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Goodwin S, Kirby KC, Raiff BR. Evolution of the substance use landscape: Implications for contingency management. J Appl Behav Anal 2024. [PMID: 39193870 DOI: 10.1002/jaba.2911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024]
Abstract
Contingency management (CM), which involves the delivery of incentives upon meeting behavioral goals, has the potential to improve substance use treatment outcomes. The intervention allows for flexibility through numerous modifiable components including changes to incentive magnitude and schedule, target behavior, and intervention structure. Unfortunately, numerous changes in the substance use landscape have occurred in the past 10 to 15 years: Substances are more potent, overdose risk has increased, new substances and methods of use have been introduced, and substance classes are increasingly being intentionally and unintentionally mixed. These developments potentially undermine CM outcomes. We explored recent substance use changes due to legislative, regulatory, social, and economic factors for four substance classes: stimulants, opioids, tobacco, and cannabis. We discuss potential adjustments to the modifiable components of CM for future research in response to these changes. By continually adapting to the shifting substance use landscape, CM can maintain optimal efficacy.
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Affiliation(s)
- Shelby Goodwin
- Department of Psychology, Rowan University, Glassboro, New Jersey, USA
| | | | - Bethany R Raiff
- Department of Psychology, Rowan University, Glassboro, New Jersey, USA
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2
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Iobst SE, Skelton KR. Reconsidering Breastfeeding Recommendations in the Context of Cannabis Use to Support Health Equity. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(24)00256-9. [PMID: 39151897 DOI: 10.1016/j.jogn.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2024] Open
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Malhotra N, Kasaraneni N, Ahadian Z, Chang H, Advani I, McDermott J, Truong C, Gaboyan S, Mittal A, Perryman A, Masso-Silva JA, Steeger CM, Bowler RP, Castaldi PJ, Sharma S, Crotty Alexander LE. Dual Use of Cannabis with Tobacco Is Associated with Increased Sugary Food and Drink Intake in Young People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1016. [PMID: 39200627 DOI: 10.3390/ijerph21081016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 09/02/2024]
Abstract
Rates of cannabis initiation among teenagers and young adults are increasing. Further, the use of various forms of cannabis (smoked or vaped) with nicotine (dual use) is increasingly common among young people. The health effects of dual use are lesser known, particularly in the context of high-potency cannabis products and across different routes of administration, which is ominous in terms of predicting future health outcomes. There is a long history of cannabis use being associated with decreased activity and increased snacking, both of which could portend an increased risk of metabolic and cardiovascular disease, particularly when these habits begin during formative years. However, modern forms of cannabis may not have these same effects. Here, we assess whether cannabis use alone and dual use of cannabis with nicotine impact dietary and exercise habits in young people. An anonymous, social media-based survey was designed based on the UC San Diego Inhalant Questionnaire and published diet and exercise questionnaires. A total of 457 surveys were completed. Young sole cannabis users represented 29% of responders, 16% were dual users of cannabis and nicotine, and 55% were non-users of either drug. Although the sole use of cannabis was not associated with dietary or activity differences relative to non-users, dual users of cannabis and nicotine reported higher consumption of unhealthy sugars. This novel finding of dual use being associated with increased sugar intake in young people raises concerns for an increased risk of metabolic syndrome and cardiovascular disease in this population.
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Affiliation(s)
- Niamh Malhotra
- Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego, San Diego, CA 92093, USA
| | - Nikita Kasaraneni
- Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego, San Diego, CA 92093, USA
- Pulmonary Critical Care Section, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Zoya Ahadian
- Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego, San Diego, CA 92093, USA
| | - Howard Chang
- Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego, San Diego, CA 92093, USA
- Pulmonary Critical Care Section, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Ira Advani
- Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego, San Diego, CA 92093, USA
- Pulmonary Critical Care Section, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Jade McDermott
- Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego, San Diego, CA 92093, USA
| | - Caitlyn Truong
- Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego, San Diego, CA 92093, USA
| | - Samvel Gaboyan
- Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego, San Diego, CA 92093, USA
- Pulmonary Critical Care Section, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Ankita Mittal
- Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego, San Diego, CA 92093, USA
| | - Alexia Perryman
- Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego, San Diego, CA 92093, USA
- Pulmonary Critical Care Section, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Jorge A Masso-Silva
- Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego, San Diego, CA 92093, USA
- Pulmonary Critical Care Section, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Christine M Steeger
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Russell P Bowler
- Department of Genomic Sciences and Systems Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Peter J Castaldi
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sunita Sharma
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO 80045, USA
| | - Laura E Crotty Alexander
- Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego, San Diego, CA 92093, USA
- Pulmonary Critical Care Section, VA San Diego Healthcare System, San Diego, CA 92161, USA
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Cuttler C, Stueber A, Cooper ZD, Russo E. Acute effects of cannabigerol on anxiety, stress, and mood: a double-blind, placebo-controlled, crossover, field trial. Sci Rep 2024; 14:16163. [PMID: 39003387 PMCID: PMC11246434 DOI: 10.1038/s41598-024-66879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/04/2024] [Indexed: 07/15/2024] Open
Abstract
Cannabigerol (CBG) is a phytocannabinoid increasing in popularity, with preclinical research indicating it has anxiolytic and antidepressant effects. However, there are no published clinical trials to corroborate these findings in humans. The primary objective of this study was to examine acute effects of CBG on anxiety, stress, and mood. Secondary objectives were to examine whether CBG produces subjective drug effects or motor and cognitive impairments. A double-blind, placebo-controlled cross-over field trial was conducted with 34 healthy adult participants. Participants completed two sessions (with a one-week washout period) via Zoom. In each, they provided ratings of anxiety, stress, mood, and subjective drug effects prior to double-blind administration of 20 mg hemp-derived CBG or placebo tincture (T0). These ratings were collected again after participants ingested the product and completed an online survey (T1), the Trier Social Stress Test (T2), a verbal memory test and the DRUID impairment app (T3). Relative to placebo, there was a significant main effect of CBG on overall reductions in anxiety as well as reductions in stress at T1. CBG also enhanced verbal memory relative to placebo. There was no evidence of subjective drug effects or impairment. CBG may represent a novel option to reduce stress and anxiety in healthy adults.
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Affiliation(s)
- Carrie Cuttler
- Department of Psychology, Washington State University, PO Box 644820, Pullman, WA, 99164-4820, USA.
| | - Amanda Stueber
- Department of Psychology, Washington State University, PO Box 644820, Pullman, WA, 99164-4820, USA
| | - Ziva D Cooper
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, USA
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Pechmann C'C, Calder D, Timberlake D, Rhee J, Padon A, Silver L. Young adult retail purchases of cannabis, product category preferences and sales trends in California 2018-21: Differences compared with older adults. Addiction 2024. [PMID: 38988183 DOI: 10.1111/add.16617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 06/17/2024] [Indexed: 07/12/2024]
Abstract
AIMS The aim of this study is to identify cannabis products according to their appeal among young adults and measure product sales trends. DESIGN, SETTING AND PARTICIPANTS This was a retrospective comparative study using point-of-sale data from licensed recreational cannabis retailers that include buyer age with birth year entered by retailers, set in California, USA. Cannabis purchases by young adults (aged 21-24, GenZ) were compared with older adults (age 25+) over 4 years (2018-21). MEASUREMENTS Sales for six cannabis product categories were analyzed using a commercial data set with imputations and a raw data set. Age-appeal metrics were dollar and unit sales to young adults, and dollar and unit share ratios (young adults/older adults), where a share ratio of 100 denotes age-appeal comparability. A product category was considered more young-adult appealing than others if its mean on a metric was at least one standard deviation above the grand mean across all product categories. FINDINGS Flower (cannabis plant material) and vapor pen appealed to young adults based on absolute dollar sales, dominating young-adult spending compared with other cannabis products (37.24 and 31.83%, respectively). Vapor pen and concentrate appealed to young adults based on dollar share ratios of 152, meaning these products comprised a 52% greater share of young-adult cannabis spending relative to older-adult spending (31.83/20.97% and 10.47/6.88%, respectively). Less appealing to young adults were pre-roll, edible/beverage and absorbable products (tincture/sublingual, capsule and topical). Flower showed the largest dollar sales growth (B = +$3.50 million/month), next to vapor pen (B = +$1.55 million/month). Vapor pen tied for highest growth in the percent of product dollars from the largest package size (B = +0.85%/month) and showed the steepest price decline (B = -0.53 price per gram/month). CONCLUSIONS In California, USA, from 2018 to 2021, relative to older adults, young adults spent a greater share of their cannabis dollars on vapor pen and concentrate (products with high potency of delta-9-tetrahydrocannabinol).
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Affiliation(s)
| | - Douglas Calder
- Paul Merage School of Business, University of California, Irvine, Irvine, CA, USA
| | - David Timberlake
- Program in Public Health, Susan & Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, USA
| | - Joshua Rhee
- Program in Public Health, Susan & Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, USA
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Manthey J, Rehm J, Verthein U. Germany's cannabis act: a catalyst for European drug policy reform? THE LANCET REGIONAL HEALTH. EUROPE 2024; 42:100929. [PMID: 38779298 PMCID: PMC11109464 DOI: 10.1016/j.lanepe.2024.100929] [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: 02/29/2024] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024]
Abstract
With the enforcement of the Cannabis Act on 1 April 2024, Germany has adopted one of the most liberal legal approaches to cannabis on the continent. The German model prioritises a non-profit approach and precludes legal market mechanisms. We believe these are the main drivers for increasing cannabis use and related health problems, based on observations following cannabis legalisation in Canada and many states in the U.S. Although legalising cannabis possession and cultivation may not immediately eliminate the illegal market, it is expected to serve public health goals. Despite the overall positive evaluation of the Cannabis Act in Germany, there are three potential areas of concern: the potential for misuse of the medical system, the normalization of cannabis use, and the influence of the cannabis industry. The German model may herald the beginning of a new generation of European cannabis policies, but concerted efforts will be required to ensure that these policy reforms serve rather than undermine public health goals.
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Affiliation(s)
- Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Jürgen Rehm
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON, M5S 1A8, Canada
- Program on Substance Abuse, Public Health Agency of Catalonia, Program on Substance Abuse & WHO CC, 81-95 Roc Boronat St., 08005, Barcelona, Spain
| | - Uwe Verthein
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
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Bass B, Padwa H, Khurana D, Urada D, Boustead A. Adult use cannabis legalization and cannabis use disorder treatment in California, 2010-2021. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 162:209345. [PMID: 38494048 DOI: 10.1016/j.josat.2024.209345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/08/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Many nations and jurisdictions have legalized non-medical adult use of cannabis, or are considering doing so. This paper contributes to knowledge of adult use legalization's associations with cannabis use disorder (CUD) treatment utilization. METHODS This study collected data from a dataset of all publicly funded substance use disorder treatment delivered in California from 2010 to 2021 (1,460,066 episodes). A logistic regression model estimates adult use legalization's impacts on CUD treatment utilization using an individual-level pre-post time series model, including individual and county-level characteristics and county and year-fixed effects. RESULTS Adult use legalization was associated with a significant decrease in the probability of admission to CUD treatment (average marginal effect (AME): -0.005, 95 % CI: -0.009, 0.000). Adult use legalization was also associated with a decrease in the probability of admission to CUD treatment for males (AME: -0.025, 95 % CI: -0.027, -0.023) Medi-Cal beneficiaries (AME: -0.025, 95 % CI: -0.027, -0.023) adults ages 21+ (AME: -0.011, 95 % CI: -0.014, -0.009) and Whites (AME: -0.012, 95 % CI: -0.015, -0.010), and an increase in the probability of admission to CUD treatment for patients referred from the criminal justice system (AME: 0.017, 95 % CI: 0.015, 0.020) and Blacks (AME: 0.004, 95 % CI: 0.000, 0.007) and Hispanics (AME: 0.009, 95 % CI: 0.006, 0.011). CONCLUSIONS Adult use legalization is associated with declining CUD treatment admissions, even though cannabis-related problems are becoming more prevalent. Policies and practices that protect public health, and engage people with CUD in treatment are needed.
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Affiliation(s)
- Brittany Bass
- University of California, Los Angeles, Department of Addiction Psychiatry, Semel Institute for Neuroscience and Human Behavior, 10911 Weyburn Avenue, Suite 200, Los Angeles, CA 90024, United States.
| | - Howard Padwa
- University of California, Los Angeles, Department of Addiction Psychiatry, Semel Institute for Neuroscience and Human Behavior, 10911 Weyburn Avenue, Suite 200, Los Angeles, CA 90024, United States.
| | - Dhruv Khurana
- University of California, Los Angeles, Department of Addiction Psychiatry, Semel Institute for Neuroscience and Human Behavior, 10911 Weyburn Avenue, Suite 200, Los Angeles, CA 90024, United States.
| | - Darren Urada
- University of California, Los Angeles, Department of Addiction Psychiatry, Semel Institute for Neuroscience and Human Behavior, 10911 Weyburn Avenue, Suite 200, Los Angeles, CA 90024, United States.
| | - Anne Boustead
- University of Arizona, School of Government and Public Policy, 331 Social Science Building, Tucson, AZ 85721, United States.
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Echeverria-Villalobos M, Guevara Y, Mitchell J, Ryskamp D, Conner J, Bush M, Periel L, Uribe A, Weaver TE. Potential perioperative cardiovascular outcomes in cannabis/cannabinoid users. A call for caution. Front Cardiovasc Med 2024; 11:1343549. [PMID: 38978789 PMCID: PMC11228818 DOI: 10.3389/fcvm.2024.1343549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/15/2024] [Indexed: 07/10/2024] Open
Abstract
Background Cannabis is one of the most widely used psychoactive substances. Its components act through several pathways, producing a myriad of side effects, of which cardiovascular events are the most life-threatening. However, only a limited number of studies address cannabis's perioperative impact on patients during noncardiac surgery. Methods Studies were identified by searching the PubMed, Medline, EMBASE, and Google Scholar databases using relevant keyword combinations pertinent to the topic. Results Current evidence shows that cannabis use may cause several cardiovascular events, including abnormalities in cardiac rhythm, myocardial infarction, heart failure, and cerebrovascular events. Additionally, cannabis interacts with anticoagulants and antiplatelet agents, decreasing their efficacy. Finally, the interplay of cannabis with inhalational and intravenous anesthetic agents may lead to adverse perioperative cardiovascular outcomes. Conclusions The use of cannabis can trigger cardiovascular events that may depend on factors such as the duration of consumption, the route of administration of the drug, and the dose consumed, which places these patients at risk of drug-drug interactions with anesthetic agents. However, large prospective randomized clinical trials are needed to further elucidate gaps in the body of knowledge regarding which patient population has a greater risk of perioperative complications after cannabis consumption.
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Affiliation(s)
| | - Yosira Guevara
- Department of Anesthesiology, St Elizabeth’s Medical Center, Brighton, MA, United States
| | - Justin Mitchell
- Department of Anesthesiology & Perioperative Medicine, UCLA Medical Center, Los Angeles, CA, United States
| | - David Ryskamp
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Joshua Conner
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Margo Bush
- University of Toledo, College of Medicine and Life Sciences, Toledo, OH, United States
| | - Luis Periel
- Touro College of Osteopathic Medicine, New York, NW, United States
| | - Alberto Uribe
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Tristan E. Weaver
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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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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Budney AJ, Borodovsky JT, Struble CA, Habib MI, Shmulewitz D, Livne O, Aharonovich E, Walsh C, Cuttler C, Hasin DS. Estimating THC Consumption from Smoked and Vaped Cannabis Products in an Online Survey of Adults Who Use Cannabis. Cannabis Cannabinoid Res 2024; 9:688-698. [PMID: 36521175 PMCID: PMC10998014 DOI: 10.1089/can.2022.0238] [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: 12/23/2022] Open
Abstract
Introduction: Quantification of consumption patterns of the primary psychoactive compounds in cannabis, which cause euphoria or intoxication, is sorely needed to identify potential risks and benefits of use and to provide meaningful safety information to the public. The diversity of products available, multiple methods of administration, and lack of labeling of products have made such quantification challenging. Our group is developing a survey instrument for estimating the quantity of delta 9-tetrahydrocannabinol (THC) consumed in population samples, which is flexible and incorporates individualized reports of patterns of consumption. This study provides an illustration of a procedure for translating self-reported consumption into milligrams of THC (mgTHC), which may serve as a working model for future quantification efforts. Methods: Social media advertising was leveraged to enroll 5627 adults who use cannabis into an online, anonymous survey study. Only those who used cannabis in the past 7 days, used flower or concentrate products, and who chose to report their quantity of use in hits per day or grams per week (n=3211) were included in this report. Formulas were used to estimate mgTHC used per day, in hits per day or grams per week; potency (%THC); constants for estimating the amount of material consumed for each hit; and a method of administration efficiency constant to account for THC loss due to the administration method. Results: The estimate for mgTHC used per day was M=92.8 mg/day (SD=97.2 mg; 1st-3rd quartile range=25-132 mg). The estimated quantity of use was much lower for those reporting in hits (M=43.7 mg, SD=43.8) than for those reporting in grams (M=115.1 mg, SD=107.0). The estimated rate of binge use in the past week, arbitrarily defined as more than 50 mgTHC within any one daily time quadrant, was 6.8%, which increased to 29.3% if 25 mgTHC was used. Conclusions: The approach illustrated in this study goes beyond existing cannabis measures by asking participants to provide highly detailed estimates of their past 7-day use patterns and then applying a logical formula to translate this information into mgTHC. This initial procedure has limitations and lacks generalization; however, we hope this demonstration stimulates testing of similar approaches and relevant laboratory experiments that will enhance the validity of cannabis consumption estimation procedures.
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Affiliation(s)
- Alan J. Budney
- 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
| | - 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
| | - Cara A. Struble
- 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
| | - Mohammad I. Habib
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Ofir Livne
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Claire Walsh
- New York State Psychiatric Institute, New York, USA
| | - Carrie Cuttler
- Department of Psychology, Washington State University, Pullman, Washington, USA
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
- New York State Psychiatric Institute, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
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Castro-Navarro I, McGuire MA, Williams JE, Holdsworth EA, Meehan CL, McGuire MK. Maternal Cannabis Use during Lactation and Potential Effects on Human Milk Composition and Production: A Narrative Review. Adv Nutr 2024; 15:100196. [PMID: 38432590 PMCID: PMC10997876 DOI: 10.1016/j.advnut.2024.100196] [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: 12/18/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
Cannabis use has increased sharply in the last 20 y among adults, including reproductive-aged women. Its recent widespread legalization is associated with a decrease in risk perception of cannabis use during breastfeeding. However, the effect of cannabis use (if any) on milk production and milk composition is not known. This narrative review summarizes current knowledge related to maternal cannabis use during breastfeeding and provides an overview of possible pathways whereby cannabis might affect milk composition and production. Several studies have demonstrated that cannabinoids and their metabolites are detectable in human milk produced by mothers who use cannabis. Due to their physicochemical properties, cannabinoids are stored in adipose tissue, can easily reach the mammary gland, and can be secreted in milk. Moreover, cannabinoid receptors are present in adipocytes and mammary epithelial cells. The activation of these receptors directly modulates fatty acid metabolism, potentially causing changes in milk fatty acid profiles. Additionally, the endocannabinoid system is intimately connected to the endocrine system. As such, it is probable that interactions of exogenous cannabinoids with the endocannabinoid system might modify release of critical hormones (e.g., prolactin and dopamine) that regulate milk production and secretion. Nonetheless, few studies have investigated effects of cannabis use (including on milk production and composition) in lactating women. Additional research utilizing robust methodologies are needed to elucidate whether and how cannabis use affects human milk production and composition.
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Affiliation(s)
- Irma Castro-Navarro
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID, United States.
| | - Mark A McGuire
- Department of Animal, Veterinary, and Food Sciences, University of Idaho, Moscow, ID, United States
| | - Janet E Williams
- Department of Animal, Veterinary, and Food Sciences, University of Idaho, Moscow, ID, United States
| | | | - Courtney L Meehan
- Department of Anthropology, Washington State University, Pullman, WA, United States
| | - Michelle K McGuire
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID, United States
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12
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Ataiants J, Wong CF, Odejimi OA, Fedorova EV, Conn BM, Lankenau SE. Medicinal cannabis use among young adults during California's transition from legalized medical use to adult-use: a longitudinal analysis. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:229-241. [PMID: 38407837 PMCID: PMC11225712 DOI: 10.1080/00952990.2024.2308098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024]
Abstract
Background: In 2016, California transitioned from legalized medical cannabis use to adult-use. Little is known about how this policy change affected medicinal cannabis use among young adults.Objectives: To identify longitudinal groups of medicinal cannabis users and concurrent changes in health- and cannabis use-related characteristics among young adults in Los Angeles between 2014 and 2021.Methods: Cannabis users (210 patients and 156 non-patients; 34% female; ages 18-26 at baseline) were surveyed annually across six waves. Longitudinal latent class analysis derived groups from two factors - cannabis patient status and self-reported medicinal use. Trajectories of health symptoms, cannabis use motives, and cannabis use (daily/near daily use, concentrate use, and problematic use) were estimated across groups.Results: Three longitudinal latent classes emerged: Recreational Users (39.3%) - low self-reported medicinal use and low-to-decreasing patient status; Recreational Patients (40.4%) - low self-reported medicinal use and high-to-decreasing patient status; Medicinal Patients (20.3%) - high self-reported medicinal use and high-to-decreasing patient status. At baseline, Medicinal Patients had higher levels of physical health symptoms and motives than recreational groups (p < .05); both patient groups reported higher level of daily/near daily and concentrate use (p < .01). Over time, mental health symptoms increased in recreational groups (p < .05) and problematic cannabis use increased among Recreational Patients (p < .01).Conclusions: During the transition to legalized adult-use, patterns of medicinal cannabis use varied among young adults. Clinicians should monitor increases in mental health symptoms and cannabis-related problems among young adults who report recreational - but not medicinal - cannabis use.
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Affiliation(s)
- Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Carolyn F. Wong
- Division of Adolescent and Young Adult Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Omolola A. Odejimi
- Department of Educational Psychology, Leadership and Higher Education, College of Education, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Ekaterina V. Fedorova
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Bridgid M. Conn
- Division of Adolescent and Young Adult Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Stephen E. Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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13
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MacCallum CA, Lo LA, Pistawka CA, Christiansen A, Boivin M. Cannabis vaporisation: Understanding products, devices and risks. Drug Alcohol Rev 2024; 43:732-745. [PMID: 38124429 DOI: 10.1111/dar.13800] [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: 03/07/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
ISSUES Vaporisation is a common method of cannabis administration. Inconsistent terminology and jargon regarding vaporisation has led to confusion. The increasing public interest and access to cannabis, combined with possible safety concerns associated with certain cannabis vaping products, warrants improved consumer and public and health care professional knowledge. APPROACH To improve this knowledge, we conducted a review of the common terminology, regulatory status, products and device types related to cannabis vaporisation. KEY FINDINGS Cannabis vaporisation devices can be separated into nine types. While vaporisation reduces respiratory risks associated with cannabis combustion, not all vaping products and device types carry the same level of safety. Metered dose inhalers and dried product vaporisers present the lowest safety risk due to a lower risk of toxin exposure and the use of lower tetrahydrocannabinol potency products. IMPLICATIONS As both vaping and cannabis use increase in popularity, focusing on accurate health education will help facilitate health promotion to encourage lower risk use. The current lack of understanding on risk differences between types of cannabis vaporisation is a missed opportunity for harm reduction. Increased opportunities for public health and health care professional education on different cannabis vaporisation devices and associated risks are warranted. Improvements to health warning labelling may also be beneficial. CONCLUSION Not all cannabis vaporisation devices and products carry the same level of risk. A better understanding of risk differentiation is needed among consumers and health professionals. Continued research, policy development and health education can lead to safer cannabis vaporisation.
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Affiliation(s)
- Caroline A MacCallum
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Lindsay A Lo
- Department of Public Health Science, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carly A Pistawka
- Faculty of Science, University of British Columbia, Vancouver, Canada
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14
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Hammond CJ, Hyer JM, Boustead AE, Fristad MA, Steelesmith DL, Brock GN, Hasin DS, Fontanella CA. Association Between Marijuana Laws and Suicide Among 12- to 25-Year-Olds in the United States From 2000 to 2019. J Am Acad Child Adolesc Psychiatry 2024; 63:345-354. [PMID: 37385585 DOI: 10.1016/j.jaac.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Cannabis use is associated with suicide-related outcomes in both adolescents and adults, and may be increasing amid shifting cannabis policies. However, little is known about the impact of medical marijuana legalization (MML) and recreational marijuana legalization (RML) policies on youth suicide. Using 20 years of national data, we examined associations between MML, RML, and suicide-related mortality among US individuals aged 12 to 25 years, and assessed whether they varied based on age and sex. METHOD Suicide deaths (N = 113,512) from the 2000-2019 National Vital Statistics System Multiple Cause of Death files for age groups 12 to 13, 14 to 16, 17 to 19, 20 to 22, and 23 to 25 years were examined in relation to time-varying cannabis law status using a staggered adoption difference-in-difference (DiD) approach with a negative binomial regression to determine associations between MML, RML, and suicide rates, controlling for individual- and state-level covariates and accounting for the varying effective dates of MML and RML by state. RESULTS The overall unadjusted annual suicide rate was 10.93/100,000, varying from 9.76 (states without marijuana laws (ML)) to 12.78 (MML states) to 16.68 (RML states). In multivariable analysis, both MML (incidence rate ratio [IRR] = 1.10, 95% CI: 1.05-1.15) and RML (IRR = 1.16, 95% CI: 1.06-1.27) were associated with higher suicide rates among female youth compared to those in states without ML. Youth aged 14 to 16 years had higher rates of suicide in states with RML compared to states with MML (IRR = 1.14, 95% CI: 1.00-1.30) and states without ML (IRR = 1.09, 95% CI: 1.00-1.20). Findings were consistent across sensitivity analyses. CONCLUSION MML and RML were associated with increased suicide-related mortality in female youth and 14- to- 16-year-old individuals of both sexes. Mechanisms through which cannabis policies are related to increased youth suicide warrant further study and should inform legislative reform.
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Affiliation(s)
| | - J Madison Hyer
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Mary A Fristad
- Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University, Columbus, Ohio
| | | | - Guy N Brock
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Deborah S Hasin
- Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Cynthia A Fontanella
- The Ohio State University Wexner Medical Center, Columbus, Ohio; Nationwide Children's Hospital, Columbus, Ohio
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15
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Hinckley J, Bhatia D, Ellingson J, Molinero K, Hopfer C. The impact of recreational cannabis legalization on youth: the Colorado experience. Eur Child Adolesc Psychiatry 2024; 33:637-650. [PMID: 35428897 PMCID: PMC10097013 DOI: 10.1007/s00787-022-01981-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/24/2022] [Indexed: 11/27/2022]
Abstract
Over the past two decades, cannabis policies have liberalized in the United States, culminating in the legalization of recreational cannabis in Colorado and Washington state in 2012. This review will focus on the impact of recreational cannabis legalization in Colorado. While the prevalence of past-year and past-month cannabis use has remained relatively steady among adolescents post-legalization, the prevalence of young adult use has continued to rise. Cannabis products with increased potency have become more prevalent and widely used. There are concerns that the use of products with increased potency will increase risk for cannabis use and comorbid mental health disorders, particularly cannabis-induced psychosis and suicidal behavior, although more research is needed to fully understand the impact of high-potency products. Since the legalization of recreational cannabis, numerous additional public health concerns have emerged: unintentional overdoses requiring acute care visits, electronic vaping-associated lung injury, increased motor vehicle collisions related to cannabis consumption, and higher rates of cannabis use during pregnancy. Lessons learned from the first decade of cannabis legalization emphasize the need for research efforts to provide evidence-based guidelines, inform prevention strategies, and implement selective interventions for at-risk populations including youth, individuals with comorbid mental health disorders, and individuals who are pregnant.
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Affiliation(s)
- Jesse Hinckley
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Devika Bhatia
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jarrod Ellingson
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Karla Molinero
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christian Hopfer
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
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16
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Skelton KR, Benjamin-Neelon SE. Cannabis Smoking and Storage within the Home: A Cross-Sectional Survey of Pregnant Women and Women with Young Children. Matern Child Health J 2024; 28:187-191. [PMID: 38270715 DOI: 10.1007/s10995-023-03891-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Child cannabis exposure has increased in recent years - a trend that parallels changes to state cannabis legality. Yet, little is known about household cannabis practices. To address this gap, this study aimed to examine household cannabis practices among a geographically diverse sample of US women of reproductive age. We also examined variations in household cannabis practices across state cannabis policies. METHODS The study sample (N = 114) included pregnant women and women with young children in their home. In Spring of 2021, 114 women completed a single cross-sectional online survey that included demographic information and asked about cannabis use, household cannabis practices (e.g., indoor smoking, cannabis storage), and cannabis use risk perceptions. We analyzed data using descriptive statistics and Fisher's exact tests. RESULTS A total of 69.23% of women reported cannabis products were allowed in their home and 42.98% reported that smoking cannabis was permitted in one or more rooms. Self-reported cannabis use, as well as partner or family cannabis use were significantly associated with allowing cannabis products in the home (p < 0.001). There was no difference in cannabis smoking rules among women in states with legalized cannabis (47.73%) than those in states that had yet to legalize (40.00%), p = 0.339. CONCLUSIONS Amid rapidly shifting cannabis policies, further examination of household cannabis practices is needed. Public heath efforts should focus on reducing in-home cannabis exposure and promote safe storage and smoking practices for families with children in the home.
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Affiliation(s)
- Kara R Skelton
- Department of Health Sciences, Towson University, 8000 York Road, Towson, MD, 21252, USA.
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA.
| | - Sara E Benjamin-Neelon
- Department of Health Sciences, Towson University, 8000 York Road, Towson, MD, 21252, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA
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17
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Guttmannova K, Fleming CB, Rhew IC, Delawalla MLM, Fairlie AM, Larimer ME, Kilmer JR. Changes in Cannabis Use From 2014 to 2019 Among Young Adults in Washington State. Am J Prev Med 2024; 66:252-259. [PMID: 37793557 PMCID: PMC10842380 DOI: 10.1016/j.amepre.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Understanding changes in cannabis use in the legalized nonmedical cannabis context is critical. Washington State, one the earliest states to implement legalization, presents a unique opportunity to examine how cannabis use and its consequences changed after the implementation of legalization for adults. With a focus on Washington State young adults, this study conducted in 2022-2023 examined changes in (1) cannabis use by sex and age, (2) preferred mode of use, and (3) cannabis use disorder symptoms. METHODS Using repeated cross-sectional data on young adults aged 18-25 years in Washington State from 2014 (premarket opening) to 2019 (N=12,945), logistic regression models assessed trends over time in the prevalence of any and frequent (20+ days) past-month cannabis use. Among individuals reporting use, multinomial logistic regressions estimated trends over time in the preferred mode of use and negative binomial regressions examined trends in the count of cannabis use disorder symptoms. RESULTS From 2014 to 2019, the prevalence of cannabis use converged by sex, with females being equally likely as males to report both any and frequent use by 2019. Among young adults reporting past-month use, smoking as the preferred mode of use decreased relative to other modes. Number of cannabis use disorder symptoms reported increased, which was not accounted for by changes in preferred mode of use. CONCLUSIONS During the 5-year period following the implementation of legalization, patterns of young adult cannabis use shifted, including particularly sharp increases among females and increases in cannabis use disorder symptoms. Future studies should investigate underlying causes for these important changes.
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Affiliation(s)
- Katarina Guttmannova
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
| | - Charles B Fleming
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Isaac C Rhew
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Miranda L M Delawalla
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Anne M Fairlie
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Mary E Larimer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Jason R Kilmer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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18
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McDonald AJ, Kurdyak P, Rehm J, Roerecke M, Bondy SJ. Youth cannabis use and subsequent health service use for mood and anxiety disorders: A population-based cohort study. Psychiatry Res 2024; 332:115694. [PMID: 38176165 DOI: 10.1016/j.psychres.2023.115694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/16/2023] [Accepted: 12/24/2023] [Indexed: 01/06/2024]
Abstract
Epidemiologic research suggests a modest association between youth cannabis use and mood and anxiety disorders (MADs). However, current evidence is based mostly on cohort studies using data from the 20th century when cannabis was significantly less potent than today. We linked population-based survey data from 2009 to 2012 with administrative records of health services covered under universal healthcare up to 2017. The cohort included youth aged 12 to 24 years at baseline living in Ontario, Canada with no prior MAD health service use (n = 8,252). We conducted a multivariable Cox model to estimate the association between cannabis use frequency (never,
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Affiliation(s)
- André J McDonald
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada.
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Rehm
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry and Psychotherapy, Centre for Interdisciplinary Addiction Research (ZIS), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Michael Roerecke
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Susan J Bondy
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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19
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Carlini BH, Garrett SB, Matos P, Nims LN, Kestens Y. Identifying policy options to regulate high potency cannabis: A multiple stakeholder concept mapping study in Washington State, USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104270. [PMID: 38043404 DOI: 10.1016/j.drugpo.2023.104270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Cannabis legalization in some U.S.A. states has catapulted the mass production of concentrates, with tetrahydrocannabinol (THC) concentrations ranging from 50-90%. A major public health concern is that these products will increase cannabis-related harms such as use disorders, psychotic symptoms, and accidental poisonings. This paper describes and contextualizes the results of a study requested by the WA State Legislature to understand perspectives of WA stakeholders on the topic. METHODS Concept Mapping (CM), a mixed-methods research approach that supports people-centered policy decisions was utilized. The goal of the study was to explore stakeholders' concern levels and support of policies to address the availability of high THC cannabis products. For analysis purposes, stakeholders were categorized into three groups: community, professionals, and cannabis advocates. RESULTS CM generated an inventory of policy ideas for regulating high-potency cannabis from a variety of stakeholders. Notably, stakeholders from community and professional groups supported environmental policy changes such as such as taxation, increasing minimum age for high concentration cannabis products, and advertising prohibition. Meanwhile, cannabis advocates (mostly industry actors) opposed taxation per THC content, proposed lowering taxes, and supported policies with low population impact such as educating parents, teachers, and youth. CONCLUSION Support for regulating high concentration THC products varied by stakeholder group. Consistent with how other health compromising industries have historically acted, cannabis industry stakeholders rejected regulation of their products. Future studies should explore non-cannabis industry stakeholders' willingness to work towards minimizing the influence of the cannabis industry in policy development processes to assure public health regulations prevail.
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Affiliation(s)
- Beatriz H Carlini
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences at the University of Washington, Seattle, WA, United States of America.
| | - Sharon B Garrett
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences at the University of Washington, Seattle, WA, United States of America
| | | | - Lexi N Nims
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences at the University of Washington, Seattle, WA, United States of America
| | - Yan Kestens
- École de santé publique de l'Université de Montréal, Montréal, Canada; Centre de Recherche en Santé Publique, Montréal, Canada
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20
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Laudermilk LT, Marusich JA, Wiley JL. Δ 9-Tetrahydrocannabinol Effects on Respiration and Heart Rate Across Route of Administration in Female and Male Mice. Cardiovasc Toxicol 2023; 23:349-363. [PMID: 37728714 PMCID: PMC10683859 DOI: 10.1007/s12012-023-09810-9] [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: 06/05/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
The physiological impact of cannabinoid receptor agonists is of great public health interest due to their increased use in recreational and therapeutic contexts. However, the body of literature on cannabinoid receptor agonists includes multiple confounding variables that complicate comparisons across studies, including route of administration, timeline across which phenotypes are observed, agonist dose, and sex of the study cohort. In this study, we characterized the impact of sex and route of administration on Δ9-tetrahydrocannabinol (THC)-induced changes in cardiopulmonary phenotypes in mice. Using noninvasive plethysmography and telemetry, we monitored heart rate and respiration in the same cohort of animals across aerosol, oral gavage, subcutaneous, and intraperitoneal administrations of THC (0-30 mg/kg THC for oral gavage, subcutaneous, and intraperitoneal, and 0-300 mg/ml THC for aerosol). All routes of THC administration altered respiratory minute volume and heart rate, with the direction of effects typically being consistent across dependent measures. THC primarily decreased respiration and heart rate, but females given oral gavage THC showed increased heart rate. Intraperitoneal and subcutaneous THC produced the longest-lasting effects, including THC-induced alterations in physiological parameters for up to 10 h, whereas effects of aerosolized THC were short lived. The fastest onset of effects of THC occurred for aerosolized and intraperitoneal THC. Altogether, the work herein establishes the impact of dosing route on THC-induced heart rate and respiratory alteration in male and female mice. This study highlights important differences in the timeline of cardiopulmonary response to THC following the most common preclinical routes of administration.
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Affiliation(s)
- Lucas T Laudermilk
- RTI International, 3040 Cornwallis Road Research Triangle Park, Research Triangle Park, NC, 27709, USA
| | - Julie A Marusich
- RTI International, 3040 Cornwallis Road Research Triangle Park, Research Triangle Park, NC, 27709, USA.
| | - Jenny L Wiley
- RTI International, 3040 Cornwallis Road Research Triangle Park, Research Triangle Park, NC, 27709, USA
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21
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Ladegard K, Bhatia D. Impact of Cannabis Legalization on Adolescent Cannabis Use. Psychiatr Clin North Am 2023; 46:635-646. [PMID: 37879828 DOI: 10.1016/j.psc.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Because of substantial limitations in available national data, such as inconsistencies among surveys and small sample sizes, the increased prevalence of cannabis use among adolescents since recreational legalization has not been directly observed. Nevertheless, both usage frequency and product potency have significantly increased, alongside alternative routes of delivery to smoking, such as vaping cannabis. Moreover, certain populations may be especially vulnerable to the effects of legalization. Regardless of differing state-level cannabis legalization status, the adverse consequences of cannabis on youth have clear negative impacts on mental health, medical symptoms, educational outcomes, and increased risk of addiction to other substances.
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Affiliation(s)
- Kristie Ladegard
- Denver Health, University of Colorado, 601 Broadway 7th Floor, MC7779, Denver, CO 80203, USA.
| | - Devika Bhatia
- University of Colorado, 13007 East 19th Place, Aurora, CO 80045, USA
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22
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Fedorova EV, Mitchel A, Finkelstein M, Ataiants J, Wong CF, Conn BM, Lankenau SE. Pre-Post Cannabis Legalization for Adult Use: A Trend Study of Two Cohorts of Young Adult Cannabis Users in Los Angeles. J Psychoactive Drugs 2023:1-11. [PMID: 37997888 PMCID: PMC11116271 DOI: 10.1080/02791072.2023.2282515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023]
Abstract
Cannabis was legalized for adult use in California in 2016 for individuals 21 and older. Among 18-20-years-olds, who can possess cannabis legally as medical cannabis patients (MCP) but not as non-patient cannabis users (NPU), the impact of adult use legalization (AUL) on cannabis and other substance use is unknown. Two cohorts of 18-20-year-old cannabis users (MCP and NPU) were surveyed, one in 2014-15 (n = 172 "pre-AUL") and another in 2019-20 (n = 139 "post-AUL"), using similar data collection methods in Los Angeles, California. Logistic and negative binomial regressions estimated cohort and MCP differences for cannabis and other drug use outcomes based on past 90-day use. In both pre- and post-AUL cohorts, MCP were more likely to self-report medical cannabis use (p < .001) while the post-AUL cohort reported greater use of edibles (p < .01), but fewer mean days of alcohol (p < .05) and cigarette (p < .01) use in multivariate models. Notably, frequency of cannabis use (days or hits per day) did not significantly differ between the pre- and post-AUL cohorts, except for greater use of edibles, despite potentially greater access to cannabis.
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Affiliation(s)
- Ekaterina V. Fedorova
- Drexel University, Dornsife School of Public Health, Department of Communisty Health and Prevention, 3215 Market Street, Philadelphia, PA 19104, United States
| | - Allison Mitchel
- Drexel University, Dornsife School of Public Health, Department of Communisty Health and Prevention, 3215 Market Street, Philadelphia, PA 19104, United States
| | - Maddy Finkelstein
- Drexel University, Dornsife School of Public Health, Department of Communisty Health and Prevention, 3215 Market Street, Philadelphia, PA 19104, United States
| | - Janna Ataiants
- Drexel University, Dornsife School of Public Health, Department of Communisty Health and Prevention, 3215 Market Street, Philadelphia, PA 19104, United States
| | - Carolyn F. Wong
- University of Southern California, Keck School of Medicine, Department of Pediatrics, 4650 Sunset Blvd., Los Angeles, CA 90027, United States
- Children’s Hospital Los Angeles, Division of Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United States
- Children’s Hospital Los Angeles, Division of Research on Children, Youth, & Families, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United States
| | - Bridgid M. Conn
- University of Southern California, Keck School of Medicine, Department of Pediatrics, 4650 Sunset Blvd., Los Angeles, CA 90027, United States
- Children’s Hospital Los Angeles, Division of Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United States
| | - Stephen E. Lankenau
- Drexel University, Dornsife School of Public Health, Department of Communisty Health and Prevention, 3215 Market Street, Philadelphia, PA 19104, United States
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23
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Borodovsky JT, Struble CA, Habib MI, Hasin DS, Shmulewitz D, Walsh C, Livne O, Aharonovich E, Budney AJ. Exploring survey methods for measuring consumption quantities of cannabis flower and concentrate products. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:733-745. [PMID: 37774316 PMCID: PMC10795727 DOI: 10.1080/00952990.2023.2246635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/06/2023] [Indexed: 10/01/2023]
Abstract
Background: Researchers need accurate measurements of cannabis consumption quantities to assess risks and benefits. Survey methods for measuring cannabis flower and concentrate quantities remain underdeveloped.Objective: We examined "grams" and "hits" units for measuring flower and concentrate quantities, and calculating milligrams of THC (mgTHC).Methods: Online survey participants (n = 2,381) reported preferred unit (hits or grams), past-week hits and grams for each product, and product %THC. Quantile regression compared mgTHC between unit-preference subgroups. Hits-based mgTHC calculations assumed a universal grams-per-hit ratio (GPHR). To examine individualized GPHRs, we tested a "two-item approach," which divided total grams by total hits, and "one-item approach," which divided 0.5 grams by responses to the question: "How many total hits would it take you to finish 1/2 g of your [product] by [administration method]?"Results: Participants were primarily daily consumers (77%), 50% female sex, mean age 39.0 (SD 16.4), 85% White, 49% employed full-time. Compared to those who preferred the hits unit, those who preferred the grams unit reported consuming more hits and grams, higher %THC products, and consequently, larger median mgTHC (flower-hits mgTHC: 32 vs. 91 (95%CI: 52-67); flower-grams mgTHC: 27 vs. 113 (95%CI: 73-95); concentrate-hits mgTHC: 29 vs. 59 (95%CI: 15-43); concentrate-grams mgTHC: 61 vs. 129 (95%CI: 43-94)). "Two-item" and "one-item" approach GPHRs were similar and frequently 50% larger or smaller than the universal GPHR.Conclusion: Allowing respondents to choose "hits" or "grams" when reporting cannabis quantities does not compromise mgTHC estimates. A low-burden, one-item approach yields individualized "hit sizes" that may improve mgTHC estimates.
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Affiliation(s)
- Jacob T. Borodovsky
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - Cara A. Struble
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
| | - Mohammad I. Habib
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
| | - 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 St, New York, NY 10032, 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
| | - 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
| | - 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 J. Budney
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
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24
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Glinn MA, Michaud GP. Potency levels of regulated cannabis products in Michigan 2021-2022. J Forensic Sci 2023; 68:1894-1905. [PMID: 37501559 DOI: 10.1111/1556-4029.15345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
Evaluation of cannabinoid concentrations in products from the legal cannabis market has been fraught with uncertainty. The lack of standardized testing methodology and the susceptibility of cannabinoids to degradation under certain storage conditions complicates the efforts to assess total tetrahydrocannabinol (THC) levels across wide geographic areas. There are few peer-reviewed surveys of cannabinoid concentrations in regulated products. Those that have been done have not characterized the effects of differences in analytical methodology, sample population, and storage conditions. Viridis Laboratories, which operates two cannabis safety compliance facilities in Michigan, has analyzed over 34,000 cannabis products throughout 2021 and 2022 before the sale in the regulated market. Fifteen cannabinoids in cannabis flower, concentrates, and infused products were tested using methanolic extraction and analysis by high-performance liquid chromatography with diode-array detection. Methods were validated before use, and the flower analysis procedure was certified by the Association of Analytical Collaboration. All the samples were tested before submission for sale and therefore had not undergone prolonged storage. The results are compared with those seen in other states as well as in the illicit market. Total THC levels in cannabis flower from the regulated market are significantly higher than those seen in illicit products. The distribution of cannabinoid levels is similar in flowers intended for either the medicinal or adult-use markets, with an average potency of 18%-23% of total THC. Total THC in concentrates averages up to 82%. Other cannabinoids are observed at significant levels, mostly in products specifically formulated to contain them. These results may act as a benchmark for potency levels in the regulated market.
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25
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Sandini TM, Onofrychuk TJ, Roebuck AJ, Hammond SA, Udenze D, Hayat S, Herdzik MA, McElroy DL, Orvold SN, Greba Q, Laprairie RB, Howland JG. Repeated Exposure to High-THC Cannabis Smoke during Gestation Alters Sex Ratio, Behavior, and Amygdala Gene Expression of Sprague Dawley Rat Offspring. eNeuro 2023; 10:ENEURO.0100-23.2023. [PMID: 37957008 PMCID: PMC10687874 DOI: 10.1523/eneuro.0100-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/21/2023] Open
Abstract
Because of the legalization of Cannabis in many jurisdictions and the trend of increasing Δ9-tetrahydrocannabinol (THC) content in Cannabis products, an urgent need exists to understand the impact of Cannabis use during pregnancy on fetal neurodevelopment and behavior. To this end, we exposed female Sprague Dawley rats to Cannabis smoke daily from gestational day 6 to 20 or room air. Maternal reproductive parameters, offspring behavior, and gene expression in the offspring amygdala were assessed. Body temperature was decreased in dams following smoke exposure and more fecal boli were observed in the chambers before and after smoke exposure in dams exposed to smoke. Maternal weight gain, food intake, gestational length, litter number, and litter weight were not altered by exposure to Cannabis smoke. A significant increase in the male-to-female ratio was noted in the Cannabis-exposed litters. In adulthood, male and female Cannabis smoke-exposed offspring explored the inner zone of an open field significantly less than control offspring. Gestational Cannabis smoke exposure did not affect behavior on the elevated plus maze test or social interaction test in the offspring. Cannabis offspring were better at visual pairwise discrimination and reversal learning tasks conducted in touchscreen-equipped operant conditioning chambers. Analysis of gene expression in the adult amygdala using RNA sequencing revealed subtle changes in genes related to development, cellular function, and nervous system disease in a subset of the male offspring. These results demonstrate that repeated exposure to high-THC Cannabis smoke during gestation alters maternal physiological parameters, sex ratio, and anxiety-like behaviors in the adulthood offspring.
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Affiliation(s)
- Thaisa M Sandini
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Timothy J Onofrychuk
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Andrew J Roebuck
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
- School of Liberal Arts, Yukon University, Whitehorse, Yukon Territory Y1A 5K4, Canada
| | - S Austin Hammond
- Global Institute for Food Security, Saskatoon, Saskatchewan S7N 4L8, Canada
| | - Daniel Udenze
- Next Generation Sequencing Facility, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Shahina Hayat
- Deparment of Oncology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Melissa A Herdzik
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Dan L McElroy
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Spencer N Orvold
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Quentin Greba
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Robert B Laprairie
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - John G Howland
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
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26
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Neu P. [Legalization of Recreational Cannabis use in Germany - Implications Based on Experiences in Uruguay, Canada und USA: a Narrative Review]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:397-403. [PMID: 37567249 DOI: 10.1055/a-2125-9106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
The current government of Germany has agreed on legalizing the recreational use of cannabis in their coalition agreement. Legalization will be implemented in 2023. This issue has continuously been a subject of controversial discussion including most parts of society, executive authorities and science. This article refers to the experiences of other countries (Uruguay, Canada, USA) yet having legalized Cannabis in the past and tries to discuss implications for Germany.
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Affiliation(s)
- Peter Neu
- Klinik für Psychiatrie und Psychotherapie, Jüdisches Krankenhaus Berlin, Berlin, Germany
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27
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Dunbar MS, Davis JP, Tucker JS, Seelam R, Rodriguez A, D'Amico EJ. Parallel trajectories of vaping and smoking cannabis and their associations with mental and physical well-being among young adults. Drug Alcohol Depend 2023; 251:110918. [PMID: 37611482 PMCID: PMC10538384 DOI: 10.1016/j.drugalcdep.2023.110918] [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: 05/12/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Vaping and smoking are common modes of using cannabis (THC) among young adults, but little is known about how patterns of cannabis vaping and smoking unfold over time or how using one or both types of products may differently affect mental and physical well-being. This study examines parallel processes of cannabis vaping and smoking over 5 years and mental and physical outcomes in a sample of young adults. METHODS Annual surveys were conducted between 2016 and 2022 with a mostly California-based cohort of 2428 young adults. Parallel process growth mixture models examined trajectories of past-month frequency of cannabis vaping and smoking from ages 20 - 25. Classes were extracted based on parallel trajectories of vaped and smoked product use. Models assessed differences in self-reported mental (anxiety, depression) and physical (ailments, subjective overall) well-being outcomes in young adulthood across classes, adjusting for demographic characteristics and mental and physical well-being at pre-baseline (average age 19). RESULTS Four cannabis vaping/smoking classes emerged: low use of cannabis (84.7%), decreasing smoking, low-moderate vaping (7.1%), stable moderate smoking, decreasing vaping (4.6%), and rapid increasing dual use (3.4%). Classes were similar on physical well-being indicators in young adulthood. The rapid increasing dual use class showed higher anxiety and depressive symptoms compared to other classes. CONCLUSION Progression to higher frequency of both vaping and smoking cannabis in young adulthood may contribute to poorer mental well-being compared to other use patterns. Targeted efforts to reduce dual vaping and smoking in young people who use cannabis may be needed.
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Affiliation(s)
- Michael S Dunbar
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, United States.
| | - Jordan P Davis
- University of Southern California, Los Angeles, CA 90089, United States
| | - Joan S Tucker
- RAND Corporation, 1776 Main St, Santa Monica, CA 90401, United States
| | - Rachana Seelam
- RAND Corporation, 1776 Main St, Santa Monica, CA 90401, United States
| | - Anthony Rodriguez
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116, United States
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28
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Florimbio AR, Walton MA, Coughlin LN, Lin LA, Bonar EE. Perceived risk of harm for different methods of cannabis consumption: A brief report. Drug Alcohol Depend 2023; 251:110915. [PMID: 37597308 DOI: 10.1016/j.drugalcdep.2023.110915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/18/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Emerging adults' (EAs; ages 18-25) perceived risk of cannabis-related harms has decreased in recent decades, potentially contributing to their high prevalence of cannabis consumption. With the changing cannabis policy and product landscape, it is critical to understand perceived risk related to different consumption methods (e.g., smoking, dabbing). We examined differences in cannabis risk perceptions by method and consumption patterns. METHODS EAs recruited from an emergency department (N=359, 71.3% female, 53.5% Black) completed assessments on individual characteristics, cannabis/other substance use, and perceived risk of cannabis-related harm for four different methods (smoking, vaping, dabbing, ingestion) and two use frequencies (occasional, regular). Analyses examined associations between variables of interest and three mutually exclusive groups: no cannabis use, smoking-only, and multiple/other methods. RESULTS Forty-two percent of EAs reported no past 3-month cannabis use, 22.8% reported smoking only, and 35.1% reported consumption via multiple/other methods. Among all participants, the methods and frequency with the largest number of EAs endorsing any perceived risk from cannabis were dabbing and vaping cannabis regularly; smoking occasionally had the smallest number of EAs endorsing perceived risk. A greater proportion of EAs in the no use group viewed vaping cannabis regularly as having the most risk (63.6%), whereas the largest proportion of EAs in the smoking-only (64.6%) and multiple/other methods (47.2%) groups perceived dabbing regularly as having the most risk. CONCLUSIONS This work shows that EAs vary in perceptions of risk across methods of cannabis use and can inform potential directions for public health and policy efforts.
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Affiliation(s)
- Autumn Rae Florimbio
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Maureen A Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Lewei Allison Lin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
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29
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Wadsworth E, Driezen P, Pacula RL, Kilmer B, Hammond D. Prices and Purchase Sources for Dried Cannabis Flower in the United States, 2019-2020. Cannabis Cannabinoid Res 2023; 8:923-932. [PMID: 35363550 DOI: 10.1089/can.2021.0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The price of cannabis has major implications for public health, public safety, social equity, and government revenues. This article examines prices and sources of purchased dried cannabis flower among consumers facing different state laws in the United States. Methods: Repeat cross-sectional survey data were collected from the International Cannabis Policy Study in 2019 and 2020. U.S. respondents were recruited through online commercial panels, ages 16-65, and purchased dried flower in the past year (n=9766). Weighted binary logistic regression models examined legal purchasing in states that had legalized recreational cannabis. Results: Compared with respondents in states with recreational stores, respondents living in "illegal," "medical," and "recreational" states without stores were associated with paying a higher unit price of dried flower (+20.5%, +23.6%, +27.4%, respectively; all p<0.05). The majority of respondents in states with recreational stores last purchased from stores/dispensaries (2019: 66.6%; 2020: 62.0%) and the odds of purchasing legally was greater with each additional year after stores opened (adjusted odds ratio=1.48, 95% confidence interval: 1.37, 1.60). Conclusions: Cannabis prices and purchase behaviors are strongly influenced by its legal status and presence of stores. After states legalize for recreational purposes, it takes multiple years for the legal market to become established as the number of retail stores increase and prices decrease. The findings demonstrate that consumers use sources that they are legally allowed to access, suggesting an increased number of physical retail stores and online delivery services could expand uptake of legal sources in states with recreational cannabis laws.
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Affiliation(s)
- Elle Wadsworth
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Pete Driezen
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Rosalie Liccardo Pacula
- Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Beau Kilmer
- RAND Drug Policy Research Center, RAND Corporation, Santa Monica, California, USA
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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30
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Ross JM, Karoly HC, Zellers SM, Ellingson JM, Corley RP, Iacono WG, Hewitt JK, McGue M, Vrieze S, Hopfer CJ. Evaluating substance use outcomes of recreational cannabis legalization using a unique co-twin control design. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:630-639. [PMID: 37262386 PMCID: PMC10689567 DOI: 10.1080/00952990.2022.2163177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/28/2022] [Accepted: 12/17/2022] [Indexed: 06/03/2023]
Abstract
Background: As more states pass recreational cannabis legalization (RCL), we must understand how RCL affects substance use.Objectives: The current study aims to examine the effect of RCL on lifetime and past-year use of cannabis, alcohol, tobacco, and other drugs, frequency of cannabis, alcohol, and tobacco use, co-use of cannabis with alcohol and tobacco, and consequences from cannabis and alcohol use.Methods: We used a unique, co-twin control design of twin pairs who were discordant for living in a state with RCL between 2018 and 2021. The sample consisted of 3,830 adult twins (41% male), including 232 twin pairs discordant for RCL. Problems from alcohol and cannabis use were assessed via the Brief Marijuana Consequences Questionnaire and the Brief Young Adult Alcohol Consequences Questionnaire.Results: Results indicated that the twin living in an RCL state was more likely to endorse past-year cannabis use (OR = 1.56, p = .009), greater number of cannabis use days in the past 6 months (β = 0.47, p = .019), but not more negative consequences from cannabis use (β = 0.21, p = .456) compared to their co-twin in a non-RCL state. There were no differences within-twin pairs in frequency of alcohol use (β=-0.05, p = .601), but the RCL twin reported fewer negative consequences from alcohol use (β=-0.29, p = .016) compared to their co-twin in a non-RCL state. We did not observe any other differences within-twin pairs on other outcomes.Conclusion: These results suggest that living in an RCL state is associated with greater cannabis frequency but not more negative consequences from cannabis use than living in a non-RCL state.
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Affiliation(s)
- J. Megan Ross
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Hollis C. Karoly
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | | | - Jarrod M. Ellingson
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - Robin P. Corley
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - William G. Iacono
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - John K. Hewitt
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Matt McGue
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Scott Vrieze
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Christian J. Hopfer
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
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31
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Dilley JA, Johnson JK, Colby AM, Sheehy TJ, Muse EJ, Filley JR, Segawa MB, Schauer GL, Kilmer B. Cannabis Retail Market Indicators in Five Legal States in the United States: A Public Health Perspective. Clin Ther 2023; 45:778-786. [PMID: 37455228 PMCID: PMC10521148 DOI: 10.1016/j.clinthera.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/01/2023] [Accepted: 06/18/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Adult-use cannabis markets are operating in multiple US states and abroad. Sales and licensing data for alcohol and tobacco are often used to understand consumption patterns and evaluate policy changes. Cannabis market data may provide similar insights, although these newly legal markets are complex and evolving, and the state data structures can differ. This study describes variations in market indicators and discusses the utility of cannabis market metrics from a public health perspective. METHODS We collected data from 5 early-adopting adult-use cannabis states: Alaska, Colorado, Massachusetts, Oregon, and Washington. Analyses focused on licensed retail outlets and retail sales revenues (pretax). Monthly data were collected from the opening of each state's adult-use market through June 2022. Joinpoint software was used to assess state trends and identify points of inflection in trends. Average sales per retailer for June 2019 and June 2022 were compared. Also described are retailers and revenue per population for 2022. FINDINGS All states showed 4 distinct periods of growth in retail licensee numbers. The greatest increases typically occurred in the first 3 to 4 months. Growth rates slowed to <1% per month for Colorado, Oregon, and Washington at months 25, 24, and 34, respectively. The number of cannabis retailers per 100,000 residents in June 2022 ranged widely, from 16.8 in Oregon to 3.0 in Massachusetts. Colorado, Oregon, and Washington each showed 4 distinct trend periods in adult-use retail sales: early rapid growth lasting <1 year, subsequent varied growth periods, and then declining sales in the most recent months, following early coronavirus disease 2019 period increases. Sales in Alaska and Massachusetts displayed more stable, consistent growth patterns. Sales per state resident for July 2021 to June 2022 also ranged widely, from $382.97 in Alaska to $180.94 in Washington. IMPLICATIONS We found some consistencies and some variations in both point-in-time measures and trends in states' adult-use cannabis markets. Differences may relate to varied state policies and general contexts (eg, economies). Market data can be useful for public health monitoring, including understanding the effects of policies intended to protect health and safety. States providing publicly accessible cannabis market data create opportunities for such use. Our results underscore the importance of considering individual state regulatory frameworks and implementation timelines in studies of cannabis legalization.
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Affiliation(s)
- Julia A Dilley
- Program Design and Evaluation Services (PDES), Multnomah County Health Department and Oregon Health Authority, Portland, Oregon, USA.
| | - Julie K Johnson
- Massachusetts Cannabis Control Commission (CCC), Worcester, Massachusetts, USA
| | - Alexander M Colby
- Massachusetts Cannabis Control Commission (CCC), Worcester, Massachusetts, USA
| | - Thomas J Sheehy
- Oregon Liquor and Cannabis Commission (OLCC), Milwaukie, Oregon, USA
| | - Eliza J Muse
- Alaska Department of Health, Anchorage, Alaska, USA
| | | | - Mary B Segawa
- Washington State Liquor and Cannabis Board (WSLCB), Olympia, Washington, USA
| | - Gillian L Schauer
- The Cannabis Regulators Association (CANNRA), Seattle, Washington, USA
| | - Beau Kilmer
- RAND Drug Policy Research Center, Santa Monica, California, USA
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32
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Wightman RS, Metrik J, Lin TR, Li Y, Badea A, Almeida R, Collins AB, Beaudoin FL. Cannabis Use Patterns and Whole-Blood Cannabinoid Profiles of Emergency Department Patients With Suspected Cannabinoid Hyperemesis Syndrome. Ann Emerg Med 2023; 82:121-130. [PMID: 37479395 PMCID: PMC10363750 DOI: 10.1016/j.annemergmed.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/17/2023] [Accepted: 03/03/2023] [Indexed: 07/23/2023]
Abstract
STUDY OBJECTIVES The objectives of this study were to characterize the detailed cannabis use patterns (eg, frequency, mode, and product) and determine the differences in the whole-blood cannabinoid profiles during symptomatic versus asymptomatic periods of participants with suspected cannabinoid hyperemesis syndrome recruited from the emergency department (ED) during a symptomatic episode. METHODS This is a prospective observational cohort study of participants with symptomatic cyclic vomiting onset after chronic cannabis use. Standardized assessments were conducted to evaluate for lifetime and recent cannabis use, cannabis use disorder, and cannabis withdrawal symptoms. Quantitative whole-blood cannabinoid testing was performed at 2 times, first when symptomatic (ie, baseline) and at least 2 weeks after the ED visit when asymptomatic. The differences in cannabinoid concentrations were compared between symptomatic and asymptomatic testing. The study was conducted from September 2021 to August 2022. RESULTS There was a difference observed between delta-9-tetrahydrocannabinol metabolites, but not the parent compound during symptomatic episodes and asymptomatic periods. Most participants (84%) reported using cannabis > once per day (median 3 times per day on weekdays, 4 times per day on weekends). Hazardous cannabis use was universal among participants; the mean cannabis withdrawal discomfort score was 13, indicating clinically significant rates of cannabis withdrawal symptoms with cessation of use. Most participants (79%) previously tried to stop cannabis use, but a few (13%) of them had sought treatment. CONCLUSION Patients presenting to the ED with cannabinoid hyperemesis syndrome have high cannabis use disorder scores. Further studies are needed to better understand the influence of THC metabolism and concentrations on symptomatic cyclic vomiting.
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Affiliation(s)
- Rachel S Wightman
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Department of Epidemiology, School of Public Health at Brown University, Providence, RI.
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University, School of Public Health, Providence, RI; Providence VA Medical Center, Providence, RI
| | | | - Yu Li
- Department of Epidemiology, School of Public Health at Brown University, Providence, RI
| | - Adina Badea
- Department of Pathology and Laboratory Medicine, Lifespan Academic Medical Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Robert Almeida
- Forensic Toxicology Laboratory, Department of Health, Rhode Island, Providence, RI
| | - Alexandra B Collins
- Department of Epidemiology, School of Public Health at Brown University, Providence, RI
| | - Francesca L Beaudoin
- Department of Epidemiology, School of Public Health at Brown University, Providence, RI
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Ross JA, Levy S. The Impact of Cannabis Use on Adolescent Neurodevelopment and Clinical Outcomes Amidst Changing State Policies. Clin Ther 2023; 45:535-540. [PMID: 37414504 DOI: 10.1016/j.clinthera.2023.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 07/08/2023]
Abstract
Cannabis is the most common illicit substance used by adolescents and the third most common psychoactive substance after alcohol and nicotine. Cannabis use during adolescence interrupts a critical period of brain development and leads to inappropriate activation of the reward pathway. Because the prefrontal cortex, which is responsible for impulse control and other executive functions, is not fully mature until the mid-twenties, the adolescent brain is especially vulnerable to damage from substance use. Although cannabis remains illegal at the federal level, recent changes in state policies have been associated with increased availability of a wide variety of cannabis products. As new products, formulations, and delivery devices that can deliver higher and faster peak doses of tetrahydrocannabinol enter the market, there is an even greater potential for cannabis to have negative clinical impacts on adolescent health. This article reviews the current literature on the impact of cannabis on adolescent health, including the neurobiology of the adolescent brain, potential clinical outcomes in adolescents who use cannabis, and the effects of changing state policies regarding cannabis on the increased availability of unregulated products.
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Affiliation(s)
- Jennifer A Ross
- Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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Cuttler C, Petrucci AS, LaFrance EM. Cognitive test performance in chronic cannabis flower users, concentrate users, and non-users. Sci Rep 2023; 13:8068. [PMID: 37202444 DOI: 10.1038/s41598-023-35217-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/15/2023] [Indexed: 05/20/2023] Open
Abstract
Extremely high-potency cannabis concentrates are becoming increasingly available and popular among consumers. While prior research indicates these products are perceived to have greater detrimental effects relative to cannabis flower, few studies have examined their relative objective effects, and no existing studies have compared the cognitive test performance of sober flower users, concentrate users, and non-users. A total of 198 healthy adults (98 non-users, 46 exclusive flower users, and 54 concentrate users) were administered a battery of tests of memory, psychomotor speed, attention, and executive functioning under sober laboratory-controlled conditions. Significant group differences were detected on tests of verbal free recall and episodic prospective memory, with both the flower users and concentrate users demonstrating significantly worse performance than non-users. Concentrate (but not flower) users performed worse than non-users on a measure of source memory, but contrary to our hypothesis, there were no significant differences between flower and concentrate users on any of the cognitive tests. Results indicate that, under sober conditions, individuals who regularly use concentrates are no more cognitively impacted than those who exclusively use flower. These null findings may reflect the tendency for concentrate users to self-titrate and use significantly lower quantities of concentrates than flower.
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Affiliation(s)
- Carrie Cuttler
- Department of Psychology, Washington State University, PO Box 644820, Pullman, WA, 99164-4820, USA.
| | - Aria S Petrucci
- Department of Psychology, Washington State University, PO Box 644820, Pullman, WA, 99164-4820, USA
| | - Emily M LaFrance
- Department of Psychology, Washington State University, PO Box 644820, Pullman, WA, 99164-4820, USA
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Manthey J, Obradors-Pineda A. Prices of flower and resin in cannabis social clubs: Analyses of register data from 220,000 collections. Drug Alcohol Rev 2023. [PMID: 37183527 DOI: 10.1111/dar.13680] [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: 01/21/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Cannabis social clubs (CSC) are community-based non-profit organisations that aim to minimise cannabis-related harm for their members. This contribution seeks to: (i) compare the cost of cannabis flower and resin in CSCs to the national average retail price on the illegal market; and (ii) identify possible quantity discounts for cannabis flower and resin distributed to members of CSCs. METHODS Routine data from four CSCs located in Barcelona, Spain, contained information on n = 220,465 collections of cannabis resin and flower (0.01-39 g per collection). The costs for 1 g of cannabis flower and resin per collection were determined. The mean national prices on illicit cannabis were obtained from Spanish police reports. RESULTS On average, members paid 6.19€ for 1 g flower (median: 6€; interquartile range: 6-7€) and 8.54€ for 1 g resin (median: 7€; interquartile range: 6-9€), with less variations for flower than for resin. Compared to the national average, prices appeared to be higher for cannabis products distributed in CSCs, but comparisons were limited by a lack of data on the variation of national prices. For resin, doubling the quantity was associated with a 20.7% (95% confidence interval 20.4-21.2%; p < 0.001) fee discount. DISCUSSION AND CONCLUSIONS Cannabis in CSCs may be more costly than the estimated national average for the illicit market. No meaningful price discount could be observed for flower but for resin. Pricing policies pursued by CSCs may help to disincentivise consumption of larger amounts but may also bar socioeconomically disadvantaged users from accessing safer alternatives than the illegal market.
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Affiliation(s)
- Jakob Manthey
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
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Myers MG, Bonar EE, Bohnert KM. Driving under the influence of cannabis, alcohol, and illicit drugs among adults in the United States from 2016 to 2020. Addict Behav 2023; 140:107614. [PMID: 36652810 DOI: 10.1016/j.addbeh.2023.107614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/10/2022] [Accepted: 01/06/2023] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Driving under the influence (DUI) of substances increases motor vehicle crash risk. Understanding current national trends of driving under the influence of alcohol (DUIA), cannabis (DUIC), and drugs other than cannabis (DUID) can inform public health efforts. Herein, we provide updated trends among United States (US) adults regarding DUIA, DUIC, DUID, and DUI of any substance. METHOD We used nationally-representative National Survey on Drug Use and Health (2016-2020) data to derive prevalence estimates of past-year DUIC, DUIA, DUID, and DUI of any substance among non-institutionalized US adults and among those reporting respective past-year substance use. Prevalence estimates and adjusted logistic regressions characterized temporal trends of these behaviors among US adults, among those with respective past-year substance use, and among stratified demographic subpopulations. RESULTS Over 1 in 10 US adults reported DUI of any substance annually from 2016 to 2020.DUIA was most prevalent among all US adults (8.7% in 2017); however, this behavior is decreasing (AOR:0.96; 95%CI:0.94,0.98). No change in DUIC among the US adult population was found, but a decrease was found among those with past-year cannabis use (AOR:0.95; 95%CI:0.93,0.98), which coincided with a 29.1% increase in past-year cannabis use. There were no significant changes in overall DUID; however, females, those ages 26-34 and 65 or older with past-year use displayed increasing trends. DUI of any substance decreased among the US adult population. CONCLUSIONS DUI remains a salient public health concern in the US and results indicate population subgroups who may benefit from impaired driving prevention interventions.
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Affiliation(s)
- Matthew G Myers
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Wilson Rd Room B601, East Lansing, MI 48824, United States.
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Building 18, Ann Arbor, MI 48109, United States.
| | - Kipling M Bohnert
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Wilson Rd Room B601, East Lansing, MI 48824, United States.
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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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Petrilli K, Hines L, Adams S, Morgan CJ, Curran HV, Freeman TP. High potency cannabis use, mental health symptoms and cannabis dependence: Triangulating the evidence. Addict Behav 2023; 144:107740. [PMID: 37121087 DOI: 10.1016/j.addbeh.2023.107740] [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: 01/05/2023] [Revised: 03/30/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Cannabis potency (concentration of Δ-9-Tetrahydrocannabinol) has been associated with risks of adverse mental health outcomes and addiction but no studies have triangulated evidence from self-report and objective measures of cannabis potency. We hypothesised that users of high potency cannabis would have higher levels of (a) anxiety, (b) depression and (c) psychosis-like symptoms (d) cannabis dependence than users of lower potency cannabis. METHODS A cross-sectional study of 410 participants donated a sample of cannabis for analysis of THC concentration and reported their cannabis potency preference. These two exposure measures were investigated for their association with cannabis dependence, depression, anxiety, and psychosis-like symptoms in separate linear/logistic regression models. RESULTS High potency cannabis preference was associated with a slight increased risk of cannabis dependence after adjusting for confounding, with the exception of cannabis use frequency (OR = 1.16, 95% CI 1.04-1.28). No association was found between THC concentration in cannabis and cannabis dependence. There was weak evidence of a small association between cannabis potency and depression and anxiety. There was no association between high potency cannabis preference or THC concentration in cannabis and psychosis-like symptoms. CONCLUSIONS Users of cannabis who preferred high potency types might be at increased risk of problematic cannabis use. This should be considered with caution as we were not able to triangulate these results with an objective measure of cannabis potency. More research is needed to understand the association between high potency cannabis use and depression and anxiety.
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Affiliation(s)
- Kat Petrilli
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK.
| | - Lindsey 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
| | - Sally Adams
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Celia J Morgan
- Washington Singer Laboratories, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology Department, 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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Aletraris L, Graves BD, Ndung’u JJ. Assessing the Impact of Recreational Cannabis Legalization on Cannabis Use Disorder and Admissions to Treatment in the United States. CURRENT ADDICTION REPORTS 2023; 10:198-209. [PMID: 37266190 PMCID: PMC10088679 DOI: 10.1007/s40429-023-00470-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 06/03/2023]
Abstract
Purpose of Review Policy implications from changes in recreational cannabis laws (RCLs) have raised public health concerns. While numerous studies have examined the impact of RCLs on cannabis use, there is less research on the risk of developing cannabis use disorder (CUD). This review summarizes the latest research on the effects of RCLs on CUD prevalence and cannabis treatment admissions. Recent Findings Nine studies were published between 2016 - 2022 that examined RCLs and CUD or treatment. Findings generally indicate an increase in CUD prevalence associated with legalization, but effects differ by age group. There was no significant association between legalization and CUD treatment admissions, and CUD admissions decreased overall during the study periods. Summary To improve policy, prevention, and treatment services, policymakers should monitor RCLs' effects on adverse public health outcomes and researchers should consider the effects on individual and community-level characteristics. We discuss methodological challenges in conducting state-level research and provide suggestions for future studies.
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Affiliation(s)
- Lydia Aletraris
- School of Social Work, University of Georgia, 279 William St, Athens, GA 30602, USA
- Center for Research On Behavioral Health and Human Services Delivery, University of Georgia, Athens, GA 30602 USA
| | - Brian D. Graves
- School of Social Work, University of Georgia, 279 William St, Athens, GA 30602, USA
| | - Joyce J. Ndung’u
- School of Social Work, University of Georgia, 279 William St, Athens, GA 30602, USA
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Yimsaard P, Lancaster KE, Sohn AH. Potential impact of Thailand's cannabis policy on the health of young adults: current status and future landscape. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 10:100145. [PMID: 37383363 PMCID: PMC10305883 DOI: 10.1016/j.lansea.2023.100145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/26/2022] [Accepted: 01/02/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Pongkwan Yimsaard
- Department of Psychiatry, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kathryn E. Lancaster
- The Ohio State University, College of Public Health, Division of Epidemiology, United States
| | - Annette H. Sohn
- TREAT Asia/amfAR, The Foundation for AIDS Research, Bangkok, Thailand
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Peterswald TJ, Mieog JC, Azman Halimi R, Magner NJ, Trebilco A, Kretzschmar T, Purdy SJ. Moving Away from 12:12; the Effect of Different Photoperiods on Biomass Yield and Cannabinoids in Medicinal Cannabis. PLANTS (BASEL, SWITZERLAND) 2023; 12:1061. [PMID: 36903921 PMCID: PMC10004775 DOI: 10.3390/plants12051061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
The standard practice to initiate flowering in medicinal cannabis involves reducing the photoperiod from a long-day period to an equal duration cycle of 12 h light (12L)/12 h dark (12D). This method reflects the short-day flowering dependence of many cannabis varieties but may not be optimal for all. We sought to identify the effect of nine different flowering photoperiod treatments on the biomass yield and cannabinoid concentration of three medicinal cannabis varieties. The first, "Cannatonic", was a high cannabidiol (CBD)-accumulating line, whereas the other two, "Northern Lights" and "Hindu Kush", were high Δ9-tetrahydrocannabinol (THC) accumulators. The nine treatments tested, following 18 days under 18 h light/6 h dark following cloning and propagation included a standard 12L:12D period, a shortened period of 10L:14D, and a lengthened period of 14L:10D. The other six treatments started in one of the aforementioned and then 28 days later (mid-way through flowering) were switched to one of the other treatments, thus causing either an increase of 2 or 4 h, or a decrease of 2 or 4 h. Measured parameters included the timing of reproductive development; the dry weight flower yield; and the % dry weight of the main target cannabinoids, CBD and THC, from which the total g cannabinoid per plant was calculated. Flower biomass yields were highest for all lines when treatments started with 14L:10D; however, in the two THC lines, a static 14L:10D photoperiod caused a significant decline in THC concentration. Conversely, in Cannatonic, all treatments starting with 14L:10D led to a significant increase in the CBD concentration, which led to a 50-100% increase in total CBD yield. The results show that the assumption that a 12L:12D photoperiod is optimal for all lines is incorrect as, in some lines, yields can be greatly increased by a lengthened light period during flowering.
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Affiliation(s)
- Tyson James Peterswald
- New South Wales Department of Primary Industries, 105 Prince Street, Orange, NSW 2800, Australia
| | - Jos Cornelis Mieog
- Southern Cross Plant Science, Southern Cross University, Military Rd., East Lismore, NSW 2480, Australia
| | - Razlin Azman Halimi
- Southern Cross Plant Science, Southern Cross University, Military Rd., East Lismore, NSW 2480, Australia
- School of Agriculture and Food, Faculty of Science, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Nelson Joel Magner
- New South Wales Department of Primary Industries, 105 Prince Street, Orange, NSW 2800, Australia
| | - Amy Trebilco
- New South Wales Department of Primary Industries, 105 Prince Street, Orange, NSW 2800, Australia
| | - Tobias Kretzschmar
- Southern Cross Plant Science, Southern Cross University, Military Rd., East Lismore, NSW 2480, Australia
| | - Sarah Jane Purdy
- New South Wales Department of Primary Industries, 105 Prince Street, Orange, NSW 2800, Australia
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Marinello S. Social Media Marketing Practices of Illinois Recreational Cannabis Dispensaries in the First Year of Legal Sales: Product Promotions, Branding, and Price Promotions. JOURNAL OF DRUG ISSUES 2023. [DOI: 10.1177/00220426231159542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Research from tobacco suggests that the recreational cannabis industry will use aggressive tactics, including product innovation and mass-marketing and advertising, to increase demand for their products. The purpose of this study is to examine product promotions, branding, and promotional pricing on recreational dispensary social media pages in the state of Illinois in the first year of legal sales. Data were collected from all recreational cannabis dispensary Facebook and Twitter accounts and a quantitative content analysis was used to analyze the data. Differences in marketing practices were assessed by neighborhood race/ethnicity and income and dispensary type. Results of the study revealed that flower and edibles were the two most heavily promoted products; promotions for vaporizers and concentrates were also promoted frequently. Posts with branded promotions and price promotions increased substantially over the year. Research suggests that this trend in marketing practices will lead to greater initiation and intensity of cannabis use.
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Affiliation(s)
- Samantha Marinello
- Division of Health Policy and Administration School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
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Ince HY, Phan H, Nasr SZ, Pierce JM, Malas N. Clearing up the smoke: Physical and mental health considerations regarding cannabis use in adolescents with cystic fibrosis. Pediatr Pulmonol 2023; 58:398-407. [PMID: 36349504 PMCID: PMC10098788 DOI: 10.1002/ppul.26241] [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: 08/02/2022] [Revised: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022]
Abstract
The cannabis plant is the most used federally illegal drug in the United States and is widely used by adolescents. Cannabis has complex effects on the body and mind. All health professionals who take care of adolescents with cystic fibrosis (CF) should be aware of the factors impacting cannabis use in CF. Given limited evidence regarding the benefits of cannabis and the significant risks, clinicians have the responsibility to identify risk of cannabis use early, counsel patients about the risks, provide a safe space for ongoing conversations about cannabis use in the context of CF care, and deliver evidence-based interventions.
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Affiliation(s)
- H Yavuz Ince
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Hanna Phan
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Samya Z Nasr
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica M Pierce
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Nasuh Malas
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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Hammig B, Jones C, Haldeman S. Pediatric Poisonings Associated With Ingestion of Marijuana Products. J Emerg Med 2023; 64:181-185. [PMID: 36822984 DOI: 10.1016/j.jemermed.2022.12.025] [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: 09/06/2022] [Revised: 10/24/2022] [Accepted: 12/13/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND Rapid changes in marijuana legislation have resulted in a wider array of products containing tetrahydrocannabinol (THC) to be legally manufactured and sold, such as edibles in the form of gummy candies and cookies. These products may be enticing to young children who mistake them for typical snack foods. OBJECTIVE Our aim was to describe emergency department (ED) visits due to unintentional ingestion of cannabis products among children aged birth to 11 years old in the United States. METHODS Using the 2019-2020 National Electronic Injury Surveillance System, U.S. ED records for poisoning events related to ingestion of THC were examined. Descriptive epidemiologic analyses were conducted to provide national estimates of the pediatric visits. RESULTS An estimated 1245 pediatric patient visits related to unintentional marijuana poisoning occurred. Most poisonings involved edible marijuana products and most patients were admitted to the hospital. CONCLUSIONS Cannabis edibles present a challenge with regard to prevention of poisonings among the pediatric population. Legislation or company policies pertaining to packaging and manufacturing are needed to limit the attraction of toddlers and young children, as well reliance on parents and caregivers for safe storage of the products. Continued and expanded public health education campaigns are warranted.
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Affiliation(s)
- Bart Hammig
- Public Health Program, University of Arkansas, Fayetteville, Arkansas
| | - Ches Jones
- Public Health Program, University of Arkansas, Fayetteville, Arkansas
| | - Sydney Haldeman
- Public Health Program, University of Arkansas, Fayetteville, Arkansas
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Stella N. THC and CBD: Similarities and differences between siblings. Neuron 2023; 111:302-327. [PMID: 36638804 PMCID: PMC9898277 DOI: 10.1016/j.neuron.2022.12.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/14/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023]
Abstract
Δ9-tetrahydrocannabinol (THC) and its sibling, cannabidiol (CBD), are produced by the same Cannabis plant and have similar chemical structures but differ dramatically in their mechanisms of action and effects on brain functions. Both THC and CBD exhibit promising therapeutic properties; however, impairments and increased incidence of mental health diseases are associated with acute and chronic THC use, respectively, and significant side effects are associated with chronic use of high-dose CBD. This review covers recent molecular and preclinical discoveries concerning the distinct mechanisms of action and bioactivities of THC and CBD and their impact on human behavior and diseases. These discoveries provide a foundation for the development of cannabinoid-based therapeutics for multiple devastating diseases and to assure their safe use in the growing legal market of Cannabis-based products.
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Affiliation(s)
- Nephi Stella
- Department of Pharmacology, Department Psychiatry and Behavioral Sciences, Center for Cannabis Research, Center for the Neurobiology of Addiction, Pain, and Emotion, University of Washington School of Medicine, Seattle, WA 98195, USA
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Vargas G, Shrier LA, Chadi N, Harris SK. High-Potency Cannabis Use in Adolescence. J Pediatr 2023; 252:191-197.e1. [PMID: 35977620 DOI: 10.1016/j.jpeds.2022.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Gabriela Vargas
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Center for Adolescent Behavioral Health Research, Boston Children's Hospital, Boston, MA
| | - Nicholas Chadi
- Université de Montréal, Montréal, Quebec, Canada; Ste-Justine Hospital Research Center, Montréal, Quebec, Canada
| | - Sion K Harris
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Center for Adolescent Behavioral Health Research, Boston Children's Hospital, Boston, MA
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Arnabal Rocca LR. Legalizing Harmful Drugs: Government Participation and Optimal policies. THE B.E. JOURNAL OF ECONOMIC ANALYSIS & POLICY 2023; 23:113-164. [PMID: 36726404 PMCID: PMC9851772 DOI: 10.1515/bejeap-2021-0309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/19/2022] [Accepted: 11/02/2022] [Indexed: 06/18/2023]
Abstract
We are currently witnessing a shift in the approach to combat traffic and consumption of illegal harmful drugs, being cannabis legalization a prominent example. In this paper, we study how to optimally regulate the market for cannabis, in a setting where consumers differ in their utility from consumption of the psychoactive component of cannabis, THC, and suffer from misperception of the health damage it causes. We analyze this problem through a vertical differentiation model, where a black market firm and a public firm compete in prices and qualities (THC content). A paternalistic government would like to correct for the misperceived health damage caused by cannabis consumption, as well as to reduce the size of the black market. It is the undesirability of black market profits what explains that the first-best allocation cannot be decentralized. We find two possible equilibria, depending on whether the public firm serves those consumers with the highest or lowest willingness to pay for quality. Paradoxically, when the public firm serves those consumers with higher taste for THC, a lower average health damage is achieved together with a better economic result for the public firm.
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Affiliation(s)
- Luis Rodrigo Arnabal Rocca
- Banco Central del Uruguay, J.P. Fabini 777, 11100Montevideo, Uruguay
- Toulouse School of Economics (TSE), Toulouse, France
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Abstract
Because of substantial limitations in available national data, such as inconsistencies among surveys and small sample sizes, the increased prevalence of cannabis use among adolescents since recreational legalization has not been directly observed. Nevertheless, both usage frequency and product potency have significantly increased, alongside alternative routes of delivery to smoking, such as vaping cannabis. Moreover, certain populations may be especially vulnerable to the effects of legalization. Regardless of differing state-level cannabis legalization status, the adverse consequences of cannabis on youth have clear negative impacts on mental health, medical symptoms, educational outcomes, and increased risk of addiction to other substances.
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Affiliation(s)
- Kristie Ladegard
- Denver Health, University of Colorado, 601 Broadway 7th Floor, MC7779, Denver, CO 80203, USA.
| | - Devika Bhatia
- University of Colorado, 13007 East 19th Place, Aurora, CO 80045, USA
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Stith S, Pearson J, Brockelman F, Keeling K, Hall B, Friedman A. Nationally Representative Surveys on Cannabis Use Lack Product Details Relevant to Public Health. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100134. [PMID: 36994372 PMCID: PMC10040319 DOI: 10.1016/j.dadr.2023.100134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/15/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
Objectives Many annual, nationally representative US surveys that assess cannabis use do not collect information on product characteristics despite varying health risks and benefits. Capitalizing on a rich dataset of primarily medical users, the purpose of this study was to describe the degree of potential misclassification in clinically relevant cannabis use measures when primary mode of use is recorded but not product type. Methods Analyses consider user-level data from the Releaf App™ database on product types, consumption modes, and potencies in a non-nationally representative sample of 26,322 cannabis administration sessions occurring in 2018, across 3,258 users. Proportions, means, and 95% confidence intervals were calculated and compared across products and modes. Results Primary consumption modes were smoking (47.1%), vaping (36.5%), and eating/drinking (10.4%), with 22.7% of users reporting multiple modes of use. Moreover, mode of use did not signify a single product type: users reported vaping both flower (41.3%) and concentrates (68.7%). Of those who smoked cannabis, 8.1% reported smoking concentrates. Concentrates averaged 3.4 times higher tetrahydrocannabinol (THC) potency and 3.1 times higher cannabidiol (CBD) potency than flower. Conclusions Cannabis consumers employ multiple consumption modes, and product type cannot be inferred from mode of use. With THC potencies markedly higher in concentrates, these findings underscore the importance of including information on cannabis product types and mode of use in surveillance surveys. Clinicians and policymakers need these data to inform treatment decisions and assess cannabis policies' implications for population health.
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D'Souza DC, DiForti M, Ganesh S, George TP, Hall W, Hjorthøj C, Howes O, Keshavan M, Murray RM, Nguyen TB, Pearlson GD, Ranganathan M, Selloni A, Solowij N, Spinazzola E. Consensus paper of the WFSBP task force on cannabis, cannabinoids and psychosis. World J Biol Psychiatry 2022; 23:719-742. [PMID: 35315315 DOI: 10.1080/15622975.2022.2038797] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The liberalisation of cannabis laws, the increasing availability and potency of cannabis has renewed concern about the risk of psychosis with cannabis. METHODS The objective of the WFSBP task force was to review the literature about this relationship. RESULTS Converging lines of evidence suggest that exposure to cannabis increases the risk for psychoses ranging from transient psychotic states to chronic recurrent psychosis. The greater the dose, and the earlier the age of exposure, the greater the risk. For some psychosis outcomes, the evidence supports some of the criteria of causality. However, alternate explanations including reverse causality and confounders cannot be conclusively excluded. Furthermore, cannabis is neither necessary nor sufficient to cause psychosis. More likely it is one of the multiple causal components. In those with established psychosis, cannabis has a negative impact on the course and expression of the illness. Emerging evidence also suggests alterations in the endocannabinoid system in psychotic disorders. CONCLUSIONS Given that exposure to cannabis and cannabinoids is modifiable, delaying or eliminating exposure to cannabis or cannabinoids, could potentially impact the rates of psychosis related to cannabis, especially in those who are at high risk for developing the disorder.
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Affiliation(s)
- Deepak Cyril D'Souza
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA.,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Marta DiForti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK.,South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Suhas Ganesh
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA.,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Tony P George
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wayne Hall
- The National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Australia
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Institute for Clinical Sciences, Imperial College London, London, UK
| | - Matcheri Keshavan
- Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center, Harvard Medical School, Boston, MA, USA
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Timothy B Nguyen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK.,Institute for Clinical Sciences, Imperial College London, London, UK
| | - Godfrey D Pearlson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Olin Neuropsychiatry Ctr. Institute of Living, Hartford, CT, USA
| | - Mohini Ranganathan
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA.,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Alex Selloni
- Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Nadia Solowij
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, NSW, Australia
| | - Edoardo Spinazzola
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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