Legal cannabis-what's in it?

CANreduce-SP-adding psychological support to web-based adherence-focused guided self-help for cannabis users: study protocol for a three-arm randomized control trial

BACKGROUND

Cannabis is the most-frequently used illicit drug in Europe. Over the last few years in Spain, treatment demand has increased, yet most cannabis users do not seek treatment despite the related problems. A web-based self-help tool, like CANreduce 2.0, could help these users to control their consumption.

METHODS

This study protocol describes a three-arm randomized controlled trial (RCT) comparing the effectiveness of three approaches, in terms of reducing cannabis use among problematic cannabis users, the first two treatment arms including the Spanish version of CANreduce 2.0 (an adherence-focused, guidance-enhanced, web-based self-help tool) (1) with and (2) without psychological support; and the third group (3) treatment as usual (TAU). Study hypotheses will be tested concerning the primary outcome: change in the number of days of cannabis use over the previous week, comparing assessments at 6 weeks and 3 and 6 months follow-up between groups and against baseline. Secondary outcomes related to cannabis use will be tested similarly. Mental disorders will be explored as predictors of adherence and outcomes. Analyses will be performed on an intention-to-treat basis, then verified by complete case analyses.

DISCUSSION

This study will test how effective the Spanish version of CANreduce 2.0 (CANreduce-SP) is at reducing both the frequency and quantity of cannabis use in problematic users and whether adding psychological support increases its effectiveness.

TRIAL REGISTRATION

This trial is registered with the Clinical Trials Protocol Registration and Results System (PRS) number: NCT04517474 . Registered 18 August 2020, (Archived by archive.is https://archive.is/N1Y64 ). The project commenced in November 2020 and recruitment is anticipated to end by November 2022.

Legalization of recreational cannabis: Facilitators and barriers to switching from an illegal to a legal source

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Limiting surveillance, quantity limits, and preserving anonymity is a facilitator.

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Competitive pricing from the illicit market and heavy regulation are barriers.

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Loyalty to current illicit suppliers is a barrier to switching to a licit market.

Illicit markets persist in places where recreational cannabis has been legalized. This study aimed to identify perceived facilitators/barriers of switching from an illicit to a licit cannabis source. Using a cross-sectional qualitative approach, 529 students, from one New Zealand university, completed a survey investigating the facilitators/barriers to switching through two open-ended questions. Perceived facilitators for switching included: safety (63.1%); price (42.7%); legal, no risk of convictions (35.3%); increased accessibility (32.3%); product diversity (14.2%). Perceived barriers included: price (66.4%); judgement (36%); regulation (28.9%); loyalty to current supplier (27.2%); reduced accessibility (13.2%). The findings provide recommendations for policies aimed at tipping people in favor of a licit over an illicit source. Avoiding arrest/convictions, and easier access, were not primary facilitators for switching. Thus, providing a licit market might be insufficient in the absence of other competitive factors, such as communicating improved product safety. Competitive pricing and regulation (tetrahydrocannabinol strength/quantity limits) were also barriers. Given legal markets aimed at minimizing harm are constrained with competing in these areas, it is significant that our findings identified other barriers which could be overcome, including limiting surveillance and quantity limits and positioning stores to preserve anonymity. The findings also highlight that loyalty to current illicit suppliers will be a significant barrier.