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Jablonska B, Negura L. Navigating the Grey Zone: The Impact of Legislative Frameworks in North America and Europe on Adolescent Cannabis Use-A Systematic Review. Behav Sci (Basel) 2024; 14:484. [PMID: 38920816 PMCID: PMC11200412 DOI: 10.3390/bs14060484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVES This paper aims to systematically review the impact of legislative framework changes in North America and Europe on adolescent cannabis use. It not only seeks to examine the prevalence of adolescent marijuana use following legislative changes but also to identify the driving forces behind fluctuations in use and to address the gaps left by previous studies. METHODS A systematic literature review was conducted in selected databases. After screening English-language publications dating from 2013 to 2023 (n = 453 studies), 24 met the inclusion criteria. Articles were considered if they analyzed the impact of legislative changes on adolescent cannabis use in countries across North America and Europe. SYNTHESIS The overall findings suggest an inconsistency regarding the prevalence of cannabis use among youth and adolescents following policy changes. The effects of modifications in cannabis policies on marijuana consumption are complex and influenced by various factors. These include the details of legislation, societal perspectives, enforcement methods, socioeconomic status, and cultural background. CONCLUSIONS The results of this analysis reveal a nuanced reality. Although research suggests a rise in cannabis use after legalization, there are variations in the outcomes observed. This highlights the significance of considering context and demographics. Moreover, studies shed light on how specific policy changes, such as depenalization, can affect cannabis use.
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Affiliation(s)
| | - Lilian Negura
- School of Social Work, Faculty of Social Sciences, University of Ottawa, 120, University Private, Ottawa, ON K1N 6N5, Canada;
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Goodwin RD, Silverman KD. Evolving Disparities in Cannabis Use Among Youth by Demographics and Tobacco and Alcohol Use in the U.S.: 2013-2021. Am J Prev Med 2024; 66:1035-1042. [PMID: 38272242 DOI: 10.1016/j.amepre.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION This study investigated the prevalence of past 30-day cannabis use among U.S. youth by cigarette use, alcohol use, demographics, and state-of-residence cannabis legal status in 2021 and examined whether changes in cannabis use prevalence were modified by these factors from 2013 to 2021. METHODS Data were drawn from the 24 states that collected cannabis use data participating in the Youth Risk Behavior Surveillance System from 2013 to 2021. Logistic regression analyses estimated past 30-day cannabis prevalence in 2021 and produced AORs by current cigarette, alcohol, and state-of-residence cannabis legal status. The same method was used with year as the exposure, adjusting for sex, race, and ethnicity, to assess trends in prevalence from 2013 to 2021. RESULTS In 2021, cannabis use was more common among female youth (16.75% vs 13.83% [AOR=1.26, 95% CI=1.16, 1.37]) and non-Hispanic Black and Hispanic youth than among non-Hispanic White youth (17.19%, 16.14% vs 14.60% [AOR=1.25, 95% CI=1.12, 1.39 and AOR=1.16, 95% CI=1.04, 1.29, respectively]). Cannabis use was much more common among youth who reported any past 30-day cigarette or alcohol use (44.90% vs 6.48% [AOR=11.80, 95% CI=10.57, 13.18]). Declines in cannabis use were observed independent of state-level cannabis law from 2013 to 2021, and cannabis use prevalence did not differ significantly by state-of-residence cannabis legal status among the 24 participating states in 2021. CONCLUSIONS Public health officials should carefully consider the potential impact of expanding commercialization of cannabis as a wellness product on youth cannabis use, especially with regard to minoritized populations and co-use with tobacco and alcohol. National and state-level public health education on cannabis use and youth-oriented prevention of cannabis uptake are long overdue.
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Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
| | - Kevin D Silverman
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, New York
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Kalbfuss J, Odermatt R, Stutzer A. Medical marijuana laws and mental health in the United States. HEALTH ECONOMICS, POLICY, AND LAW 2024:1-16. [PMID: 38562089 DOI: 10.1017/s1744133124000033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The consequences of legal access to medical marijuana for individuals' well-being are controversially assessed. We contribute to the discussion by evaluating the impact of the introduction of medical marijuana laws across US states on self-reported mental health considering different motives for cannabis consumption. Our analysis is based on BRFSS survey data from close to eight million respondents between 1993 and 2018 that we combine with information from the NSDUH to estimate individual consumption propensities. We find that eased access to marijuana through medical marijuana laws reduce the reported number of days with poor mental health for individuals with a high propensity to consume marijuana for medical purposes and for those individuals who likely suffer from frequent pain.
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Affiliation(s)
- Jörg Kalbfuss
- Faculty of Economics, University of Cambridge, Cambridge, UK
| | - Reto Odermatt
- Faculty of Business and Economics, Center for Research in Economics and Well-Being (CREW), University of Basel, Basel, Switzerland
| | - Alois Stutzer
- Faculty of Business and Economics, Center for Research in Economics and Well-Being (CREW), University of Basel, Basel, Switzerland
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Pawar AKS, Firmin ES, Wilens TE, Hammond CJ. Systematic Review and Meta-Analysis: Medical and Recreational Cannabis Legalization and Cannabis Use Among Youth in the United States. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00141-2. [PMID: 38552901 DOI: 10.1016/j.jaac.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/06/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Dramatic changes in state-level cannabis laws (CL) over the past 25 years have shifted societal beliefs throughout the United States, with unknown implications for youth. In the present study, we conducted an updated systematic review and meta-analysis examining estimated effects of medical cannabis legalization (MCL) and recreational cannabis legalization (RCL) on past-month cannabis use among US youth. METHOD A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, followed by a subsequent meta-analysis investigating the associations between state-level cannabis laws (ie, MCL vs non-MCL, and RCL vs non-RCL) and past-month cannabis use prevalence among US adolescents and young adults. Supplemental analyses examined age-group effects and design-related factors. RESULTS Our search identified 4,604 citations, 34 and 30 of which were included in qualitative and quantitative analyses, respectively. Meta-analysis of MCL studies identified no significant association between MCL and change in past-month youth cannabis use (odds ratio [OR] = 0.981, 95% CI = 0.960, 1.003). Meta-analysis of RCL studies showed significantly increased odds of past-month cannabis use (OR = 1.134, 95% CI = 1.116-1.153). Meta-analysis of more recent studies, however, showed a significantly increased odds of past-month cannabis use among both adolescents and young adults (OR = 1.089, 95% CI = 1.015,1.169, and OR = 1.221, 95% CI = 1.188,1.255, respectively). CONCLUSION Cannabis legalization has complex and heterogenous effects on youth use that may differ across law types. Our meta-analytic results showed modest positive effects of RCL on past-month cannabis use (more so in young adults than in adolescents) and minimal effects of MCL on these outcomes in US youth. Given the shift toward recreational legalization, additional focus on RCL effects is warranted.
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Affiliation(s)
- Aditya K S Pawar
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Gilman JM, Iyer MT, Pottinger EG, Klugman EM, Hughes D, Potter K, Tervo-Clemmens B, Roffman JL, Evins AE. State-Level Recreational Cannabis Legalization Is Not Differentially Associated with Cannabis Risk Perception Among Children: A Multilevel Regression Analysis. Cannabis Cannabinoid Res 2024; 9:343-352. [PMID: 36301559 PMCID: PMC10874817 DOI: 10.1089/can.2022.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: As more states pass recreational cannabis laws (RCLs) for adults, there is concern that increasing (and state-sanctioned) cannabis acceptance will result in a reduced perception of risk of harm from cannabis among children. We aimed to discover whether children in states with RCLs had decreased perception of risk from cannabis compared with children in states with illicit cannabis. Methods: We analyzed data from the multisite multistate Adolescent Brain and Cognitive Development Study to determine how the perception of cannabis harm among children (age at baseline: 9-10; N=10,395) changes over time in states with and without RCLs. Using multilevel modeling, we assessed survey responses from children longitudinally across 3 years, adjusting for state-, family-, and participant-level clustering and child-level factors, including demographics (sex, race, and socioeconomic status), religiosity, and trait impulsivity. Results: There was no significant main effect of state RCLs on perceived risk of cannabis use, and no differences in change over time by state RCLs, even after controlling for demographic factors and other risk (e.g., impulsivity) and protective (e.g., religiosity) factors. Conclusions: This analysis indicates that state-level RCLs are not associated with differential perception of cannabis risk among children, even after controlling for demographics, trait impulsivity, and religiosity. Future studies could assess how perception of risk from cannabis changes as children and adolescents continue to mature in states with and without RCLs.
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Affiliation(s)
- Jodi M. Gilman
- Center for Addiction Medicine, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Mallika T. Iyer
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | | | - Emma M. Klugman
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - Dylan Hughes
- Center for Addiction Medicine, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Kevin Potter
- Center for Addiction Medicine, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Brenden Tervo-Clemmens
- Center for Addiction Medicine, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Joshua L. Roffman
- Center for Addiction Medicine, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - A. Eden Evins
- Center for Addiction Medicine, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Wilds KM, Riddell JR. Cannabis Policy and Consumption: Taking into account Substitution Effects. Subst Use Misuse 2023; 59:97-109. [PMID: 37781770 DOI: 10.1080/10826084.2023.2262012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Background: Previous studies examining the cannabis-alcohol substitution effect have found that medical cannabis policies may result in substituting the use of cannabis in place of alcohol use. Objectives: This study adds to the literature on cannabis-alcohol substitution by analyzing the effect of decriminalization, medicinal cannabis, and adult-use legalization cannabis policies (2002-2019) on cannabis and alcohol use and substance substitution for all 50 states and the District of Columbia (N=867). Results: Results support the notion that liberalized cannabis policies can increase the prevalence of cannabis use. An adult-use legalization specific analysis yielded findings suggesting a complex and heterogenous effect of such laws on cannabis-alcohol complementation. Conclusion: Given the lack of clarity and heterogenous effects of cannabis laws, policy makers should carefully take into consideration the benefits of medical cannabis laws, along with the risks of decriminalization and adult-use legalization.
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Affiliation(s)
- Katherine M Wilds
- Department of Criminology and Criminal Justice, The University of Texas at Dallas, Richardson, United States
| | - Jordan R Riddell
- School of Criminology and Criminal Justice, Missouri State University, Springfield, United States
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Ladegard K, Bhatia D. Impact of Cannabis Legalization on Adolescent Cannabis Use. Psychiatr Clin North Am 2023; 46:635-646. [PMID: 37879828 DOI: 10.1016/j.psc.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Because of substantial limitations in available national data, such as inconsistencies among surveys and small sample sizes, the increased prevalence of cannabis use among adolescents since recreational legalization has not been directly observed. Nevertheless, both usage frequency and product potency have significantly increased, alongside alternative routes of delivery to smoking, such as vaping cannabis. Moreover, certain populations may be especially vulnerable to the effects of legalization. Regardless of differing state-level cannabis legalization status, the adverse consequences of cannabis on youth have clear negative impacts on mental health, medical symptoms, educational outcomes, and increased risk of addiction to other substances.
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Affiliation(s)
- Kristie Ladegard
- Denver Health, University of Colorado, 601 Broadway 7th Floor, MC7779, Denver, CO 80203, USA.
| | - Devika Bhatia
- University of Colorado, 13007 East 19th Place, Aurora, CO 80045, USA
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Sevigny EL, Greathouse J, Medhin DN. Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1362. [PMID: 37915420 PMCID: PMC10616541 DOI: 10.1002/cl2.1362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
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.
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Affiliation(s)
- Eric L. Sevigny
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
| | - Jared Greathouse
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
| | - Danye N. Medhin
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
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Reece AS, Hulse GK. Perturbation of 3D nuclear architecture, epigenomic dysregulation and aging, and cannabinoid synaptopathy reconfigures conceptualization of cannabinoid pathophysiology: part 1-aging and epigenomics. Front Psychiatry 2023; 14:1182535. [PMID: 37732074 PMCID: PMC10507876 DOI: 10.3389/fpsyt.2023.1182535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/07/2023] [Indexed: 09/22/2023] Open
Abstract
Much recent attention has been directed toward the spatial organization of the cell nucleus and the manner in which three-dimensional topologically associated domains and transcription factories are epigenetically coordinated to precisely bring enhancers into close proximity with promoters to control gene expression. Twenty lines of evidence robustly implicate cannabinoid exposure with accelerated organismal and cellular aging. Aging has recently been shown to be caused by increased DNA breaks. These breaks rearrange and maldistribute the epigenomic machinery to weaken and reverse cellular differentiation, cause genome-wide DNA demethylation, reduce gene transcription, and lead to the inhibition of developmental pathways, which contribute to the progressive loss of function and chronic immune stimulation that characterize cellular aging. Both cell lineage-defining superenhancers and the superanchors that control them are weakened. Cannabis exposure phenocopies the elements of this process and reproduces DNA and chromatin breakages, reduces the DNA, RNA protein and histone synthesis, interferes with the epigenomic machinery controlling both DNA and histone modifications, induces general DNA hypomethylation, and epigenomically disrupts both the critical boundary elements and the cohesin motors that create chromatin loops. This pattern of widespread interference with developmental programs and relative cellular dedifferentiation (which is pro-oncogenic) is reinforced by cannabinoid impairment of intermediate metabolism (which locks in the stem cell-like hyper-replicative state) and cannabinoid immune stimulation (which perpetuates and increases aging and senescence programs, DNA damage, DNA hypomethylation, genomic instability, and oncogenesis), which together account for the diverse pattern of teratologic and carcinogenic outcomes reported in recent large epidemiologic studies in Europe, the USA, and elsewhere. It also accounts for the prominent aging phenotype observed clinically in long-term cannabis use disorder and the 20 characteristics of aging that it manifests. Increasing daily cannabis use, increasing use in pregnancy, and exponential dose-response effects heighten the epidemiologic and clinical urgency of these findings. Together, these findings indicate that cannabinoid genotoxicity and epigenotoxicity are prominent features of cannabis dependence and strongly indicate coordinated multiomics investigations of cannabinoid genome-epigenome-transcriptome-metabolome, chromatin conformation, and 3D nuclear architecture. Considering the well-established exponential dose-response relationships, the diversity of cannabinoids, and the multigenerational nature of the implications, great caution is warranted in community cannabinoid penetration.
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Affiliation(s)
- Albert Stuart Reece
- Division of Psychiatry, University of Western Australia, Crawley, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Gary Kenneth Hulse
- Division of Psychiatry, University of Western Australia, Crawley, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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Gonçalves PD, Bruzelius E, Levy NS, Segura LE, Livne O, Gutkind S, Boustead AE, Hasin DS, Mauro PM, Silver D, Macinko J, Martins SS. Recreational cannabis legislation and binge drinking in U.S. adolescents and adults. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104085. [PMID: 37329666 PMCID: PMC10527765 DOI: 10.1016/j.drugpo.2023.104085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/12/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Recreational cannabis laws (RCLs) may have spillover effects on binge drinking. Our aims were to investigate binge drinking time trends and the association between RCLs and changes in binge drinking in the United States (U.S.). METHODS We used restricted National Survey on Drug Use and Health data (2008-2019). We examined trends in the prevalence of past-month binge drinking by age groups (12-20, 21-30, 31-40, 41-50, 51+). Then, we compared model-based prevalences of past-month binge drinking before and after RCL by age group, using multi-level logistic regression with state random intercepts, an RCL by age group interaction term, and controlling for state alcohol policies. RESULTS Binge drinking declined overall from 2008 to 2019 among people aged 12-20 (17.54% to 11.08%), and those aged 21-30 (43.66% to 40.22%). However, binge drinking increased among people aged 31+ (ages 31-40: 28.11% to 33.34%, ages 41-50: 25.48% to 28.32%, ages 51+: 13.28% to 16.75%). When investigating model-based prevalences after versus before RCL, binge drinking decreased among people aged 12-20 (prevalence difference=-4.8%; adjusted odds ratio (aOR)=0.77, [95% confidence interval (CI) 0.70-0.85]), and increased among participants aged 31-40 (+1.7%; 1.09[1.01-1.26]), 41-50 (+2.5; 1.15[1.05-1.26]) and 51+ (+1.8%; 1.17[1.06-1.30]). No RCL-related changes were noted in respondents ages 21-30. CONCLUSIONS Implementation of RCLs was associated with increased past-month binge drinking in adults aged 31+ and decreased past-month binge drinking in those aged < 21. As the cannabis legislative landscape continues to change in the U.S., efforts to minimize harms related to binge drinking are critical.
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Affiliation(s)
- Priscila Dib Gonçalves
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Emilie Bruzelius
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Natalie S Levy
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Luis E Segura
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ofir Livne
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Sarah Gutkind
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Anne E Boustead
- School of Government & Public Policy, University of Arizona, USA
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Pia M Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Diana Silver
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, NY, USA
| | - James Macinko
- Departments of Community Health Sciences and Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
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Sandhyavenu H, Patel HP, Patel RH, Desai R, Patel AA, Patel BA, Patel J, Zahid S, Khan SU, Deshmukh A, Nasir K, DeSimone CV, Dani SS, Thakkar S. Rising trend of acute myocardial infarction among young cannabis users: A 10-year nationwide gender and race stratified analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 16:200167. [PMID: 36874042 PMCID: PMC9975233 DOI: 10.1016/j.ijcrp.2022.200167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
Background The use of cannabis has massively increased among younger patients due to increasing legalization and availability. Methods We performed a retrospective nationwide study using the Nationwide inpatient sample (NIS) database to analyze the trends of acute myocardial infarction (AMI) in young cannabis users and related outcomes among patients aged 18-49 years from 2007 to 2018, using ICD-9 and ICD-10 codes. Results Out of 819,175 hospitalizations, 230,497 (28%) admissions reported using cannabis. There was a significantly higher number of males (78.08% vs. 71.58%, p < 0.0001) and African Americans (32.22% vs. 14.06%, p < 0.0001) admitted with AMI and reported cannabis use. The incidence of AMI among cannabis users consistently increased from 2.36% in 2007 to 6.55% in 2018. Similarly, the risk of AMI in cannabis users among all races increased, with the biggest increase in African Americans from 5.69% to 12.25%. In addition, the rate of AMI in cannabis users among both sexes showed an upward trend, from 2.63% to 7.17% in males and 1.62%-5.12% in females. Conclusion The incidence of AMI in young cannabis users has increased in recent years. The risk is higher among males and African Americans.
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Affiliation(s)
| | - Harsh P Patel
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL, USA
| | - Riddhiben H Patel
- Department of Internal Medicine, HCA Medical City Arlington, Dallas, Tx, USA
| | - Rohan Desai
- Department of Internal Medicine, Texas Tech University Health Science Center El Paso, El Paso, Tx, USA
| | - Achint A Patel
- Department of Public Health, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Bhavin A Patel
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Jaimin Patel
- Department of Internal Medicine, GCS Medical College, Gujarat, India
| | - Salman Zahid
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Safi U Khan
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tx, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Khurram Nasir
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tx, USA
| | | | - Sourbha S Dani
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Samarthkumar Thakkar
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tx, USA
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Wheldon CW, Watson RJ, Cunningham C, Fish JN. State Marijuana Laws and Marijuana Use Among Sexual and Gender Minority Youth in the United States. LGBT Health 2023; 10:121-129. [PMID: 36251936 PMCID: PMC9986016 DOI: 10.1089/lgbt.2021.0419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: The purpose of this study was to explore the association between state-level marijuana policies and marijuana use among sexual and gender minority (SGM) adolescents. Methods: A secondary analysis was conducted using a nonprobability sample, the 2017 LGBTQ National Teen Survey, based on 10,027 youth who reported their marijuana use behaviors and state of residence. Random intercept multilevel models were estimated to account for between- and within-state variability. Results: State marijuana possession laws were not associated with lifetime use; however, the odds of current marijuana use were 50% greater among youth living in states with legalized marijuana possession for recreational use (adjusted odds ratio [aOR] = 1.50; 95% confidence interval [CI]: 1.21-1.86) compared with states that prohibit any possession. Lesbian, gay, bisexual, transgender, and queer victimization was associated with greater odds of lifetime (aOR = 1.98; 95% CI: 1.78-2.20) and current (aOR = 1.99; 95% CI: 1.74-2.27) marijuana use. Conclusions: State-level policies governing recreational marijuana possession are associated with current marijuana use among SGM youth. Public health approaches to control underage access to legal marijuana and mitigate substance use-related health disparities are needed.
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Affiliation(s)
- Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Casey Cunningham
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Jessica N Fish
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
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13
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Cooper M, Panchalingam T, Ce S, Shi Y. Behavioral economic relationship between cannabis and cigarettes: Evidence from hypothetical purchase tasks. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 112:103951. [PMID: 36608406 PMCID: PMC11147132 DOI: 10.1016/j.drugpo.2022.103951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/17/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND In the United States (U.S), cannabis policies have been increasingly liberalized whereas tobacco policies have been increasingly stringent. Given the high prevalence of cannabis and tobacco dual use, there are concerns that a policy regulating one substance may unintendedly influence the other. This study examined the responsiveness of the demand for cannabis joints and cigarettes when price varied. METHODS The study included 338 adult participants (21+) who used both cannabis and tobacco and lived in one of the U.S. states with recreational cannabis legalized by the time of interview in 2019. They completed hypothetical purchase tasks to indicate the quantity desired of cannabis joints and cigarette packs 1) when only one substance was available with escalating prices and 2) when both substances were concurrently available with escalating prices of cannabis joints and a fixed price of cigarette packs. We estimated 1) the own-price elasticity of demand for each substance using nonlinear exponential demand model, and 2) the cross-price elasticity of demand at aggregate level using nonlinear exponential demand model and at individual level using log-linear demand model. RESULTS The estimates for the rate of change of own-price elasticity (α) were 0.0011 (SE = 0.000039, p < 0.001) for cannabis joints and 0.00095 (SE = 0.000037, p < 0.001) for cigarette packs. The aggregate-level estimates of cross-price elasticity (I = 13.032, SE = 0.34, p < 0.001; β = 0.0029, SE = 0.0021, p > 0.05) suggest an independent relationship between the two substances. At individual level, 78.70% of the participants treated the two substances as independent, 17.46% as complements, and 3.85% as substitutes. CONCLUSIONS For most adults who used both cannabis and tobacco in the U.S., cannabis joints and cigarettes had an independent relationship. Policies regulating the price of cannabis may not have large unintended consequences on cigarette use.
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Affiliation(s)
- Michael Cooper
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Thadchaigeni Panchalingam
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Shang Ce
- Department of Internal Medicine, The Ohio State University. 281 W Lane Ave, Columbus, OH 43120, USA
| | - Yuyan Shi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. 9500 Gilman Dr., La Jolla, CA 92093, USA.
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14
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Abstract
Because of substantial limitations in available national data, such as inconsistencies among surveys and small sample sizes, the increased prevalence of cannabis use among adolescents since recreational legalization has not been directly observed. Nevertheless, both usage frequency and product potency have significantly increased, alongside alternative routes of delivery to smoking, such as vaping cannabis. Moreover, certain populations may be especially vulnerable to the effects of legalization. Regardless of differing state-level cannabis legalization status, the adverse consequences of cannabis on youth have clear negative impacts on mental health, medical symptoms, educational outcomes, and increased risk of addiction to other substances.
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Affiliation(s)
- Kristie Ladegard
- Denver Health, University of Colorado, 601 Broadway 7th Floor, MC7779, Denver, CO 80203, USA.
| | - Devika Bhatia
- University of Colorado, 13007 East 19th Place, Aurora, CO 80045, USA
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15
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Weinberger AH, Wyka K, Kim JH, Smart R, Mangold M, Schanzer E, Wu M, Goodwin RD. A difference-in-difference approach to examining the impact of cannabis legalization on disparities in the use of cigarettes and cannabis in the United States, 2004-17. Addiction 2022; 117:1768-1777. [PMID: 34985165 DOI: 10.1111/add.15795] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
AIMS To estimate the impact of recreational and medical cannabis laws (RCL, MCL) on the use of cannabis and cigarettes in the United States. DESIGN A difference-in-difference approach was applied to data from the 2004-17 National Survey on Drug Use and Health (NSDUH). SETTING United States. PARTICIPANTS Nationally representative cross-sectional survey of Americans aged 12 years and older (combined analytical sample for 2004-17, n = 783 663). MEASUREMENTS Data on past-month use of (1) cigarettes and (2) cannabis were used to classify respondents into four groups: cigarette and cannabis co-use, cigarette-only use, cannabis-only use or no cigarette or cannabis use. State of residence was measured by self-report. MCL/RCL status came from state government websites. FINDINGS Difference-in-difference analyses suggest that MCL was associated with an increase in cigarette-cannabis co-use overall [adjusted odds ratio (aOR) = 1.09; 95% confidence interval (CI) = 1.02-1.16], with the greatest increases among those aged 50 years and above (aOR = 1.60; CI = 1.39-1.84), married (aOR = 1.19; CI = 1.07-1.31), non-Hispanic (NH) black (aOR = 1.14; CI = 1.02-1.07) and with a college degree or above (aOR = 1.15; CI = 1.06-1.24). MCL was associated with increases in cigarette-only use among those aged 50 years and above (aOR = 1.07; CI = 1.01-1.14) and NH black (aOR = 1.16; CI = 1.06-1.27) and increases in cannabis-only use among those aged 50 years and above (aOR = 1.24; CI = 1.07-1.44) and widowed/divorced/separated (aOR = 1.18; CI = 1.01-1.37). RCL was associated with an increase in cannabis-only use overall (aOR = 1.21; 95% CI = 1.09-1.34), a decline in cigarette-only use overall (aOR = 0.89; 95% CI = 0.81-0.97) and increases in co-use among those who were married (aOR = 1.24; CI = 1.02-1.50) and aged 50 years and above (aOR = 1.37; CI = 1.03-1.84). CONCLUSIONS Recreational and medical cannabis legalization have had a varying impact on the use, and co-use, of cannabis and cigarettes in the United States.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.,Department of Epidemiology and Population Health, Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
| | - June H Kim
- Institute for Implementation Science in Population Health, The City University of New York, New York, NY, USA
| | | | - Michael Mangold
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Ellen Schanzer
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Melody Wu
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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16
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Pacula RL, Smart R, Lira MC, Pessar SC, Blanchette JG, Naimi TS. Relationships of Cannabis Policy Liberalization With Alcohol Use and Co-Use With Cannabis: A Narrative Review. Alcohol Health Res World 2022; 42:06. [PMID: 35360879 PMCID: PMC8936161 DOI: 10.35946/arcr.v42.1.06] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The liberalization of cannabis policies has the potential to affect the use of other substances and the harms from using them, particularly alcohol. Although a previous review of this literature found conflicting results regarding the relationship between cannabis policy and alcohol-related outcomes, cannabis policies have continued to evolve rapidly in the years since that review. SEARCH METHODS The authors conducted a narrative review of studies published between January 1, 2015, and December 31, 2020, that assessed the effects of cannabis policies on the use of alcohol in the United States or Canada. SEARCH RESULTS The initial search identified 3,446 unique monographs. Of these, 23 met all inclusion criteria and were included in the review, and five captured simultaneous or concurrent use of alcohol and cannabis. DISCUSSION AND CONCLUSIONS Associations between cannabis policy liberalization and alcohol use, alcohol-related outcomes, and the co-use of alcohol and cannabis were inconclusive, with studies finding positive associations, no associations, and negative associations. Although several studies found that cannabis policy liberalization was associated with decreases in alcohol use measures, these same studies showed no impact of the cannabis policy on cannabis use itself. The lack of a consistent association was robust to subject age, outcome measure (e.g., use, medical utilization, driving), and type of cannabis policy; however, this may be due to the small number of studies for each type of outcome. This paper discusses several notable limitations of the evidence base and offers suggestions for improving consistency and comparability of research going forward, including a stronger classification of cannabis policy, inclusion of measures of the alcohol policy environment, verification of the impact of cannabis policy on cannabis use, and consideration of mediation effects.
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Affiliation(s)
| | | | | | | | | | - Timothy S Naimi
- Canadian Institute for Substance Use Research, Victoria, British Columbia, Canada
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17
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Neeley GW, Richardson LE. Marijuana Policy Bundles in the American States Over Time and Their Impact on the Use of Marijuana and Other Drugs. EVALUATION REVIEW 2022; 46:165-199. [PMID: 35196883 DOI: 10.1177/0193841x221077795] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
American states have used different approaches in adoption of cannabis policies and continue to modify those policies after approval. States also differ in how long it takes to implement such policies, and this influences the availability of legal marijuana. Such policy differences and implementation timelines could influence usage of marijuana and other illicit drugs by adolescents, young adults, and older adults. We develop an original coding scheme for marijuana legalization policies by classifying policy bundles characterized by three views of marijuana: as a pharmaceutical; as a permissive drug, or as a state fiscal revenue source. We test the impact of state legal marijuana policy characteristics on age group rates of marijuana use with panel regression models including control variables and fixed effects for 2000-2019. This design moves beyond a dichotomous construct of marijuana legalization and accounts for the dynamic adaptation of policies beyond their initial adoption. States with a higher pharmaceutical score experienced lower marijuana usage rates for adolescents and young adults while states with a permissive approach or fiscal approach experienced higher rates of marijuana use for all age groups. We find no consistent spillover effect of the pharmaceutical or permissive marijuana policy bundles on other illicit drug use for any age group, but fiscal bundles show some association with greater illicit drug use for adults. These more nuanced measures better reflect state policies as implemented and provide more clarity of the policy impact on target populations' marijuana usage.
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Affiliation(s)
- Grant W Neeley
- Department of Political Science, 2824University of Dayton, Dayton, OH, USA
| | - Lilliard E Richardson
- School of Public Policy, 311285Pennsylvania State University, University Park, PA, USA
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18
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Dolan SB, Spindle TR, Vandrey R, Johnson MW. Behavioral economic interactions between cannabis and alcohol purchasing: Associations with disordered use. Exp Clin Psychopharmacol 2022; 30:159-171. [PMID: 33001691 PMCID: PMC8209692 DOI: 10.1037/pha0000397] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
As cannabis policy changes, there is an urgent need to understand interactions between cannabis and alcohol couse. An online sample of 711 adult past-month cannabis and alcohol users completed both single-item hypothetical purchasing tasks for cannabis and alcohol and cross-commodity purchasing tasks assessing adjusting-price cannabis with concurrently available, fixed-price alcohol, and vice versa. Participants provided information about cannabis and alcohol use patterns, and completed the Alcohol and Cannabis Use Disorder Identification Tests (AUDIT and CUDIT, respectively). Group data showed that cannabis and alcohol served as complements (as the price of the adjusting-price commodity increased, consumption of both commodities decreased). However, individual data showed substantial variability with nontrivial proportions showing patterns of complementarity, substitution, and independence. More negative slopes (greater complementarity) for fixed-price cannabis and alcohol were both associated with greater self-reported drug consumption and CUDIT and AUDIT scores. The negative relation between cross-price slope and CUDIT/AUDIT score indicates that individuals who treat cannabis and alcohol more as complements are more likely to experience disordered use. Based on these cross-commodity purchasing data, when both cannabis and alcohol are concurrently available at low prices, both may be used at high levels, whereas limiting consumption of one commodity (e.g., through increased price) may reduce consumption of the other. These data show the importance of examining individual participant analyses of behavioral economic drug interactions and suggest that manipulation of cost (e.g., through taxes) or cosale restrictions are potential public health regulatory mechanisms for reducing alcohol and cannabis use and couse behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Sean B Dolan
- Department of Psychiatry and Behavioral Sciences
| | | | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences
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19
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Kan E, Beardslee J, Steinberg L, Frick PJ, Cauffman E. Impact of recreational cannabis legalization on cannabis use, other substance use, and drug-related offending among justice-system-involved youth. BEHAVIORAL SCIENCES & THE LAW 2022; 40:292-309. [PMID: 35460288 DOI: 10.1002/bsl.2573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/28/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
The present study assessed whether cannabis use, other types of substance use, and drug-related offending changed among 1216 justice-system-involved youth after recreational cannabis legalization. Using generalized estimating equation population-averaged models, we compared youth in California, where recreational cannabis is legalized, and Pennsylvania, where recreational use is still prohibited. Results indicated that cannabis use, cannabis selling, and driving under the influences (DUIs) increased more among Pennsylvanian than Californian youth. We found no changes in alcohol or noncannabis drug use after legalization. Cigarette use did not change significantly among Pennsylvanian youth, but Californian youth exhibited decreased cigarette use after legalization. Although not directly tested in the present analysis, it is possible that changes in state-level recreational cannabis policies throughout the U.S. may contribute to more permissive attitudes toward cannabis, which leads to higher use and use-related outcomes. Future research should continue to consider the potential impacts of legalization on other types of risky and illegal behavior.
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Affiliation(s)
- Emily Kan
- Department of Psychological Science, University of California, Irvine, California, USA
| | - Jordan Beardslee
- Department of Psychological Science, University of California, Irvine, California, USA
| | - Laurence Steinberg
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Paul J Frick
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Elizabeth Cauffman
- Department of Psychological Science, University of California, Irvine, California, USA
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20
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Schleimer JP, Smith N, Zaninovic V, Keyes KM, Castillo-Carniglia A, Rivera-Aguirre A, Cerdá M. Trends in the sequence of initiation of alcohol, tobacco, and marijuana use among adolescents in Argentina and Chile from 2001 to 2017. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 100:103494. [PMID: 34666217 DOI: 10.1016/j.drugpo.2021.103494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/08/2021] [Accepted: 10/02/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Variation in drug policies, norms, and substance use over time and across countries may affect the normative sequences of adolescent substance use initiation. We estimated relative and absolute time-varying associations between prior alcohol and tobacco use and adolescent marijuana initiation in Argentina and Chile. Relative measures quantify the magnitude of the associations, whereas absolute measures quantify excess risk. METHODS We analyzed repeated, cross-sectional survey data from the National Surveys on Drug Use Among Secondary School Students in Argentina (2001-2014) and Chile (2001-2017). Participants included 8th, 10th, and 12th grade students (N = 680,156). Linear regression models described trends over time in the average age of first use of alcohol, tobacco, and marijuana. Logistic regression models were used to estimate time-varying risk ratios and risk differences of the associations between prior alcohol and tobacco use and current-year marijuana initiation. RESULTS Average age of marijuana initiation increased and then decreased in Argentina and declined in Chile. In both countries, the relative associations between prior tobacco use and marijuana initiation weakened amid declining rates of tobacco use; e.g., in Argentina, the risk ratio was 19.9 (95% CI: 9.0-30.8) in 2001 and 11.6 (95% CI: 9.0-13.2) in 2014. The relative association between prior alcohol use and marijuana initiation weakened Chile, but not in Argentina. On the contrary, risk differences (RD) increased substantially across both relationships and countries, e.g., in Argentina, the RD for tobacco was 3% (95% CI: 0.02-0.03) in 2001 and 12% (95% CI: 0.11-0.13) in 2014. CONCLUSION Diverging trends in risk ratios and risk differences highlight the utility of examining multiple measures of association. Variation in the strength of the associations over time and place suggests the influence of environmental factors. Increasing risk differences indicate alcohol and tobacco use may be important targets for interventions to reduce adolescent marijuana use.
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Affiliation(s)
- Julia P Schleimer
- Violence Prevention Research Program, Department of Emergency Medicine, University of California, Davis School of Medicine, 2315 Stockton Blvd., Sacramento, CA 95817, USA.
| | - Nathan Smith
- Department of Psychology, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA
| | - ViniNatalie Zaninovic
- Silver School of Social Work, New York University, 1 Washington Square N, New York, NY 10003, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St. NY, NY 10032, New York, NY, USA
| | - Alvaro Castillo-Carniglia
- Society and Health Research Center, Universidad Mayor, Badajoz 130, Las Condes, Santiago, Chile; School of Public Health, Universidad Mayor, Jose Toribio Medina #38, Santiago, Chile; Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA
| | - Ariadne Rivera-Aguirre
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA
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21
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French MT, Zukerberg J, Lewandowski TE, Piccolo KB, Mortensen K. Societal Costs and Outcomes of Medical and Recreational Marijuana Policies in the United States: A Systematic Review. Med Care Res Rev 2022; 79:743-771. [PMID: 35068253 DOI: 10.1177/10775587211067315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Significant support exists in the United States for legalization of marijuana/cannabis. As of 2021, 36 states and four territories approved the legalization of medical cannabis via medical marijuana laws (MMLs), and 15 states and District of Columbia (DC) have adopted recreational marijuana laws (RMLs). We performed structured and systematic searches of articles published from 2010 through September 2021. We assess the literature pertaining to adolescent marijuana use; opioid use and opioid-related outcomes; alcohol use; tobacco use; illicit and other drug use; marijuana growing and cultivation; employment, earnings, and other workplace outcomes; academic achievement and performance; criminal activity; perceived harmfulness; traffic and road safety; and suicide and sexual activity. Overall, 113 articles satisfied our inclusion criteria. Except for opioids, studies on use of other substances (illicit drugs, tobacco, and alcohol) were inconclusive. MMLs and RMLs do not generate negative outcomes in the labor market, lead to greater criminal activity, or reduce traffic and road safety.
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22
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Hard GA, Jones AA, Das A, Johnson JK. Medical Cannabis Laws and Adolescent Alcohol Use Initiation. CANNABIS (RESEARCH SOCIETY ON MARIJUANA) 2022; 5:1-10. [PMID: 36506781 PMCID: PMC9733836 DOI: 10.26828/cannabis/2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background The effects of medical cannabis laws (MCLs) on adolescent alcohol use remains unclear. Previous literature investigates alcohol consumption rather than alcohol initiation among adolescents, and does not examine the effect by sociodemographic characteristics and state-level dispensary status. We used population representative, state-level data to examine the relationship between MCLs and adolescent alcohol initiation. Methods Data for this study were derived from the Youth Risk Behavior Survey (YRBS), a nationally representative, cross-sectional school-based survey administered by the Centers for Disease Control (CDC) in odd-numbered years from 1991 to 2015. We used a difference-in-difference model to assess pre and post effects of state MCL enactment on adolescent alcohol use initiation. Logistic regression analyses assessed associations between MCLs and varying ages of initiation. We further stratified our results by race/ethnicity, gender, and dispensary status. Results Results from adjusted logistic regression models showed higher odds of initiating alcohol among adolescents in states without MCLs when compared to adolescents in states with MCLs (OR 1.37, [95% CI = 1.29, 1.44]). This effect was consistent across age, race/ethnicity, and gender groups. Reductions in self-report of alcohol initiation were also consistently found in multiple age strata (9-10, 11-12, and 13-14), though this finding did not reach conventional levels of statistical detection in all race/ethnicities. Conclusions Our findings support a substitutive effect, suggesting that adolescents in states with MCLs, as opposed to states without MCLs, may substitute cannabis for alcohol. Considering the evolving landscape of medical cannabis laws and the proliferation of state-level legalization laws, further research into the effects of such policies, such as adult-use cannabis laws, is warranted to further elucidate their effects on adolescent substance use.
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Affiliation(s)
- Gregory A. Hard
- MGH Institute of Health Professions, 36 First Avenue, Boston MA 02129,Division of Child and Adolescent Psychiatry, McLean Hospital, Belmont, MA 02478
| | - Abenaa A. Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, 105 Health and Human Development Building, University Park, PA 16802, USA
| | - Abhery Das
- University of California, Irvine, 653 East Peltason Drive, Irvine, CA 92617
| | - Julie K. Johnson
- Cannabis Policy Research Center of Excellence, Research Department, Cannabis Control Commission, Commonwealth of Massachusetts, 2 Washington Square, 2nd Floor, Worcester, MA 01604
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23
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Bhatia D, Hinckley J, Mikulich S, Sakai J. Cannabis Legalization and Adolescent Use of Electronic Vapor Products, Cannabis, and Cigarettes. J Addict Med 2022; 16:e16-e22. [PMID: 35120066 DOI: 10.1097/adm.0000000000000831] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Cannabis legalization may have unintended consequences, such as effects on prevalence of adolescent use of other substances. We hypothesize that in states that have legalized recreational cannabis (RCL states), electronic vapor product use ("vaping"), cannabis, and cigarette use among adolescents is more prevalent than in states that have only legalized medical cannabis (MCL states) and states that have neither legalized recreational nor medical cannabis (NL states). METHODS Data are from the Center for Disease Control's 2017 Youth Risk Behavior Surveillance Survey (n = 107,665), a nationally representative survey of US high school students. We categorized student responses by cannabis legalization status of the state in which they lived at time of survey, then tested associations between cannabis legalization status and adolescent vaping, cannabis, and cigarette use, using logistic regressions. RESULTS Students in RCL states were significantly more likely to report current vaping behaviors compared to NL students [odds ratios (OR's) 2.07-2.21]. Students in cannabis-legal states were significantly more likely to report ever or currently using cannabis compared to NL students (OR's 1.27-1.40). MCL students were significantly less likely to report current cigarette smoking (OR = 0.86) compared to NL students. CONCLUSIONS Adolescents in cannabis-legal states were more likely to report vaping and cannabis use compared to adolescents in NL states. Public health officials, policymakers, and clinicians should consider the associations between cannabis legalization and adolescent vaping, cigarette, and cannabis use patterns.
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Affiliation(s)
- Devika Bhatia
- University of Colorado Anschutz Medical Campus, Aurora, CO (DB, JH, SM, JS)
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24
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Noël C, Armiento C, Péfoyo AK, Klein R, Bédard M, Scharf D. Adolescent exposure to cannabis marketing following recreational cannabis legalization in Canada: A pilot study using ecological momentary assessment. Addict Behav Rep 2021; 14:100383. [PMID: 34938841 PMCID: PMC8664871 DOI: 10.1016/j.abrep.2021.100383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/14/2021] [Accepted: 10/01/2021] [Indexed: 11/02/2022] Open
Abstract
Objective The goal of this pilot study was to assess the feasibility of a 9-day, smartphone-based ecological momentary assessment (EMA) protocol for tracking the frequency of Canadian adolescents' exposures to cannabis marketing, their reactions to such exposures, and the context in which exposures occur in the real-world and in real-time. Method Participants were n = 18 adolescents between the ages of 14 and 18 years of age. They used an EMA application to capture and describe cannabis marketing exposures through photographs and brief questionnaires assessing marketing channel and context. Participants also rated their reactions to each exposure in real-time. Results Results showed that participants were generally compliant with the protocol. Participants recorded 40 total exposures to cannabis marketing, representing an average of 2.2 (SD 2.3) exposures per participant during the 9-day study. Exposures tended to occur in the afternoon (45.0%) or evening (37.5%), and while participants were at home (70%) and alone (52.5%). Most exposures occurred through promotion by public figures (27.5%) or explicitly marked internet ads (27.5%). Conclusion This is the first study to demonstrate the feasibility and utility of EMA to capture adolescent exposures to cannabis marketing as it occurs in participants' natural environments. Our research offers an early look at the predictable wave of cannabis advertising targeting youth and a promising approach for studying its impacts in a post-legalization context, as well as a strategy for assessing policies, such as advertising restrictions, intending to mitigate the harms of early cannabis use among youth.
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Affiliation(s)
- Chelsea Noël
- Lakehead University, Behavioural Research and Northern Community Health Evaluative Services (BRANCHES) Laboratory, Canada.,Lakehead University, Department of Psychology, Canada
| | - Christopher Armiento
- Lakehead University, Behavioural Research and Northern Community Health Evaluative Services (BRANCHES) Laboratory, Canada.,Lakehead University, Department of Psychology, Canada
| | - Anna Koné Péfoyo
- Lakehead University, Behavioural Research and Northern Community Health Evaluative Services (BRANCHES) Laboratory, Canada.,Lakehead University, Department of Health Sciences, Canada
| | - Rupert Klein
- Lakehead University, Department of Psychology, Canada
| | - Michel Bédard
- Lakehead University, Department of Health Sciences, Canada
| | - Deborah Scharf
- Lakehead University, Behavioural Research and Northern Community Health Evaluative Services (BRANCHES) Laboratory, Canada.,Lakehead University, Department of Psychology, Canada
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Weinberger AH, Zhu J, Levin J, Moeller SJ, McKee SA, Goodwin RD. Changes in alcohol use by cannabis use status among adolescents and young adults in the United States: Emerging evidence for both substitution and complementarity. Alcohol Clin Exp Res 2021; 45:2536-2545. [PMID: 34928520 DOI: 10.1111/acer.14737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 10/09/2021] [Accepted: 10/31/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The majority of adolescents and young adults (AYA) who use cannabis also use alcohol. Although cannabis use is increasing in the United States (US), it is not known whether the increase contributes to either increased co-use of alcohol and cannabis (e.g., complementarity) or replacement of alcohol with cannabis (e.g., substitution). The current study estimated the prevalence of alcohol use by cannabis use status among US AYA ages 12 to 25 in 2018 and trends in alcohol use by cannabis use status from 2002 to 2018. METHODS Data were drawn from the 2002 to 2018 National Survey on Drug Use and Health public use data files. The analytic sample included AYA ages 12 to 25 (2018 sample, n = 26,924; total combined sample 2002 to 2018, n = 576,053). Linear and logistic regression models were used to estimate past-month alcohol use, daily alcohol use, and average quantity of alcohol consumed among AYA with and without past-month cannabis use from 2002 to 2018. RESULTS In 2018, any alcohol use and daily alcohol use were significantly more common among AYA who used cannabis use than those who did not use cannabis. Overall, any alcohol use, daily alcohol use, and average drinks per day declined from 2002 to 2018 among AYA irrespective of recent cannabis use. However, the decline in any alcohol use, daily alcohol use, and average alcohol drinks per day was more rapid among AYA who used cannabis (daily and nondaily) than those who did not use cannabis. The rate of decline in average alcohol drinks per day was also higher among AYA with daily compared to nondaily cannabis use. CONCLUSIONS Even with declines in alcohol use over time, drinking is much more common among AYA who report cannabis than those without recent cannabis use, which is consistent with complementarity. Yet, because the decline in alcohol use has been more rapid among AYA who use cannabis, there is also evidence of substitution. Thus, the current data on alcohol and cannabis use are consistent with both complementarity and substitution. However, these relationships may change as cannabis legalization expands over time.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jiaqi Zhu
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, New York, USA
| | - Jacob Levin
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Scott J Moeller
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Sherry A McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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26
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Fan CC, Marshall A, Smolker H, Gonzalez MR, Tapert SF, Barch DM, Sowell E, Dowling GJ, Cardenas-Iniguez C, Ross J, Thompson WK, Herting MM. Adolescent Brain Cognitive Development (ABCD) study Linked External Data (LED): Protocol and practices for geocoding and assignment of environmental data. Dev Cogn Neurosci 2021; 52:101030. [PMID: 34891080 PMCID: PMC8666341 DOI: 10.1016/j.dcn.2021.101030] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/17/2021] [Accepted: 10/27/2021] [Indexed: 02/03/2023] Open
Abstract
Our brain is constantly shaped by our immediate environments, and while some effects are transient, some have long-term consequences. Therefore, it is critical to identify which environmental risks have evident and long-term impact on brain development. To expand our understanding of the environmental context of each child, the Adolescent Brain Cognitive Development (ABCD) Study® incorporates the use of geospatial location data to capture a range of individual, neighborhood, and state level data based on the child's residential location in order to elucidate the physical environmental contexts in which today's youth are growing up. We review the major considerations and types of geocoded information incorporated by the Linked External Data Environmental (LED) workgroup to expand on the built and natural environmental constructs in the existing and future ABCD Study data releases. Understanding the environmental context of each youth furthers the consortium's mission to understand factors that may influence individual differences in brain development, providing the opportunity to inform public policy and health organization guidelines for child and adolescent health.
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Affiliation(s)
- Chun Chieh Fan
- Population Neuroscience and Genetics Lab, University of California, San Diego, La Jolla, CA, USA; Center for Human Development, University of California, San Diego, La Jolla, CA, USA.
| | - Andrew Marshall
- Division of Children, Youth, and Families, Children's Hospital Los Angeles, Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Harry Smolker
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Marybel R Gonzalez
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Susan F Tapert
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Deanna M Barch
- Departments of Psychological & Brain Sciences, Psychiatry, and Radiology, Washington University, St. Louis, MO, USA
| | - Elizabeth Sowell
- Division of Children, Youth, and Families, Children's Hospital Los Angeles, Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | | | - Carlos Cardenas-Iniguez
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jessica Ross
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Wesley K Thompson
- Population Neuroscience and Genetics Lab, University of California, San Diego, La Jolla, CA, USA
| | - Megan M Herting
- Division of Children, Youth, and Families, Children's Hospital Los Angeles, Department of Pediatrics, University of Southern California, Los Angeles, CA, USA; Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
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Yan T, Goldman RD. Bupropion for smoking cessation in adolescents. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:743-745. [PMID: 34649897 DOI: 10.46747/cfp.6710743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
QUESTION An adolescent who smokes regularly came to my clinic for help quitting. While I am aware that bupropion is a first-line medication for smoking cessation among adults, is it effective and safe for adolescents? ANSWER Most adolescent smokers in Canada would like to quit, but more than 90% of the attempts are unsuccessful. Bupropion appears to be more effective than other pharmacologic options in improving abstinence among adolescents who smoke in the short term; however, it is not approved by Health Canada for those younger than 18 years. Bupropion has not been associated with an increase in adverse events in smoking cessation trials. More research is needed on the long-term effectiveness and safety of bupropion in this population.
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28
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Yan T, Goldman RD. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:e285-e287. [PMID: 34649912 PMCID: PMC8516167 DOI: 10.46747/cfp.6710e285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Question Un fumeur adolescent m’a souvent consulté à la clinique pour me demander de l’aider pour arrêter de fumer. Je sais que le bupropion est un médicament de première intention pour la cessation tabagique, mais est-il efficace et sécuritaire chez les adolescents? Réponse La plupart des fumeurs adolescents au Canada aimeraient cesser de fumer, mais plus de 90 % des tentatives échouent. Le bupropion semble être plus efficace que les autres options pharmacologiques pour améliorer l’abstinence à court terme chez les adolescents; toutefois, Santé Canada ne l’a pas homologué pour les personnes de moins de 18 ans. Le bupropion n’est pas associé à un plus grand nombre d’événements indésirables dans les essais sur la cessation du tabagisme. Plus de recherches sont nécessaires sur l’efficacité et l’innocuité du bupropion à long terme dans cette population.
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Hindocha C, McClure EA. Unknown population-level harms of cannabis and tobacco co-use: if you don't measure it, you can't manage it. Addiction 2021; 116:1622-1630. [PMID: 33047862 PMCID: PMC8041912 DOI: 10.1111/add.15290] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/22/2020] [Accepted: 10/05/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Nationally representative data of cannabis-tobacco co-use have shown that these substances are closely entwined and have significant adverse health consequences, although population-level harms of co-use are largely unknown. Current epidemiological research does not assess co-use in a manner that has yielded the necessary data to draw conclusions regarding health effects. This has given rise to a hidden population of co-users who go under-served. Therefore, this paper has two aims: (1) to review new challenges in the collection of co-use data due to rapidly changing regulations of cannabis and nicotine products and (2) to provide recommendations for the terminology and assessment of co-use. ARGUMENT We argue that: (1) the prevalence of co-use is not being assessed accurately at a population level and (2) changes in legalization have created novel challenges, but without proper monitoring the impact on co-use will go undetected. We propose a three-level tiered set of recommendations for co-use assessments, which includes assessments of cannabis, tobacco and co-use metrics ranging from least burdensome (self-report of co-administered products) to most burdensome (assays, event-level data). CONCLUSIONS We propose that clinical studies begin to incorporate cannabis-tobacco co-use assessments to justify better their inclusion in clinical trials and national surveillance surveys. Integration of co-use assessments will aid in understanding the true impact on co-use of the changing cannabis and tobacco/nicotine regulatory environments. Co-use is prevalent and problematic, and the ability to make conclusions about its health outcomes is hindered by lack of nuance in data collection. If you do not measure it, you cannot manage it.
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Affiliation(s)
- 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
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, MSC 861, 67 President Street, Charleston, SC 29425-8610, USA
- Hollings Cancer Center, Medical University of South Carolina
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30
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Coley RL, Kruzik C, Ghiani M, Carey N, Hawkins SS, Baum CF. Recreational Marijuana Legalization and Adolescent Use of Marijuana, Tobacco, and Alcohol. J Adolesc Health 2021; 69:41-49. [PMID: 33243722 DOI: 10.1016/j.jadohealth.2020.10.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/02/2020] [Accepted: 10/18/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE Given the rapid expansion of recreational marijuana legalization (RML) polices, it is essential to assess whether such policies are associated with shifts in the use of marijuana and other substances, particularly for adolescents, who are uniquely susceptible to negative repercussions of marijuana use. This analysis seeks to provide greater generalizability, specificity, and methodological rigor than limited prior evidence. METHODS Youth Risk Behavior Survey data from 47 states from 1999 to 2017 assessed marijuana, alcohol, cigarette, and e-cigarette use among adolescents (14-18+ years; N = 1,077,938). Associations between RML and adolescent past-month substance use were analyzed using quasi-experimental difference-in-differences zero-inflated negative binomial models. RESULTS Controlling for other state substance policies, year and state fixed effects, and adolescent demographic characteristics, models found that RML was not associated with a significant shift in the likelihood of marijuana use but predicted a small significant decline in the level of marijuana use among users (incidence rate ratio = .844, 95% confidence interval [.720-.989]) and a small increase in the likelihood of any e-cigarette use (odds ratio of zero use = .647, 95% confidence interval [.515-.812]). Patterns did not vary over adolescent age or sex, with minimal differences across racial/ethnic groups. CONCLUSIONS Results suggest minimal short-term effects of RML on adolescent substance use, with small declines in marijuana use and increase in the likelihood of any e-cigarette use. Given the delayed rollout of commercial marijuana sales in RML states and rapid expansion of RML policies, ongoing assessment of the consequences for adolescent substance use and related health and behavioral repercussions is essential.
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Affiliation(s)
- Rebekah Levine Coley
- Department of Counseling Developmental, Educational Psychology, Lynch School of Education and Human Development, Boston College, Chestnut Hill, Massachusetts.
| | - Claudia Kruzik
- Department of Counseling Developmental, Educational Psychology, Lynch School of Education and Human Development, Boston College, Chestnut Hill, Massachusetts
| | | | - Naoka Carey
- Department of Counseling Developmental, Educational Psychology, Lynch School of Education and Human Development, Boston College, Chestnut Hill, Massachusetts
| | | | - Christopher F Baum
- School of Social Work, Boston College, Chestnut Hill, Massachusetts; Department of Economics, Boston College, Chestnut Hill, Massachusetts; Department of Macroeconomics, German Institute for Economic Research (DIW Berlin), Berlin, Germany
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Zuckermann AM, Battista KV, Bélanger RE, Haddad S, Butler A, Costello MJ, Leatherdale ST. Trends in youth cannabis use across cannabis legalization: Data from the COMPASS prospective cohort study. Prev Med Rep 2021; 22:101351. [PMID: 33816088 PMCID: PMC8010707 DOI: 10.1016/j.pmedr.2021.101351] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/04/2021] [Accepted: 02/26/2021] [Indexed: 12/12/2022] Open
Abstract
Canada legalized recreational cannabis use for adults on October 17, 2018 with decision-makers emphasising the need to reduce cannabis use among youth. We sought to characterise trends of youth cannabis use before and after cannabis legalization by relying on a quasi-experimental design evaluating cannabis use among high school students in Alberta, British Columbia, Ontario, and Québec who participated in the COMPASS prospective cohort study. Overall trends in use were examined using a large repeat cross-sectional sample (n = 102,685) at two time points before legalization (16/17 and 17/18 school years) and one after (18/19 school year). Further differential changes in use among students affected by legalization were examined using three sequential four-year longitudinal cohorts (n = 5,400) of students as they progressed through high school. Youth cannabis use remains common with ever-use increasing from 30.5% in 2016/17 to 32.4% in 2018/19. In the repeat cross-sectional sample, the odds of ever use in the year following legalization were 1.05 times those of the preceding year (p = 0.0090). In the longitudinal sample, no significant differences in trends of cannabis use over time were found between cohorts for any of the three use frequency metrics. Therefore, it appears that cannabis legalization has not yet been followed by pronounced changes on youth cannabis use. High prevalence of youth cannabis use in this sample remains a concern. These data suggest that the Cannabis Act has not yet led to the reduction in youth cannabis use envisioned in its public health approach.
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Affiliation(s)
- Alexandra M.E. Zuckermann
- University of Waterloo, School of Public Health and Health Systems, 200 University Avenue, Waterloo, ON N2L 3G1, Canada
| | - Katelyn V. Battista
- University of Waterloo, School of Public Health and Health Systems, 200 University Avenue, Waterloo, ON N2L 3G1, Canada
| | - Richard E. Bélanger
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, 2525 chemin de la Canardière, Quebec City, QC G1J 0A4, Canada
- Department of Pediatrics, Faculty of Medicine, Université Laval, 1050 avenue de la Médecine, Quebec City, QC G1V 0A6, Canada
| | - Slim Haddad
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, 2525 chemin de la Canardière, Quebec City, QC G1J 0A4, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050 avenue de la Médecine, Quebec City, QC G1V 0A6, Canada
| | - Alexandra Butler
- University of Waterloo, School of Public Health and Health Systems, 200 University Avenue, Waterloo, ON N2L 3G1, Canada
| | - Mary Jean Costello
- Homewood Research Institute, 150 Delhi Street, Riverslea Building, Guelph, ON N1E 6K9, Canada
| | - Scott T. Leatherdale
- University of Waterloo, School of Public Health and Health Systems, 200 University Avenue, Waterloo, ON N2L 3G1, Canada
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32
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Das A, Johnson JK, Hard GA, Jones AA. State Medical Marijuana Laws and Initiation of Cigarettes among Adolescents in the U.S., 1991-2015. CANNABIS (RESEARCH SOCIETY ON MARIJUANA) 2021; 4:60-68. [PMID: 36405952 PMCID: PMC9674114 DOI: 10.26828/cannabis/2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objective Although cigarette use has declined among adolescents, marijuana use has increased in subgroups of this population. The association between medical marijuana laws (MMLs) and cigarette initiation among adolescents, however, needs further examination. We investigated the association between MMLs and age of cigarette initiation and stratified findings by gender, race/ethnicity, and state dispensary status. Method Data were from N=939,725 adolescents in 9th-12th grade living in 46 states who participated in the Youth Risk Behavior Surveillance System between 1991-2015. Participants were asked the age they first smoked a cigarette and other sociodemographic characteristics. States were categorized as MML states if they had legalized marijuana for medicinal purposes by 2015. We used a difference-in-difference methodology and logistic regressions to assess the relationship between MMLs and cigarette initiation. Results Our results indicate lower odds of initiating cigarettes, in every age group (8 years old or younger, 9-10, 11-12, 13-14, 15-16, 17 years old or older) in states with MMLs when compared to non-MML states. After stratification, we find lower odds of cigarette initiation in certain age groups by gender, race/ethnicity, and state dispensary status. We report no difference in state MML implementation and age of cigarette initiation among Hispanic adolescents in every age group, and Black adolescents 8 years or younger and 17 years or older. Conclusions Cigarette initiation has decreased among adolescents in MML states compared with those in non-MML states. Further research should evaluate how MMLs and recreational marijuana policies are associated with e-cigarette initiation and use.
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Affiliation(s)
- Abhery Das
- Program in Public Health, University of California, Irvine, 653 East Peltason Drive, Irvine, CA 92617
| | - Julie K. Johnson
- Cannabis Policy Research Center of Excellence, Research Department, Cannabis Control Commission, Commonwealth of Massachusetts, 2 Washington Square, 2nd Floor, Worcester, MA 01604
| | - Gregory A. Hard
- MGH Institute of Health Professions, 36 First Avenue, Boston MA 02129
| | - Abenaa A. Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, 105 Health and Human Development Building, University Park, PA 16802, USA
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Le Foll B. Opioid-sparing effects of cannabinoids: Myth or reality? Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110065. [PMID: 32828853 DOI: 10.1016/j.pnpbp.2020.110065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/09/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022]
Abstract
A converging line of evidence is indicating that cannabinoids may have an opioid-sparing effect. This property, well validated in preclinical studies, allow when both drugs are co-administered to reduce the dose of opioids without loss of analgesic effects. A meta-analysis of pre-clinical studies indicated in 2017 that the median effective dose (ED50) of morphine administered in combination with delta-9-tetrahydrocannabinol (delta-9-THC) is 3.6 times lower than the ED50 of morphine alone (Nielsen et al., 2017). However, very few studies have been conducted in humans to validate this effect. This narrative review provides an update on whether or not cannabinoid drugs can be used to produce an opioid sparing effect. For this, various lines of evidence ranging from preclinical, epidemiological and human studies will be summarized. Overall, this review indicates that the preclinical results are strongly and consistently supportive of the presence of an opioid sparing effect of cannabinoid drugs. However, to date the clinical studies have been mostly negative; and, the evidence collected in humans so far is so limited that it is premature to conclude. Therefore, prospective high quality controlled clinical trials are still required to validate this. Priorities for future research are also discussed.
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Affiliation(s)
- Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada; Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Division of Brain and Therapeutics, University of Toronto, Toronto, ON, Canada.; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
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Mennis J, Stahler GJ, Mason MJ. Treatment admissions for opioids, cocaine, and methamphetamines among adolescents and emerging adults after legalization of recreational marijuana. J Subst Abuse Treat 2021; 122:108228. [DOI: 10.1016/j.jsat.2020.108228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 10/21/2020] [Accepted: 11/26/2020] [Indexed: 12/17/2022]
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Poghosyan H, Noonan EJ, Badri P, Braun I, Young GJ. Association between daily and non-daily cannabis use and depression among United States adult cancer survivors. Nurs Outlook 2021; 69:672-685. [PMID: 33581859 DOI: 10.1016/j.outlook.2021.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cancer survivors are vulnerable to Cannabis Use (CU) and at increased risk for depression. Yet, the relationship between CU and depression among cancer survivors is unknown. PURPOSE The purpose of this study was to estimate the prevalence of daily/non-daily CU, investigate the association between CU and depression and evaluate CU reasons and methods of administration among cancer survivors. METHOD Population-based, nationally representative sample of cancer survivors aged ≥18 (n = 10,799) from 2018 Behavioral Risk Factor Surveillance System Survey was used. Weighted descriptive statistics and multivariate logistic regression were conducted. FINDINGS Overall, 4.2% reported daily and 4.1% non-daily CU. Those who self-reported depression had higher prevalence of daily and non-daily CU than those not reporting depression. Daily CU was associated with 120% increased odds of depression (odds ratio = 2.2, 95% confidence interval [1.3, 3.7]) compared with none-users. DISCUSSION Efforts to improve open communications and evidence-informed discussions regarding benefits and risks of CU and reasons for using cannabis between clinicians and cancer survivors are imperative.
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Affiliation(s)
- Hermine Poghosyan
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA.
| | - Edward J Noonan
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA
| | - Padmapriya Badri
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA
| | | | - Gary J Young
- Center for Health Policy and Healthcare Research, Bouvé College of Health Sciences, Northeastern University, Boston, MA
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36
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Ross JM, Rieselbach MM, Hewitt JK, Banich MT, Rhee SH. Children's Knowledge of Cannabis and Other Substances in States with Different Cannabis Use Regulations. Subst Use Misuse 2021; 56:2126-2133. [PMID: 34486481 PMCID: PMC8803397 DOI: 10.1080/10826084.2021.1972316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Public acceptance of cannabis continues to increase across the US, yet there has been little research on how cannabis legalization affects young children. The present study compared knowledge of cannabis and other substances among children living in states with different cannabis laws and examined whether the association between such substance knowledge and externalizing behavior varies by state cannabis regulations. Methods: Participants were from the Adolescent Brain Cognitive DevelopmentSM Study (ABCD Study®) at the baseline assessment (N = 11,875, ages 9-11, collected from 2016 to 2018). Chi-square difference tests were used to compare nested models testing group differences in knowledge of substances and the association between externalizing disorder/behavior and substance knowledge as a function of state legality of cannabis use (recreational, medical, low THC/CBD, none). Results: Children living in states with more permissive cannabis laws had a greater knowledge of cannabis and reported more alcohol experimentation. In contrast, knowledge regarding alcohol, tobacco, and other illicit drugs was not greater in children from states with more permissive cannabis laws. Externalizing disorder/behavior was not significantly associated with cannabis knowledge in any group and not significantly different across groups. The association between externalizing disorder/behavior and illicit drug knowledge was significant only in states with the recreational and medical use laws but did not differ significantly across groups. Conclusion: Children living in environments with more permissive cannabis regulations have greater knowledge of cannabis, but not other substances, and report more experimentation with alcohol.
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Affiliation(s)
- J Megan Ross
- Division of Addiction Sciences, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Maya M Rieselbach
- Insitute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado, USA.,Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - John K Hewitt
- Insitute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado, USA.,Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Marie T Banich
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA.,Institute of Cognitive Science, University of Colorado Boulder, Boulder, Colorado, USA
| | - Soo Hyun Rhee
- Insitute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado, USA.,Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
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37
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Impact of state-level cannabis legalization on poly use of alcohol and cannabis in the United States, 2004-2017. Drug Alcohol Depend 2021; 218:108364. [PMID: 33143941 DOI: 10.1016/j.drugalcdep.2020.108364] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cannabis policy has shifted toward legalization in many parts of the United States (US). While attention has been focused on whether legalization will lead to changes in cannabis use, it is conceivable that legalization will also affect use of substances that individuals frequently use with cannabis. This study assessed whether cannabis legalization impacted the prevalence of poly use of cannabis and alcohol from 2004 to 2017 and estimated the prevalence of cannabis and alcohol poly use in 2017. METHODS Public and restricted-use data from the US 2004-2017 National Survey on Drug Use and Health were analyzed. Data on past-month cannabis and alcohol use were assessed each year. Cannabis legalization was determined by the presence or absence of medical marijuana laws (MML) and recreational marijuana laws (RML) in each state. Difference-in-difference approach was used to estimate the association of MML and RML on cannabis and alcohol use overall and by sociodemographic subgroups (e.g., age, income, education). RESULTS Between 2004 and 2017, poly use of cannabis and alcohol increased while alcohol-only use decreased. MML were associated with increases in poly use only among adults over age 50 and among those with higher annual incomes and higher education, while RML were associated with increases in poly use broadly among adults across sociodemographic groups. CONCLUSIONS Legalization of cannabis was associated with increases in cannabis-alcohol poly use in the US. RML were associated with increases across demographics, while the impact of MML was more limited to certain sociodemographic groups.
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Palamar JJ, Strain EC. News and social media coverage is associated with more downloads and citations of manuscripts that focus on substance use. Drug Alcohol Depend 2021; 218:108357. [PMID: 33317951 PMCID: PMC7750283 DOI: 10.1016/j.drugalcdep.2020.108357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND A variety of substance use-related topics are discussed in the public discourse; however, it is unknown how public discussion of published substance-related findings relates to manuscript downloads and citations. This manuscript examines how traditional and social media coverage of published findings about substance use affects downloads and scientific citations. METHODS Altmetric and bibliographic information was obtained for manuscripts published in Drug and Alcohol Dependence between 2018 and 2019 (n = 943). Associations were examined between news and social media coverage (i.e., Twitter, Facebook) in relation to number of manuscript downloads and number of citations. This was done in a bivariable manner and in a multivariable manner examining correlates of being in the top 10th percentile of downloads and citations. RESULTS 73.3 % of articles were shared on Twitter, 23.6 % were shared on Facebook, and 13.9 % were covered in news sources (with 4.0 % receiving major media coverage). Epidemiology papers were among the most covered in the news, and e-cigarette review papers were among the most downloaded. News and social media coverage were positively associated with number of downloads and citations in bivariable models and with achieving the top 10 % of downloads and citations in multivariable models (ps < .001). Publishing a press release was associated with higher likelihood of receiving additional news coverage (aPR = 7.85, 95 % CI: 5.15-11.97). CONCLUSIONS Traditional and social media coverage of manuscripts focusing on substance use are associated with more downloads and citations. Researchers should consider sharing findings not only to increase downloads and citations but also to educate the general public.
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Affiliation(s)
- Joseph J. Palamar
- New York University School of Medicine, Department of Population Health, 180 Madison Avenue, New York, NY 10016,Center for Drug Use and HIV/HCV Research, New York University College of Global Public Health, 665 Broadway, New York, NY 10012
| | - Eric C. Strain
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, 21224
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Abuhasira R, Novack V. Increased risk of cardiac arrhythmias with cannabis use - More studies are needed. Eur J Intern Med 2020; 80:14-15. [PMID: 32773275 DOI: 10.1016/j.ejim.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Ran Abuhasira
- Cannabis Clinical Research Institute and Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Victor Novack
- Cannabis Clinical Research Institute and Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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40
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Kwan LY, Eaton DL, Andersen SL, Dow-Edwards D, Levin ED, Talpos J, Vorhees CV, Li AA. This is your teen brain on drugs: In search of biological factors unique to dependence toxicity in adolescence. Neurotoxicol Teratol 2020; 81:106916. [DOI: 10.1016/j.ntt.2020.106916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023]
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Risso C, Boniface S, Subbaraman MS, Englund A. Does cannabis complement or substitute alcohol consumption? A systematic review of human and animal studies. J Psychopharmacol 2020; 34:938-954. [PMID: 32648806 DOI: 10.1177/0269881120919970] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Whether alcohol and cannabis complement or substitute each other has been studied for over two decades. In the changing cannabis policy landscape, debates are moving rapidly and spill-over effects on other substances are of interest. AIMS update and extend a previous systematic review, by: (a) identifying new human behavioural studies reporting on substitution and/or complementarity of alcohol and cannabis, and (b) additionally including animal studies. METHODS We replicated the search strategy of an earlier systematic review, supplemented with a new search for animal studies. Search results were crossed checked against the earlier review and reference lists were hand searched. Findings were synthesised using a narrative synthesis. RESULTS Sixty-five articles were included (64 in humans, one in animals). We synthesised findings into categories: patterns of use, substitution practices, economic relationship, substance use disorders, policy evaluation, others and animal studies. Overall, 30 studies found evidence for substitution, 17 for complementarity, 14 did not find evidence for either, and four found evidence for both. CONCLUSIONS Overall, the evidence regarding complementarity and substitution of cannabis and alcohol is mixed. We identified stronger support for substitution than complementarity, though evidence indicates different effects in different populations and to some extent across different study designs. The quality of studies varied and few were designed specifically to address this question. Dedicated high-quality research is warranted.
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Affiliation(s)
- Constanza Risso
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Clinica las Condes, Santiago, Chile
| | - Sadie Boniface
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Amir Englund
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Komro KA. The Centrality of Law for Prevention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:1001-1006. [PMID: 32804333 PMCID: PMC7430129 DOI: 10.1007/s11121-020-01155-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kelli A Komro
- Department of Behavioral, Social and Health Education Sciences, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, GCR 564, Atlanta, GA, 30322, USA.
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Conyers G, Ayres I. A lottery test of the effect of dispensaries on emergency room visits in Arizona. HEALTH ECONOMICS 2020; 29:854-864. [PMID: 32548868 DOI: 10.1002/hec.4013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 02/02/2020] [Accepted: 02/10/2020] [Indexed: 06/11/2023]
Abstract
In August 2012, the Arizona Department of Health Services conducted a lottery to allocate licenses for the state's first medical marijuana dispensaries. The lottery randomly selected an applicant within each of 69 contested Community Health Analysis Areas to open a dispensary. By comparing 36 zip codes with winning applications to 48 zip codes with losing applications and weighting using propensity scores based on the true probability of winning, we estimate the causal effect of the allocation of a dispensary on the emergency room visits of residents of that zip code. Outcomes of interest are emergency room visits for acute symptoms caused by cannabis, opioids, alcohol, and cocaine. Using emergency room discharge data from 2010 to 2016, we find evidence of an increase in visits for acute cannabis-related causes for the winning set of zip codes and weak evidence of an increase in visits for opioid-related causes. The results indicate that in the four years following the lottery, emergency room visits for acute cannabis causes rose by approximately 45% in allocated zip codes relative to non-allocated zip codes. Because of the high likelihood of spillovers to neighboring zip codes, these effects are likely underestimates.
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Affiliation(s)
| | - Ian Ayres
- Yale Law School, Yale University, New Haven, Connecticut
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44
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Wong SW, Buu A, Lin HC. State Medical Marijuana Laws and Associated Marijuana Use, Attitudes, and Perceived Social Norms among Adolescents in the U.S. J Psychoactive Drugs 2020; 52:383-392. [PMID: 32723036 DOI: 10.1080/02791072.2020.1795325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Statewide medical marijuana laws (MMLs) in the U.S. may be associated with adolescent marijuana use behavior, attitudes toward marijuana use, and social norms. This study used data from the National Study on Drug Use and Health (2013-2016) to examine the associations of state MML with marijuana use, use frequency, and attitudes and perceived peer and parental social norms toward using marijuana. Propensity-score matching was used to reduce selection bias between states with and without MML (matched N = 50,000). Results showed that adolescents residing in states with MML had higher odds of using marijuana in the past month and past year (OR = 1.45 and 1.49; ps < .001), higher marijuana use frequencies in the past month (β = 0.12, p < .001), relatively more neutral attitudes toward marijuana use (β = - 0.06, p < .001), and weaker perception of peer and parental disapproval of marijuana use (β = - 0.04 and -0.02, ps < .001). Our findings suggested that for the states that have implemented MML, special efforts should be strengthened to prevent and reduce adolescent marijuana use. For the states that have not yet implemented MML, the associations between MML and adolescent marijuana use attitudes and perceived norms should be taken into account when legislating medical marijuana and designing prevention and intervention efforts.
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Affiliation(s)
- Su-Wei Wong
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston , Houston, TX, USA
| | - Anne Buu
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston , Houston, TX, USA
| | - Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington , Bloomington, IN, USA
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Philbin MM, Mauro PM, Greene ER, LaBossier NJ, Giovenco DP, Martins SS. Medical cannabis laws and medical and non-medical prescription stimulant use among a nationally representative sample of US Adults: Examining the role of sexual identity and gender. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102861. [PMID: 32717704 DOI: 10.1016/j.drugpo.2020.102861] [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: 03/31/2020] [Revised: 06/29/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Medical marijuana laws (MMLs) can impact marijuana and opioid use, but the relationship between MMLs and other drugs, such as prescription stimulants, remains unexamined. Because lesbian, gay and bisexual (LGB) individuals report higher levels of prescription stimulant use than heterosexuals, we explored the relationship between MMLs and past-year medical and non-medical stimulant use by sexual identity and gender. METHODS We pooled 2015-2017 National Survey on Drug Use and Health data for adults (n = 126 463), and used survey-weighted multinomial logistic regression to estimate odds of past-year (a) medical prescription stimulant use, (b) non-medical prescription stimulant use and (c) non-medical versus medical stimulant use. We stratified by gender, adjusted for sociodemographic characteristics, and tested the interaction between MML state residence and sexual identity. RESULTS Bisexual men had higher medical (6.4% versus 4.1%; aROR=1.93[1.29-2.88]) and non-medical stimulant use 6.6% versus 2.4%; aROR=2.23[1.44-3.44]) than heterosexual men. Bisexual women had higher non-medical stimulant use (6.8% versus 1.6%; aROR=1.54[1.23-2.93] than heterosexual women. Female (aROR=0.70[0.62-0.78]) and male (aROR=0.74[0.66-0.82]) heterosexuals in MML states had lower odds of medical stimulant use than in non-MML states. Bisexual men in MML states had lower odds of medical (aROR=0.36[0.21-0.61]) and non-medical stimulant use (aROR=0.48[0.29-0.81]) than bisexual men in non-MML states. Similar patterns emerged for bisexual women's non-medical use (aROR=0.57[0.40-0.81]). CONCLUSION Prescription stimulant use was higher in non-MML states for most LGB subgroups. MMLs may differentially impact stimulant use, primarily for bisexual men and women. States enacting MMLs should consider potential impacts on drugs other than marijuana, especially among LGB populations.
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Affiliation(s)
- Morgan M Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health. New York, NY, 10032, USA.
| | - Pia M Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health. New York, NY, 10032, USA.
| | - Emily R Greene
- Department of Epidemiology, Columbia University Mailman School of Public Health. New York, NY, 10032, USA.
| | - Natalie J LaBossier
- Boston University School of Medicine, Boston University. Boston, MA, 02118, USA
| | - Daniel P Giovenco
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health. New York, NY, 10032, USA.
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health. New York, NY, 10032, USA.
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46
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Hasin DS, Shmulewitz D, Cerdá M, Keyes KM, Olfson M, Sarvet AL, Wall MM. U.S. Adults With Pain, a Group Increasingly Vulnerable to Nonmedical Cannabis Use and Cannabis Use Disorder: 2001-2002 and 2012-2013. Am J Psychiatry 2020; 177:611-618. [PMID: 31964162 PMCID: PMC7332392 DOI: 10.1176/appi.ajp.2019.19030284] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Given changes in U.S. marijuana laws, attitudes, and use patterns, individuals with pain may be an emerging group at risk for nonmedical cannabis use and cannabis use disorder. The authors examined differences in the prevalence of nonmedical cannabis use and cannabis use disorder among U.S. adults with and without pain, as well as whether these differences widened over time. METHODS Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, 2001-2002; N=43,093) and NESARC-III (2012-2013; N=36,309) were analyzed using logistic regression. Risk differences of past-year nonmedical cannabis use, frequent (at least three times a week) nonmedical use, and DSM-IV cannabis use disorder were estimated for groups with and without moderate to severe pain, and these risk differences were tested for change over time. RESULTS Any nonmedical cannabis use was more prevalent in respondents with than without pain (2001-2002: 5.15% compared with 3.74%; 2012-2013: 12.42% compared with 9.02%), a risk difference significantly greater in the 2012-2013 data than in the 2001-2002 data. The prevalence of frequent nonmedical cannabis use did not differ by pain status in the 2001-2002 survey, but was significantly more prevalent in those with than without pain in the 2012-2013 survey (5.03% compared with 3.45%). Cannabis use disorder was more prevalent in respondents with than without pain (2001-2002: 1.77% compared with 1.35%; 2012-2013: 4.18% compared with 2.74%), a significantly greater risk difference in the data from 2012-2013 than from 2001-2002. CONCLUSIONS The results suggest that adults with pain are a group increasingly vulnerable to adverse cannabis use outcomes, warranting clinical and public health attention to this risk. Psychiatrists and other health care providers treating patients with pain should monitor such patients for signs and symptoms of cannabis use disorder.
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Affiliation(s)
- Deborah S. Hasin
- NewYork State Psychiatric Institute, NewYork; Department of Psychiatry, Columbia University Medical Center, New York; Department of Epidemiology, Columbia University Mailman School of Public Health, New York
| | - Dvora Shmulewitz
- NewYork State Psychiatric Institute, New York; Department of Psychiatry, Columbia University Medical Center, New York; Department of Epidemiology, Columbia University Mailman School of Public Health, New York
| | - Magdalena Cerdá
- Columbia University Mailman School of Public Health, New York; Department of Population Health, New York University, New York
| | - Katherine M. Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York
| | - Mark Olfson
- NewYork State Psychiatric Institute, New York; Department of Psychiatry, Columbia University Medical Center, New York, Department of Epidemiology
| | - Aaron L. Sarvet
- Department of Epidemiology, Harvard University School of Public Health, Boston
| | - Melanie M. Wall
- NewYork State Psychiatric Institute, New York; Department of Psychiatry, Columbia University Medical Center, New York; Department of Biostatistics
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47
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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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48
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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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Trends in Cannabis Treatment Admissions in Adolescents/Young Adults: Analysis of TEDS-A 1992 to 2016. J Addict Med 2020; 14:e29-e36. [PMID: 31985511 DOI: 10.1097/adm.0000000000000586] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aims to evaluate changes in cannabis use patterns, referral sources, and admissions in adolescents and young adults (YAs). As the United States increasingly moves toward liberalization of cannabis laws, it is critical to have baseline information of use patterns in this population. METHODS Data were drawn from Treatment Episode Data Set-Admissions (TEDS-A) for adolescents (12-17 years) and young adults (18-24 years) entering treatment from 1992 to 2016 for primary cannabis use (N = 3,794,213). Rao-Scott chi-square tests were used to test for significant changes in proportions of individuals admitted to treatment for primary cannabis use and between 4-year increments from 1992 to 2016 (N = 1,052,724). Logistic regression assessed odds of admissions for primary cannabis use versus other substances. RESULTS Treatment admissions for cannabis among adolescents/YAs rose 3-fold from 1992 (49,996) to 1996 (125,858). The majority of referrals came from the criminal justice system (56%). Cannabis is increasingly the sole substance of use, with polysubstance use decreasing from 89% in 1992 to 59% in 2016. While alcohol-related treatment admissions were most common in 1992, admissions for treatment of cannabis use (followed by heroin and alcohol) were highest (38%) by 2016. Being an adolescent (odds ratio [OR] 3.1, 95% confidence interval [CI] 3.1-3.2), non-Hispanic black (OR 6.2, 95% CI 6.2-6.3), male (female OR 0.6, 95% CI 0.6-0.6) with co-occurring alcohol use (OR 25.9, 95% CI 25.7-26.1) was associated with admission for treatment of primary cannabis use as compared with other substances. CONCLUSIONS Public health efforts will be needed to ensure ongoing access and referral to treatment as the legal status of cannabis continues to change. Prevention and treatment efforts should target co-occurring alcohol and cannabis use.
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50
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Nkansah-Amankra S. Revisiting the Association Between "Gateway Hypothesis" of Early Drug Use and Drug Use Progression: A Cohort Analysis of Peer Influences on Drug Use Progression Among a Population Cohort. Subst Use Misuse 2020; 55:998-1007. [PMID: 32077787 DOI: 10.1080/10826084.2020.1720245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background and objective: Findings from observational studies indicate that early drug use is a strong predictor of further drug abuse. Because competing explanations abound in cross-sectional studies, causal interpretations from these investigations pose considerable challenge. We evaluated the relationship between early drug use and progression, while estimating modifying influences of adolescents' social contexts. Method: We applied a national longitudinal survey of 11,182 adolescents growing into adulthood over a 14-year period. The data provided a natural setting to evaluate the relationship between early drug use and drug use in three subsequent waves. We applied generalized estimating equation models to analyze these relationships. Results: Evidence showed over a relatively short period (approximately one year) early drug use was an independent predictor of illicit drugs in adolescence but not adulthood. The adjusted odds ratio for using substances in adulthood were marijuana (aOR, 1.33; 95% CI: 1.11-1.60), illicit drugs (aOR, 1.49; 95% CI: 1.04-2.12) and cocaine (aOR, 5.00; 95% CI: 2.75-9.10). Further, drug use was higher among older adolescence living in a neighborhood and reporting drug use as a big problem. In adulthood, neighborhood drug problems appear to have minimal influence on drug use escalation. Conclusion: The current findings call into question the causal interpretation of early drug use among adolescents as determinants of future drug escalation in adulthood. The overall impact of peer relationships on future drug escalation might depend on not only the extent of adolescent closeness to peers but also on continuity of friendship over time and other influencing social contexts.
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Affiliation(s)
- Stephen Nkansah-Amankra
- Department of Behavioral & Community Health (BCH), School of Public Health, University of Maryland, College Park, MD, USA
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