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Padoan F, Colombrino C, Sciorio F, Piacentini G, Gaudino R, Pietrobelli A, Pecoraro L. Concerns Related to the Consequences of Pediatric Cannabis Use: A 360-Degree View. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1721. [PMID: 38002812 PMCID: PMC10670833 DOI: 10.3390/children10111721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023]
Abstract
Cannabis, a plant known for its recreational use, has gained global attention due to its widespread use and addiction potential. Derived from the Cannabis sativa plant, it contains a rich array of phytochemicals concentrated in resin-rich trichomes. The main cannabinoids, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), interact with CB1 and CB2 receptors, influencing various physiological processes. Particularly concerning is its prevalence among adolescents, often driven by the need for social connection and anxiety alleviation. This paper provides a comprehensive overview of cannabis use, its effects, and potential health risks, especially in adolescent consumption. It covers short-term and long-term effects on different body systems and mental health and highlights the need for informed decision making and public health initiatives, particularly regarding adolescent cannabis use.
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Affiliation(s)
| | | | | | | | | | | | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
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Costiniuk C, MacCallum CA, Boivin M, Rueda S, Lacasse G, Walsh Z, Daeninck PJ, Margolese S, Mandarino E, Deol JK, Sanchez T, Bell AD. Why a distinct medical stream is necessary to support patients using cannabis for medical purposes. J Cannabis Res 2023; 5:25. [PMID: 37403136 DOI: 10.1186/s42238-023-00195-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Since 2001, Canadians have been able to obtain cannabis for medical purposes, initially through the Access to Cannabis for Medical Purposes Regulations (ACMPR). The Cannabis Act (Bill C-45) came into force on October 17, 2018, replacing the ACMPR. The Cannabis Act enables Canadians to possess cannabis purchased from a licensed retailer without authorization for either medical or nonmedical purposes. The Cannabis Act is currently the guiding legislation which governs both medical and nonmedical access. The Cannabis Act contains some improvements for patients but is essentially the same as its previous legislation. Beginning in October 2022, the federal government is conducting a review of the Cannabis Act and is questioning whether a distinct medical cannabis stream is still required, given the ease of access to cannabis and cannabis products. Although there is overlap in the reasons for medical and recreational cannabis use, the distinct legislation of medical versus recreational use of cannabis in Canada may be under threat. MAIN BODY A large segment of the medical, academic, research, and lay communities agree that there is a need for distinct medical and recreational cannabis streams. Perhaps most importantly, separation of these streams is necessary to ensure that both medical cannabis patients and healthcare providers receive the required support needed to optimize benefits while minimizing risks associated with medical cannabis use. Preservation of distinct medical and recreational streams can help to ensure that needs of different stakeholders are met. For example, patients require guidance in the form of assessing the appropriateness of cannabis use, selection of appropriate products and dosage forms, dosing titration, screening for drug interactions, and safety monitoring. Healthcare providers require access to undergraduate and continuing health education as well as support from their professional organizations to ensure medical cannabis is appropriately prescribed. Although there are challenges in conducing research, as motives for cannabis use frequently straddle boundaries between medical versus recreational cannabis use, maintenance of a distinct medical stream is also necessary to ensure adequate supply of cannabis products appropriate for medical use, to reduce stigma associated with cannabis in both patients and providers, to help enable reimbursement for patients, to facilitate removal of taxation on cannabis used for medical purposes, and to promote research on all aspects of medical cannabis. CONCLUSION Cannabis products for medical and recreational purposes have different objectives and needs, requiring different methods of distribution, access, and monitoring. HCPs, patients, and the commercial cannabis industry would serve Canadians well to continue to advocate to policy makers to ensure the continued existence of two distinct streams and must strive to make ongoing improvements to the current programs.
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Affiliation(s)
- Cecilia Costiniuk
- Chronic Viral Illness Service/Division of Infectious Diseases, McGill University Health Centre, McGill Cannabis Research Centre and Research Institute of the McGill University Health Centre, Montreal, QC, H4A 3J1, Canada.
| | - Caroline A MacCallum
- Department of Medicine and Division of Palliative Care, University of British Columbia and Greenleaf Medical Clinic, Vancouver, BC, Canada
| | | | - Sergio Rueda
- Department of Psychiatry and Institute of Health Policy, Management and Evaluation, Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - Paul J Daeninck
- Department of Internal Medicine, CancerCare Manitoba, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Shari Margolese
- Canadian Institutes of Health Research (CIHR) Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Enrico Mandarino
- Canadian Institutes of Health Research (CIHR) Canadian HIV Trials Network, Vancouver, BC, Canada
- MJardin Canada, Toronto, ON, Canada
| | - Jagpaul Kaur Deol
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Tatiana Sanchez
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - Alan D Bell
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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López-Méndez M, Ospina-Escobar A, Iskandar R, Alarid-Escudero F. Age-specific rates of onset of cannabis use in Mexico. Addict Behav 2021; 122:107038. [PMID: 34325204 PMCID: PMC8645182 DOI: 10.1016/j.addbeh.2021.107038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/24/2021] [Accepted: 06/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over the previous two decades, the lifetime prevalence of cannabis use has risen among Mexico's population. AIMS Estimate the sex- and age-specific rates of onset of cannabis use over time. DESIGN Five nationally representative cross-sectional surveys, the Mexican National Surveys of Addictions (1998, 2002, 2008, 2012) and the Mexican National Survey on Drugs, Alcohol, and Tobacco Consumption (2016). SETTING Mexico. PARTICIPANTS Pooled sample of 141,342 respondents aged between 12 and 65 years of which 43.6%(n = 61,658) are male and 56.4% (n = 79,684) are female. MEASUREMENTS We estimated the age-specific rates of onset of cannabis as the conditional rate of consuming cannabis for the first time at a specific age. METHODS Time-to-event flexible-parametric models with spline specifications of the hazard function. Stratified analysis by sex and control for temporal trends by year of data collection or decennial birth cohort. FINDINGS Age-specific rates of onset of cannabis use per 1,000 individuals increased over time for females and males. Peak rates of onset of cannabis use per 1,000 ranged from 0.935 (95%CI = [0.772, 1.148]) in 1998, to 5.391 (95%CI = [4.924, 5.971]) in 2016 for females; and from 7.513 (95%CI = [6.732, 10.063]) in 1998, to 26.107 (95%CI = [25.918,30.654]) in 2016 for males. Across decennial birth-cohorts, peak rates of onset of cannabis use per 1,000 individuals for females ranged from 0.234 (95%CI = [0.078, 0.768]) for those born in the 1930s, to 14.611 (95%CI = [13.243, 16.102]) for those born in the 1990s; and for males, from 4.086 (95%CI = [4.022, 7.857]) for those born in the 1930s, to 38.693 (95%CI = [24.847, 48.670]) for those born in the 1990s. CONCLUSION Rates of onset of cannabis increased over the previous two decades for both females and males but remained higher for males. Across recent cohorts, the rates of onset have increased at a faster rate among females than males.
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Affiliation(s)
| | - Angélica Ospina-Escobar
- Programa de Cátedras CONACyT, Mexico; Drug Policy Program, Center for Research and Teaching in Economics (CIDE), Aguascalientes, Mexico; Division of Multidisciplinary Studies, Center for Research and Teaching in Economics (CIDE), Aguascalientes, Mexico
| | - Rowan Iskandar
- Center for Evidence Synthesis in Health, Brown University, Providence, RI, USA; Center of Excellence in Decision-Analytic Modeling and Health Economics Research, sitem-insel, Bern, Switzerland
| | - Fernando Alarid-Escudero
- Drug Policy Program, Center for Research and Teaching in Economics (CIDE), Aguascalientes, Mexico; Division of Public Administration, Center for Research and Teaching in Economics (CIDE), Aguascalientes, Mexico.
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Adams PJ, Rychert M, Wilkins C. Policy influence and the legalized cannabis industry: learnings from other addictive consumption industries. Addiction 2021; 116:2939-2946. [PMID: 33739486 DOI: 10.1111/add.15483] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/13/2020] [Accepted: 03/02/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM New Zealand has recently legalized medicinal cannabis and has explored the possibility of legalizing large-scale recreational cannabis supply. In the process, concerns have emerged regarding whether corporations involved in the large-scale production and sale of legalized cannabis will invest in tactics of influence with policymakers and the public. This paper aimed to examine the various ways a legalized cannabis industry could seek to influence governments and the public in the New Zealand reform context. METHOD Based on the study of industry tactics with alcohol, tobacco and gambling, we applied a three-chain model of industry influence that breaks tactics into the 'public good', 'knowledge' and 'political' chains. RESULTS Exploratory analysis of the nascent cannabis industry's activity in New Zealand provided signs of industry influence strategies related to all three chains. The medicinal cannabis industry has associated the establishment of a legal cannabis sector with regional economic development and employment, supported lobbying for recreational law reform, funded NGOs involved in lobbying for law reform, established research partnerships with universities, invited ex-politicians on advisory boards, and participated in government public sector partnerships. CONCLUSION There is emerging evidence that the legal cannabis industry is using strategies to influence the regulatory environment in New Zealand.
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Affiliation(s)
- Peter J Adams
- Centre for Addiction Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Marta Rychert
- Social and Health Outcomes Research and Evaluation (SHORE), SHORE and Whaariki Research Centre, College of Health, Massey University, P.O. Box 6137, Wellesley Street, Auckland, New Zealand
| | - Chris Wilkins
- Social and Health Outcomes Research and Evaluation (SHORE), SHORE and Whaariki Research Centre, College of Health, Massey University, P.O. Box 6137, Wellesley Street, Auckland, New Zealand
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Wilkins C, Tremewan J, Rychert M, Atkinson Q, Fischer K, Forsyth GAL. Predictors of voter support for the legalization of recreational cannabis use and supply via a national referendum. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103442. [PMID: 34560621 DOI: 10.1016/j.drugpo.2021.103442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/10/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND A national referendum to legalise recreational cannabis use and supply in New Zealand via the Cannabis Legalisation and Control Bill (CLCB) was recently narrowly defeated. Understanding the underlying factors for this result can inform the cannabis legalisation debate in other countries. AIMS To investigate predictors of voter support for and opposition to the CLCB. METHOD A representative population panel of 1,022 people completed an online survey of intended voting on the CLCB referendum, which included questions on demographics, drug use history, medicinal cannabis, perceptions of the health risk and moral views of cannabis use, political affiliation, religiosity, community size and reading of the CLCB. Regression models were developed to predict support for the CLCB, with additional predictor variables added over successive iterations. RESULTS The most robust predictors of support for the CLCB were use of and policy support for medicinal cannabis use, voting for a left-wing political party, having a positive moral view of cannabis use, living in a small town and having read the CLCB. Predictors of opposing the CLCB were voting for right-wing parties, considering "frequent" cannabis use to be a high health risk, and lifetime use of other drugs. Age, ethnicity, education, employment status, religiosity and lifetime cannabis use were not significant predictors after controlling for other variables. CONCLUSIONS Support for cannabis legalization was not based on broad demographics, but rather specific views concerning the medicinal benefit, morality of cannabis use, health risk of frequent cannabis use, political party affiliation, and knowledge of the proposed regulatory controls of the CLCB. The influence of moral views of cannabis use on voting behaviour suggest the need to debate the right to use cannabis. The importance of knowledge of the proposed regulatory controls of the CLCB on voting underlines the need to raise awareness of proposed regulatory controls during debate.
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Affiliation(s)
- C Wilkins
- SHORE & Whariki Research Centre, Massey University, New Zealand.
| | - J Tremewan
- Department of Economics, University of Auckland, New Zealand
| | - M Rychert
- SHORE & Whariki Research Centre, Massey University, New Zealand
| | - Q Atkinson
- School of Psychology, University of Auckland, New Zealand
| | - K Fischer
- School of Psychology, University of Auckland, New Zealand
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Rychert M, Wilkins C. Response to commentaries: The politics (and science) of cannabis law reform. Drug Alcohol Rev 2021; 40:888-889. [PMID: 34008229 DOI: 10.1111/dar.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Marta Rychert
- SHORE and Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Chris Wilkins
- SHORE and Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand
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Pacula RL. Commentary on Rychert and Wilkins (2021) 'Why did New Zealand's referendum to legalise recreational cannabis fail?'. Drug Alcohol Rev 2021; 40:884-885. [PMID: 34002906 DOI: 10.1111/dar.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Rosalie Liccardo Pacula
- Department of Health Policy and Management, Sol Price School of Public Policy and Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, USA
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Rychert M, Wilkins C. Why did New Zealand's referendum to legalise recreational cannabis fail? Drug Alcohol Rev 2021; 40:877-881. [PMID: 33677836 DOI: 10.1111/dar.13254] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Abstract
New Zealand recently held the world's first national referendum on cannabis legalisation involving a detailed bill to regulate retail sale and supply of cannabis for recreational (non-medical) adult use (i.e. the Cannabis Legalisation and Control Bill; CLCB). The referendum generated significant domestic debate and lobbying from both sides of the issue. The CLCB was narrowly defeated, with 48.4% voting to support versus 50.7% opposed. In this commentary, we discuss the referendum campaigns and other political and social factors that may have contributed to the result. Voting patterns appeared to largely follow traditional conservative-liberal, urban-rural and age divides. The referendum format created a public campaigning environment that encouraged persuasion and selective use of evidence rather than rational discussion of all the evidence and related knowledge gaps. The self-imposed neutrality of the centre left Labour Party and its popular leader may have been a decisive factor in the narrow defeat. It did not appear to be the case that anti-CLCB groups outspent the pro-CLCB movement in online promotional advertisements, and the leading digital media appeared largely neutral or mildly in favour of reform. The recent New Zealand experience illustrates the uncertainties of attempting to achieve cannabis law reform via a public referendum vote.
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Affiliation(s)
- Marta Rychert
- SHORE and Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Chris Wilkins
- SHORE and Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand
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Smart R. Acknowledging and monitoring the costs of seriously regulating cannabis. Addiction 2021; 116:235-236. [PMID: 33058353 DOI: 10.1111/add.15274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Rosanna Smart
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
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Wilkins C, Rychert M. The rejection of cannabis legalization in New Zealand: issues with the Cannabis Legalization and Control Bill or wider concerns? Addiction 2021; 116:236-238. [PMID: 33417296 DOI: 10.1111/add.15361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Chris Wilkins
- SHORE and Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Marta Rychert
- SHORE and Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
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Lenton S. Regulating cannabis retail for public health over private profit. Addiction 2021; 116:233-235. [PMID: 32975340 DOI: 10.1111/add.15255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/03/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Simon Lenton
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
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12
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Affiliation(s)
- Janna Cousijn
- Neuroscience of Addiction (NofA) Laboratory, Department of PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
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Freeman TP, Lynskey MT. Minimum THC unit pricing: an opportunity for harm reduction. Addiction 2021; 116:232-233. [PMID: 33073421 DOI: 10.1111/add.15264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
| | - Michael T Lynskey
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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