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Cooper M, Shi Y. The impacts of packaging on preferences for cannabis edibles: A discrete choice experiment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104453. [PMID: 38796927 DOI: 10.1016/j.drugpo.2024.104453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/27/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUNDS Cannabis edibles recently gained considerable market share in the United States. The tobacco and food literatures consistently suggest that product packaging regulations are crucial to substance control, but little is known about how product packaging may impact cannabis edible use. This study aims to estimate the impacts of packaging on individual preferences for cannabis edibles and explore heterogeneities in preferences by cannabis use status and use purposes. METHODS 1578 adults were recruited, who lived in 18 states and Washington D.C. in the United States that legalized recreational cannabis by the time of data collection in August and September of 2022. An online discrete choice experiment was conducted to elicit individual choices between cannabis edibles with variations in five packaging attributes: package style, health claim, potency indicator, warning label position, and warning label text. Mixed logit regressions were used to assess associations between package attributes and package choices. Subsample analysis was conducted by cannabis use status (users vs. nonusers) and use purposes (medical-only, recreational-only, and dual-purpose) to detect heterogeneities. RESULTS Almost all subsamples prefer branded packages to plain packages, any health claim to no health claim, and any potency indicator to no potency indicator. Cannabis users, particularly recreational-only users and dual-purpose users, also prefer youth-appealing packages to branded packages. Warning label position and text have limited impacts on choices. Overall, package style is perceived to be the most important attribute among the five (relative importance 33.2-50.8%), followed by health claim (relative importance 22.6-30.5%). CONCLUSION In the United States, adults' preferences for cannabis edibles are associated with packaging features. Policies requiring plain package and prohibiting youth-appealing package and unsubstantiated health claims may be effective methods of cannabis control.
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Affiliation(s)
- Michael Cooper
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. 9500 Gilman Dr., La Jolla, CA 92093, United States
| | - Yuyan Shi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. 9500 Gilman Dr., La Jolla, CA 92093, United States.
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Wood S, Gabrys R, Freeman T, Hammond D. Canada's THC unit: Applications for the legal cannabis market. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104457. [PMID: 38772194 DOI: 10.1016/j.drugpo.2024.104457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/23/2024]
Abstract
The legalization of cannabis in Canada has accelerated the need for a standardized approach to measuring and communicating the amount of delta-9-tetrahydrocannabinol (THC) in cannabis products. This article offers an overview of the considerations associated with establishing and implementing a standard THC unit in the Canadian context. The article begins by discussing the applications of a standard THC unit, emphasizing its potential use in product labelling, consumer education, and product reporting and surveillance. The article then examines key considerations for identifying what a Canadian THC unit should be set at, specifically within the context of a country with a regulated commercial cannabis market. This is followed by a discussion of additional considerations related to the adoption of a Canadian THC unit, including its use across various product formats and modes of administration. A significant focus of this article is on prioritizing public health and safety and informed decision-making among adult consumers as the legal cannabis market evolves. Collaboration among various stakeholders, such as government agencies, industry, and public health professionals, is highlighted as crucial for a successful transition to the use of Canada's THC unit.
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Affiliation(s)
- Shea Wood
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Suite 500, Ottawa, ON K1P 5E7, Canada.
| | - Robert Gabrys
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Suite 500, Ottawa, ON K1P 5E7, Canada; Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa K1S 5B6, ON, Canada
| | - Tom Freeman
- Addiction and Mental Health Group, Department of Psychology, University of Bath, Bath BA2 7AY, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
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Fortier A, Zouaoui I, Dumais A, Potvin S. Effects of Recreational Cannabis Legalization on Mental Health: Scoping Review. Psychiatr Serv 2024:appips20230434. [PMID: 38650490 DOI: 10.1176/appi.ps.20230434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Recreational cannabis legalization (RCL) is expanding rapidly. RCL's effects on mental health issues are of particular concern because cannabis use is more frequent among people receiving psychiatric care and is associated with several psychiatric disorders. The authors conducted a scoping review to examine the evidence and discern gaps in the literature concerning the effects of RCL on mental health and to assess the factors responsible for an observed heterogeneity in research results. METHODS This scoping literature review followed PRISMA guidelines. Five databases-MEDLINE, CINAHL, Embase, APA PsycInfo, and Web of Science-were searched for English- or French-language reports published between January 1, 2012, and April 30, 2023. RESULTS Twenty-eight studies from the United States and Canada were found. The studies were classified by category of the study's data (patients receiving psychiatric care [k=1], death records [k=4], emergency department or hospital records [k=10], and the general population [k=13]) and by the diagnosis (schizophrenia or psychoses, mood disorders, anxiety disorders and symptoms, suicide or suicidal ideation, or other mental health issues) examined. The review findings revealed a paucity of research and indicated mixed and largely inconclusive results of the studies examined. Research gaps were found in the examination of potential changes in cannabis use patterns among people receiving psychiatric care and in the availability of longitudinal studies. CONCLUSIONS Clinicians, researchers, and policy makers need to collaborate to address the research gaps and to develop evidence-based policies that reflect a thorough understanding of the effects associated with RCL.
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Affiliation(s)
- Alexandra Fortier
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, and Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal
| | - Inès Zouaoui
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, and Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal
| | - Alexandre Dumais
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, and Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal
| | - Stéphane Potvin
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, and Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal
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Petrilli K, Lawn W, Lees R, Mokrysz C, Borissova A, Ofori S, Trinci K, Dos Santos R, Leitch H, Soni S, Hines LA, Lorenzetti V, Curran HV, Freeman TP. Enhanced cannabis timeline followback (EC-TLFB): Comprehensive assessment of cannabis use including standard THC units and validation through biological measures. Addiction 2024; 119:772-783. [PMID: 38105033 DOI: 10.1111/add.16405] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023]
Abstract
AIMS The aims of this study were to present an enhanced cannabis timeline followback (EC-TLFB) enabling comprehensive assessment of cannabis use measures, including standard tetrahydrocannabinol (THC) units, and to validate these against objectively indexed urinary 11-nor-9-carboxy-tetrahydrocannabinol (THC-COOH) concentrations. DESIGN We used cross-sectional baseline data from the 'CannTeen' observational longitudinal study. SETTING The study was conducted in London, UK. PARTICIPANTS A total of 147 participants who used cannabis regularly took part in the study (n = 71 female, n = 76 male; mean age = 21.90, standard deviation = 5.32). MEASUREMENTS The EC-TLFB was used to calculate frequency of cannabis use, method of administration, including co-administration with tobacco, amount of cannabis used (measured with unaided self-report and also using pictorial aided self-report) and type of cannabis product (flower, hash) which was used to estimate THC concentration (both from published data on THC concentration of products and analysis of cannabis samples donated by participants in this study). We calculated total weekly standard THC units (i.e. 5 mg THC for all cannabis products and methods of administration) using the EC-TLFB. The outcome variable for validation of past week EC-TLFB assessments was creatinine-normalized carboxy-tetrahydrocannabinol (THC-COOH) in urine. FINDINGS All measures of cannabis exposure included in this analysis were positively correlated with levels of THC-COOH in urine (r = 0.41-0.52). Standard THC units, calculated with average concentrations of THC in cannabis in the UK and unaided self-report measures of amount of cannabis used in grams showed the strongest correlation with THC-COOH in urine (r = 0.52, 95% bias-corrected and accelerated = 0.26-0.70). CONCLUSIONS The enhanced cannabis timeline followback (EC-TLFB) can provide a valid assessment of a comprehensive set of cannabis use measures including standard tetrahydrocannabinol units as well as and traditional TLFB assessments (e.g. frequency of use and grams of cannabis use).
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Affiliation(s)
- Kat Petrilli
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Will Lawn
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Rachel Lees
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Anya Borissova
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK
| | - Shelan Ofori
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Katie Trinci
- Clinical Psychopharmacology Unit, University College London, London, UK
| | | | - Harry Leitch
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Shilpa Soni
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Lindsey A Hines
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Programme, the Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
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Borodovsky JT, Hasin DS, Shmulewitz D, Walsh C, Livne O, Aharonovich E, Struble CA, Habib MI, Budney AJ. Typical Hits, Grams, or Joints: Evaluating Cannabis Survey Measurement Strategies for Quantifying Consumption. Cannabis Cannabinoid Res 2024; 9:646-658. [PMID: 36577020 PMCID: PMC10998027 DOI: 10.1089/can.2022.0237] [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] [Indexed: 12/29/2022] Open
Abstract
Aim: Standardized survey measures that capture diverse cannabis consumption patterns are needed to inform public health and policy. Our team is developing a flexible, personalized, low-burden survey item inventory to measure cannabis use patterns and estimate milligrams of THC (mgTHC) consumption in large samples. This study aimed to identify measurement gaps and analysis implications associated with an initial pool of candidate items that assessed use of cannabis flower and concentrate products (smoked and/or vaporized). Methods: Adult cannabis consumers (n=4247) completed an online survey assessing cannabis use frequency, quantity, product types, product potencies (%THC), and methods of administration. Participants chose to report their consumption quantities using one of three units: "hits per day," "grams per week," or "joints per week." Respondents also indicated whether their past 7-day consumption pattern represented their typical pattern. Results: Eighty-one percent had used cannabis daily in the past week. Thirty-two percent, 53%, and 15% chose to report flower and concentrate consumption quantity in hits, grams, and joints, respectively. Approximately 80-90% of responses for the number of hits, grams, and joints consumed were less than the maximum response option-suggesting that response options captured the full range of potential cannabis consumption behaviors. Those who chose grams or joints units were generally more likely to endorse higher risk cannabis use (e.g., morning use, high %THC products) in the past week than those who chose the hits unit (adjusted Odds Ratio range: 1.2-3.9). Among those who reported that the past week represented their typical behavior (83%), past 30-day and past 7-day frequencies were highly correlated (Spearman's Rho=0.77)-supporting the feasibility of using lower burden "typical week" items to extrapolate patterns beyond a 1-week time frame. Conclusion: Results from this online convenience sample of frequent cannabis consumers suggest that the current items yield coherent and expected response patterns. Although additional testing is required, a standardized, flexible survey instrument for large-scale assessment of cannabis patterns and calculation of mgTHC seems within reach.
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Affiliation(s)
- Jacob T. Borodovsky
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Claire Walsh
- New York State Psychiatric Institute, New York, New York, USA
| | - Ofir Livne
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Cara A. Struble
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Mohammad I. Habib
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Alan J. Budney
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
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Lorenzetti V, Gaillard A, McTavish E, Grace S, Rossetti MG, Batalla A, Bellani M, Brambilla P, Chye Y, Conrod P, Cousijn J, Labuschagne I, Clemente A, Mackey S, Rendell P, Solowij N, Suo C, Li CSR, Terrett G, Thompson PM, Yücel M, Garavan H, Roberts CA. Cannabis Dependence is Associated with Reduced Hippocampal Subregion Volumes Independently of Sex: Findings from an ENIGMA Addiction Working Group Multi-Country Study. Cannabis Cannabinoid Res 2024. [PMID: 38498015 DOI: 10.1089/can.2023.0204] [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: 03/19/2024] Open
Abstract
Background: Males and females who consume cannabis can experience different mental health and cognitive problems. Neuroscientific theories of addiction postulate that dependence is underscored by neuroadaptations, but do not account for the contribution of distinct sexes. Further, there is little evidence for sex differences in the neurobiology of cannabis dependence as most neuroimaging studies have been conducted in largely male samples in which cannabis dependence, as opposed to use, is often not ascertained. Methods: We examined subregional hippocampus and amygdala volumetry in a sample of 206 people recruited from the ENIGMA Addiction Working Group. They included 59 people with cannabis dependence (17 females), 49 cannabis users without cannabis dependence (20 females), and 98 controls (33 females). Results: We found no group-by-sex effect on subregional volumetry. The left hippocampal cornu ammonis subfield 1 (CA1) volumes were lower in dependent cannabis users compared with non-dependent cannabis users (p<0.001, d=0.32) and with controls (p=0.022, d=0.18). Further, the left cornu ammonis subfield 3 (CA3) and left dentate gyrus volumes were lower in dependent versus non-dependent cannabis users but not versus controls (p=0.002, d=0.37, and p=0.002, d=0.31, respectively). All models controlled for age, intelligence quotient (IQ), alcohol and tobacco use, and intracranial volume. Amygdala volumetry was not affected by group or group-by-sex, but was smaller in females than males. Conclusions: Our findings suggest that the relationship between cannabis dependence and subregional volumetry was not moderated by sex. Specifically, dependent (rather than non-dependent) cannabis use may be associated with alterations in selected hippocampus subfields high in cannabinoid type 1 (CB1) receptors and implicated in addictive behavior. As these data are cross-sectional, it is plausible that differences predate cannabis dependence onset and contribute to the initiation of cannabis dependence. Longitudinal neuroimaging work is required to examine the time-course of the onset of subregional hippocampal alterations in cannabis dependence, and their progression as cannabis dependence exacerbates or recovers over time.
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Affiliation(s)
- Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Alexandra Gaillard
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
- Centre for Mental Health and Department of Health Sciences and Biostatistics, Swinburne University, Hawthorn, Australia
| | - Eugene McTavish
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Sally Grace
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Maria Gloria Rossetti
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Albert Batalla
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Marcella Bellani
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Paolo Brambilla
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Yann Chye
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Patricia Conrod
- Department of Psychiatry, Université de Montreal, CHU Ste Justine Hospital, Montreal, Canada
| | - Janna Cousijn
- Neuroscience of Addiction Lab, Center for Substance Use and Addiction Research (CESAR), Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Izelle Labuschagne
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Australia
| | - Adam Clemente
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Scott Mackey
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
| | - Peter Rendell
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Australia
| | - Nadia Solowij
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Chao Suo
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gill Terrett
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Paul M Thompson
- Department of Neurology, Imaging Genetics Center, Stevens Institute for Neuroimaging & Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, California, USA
| | - Murat Yücel
- QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Hugh Garavan
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Australia
| | - Carl A Roberts
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
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Goulette M, Schlienz NJ, Case AA, Hansen E, Rivard C, Ashare RL, Goniewicz ML, Bansal-Travers M, Hyland A, Smith DM. Self-reported knowledge of tetrahydrocannabinol and cannabidiol concentration in cannabis products among cancer patients and survivors. Support Care Cancer 2024; 32:210. [PMID: 38443674 PMCID: PMC10915076 DOI: 10.1007/s00520-024-08374-w] [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: 10/02/2023] [Accepted: 02/11/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Cannabis use may introduce risks and/or benefits among people living with cancer, depending on product type, composition, and nature of its use. Patient knowledge of tetrahydrocannabinol (THC) or cannabidiol (CBD) concentration could provide information for providers about cannabis use during and after treatment that may aide in risk and benefit assessments. This study aimed to examine knowledge of THC or CBD concentration among patients living with cancer who consume cannabis, and factors associated with knowledge of cannabinoid concentrations. METHODS People living with cancer who consumed cannabis since their diagnosis (n = 343) completed an anonymous, mixed-mode survey. Questions assessed usual mode of delivery (MOD), knowledge of THC/CBD concentration, and how source of acquisition, current cannabis use, and source of instruction are associated with knowledge of THC/CBD concentration. Chi-square and separate binary logistic regression analyses were examined and weighted to reflect the Roswell Park patient population. RESULTS Less than 20% of people living with cancer had knowledge of THC and CBD concentration for the cannabis products they consumed across all MOD (smoking- combustible products, vaping- vaporized products (e-cigarettes), edibles-eating or drinking it, and oral- taking by mouth (pills)). Source of acquisition (smoking-AOR:4.6, p < 0.01, vaping-AOR:5.8, p < 0.00, edibles-AOR:2.6, p < 0.04), current cannabis use (edibles-AOR:5.4, p < 0.01, vaping-AOR: 11.2, p < 0.00, and oral-AOR:9.3, p < 0.00), and source of instruction (vaping only AOR:4.2, p < 0.05) were found to be variables associated with higher knowledge of THC concentration. CONCLUSION Self-reported knowledge of THC and CBD concentration statistically differed according to MOD, source of acquisition, source of instruction, and current cannabis use.
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Affiliation(s)
- Michelle Goulette
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
- State University of New York at Buffalo, Buffalo, NY, USA
| | - Nicolas J Schlienz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Amy A Case
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Eric Hansen
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Cheryl Rivard
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | | | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Danielle M Smith
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
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8
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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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Lapierre É, de Ronne M, Boulanger R, Torkamaneh D. Comprehensive Phenotypic Characterization of Diverse Drug-Type Cannabis Varieties from the Canadian Legal Market. PLANTS (BASEL, SWITZERLAND) 2023; 12:3756. [PMID: 37960111 PMCID: PMC10648736 DOI: 10.3390/plants12213756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023]
Abstract
Cannabis (Cannabis sativa L.) stands as a historically significant and culturally important plant, embodying economic, social, and medicinal relevance for human societies. However, years of prohibition and stigmatization have hindered the cannabis research community, which is hugely undersized and suffers from a scarcity of understanding of cannabis genetics and how key traits are expressed or inherited. In this study, we conducted a comprehensive phenotypic characterization of 176 drug-type cannabis accessions, representative of Canada's legal market. We assessed germination methods, evaluated various traits including agronomic, morphological, and cannabinoid profiles, and uncovered significant variation within this population. Notably, the yield displayed a negative correlation with maturity-related traits but a positive correlation with the fresh biomass. Additionally, the potential THC content showed a positive correlation with maturity-related traits but a negative correlation with the yield. Significant differences were observed between the plants derived from regular female seeds and feminized seeds, as well as between the plants derived from cuttings and seeds for different traits. This study advances our understanding of cannabis cultivation, offering insights into germination practices, agronomic traits, morphological characteristics, and biochemical diversity. These findings establish a foundation for precise breeding and cultivar development, enhancing cannabis's potential in the legal market.
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Affiliation(s)
- Éliana Lapierre
- Département de Phytologie, Université Laval, Québec, QC G1V 0A6, Canada; (É.L.); (M.d.R.); (R.B.)
- Institut de Biologie Intégrative et des Systèmes (IBIS), Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche et d’Innovation sur les Végétaux (CRIV), Université Laval, Québec, QC G1V 0A6, Canada
- Institut Intelligence et Données (IID), Université Laval, Québec, QC G1V 0A6, Canada
| | - Maxime de Ronne
- Département de Phytologie, Université Laval, Québec, QC G1V 0A6, Canada; (É.L.); (M.d.R.); (R.B.)
- Institut de Biologie Intégrative et des Systèmes (IBIS), Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche et d’Innovation sur les Végétaux (CRIV), Université Laval, Québec, QC G1V 0A6, Canada
- Institut Intelligence et Données (IID), Université Laval, Québec, QC G1V 0A6, Canada
| | - Rosemarie Boulanger
- Département de Phytologie, Université Laval, Québec, QC G1V 0A6, Canada; (É.L.); (M.d.R.); (R.B.)
| | - Davoud Torkamaneh
- Département de Phytologie, Université Laval, Québec, QC G1V 0A6, Canada; (É.L.); (M.d.R.); (R.B.)
- Institut de Biologie Intégrative et des Systèmes (IBIS), Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche et d’Innovation sur les Végétaux (CRIV), Université Laval, Québec, QC G1V 0A6, Canada
- Institut Intelligence et Données (IID), Université Laval, Québec, QC G1V 0A6, Canada
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Coelho SG, Rueda S, Costiniuk CT, Jenabian MA, Margolese S, Mandarino E, Shuper PA, Hendershot CS, Cunningham JA, Arbess G, Singer J, Wardell JD. Knowledge of Cannabinoid Content Among People Living with HIV Who Use Cannabis: a Daily Diary Study. Int J Behav Med 2023:10.1007/s12529-023-10221-x. [PMID: 37794278 DOI: 10.1007/s12529-023-10221-x] [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] [Accepted: 09/07/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Many people living with HIV (PLWH) use cannabis for medicinal reasons. Patients' knowledge of the tetrahydrocannabinol (THC) and cannabidiol (CBD) concentrations of the cannabis products they use may be important in helping patients achieve symptom relief while guarding against potential risks of cannabis use. However, no studies have examined cannabinoid concentration knowledge among PLWH. METHOD PLWH (N = 29; 76% men, mean age 47 years) reporting cannabis use for both medicinal and nonmedicinal reasons completed daily surveys over 14 days assessing cannabis products used, knowledge of cannabinoid concentrations of cannabis products used, cannabis use motives (medicinal, nonmedicinal, both), and positive and negative cannabis-related consequences. Across the 361 cannabis use days captured on the daily surveys, at least some knowledge of cannabinoid concentrations was reported on an average of 43.1% (for THC) and 26.6% (for CBD) of the days. RESULTS Generalized linear mixed models revealed that participants were more likely to report knowing THC and CBD concentrations on days when they used non-flower forms of cannabis relative to days when they used cannabis flower only. Participants who used cannabis for medicinal reasons on a greater proportion of days had greater knowledge of cannabinoid concentration overall across days. Further, greater overall knowledge of cannabinoid concentrations was associated with fewer reported negative cannabis-related consequences. CONCLUSIONS Findings suggest that among PLWH, knowledge of cannabinoid concentrations may be higher when using non-flower cannabis products and among those reporting primarily medicinal cannabis use. Moreover, knowledge of cannabinoid concentration may protect against negative cannabis-related consequences in this population.
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Affiliation(s)
- Sophie G Coelho
- Department of Psychology, York University, 277 Behavioural Sciences Building, 4700 Keele St., Toronto, ON, Canada
| | - Sergio Rueda
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Cecilia T Costiniuk
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
- Chronic Viral Illness Service and Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Infection and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Mohammad-Ali Jenabian
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
- Department of Biological Sciences, Université du Québec á Montréal, Montreal, QC, Canada
| | | | | | - Paul A Shuper
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Christian S Hendershot
- Department of Psychiatry, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
- Bowles Centre for Alcohol Studies, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - John A Cunningham
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Addictions, Kings College London, London, UK
| | - Gordon Arbess
- Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Joel Singer
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey D Wardell
- Department of Psychology, York University, 277 Behavioural Sciences Building, 4700 Keele St., Toronto, ON, Canada.
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.
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11
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McClure EA, Hamilton L, Schauer GL, Matson TE, Lapham GT. Cannabis and nicotine co-use among primary care patients in a state with legal cannabis access. Addict Behav 2023; 140:107621. [PMID: 36706676 PMCID: PMC10854219 DOI: 10.1016/j.addbeh.2023.107621] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/28/2022] [Accepted: 01/14/2023] [Indexed: 01/21/2023]
Abstract
The aim of this exploratory analysis was to evaluate cannabis exposure, reasons for use and problematic cannabis use among adult primary care patients in Washington state (United States) who co-use cannabis and nicotine (tobacco cigarettes and/or nicotine vaping) compared to patients who endorse current cannabis use only. As part of a NIDA Clinical Trials Network (CTN) parent study, patients who completed a cannabis screen as part of routine primary care were randomly sampled (N = 5,000) to a receive a confidential cannabis survey. Patients were stratified and oversampled based on the frequency of past-year cannabis use and for Black, indigenous, or other persons of color. Patients who endorsed past 30-day cannabis use are included here (N = 1388). Outcomes included; prevalence of cannabis use, days of cannabis use per week and times used per day, methods of use, THC:CBD content, non-medical and/or medical use, health symptoms managed, and cannabis use disorder (CUD) symptom severity. We conducted unadjusted bivariate analyses comparing outcomes between patients with cannabis and current nicotine co-use to patients with cannabis-only use. Nicotine co-use (n = 352; 25.4 %) was associated with differences in method of cannabis use, THC:CBD content, days of use per week and times used per day, number of health symptoms managed, and CUD severity (all p < 0.001), compared to primary care patients with cannabis-only use (n = 1036). Interventions targeting cannabis and nicotine co-use in primary care are not well-established and further research is warranted given findings of more severe cannabis use patterns and the adverse health outcomes associated with co-use.
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Affiliation(s)
- Erin A McClure
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, United States; Medical University of South Carolina, Hollings Cancer Center, United States.
| | - Leah Hamilton
- Kaiser Permanente Washington Health Research Institute, United States
| | - Gillian L Schauer
- University of Washington, Addictions, Drug & Alcohol Institute, United States
| | - Theresa E Matson
- Kaiser Permanente Washington Health Research Institute, United States; University of Washington, Department of Health Systems and Population Health, United States
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, United States; University of Washington, Department of Health Systems and Population Health, United States
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12
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Hasin DS, Borodovsky J, Shmulewitz D, Walsh C, Struble CA, Livne O, Habib MI, Fink DS, Aharonovich E, Budney A. Adult use of highly-potent Δ9-THC cannabis concentrate products by U.S. state cannabis legalization status, 2021. Addict Behav 2023; 140:107617. [PMID: 36736229 PMCID: PMC9930475 DOI: 10.1016/j.addbeh.2023.107617] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Compared to plant/flower cannabis products, cannabis concentrates have higher average potency of delta-9-tetrahydrocannabinol (Δ9-THC), which may be associated with greater likelihood of cannabis-related harms. Information on factors associated with use of cannabis concentrates is needed. METHODS Respondents were 4,328 adult past-7-day cannabis users from all 50 U.S. states and Washington DC (DC) who participated in an online 2021 survey. Using logistic regression to generate adjusted odds ratios (aOR), we investigated whether participants in states that enacted recreational cannabis laws (RCL, 12 states plus DC [treated as a state], n = 1,236) or medical cannabis laws (MCL-only, 23 states, n = 2,030) by December 31, 2020 were more likely than those in states without cannabis laws (no-CL, 15 states, n = 1,062) to use cannabis concentrate products in the prior 7 days. RESULTS Most participants (92.4%) used plant material in the prior 7 days; 57.0% used cannabis concentrates. In RCL, MCL and no-CL states, concentrate use was reported by 61.5%, 56.6%, and 52.5%, respectively. Compared to participants in no-CL states, odds of using cannabis concentrate products were greater among those in RCL states (aOR = 1.47; CI = 1.17-1.84) and MCL-only states (aOR = 1.29; CI = 1.08-1.55). Whether states had legally-authorized dispensaries had little effect on results. CONCLUSION Results suggest that individuals in MCL-only and RCL states are more likely to use cannabis concentrate products. Determining mechanisms underlying these results, e.g., commercialization, could provide important information for prevention. Clinicians should be alert to patient use of concentrates, especially in MCL-only and RCL states. Continued monitoring is warranted as additional states legalize cannabis use.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168(th) St, New York, NY 10032, USA.
| | - Jacob Borodovsky
- Department of Psychiatry, Dartmouth Geisel School of Medicine, One Medical Center Drive, Lebanon, NH 03756, USA.
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Claire Walsh
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Cara A Struble
- Department of Psychiatry, Dartmouth Geisel School of Medicine, One Medical Center Drive, Lebanon, NH 03756, USA.
| | - Ofir Livne
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Mohammad I Habib
- Department of Psychiatry, Dartmouth Geisel School of Medicine, One Medical Center Drive, Lebanon, NH 03756, USA.
| | - David S Fink
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Alan Budney
- Department of Psychiatry, Dartmouth Geisel School of Medicine, One Medical Center Drive, Lebanon, NH 03756, USA.
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13
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Dowd AN, Zamarripa CA, Sholler DJ, Strickland JC, Goffi E, Borodovsky JT, Weerts EM, Vandrey R, Spindle TR. A cross-sectional survey on cannabis: Characterizing motives, opinions, and subjective experiences associated with the use of various oral cannabis products. Drug Alcohol Depend 2023; 245:109826. [PMID: 36871378 PMCID: PMC10044512 DOI: 10.1016/j.drugalcdep.2023.109826] [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: 12/13/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Cannabis-infused products available for oral consumption include food and drink items (i.e., edibles) (e.g., baked goods, gummy-, chocolate-, and hard-candies, beverages/drinks) as well as non-food formulations (e.g., oils/tinctures, pills/capsules). This study characterized the motives, opinions, and subjective experiences associated with the use of these seven subtypes of oral cannabis products. METHODS This web-based survey collected cross-sectional, self-report data from a convenience sample of 370 adults regarding various use-motives, self-reported cannabinoid content, subjective experiences, and opinions related to ingesting oral cannabis products with alcohol and/or food. Advice participants had received about modifying oral cannabis product effects, in general, was also collected. RESULTS Participants reported consuming cannabis baked goods and gummy candies most frequently over the past year (68% and 63%, respectively). Participants were less likely to use oils/tinctures for enjoyment/desire relative to other product types and more likely to use oils/tinctures for therapeutic purposes (e.g., medication-replacement). Self-reported cannabinoid content was highly variable across participants and within product subtype. Participants reported feeling stronger and longer-lasting effects when consuming oral cannabis products on an empty stomach and 43% received advice to "eat a snack or meal" to mitigate effects that are too strong, which contrasts with controlled studies. Finally, 43% of participants reported modifying their experiences with alcohol at least some of time. CONCLUSIONS These findings underscore the need to further evaluate use-motives as well as the interaction between dietary factors, cannabinoid pharmacokinetics, and subjective drug effects and the interactive effects of oral cannabis products and alcohol in a controlled laboratory setting.
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Affiliation(s)
- Ashley N Dowd
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA.
| | - C Austin Zamarripa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Dennis J Sholler
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Elia Goffi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Jacob T Borodovsky
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Elise M Weerts
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Tory R Spindle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
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Robinson EA, Gleeson J, Arun AH, Clemente A, Gaillard A, Rossetti MG, Brambilla P, Bellani M, Crisanti C, Curran HV, Lorenzetti V. Measuring white matter microstructure in 1,457 cannabis users and 1,441 controls: A systematic review of diffusion-weighted MRI studies. FRONTIERS IN NEUROIMAGING 2023; 2:1129587. [PMID: 37554654 PMCID: PMC10406316 DOI: 10.3389/fnimg.2023.1129587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/09/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Cannabis is the most widely used regulated substance by youth and adults. Cannabis use has been associated with psychosocial problems, which have been partly ascribed to neurobiological changes. Emerging evidence to date from diffusion-MRI studies shows that cannabis users compared to controls show poorer integrity of white matter fibre tracts, which structurally connect distinct brain regions to facilitate neural communication. However, the most recent evidence from diffusion-MRI studies thus far has yet to be integrated. Therefore, it is unclear if white matter differences in cannabis users are evident consistently in selected locations, in specific diffusion-MRI metrics, and whether these differences in metrics are associated with cannabis exposure levels. METHODS We systematically reviewed the results from diffusion-MRI imaging studies that compared white matter differences between cannabis users and controls. We also examined the associations between cannabis exposure and other behavioral variables due to changes in white matter. Our review was pre-registered in PROSPERO (ID: 258250; https://www.crd.york.ac.uk/prospero/). RESULTS We identified 30 diffusion-MRI studies including 1,457 cannabis users and 1,441 controls aged 16-to-45 years. All but 6 studies reported group differences in white matter integrity. The most consistent differences between cannabis users and controls were lower fractional anisotropy within the arcuate/superior longitudinal fasciculus (7 studies), and lower fractional anisotropy of the corpus callosum (6 studies) as well as higher mean diffusivity and trace (4 studies). Differences in fractional anisotropy were associated with cannabis use onset (4 studies), especially in the corpus callosum (3 studies). DISCUSSION The mechanisms underscoring white matter differences are unclear, and they may include effects of cannabis use onset during youth, neurotoxic effects or neuro adaptations from regular exposure to tetrahydrocannabinol (THC), which exerts its effects by binding to brain receptors, or a neurobiological vulnerability predating the onset of cannabis use. Future multimodal neuroimaging studies, including recently developed advanced diffusion-MRI metrics, can be used to track cannabis users over time and to define with precision when and which region of the brain the white matter changes commence in youth cannabis users, and whether cessation of use recovers white matter differences. SYSTEMATIC REVIEW REGISTRATION www.crd.york.ac.uk/prospero/, identifier: 258250.
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Affiliation(s)
- Emily Anne Robinson
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - John Gleeson
- Digital Innovation in Mental Health and Well-Being Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Arush Honnedevasthana Arun
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Adam Clemente
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Alexandra Gaillard
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Maria Gloria Rossetti
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Marcella Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Camilla Crisanti
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - H. Valerie Curran
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom
| | - Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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15
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Trends in the use of cannabis products in Canada and the USA, 2018 – 2020: Findings from the International Cannabis Policy Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103716. [DOI: 10.1016/j.drugpo.2022.103716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 11/22/2022]
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16
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Lorenzetti V, Hindocha C, Petrilli K, Griffiths P, Brown J, Castillo‐Carniglia Á, Caulkins JP, Englund A, ElSohly MA, Gage SH, Groshkova T, Gual A, Hammond D, Lawn W, López‐Pelayo H, Manthey J, Mokrysz C, Pacula RL, van Laar M, Vandrey R, Wadsworth E, Winstock A, Hall W, Curran HV, Freeman TP. The International Cannabis Toolkit (iCannToolkit): a multidisciplinary expert consensus on minimum standards for measuring cannabis use. Addiction 2022; 117:1510-1517. [PMID: 34590359 PMCID: PMC9298052 DOI: 10.1111/add.15702] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The lack of an agreed international minimum approach to measuring cannabis use hinders the integration of multidisciplinary evidence on the psychosocial, neurocognitive, clinical and public health consequences of cannabis use. METHODS A group of 25 international expert cannabis researchers convened to discuss a multidisciplinary framework for minimum standards to measure cannabis use globally in diverse settings. RESULTS The expert-based consensus agreed upon a three-layered hierarchical framework. Each layer-universal measures, detailed self-report and biological measures-reflected different research priorities and minimum standards, costs and ease of implementation. Additional work is needed to develop valid and precise assessments. CONCLUSIONS Consistent use of the proposed framework across research, public health, clinical practice and medical settings would facilitate harmonisation of international evidence on cannabis consumption, related harms and approaches to their mitigation.
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Affiliation(s)
- Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, the Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health SciencesAustralian Catholic UniversityMelbourneAustralia
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
| | - Kat Petrilli
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
| | - Paul Griffiths
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)LisbonPortugal
| | - Jamie Brown
- Behavioural Science and Health Institute of Epidemiology and HealthUniversity College LondonLondonUK
| | - Álvaro Castillo‐Carniglia
- Society and Health Research Center and School of Public HealthUniversidad MayorSantiagoChile
- Department of Population HealthNYU Grossman School of MedicineNew YorkNYUSA
| | | | - Amir Englund
- Addictions Department, Institute of Psychiatry, Psychology & NeuroscienceKings College LondonLondonUK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Mahmoud A. ElSohly
- National Center for Natural Products Research, School of PharmacyUniversity of MississippiUniversityMSUSA
- Department Pharmaceutics and Drug Delivery, School of PharmacyUniversity of Mississippi, UniversityMSUSA
| | - Suzanne H. Gage
- Department of Psychology, Institute of Population HealthUniversity of LiverpoolLiverpoolUK
| | - Teodora Groshkova
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)LisbonPortugal
| | - Antoni Gual
- Psychiatry DepartmentNeurosciences Institute, Hospital Clínic, IDIBAPS, RTABarcelonaSpain
| | - David Hammond
- School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada
| | - Will Lawn
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
- Addictions Department, Institute of Psychiatry, Psychology & NeuroscienceKings College LondonLondonUK
| | - Hugo López‐Pelayo
- Psychiatry DepartmentNeurosciences Institute, Hospital Clínic, IDIBAPS, RTABarcelonaSpain
| | - Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
| | - Rosalie Liccardo Pacula
- USC Sol Price School of Public PolicyUSC Leonard D. Schaeffer Center for Health Policy & EconomicsLos AngelesCAUSA
| | | | - Ryan Vandrey
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Elle Wadsworth
- School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada
| | - Adam Winstock
- Behavioural Science and Health Institute of Epidemiology and HealthUniversity College LondonLondonUK
- Global Drug SurveyLondonUK
| | - Wayne Hall
- National Addiction Centre, King's College LondonLondonUK
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
| | - H. Valerie Curran
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
| | - Tom P. Freeman
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
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Goodman S, Hammond D. THC labeling on cannabis products: an experimental study of approaches for labeling THC servings on cannabis edibles. J Cannabis Res 2022; 4:17. [PMID: 35387681 PMCID: PMC8988394 DOI: 10.1186/s42238-022-00124-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over-consumption is a common adverse outcome from cannabis edibles. States such as Colorado require each serving of cannabis edible to carry a THC symbol. This study aimed to test whether packaging edibles in separate servings and/or indicating the THC level per serving improves consumer understanding of serving size. METHODS An 3 × 2 experimental task was conducted as part of the 2019 International Cannabis Policy Study online survey. Respondents from Canada and the US (n = 45,504) were randomly assigned to view an image of a chocolate cannabis edible. Packages displayed THC labels according to 1 of 6 experimental conditions: packaging (3 levels: whole multi-serving bar; individual chocolate squares; separately packaged squares) and THC stamp (2 levels: stamp on each square vs. no stamp). Logistic regression tested the effect of packaging and THC stamp on odds of correctly identifying a standard serving, among edible consumers and non-consumers separately. Edible consumers were also asked about their awareness of a standard THC serving. RESULTS Only 14.6% of edible consumers reported knowing the standard serving of THC for cannabis edibles. In the experimental task, among non-consumers who saw stamped bars, the multi-serving bar (AOR = 1.16 (1.08, 1.24) p < 0.001) and individually packaged squares (AOR = 1.08 (1.01, 1.16), p = 0.031) elicited more correct responses than individual squares. There was no difference in packaging formats when stamps were absent (p > 0.05 for all). Among edible consumers, there was no effect of the packaging (p = 0.992) or stamp manipulation (p = 0.988). Among both edible consumers and non-consumers, respondents in US states with legal recreational cannabis performed better than Canadians (p < 0.001). CONCLUSIONS Regulations that require THC information to be stamped or indicated on each serving of cannabis edible may facilitate understanding of how much to consume, especially among novice consumers.
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Affiliation(s)
- Samantha Goodman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada.
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Wadsworth E, Driezen P, Pacula RL, Hammond D. Cannabis flower prices and transitions to legal sources after legalization in Canada, 2019-2020. Drug Alcohol Depend 2022; 231:109262. [PMID: 34998249 DOI: 10.1016/j.drugalcdep.2021.109262] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/21/2021] [Accepted: 11/19/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The post-tax price of legal cannabis has the potential to influence whether consumers transition from the illegal to legal cannabis market. The aims of the study were to: 1) estimate the percentage who report purchasing dried flower at different sources; 2) estimate the unit price of dried flower; and 3) examine the association between price and legality of purchase source. METHODS Repeat cross-sectional survey data come from Canadian respondents from the International Cannabis Policy Study conducted in 2019 and 2020. Respondents were recruited through online commercial panels, of legal age to purchase cannabis (up to 65 years), and purchased dried flower in the past 12-months (n = 4923). Weighted binary logistic regression models examined the association between price and legality of source. RESULTS The proportion of consumers last purchasing dried flower from legal sources increased from 2019 to 2020 (45.7% vs 58.1%) and in the past 12-months, the average percent of dried flower consumers reported purchasing from legal sources increased from 2019 to 2020 (55.7% vs 67.5%). The mean price of legal dried flower decreased in 2020 ($12.63 vs $11.16; p < 0.001), but remained more expensive than illegal dried flower in both years ($12.63 vs $9.04 in 2019; p < 0.001, $11.16 vs $9.41 in 2020; p < 0.001). CONCLUSIONS Two years after legalization in Canada, the price of dried flower from legal sources decreased, along with a greater percentage of consumers purchasing from legal sources than after one year. Price and retail policies must continue to encourage the transition to the legal market in Canada.
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Affiliation(s)
- Elle Wadsworth
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada.
| | - Pete Driezen
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada; Department of Psychology, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Rosalie Liccardo Pacula
- University of Southern California, Sol Price School of Public Policy and Schaeffer Center for Health Policy & Economics, Verna & Peter Dauterive Hall 514 J, Los Angeles, CA 90089-3333, USA
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
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