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Pawson M, Kelly BC. Hemp-based psychoactive use and risk among young adults: Trend theory, policy, and regulation beyond legality. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 130:104523. [PMID: 39024688 DOI: 10.1016/j.drugpo.2024.104523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Hemp-based psychoactives comprise a burgeoning legal substance market with rising trends in use across the U.S. and Canada as well as parts of Europe. Currently, scant empirical research on the use of these Novel Psychoactive Substances (NPS) exists. By examining policy, market conditions, consumer uptake, and related risks, this research extends theory on drug trends by describing the regulatory environments that shape the emergence and popularity of psychoactive hemp-based products among young adults. METHODS Relying on ethnographic fieldwork of hemp-based markets across 3 U.S. state hemp and cannabis policy contexts as well as in-depth interviews with 40 young adult cannabis consumers recruited across 10 U.S. states, we examined how regulatory conditions shape hemp-based psychoactive markets, trends in their use, and associated risks. RESULTS Young adults are motivated to consume hemp-based psychoactives due to the regulatory and market environments that facilitate the production of highly potent products that are inexpensive and easily accessible. States that regulate hemp-based psychoactives as cannabis, do not provide hemp markets with a competitive advantage and as such see minimal uptake. In the absence of hemp specific policies, substantial variations in product potencies, insufficient dosing information, and unscrupulous product packaging practices may increase related risks. CONCLUSION Trend theory provides insight into the complex relationships that exist between drug policy, markets, and the proliferation of legal highs. Understanding the contextual significance that both market and regulatory conditions have on legal drug production, distribution, and consumption may better inform approaches to reduce the risks commonly associated with novel psychoactive substances like hemp-based psychoactives.
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Affiliation(s)
- Mark Pawson
- Department of Sociology, Purdue University 700 W State St, West Lafayette, IN 47907, United States.
| | - Brian C Kelly
- Department of Sociology, Purdue University 700 W State St, West Lafayette, IN 47907, United States
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Mital S, Bishop L, Bugden S, Grootendorst P, Nguyen HV. Association between non-medical cannabis legalization and alcohol sales: Quasi-experimental evidence from Canada. Drug Alcohol Depend 2024; 257:111137. [PMID: 38460325 DOI: 10.1016/j.drugalcdep.2024.111137] [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] [Received: 10/16/2023] [Revised: 02/04/2024] [Accepted: 02/18/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND There is increasing interest in understanding the impact of non-medical cannabis legalization on use of other substances, especially alcohol. Evidence on whether cannabis is a substitute or complement for alcohol is both mixed and limited. This study provides the first quasi-experimental evidence on the impact of Canada's legalization of non-medical cannabis on beer and spirits sales. METHODS We used the interrupted time series design and monthly data on beer sales between January 2012 and February 2020 and spirits sales between January 2016 and February 2020 across Canada to investigate changes in beer and spirits sales following Canada's cannabis legalization in October 2018. We examined changes in total sales, nationally and in individual provinces, as well as changes in sales of bottled, canned and kegged beer. RESULTS Canada-wide beer sales fell by 96 hectoliters per 100,000 population (p=0.011) immediately after non-medical cannabis legalization and by 4 hectoliters per 100,000 population (p>0.05) each month thereafter for an average monthly reduction of 136 hectoliters per 100,000 population (p<0.001) post-legalization. However, the legalization was associated with no change in spirits sales. Beer sales reduced in all provinces except the Atlantic provinces. By beer type, the legalization was associated with declines in sales of canned and kegged beer but there was no reduction in sales of bottled beer. CONCLUSIONS Non-medical cannabis legalization was associated with a decline in beer sales in Canada, suggesting substitution of non-medical cannabis for beer. However, there was no change in spirits sales following the legalization.
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Affiliation(s)
- Shweta Mital
- College of Pharmacy, University of Manitoba, Winnipeg, Canada
| | - Lisa Bishop
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada
| | - Shawn Bugden
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada
| | - Paul Grootendorst
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Hai V Nguyen
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada.
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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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Kerr DCR, Levy NS, Bae H, Boustead AE, Martins SS. Cannabis and Alcohol Use by U.S. Young Adults, 2008-2019: Changes in Prevalence After Recreational Cannabis Legalization. Am J Prev Med 2023; 65:983-992. [PMID: 37331488 PMCID: PMC10725514 DOI: 10.1016/j.amepre.2023.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Young adults' cannabis and alcohol use patterns have changed after state recreational cannabis legalization according to studies based on college samples but not nationally representative samples. Associations between recreational cannabis legalization and changes in cannabis and alcohol use outcomes among young adults were examined, including differences by college enrollment and minor status (ages 18-20 vs 21-23 years). METHODS Repeated cross-sectional data (2008-2019) were collected from college-eligible participants aged 18-23 years in the National Survey on Drug Use and Health. Self-reported past-month cannabis use and frequent use (≥20 days) and a proxy for past-year DSM-5 cannabis use disorder were primary outcomes; past-month frequent alcohol use and binge drinking were secondary outcomes. Multilevel logistic regression models quantified changes in outcome prevalence from the study years before to after recreational cannabis legalization, adjusting for secular trends. Analyses were conducted on March 22, 2022. RESULTS Prevalence increased from before to after recreational cannabis legalization for past-month cannabis use (from 21% to 25%) and past-year proxy cannabis use disorder (from 11% to 13%); the increases were statistically significant [adjusted odds ratio (95% CI) = 1.20 (1.08-1.32) and 1.14 (1.003-1.30), respectively]. Increases were detected for young adults who were not in college and who were aged 21-23 years. Recreational cannabis legalization impacts were not detected for secondary outcomes. CONCLUSIONS Some young adults appear sensitive to state recreational cannabis legalization, including in terms of cannabis use disorder risk. Additional prevention efforts should be directed to young adults who are not in college and timed to occur before age 21 years.
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Affiliation(s)
- David C R Kerr
- School of Psychological Science, Oregon State University, Corvallis, Oregon
| | - Natalie S Levy
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Harold Bae
- Biostatistics Program, School of Behavioral and Population Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Anne E Boustead
- School of Government and Public Policy, University of Arizona, Tucson, Arizona
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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Palamar JJ, Le A. Prevalence of self-reported adverse effects associated with drug use among nightclub and festival attendees, 2019-2022. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100149. [PMID: 37025564 PMCID: PMC10070077 DOI: 10.1016/j.dadr.2023.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/18/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Research investigating adverse effects from drug use has focused extensively on poisonings and mortality. This study focuses on drug-related adverse effects not necessarily resulting in hospitalization or death among a population known for high prevalence of party drug use-electronic dance music (EDM) nightclub and festival attendees. METHODS Adults entering EDM venues were surveyed in 2019-2022 (n = 1952). Those reporting past-month use of a drug were asked whether they had experienced a harmful or very unpleasant effect after use. We examined 20 drugs and drug classes with a particular focus on alcohol, cannabis, cocaine, and ecstasy. Prevalence and correlates of adverse effects were estimated. RESULTS Almost half (47.6%) of adverse effects involved alcohol and 19.0% involved cannabis. 27.6% of those using alcohol reported an adverse effect, while 19.5%, 15.0%, and 14.9% of participants reported an effect from use of cocaine, ecstasy, and cannabis, respectively. Use of less prevalent drugs, such as NBOMe, methamphetamine, fentanyls, and synthetic cathinones, tended to be associated with higher prevalence of adverse effects. The most consistent risk factor was younger age, while past-month use of a greater number of drugs was often a protective factor against adverse effects. For most drugs, taking too much was the most common perceived reason for the adverse effect, and visiting a hospital after use was most prevalent among those experiencing an adverse effect from cocaine (11.0%). CONCLUSIONS Adverse drug effects are common in this population and results can inform prevention and harm reduction in this population and the general population.
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Affiliation(s)
- Joseph J. Palamar
- New York University Grossman School of Medicine, Department of Population Health, 180 Madison Avenue, Room 1752, New York, NY 10016, USA
| | - Austin Le
- New York University Grossman School of Medicine, Department of Population Health, 180 Madison Avenue, Room 1752, New York, NY 10016, USA
- New York University College of Dentistry, New York, NY, USA
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Bailey JA, Tiberio SS, Kerr DCR, Epstein M, Henry KL, Capaldi DM. Effects of Cannabis Legalization on Adolescent Cannabis Use Across 3 Studies. Am J Prev Med 2023; 64:361-367. [PMID: 36372654 PMCID: PMC9975019 DOI: 10.1016/j.amepre.2022.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Canada, Uruguay, and 18 states in the U.S. have legalized the use of nonmedical (recreational) cannabis for adults, yet the impact of legalization on adolescent cannabis use remains unclear. This study examined whether cannabis legalization for adults predicted changes in the probability of cannabis use among adolescents aged 13-18 years. METHODS Data were drawn from 3 longitudinal studies of youth (spanning 1999-2020) centered in 3 U.S. states: Oregon, New York, and Washington. During this time, Oregon (2015) and Washington (2012) passed cannabis legalization; New York did not. In each study, youth average age was 15 years (total N=940; 49%-56% female, 11%-81% Black/African American and/or Latinx). Multilevel modeling (in 2021) of repeated measures tested whether legalization predicted within- or between-person change in past-year cannabis use or use frequency over time. RESULTS Change in legalization status across adolescence was not significantly related to within-person change in the probability or frequency of self-reported past-year cannabis use. At the between-person level, youth who spent more of their adolescence under legalization were no more or less likely to have used cannabis at age 15 years than adolescents who spent little or no time under legalization. CONCLUSIONS This study addresses several limitations of repeated cross-sectional studies of the impact of cannabis legalization on adolescent cannabis use. Findings are not consistent with changes in the prevalence or frequency of adolescent cannabis use after legalization. Ongoing surveillance and analyses of subpopulations are recommended.
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Affiliation(s)
- Jennifer A Bailey
- Social Development Research Group (SDRG), School of Social Work, University of Washington, Seattle, Washington.
| | | | | | - Marina Epstein
- Social Development Research Group (SDRG), School of Social Work, University of Washington, Seattle, Washington
| | - Kimberly L Henry
- Department of Psychology, College of Natural Sciences, Colorado State University, Fort Collins, Colorado
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Daldegan-Bueno D, Lindner SR, Kovaleski D, Fischer B. Cannabis use, risk behaviours and harms in Brazil: A comprehensive review of available data indicators. Drug Alcohol Rev 2023; 42:318-336. [PMID: 36443987 DOI: 10.1111/dar.13571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 12/02/2022]
Abstract
ISSUES Cannabis use and related health/social outcome indicator data for Brazil-where non-medical cannabis is generally illegal-are limited. APPROACH Towards a comprehensive overview of relevant indicators, we searched primary databases by combining MeSH-index terms related to cannabis, geographic location and subtopic terms (e.g., use, health, mortality) focusing on cannabis use and key outcome indicators in Brazil since 2010. In addition, relevant 'grey literature' (e.g., survey reports) was identified. Key indicator data were mainly narratively summarised. KEY FINDINGS Overall, cannabis use has increased somewhat since pre-2010, with (past-year) use rates measured at 2-3% for general population adults, yet 5% or higher among youth and/or (e.g., post-secondary) student populations. For key risk behaviours, the presence of tetrahydrocannabinol-positivity among motor-vehicle drivers has been measured at <2%. While the prevalence of cannabis use disorder appears to have decreased, the relative proportion of treatment provided for cannabis-related problems increased. National- and local-based studies indicated an association of cannabis use with mental health harms, including depression and suicidality. Although some non-representative and/or local studies contain information, other monitoring data, including cannabis-related risks and harms (e.g., cannabis-related driving, mortality, hospitalisations), are limited in availability. IMPLICATIONS AND CONCLUSION The prevalence of cannabis use in Brazil is comparably low (e.g., relative to elsewhere in the Americas). Data on numerous key cannabis-related indicators is absent, or limited in scope for Brazil. Considering ongoing evolutions in cannabis control and its status as the most common illicit drug, more comprehensive surveillance of cannabis use and related outcomes is advised.
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Affiliation(s)
- Dimitri Daldegan-Bueno
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Sheila R Lindner
- Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Douglas Kovaleski
- Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
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Fischer B, Robinson T, Bullen C, Curran V, Jutras-Aswad D, Medina-Mora ME, Pacula RL, Rehm J, Room R, van den Brink W, Hall W. Lower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use: A comprehensive evidence and recommendations update. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103381. [PMID: 34465496 DOI: 10.1016/j.drugpo.2021.103381] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based 'Lower Risk Cannabis Use Guidelines' (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis. METHODS Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process. RESULTS A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible. CONCLUSIONS Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.
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Affiliation(s)
- Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Tessa Robinson
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Chris Bullen
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Health Innovation (NIHI), The University of Auckland, Auckland, New Zealand
| | - Valerie Curran
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Maria Elena Medina-Mora
- Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico; Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rosalie Liccardo Pacula
- Schaeffer Center for Health Policy and Economics, Sol Price School of Public Policy, University of Southern California, Los Angeles, United States
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction & Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Wim van den Brink
- Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Wayne Hall
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD 4072, Australia; National Addiction Centre, Institute of Psychiatry, Kings College London, United Kingdom
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Psychosocial and health problems associated with alcohol use disorder and cannabis use disorder in U.S. adults. Drug Alcohol Depend 2021; 229:109137. [PMID: 34763137 PMCID: PMC8665071 DOI: 10.1016/j.drugalcdep.2021.109137] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although the problems associated with alcohol use disorder (AUD) are well known, little is known about the psychosocial problems associated with cannabis use disorder (CUD), and the harmfulness of CUD relative to AUD. We compared the odds of psychosocial and health-related problems between individuals with DSM-5 AUD-only, CUD-only and co-occurring AUD+CUD. METHODS The 2012-2013 NESARC-III, a nationally representative cross-sectional survey of non-institutionalized US adults (n = 36,309), assessed participants for DSM-5 AUD, CUD, and psychosocial (interpersonal, financial, legal) and health-related problems. Based on their responses, participants were categorized into mutually exclusive groups: no AUD/CUD, AUD-only, CUD-only, and AUD+CUD. Multivariable logistic regression models examined the associations between psychosocial problems and the four AUD/CUD groups, adjusting for sociodemographic characteristics. RESULTS People with AUD-only, CUD-only, and AUD+CUD had higher odds of most interpersonal problems (adjusted odds ratio [aORs] 1.07-4.01), financial problems (aORs 1.53-4.28), legal problems (aORs 3.34-7.71), and health-related problems (aORs 1.29-1.92). The odds of psychosocial and health-related problems were similar for CUD-only and AUD-only in direct comparisons. Compared to those with AUD-only, those with AUD+CUD had higher odds of most problems examined (aORs 1.42-2.31). In contrast, there were few differences when comparing AUD+CUD with CUD-only. CONCLUSIONS AUD and CUD were similarly associated with interpersonal, financial, and legal problems, emergency treatment and suicide attempt. People with AUD+CUD had higher odds of certain problems than individuals with either AUD-only or CUD-only. Although most people who use cannabis do not experience harms, our results indicate that CUD does not appear to be less harmful than AUD.
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Guttmannova K, Fleming CB, Rhew IC, Abdallah DA, Patrick ME, Duckworth JC, Lee CM. Dual trajectories of cannabis and alcohol use among young adults in a state with legal nonmedical cannabis. Alcohol Clin Exp Res 2021; 45:1458-1467. [PMID: 34089527 PMCID: PMC8357031 DOI: 10.1111/acer.14629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/18/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understanding the nature of the association between cannabis and alcohol use within individuals over time in the era of legalized cannabis is of crucial importance for assessing the public health consequences of increasing cannabis use. An important unanswered question is whether cannabis and alcohol use substitute for one another. Specifically, is greater use of one substance associated with less use of the other substance (i.e., a negative association) or are the substances complementary and their association positive? METHODS We used 24 consecutive months of data on a young adult sample (n = 774; 56% female, age 18-25 during the study) who drank alcohol in the year prior to enrollment. The sample was recruited in Washington State in 2015/2016 (after legalization of nonmedical cannabis) using media advertisements and community flyers and outreach. Using parallel process latent growth curve models, we assessed three types of association between cannabis and alcohol use across the 24-month period: (1) an association between average levels of cannabis and alcohol use; (2) an association between rates of change in cannabis and alcohol use; and (3) correlations between shorter-term deviations/fluctuations off of longer-term trajectories of level and change in cannabis and alcohol use. RESULTS We found a positive association between the average frequency of cannabis and alcohol use; individuals who used cannabis more frequently on average also drank alcohol more frequently on average. Change over time in cannabis use was positively associated with change in alcohol use. There was also a contemporaneous positive association between fluctuations in cannabis and alcohol use. CONCLUSIONS Overall, we found no evidence of substitution. Rather, the results suggest a complementary relationship between cannabis and alcohol use, such that the use of cannabis and alcohol rises and falls together.
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Affiliation(s)
- Katarina Guttmannova
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Charles B. Fleming
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Isaac C. Rhew
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Devon Alisa Abdallah
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Megan E. Patrick
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | | | - Christine M. Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Lee CR, Lee A, Goodman S, Hammond D, Fischer B. The Lower-Risk Cannabis Use Guidelines' (LRCUG) recommendations: How are Canadian cannabis users complying? Prev Med Rep 2020; 20:101187. [PMID: 33083205 PMCID: PMC7554648 DOI: 10.1016/j.pmedr.2020.101187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/19/2020] [Indexed: 12/19/2022] Open
Abstract
Canada, alongside other jurisdictions, implemented non-medical cannabis legalization in 2018, partly towards improving public health. Evidence-based 'Lower-Risk Cannabis Use Guidelines' (LRCUG), including recommendations for cannabis users on how to decrease risk-behaviors for harms, have been developed and widely disseminated in Canada since 2017. However, knowledge on users' compliance with the LRCUG is limited. We identified four major Canadian (three national, one provincial) population surveys presenting key data on cannabis-related behaviors: the National Cannabis Survey, Canadian Cannabis Survey, Canadian Tobacco, Alcohol & Drugs Survey, and CAMH Monitor. We scanned each survey for indicator data mapping onto either of the LRCUG's recommendations for the years 2017 to 2019. Relevant indicator data, albeit with varying operationalizations, were found for six of the ten LRCUG's recommendation clusters in at least some of the surveys, and were extracted and summarized. For results, substantial -- but declining -- majorities of users consumed cannabis by smoking, yet with shifts towards other use modes. Between one- to two-in-five users engaged in the risk-behaviors of using high-potency cannabis products, frequent cannabis use and cannabis-impaired driving, respectively. A small proportion of pregnant or breastfeeding women continued cannabis use during the study period. The data identified found suggested a heterogeneous picture regarding cannabis users' compliance with the LRCUG's recommendations. Non-compliance is highest for recommendations regarding modes-of-use, and applies to minorities of users for other risks factors. These sub-groups are at elevated risk for acute (e.g., accidents) or long-term (e.g., dependence) cannabis-related harms contributing to the public health burden. Appropriate targeted interventions in these areas require improvement.
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Affiliation(s)
- Chae-Rim Lee
- Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Angelica Lee
- Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Samantha Goodman
- School of Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - David Hammond
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Benedikt Fischer
- Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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12
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The Lower-Risk Cannabis Use Guidelines (LRCUG): A ready-made targeted prevention tool for cannabis in New Zealand. PUBLIC HEALTH IN PRACTICE 2020; 1:100046. [PMID: 36101675 PMCID: PMC9461312 DOI: 10.1016/j.puhip.2020.100046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/10/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022] Open
Abstract
Cannabis use is common, especially among young people, and associated with risks for select acute and chronic adverse health and social outcomes. New Zealand features overall high cannabis use levels, yet may soon follow other jurisdictions and implement legalization of non-medical cannabis use and supply towards public health objectives. While existing cannabis-oriented interventions mainly focus on primary prevention and treatment (e.g., for dependence), key harms from use are crucially influenced by risk factors that can be modified by the user. On this basis, and similar to other health behavior-oriented interventions, ‘Lower-Risk Cannabis Use Guidelines’ (LRCUG), consisting of 10 recommendation clusters for lower-risk use, were systematically developed in Canada as an evidence-based, targeted prevention tool towards reducing adverse outcomes among cannabis users. We briefly summarize the concept of and experiences with implementation of the LRCUG elsewhere, and describe how their adoption as a population health intervention may serve public health goals of possible cannabis legalization in New Zealand and elsewhere. Cannabis is common, but involves risks for acute and chronic adverse outcomes. Many adverse outcomes are influenced by user-modifiable risk factors. Cannabis use and supply legalization may be implemented in New Zealand. Evidence-based ‘Lower-Risk Cannabis Use Guidelines’ are a targeted prevention tool. LRCUG may serve a valuable intervention towards legalization’s public health outcomes.
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13
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Dharmapuri S, Miller K, Klein JD. Marijuana and the Pediatric Population. Pediatrics 2020; 146:peds.2019-2629. [PMID: 32661188 DOI: 10.1542/peds.2019-2629] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2020] [Indexed: 11/24/2022] Open
Abstract
Cannabinoids, the psychoactive compounds in marijuana, are one of the most commonly used substances in the United States. In this review, we summarize the impact of marijuana on child and adolescent health and discuss the implications of marijuana use for pediatric practice. We review the changing epidemiology of cannabis use and provide an update on medical use, routes of administration, synthetic marijuana and other novel products, the effect of cannabis on the developing brain, other health and social consequences of use, and issues related to marijuana legalization.
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Affiliation(s)
- Sadhana Dharmapuri
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois.,Department of Pediatrics, Cook County Health and Hospitals System, Chicago, Illinois; and
| | - Kathleen Miller
- Adolescent Medicine Fellowship Program, Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois;
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14
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Abstract
OBJECTIVES Understanding trends of marijuana use in the USA throughout a period of particularly high adoption of marijuana-legalisation, and understanding demographics most at risk of use, is important in evolving healthcare policy and intervention. This study analyses the demographic-specific changes in the prevalence of marijuana use in the USA between 2005 and 2018. DESIGN, SETTING AND PARTICIPANTS A 14-year retrospective cross-sectional analysis of the National Health and Nutrition Examination Survey database, a publicly available biennially collected national survey, weighted to represent the entire US population. A total of 35 212 adults between 18 and 69 years old participated in the seven-cycles of surveys analysed (2005-2018). PRIMARY OUTCOME MEASURED Lifetime use, first use before 18 years old, and past-year use of marijuana. RESULTS The majority of adults reported ever using marijuana. While the overall prevalence of lifetime marijuana use remained stable (p=0.53), past-year use increased significantly between 2005 and 2018 (p<0.001) with highest rate of past-year use among younger age groups (p<0.001), males (p<0.001) and those with income below poverty level (p<0.001). Past-year use was the most common among non-Hispanic blacks, and less common among Hispanic/Mexican populations (p<0.002). Trends in past-year use increased among all age categories, males/females, all ethnicities, those with high school education/above, and those at all income levels (p<0.01 for all). CONCLUSIONS While lifetime marijuana use remained stable, past-year use significantly increased between 2005 and 2018. While past-year use remained the most common in younger age groups, males, non-Hispanic blacks and those with lower income; increasing trends in past-year use were significant for all age, sex, race and income categories, and for those with high school education/above. With high adoption of marijuana-legalisation laws during this period, our results suggest an associated increase in past-year marijuana use.An accurate understanding of those most at risk can help to inform decisions of healthcare policy-makers and professionals, and facilitate a safe transition of changing marijuana legalisation and use in the USA.
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Affiliation(s)
- William Mitchell
- Harvard School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | - Roma Bhatia
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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15
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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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16
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Hall W, Lynskey M. Assessing the public health impacts of legalizing recreational cannabis use: the US experience. World Psychiatry 2020; 19:179-186. [PMID: 32394566 PMCID: PMC7215066 DOI: 10.1002/wps.20735] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The sale of cannabis for adult recreational use has been made legal in nine US states since 2012, and nationally in Uruguay in 2013 and Canada in 2018. We review US research on the effects of legalization on cannabis use among adults and adolescents and on cannabis-related harms; the impact of legalizing adult recreational use on cannabis price, availability, potency and use; and regulatory policies that may increase or limit adverse effects of legalization. The legalization of recreational cannabis use in the US has substantially reduced the price of cannabis, increased its potency, and made cannabis more available to adult users. It appears to have increased the frequency of cannabis use among adults, but not so far among youth. It has also increased emergency department attendances and hospitalizations for some cannabis-related harms. The relatively modest effects on cannabis use to date probably reflect restrictions on the number and locations of retail cannabis outlets and the constraints on commercialization under a continued federal prohibition of cannabis. Future evaluations of legalization should monitor: cannabis sales volumes, prices and content of tetrahydrocannabinol; prevalence and frequency of cannabis use among adolescents and adults in household and high school surveys; car crash fatalities and injuries involving drivers who are cannabis-impaired; emergency department presentations related to cannabis; the demand for treatment of cannabis use disorders; and the prevalence of regular cannabis use among vulnerable young people in mental health services, schools and the criminal justice system. Governments that propose to legalize and regulate cannabis use need to fund research to monitor the impacts of these policy changes on public health, and take advantage of this research to develop ways of regulating can-nabis use that minimize adverse effects on public health.
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Affiliation(s)
- Wayne Hall
- University of Queensland Centre for Youth Substance Abuse Research, Brisbane, Australia
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Michael Lynskey
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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17
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Chrystoja BR, Rehm J, Crépault JF, Shield K. Effect of alcohol prohibition on liver cirrhosis mortality rates in Canada from 1901 to 1956: A time-series analysis. Drug Alcohol Rev 2020; 39:637-645. [PMID: 32452070 DOI: 10.1111/dar.13089] [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: 01/14/2020] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION AND AIMS The extent to which alcohol consumption in Canada was affected by alcohol prohibition in the early 20th century remains unclear. Since there is a dearth of data on consumption during this time, we estimated the effect of alcohol prohibition on alcohol consumption, as measured by changes in liver cirrhosis mortality rates in Canada. DESIGN AND METHODS Annual liver cirrhosis mortality data were obtained for 1901 to 1956 for the provinces of Alberta, British Columbia, Manitoba, New Brunswick, Nova Scotia, Ontario and Saskatchewan. Changes in death rates were assessed, by province, using autoregressive integrated moving average models. Results were pooled across provinces using a fixed effects meta-analysis. A secondary fixed effects meta-analysis was performed which only included provinces with data for before, during and after prohibition, and excluded provinces with data only beginning during prohibition. RESULTS Prohibition was associated with a statistically significant decrease in liver cirrhosis death rates only in Nova Scotia (P = 0.01). Pooling of provincial results indicated that prohibition resulted in 0.39 (95% confidence interval 0.06, 0.72; P = 0.02) fewer liver cirrhosis deaths per 100 000 people. In the restricted meta-analysis, prohibition resulted in 0.65 (95% confidence interval 0.18, 1.12; P < 0.01) fewer liver cirrhosis deaths per 100 000 people. DISCUSSION AND CONCLUSIONS Although alcohol prohibition in Canada did not eliminate alcohol consumption, our findings suggest that prohibition was associated with reduced consumption, as evidenced by a reduction in liver cirrhosis mortality rates. Further, it's important to reflect on alcohol's history in Canada and use those policy lessons to guide the construction of effective cannabis legislation.
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Affiliation(s)
- Bethany R Chrystoja
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jean-François Crépault
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, Canada
| | - Kevin Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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18
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Fischer B, Bullen C, Hall W. A call for greater policy and regulatory coherence for an expanding menu of legal psychoactive substances. Drug Alcohol Rev 2020; 39:737-742. [PMID: 32420658 DOI: 10.1111/dar.13071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/20/2020] [Accepted: 03/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Benedikt Fischer
- School of Population Health, University of Auckland, Auckland, New Zealand.,School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, Canada.,Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Chris Bullen
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia.,National Addiction Centre, Kings College London, London, UK
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19
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Vilches JR, Taylor MB, Filbey FM. A Multiple Correspondence Analysis of Patterns of CBD Use in Hemp and Marijuana Users. Front Psychiatry 2020; 11:624012. [PMID: 33519562 PMCID: PMC7840961 DOI: 10.3389/fpsyt.2020.624012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022] Open
Abstract
Background: With the passing of the 2018 Agriculture Improvement Act that legalized hemp-derived products, i.e., cannabidiol (CBD), the use of CBD has increased exponentially. To date, the few studies that have characterized individuals who use CBD suggest that co-use of CBD and tetrahydrocannabinol (THC)-dominant cannabis, i.e., marijuana, is highly prevalent. It is, therefore, important to investigate the relationship between CBD use and marijuana use to understand the antecedents and consequences of co-use of these two cannabis products. Methods: We conducted an online survey using structured questionnaires to determine differences in CBD users with (CBD+MJ) and without co-morbid marijuana use. Group comparisons were carried out using chi-square tests and ANOVA. Multiple correspondence analysis (MCA) with bootstrap ratio testing was performed to examine the relationship between the categorical data. Results: We received 182 survey responses from current CBD users. CBD+MJ had more types of CBD administration (F = 17.07, p < 0.001) and longer lifetime duration of CBD use (χ2 = 12.85, p < 0.05). Results from the MCA yielded two statistically significant dimensions that accounted for 77% of the total variance. Dimension 1 (representing 57% of the variance) associated CBD+MJ with indication of CBD use for medical ailments, use of CBD for more than once a day for longer than 2 years, applying CBD topically or consuming it via vaping or edibles, being female, and, having lower educational attainment. Dimension 2 (representing 20% of the variance) separated the groups primarily on smoking-related behaviors where CBD+MJ was associated with smoking CBD and nicotine. Conclusions: Identifying the factors that influence use of CBD and marijuana can inform future studies on the risks and benefits associated with each substance as well as the impacts of policies related to cannabis-based products.
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Affiliation(s)
- Joseph R Vilches
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, United States.,Department of Psychology, University of North Texas, Denton, TX, United States
| | - Mackenzie B Taylor
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, United States
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, United States
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20
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Ashford RD, Brown AM, Dorney G, McConnell N, Kunzelman J, McDaniel J, Curtis B. Reducing harm and promoting recovery through community-based mutual aid: Characterizing those who engage in a hybrid peer recovery community organization. Addict Behav 2019; 98:106037. [PMID: 31330467 PMCID: PMC6708724 DOI: 10.1016/j.addbeh.2019.106037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/13/2019] [Accepted: 06/25/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Peer-based support services are often used within harm reduction organizations, and more recently within recovery community organizations (RCO). Identifying the characteristics of individuals who engage with these novel RCOs is needed. Additionally, conducting collaborative research with communities of people who use drugs (PWUD) or are in recovery is an effective and rewarding approach that allows individuals to take ownership and play a critical role in the study. METHODS This exploratory study employs a community-based participatory research (CBPR) framework in partnership with a peer-led hybrid recovery community organization, Rebel Recovery, in Florida. Peer staff participated in all phases of the study, helping to inform the study protocol, data collection, analysis, interpretation, and results write-up. A cross-sectional survey instrument was used to collect consumer intake data. Pearson Chi-square tests and multivariate binomial logistic regressions were used to examine relationships between consumer characteristics and service utilization. RESULTS Consumers (n = 396) of Rebel Recovery peer support services had a mean age of 35.60 years (SD = 9.74). Many were experiencing homelessness (35.4%), unemployed (69.7%), high school graduates or GED holders (68.2%) and had a last year income of less than $10,000 (58.3%). The majority were users of heroin primarily (70.7%), with intravenous use being the preferred route of administration (63.9%). Exploratory analysis found that gender, marital status, and involvement in the child welfare system were significantly related to primary substance of use. Past 30-day engagement in recovery meetings had several statistically significant predictors including primary substance of use, age, housing status, annual income level, past-30-day arrests, tobacco use, and alcohol harm perception. Process findings from the CBPR methods used reconfirm the value of including peers in research involving PWUD and individuals in recovery. CONCLUSIONS Results suggest that peer-based support services at a hybrid recovery community organization can successfully engage populations that are often underserved (i.e., experiencing homelessness, involved in drug court, intravenous users, etc.). Significant relationships identified in the exploratory analysis suggest that additional education concerning overdose and the potential benefits of recovery meetings may be useful for specific consumers. Additionally, several recommendations and benefits of engaging in community-based participatory research with peer-led organizations are made for future research.
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Affiliation(s)
- Robert D Ashford
- Substance Use Disorders Institute, University of the Sciences, Philadelphia, PA, United States of America.
| | - Austin M Brown
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, United States of America.
| | | | | | | | - Jessica McDaniel
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, United States of America.
| | - Brenda Curtis
- National Institutes of Health, National Institute on Drug Abuse, Baltimore, MD, United States of America.
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21
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Shanahan M, Cyrenne P. Cannabis policies in Canada: How will we know which is best? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 91:102556. [PMID: 31563287 DOI: 10.1016/j.drugpo.2019.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/07/2019] [Accepted: 09/17/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The recent legalisation of cannabis in Canada by the Federal Government, along with the accompanying laws and regulations of provincial and territorial governments provides an opportunity to assess the expected benefits and harms of legalisation. While the legislative changes have been initiated by the federal government, much of the responsibility for the implementation falls onto the provinces and territories. These jurisdictions are responsible for regulating the wholesale distribution, retail structures, cannabis consumption, as well as a host of other regulations. METHODS Key characteristics of policies outlined are categorised according to a framework previously developed by the authors (2018). The categories are: (1) government regulation or control, (2) social costs that accompany its use, and (3) legal sanctions that accompany its production and use. Towards that end, we develop a framework for a cost benefit analysis (CBA) outlining in some detail the data that is needed to undertake a credible economic evaluation of cannabis policies. RESULTS Key data issues discussed include consumer surplus, government receipts including legal and regulatory costs, impact on substitutes, change in profits to firms (growers, wholesalers, and retailers), incomes earned in the industry, health and other costs incurred by cannabis users. DISCUSSION This paper presents a summary of the expected categories of costs and benefits given the various provincial cannabis policies. Additionally, it provides a framework for subsequent cost benefit analyses which can quantify said harms and benefits.
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Affiliation(s)
- Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, 2052 NSW, Australia.
| | - Philippe Cyrenne
- Department of Economics, Faculty of Business and Economics, University of Winnipeg, Winnipeg, Manitoba, Canada
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22
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Barry RA. Unpacking the Socioeconomic Dynamics of Marijuana Policy Change: Why Does It Matter? J Adolesc Health 2019; 65:5-6. [PMID: 31229055 DOI: 10.1016/j.jadohealth.2019.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Rachel Ann Barry
- Global Public Health Unit, School of Social & Political Science, University of Edinburgh, Edinburgh, Scotland, United Kingdom
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23
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Cannabis and Tramadol are Prevalent among the First Episode Drug-Induced Psychosis in the Egyptian Population: Single Center Experience. REPORTS 2019. [DOI: 10.3390/reports2020016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
(1) Background: Cannabis and tramadol are featuring prominently in Egypt; however, their prevalence in first episode psychosis is still uncertain. We aimed at determining the prevalence of cannabis and tramadol among the first-psychotic episode in Egyptian inpatients and to compare the demographic and psychopathological profiles of substance abusers versus patients with the comorbid diagnosis. (2) Methods: Patients presented with psychotic episode and admitted to Mansoura Psychiatric Department were recruited. Diagnosis of psychiatric illness and drug/substance use was carried out using the Diagnostic and Statistical Manual- Fourth Edition (DSM-IV) criteria. Standard urine tests and thin layer chromatography were performed to detect cannabis and tramadol. (3) Results: Of the 100 subjects in the study, the majority (55.6%) of patients were cannabis-only positive. Overall, cannabis-alone showed the highest frequency of substance used among the currently diagnosed psychotic disorders. According to urine tests, cannabis demonstrates the higher frequency of intake in both studied groups. 66.7% of the studied population had 1–5 years self-reported histories of substance abuse predating the first psychotic episode. (4) Conclusions: The percentage of cannabis and tramadol among the first episode psychotic patients has been unexpectedly high and the standard urine testing should be considered in emergency and mental health facilities.
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24
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Koval AL, Kerr DCR, Bae H. Perceived prevalence of peer marijuana use: changes among college students before and after Oregon recreational marijuana legalization. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:392-399. [DOI: 10.1080/00952990.2019.1599381] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Andrew L. Koval
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, USA
| | - David C. R. Kerr
- School of Psychological Science, Oregon State University, Corvallis, USA
| | - Harold Bae
- College of Public Health and Human Sciences, Oregon State University, Corvallis, USA
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25
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Affiliation(s)
- Wayne Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Queensland, Australia; National Addiction Centre, King's College London, London, UK
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26
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Habecker P, Welch-Lazoritz M, Dombrowski K. Rural and Urban Differences in Nebraskans’ Access to Marijuana, Methamphetamine, Heroin, and Prescription Pills. JOURNAL OF DRUG ISSUES 2018. [DOI: 10.1177/0022042618786717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The ability of a user to access a given type of drug is related to the configuration of the market for that drug, and a range of economic and criminal justice concerns. This study focuses on Nebraskan’s “ready access” to four types of drugs (marijuana, methamphetamine, heroin, and prescription pills) in 2016, using a statewide survey of housed Nebraskan adults. Ready access is defined as a participant knowing at least one person from whom they could obtain a given type of drug if they wanted to. We found that 35% of adult Nebraskans knew at least one person from whom they could obtain marijuana, 8.9% for methamphetamine, 4.5% for heroin, and 17.8% knew at least one source for prescription pills. Relationships between knowing a source for each type of drug and rurality, sex, race, religious attendance, mental health symptoms, and education are explored.
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27
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Hall W. The future of the international drug control system and national drug prohibitions. Addiction 2018; 113:1210-1223. [PMID: 28884869 DOI: 10.1111/add.13941] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/21/2017] [Accepted: 07/10/2017] [Indexed: 01/17/2023]
Abstract
A major impediment to any nation abandoning the policy of drug prohibition has been the fact that international drug treaties to which the majority of United Nations (UN) member states are signatory prohibit the non-medical use of amphetamines, cannabis, cocaine and heroin. The future of these treaties is now uncertain because of decisions by Uruguay, eight US states and Canada to legalize cannabis use. This paper: (1) provides a brief account of the international drug control treaties; (2) outlines the major criticisms of the treaties; (3) analyses critically proposals for treaty reform; and (4) provides a personal view on policies that nation states could adopt to minimize the harms from the use of cannabis, party drugs and hallucinogens, opioids, stimulants and new psychoactive substances. It is argued that: a major risk of cannabis legalization in the United States is promotion of heavy use and increased harm by a weakly regulated industry; some cautious national experiments with the regulation of party drugs and hallucinogens would be informative; a strong case remains for prohibiting the nonmedical use of opioids while mitigating the adverse effects that this policy has on opioid-dependent people; stimulant legalization will probably increase problem use but prohibition is difficult to enforce, highlighting the urgency of finding better ways to reduce demand for these drugs and respond to problem users; and that it is unclear what the best approach is to reducing possible harms that may arise from the use of new psychoactive substances.
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Affiliation(s)
- Wayne Hall
- National Addiction Centre, Institute of Psychiatry, Psychiatry and Neuroscience, King's College, London, London, UK.,The Centre for Youth Substance Abuse Research, The University of Queensland, Herston, QLD, Australia.,National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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28
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Hall W, Kozlowski LT. The diverging trajectories of cannabis and tobacco policies in the United States: reasons and possible implications. Addiction 2018; 113:595-601. [PMID: 28544367 DOI: 10.1111/add.13845] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/12/2016] [Accepted: 04/12/2017] [Indexed: 01/09/2023]
Abstract
AIM To examine briefly the (i) rationales for two policy proposals in the United States to make it mandatory for cigarettes to contain very low levels of nicotine and to legalize cannabis for recreational use by adults; and (ii) possible lessons that participants in each policy debate may learn from each other. METHOD We briefly describe the diverging policies towards cannabis and tobacco in the United States, explain and critically analyse their rationales and discuss possible policy lessons. RESULTS Advocates of cannabis legalization have argued that prohibition has been an ineffective and expensive policy that penalizes ethnic minority users unjustly of a drug that is far less harmful than alcohol. The prohibition of traditional tobacco cigarettes has been advocated as a way to eliminate cigarette smoking. These proposals embody very different attitudes towards the harms of recreational adult drug use. Advocates of nicotine prohibition demand that alternative methods of nicotine delivery must be shown to be completely safe before adults are allowed to use them. Advocates of tobacco prohibition ignore evidence that smokers may not use these products and the likelihood of expanding the illicit tobacco market. Advocates of legalizing and regulating recreational cannabis ignore the need to tax and regulate sales in order to minimize the harms of heavy use. CONCLUSIONS It is not clear that the prohibition of adult use has a useful role to play in the regulation of either cannabis or tobacco. If both products remain legal, the goals of regulating tobacco and cannabis products should be to restrict youth access, promote the use of the least harmful products, provide users with evidence-based information on both absolute and differential product risks of use and use differential taxes and marketing controls to promote ways of using these products that cause the least harm to their users.
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Affiliation(s)
- Wayne Hall
- The Centre for Youth Substance Abuse Research, University of Queensland, Australia and National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Lynn T Kozlowski
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, USA
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Wilkins C. A “not-for-profit” regulatory model for legal recreational cannabis: Insights from the regulation of gaming machine gambling in New Zealand. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 53:115-122. [DOI: 10.1016/j.drugpo.2017.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/05/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022]
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Hasin DS. US Epidemiology of Cannabis Use and Associated Problems. Neuropsychopharmacology 2018; 43:195-212. [PMID: 28853439 PMCID: PMC5719106 DOI: 10.1038/npp.2017.198] [Citation(s) in RCA: 382] [Impact Index Per Article: 63.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 12/12/2022]
Abstract
This review provides an overview of the changing US epidemiology of cannabis use and associated problems. Adults and adolescents increasingly view cannabis as harmless, and some can use cannabis without harm. However, potential problems include harms from prenatal exposure and unintentional childhood exposure; decline in educational or occupational functioning after early adolescent use, and in adulthood, impaired driving and vehicle crashes; cannabis use disorders (CUD), cannabis withdrawal, and psychiatric comorbidity. Evidence suggests national increases in cannabis potency, prenatal and unintentional childhood exposure; and in adults, increased use, CUD, cannabis-related emergency room visits, and fatal vehicle crashes. Twenty-nine states have medical marijuana laws (MMLs) and of these, 8 have recreational marijuana laws (RMLs). Many studies indicate that MMLs or their specific provisions did not increase adolescent cannabis use. However, the more limited literature suggests that MMLs have led to increased cannabis potency, unintentional childhood exposures, adult cannabis use, and adult CUD. Ecological-level studies suggest that MMLs have led to substitution of cannabis for opioids, and also possibly for psychiatric medications. Much remains to be determined about cannabis trends and the role of MMLs and RMLs in these trends. The public, health professionals, and policy makers would benefit from education about the risks of cannabis use, the increases in such risks, and the role of marijuana laws in these increases.
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Affiliation(s)
- Deborah S Hasin
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
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31
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Carliner H, Brown QL, Sarvet AL, Hasin DS. Cannabis use, attitudes, and legal status in the U.S.: A review. Prev Med 2017; 104:13-23. [PMID: 28705601 PMCID: PMC6348863 DOI: 10.1016/j.ypmed.2017.07.008] [Citation(s) in RCA: 358] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/27/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
Abstract
Cannabis is widely used among adolescents and adults. In the U.S., marijuana laws have been changing, and Americans increasingly favor legalizing cannabis for medical and recreational uses. While some can use cannabis without harm, others experience adverse consequences. The objective of this review is to summarize information on the legal status of cannabis, perceptions regarding cannabis, prevalence and time trends in use and related adverse consequences, and evidence on the relationship of state medical (MML) and recreational (RML) marijuana laws to use and attitudes. Twenty-nine states now have MMLs, and eight of these have RMLs. Since the early 2000s, adult and adolescent perception of cannabis use as risky has decreased. Over the same time, the prevalence of adolescent cannabis use has changed little. However, adult cannabis use, disorders, and related consequences have increased. Multiple nationally representative studies indicate that MMLs have had little effect on cannabis use among adolescents. However, while MML effects have been less studied in adults, available evidence suggests that MMLs increase use and cannabis use disorders in adults. While data are not yet available to evaluate the effect of RMLs, they are likely to lower price, increase availability, and thereby increase cannabis use. More permissive marijuana laws may accomplish social justice aims (e.g., reduce racial disparities in law enforcement) and generate tax revenues. However, such laws may increase cannabis-related adverse health and psychosocial consequences by increasing the population of users. Dissemination of balanced information about the potential health harms of cannabis use is needed.
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Affiliation(s)
- Hannah Carliner
- Columbia University, Department of Psychiatry, United States; Columbia University Mailman School of Public Health, Department of Epidemiology, United States; New York State Psychiatric Institute, United States
| | - Qiana L Brown
- Columbia University Mailman School of Public Health, Department of Epidemiology, United States; Nathan Kline Institute for Psychiatric Research, New York State Office of Mental Health, United States; New York University School of Medicine, Department of Psychiatry, United States
| | | | - Deborah S Hasin
- Columbia University, Department of Psychiatry, United States; Columbia University Mailman School of Public Health, Department of Epidemiology, United States; New York State Psychiatric Institute, United States.
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Kerr DCR, Bae H, Phibbs S, Kern AC. Changes in undergraduates' marijuana, heavy alcohol and cigarette use following legalization of recreational marijuana use in Oregon. Addiction 2017; 112:1992-2001. [PMID: 28613454 DOI: 10.1111/add.13906] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/23/2017] [Accepted: 06/02/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Recreational marijuana legalization (RML) went into effect in Oregon in July 2015. RML is expected to influence marijuana use by adolescents and young adults in particular, and by those with a propensity for substance use. We sought to quantify changes in rates of marijuana use among college students in Oregon from pre- to post-RML relative to college students in other states across the same time period. DESIGN Repeated cross-sectional survey data from the 2012-16 administrations of the Healthy Minds Study. SETTING Seven 4-year universities in the United States. PARTICIPANTS There were 10 924 undergraduate participants. One large public Oregon university participated in 2014 and 2016 (n = 588 and 1115, respectively); six universities in US states where recreational marijuana use was illegal participated both in 2016 and at least once between 2012 and 2015. MEASUREMENTS Self-reported marijuana use in the past 30 days (yes/no) was regressed on time (pre/post 2015), exposure to RML (i.e. Oregon students in 2016) and covariates using mixed-effects logistic regression. Moderation of RML effects by recent heavy alcohol use was examined. FINDINGS Rates of marijuana use increased from pre- to post-2015 at six of the seven universities, a trend that was significant overall. Increases in rates of marijuana use were significantly greater in Oregon than in comparison institutions, but only among students reporting recent heavy alcohol use. CONCLUSIONS Rates of Oregon college students' marijuana use increased (relative to that of students in other states) following recreational marijuana legislation in 2015, but only for those who reported recent heavy use of alcohol. Such alcohol misuse may be a proxy for vulnerabilities to substance use or lack of prohibitions (e.g. cultural) against it.
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Affiliation(s)
| | - Harold Bae
- Oregon State University, Corvallis, OR, USA
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Wang C, Hou L, Li J, Xu Z, Gao T, Yang J, Zhang H, Li X, Du P. Occurrence of diazepam and its metabolites in wastewater and surface waters in Beijing. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:15379-15389. [PMID: 28508332 DOI: 10.1007/s11356-017-8922-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 03/23/2017] [Indexed: 06/07/2023]
Abstract
Occurrence of diazepam and its metabolites, nordiazepam, temazepam, and oxazepam in the water environment in Beijing was investigated. Samples were collected from four rivers flowing through the city and from all the thirteen sewage treatment plants in the urban area. Average influent concentrations of diazepman, temazepam, and oxazepam in 2013 summer ranged from 0.9 to 7.1, 1.5 to 3.4, and 2.9 to 12.4 ng L-1, respectively, whereas nordiazepam concentrations were below quantification limit on the majority of sampling dates. No significant seasonal variation in influent concentrations was observed. Removal during treatment was low for diazepman (<50%), temazepam (<20%), and oxazepam (<20%), consistent with previous findings reported in the literature. Wastewater-based epidemiology approach was applied to back-calculate population size-normalized diazepam consumption (using temazepam as biomarker) in Beijing, which was found to be at least 3.8 times more of the national average. Diazepam, temazepam, and oxazepam were widely detected in surface waters, with concentrations greater than concentrations in sewage influents at many sampling points, strongly indicating direct discharge of wastewater of high diazepam concentrations into the surface waters in the city.
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Affiliation(s)
- Congcong Wang
- Laboratory of Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, 100871, Beijing, People's Republic of China
| | - Linlin Hou
- College of Chemistry and Chemical Engineering, Anyang Normal University, 45500, Henan, People's Republic of China
| | - Jing Li
- Laboratory of Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, 100871, Beijing, People's Republic of China
| | - Zeqiong Xu
- Laboratory of Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, 100871, Beijing, People's Republic of China
| | - Tingting Gao
- Laboratory of Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, 100871, Beijing, People's Republic of China
| | - Jun Yang
- Beijing Urban Drainage Monitoring Center Co. Ltd., Beijing, 100012, China
| | - Huafang Zhang
- Beijing Urban Drainage Monitoring Center Co. Ltd., Beijing, 100012, China
| | - Xiqing Li
- Laboratory of Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, 100871, Beijing, People's Republic of China.
| | - Peng Du
- Laboratory of Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, 100871, Beijing, People's Republic of China.
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