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Bezalwar A, Patil PS, Pajai S, Girdhar A. Journey of Marijuana From "Folk Tales" to "Doors of Justice": A Comprehensive Review. Cureus 2024; 16:e57190. [PMID: 38681315 PMCID: PMC11056232 DOI: 10.7759/cureus.57190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
This comprehensive review delves into the intricate journey of marijuana in India, tracing its historical and cultural significance from ancient times to the present day. Despite its deep-rooted presence in religious rituals, traditional medicine, and cultural festivities, marijuana faces stringent prohibition under the Narcotic Drugs and Psychotropic Substances Act 1985. This review critically examines the current legal framework, highlighting its societal impacts and limitations. Through an evidence-based analysis, it advocates for a reevaluation of marijuana laws to align with contemporary realities, promoting public health, social equity, and economic development. By envisioning a future of evidence-based regulation and innovation, India can unlock the full potential of marijuana as a "miracle crop" for the betterment of its people and society.
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Affiliation(s)
- Apurva Bezalwar
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pradeep S Patil
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shobha Pajai
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Anshita Girdhar
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Lim CCW, Sun T, Gartner C, Connor J, Fahmi M, Hall W, Hames S, Stjepanović D, Chan G, Leung J. What is the hype on #MedicinalCannabis in the United States? A content analysis of medicinal cannabis tweets. Drug Alcohol Rev 2024; 43:28-35. [PMID: 36809569 PMCID: PMC10952640 DOI: 10.1111/dar.13618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Medicinal cannabis is now legal in 44 US jurisdictions. Between 2020 and 2021 alone, four US jurisdictions legalised medicinal cannabis. The aim of this study is to identify themes in medicinal cannabis tweets from US jurisdictions with different legal statuses of cannabis from January to June 2021. METHODS A total of 25,099 historical tweets from 51 US jurisdictions were collected using Python. Content analysis was performed on a random sample of tweets accounting for the population size of each US jurisdictions (n = 750). Results were presented separately by tweets posted from jurisdictions where all cannabis use (non-medicinal and medicinal) is 'fully legalised', 'illegal' and legal for 'medical-only' use. RESULTS Four themes were identified: 'Policy', 'Therapeutic value', 'Sales and industry opportunities' and 'Adverse effects'. Most of the tweets were posted by the public. The most common theme was related to 'Policy' (32.5%-61.5% of the tweets). Tweets on 'Therapeutic value' were prevalent in all jurisdictions and accounted for 23.8%-32.1% of the tweets. Sales and promotional activities were prominent even in illegal jurisdictions (12.1%-26.5% of the tweets). Fewer than 10% of tweets were about intoxication and withdrawal symptoms. DISCUSSION AND CONCLUSION This study has explored if content themes of medicinal cannabis tweets differed by cannabis legal status. Most tweets were pro-cannabis and they were related to policy, therapeutic value, and sales and industry opportunities. Tweets on unsubstantiated health claims, adverse effects and crime warrants continued surveillance as these conversations could allow us to estimate cannabis-related harms to inform health surveillance.
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Affiliation(s)
- Carmen C. W. Lim
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
- School of PsychologyThe University of QueenslandBrisbaneAustralia
| | - Tianze Sun
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
- School of PsychologyThe University of QueenslandBrisbaneAustralia
| | - Coral Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public HealthThe University of QueenslandBrisbaneAustralia
| | - Jason Connor
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
- Discipline of PsychiatryThe University of QueenslandBrisbaneAustralia
| | - Marco Fahmi
- School of Languages and CulturesThe University of QueenslandBrisbaneAustralia
| | - Wayne Hall
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
| | - Sam Hames
- Digital ObservatoryQueensland University of TechnologyBrisbaneAustralia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
| | - Gary Chan
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
| | - Janni Leung
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
- School of PsychologyThe University of QueenslandBrisbaneAustralia
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Chaffee BW, Donaldson CD, Couch ET, Andersen-Rodgers E, Guerra C, Cheng NF, Ameli N, Stupplebeen D, Farooq O, Wilkinson M, Gansky S, Zhang X, Hoeft K. "I think we can do without [tobacco]": support for policies to end the tobacco epidemic among California adolescents. Tob Control 2023:tc-2023-058288. [PMID: 38148144 PMCID: PMC11199374 DOI: 10.1136/tc-2023-058288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION The tobacco endgame, policies aiming to end the commercial tobacco epidemic, requires sustained public support, including among youth. We assessed endgame support among California (USA) adolescents, including their reasons and associated participant and policy-specific factors. METHODS Teens, Nicotine and Tobacco Project online surveys (n=4827) and focus groups were conducted in 2021 and 2022 among California residents aged 12-17 years. Cross-sectional survey participants were asked their agreement level with eight policy statements related to tobacco and/or cannabis sales restrictions, use in public places and use in multiunit housing. Ordered logistic regression modelled level of agreement according to respondent characteristics, behaviours and statement content. Qualitative data were collected through focus groups (n=51 participants), which were analysed to provide insight into support for different policies. RESULTS Most survey participants agreed or strongly agreed with tobacco product sales restrictions (72%-75%, depending on the policy), bans on use in public spaces (76%-82%) and smoke-free (79%) and vape-free (74%) apartment buildings. Support was stronger among younger, female, Asian and tobacco non-using participants and for policies directed at 'tobacco' (vs 'vapes' or cannabis), at flavoured tobacco (compared with all tobacco), and when statements featured 'should end' (vs 'not allowed'). Focus group participants who were supportive viewed policies as protecting children from harmful products, while those less supportive cited concerns about limiting adults' freedoms and unintended consequences. CONCLUSIONS Most participants supported strong tobacco control policies. Public communication that promotes broader endgame benefits besides protecting youth and accelerates industry denormalisation may counter youth concerns and further bolster their support.
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Affiliation(s)
- Benjamin W Chaffee
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Candice D Donaldson
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, California, USA
| | - Elizabeth T Couch
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth Andersen-Rodgers
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, California, USA
| | - Claudia Guerra
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Nancy F Cheng
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Niloufar Ameli
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - David Stupplebeen
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, California, USA
| | - Omara Farooq
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, California, USA
| | - Monica Wilkinson
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, California, USA
| | - Stuart Gansky
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Xueying Zhang
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, California, USA
| | - Kristin Hoeft
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
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Shahzad H, Lee M, Munjal V, Veliky C, Yu E. Unlocking the Healing Potential: Cannabinoids in Spine Surgery for Pain Relief and Recovery. JBJS Rev 2023; 11:01874474-202311000-00004. [PMID: 37972215 DOI: 10.2106/jbjs.rvw.23.00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
» Cannabinoids, such as D9-tetrahydrocannabinol and cannabidiol, interact with endocannabinoid receptors in the central nervous system and immune system, potentially offering pain relief. The entourage effect, resulting from the interaction of multiple cannabis components, may enhance therapeutic impact and efficacy, making them promising candidates for exploring pain relief in spine operations, known to be among the most painful operative procedures.» The use of cannabinoids in pain management requires careful consideration of safety, including their cognitive and psychomotor effects, potential cardiovascular risks, risk of dependence, mental health implications, and drug interactions.» Few studies have analyzed cannabinoid use in relation to spine surgery, with variable results reported, indicating possible effects on reoperation rates, mortality, complications, postoperative opioid use, and length of hospital stay.» Current knowledge gaps exist in the understanding of cannabinoid effects on spine surgery, including the exploration of different administration routes, timing, dosage, and specific outcomes. In addition, mechanistic explanations for the observed results are lacking.» Ethical considerations related to informed consent, medical expertise, societal impact, and legal compliance must also be thoroughly addressed when considering the utilization of cannabinoids in spinal pathologies and back pain treatment.
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Affiliation(s)
- Hania Shahzad
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Hultgren BA, Guttmannova K, Cadigan JM, Kilmer JR, Delawalla MLM, Lee CM, Larimer ME. Injunctive Norms and Driving Under the Influence and Riding With an Impaired Driver Among Young Adults in Washington State. J Adolesc Health 2023; 73:852-858. [PMID: 37530684 DOI: 10.1016/j.jadohealth.2023.06.010] [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] [Received: 11/21/2022] [Revised: 05/18/2023] [Accepted: 06/09/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Alcohol- and cannabis-impaired driving behaviors remain a public health concern especially among young adults (i.e., ages 18-25). Limited updates to prevention efforts for these behaviors may be due, in part, to limited understanding of malleable psychosocial predictors. The current study assessed associations between perceived injunctive norms (i.e., acceptability) of driving under the influence of alcohol (DUI-A) and cannabis (DUI-C), and riding with a driver under the influence of alcohol (RWI-A) and cannabis (RWI-C) in Washington State young adults. METHODS Participants included 1,941 young adults from the 2019 cohort of the Washington Young Adult Health Survey. Weighted logistic regressions assessed the associations between peer injunctive norms and impaired driving-related behaviors. RESULTS A weighted total of 11.5% reported DUI-A, 12.4% DUI-C, 10.9% RWI-A, and 20.9% RWI-C at least once in the past 30 days. Overlap between the outcomes was observed, indicating some young adults had engaged in multiple impaired driving-related behaviors. After controlling for substance use frequency, weighted logistic regressions indicated more positive perceived injunctive norms were associated with nearly 2 ½ times higher odds of DUI-A, 8 times higher odds of DUI-C, 4 times higher odds of RWI-A and six and a half times higher odds of RWI-C. DISCUSSION Results increase the understanding of how injunctive norms-a potentially malleable psychosocial factor-are associated with four impaired driving-related outcomes. Prevention programs that focus on assessing and addressing the norms of these outcomes individually and collectively, such as normative feedback interventions and media campaigns, may be helpful in reducing these behaviors.
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Affiliation(s)
- Brittney A Hultgren
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, School of Medicine, University of Washington, Seattle, Washington.
| | - Katarina Guttmannova
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, School of Medicine, University of Washington, Seattle, Washington
| | - Jennifer M Cadigan
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, School of Medicine, University of Washington, Seattle, Washington
| | - Jason R Kilmer
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, School of Medicine, University of Washington, Seattle, Washington; Department of Psychology, University of Washington, Seattle, Washington
| | - Miranda L M Delawalla
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, School of Medicine, University of Washington, Seattle, Washington
| | - Christine M Lee
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, School of Medicine, University of Washington, Seattle, Washington
| | - Mary E Larimer
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, School of Medicine, University of Washington, Seattle, Washington; Department of Psychology, University of Washington, Seattle, Washington
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Cui Y, LoParco CR, Bar-Zeev Y, Duan Z, Levine H, Abroms LC, Wang Y, Khayat A, Berg CJ. Theory-based correlates of cannabis use and intentions among US and Israeli adults: a mixed methods study. Subst Abuse Treat Prev Policy 2023; 18:54. [PMID: 37674246 PMCID: PMC10483868 DOI: 10.1186/s13011-023-00562-x] [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: 06/18/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND In the US and Israel, non-medical ('recreational') cannabis use is illegal at the national level; however, use rates are high and decriminalization and legalization is spreading. Thus, theory-based intervention efforts, especially for youth prevention, are crucial. METHODS This mixed-methods study of adults in the US (n = 1,128) and Israel (n = 1,094) analyzed: 1) cross-sectional survey data (Fall 2021) to identify theory-based correlates (risk perceptions, social norms) of past-month cannabis use, next-year use intentions, and intentions to use in the home or among children if non-medical cannabis was legal, using multivariable regression; and 2) qualitative interviews regarding perceptions of cannabis policies and use (US n = 40, Israel n = 44). RESULTS 16.7% reported past-month use; 70.5%, 56.3%, and 82.6% indicated "not at all likely" regarding next-year use and use in the home and among children if legal. Lower perceived risk and greater social norms were associated with past-month use, greater use intentions, and greater intentions to use in the home or among children. Past-month use was more prevalent among US (vs. Israeli) participants (22.0% vs. 11.2%); however, in multivariable regression controlling for past-month use, being from Israel was associated with greater use intentions (next-year; in the home/among children). Qualitative themes indicated: concerns about use (e.g., increasing use, health risks, driving-related risks) and legalization (e.g., impact on society/economy, marketing), and perceived benefits of use (e.g., medical) and legalization (e.g., access/safety, economic, individual rights). CONCLUSIONS Despite differences in cannabis perceptions and use across countries, perceived risk and social norms are relevant intervention targets regardless of sociopolitical context.
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Affiliation(s)
- Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Cassidy R LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Zongshuan Duan
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
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Matheson J, Le Foll B. Impacts of recreational cannabis legalization on use and harms: A narrative review of sex/gender differences. Front Psychiatry 2023; 14:1127660. [PMID: 36970279 PMCID: PMC10036775 DOI: 10.3389/fpsyt.2023.1127660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
Legalization of cannabis use for non-medical (recreational) purposes is changing the global cannabis landscape. As attitudes toward cannabis use become more positive and prevalence of use increases in complex ways, concerns emerge about the potential for increased cannabis-attributable harms. Understanding the who, why, and when of this likely increase in cannabis-attributable harms is thus an important public health priority. Both sex and gender contribute to variability in the use, effects, and harms of cannabis and thus sex/gender considerations are important when evaluating the impacts of cannabis legalization. The goal of this narrative review is to broadly discuss sex/gender differences in attitudes toward and prevalence of cannabis use, whether there are sex/gender differences in the impacts of cannabis legalization, and why these sex/gender differences might exist. One of our strongest conclusions is that men have always been more likely to use cannabis than women, yet the sex/gender gap in prevalence of cannabis use has narrowed over time, and this might be partly due to cannabis legalization. The existing evidence suggests that there have also been sex/gender differences in the impacts of legalization on cannabis-attributable harms such as cannabis-involved motor vehicle collisions and hospitalizations, though these results are more variable. The body of literature reviewed has focused almost exclusively on samples of cisgender research participants, and thus future research should encourage inclusion of transgender and gender-diverse participants. More consideration of sex- and gender-based analysis in research evaluating long-term impacts of cannabis legalization is a clear research priority.
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Affiliation(s)
- Justin Matheson
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
- *Correspondence: Justin Matheson,
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Waypoint Centre for Mental Health Care, Waypoint Research Institute, Penetanguishene, ON, Canada
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Chiu V, Chan G, Hall W, Hides L, Leung J. Trends in cannabis use intention around the period of cannabis legalisation in Australia: An age-period-cohort model. Drug Alcohol Rev 2023; 42:337-345. [PMID: 36445753 PMCID: PMC10098937 DOI: 10.1111/dar.13578] [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: 01/03/2022] [Revised: 10/30/2022] [Accepted: 10/30/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study examines age, time period and birth cohort trends in cannabis use intention and weekly use in Australia over a period in which medicinal cannabis was legalised. METHODS Hierarchical age-period-cohort models were used to analyse the National Drug Strategy Household Survey between 2001 and 2019, including 158,395 participants aged 18-79 years. RESULTS The hierarchical age-period-cohort model demonstrated a decrease in likelihood of intending to try cannabis as age increases. Similar age effects were found in intending to use cannabis as often or less often. There was broad-based shift in attitudes for people wanting to try cannabis (2007: b = -0.51 [-0.82, -0.21]; 2019: b = 0.68 [0.38, 0.98]) or use cannabis more often (2007: b = -0.15 [-0.50, 0.20]; 2019: b = 0.83 [0.49, 1.18]). The population trend of weekly cannabis use decreased in the earlier periods but increased since 2013 (b = -0.13 [-0.25, -0.02] vs 2019: b = 0.06 [-0.09, 0.20]). This suggests that legalisation would increase uptake of cannabis and consumption among current consumers. There were distinctive inter-generation variations: people born between 1950s and 1960s had more liberal views towards cannabis use than people born before or after (p < 0.05). There were indications that young people born in the 1990 s are catching up with the baby boomers in using cannabis more often if it was legal. DISCUSSION AND CONCLUSIONS There has been a population-based shift in Australia in favourable attitudes towards cannabis use, more so among those born in the 1950s to 1960s than other generations. Liberal attitudes and more frequent cannabis use may put certain cohorts at higher risks of cannabis dependence and related harms.
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Affiliation(s)
- Vivian Chiu
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Gary Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, Australia
| | - Leanne Hides
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Janni Leung
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Muacevic A, Adler JR. How Demographic Factors Impact Attitudes Toward the Recreational Use of Cannabis. Cureus 2023; 15:e34304. [PMID: 36860218 PMCID: PMC9970729 DOI: 10.7759/cureus.34304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 01/30/2023] Open
Abstract
While cannabis legalization in the United States has become more commonplace, differences in attitudes toward its use persist. Negative attitudes toward cannabis create barriers to care for those seeking its use for therapeutic purposes. Existing research regarding the attitudes surrounding cannabis is specific to medical cannabis (MC) use or cannabis use in general. To address this gap, the present research sought to explore the demographic factors that influence attitudes toward recreational cannabis, including gender, age, ethnicity, race, level of education, marital status, number of children, the legal status of cannabis in the state of residency, employment status, political party affiliation, political view, and religion. The Recreational Cannabis Attitudes Scale (RCAS) was used to measure participants' attitudes toward recreational cannabis. A one-way analysis of variance (ANOVA) or one-way Welch ANOVA was used to determine variations in RCAS scores between different demographic groups. Data from 645 participants indicated that gender (P = 0.039), employment status (P = 0.016), political party affiliation (P = 0.002), political view (P = 0.0005), the legal status of the state of residence (P = 0.003), religion (P = 0.0005), and experience with cannabis (P = 0.0005) had significant variations between groups regarding attitudes toward recreational cannabis. Understanding the factors that inform attitudes is critical to efforts to destigmatize cannabis use. Education about cannabis is an effective measure in reducing stigma, and paired with demographic information, advocacy efforts can be more accurately targeted.
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Clobes TA, Gagnon M. Demographic factors that impact attitudes toward medical cannabis. PEC INNOVATION 2022; 1:100085. [PMID: 37213732 PMCID: PMC10194315 DOI: 10.1016/j.pecinn.2022.100085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/03/2022] [Accepted: 09/13/2022] [Indexed: 05/23/2023]
Abstract
Objective This study aims to identify pertinent demographic characteristics that influence attitudes toward medical cannabis. Methods Survey respondents were recruited through social media posts, partnering with community organizations, and snowball sampling. Attitudes were measured with a modified version of the medical component of the Recreational and Medical Cannabis Attitudes Scale (MMCAS). Data were analyzed using a one-way ANOVA or one-way Welch ANOVA to determine differences within demographic characteristics. A Tukey-Kramer, or Games-Howell, post-hoc analysis was conducted to determine specific groups within the independent variables that significantly impacted medical cannabis attitudes. Results A total of 645 participants completed the survey. Significant variation in MMCAS was noted between groups based on race, political party affiliation, political view, religion, state legal status, and past/current cannabis use. There were no significant variations noted in MMCAS for apolitical factors. Conclusion Political, religious, and legal demographic factors impact attitudes toward medical cannabis. Innovation The use of health education targeted at the groups of people who continue to harbor antiquated attitudes toward medical cannabis will help to improve patient access and, thus, patient outcomes. Cannabis advocates can innovatively apply health education efforts to groups of people who are aligned with the demographic factors identified in this current work.
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Yaskewich DM. Local Prohibitions on Marijuana Businesses With On-Site Consumption: Evidence from New York State. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221138229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As several US states have legalized recreational marijuana over the past decade, local approval of commercial marijuana activities has faced opposition in a non-negligible share of communities. A common provision in state laws often grants local governments the authority to prohibit marijuana businesses from locating within their jurisdictions. This paper analyzed determinants of local government policies in New York State following the legalization of recreational marijuana in 2021. A key feature of New York’s law authorized municipal governments to pass an “opt-out” ordinance prohibiting marijuana retail stores, on-site consumption establishments, or both. Based on results from multilevel logistic regression models, the likelihood of allowing commercial marijuana activities was higher for local governments representing communities with larger Black populations, fewer evangelical Protestants, and lower levels of household income. While slightly more municipalities prohibited on-site consumption, determinants of opt-out decisions were similar for both retail and consumption businesses.
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Isorna Folgar M, Burillo-Putze G, José Villanueva-Blasco V. Captura corporativa, fake news procannabis y posición de los consumidores ante su regulación. Glob Health Promot 2022; 30:95-104. [PMID: 35897158 DOI: 10.1177/17579759221107604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RESUMEN Introducción. La captura corporativa es el proceso en el que las decisiones políticas responden a un interés particular de carácter privado, en detrimento del interés público. La industria del cannabis ha desarrollado estrategias de captura de políticas y de difusión de fake news (noticias falsas) con el objeto de fomentar una visión del cannabis como sustancia inocua e, incluso, sanadora de enfermedades, promoviendo así una buena imagen de esta sustancia, de las corporaciones y consumidores, presionando para su legalización. OBJETIVOS (1) Analizar las estrategias de difusión de mensajes y fake news promotoras del cultivo, consumo y regulación del cannabis a través de distintos canales, y (2) explorar el posicionamiento frente al debate legislativo sobre esta sustancia en una muestra de estudiantes universitarios consumidores de cannabis. Metodología. (1) Estudio de carácter exploratorio para identificar y analizar las estrategias de la industria y, (2) estudio no probabilístico con muestreo por conveniencia mediante encuesta telemática difundida entre estudiantes de 11 universidades españolas (439 participantes). Resultados y conclusiones. La promoción del cultivo y del consumo de cannabis, relativizando sus efectos perjudiciales y presentándolo como una sustancia medicinal, aparece en las distintas estrategias utilizadas por la industria para difundir una imagen positiva del cannabis y de los consumidores. Estos mensajes tienen correspondencia con el posicionamiento de los consumidores, de los que el 82.6 % apoya alguna forma de regulación del cannabis.
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Affiliation(s)
- Manuel Isorna Folgar
- Facultad de Educación y Trabajo Social, Campus As Lagoas, Universidad de Vigo, Ourense, España
| | - Guillermo Burillo-Putze
- Área de Toxicología Clínica, Servicio de Urgencias, Universidad Europea de Canarias, Tenerife, España
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Assanangkornchai S, Thaikla K, Talek M, Saingam D. Medical cannabis use in Thailand after its legalization: a respondent-driven sample survey. PeerJ 2022; 10:e12809. [PMID: 35047242 PMCID: PMC8759353 DOI: 10.7717/peerj.12809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/27/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Many countries now allow the consumption of cannabis or cannabinoids for medical purposes with varying approaches concerning products allowed and the regulatory frameworks prevailing their endowment. On 18 February 2019 Thailand passed legislation allowing the use of cannabis for medical purposes. This study aimed to examine patterns and purposes for consumption of medical cannabis, and consumers' perceptions and opinions towards benefits and harms of cannabis and related policies in 2019-2020. METHODS A cross-sectional study using a respondent-driven sampling (RDS) method was conducted in four sites across Thailand. Participants were 485 adults aged 18 years and over, living in the study region, who had used cannabis for medical purposes within the past 12 months. Face-to-face interviews using a structured questionnaire were used to collect data on (1) demographic characteristics, (2) pattern of consumption, (3) source of information and perception of benefits and harms of medical cannabis, and (4) opinion towards cannabis policies. Data were analyzed using RDS Analyst and presented as percentage and mean with 95% confidence interval (CI). RESULTS Most participants (84.7%, 95% CI [78.9-90.5]) used an oral form of crude oil extract while 9.2% (95% CI [4.1-14.2]) used the raw form. The most common uses were for treatment of cancers (23.3%, 95% CI [16.1-30.4]), neuropsychiatric symptoms (22.8%, 95% CI [17.5-28.0]), and musculoskeletal pains (21.6%, 95% CI [16.7-26.6]). Illegal sources such as underground traders (54.5%, 95% CI [40.8-68.3]), friends and relatives (12.2%, 95% CI [6.2-18.3]), not-for-profit provider groups (5.2%, 95% CI [0.5-10.9]), and clandestine growers or producers (2.9%, 95% CI [0.6-5.3]) were the main suppliers. Most (>80%) perceived cannabis could treat cancers, chronic pains, insomnia, Parkinson's disease and generalized anxiety disorder. Less than half perceived that cannabis could cause adverse conditions e.g., palpitation, panic, memory impairment and schizophrenic-like psychosis. Most respondents agreed or strongly agreed with the policies regarding permission to use cannabis for medical purposes (95.1%, 95% CI [92.0-98.2]), for the legal sale of medical cannabis products (95.9%, 95% CI [93.7-98.2]), and for people to grow cannabis for medical use (94.2%, 95% CI [91.8-96.5]). However, only two-thirds agreed with policies concerning the sales of cannabis (65.3%, 95% CI [56.9-73.7]) and home-grown cannabis for recreational purposes (61.3%, 95% CI [52.7-69.9]). CONCLUSION Our study reports the experiences of consumers of medical cannabis in the first year after its legalization in Thailand. Consumers reported various patterns and indications of consumption that were not supported by scientific evidence, but had positive perception of the results of consumption. These findings highlight ongoing policy challenges for Thailand and can be a lesson to be learned for other countries in the region.
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Affiliation(s)
- Sawitri Assanangkornchai
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Kanittha Thaikla
- Research Institute for Health Sciences, Chiang Mai University, Muang, Chiang Mai, Thailand
| | - Muhammadfahmee Talek
- Faculty of Nursing Pattani Campus, Prince of Songkla University, Muang, Pattani, Thailand
| | - Darika Saingam
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Adams PJ, Rychert M, Wilkins C. Policy influence and the legalized cannabis industry: learnings from other addictive consumption industries. Addiction 2021; 116:2939-2946. [PMID: 33739486 DOI: 10.1111/add.15483] [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: 08/06/2020] [Revised: 10/13/2020] [Accepted: 03/02/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM New Zealand has recently legalized medicinal cannabis and has explored the possibility of legalizing large-scale recreational cannabis supply. In the process, concerns have emerged regarding whether corporations involved in the large-scale production and sale of legalized cannabis will invest in tactics of influence with policymakers and the public. This paper aimed to examine the various ways a legalized cannabis industry could seek to influence governments and the public in the New Zealand reform context. METHOD Based on the study of industry tactics with alcohol, tobacco and gambling, we applied a three-chain model of industry influence that breaks tactics into the 'public good', 'knowledge' and 'political' chains. RESULTS Exploratory analysis of the nascent cannabis industry's activity in New Zealand provided signs of industry influence strategies related to all three chains. The medicinal cannabis industry has associated the establishment of a legal cannabis sector with regional economic development and employment, supported lobbying for recreational law reform, funded NGOs involved in lobbying for law reform, established research partnerships with universities, invited ex-politicians on advisory boards, and participated in government public sector partnerships. CONCLUSION There is emerging evidence that the legal cannabis industry is using strategies to influence the regulatory environment in New Zealand.
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Affiliation(s)
- Peter J Adams
- Centre for Addiction Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Marta Rychert
- Social and Health Outcomes Research and Evaluation (SHORE), SHORE and Whaariki Research Centre, College of Health, Massey University, P.O. Box 6137, Wellesley Street, Auckland, New Zealand
| | - Chris Wilkins
- Social and Health Outcomes Research and Evaluation (SHORE), SHORE and Whaariki Research Centre, College of Health, Massey University, P.O. Box 6137, Wellesley Street, Auckland, New Zealand
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Ruheel MA, Gomes Z, Usman S, Homayouni P, Ng JY. Facilitators and barriers to the regulation of medical cannabis: a scoping review of the peer-reviewed literature. Harm Reduct J 2021; 18:106. [PMID: 34649577 PMCID: PMC8515704 DOI: 10.1186/s12954-021-00547-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/17/2021] [Indexed: 01/01/2023] Open
Abstract
Background In recent decades, several political, legislative, judicial, consumer, and commercial processes around the world have advanced legalization efforts for the use of medical cannabis (MC). As the use of MC evolves through legislative reform, with an increase in public acceptance and therapeutic potential, a need exists to further investigate the facilitators and barriers to MC regulation. Methods A scoping review was conducted to identify the facilitators and barriers associated with the implementation of MC regulations. MEDLINE, EMBASE, AMED and PsycINFO databases were systematically searched; no restrictions were placed on geographic location/jurisdiction. Eligible articles included those that evaluated the MC regulatory framework of one or more countries. Results Twenty-two articles were deemed eligible and included in this review. Themes identified include: (1) effects of conflicts, mindset, and ideology of state population, (2) the use of comparisons to analyze MC regulation, and (3) the need for more knowledge, advice, and empirical/clinical evidence to inform future MC policies. Conclusion Policymakers should be aware of facilitators to the MC regulation implementation process, such as the influence of state and federal congruence, increased transparency, and the incorporation of stakeholder concerns, in order to effectively respond to a growing societal acceptance of MC and its use among patients. Given a comprehensive understanding of these influential factors, policymakers may be better equipped to meet the consumer and commercial demands of a rapidly evolving MC regulatory environment.
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Affiliation(s)
- Mohammad Ali Ruheel
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Zoya Gomes
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Sana Usman
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Pargol Homayouni
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Jeremy Y Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
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Perlman AI, McLeod HM, Ventresca EC, Salinas MG, Post PJ, Schuh MJ, Abu Dabrh AM. Medical Cannabis State and Federal Regulations: Implications for United States Health Care Entities. Mayo Clin Proc 2021; 96:2671-2681. [PMID: 34607636 DOI: 10.1016/j.mayocp.2021.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/16/2021] [Accepted: 05/11/2021] [Indexed: 10/20/2022]
Abstract
Thirty-six states and four territories in the United States have legalized cannabis for medical and/or recreational use. Marijuana, however, continues to be classified as a schedule I substance under the Federal Controlled Substance Act and remains illegal under US federal law. The incongruity between state and federal legislation creates various challenges for stakeholders: patients, medical trainees, providers, and health care institutions. This communication provides an overview of the major policies impacting Cannabis sativa use within the United States, various state and federal regulations, and highlights potential implications for health care institutions moving forward. Existing literature, regulations, and policies on medical marijuana (MMJ) use in health care settings were searched, reviewed, analyzed, and distilled. As a consequence of legislative inconsistencies, there is insufficient clarity and resultant challenges regarding MMJ usage, prescription, possession, education, and research-related policies for health care stakeholders across the United States. Coupled with limited scientific evidence on the clinical efficacy of MMJ, the needs of the patient and the quality of health care delivery may be affected as hospitals balance the competing risks of being legislatively compliant while protecting the rights of patients and health care employees. There is a recognized need to better define acceptable MMJ policies and regulations in health care settings that are evidence-based, legally compliant, and adequately address the needs of both patients and providers. Given the complexity of the legal and policy landscape, there are potential opportunities for improvement, including in medical education and training, research, and usage oversight of MMJ for stakeholders in the United States.
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Affiliation(s)
- Adam I Perlman
- Department of Integrative Health, Mayo Clinic, Jacksonville, FL.
| | - Heidi M McLeod
- Department of Integrative Health, Mayo Clinic, Jacksonville, FL
| | | | | | - Peter J Post
- Department of Pharmacy, Mayo Clinic, Rochester, NY
| | - Michael J Schuh
- Department of Family Medicine and Palliative Medicine and Pharmacy, Mayo Clinic, Jacksonville, FL
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Wilkins C, Tremewan J, Rychert M, Atkinson Q, Fischer K, Forsyth GAL. Predictors of voter support for the legalization of recreational cannabis use and supply via a national referendum. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103442. [PMID: 34560621 DOI: 10.1016/j.drugpo.2021.103442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/10/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND A national referendum to legalise recreational cannabis use and supply in New Zealand via the Cannabis Legalisation and Control Bill (CLCB) was recently narrowly defeated. Understanding the underlying factors for this result can inform the cannabis legalisation debate in other countries. AIMS To investigate predictors of voter support for and opposition to the CLCB. METHOD A representative population panel of 1,022 people completed an online survey of intended voting on the CLCB referendum, which included questions on demographics, drug use history, medicinal cannabis, perceptions of the health risk and moral views of cannabis use, political affiliation, religiosity, community size and reading of the CLCB. Regression models were developed to predict support for the CLCB, with additional predictor variables added over successive iterations. RESULTS The most robust predictors of support for the CLCB were use of and policy support for medicinal cannabis use, voting for a left-wing political party, having a positive moral view of cannabis use, living in a small town and having read the CLCB. Predictors of opposing the CLCB were voting for right-wing parties, considering "frequent" cannabis use to be a high health risk, and lifetime use of other drugs. Age, ethnicity, education, employment status, religiosity and lifetime cannabis use were not significant predictors after controlling for other variables. CONCLUSIONS Support for cannabis legalization was not based on broad demographics, but rather specific views concerning the medicinal benefit, morality of cannabis use, health risk of frequent cannabis use, political party affiliation, and knowledge of the proposed regulatory controls of the CLCB. The influence of moral views of cannabis use on voting behaviour suggest the need to debate the right to use cannabis. The importance of knowledge of the proposed regulatory controls of the CLCB on voting underlines the need to raise awareness of proposed regulatory controls during debate.
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Affiliation(s)
- C Wilkins
- SHORE & Whariki Research Centre, Massey University, New Zealand.
| | - J Tremewan
- Department of Economics, University of Auckland, New Zealand
| | - M Rychert
- SHORE & Whariki Research Centre, Massey University, New Zealand
| | - Q Atkinson
- School of Psychology, University of Auckland, New Zealand
| | - K Fischer
- School of Psychology, University of Auckland, New Zealand
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Brown JD, Rivera Rivera KJ, Hernandez LYC, Doenges MR, Auchey I, Pham T, Goodin AJ. Natural and Synthetic Cannabinoids: Pharmacology, Uses, Adverse Drug Events, and Drug Interactions. J Clin Pharmacol 2021; 61 Suppl 2:S37-S52. [PMID: 34396558 DOI: 10.1002/jcph.1871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/01/2021] [Indexed: 01/15/2023]
Abstract
The purpose of this narrative review is to describe the current use environment of both natural and synthetic cannabinoids while providing context for cannabinoid chemistry and pharmacology. In addition to a long history of recreational and nonmedical use, natural cannabinoids are increasingly used as prescription products, through medical cannabis programs, and as consumer health products. Despite anecdotal safety evidence, cannabis and cannabinoids are pharmacologically complex and pose risks for adverse drug events and drug-drug interactions. Synthetic cannabinoids, particularly agonists of cannabinoid receptors, are more potent than natural cannabinoids and can lead to more severe reactions and medical emergencies. This review provides a summary of approved uses and an overview of mechanisms of action for adverse drug events with natural and synthetic cannabinoids. Clinical considerations for special populations that may be at heightened risk for drug-drug interactions and adverse drug events while using natural or synthetic cannabinoids are examined, and recommendations are provided.
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Affiliation(s)
- Joshua D Brown
- Center for Drug Evaluation & Safety, University of Florida, Gainesville, Florida, USA.,Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA.,Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | | | | | - Matthew R Doenges
- University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - India Auchey
- University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Thanh Pham
- University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Amie J Goodin
- Center for Drug Evaluation & Safety, University of Florida, Gainesville, Florida, USA.,Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA.,Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
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Ngueta G, Ndjaboue R. Lifetime marijuana use in relation to cadmium body burden of US adults: results from the national health and nutrition examination surveys, 2009–2016. Public Health 2020; 187:77-83. [DOI: 10.1016/j.puhe.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 11/28/2022]
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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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Lowry DE, Corsi DJ. Trends and correlates of cannabis use in Canada: a repeated cross-sectional analysis of national surveys from 2004 to 2017. CMAJ Open 2020; 8:E487-E495. [PMID: 32737023 PMCID: PMC7428071 DOI: 10.9778/cmajo.20190229] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cannabis is the most widely used drug in Canada. We examined the trends in past-year cannabis consumption by sociodemographic and geographic characteristics. METHODS We conducted a repeated cross-sectional analysis of the Canadian Tobacco Use Monitoring Survey, the Canadian Tobacco, Alcohol and Drugs Survey and the Canadian Alcohol and Drug Use Monitoring Survey from 2004 to 2017. Respondents were aged 15 years and older. Past-year cannabis use was analyzed using multivariable logistic regression and segmented logistic regression. RESULTS We analyzed 289 823 respondents (51% female) between 2004 and 2017. Between 2004 and 2017, the overall prevalence of cannabis use increased from 12.2% (95% confidence interval [CI] 11.0%-13.5%) to 18.7% (95% CI 16.2%-21.5%) among men and from 6.6% (95% CI 5.9%-7.4%) to 11.1% (95% CI 9.4%-13.0%) among women. The crude rate of change was greater between 2011 and 2017 than that between 2004 and 2011 in men (odds ratio [OR] per annual change: 1.08, 95% CI 1.05-1.11) and women (OR 1.11, 95% CI 1.07-1.15). After adjustment for age, education, tobacco smoking and province, the 2011-2017 trend was stronger in men (adjusted OR 1.24, 95% CI 1.05-1.46), but not in women (adjusted OR 1.13, 95% CI 0.93-1.37). Cannabis use was associated with tobacco smoking (OR 4.94, 95% CI 4.65-5.25). Heterogeneity was found in cannabis use trends by age, education and province. Cannabis use decreased among respondents aged 15-19 years and increased in other age groups. INTERPRETATION Cannabis consumption in Canada has increased and varies by sex, age, level of education and geography. Increases vary by sociodemographic factors and may be faster among certain groups. Further studies are warranted post-legalization.
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Affiliation(s)
- Dana E Lowry
- Ottawa Hospital Research Institute (Lowry, Corsi), University of Ottawa; Faculty of Medicine (Corsi), School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont
| | - Daniel J Corsi
- Ottawa Hospital Research Institute (Lowry, Corsi), University of Ottawa; Faculty of Medicine (Corsi), School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont.
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Brown JD, Costales B, van Boemmel-Wegmann S, Goodin AJ, Segal R, Winterstein AG. Characteristics of Older Adults Who Were Early Adopters of Medical Cannabis in the Florida Medical Marijuana Use Registry. J Clin Med 2020; 9:E1166. [PMID: 32325769 PMCID: PMC7230351 DOI: 10.3390/jcm9041166] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/18/2022] Open
Abstract
Use of medical marijuana is increasing in the United States and older adults are the fastest growing user group. There is little information about the characteristics and outcomes related to medical marijuana use. This study is a descriptive analysis of older adults (aged ≥50 years old) who were early adopters of a medical marijuana program in the U.S. state of Florida. Per state legislation, initial and follow-up treatment plans were submitted to the University of Florida College of Pharmacy. Data collection included demographics, clinical history, medical conditions, substance use history, prescription history, and health status. Follow-up treatment plans noted changes in the chief complaint and actions taken since the initial visit. Of the state's 7548 registered users between August 2016 and July 2017, N = 4447 (58.9%) were older adults. Patients utilized cannabidiol (CBD)-only preparations (45%), preparations that had both tetrahydrocannabinol (THC) and CBD (33.3%) or were recorded to use both CBD-only and THC + CBD products (21.7%). The chief complaints indicating medical cannabis treatment were musculoskeletal disorders and spasms (48.4%) and chronic pain (45.4%). Among other prescription medications, patients utilized antidepressants (23.8%), anxiolytics and benzodiazepines (23.5%), opioids (28.6%), and cardiovascular agents (27.9%). Among all drug classes with potential sedating effects, 44.8% of the cohort were exposed to at least one. Patients with follow-up visits (27.5%) exhibited marked improvement as assessed by the authorizing physicians. However, the patient registry lacked detailed records and linkable information to other data resources to achieve complete follow up in order to assess safety or efficacy. Future improvements to registries are needed to more adequately capture patient information to fill knowledge gaps related to the safety and effectiveness of medical marijuana, particularly in the older adult population.
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Affiliation(s)
- Joshua D. Brown
- Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA; (B.C.); (S.v.B.-W.); (A.J.G.); (R.S.); (A.G.W.)
- Consortium for Medical Marijuana Clinical Outcomes Research, Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA
| | - Brianna Costales
- Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA; (B.C.); (S.v.B.-W.); (A.J.G.); (R.S.); (A.G.W.)
| | - Sascha van Boemmel-Wegmann
- Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA; (B.C.); (S.v.B.-W.); (A.J.G.); (R.S.); (A.G.W.)
| | - Amie J. Goodin
- Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA; (B.C.); (S.v.B.-W.); (A.J.G.); (R.S.); (A.G.W.)
- Consortium for Medical Marijuana Clinical Outcomes Research, Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA
| | - Richard Segal
- Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA; (B.C.); (S.v.B.-W.); (A.J.G.); (R.S.); (A.G.W.)
| | - Almut G. Winterstein
- Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA; (B.C.); (S.v.B.-W.); (A.J.G.); (R.S.); (A.G.W.)
- Consortium for Medical Marijuana Clinical Outcomes Research, Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA
- Department of Epidemiology, University of Florida College of Colleges of Public Health and Health Professions and Medicine, Gainesville, FL 32610, USA
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Greer A, Ritter A. The legal regulation of drugs and role of government: Perspectives from people who use drugs. Drug Alcohol Depend 2020; 206:107737. [PMID: 31760251 DOI: 10.1016/j.drugalcdep.2019.107737] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/31/2019] [Accepted: 11/09/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The legalization and regulation of currently illicit drugs has come to the forefront of drug policy debates in recent years, particularly in the context of cannabis legalization and the opioid crisis in North America. However, sufficient granularity on the various aspects of a legally regulated drug supply is missing from these debates. Further, the voices and opinions of people who use drugs have generally been absent from drug law reform deliberations. This study aimed to examine the views of people who use drugs and who are deeply impacted by drug policies to understand the perceived impacts and role of government under a legalized-regulated market. METHODS Four focus groups were held with people who use drugs in Sydney, Australia. RESULTS Most participants supported various models of legalization, although the perspectives on these models were diverse. Overriding these views was skepticism over the government's role in regulating a legal market, as well as concern for the personal agency of people who use drugs under a medically regulated drug supply model. Some participants discussed potential harms (e.g. increases in use and initiation), but emphasized the benefits (e.g. increases in quality and safety) from legal reform. DISCUSSION While there was support for legal models of drug supply regulation, findings have major implications in terms of how governments and medical systems may perpetuate the oppression of people who use drugs through regulation, and urge future drug policy deliberations to include broader perspectives from the affected community.
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Affiliation(s)
- Alissa Greer
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby BC V5A 1S6, Canada.
| | - Alison Ritter
- Drug Policy Modeling Program, Social Policy Research Centre, University of New South Wales, Kensington NSW 2052, Australia
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Struble CA, Ellis JD, Lundahl LH. Beyond the Bud: Emerging Methods of Cannabis Consumption for Youth. Pediatr Clin North Am 2019; 66:1087-1097. [PMID: 31679599 DOI: 10.1016/j.pcl.2019.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cannabis continues to be the most widely used illicit substance among youth, as many teens view the risks of cannabis consumption to be low. With cannabis laws becoming lax and dispensaries becoming more prevalent throughout the United States, highly concentrated Δ-9-tetrahydrocannibinol (THC) is becoming readily available. This article examines the available literature on consumption of concentrated THC, focusing on potential consequences of concentrate use among youth. Various methods for consuming concentrated THC, including ingestion of edibles, vaping, and dabbing, are discussed, along with associated risks of each consumption method. Recommendations for health professionals are provided.
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Affiliation(s)
- Cara A Struble
- Department of Psychiatry and Behavioral Neurosciences, Substance Abuse Research Division, Wayne State University, 3901 Chrysler Service Drive, Suite 2A, Detroit, MI 48201, USA; Department of Psychology, Wayne State University, 5057 Woodward Avenue, 7th Floor, Detroit, MI 48202, USA
| | - Jennifer D Ellis
- Department of Psychiatry and Behavioral Neurosciences, Substance Abuse Research Division, Wayne State University, 3901 Chrysler Service Drive, Suite 2A, Detroit, MI 48201, USA; Department of Psychology, Wayne State University, 5057 Woodward Avenue, 7th Floor, Detroit, MI 48202, USA
| | - Leslie H Lundahl
- Department of Psychiatry and Behavioral Neurosciences, Substance Abuse Research Division, Wayne State University, 3901 Chrysler Service Drive, Suite 2A, Detroit, MI 48201, USA.
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