannabis users show altered functional connectivity within known functional circuits, that may underlie inefficient recruitment of brain regions, as largely increased functional activation has been observed compared to controls. This disruption in some cases may contribute to the development of adverse mental health conditions; increasing the chances or accelerating the onset, of their development. Preclinical evidence, further supports disruption from cannabis use being specific to the developmental period. Future studies are required to better investigate adolescent cannabis use with more accuracy using better defined groups or longitudinal studies and examine the permanency of these changes following caseation of use. Furthermore, research is required to identify heritable risk factors to cannabis use. There is a need for caution when considering the therapeutic potential of cannabis for adolescence and particularly in public discourse leading to potential trivialization of possible harm from cannabis use in adolescence. Current evidence indicates that adolescence is a sensitive period during which cannabis use may result in adverse neurocognitive effects that appear to show a level of permanency into adulthood.

Changing landscape of cannabis: novel products, formulations, and methods of administration

Laws regulating cannabis have changed radically in the U.S. and abroad. Historically, users smoked dried cannabis flowers that contained Δ9-tetrahydrocannabinol (THC), the primary psychoactive component of cannabis, as the principal product constituent. Coincident with cannabis legalization and increased interest in medicinal use of the plant, there is now an expansive retail cannabis marketplace with novel cannabis products, formulations, and methods of administration. In this review, we describe emergent cannabis product chemotypes (e.g. THC-dominant, CBD-dominant, balanced or 'hybrid' with high concentrations of THC and CBD), product formulations (e.g. edibles, concentrates), and methods of administration (e.g. smoked, vaporized, orally ingested). Psychologists can play a pivotal role in studying the health impact of cannabis legalization and conducting research to inform product regulation.

Who's Buying What and How Much? Correlates of Purchase Behaviors From Medical Marijuana Dispensaries in Los Angeles, California

Venue-based distribution of marijuana has become the normative model in the United States to obtain marijuana. This study examines one-time purchase behaviors at medical marijuana dispensaries (MMDs) to identify potential venue- and individual-level targets for prevention. We used a two-stage, venue-based sampling approach to randomly select patrons exiting 16 MMDs in Los Angeles, California during the spring of 2013. Patrons (N = 595) reported their discrete purchase behaviors during their most recent visit to the sampled MMD. We used hierarchical linear modeling to examine the amount spent on marijuana products, regressed on characteristics of the sampled dispensaries and their patrons. We used hierarchical generalized linear modeling to examine the likelihood of purchasing specific types of marijuana products and total grams of loose-leaf buds purchased. Patrons spent US$41.73 on average, with a range of $0-$330. We observed significant variation in purchase behaviors across MMDs and associations between venues located within high median income census tracts and a higher total amount spent and lower odds of purchasing only loose-leaf buds. The networked distance between a patron's home and the sampled MMD was positively associated with the total amount spent and total quantity of buds purchased. We also found significant relationships between medical conditions reported for use in three models: total amount spent, purchase of pre-rolled joints, and total grams of buds purchased. Policy makers may want to explore regulating the availability of specialty items that may be attractive to naïve users, such as pre-rolled joints or edibles, or high-concentration products that may be sought out by regular, heavy users.

Early evidence of the impact of cannabis legalization on cannabis use, cannabis use disorder, and the use of other substances: Findings from state policy evaluations

Background: The past decade has seen unprecedented shifts in the cannabis policy environment, and the public health impacts of these changes will hinge on how they affect patterns of cannabis use and the use and harms associated with other substances.Objectives: To review existing research on how state cannabis policy impacts substance use, emphasizing studies using methods for causal inference and highlighting gaps in our understanding of policy impacts on evolving cannabis markets.Methods: Narrative review of quasi-experimental studies for how medical cannabis laws (MCLs) and recreational cannabis laws (RCLs) affect cannabis use and use disorders, as well as the use of or harms from alcohol, opioids, and tobacco.Results: Research suggests MCLs increase adult but not adolescent cannabis use, and provisions of the laws associated with less regulated supply may increase adult cannabis use disorders. These laws may reduce some opioid-related harms, while their impacts on alcohol and tobacco use remain uncertain. Research on RCLs is just emerging, but findings suggest little impact on the prevalence of adolescent cannabis use, potential increases in college student use, and unknown effects on other substance use.Conclusions: Research on how MCLs influence cannabis use has advanced our understanding of the importance of heterogeneity in policies, populations, and market dynamics, but studies of how MCLs relate to other substance use often ignore these factors. Understanding effects of cannabis laws requires greater attention to differences in short- versus long-term effects of the laws, nuances of policies and patterns of consumption, and careful consideration of appropriate control groups.

Cannabis Concentrate Use in Adolescents

BACKGROUND

Cannabis concentrates, which are cannabis plant extracts that contain high concentrations of Δ-9-tetrahydrocannbinol (THC), have become increasingly popular among adults in the United States. However, no studies have reported on the prevalence or correlates of cannabis concentrate use in adolescents, who, as a group, are thought to be particularly vulnerable to the harms of THC.

METHODS

Participants are a racially and ethnically diverse group of 47 142 8th-, 10th-, and 12th-grade students recruited from 245 schools across Arizona in 2018. Participants reported on their lifetime and past-month marijuana and cannabis concentrate use, other substance use, and risk and protective factors for substance use problems spanning multiple life domains (ie, individual, peer, family, school, and community).

RESULTS

Thirty-three percent of all 8th-, 10th-, and 12th-graders reported lifetime cannabis use, and 24% reported lifetime concentrate use. Seventy-two percent of all lifetime cannabis users had used concentrates. Relative to adolescent cannabis users who had not used concentrates, adolescent concentrate users were more likely to use other substances and to experience more risk factors, and fewer protective factors, for substance use problems across numerous life domains.

CONCLUSIONS

Most adolescent cannabis users have used concentrates. Based on their risk and protective factor profile, adolescent concentrate users are at higher risk for substance use problems than adolescent cannabis users who do not use concentrates. Findings raise concerns about high-risk adolescents' exposure to high-THC cannabis.

Frequently asked questions about dabbing concentrates in online cannabis community discussion forums

BACKGROUND

"Dabbing" involves vaporizing a "dab" of cannabis concentrate on a heated "nail," passing the vapour through a water-pipe rig or portable pen device, and inhaling the vapour. While some cannabis industry media claims that this process is cleaner, safer, and more effective for getting high, medical and public health sources raise concerns about residual solvents and pesticides, unexpectedly intense effects, and rapid increases in tolerance. The aim of this study is to characterize the content of questions about dabbing posed in cannabis and dabbing-specific forums on the Reddit social media platform, as well as comment responses to these questions.

METHODS

We conducted a content analysis of one year (2017) of information-seeking user-generated posts to three Reddit online cannabis community discussion forums ("subreddits") that contained the terms "dab" and "question." We also examined post engagement and the types and sentiment of information exchanged in the comment responses.

RESULTS

Across 193 dabbing question posts, the most frequently asked question content was about types and logistical use of devices and related equipment (38%) and comparisons of cannabis products (32%), followed by questions about the step-by-step process of getting high (18%), legal issues (17%), and health concerns (13%). Nearly every post had a response (98%), with a median 5 comments per post and few negative (i.e. hostile, condescending, or trolling) comments (4%). Source of advice or information was stated in about a quarter (26%) of comment responses, with the overwhelming majority of this information (89%) coming from disclosures of personal experience vs. web or commercial sources.

CONCLUSION

People seeking advice online about dabbing inquired most often about logistics of use, but less often about health, tolerance, and legal risks. These findings may be used to inform public health efforts and health practitioner education as cannabis becomes increasingly legal and accessible.

Web-Based Eligibility Quizzes to Verify Opioid Use and County Residence Among Rural Young Adults: Eligibility Screening Results from a Feasibility Study

Background

Web-based methods can be used to collect data from hidden populations, including people who use drugs (PWUD). These methods might be especially advantageous among PWUD in rural areas, where transportation barriers are prevalent, stigma may heighten concerns about confidentiality, and internet access is improving. However, Web-based research with PWUD can be challenging, especially in verifying eligibility. Administering quizzes to verify residential and substance use eligibility could prove valuable in online research among PWUD, yet the utility of this approach is currently unknown.

Objective

This study describes the implementation of online eligibility quizzes about the local community to verify residence in the target study area along with drug dose, appearance, and price to verify opioid misuse.

Methods

To be eligible, individuals had to live in 1 of 5 eastern Kentucky counties, report using opioids to get high in the past 30 days, and be 18 to 35 years old. Participants recruited from August 2017 to July 2018 were asked questions about their opioid use followed by a quiz about drug dose, appearance, and price to verify substance use eligibility. Residential eligibility was verified with 5-question quizzes assessing knowledge of the county where they reported living. Questions tested knowledge about towns, festivals, and landmarks; local school mascots and colors; and presence of certain retail stores, restaurants, and facilities (eg, jails). A subsample that reported using opioids in the past 24 hours was randomly selected to complete urine drug testing (UDT). Nonparametric tests were performed to explore differences across demographic subgroups.

Results

Of the 410 entries assessed for eligibility, 39.3% (161/410) were ineligible as they reported no substance use, being outside the age range, or living outside the study area. Of the remaining 249 who met the eligibility criteria based on age, residency, and opioid misuse, 94.0% (234/249) passed the eligibility quizzes. Among those who passed the heroin quiz, 99.4% (167/168) recognized the image of powdered heroin, 94.6% (159/168) answered the cap size (ie, the purchase unit) question correctly, and 97.0% (163/168) answered the street price question correctly. Among those who passed the drug quiz for prescription opioids, 95% (36/38) answered the dose question correctly, and 82% (31/38) selected the correct image. In a random sample of participants who completed UDT within 3 days of their online screening, 74% (25/34) tested positive for an opioid.

Conclusions

This study demonstrated the utility of using online eligibility screening quizzes to verify opioid misuse and residence. Participants accurately recognized heroin and prescription opioid doses, prices, and images and correctly answered questions about features of their county. Online quizzes to screen and enroll PWUD hold promise for future research as an alternative to more time- and resource-intensive approaches that could offset the advantages of Web-based methods.

Butane hash oil and dabbing: insights into use, amateur production techniques, and potential harm mitigation

The use of marijuana concentrates has escalated in recent years with butane extracts appearing particularly popular. The administration of butane hash oil, colloquially referred to as “dabbing,” is distinct from traditional flower cannabis usage due to the THC content of samples and the presence of impurities such as unpurged butane. While this may confer heightened risk to the user, additional significant concerns are tied to fires and explosions. Using butane as a solvent in amateur “blasting” methods may result in a flammable vapor pooling in enclosed spaces and igniting when exposed to a spark. As research on butane extract users, amateur production techniques, health risks, and legality is in its infancy, we explored existing studies on the topic to create a review of substantiated knowledge related to THC extracted using butane. The resulting assessment centers on three areas: 1) dab users including both recreational users and medical marijuana patients; 2) butane extraction techniques including illicit amateur open methods and the safer closed-loop system employed in medicinal/recreational states; and 3) risks, both related to fires and legality. We follow the presentation of this material with a summary of the (mis)information reaching the public in print and online sources so that public educational campaigns can focus on dispelling the inaccuracies and false notions of safety that may be tied to amateur production.

E-cigarettes-An unintended illicit drug delivery system

Since the introduction of electronic cigarettes (e-cigarettes) in 2003, the technology has advanced allowing for greater user modifications, with users now able to control voltage, battery power, and constituents of the e-cigarette liquid. E-cigarettes have been the subject of a growing body of research with most research justifiably focused on the chemical makeup and risk analysis of chemicals, metals, and particulates found in e-cigarette liquids and vapor. Little research to date has focused on assessing the risks associated with the drug delivery unit itself and its potential for use as an illicit drug delivery system. In light of this, a range of illicit drugs was researched focusing on pharmacodynamics, usual method of administration, the dosage required for toxicity, toxic effects, and evidence of existing use in e-cigarettes in both literature and online illicit drug forums. A systematic literature search found evidence of current use of e-cigarettes to vape almost all illicit drug types analyzed. This presents both a potential population health risk and a management issue for clinicians. It also raises the issue of policing illicit drugs due to potential altered characteristic smells and storage within e-cigarette fluids. E-cigarettes are a viable illicit drug delivery system with evidence both inside and outside of the formal medical literature detailing their potential use for drug delivery of a wide range of illicit and legal drugs.

Prevalence and Sociodemographic Correlates of Adolescent Use and Polyuse of Combustible, Vaporized, and Edible Cannabis Products

IMPORTANCE

Cannabis legalization and commercialization have introduced novel alternative cannabis products, including edible and vaporized cannabis that might appeal to youth and be associated with polyuse (ie, use of ≥2 different products).

OBJECTIVE

To investigate the prevalence, patterns, and sociodemographic correlates of cannabis product use across combustible, edible, and vaporized administration methods, including polyuse of cannabis via multiple administration methods.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional survey study included 10th-grade students from 10 Los Angeles, California, area high schools from January 2 through October 6, 2015. Students were recruited from respondents in the Happiness and Health Study, an ongoing prospective cohort study in the 10 high schools. Students not in school during administration of the pencil-and-paper survey completed abbreviated surveys by telephone, internet, or mail. Data were analyzed from July 17, 2017, through July 12, 2018.

EXPOSURES

Self-reported sex, race/ethnicity, and socioeconomic status (SES). Students with high SES had parents who attained college or a higher educational level and were ineligible for free or subsidized lunch; those with low SES had parents with lower educational attainment or were eligible for free or subsidized lunch.

MAIN OUTCOMES AND MEASURES

Self-report of ever use (yes or no) and past 30-day use (yes or no) status and frequency of use (days in past 30 days) of combustible, edible, and vaporized cannabis.

RESULTS

The sample included 3177 tenth-grade students (93.5% of study enrollees); among these students, 1715 (54.0%) were girls and the mean (SD) age was 16.1 (0.4) years. Among those with available demographic data, respondents were diverse in race/ethnicity (537 [17.2%] Asian; 149 [4.8%] black; 1510 [48.3%] Hispanic; 507 [16.2%] white; 207 [6.6%] multiethnic/multiracial; and 216 [6.9%] other) and included 1654 (60.1%) with a low SES. Prevalence of ever use was highest for combustible products (993 [31.3%]), followed by edible (676 [21.3%]) and vaporized (333 [10.5%]) products. A similar pattern was found for past 30-day use (426 [13.4%] for combustible, 249 [7.8%] for edible, and 156 [4.9%] for vaporized cannabis). Among participants who reported using cannabis in the past 30 days, mean frequency of use of combustible cannabis was higher by 2.65 days (95% CI, 1.40-3.91 days, P = .001) than the mean frequency of use for edible cannabis and 1.75 days higher (95% CI, 0.59-2.90 days, P = .003) than frequency of use for vaporized cannabis. Most cannabis users (665 [61.7%]) used multiple administration methods, and 260 (8.2%) used all 3 methods. Boys had higher prevalence of ever use for vaporized (170 [11.6%] vs 163 [9.5%]) but not combustible (459 [31.4%] vs 534 [31.1%]) or edible (303 [20.7%] vs 373 [21.7%]) cannabis. Respondents with low SES had higher prevalence of ever use for combustible (614 [37.1%] vs 242 [22.0%]) and edible (408 [24.7%] vs 166 [15.1%]) but not vaporized (186 [11.2%] vs 93 [8.5%]) cannabis.

CONCLUSIONS AND RELEVANCE

Among 10th-grade students in Los Angeles, use of cannabis via alternative administration methods was of appreciable prevalence, predominately reported in conjunction with other cannabis products and unequally distributed across sociodemographic strata. Prevention programs and regulatory restrictions addressing the spectrum of cannabis products might benefit pediatric public health.

Made from concentrate? A national web survey assessing dab use in the United States

BACKGROUND

Cannabis concentrates, including dabs, contain extremely high levels of Δ⁹-tetrahydrocannabinol (THC). Although these products appear to be gaining popularity among recreational cannabis consumers, little data exists regarding concentrate use in the US. We conducted a national web-based survey to examine patterns of concentrate use, specifically dabbing.

METHODS

4077 respondents completed a survey designed to assess the use of conventional flower cannabis relative to dabs. Individuals provided information about frequency and magnitude of use, and also completed the Marijuana Motives Measure and Severity of Dependence Scale to examine whether dab users have different motives for use and/or demonstrate more severe consequences of use compared to those who only use conventional flower products.

RESULTS

58% of respondents reported they had tried dabs at least once and 36.5% endorsed regular use (once a month or more). Those who use regularly use dabs were significantly more likely to report using for experimentation (feeling "curious") relative to reasons for using conventional flower products. Interestingly, motives reflecting positive effects (i.e., coping, sleep problems, relieving social anxiety) were endorsed more highly for flower use. In addition, regular dab users reported being more worried about their use of cannabis products relative to those who had tried dabs but did not use regularly.

CONCLUSIONS

Results indicate that cannabis consumers do not necessarily choose dabs over flower products for positive effects, but rather appear to choose these highly potent products for experimentation. As concentrate use may lead to increased cannabis-related problems, studies directly assessing concentrate users are needed.

Exploring cannabis concentrates on the legal market: User profiles, product strength, and health-related outcomes

Background

Concentrated cannabis products are increasingly available and used, particularly in states with legal cannabis, but little is known about the profiles and characteristics of concentrate users. We aimed to characterize user profiles of cannabis users living in states with legal medical or recreational cannabis who reported using concentrates to those who do not use concentrates.

Methods

An anonymous online survey was advertised in California, Colorado, Nevada, Oregon, and Washington. We compared respondents who endorsed frequent concentrate use (FC; N = 67) (i.e. 4 days/week) with cannabis users who never use concentrates (NC; N = 64), and with those who smoke/vaporize cannabis flower frequently but never or very rarely use concentrates (FF; N = 60), on measures related to cannabis use patterns and cannabinoid product strength, other substance use, and occupational functioning and health.

Results

FC endorsed more symptoms of cannabis use disorder as compared to non-concentrate users (p < 0.05), but were similar to FF and NC on other health and occupational outcomes. FC also differed from FF and NC in that they tended to use cannabis that was higher in THC (p < 0.0005), even when using non-concentrated forms of cannabis (p < 0.005). Over half of FC users reported typically using concentrates of at least 80% THC, and 21% endorsed use of (non-concentrated) dry cannabis flower containing at least 30% THC.

Conclusions

Concentrate users endorsed higher symptoms of cannabis use disorder and use higher strength cannabis even when using non-concentrated forms. Frequent use of concentrates may be associated with additional risks over and above frequent use of flower forms.

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Use of high potency concentrates is on the rise with little data on their impact.

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We compare profiles of concentrate users to users of other forms of cannabis.

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Concentrate users have more Cannabis Use Disorder symptoms.

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THC strengths are higher in concentrate users even when using other forms of cannabis.

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Concentrates may pose greater abuse risk relative to other forms of cannabis.

Initiation of vaporizing cannabis: Individual and social network predictors in a longitudinal study of young adults

BACKGROUND

A trend has recently emerged of individuals using electronic nicotine delivery systems (ENDS) or similar devices to vaporize cannabis, either in the form of high-potency THC concentrates or cannabis plant material. Peer use is central to the adoption of substance use behaviors in young adulthood, but little is known about peer influence for initiating cannabis vaping.

METHODS

A longitudinal investigation of first-year college students (N = 1313) using social network methods was conducted to determine the prevalence of vaping cannabis, differences in networks between individuals who initiate vaping cannabis, and predictors of initiation of vaping cannabis across two time points. The surveys were available for two weeks beginning in the sixth week of each semester.

RESULTS

We found that 9.4% vaped in their lifetime but not since the first survey, 7.5% vaped in their lifetime and since the first survey, and 5.9% reported vaping cannabis at the second survey. Lifetime cannabis use, lifetime ENDS use, and number of peers who initiated vaping cannabis from Time 1 to Time 2 were significantly associated with increased odds of the initiation of vaping cannabis; the number of any-cannabis-using or any-ENDS-using peers was not associated with increased odds of initiating vaping cannabis.

CONCLUSIONS

Individuals with the greatest risk of initiation of vaping cannabis during the first year of college are those with a prior history of other cannabis use and ENDS use and who have peers in their network who initiate cannabis vaping.

Cannabis regulatory science: risk-benefit considerations for mental disorders

The evolving legal cannabis landscape in the US continues to present novel regulatory challenges that necessitate the development of a Cannabis Regulatory Science. Two specific issues of concern within Cannabis Regulatory Science are (1) the impact that cannabis use has on the incidence, prevalence, and severity of mental disorders, and (2) how cannabis laws and regulations modify this impact. This paper first provides several conceptual points that are useful for evaluating the relationship between cannabis use and mental disorders. Second, it selectively reviews and comments on data relevant to the relationship between cannabis use and depression, several forms of anxiety, post-traumatic stress disorder, schizophrenia, and bipolar disorder. Next, regulatory and public health parallels between the nascent cannabis industry and the pharmaceutical, tobacco, and alcohol industries are discussed. The focus is on specific types of industry practices that may harm those with or at risk for mental disorders. Recommendations are then offered for legal cannabis regulations that could mitigate this harm. Last, future research goals are discussed for building the field of Cannabis Regulatory Science and addressing the potential negative impact of cannabis on those with mental disorders.

A Twitter-based survey on marijuana concentrate use

AIMS

The purpose of this paper is to analyze characteristics of marijuana concentrate users, describe patterns and reasons of use, and identify factors associated with daily use of concentrates among U.S.-based cannabis users recruited via a Twitter-based online survey.

METHODS

An anonymous Web-based survey was conducted in June 2017 with 687 U.S.-based cannabis users recruited via Twitter-based ads. The survey included questions about state of residence, socio-demographic characteristics, and cannabis use including marijuana concentrates. Multiple logistic regression analyses were conducted to identify characteristics associated with lifetime and daily use of marijuana concentrates.

RESULTS

Almost 60% of respondents were male, 86% were white, and the mean age was 43.0 years. About 48% reported marijuana concentrate use. After adjusting for multiple testing, significant predictors of concentrate use included: living in "recreational" (AOR = 2.04; adj. p = .042) or "medical, less restrictive" (AOR = 1.74; adj. p = .030) states, being younger (AOR = 0.97, adj. p = .008), and daily herbal cannabis use (AOR = 2.57, adj. p = .008). Out of 329 marijuana concentrate users, about 13% (n = 44) reported daily/near daily use. Significant predictors of daily concentrate use included: living in recreational states (AOR = 3.59, adj. p = .020) and using concentrates for therapeutic purposes (AOR = 4.34, adj. p = .020).

CONCLUSIONS

Living in states with more liberal marijuana policies is associated with greater likelihood of marijuana concentrate use and with more frequent use. Characteristics of daily users, in particular, patterns of therapeutic use warrant further research with community-recruited samples.

Leveraging user perspectives for insight into cannabis concentrates

BACKGROUND

The US has seen an increase in the popularity of highly concentrated forms of cannabis (hereafter concentrates) and too little is known about the potential risks associated with their use.

OBJECTIVES

The present study aims to better understand the patterns and outcomes of concentrates use through the perspectives of young adult users.

METHODS

Participants (N = 234, 27.9% female) aged 18-35 years were recruited using SurveyMonkey Audience® and had ingested concentrates at least once in the past 6 months. They were queried on concentrates use patterns (e.g., frequency, medical/recreational) and the effects experienced after using concentrates (e.g., physiological/psychological, strength/duration).

RESULTS

A total of 27.8% of participants reported frequent use of concentrates (≥10 days in past month). Those who used for medical purposes or lived in states where use is legal were more likely to use concentrates frequently. While most (64.2%) did not report experiencing potentially serious side effects, some reported a sense of altered reality/confusion (23.3%), rapid heartbeat (11.2%), lung pain (9.9%) and severe paranoia (6.9%). Among those who used concentrates in the past month (N = 168), 72.6% used concentrates with other cannabis forms, 57.7% used along with alcohol, and 22.6% used with other drugs.

CONCLUSION

Continued research on concentrates use in the US is needed. Research-informed policies that foster safe and responsible use of concentrates are necessary to protect users, especially those who use concentrates frequently, from potential negative side effects.

"You got to love rosin: Solventless dabs, pure, clean, natural medicine." Exploring Twitter data on emerging trends in Rosin Tech marijuana concentrates

BACKGROUND

"Rosin tech" is an emerging solventless method consisting in applying moderate heat and constant pressure on marijuana flowers to prepare marijuana concentrates referred to as "rosin." This paper explores rosin concentrate-related Twitter data to describe tweet content and analyze differences in rosin-related tweeting across states with varying cannabis legal statuses.

METHOD

English language tweets were collected between March 15, 2015 and April 17, 2017, using Twitter API. U.S. geolocated unique (no retweets) tweets were manually coded to evaluate the content of rosin-related tweets. Adjusted proportions of Twitter users and personal communication tweets per state related to rosin concentrates were calculated. A permutation test was used to analyze differences in normalized proportions between U.S. states with different cannabis legal statuses.

RESULTS

eDrugTrends collected 8389 tweets mentioning rosin concentrates/technique. 4164 tweets (49.6% of total sample) posted by 1264 unique users had identifiable state-level geolocation. Content analysis of 2010 non-retweeted tweets revealed a high proportion of media-related tweets (44.2%) promoting rosin as a safer and solventless production method. Tweet-volume-adjusted percentages of geolocated Twitter users and personal communication tweets about rosin were respectively up to seven and sixteen times higher between states allowing recreational use of cannabis and states where cannabis is illegal.

CONCLUSION

Our results indicate that there are higher proportions of personal communication tweets and Twitter users tweeting about rosin in U.S. states where cannabis is legalized. Rosin concentrates are advertised as a safer, more natural form of concentrates, but more research on this emerging form of marijuana concentrate is needed.