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Pratschke J. Harm reduction strategies for cannabis-related problems: a literature review and typology. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01839-3. [PMID: 38935216 DOI: 10.1007/s00406-024-01839-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
Measures that seek to minimise the health and social consequences of substance use are an integral part of national drug strategies in many European countries. Against the backdrop of a high prevalence of cannabis use in the economically advanced countries, and increasing demand for treatment for cannabis-related problems, a range of harm reduction measures have been implemented by peers, statutory bodies and third-sector organisations. Based on a systematic review of the literature, the author describes these different forms of intervention, identifies innovative strategies and presents a simple typology that can be used when exploring existing measures or seeking to develop new policies. This typology covers different kinds of legal, socio-organisational and health-related interventions. All study designs were eligible for inclusion, with the exception of case reports, non-systematic reviews, editorials and news stories. Studies had to be published between 2011 and 2022, in English, and they had to refer to Europe, the Americas, Australia or New Zealand. A two-concept search was implemented using Embase.com and a number of other databases, combined with citation searches and manual website searching to improve coverage of research reports and advocacy documents. A total of 35 documents were deemed eligible, many of which rely on qualitative research methods.
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Affiliation(s)
- Jonathan Pratschke
- Department of Social Science, University of Naples Federico II, Vico Monte della Pietà, 1, Naples, 80138, Italy.
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2
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Kulak JA, Voit HE, Balfour CA, Homish GG. College health providers' knowledge and confidence in addressing students' vaping: Evidence from a pilot study in New York State. PEC INNOVATION 2023; 2:100123. [PMID: 37214494 PMCID: PMC10194164 DOI: 10.1016/j.pecinn.2023.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/21/2022] [Accepted: 01/16/2023] [Indexed: 05/24/2023]
Abstract
Objective This study examines the knowledge and confidence of college healthcare providers in discussing vaping with their college student populations. Methods This is a mixed-methods descriptive study using a sequential-explanatory approach, consisting of a cross-sectional, online survey followed by qualitative interviews. Survey data was collected from 50 college health providers located at 26 colleges in the 64-campus State University of New York system. Targeted semi-structured interviews (N = 11) were conducted by telephone with providers who completed the survey. Results Despite high reported levels of knowledge and confidence, few providers had participated in educational activities relative to vaping. There was evidence of misinformation about e-cigarettes, and they did not know what product (nicotine/cannabis) students typically vape. Conclusions Findings indicate a potential disconnect between providers' perceived and actual knowledge of college student vaping and demonstrate areas of opportunity to assist college health providers in comprehensively addressing vaping with their college student populations. Innovation College health providers played a key role in lowering rates of combustible cigarette smoking, but little is known about how they are now are communicating with college students about e-cigarette and cannabis vaping. This paper examines college health providers' knowledge, confidence, and training needs relative to vaping communications.
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Affiliation(s)
- Jessica A. Kulak
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Hannah E. Voit
- Department of Health, Nutrition, and Dietetics, Buffalo State College, Buffalo, NY, USA
| | - Cierra A. Balfour
- Department of Health, Nutrition, and Dietetics, Buffalo State College, Buffalo, NY, USA
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
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Steeger CM, Hitchcock LN, Bryan AD, Hutchison KE, Hill KG, Bidwell LC. Associations between self-reported cannabis use frequency, potency, and cannabis/health metrics. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103278. [PMID: 34062287 PMCID: PMC8585676 DOI: 10.1016/j.drugpo.2021.103278] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Research shows that cannabis use frequency is associated with cannabis dependence and health metrics. However, much less is known about how self-reported cannabis potency (THC and CBD) may be associated with the same metrics, and whether any associations exist after accounting for frequency of cannabis use. Moreover, even less is known about how these relations may differ across cannabis product forms. This exploratory study examined 1) associations between cannabis frequency, potency, and cannabis/health metrics, and 2) whether associations between potency and cannabis/health metrics remained after controlling for frequency of use. METHODS Using a sample of adult recreational cannabis users in Colorado (N = 300), we tested the relationship between self-reported cannabis use metrics of frequency and potency of flower, edible, and concentrate products with separate measures of problematic cannabis use (i.e., dependence, withdrawal, craving), depression, anxiety, and general perceived health. RESULTS Greater frequency of flower and concentrate (but not edible) use were associated with greater problematic cannabis use, and greater concentrate use frequency was also associated with more mental health problems. Partial correlations controlling for average frequency of use across all product forms and CBD potency per product showed that one significant association between THC potency and cannabis/health metrics remained (i.e., higher THC concentrate potency with better health), and one emerged (i.e., higher THC concentrate potency with lower cannabis withdrawal). CONCLUSIONS Frequency of use is reliably associated with problematic cannabis use for flower and concentrates, but it did not account for all observed associations in this study. Differences in patterns of associations between frequency and potency and cannabis/health metrics across cannabis forms suggest a need for better understanding user reports of THC and CBD potency, individual differences among users, and improved measurement.
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Affiliation(s)
- Christine M Steeger
- Institute of Behavioral Science, University of Colorado Boulder, 1440 15th St., Boulder, CO 80309, USA.
| | - Leah N Hitchcock
- Institute of Cognitive Science, University of Colorado Boulder, 344 UCB, Boulder, CO 80309, USA
| | - Angela D Bryan
- Institute of Cognitive Science, University of Colorado Boulder, 344 UCB, Boulder, CO 80309, USA; Department of Psychology & Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO 80309, USA
| | - Kent E Hutchison
- Institute of Cognitive Science, University of Colorado Boulder, 344 UCB, Boulder, CO 80309, USA; Department of Psychology & Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO 80309, USA
| | - Karl G Hill
- Institute of Behavioral Science, University of Colorado Boulder, 1440 15th St., Boulder, CO 80309, USA
| | - L Cinnamon Bidwell
- Institute of Cognitive Science, University of Colorado Boulder, 344 UCB, Boulder, CO 80309, USA; Department of Psychology & Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO 80309, USA
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Oldfield K, Evans S, Braithwaite I, Newton-Howes G. Don’t make a hash of it! A thematic review of the literature relating to outcomes of cannabis regulatory change. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2021.1901855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Karen Oldfield
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
- School of Biological Sciences, Victoria University of Wellington (VUW), Wellington, New Zealand
- Medical Cannabis Research Collaborative (MCRC) NZ, Wellington, New Zealand
| | - Sean Evans
- Addiction Services, Capital and Coast District Health Board (CCDHB), Wellington, New Zealand
| | - Irene Braithwaite
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
- School of Biological Sciences, Victoria University of Wellington (VUW), Wellington, New Zealand
- Medical Cannabis Research Collaborative (MCRC) NZ, Wellington, New Zealand
| | - Giles Newton-Howes
- Medical Cannabis Research Collaborative (MCRC) NZ, Wellington, New Zealand
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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Alvarez L, Colonna R, Kim S, Chen C, Chippure K, Grewal J, Kimm C, Randell T, Leung V. Young and under the influence: A systematic literature review of the impact of cannabis on the driving performance of youth. ACCIDENT; ANALYSIS AND PREVENTION 2021; 151:105961. [PMID: 33421731 DOI: 10.1016/j.aap.2020.105961] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/20/2020] [Accepted: 12/19/2020] [Indexed: 05/16/2023]
Abstract
BACKGROUND Young drivers ages 15-24 continue to constitute a high-risk population for fatal motor vehicle collisions (MVCs) compared to all other age groups. Driving under the influence of cannabis is an important contributor to the high rates of MVCs among youth. Understanding the specific impact of cannabis on the driving performance outcomes of young drivers can inform injury prevention, education, and intervention strategies. OBJECTIVES This systematic literature review (SLR) aims to determine the Class (I- highest to IV-lowest) of evidence and level of confidence (A-high to U-insufficient) in the effects of cannabis on the driving performance of young drivers. METHODS Registered in PROSPERO (#CRD42020180541), this SLR searched seven data bases and appraised the quality and confidence in the evidence using an established research methodology. RESULTS Class II evidence suggests that THC is likely to reduce mean speed, headway distance, and reaction time; and increase lane and steering wheel position variability among young drivers (Level B, moderate confidence). CONCLUSIONS This study shows that there is a moderate to low level of confidence on the impact of cannabis on the specific driving performance outcomes of young drivers. A need remains for Class I and II studies that focus on the specific effects on young drivers, distinguish between the biological and socially constructed variables of sex and gender, and includes larger and more representative samples.
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Affiliation(s)
- Liliana Alvarez
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Canada.
| | - Robert Colonna
- Health and Rehabilitation Sciences Graduate Program, Western University, London, Canada
| | - Sean Kim
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Caron Chen
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Canada
| | - Katherine Chippure
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Canada
| | - Jasleen Grewal
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Canada
| | - Chris Kimm
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Canada
| | - Travis Randell
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Canada
| | - Victoria Leung
- Schulich School of Medicine and Dentistry, Western University, London, Canada
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Howard J, Osborne J. Cannabis and work: Need for more research. Am J Ind Med 2020; 63:963-972. [PMID: 32797692 DOI: 10.1002/ajim.23170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/12/2022]
Abstract
Cannabis sativa is one of the oldest and most widely used plants in the world with a variety of industrial, medical, and nonmedical applications. Despite its long history, cannabis-derived products remain a source of controversy across the fields of medicine, law, and occupational safety and health. More favorable public attitudes about cannabis in the US have resulted in greater access to cannabis through legalization by states, leading to more consumption by workers. As more states adopt cannabis access laws, and as more workers choose to consume cannabis products, the implications for existing workplace policies, programs, and practices become more salient. Past workplace practices were grounded in a time when cannabis consumption was always viewed as problematic, considered a moral failing, and was universally illegal. Shifting cultural views and the changing legal status of cannabis indicate a need for research into the implications and challenges relating to cannabis and work. This commentary suggests research needs in the following areas: (a) data about industries and occupations where cannabis consumption among workers is most prevalent; (b) adverse health consequences of cannabis consumption among workers; (c) workplace supported recovery programs; (d) hazards to workers in the emerging cannabis industry; (e) relationship between cannabis consumption and occupational injuries; (f) ways to assess performance deficits and impairment from cannabis consumption; (g) consumption of synthetic cannabinoids to evade detection by drug testing; (h) cannabis consumption and its effect on occupational driving; and (i) ways to craft workplace policies and practices that take into consideration conflicting state and federal laws pertaining to cannabis.
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Affiliation(s)
- John Howard
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention US Department of Health and Human Services Washington DC
| | - Jamie Osborne
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention US Department of Health and Human Services Atlanta Georgia
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Prevalence and forms of cannabis use in legal vs. illegal recreational cannabis markets. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 76:102658. [DOI: 10.1016/j.drugpo.2019.102658] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/12/2019] [Accepted: 12/29/2019] [Indexed: 11/18/2022]
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Bonomo Y, Norman A, Biondo S, Bruno R, Daglish M, Dawe S, Egerton-Warburton D, Karro J, Kim C, Lenton S, Lubman DI, Pastor A, Rundle J, Ryan J, Gordon P, Sharry P, Nutt D, Castle D. The Australian drug harms ranking study. J Psychopharmacol 2019; 33:759-768. [PMID: 31081439 DOI: 10.1177/0269881119841569] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIM The aim of the current study was to review drug harms as they occur in Australia using the Multi-criteria Decision Analysis (MCDA) methodology adopted in earlier studies in other jurisdictions. METHOD A facilitated workshop with 25 experts from across Australia, was held to score 22 drugs on 16 criteria: 9 related to harms that a drug produces in the individual and 7 to harms to others. Participants were guided by facilitators through the methodology and principles of MCDA. In open discussion, each drug was scored on each criterion. The criteria were then weighted using a process of swing weighting. Scoring was captured in MCDA software tool. RESULTS MCDA modelling showed the most harmful substances to users were fentanyls (part score 50), heroin (part score 45) and crystal methamphetamine (part score 42). The most harmful substances to others were alcohol (part score 41), crystal methamphetamine (part score 24) and cigarettes/tobacco (part score 14). Overall, alcohol was the most harmful drug when harm to users and harm to others was combined. A supplementary analysis took into consideration the prevalence of each substance in Australia. Alcohol was again ranked the most harmful substance overall, followed by cigarettes, crystal methamphetamine, cannabis, heroin and pharmaceutical opioids. CONCLUSIONS The results of this study make an important contribution to the emerging international picture of drug harms. They highlight the persistent and pervasive harms caused by alcohol. Policy implications and recommendations are discussed. Policies to reduce harm from alcohol and methamphetamine should be a priority.
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Affiliation(s)
- Yvonne Bonomo
- 1 Department of Addiction Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, VIC, Australia
| | - Amanda Norman
- 1 Department of Addiction Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, VIC, Australia
| | - Sam Biondo
- 2 Victorian Alcohol and Drug Association (VAADA), Melbourne, VIC, Australia
| | - Raimondo Bruno
- 3 School of Medicine (Psychology), University of Tasmania, Hobart, TAS, Australia
| | - Mark Daglish
- 4 Alcohol and Drug Service, Metro North Hospital and Health Service, The University of Queensland, St Lucia, Brisbane, QLD, Australia
| | - Sharon Dawe
- 5 School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Diana Egerton-Warburton
- 6 Department of Medicine, School of Clinical Sciences at Monash Health, Melbourne, VIC, Australia
| | - Jonathan Karro
- 7 Emergency Department, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Charles Kim
- 8 Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Simon Lenton
- 9 National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Dan I Lubman
- 10 Turning Point, Eastern Health and Monash University, Melbourne, VIC, Australia
| | - Adam Pastor
- 1 Department of Addiction Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, VIC, Australia
| | - Jill Rundle
- 11 Western Australian Network of Alcohol and Drug Agencies, Perth, WA, Australia
| | - John Ryan
- 12 Penington Institute, Melbourne, VIC, Australia
| | | | - Patrick Sharry
- 14 Australian Graduate School of Management, University of New South Wales, Sydney, NSW, Australia
| | | | - David Castle
- 16 Mental Health, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, VIC, Australia
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Examining links between cannabis potency and mental and physical health outcomes. Behav Res Ther 2019; 115:111-120. [DOI: 10.1016/j.brat.2018.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/07/2018] [Accepted: 11/16/2018] [Indexed: 11/17/2022]
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Anderson DM, Rees DI, Tekin E. Medical marijuana laws and workplace fatalities in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 60:33-39. [PMID: 30092547 DOI: 10.1016/j.drugpo.2018.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/13/2018] [Accepted: 07/15/2018] [Indexed: 11/25/2022]
Abstract
AIMS The aim of this research was to determine the association between legalizing medical marijuana and workplace fatalities. DESIGN Repeated cross-sectional data on workplace fatalities at the state-year level were analyzed using a multivariate Poisson regression. SETTING To date, 29 states and the District of Columbia have legalized the use of marijuana for medicinal purposes. Although there is increasing concern that legalizing medical marijuana will make workplaces more dangerous, little is known about the relationship between medical marijuana laws (MMLs) and workplace fatalities. PARTICIPANTS All 50 states and the District of Columbia for the period 1992-2015. MEASUREMENTS Workplace fatalities by state and year were obtained from the Bureau of Labor Statistics. Regression models were adjusted for state demographics, the unemployment rate, state fixed effects, and year fixed effects. FINDINGS Legalizing medical marijuana was associated with a 19.5% reduction in the expected number of workplace fatalities among workers aged 25-44 (incident rate ratio [IRR], 0.805; 95% CI, .662-.979). The association between legalizing medical marijuana and workplace fatalities among workers aged 16-24, although negative, was not statistically significant at conventional levels. The association between legalizing medical marijuana and workplace fatalities among workers aged 25-44 grew stronger over time. Five years after coming into effect, MMLs were associated with a 33.7% reduction in the expected number of workplace fatalities (IRR, 0.663; 95% CI, .482-.912). MMLs that listed pain as a qualifying condition or allowed collective cultivation were associated with larger reductions in fatalities among workers aged 25-44 than those that did not. CONCLUSIONS The results provide evidence that legalizing medical marijuana improved workplace safety for workers aged 25-44. Further investigation is required to determine whether this result is attributable to reductions in the consumption of alcohol and other substances that impair cognitive function, memory, and motor skills.
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Affiliation(s)
- D Mark Anderson
- Department of Agricultural Economics and Economics, Montana State University, P.O. Box 172920, Bozeman, MT, 59717-2920, United States.
| | - Daniel I Rees
- Department of Economics, University of Colorado Denver, United States.
| | - Erdal Tekin
- School of Public Affairs, American University, United States.
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