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Matthay EC, Mousli LM, Sun C, Lewis J, Jacobs LM, Heard S, Ho R, Schmidt LA, Apollonio DE. Associations of Local Cannabis Control Policies With Harmful Cannabis Exposures Reported to the California Poison Control System. Epidemiology 2024; 35:447-457. [PMID: 38912711 PMCID: PMC11191557 DOI: 10.1097/ede.0000000000001737] [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: 07/19/2023] [Accepted: 03/18/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Cannabis exposures reported to the California Poison Control System increased following the initiation of recreational cannabis sales on 1 January 2018 (i.e., "commercialization"). We evaluated whether local cannabis control policies adopted by 2021 were associated with shifts in harmful cannabis exposures. METHODS Using cannabis control policies collected for all 539 California cities and counties in 2020-2021, we applied a differences-in-differences design with negative binomial regression to test the association of policies with harmful cannabis exposures reported to California Poison Control System (2011-2020), before and after commercialization. We considered three policy categories: bans on storefront recreational retail cannabis businesses, overall restrictiveness, and specific recommended provisions (restricting product types or potency, packaging and labeling restrictions, and server training requirements). RESULTS Localities that ultimately banned storefront recreational retail cannabis businesses had fewer harmful cannabis exposures for children aged <13 years (rate ratio = 0.82; 95% confidence interval = 0.65, 1.02), but not for people aged >13 years (rate ratio = 0.97; 95% confidence interval = 0.85, 1.11). Of 167 localities ultimately permitting recreational cannabis sales, overall restrictiveness was not associated with harmful cannabis exposures among children aged <13 years, but for people aged >13 years, a 1-standard deviation increase in ultimate restrictiveness was associated with fewer harmful cannabis exposures (rate ratio = 0.93; 95% confidence interval = 0.86, 1.01). For recommended provisions, estimates were generally too imprecise to detect associations with harmful cannabis exposures. CONCLUSION Bans on storefront retail and other restrictive approaches to regulating recreational cannabis may be associated with fewer harmful cannabis exposures for some age groups following statewide commercialization.
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Affiliation(s)
- Ellicott C. Matthay
- From the Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Leyla M. Mousli
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Chloe Sun
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Justin Lewis
- California Poison Control System, School of Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Laurie M. Jacobs
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Stuart Heard
- California Poison Control System, School of Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Raymond Ho
- California Poison Control System, School of Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Laura A. Schmidt
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, San Francisco, CA
- Department of Humanities and Social Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Dorie E. Apollonio
- School of Pharmacy, University of California, San Francisco, San Francisco, CA
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Dawson D, Stjepanovic D, Lorenzetti V, Hall WD, Leung J. How much cannabis is used in a joint in Australia? An experimental investigation into use by potency and frequency. Drug Alcohol Rev 2024; 43:226-232. [PMID: 37717253 DOI: 10.1111/dar.13747] [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: 03/20/2023] [Revised: 07/13/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Cannabis use is highly prevalent in Australia, yet current survey metrics measure tetrahydrocannabinol (THC) exposure with limited accuracy. Often survey items measure cannabis quantity by assuming specific modes of use (i.e., 'how many joints do you use?'), which fail to capture variations in cannabis use and the diverse modes of use (e.g., joints, cones, spliffs). This study investigated how much cannabis is used in these modes of administration in an Australian sample. METHODS Participants (N = 31, Mage = 25.77; 51% university students) completed the Roll a Joint Paradigm in which they rolled joints, spliffs and packed cones as they would typically, using oregano as 'cannabis.' Participants then prepared each again but with cannabis of higher or lower potency. RESULTS The amount of cannabis used across different modes of administration was variable: joints (range 0.10-1.25 g), spliffs (range 0.12-1.21 g) and cones (range 0.03-0.41 g). Participants who used cannabis daily rolled three times the amount of cannabis into a joint. DISCUSSION AND CONCLUSIONS The amount of cannabis used in common modes of administration may be highly variable. Daily use may be associated using larger quantities of cannabis. Titration attempts based on potency were not proportional or consistent across modes of administration. The results indicate people may adjust the quantity of cannabis based on perceived potency, however, not proportional to THC concentration. Inconsistency in the amount of cannabis used based on potency and within different modes of administration may represent a problem for self-report metrics which ask participants to report cannabis use in joints.
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Affiliation(s)
- Danielle Dawson
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Daniel Stjepanovic
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- Queensland Alliance for Environmental Health Science, The University of Queensland, Brisbane, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
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Van Halm-Lutterodt N, Albright JA, Storlie NR, Mesregah MK, Ansari K, Balmaceno-Criss M, Daher M, Bartels-Mensah M, Xu Y, Diebo BG, Hai Y, Chandler DR, Daniels AH. Cannabis use Disorder and Complications After Anterior Cervical Diskectomy and Fusion. World Neurosurg 2024; 181:e1001-e1011. [PMID: 37956902 DOI: 10.1016/j.wneu.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE The aim of this study, a retrospective database analysis, was to assess the impact of baseline cannabis use disorder (CUD) on perioperative complication outcomes in patients undergoing primary 1- to 2-level anterior cervical diskectomy and fusion (ACDF) surgery. METHODS The PearlDiver Database was queried from January 2010 to December 2021 for patients who underwent primary 1- to 2-level ACDF surgery for degenerative spine disease. Patients with CUD diagnosis 6 months before the index ACDF surgery (i.e., CUD) were propensity matched with patients without CUD (i.e., control in a ratio of 1:1, employing age, gender, and Charlson Comorbidity Index as matching covariates). Univariate and multivariable analysis models with adjustment of confounding variables were used to evaluate the risk of CUD on perioperative complications between the propensity-matched cohorts. RESULTS The 1:1 matched cohort included 838 patients in each group. Following multivariate analysis, CUD was demonstrated to be associated with an increased incidence of hospital readmission at 90 days (odds ratio [OR] = 2.64, 95% confidence interval: [1.19 to 6.78], [P = 0.027]) and revision surgery at 1 year postoperative (OR = 3.36, 95% confidence interval: [1.17 to 14.18], [P = 0.049]). CUD was additionally associated with reduced risk of overall medical complications at both 6 months and 1 year postoperative (OR = 0.55, [P = 0.021], and OR = 0.54, [P = 0.015], respectively). CONCLUSIONS These findings indicate that isolated baseline CUD is associated with an increased risk of hospital readmission at 90 days postoperative and cervical spine reoperation at 1 year after primary 1- to 2-level ACDF surgery with a decrease in overall medical complications, cardiac arrhythmias, and acute renal failure.
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Affiliation(s)
- Nicholas Van Halm-Lutterodt
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA; School of Public Health and Professional Studies, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA; Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Orthopedics Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - J Alex Albright
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | | | - Mohamed Kamal Mesregah
- Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
| | - Kashif Ansari
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA; Department of Economics, Brown University, Providence, Rhode Island, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA; The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Mohammad Daher
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Mercy Bartels-Mensah
- Department of Clinical Sciences, University of Debrecen School of Medicine, Debrecen, Hungary
| | - Yulun Xu
- Department of Neurological Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bassel G Diebo
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - David Ray Chandler
- School of Public Health and Professional Studies, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA; Andrews Institute of Orthopedics and Sports Medicine, Gulf Breeze, Florida, USA
| | - Alan H Daniels
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA.
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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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Skumlien M, Craft S. Commentary on Allaf et al.: Comparing countries with different legal cannabis markets can inform on the impact of regulating product type and potency. Addiction 2023; 118:2275-2276. [PMID: 37544881 PMCID: PMC10952587 DOI: 10.1111/add.16312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Martine Skumlien
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
| | - Sam Craft
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
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Affiliation(s)
- Tom P Freeman
- Addiction and Mental Health Group, Department of Psychology, University of Bath, Bath, UK
| | - Wayne Hall
- National Centre for Youth Substance Use Research, University of Queensland, St Lucia, QLD, Australia
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Hall W, Hoch E. Minimizing double standards in assessing the adverse and beneficial effects of cannabis. Addiction 2023; 118:1606-1608. [PMID: 37331720 DOI: 10.1111/add.16267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023]
Affiliation(s)
- Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
| | - Eva Hoch
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
- IFT Institut für Therapieforschung, Centre of Health and Addiction Research, Munich, Germany
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Pardal M, Wadsworth E. Strictly regulated cannabis retail models with state control can provide lessons in how jurisdictions can regulate THC. Addiction 2023; 118:1005-1007. [PMID: 36992661 DOI: 10.1111/add.16182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Mafalda Pardal
- RAND Europe, Brussels, Belgium
- Ghent University, Ghent, Belgium
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Caulkins JP. The virtues of bans on high-THC content cannabis products? Addiction 2023; 118:1004-1005. [PMID: 36709770 DOI: 10.1111/add.16131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
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