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Carnide N, Chrystoja BR, Lee H, Furlan AD, Smith PM. Cannabis use motives and associations with personal and work characteristics among Canadian workers: a cross-sectional study. J Occup Med Toxicol 2024; 19:25. [PMID: 38872177 DOI: 10.1186/s12995-024-00424-7] [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: 03/27/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Research on cannabis use motives has focused on youth. Little is known about motives among working adults, including how work may play a role. This study aimed to describe cannabis use motives and their connection to work, and identify the personal and work correlates of work-related motives among a sample of workers. METHODS A national, cross-sectional sample of Canadian workers were queried about their cannabis use. Workers reporting past-year cannabis use (n = 589) were asked their motives for using cannabis and whether each motive was related to work or helped them manage at work (i.e., work-related). Multinomial logistic regression analyses were conducted to estimate the associations of personal and work characteristics with work-related cannabis use motives (no work-related motives, < 50% of motives work-related, ≥ 50% of motives work-related). RESULTS Use for relaxation (59.3%), enjoyment (47.2%), social reasons (35.3%), coping (35.1%), medical reasons (30.9%), and sleep (29.9%) were the most common motives. Almost 40% of respondents reported one or more of their cannabis use motives were work-related, with coping (19.9%) and relaxation (16.3%) most commonly reported as work-related. Younger age, poorer general health, greater job stress, having a supervisory role, and hazardous work were associated with increased odds of reporting at least some cannabis use motives to be work-related, while work schedule and greater frequency of alcohol use were associated with reduced odds of motives being primarily work-related. CONCLUSIONS Cannabis use motives among workers are diverse and frequently associated with work. Greater attention to the role of work in motivating cannabis use is warranted.
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Affiliation(s)
- Nancy Carnide
- Institute for Work & Health, 400 University Avenue, Suite 1800, Toronto, ON, M5G 1S5, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada.
| | - Bethany R Chrystoja
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Hyunmi Lee
- Institute for Work & Health, 400 University Avenue, Suite 1800, Toronto, ON, M5G 1S5, Canada
| | - Andrea D Furlan
- Institute for Work & Health, 400 University Avenue, Suite 1800, Toronto, ON, M5G 1S5, Canada
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, room 7- 141, Toronto, ON, M5G 2A2, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, 3rd floor, Toronto, ON, M5S 3H2, Canada
| | - Peter M Smith
- Institute for Work & Health, 400 University Avenue, Suite 1800, Toronto, ON, M5G 1S5, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada
- Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Das A, Hendershot CS, Husain MI, Knyahnytska Y, Elsaid S, Le Foll B, Kloiber S. Perceptions, Experiences, and Patterns of Cannabis Use in Individuals with Mood and Anxiety Disorders in the Context of Cannabis Legalization and Medical Cannabis Program in Canada - A Qualitative Study. PHARMACOPSYCHIATRY 2024; 57:141-151. [PMID: 38467156 DOI: 10.1055/a-2264-1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Perceptions of cannabis as a potential medical treatment for mood and anxiety disorders have been increasing in the context of legalizations, availability, and medical cannabis programs, though current evidence predominately indicates risks and negative effects of cannabis use (CU) on mental health outcomes. This study aims to understand motivations, perceptions, effects, and patterns of CU in individuals with mood and anxiety disorders. METHODS Thirty-six adult patients diagnosed with mood or anxiety disorders, obsessive-compulsive disorder, or posttraumatic stress disorder who were currently using cannabis completed an in-depth qualitative interview on individual motivations, perceptions, experiences, effects, and patterns of their CU. The thematic analysis focused on phases of CU and sources of cannabis products and information. RESULTS Reported motivations for initiation of CU included curiosity, peer pressure, and dissatisfaction with conventional treatments. Factors such as psychotropic effects and coping with mental health symptoms and insomnia contributed to the continuation of CU. More negative effects, including cognitive dysfunction, worsening of mood, and anxiety symptoms, were acknowledged with ongoing CU. Concerning findings included common initiation of CU before age 18, combined medical and recreational CU, rare consultation of medical professionals on CU, and potential effects and harms. DISCUSSION Findings indicate individual complexity of motivations, perceptions, and patterns of CU in the study population. The reported potential beneficial effects of specific cannabis products should be further investigated. Findings emphasize patient-provider dialogue on both CU and conventional treatments. Information from this study can contribute to and inform the development of education, prevention, and intervention strategies.
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Affiliation(s)
- Ankita Das
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Christian S Hendershot
- Department of Psychiatry and Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, NC, USA
| | - M Ishrat Husain
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yuliya Knyahnytska
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Sonja Elsaid
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Bernard Le Foll
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Canada
| | - Stefan Kloiber
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
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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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4
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Amin S, Chae SW, Kawamoto CT, Phillips KT, Pokhrel P. Cannabis use among cancer patients and survivors in the United States: a systematic review. JNCI Cancer Spectr 2024; 8:pkae004. [PMID: 38291891 PMCID: PMC10868394 DOI: 10.1093/jncics/pkae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND How cannabis products are being used by cancer patients and survivors in the United States is poorly understood. This study reviewed observational data to understand the modes, patterns, reasons, discontinuation, and adverse experiences of cannabis use. METHODS PubMed and PsycINFO database searches were conducted between May 2022 and November 2022. Of the 1162 studies identified, 27 studies met the inclusion criteria. The intercoder agreement was strong (0.81). RESULTS The majority (74%) of the studies were cross-sectional in design. Study samples were approximately equal proportions of men and women and majority White participants. The prevalence of cannabis use based on national samples ranged between 4.8% and 22%. The most common modes of cannabis intake were topical application (80%), smoking (73%), vaping (12%), and ingestion of edible products (10%). Younger age, male gender, being a current or former smoker, and higher socioeconomic status were associated with greater likelihood of cannabis use. The main motive for cannabis use was management of symptoms due to cancer or cancer treatment such as pain, nausea, lack of sleep, and anxiety. A majority of the participants across studies reported that cannabis helped reduce these symptoms. Lack of symptom improvement, side effects such as fatigue and paranoia, cost, and social stigma were identified as some of the reasons for discontinuing cannabis use. CONCLUSIONS It appears that cannabis may help cancer patients and survivors manage symptoms. However, more longitudinal studies are needed to determine whether positive experiences of cannabis use outweigh adverse experiences over time in this vulnerable population.
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Affiliation(s)
- Samia Amin
- Population Sciences Program, University of Hawaiʻi Cancer Center, University of Hawaiʻi at Manoa, Honolulu, HI, USA
| | - Si Woo Chae
- Population Sciences Program, University of Hawaiʻi Cancer Center, University of Hawaiʻi at Manoa, Honolulu, HI, USA
| | - Crissy T Kawamoto
- Population Sciences Program, University of Hawaiʻi Cancer Center, University of Hawaiʻi at Manoa, Honolulu, HI, USA
| | - Kristina T Phillips
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Pallav Pokhrel
- Population Sciences Program, University of Hawaiʻi Cancer Center, University of Hawaiʻi at Manoa, Honolulu, HI, USA
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5
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Conn BM, Brammer WA, Choi S, Fedorova EV, Ataiants J, Lankenau SE, Wong CF. Mental and Physical Health-Related Cannabis Motives Mediate the Relationship between Childhood Trauma and Problematic Cannabis Use over Time among Emerging Adult Cannabis Users. Subst Use Misuse 2023; 59:193-207. [PMID: 37822106 PMCID: PMC10842029 DOI: 10.1080/10826084.2023.2267111] [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: 10/13/2023]
Abstract
BACKGROUND While growing evidence has identified mental and physical health-related cannabis use motives as significant mechanisms between childhood trauma and problematic cannabis use (PCU) for emerging adults (EA), there is a need to understand the longitudinal stability of these pathways and how they impact PCU as cannabis users age into later adulthood. METHODS The current study extends an analysis examining the impact of childhood trauma (e.g., emotional abuse, sexual abuse) on multiple indicators of PCU through a range of cannabis use motives. 339 medical cannabis patient and non-patient EA users from the Los Angeles area were sampled at baseline (mean age = 21.23; SD = 2.48). The present analysis used four waves of follow-up data collected from 2016 to 2018 (W3, W4) and 2019-2020 (W5, W6). RESULTS Use of cannabis to cope with nausea, sleep, pain, and emotional distress mediated the relationships between some types of childhood abuse and PCU at W4, though most associations attenuated by later adulthood (W6). Specifically, greater emotional distress and nausea motives were associated with greater PCU in models of emotional abuse and neglect and sexual abuse, with emotional distress continuing to mediate at W6. Conversely, sleep and pain motives were associated with lower PCU in models for emotional neglect. CONCLUSIONS Mental and physical health-related motives reflect potential intervenable factors that predict PCU in emerging adulthood among EA cannabis users with histories of childhood trauma. Results highlight the importance of and value for assessing a wide range of motives and PCU outcomes to target and address areas for intervention.
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Affiliation(s)
- Bridgid M Conn
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Whitney A Brammer
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Susie Choi
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Ekaterina V Fedorova
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Carolyn F Wong
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
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6
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DiGuiseppi GT, Fedorova EV, Lankenau SE, Davis JP, Wong CF. Egocentric Network Characteristics and Cannabis Use in a Sample of Young Adult Medical Cannabis Patients and Nonpatient Users. J Stud Alcohol Drugs 2022; 83:802-811. [PMID: 36484577 PMCID: PMC9756408 DOI: 10.15288/jsad.21-00286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 05/13/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Social factors play an important role in young adults' substance use behaviors, but little is known about how egocentric social network factors are related to young adults' cannabis use. Young adults also report medicinal and recreational uses of cannabis, which may alter the strength of these relationships. Therefore, medical cannabis patient status and medicinal/recreational orientation toward cannabis were examined as moderators of these relationships. METHOD Young adult medical cannabis patients (n = 182) and nonpatient users (n = 157) were surveyed in Los Angeles in 2015-2016 about their cannabis use, orientation (medicinal and/or recreational), and egocentric networks (cannabis use network size, social support network size, descriptive and injunctive norms). Regression models examined associations between network characteristics and past-90-day use and problematic use, and tested interactions between network characteristics and both patient status and cannabis use orientation. RESULTS Only descriptive norms (adjusted incidence rate ratio [aIRR] = 1.19, 95% confidence interval [CI] [1.06, 1.33]) were associated with more frequent use, but not problematic use. Descriptive norms interacted with cannabis use orientation: descriptive norms were positively associated with cannabis use days among medicinally oriented users (aIRR = 1.22, 95% CI [1.02, 1.46]). However, this relationship was stronger for recreationally oriented users (aIRR = 1.62, 95% CI [1.31, 2.01]). No interactions were found predicting problematic use. CONCLUSIONS Descriptive cannabis use norms among one's personal network members are an important variable predicting young adults' cannabis use, but not problematic use. Perceived descriptive norms may be a stronger motivator to use for recreational users than medicinal users.
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Affiliation(s)
- Graham T. DiGuiseppi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Ekaterina V. Fedorova
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Stephen E. Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Jordan P. Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Carolyn F. Wong
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
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7
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Brammer WA, Conn BM, Iverson E, Lankenau SE, Dodson C, Wong CF. Coping Motives Mediate the Association of Trauma History with Problematic Cannabis Use in Young Adult Medical Cannabis Patients and Non-Patient Cannabis Users. Subst Use Misuse 2022; 57:684-697. [PMID: 35193442 PMCID: PMC11148629 DOI: 10.1080/10826084.2022.2026970] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Despite evidence of the contribution of childhood trauma to the development of problematic cannabis use, its mediating pathways are largely unknown. Given the link between cannabis motives with trauma and problematic cannabis use, motives of use may represent a construct through which trauma impacts problematic cannabis use. Methods: A sample of 339 medical cannabis patient and non-patient young adult users from the Los Angeles area were sampled at baseline and one year later. The current study examined the impact of childhood trauma on problematic use through a variety of cannabis use motives. Results: Controlling for age, socioeconomic status, perceived stress, and baseline problematic use, endorsing the use of cannabis to cope with distress at baseline uniquely mediated the associations between different childhood trauma types (e.g., physical abuse, neglect, sexual trauma) and problematic use one year later. Experience of any childhood trauma was positively associated with coping motives, whereas emotional and physical abuse were positively associated with pain motives, and sexual abuse was positively associated with sleep motives. Using cannabis for coping and increasing attention/focus were also positively associated with higher problematic use, whereas using cannabis for sleep was inversely associated with problematic use one year later. Conclusions: The motives of coping with distress and inattention may represent intermediate constructs through which trauma leads to later problematic cannabis use. Results highlight the need to clarify the pathways between health and non-health-oriented motives and cannabis use over time.
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Affiliation(s)
- Whitney A Brammer
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Bridgid M Conn
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
- Keck School of Medicine, Department of Pediatrics, University of Southern California, Los Angeles, California, USA
| | - Ellen Iverson
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
- Keck School of Medicine, Department of Pediatrics, University of Southern California, Los Angeles, California, USA
| | - Stephen E Lankenau
- Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, USA
| | - Chaka Dodson
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Carolyn F Wong
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
- Keck School of Medicine, Department of Pediatrics, University of Southern California, Los Angeles, California, USA
- Division of Research on Children, Youth, & Families, Children's Hospital Los Angeles, Los Angeles, California, USA
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8
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Wong CF, Mendez SEA, Conn BM, Iverson E, Lankenau SE. Attitudes and beliefs about recreational cannabis legalization among cannabis-using young adults in Los Angeles: Impact on concurrent cannabis practices and problematic cannabis use. Drug Alcohol Depend 2021; 228:109053. [PMID: 34610520 PMCID: PMC11104431 DOI: 10.1016/j.drugalcdep.2021.109053] [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: 04/10/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study investigated differences in attitudes and beliefs about recreational cannabis legalization (RCL) among cannabis-using young adults comprised of medical cannabis patients (MCP) and non-patient users (NPU). We further investigated whether these variations are associated with concurrent cannabis practices and problematic use. METHOD Cannabis-using young adults (N = 301) were interviewed between 2017 and 2018 - after RCL and through the early months after storefront sales began. Latent class analysis empirically derived groups based on participants' attitudes/beliefs about the impact of RCL. Socio-demographic factors, patient status, medicinal and/or recreational use, and social norms differentiated latent class memberships, while concurrent cannabis practices and problematic use served as distal outcomes. The manual Bolck, Croon, and Hagenaars (BCH) three-step process modeled all covariates and distal outcomes simultaneously in the final LCA solution. RESULTS Three patterns emerged: Impacted (RCL had broad impact on attitudes/beliefs) (n = 113), Partially-Impacted (RCL had some impact on attitudes/beliefs) (n = 131) and Neutral (RCL had no/limited impact) (n = 57). MCP were more likely to be Neutral than Partially-Impacted users while those who reported recreational cannabis use were more likely to be Impacted than Neutral users. Class membership predicted cannabis practices and problematic use with Impacted individuals reporting the greatest recent days of use, number of hits per day, and highest scores in problematic cannabis use compared to Partially-Impacted and Neutral users. CONCLUSION Variability in attitudes/beliefs about RCL served as strong drivers of concurrent cannabis practices and problematic use. Findings provide an important baseline for tracking attitudes/beliefs' long-term health and substance use impact as retail cannabis sales evolve.
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Affiliation(s)
- Carolyn F Wong
- Children's Hospital Los Angeles, Division of Adolescent and Young Adult Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, USA; University of Southern California, Keck School of Medicine, Department of Pediatrics, 4650 Sunset Blvd., MS #71, Los Angeles, CA 90027, USA.
| | - Stephanie E A Mendez
- USC University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS#53, Los Angeles, CA 90027, USA
| | - Bridgid M Conn
- Children's Hospital Los Angeles, Division of Adolescent and Young Adult Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, USA; University of Southern California, Keck School of Medicine, Department of Pediatrics, 4650 Sunset Blvd., MS #71, Los Angeles, CA 90027, USA
| | - Ellen Iverson
- Children's Hospital Los Angeles, Division of Adolescent and Young Adult Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, USA; University of Southern California, Keck School of Medicine, Department of Pediatrics, 4650 Sunset Blvd., MS #71, Los Angeles, CA 90027, USA
| | - Stephen E Lankenau
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA 19104, USA
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9
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Fedorova EV, Wong CF, Conn BM, Ataiants J, Iverson E, Lankenau SE. COVID-19’s Impact on Substance Use and Well-Being of Younger Adult Cannabis Users in California: A Mixed Methods Inquiry. JOURNAL OF DRUG ISSUES 2021; 52:207-224. [PMID: 35382397 PMCID: PMC8919106 DOI: 10.1177/00220426211052673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Few qualitative studies have examined the impact of COVID-19 on cannabis and alcohol use, and overall well-being among cannabis users. Cannabis users (aged 26-32) were surveyed quantitatively (n=158) and interviewed qualitatively (n=29) in April 2020–May 2021 in Los Angeles. 63.3% of the quantitative sample reported increasing use of either cannabis (29.1%) or alcohol (15.2%) or both (19.0%) following the COVID-19 outbreak. Qualitative data revealed that increases in cannabis and alcohol use were largely attributed to changes in employment and staying at home resulting in fewer impediments and boredom. Themes of loneliness and utilization of various coping strategies were more pronounced among those who increased cannabis and/or alcohol use. For some, increases in cannabis/alcohol use were temporary until participants adjusted to “a new normal” or embraced more adaptive coping strategies. Results suggest monitoring cannabis/alcohol use trends and identifying coping strategies to reduce the pandemic’s impact on substance use and mental health.
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Affiliation(s)
- Ekaterina V. Fedorova
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Carolyn F. Wong
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Adolescent Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, United States
- Division of Research on Children, Youth, & Families, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Bridgid M. Conn
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Adolescent Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Ellen Iverson
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Adolescent Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Stephen E. Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
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10
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Manu E, Douglas M, Ntsaba MJ. Theoretical understanding of contextual motivations for sustained adolescent marijuana use in South Africa. S Afr J Psychiatr 2021; 27:1615. [PMID: 34394975 PMCID: PMC8335752 DOI: 10.4102/sajpsychiatry.v27i0.1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 05/03/2021] [Indexed: 12/04/2022] Open
Abstract
Background Although various reasons for adolescent marijuana use have extensively been explored, contextual factors that sustain the practice in settings where the plant is illegally cultivated, especially in South Africa, remain a grey area. Aim We aimed to explore the contextual factors of sustained adolescent marijuana use in two illicit marijuana-growing settings of the Ingquza Hill Local Municipality of South Africa, based on the differential opportunity theory (DOT) and subcultural theory (SCT). Setting The study was conducted in two illicit marijuana-growing communities in the Ingquza Hill Local Municipality of the Eastern Cape Province of South Africa. Methods Exploratory qualitative research, using focus group discussions approach, was conducted amongst 37 participants, four focus groups and in two communities in the Ingquza Hill Municipality of the Eastern Cape Province of South Africa. Purposive and snowball sampling techniques were used to select the communities and participants, respectively. The data were analysed using a thematic content analysis approach and presented under various themes. Results Nine themes, grouped under two broad factors, DOT influences (availability and affordability of marijuana, idleness and means of dealing with personal problems) and SCT influences (peer conformity, the pleasure derived from marijuana smoking, manipulation of appetite, health reasons, for higher cognitive function and addiction), emerged from the analysis. Conclusion As marijuana has been identified to be a gateway drug for the use of other illicit drugs, its sustained usage amongst adolescents poses a health challenge to the user, community and the country’s healthcare system at large. Hence, there is the need to intensify adolescent marijuana use prevention campaigns in illicit marijuana-growing contexts of South Africa, focussing on the differential opportunities and subcultural inclinations that promote the behaviour in those contexts.
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Affiliation(s)
- Emmanuel Manu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Mbuyiselo Douglas
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Mohlomi J Ntsaba
- Department of Nursing, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
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11
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An Exploration of Self-Reported Medicinal Cannabis Use Among a Sample of Eastern Canadian Postsecondary Students. J Behav Health Serv Res 2021; 49:487-499. [PMID: 34240307 DOI: 10.1007/s11414-021-09763-3] [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] [Accepted: 06/13/2021] [Indexed: 01/29/2023]
Abstract
In October 2018, prior to the legalization of cannabis in Canada, a survey was completed by 1050 Memorial University of Newfoundland students. Both descriptive quantitative and thematic qualitative data analyzes were used. Approximately 16% of the sample reported ever using cannabis for medicinal purposes (n=175), with only 16.6% of medicinal users reporting authorization by a healthcare provider (HCP). The majority (80.2%) were aware of possible side effects of cannabis. Prior personal experience (65.3%) and peer influence (59.5%) informed participants' medicinal use. Approximately 40% reported having replaced/reduced prescribed medication. Roughly 60% of medicinal users had not disclosed their use to their HCP. Consistent with previous studies, medicinal cannabis use among postsecondary students appears to be largely motivated for mental health related conditions and is grounded in personal experience versus evidence-based guidelines. There is a need for increased communication between HCPs and patients to promote lower-risk use among medicinal cannabis users.
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12
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Fedorova EV, Ataiants J, Wong CF, Iverson E, Lankenau SE. Changes in Medical Cannabis Patient Status before and after Cannabis Legalization in California: Associations with Cannabis and Other Drug Use. J Psychoactive Drugs 2021; 54:129-139. [PMID: 34044753 DOI: 10.1080/02791072.2021.1926604] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
It is unknown how patterns of cannabis and other drug use changed among young adult cannabis users as they became, exited or stayed medical cannabis patients (MCPs) after California legalized cannabis for adult use in 2016. A cohort of 18-26 year-old cannabis users was recruited in Los Angeles in 2014-15 (64.8% male; 44.1% Hispanic/Latinx). Based on wave 1 (pre-legalization) and wave 4 (post-legalization) MCP status, four transition groups emerged: MCP, Into MCP, Out of MCP and NPU (non-patient user). Relationships between self-reported medical cannabis use, transition group membership, and cannabis/other drug use outcomes were examined. Changes in cannabis practices were consistent with changes in MCP status. Cannabis days, concentrate use, self-reported medical cannabis use and driving under influence of cannabis were highest among MCP, increased for Into MCP, and decreased for Out of MCP in wave 4. A majority of drug use outcomes decreased significantly by wave 4. Self-reported medical cannabis use was associated with more frequent cannabis use but less problematic cannabis and other drug use. Future studies should continue to monitor the impact of policies that legalize cannabis for medical or recreational use, and medical motivations for cannabis use on young adults' cannabis and other drug use.
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Affiliation(s)
- Ekaterina V Fedorova
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Janna Ataiants
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Carolyn F Wong
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.,Division of Adolescent Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Division of Research on Children, Youth, & Families, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ellen Iverson
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.,Division of Adolescent Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
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13
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Hummer JF, Seelam R, Pedersen ER, Tucker JS, Klein DJ, D'Amico EJ. Why Young Adults Obtain a Medical Marijuana Card: Associations with Health Symptoms and Heaviness of Use. ACTA ACUST UNITED AC 2021; 4:27-39. [PMID: 34179729 PMCID: PMC8232346 DOI: 10.26828/cannabis/2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective. Prior studies documenting more frequent and problematic use among young adults who have acquired medical marijuana (MM) cards have broadly compared those who use medically to those who use recreationally. Gaining a better picture of how health symptoms and problematic use vary both within those who have a MM card for specific condition domains and between those who do not have a MM card can provide key information for medical practitioners and states interested in adopting or updating MM policies. Method. The current study categorizes young adults authorized to use MM into three mutually exclusive groups based on endorsements of qualifying conditions: (1) Physical Health only (e.g., AIDS, arthritis, cancer; n = 34); (2) Behavioral Health only (e.g., anxiety, depression, sleep problems; n = 75); and (3) Multiple Conditions (a physical and behavioral health condition; n = 71). Multiple and logistic regression models examined differences across marijuana use, problems, mental health, physical health, and sleep quality for MM condition categories and for those that only use marijuana recreationally (n = 1,015). Results. After adjusting for socio-demographic factors (age, sex, sexual orientation, educational status, employment status, race/ethnicity, mother’s education, prior intervention involvement in youth), MM card holders, particularly those with physical health or multiple health conditions, reported heavier, more frequent, and more problematic and risky marijuana use compared to those using recreationally. Despite this pattern, those in different MM condition categories were generally not found to be more symptomatic in domains of mental or physical health relevant to their respective conditions, compared to different category groups or to those using recreationally. Conclusions. Findings emphasize the importance of providers conducting a careful assessment of reasons for needing a card, along with use, to reduce potential harms while adding credibility to a medical movement with genuine promise of relief for many medical conditions.
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Affiliation(s)
- Justin F Hummer
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407
| | - Rachana Seelam
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407
| | - Eric R Pedersen
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407.,University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, 2250 Alcazar Street, Suite 2200, Los Angeles, CA 90033
| | - Joan S Tucker
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407
| | - David J Klein
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407
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14
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Fedorova EV, Wong CF, Ataiants J, Iverson E, Conn B, Lankenau SE. Cannabidiol (CBD) and other drug use among young adults who use cannabis in Los Angeles. Drug Alcohol Depend 2021; 221:108648. [PMID: 33676073 PMCID: PMC8462788 DOI: 10.1016/j.drugalcdep.2021.108648] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Cannabidiol (CBD) is purportedly a promising therapeutic agent to provide relief for a variety of medical conditions with mild or no psychoactive effects. However, little is known about young adults who use cannabis and CBD-dominant products, and associations between CBD use and other drug use. METHODS Young adults (aged 24-32) who currently used cannabis (n = 239) were surveyed in Los Angeles in March 2019 through March 2020. The sample was divided into CBD-dominant (at least 1:1 CBD:THC ratio) and THC-dominant product users. We described CBD forms, reasons and conditions for CBD use and examined between-group differences in sociodemographic characteristics, cannabis practices, health and other drug use. RESULTS CBD-dominant users were more likely to be female, use cannabis at lower frequency and amount (except for edible/drinkable/oral products), self-report medical motivation for cannabis use, use cannabis for pain and report more health problems. Oil, flower, topicals and sprays/drops/tinctures were the most prevalent CBD forms. Psychological problems and pain were commonly reported conditions and medical reasons for CBD use. CBD-dominant users were more likely to report illicit drug use, where psilocybin use was markedly different between the two groups. CONCLUSIONS CBD use was associated with health histories and motivations linked to pain and psychological problems. Positive association between CBD use and illicit drug use may indicate self-medication for psychological conditions. Future studies should evaluate the effectiveness of various CBD forms and dose regimens for treatment of pain and psychological problems, and as a potential intervention for decreasing other drug use and associated harms.
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Affiliation(s)
- Ekaterina V. Fedorova
- Drexel University, Dornsife School of Public Health,
Department of Community 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
| | - Janna Ataiants
- Drexel University, Dornsife School of Public Health,
Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA
19104, United States
| | - Ellen Iverson
- 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
| | - Bridgid Conn
- University of Southern California, Keck School of Medicine,
Department of Pediatrics, 4650 Sunset Blvd., Los Angeles, CA 90027, United
States
| | - Stephen E. Lankenau
- Drexel University, Dornsife School of Public Health,
Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA
19104, United States
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15
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Ataiants J, Fedorova EV, Wong CF, Iverson E, Gold JI, Lankenau SE. Pain Profiles among Young Adult Cannabis Users: An Analysis of Antecedent Factors and Distal Outcomes. Subst Use Misuse 2021; 56:1144-1154. [PMID: 33882778 PMCID: PMC8249053 DOI: 10.1080/10826084.2021.1910707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pain is a primary reason for medical cannabis use among young adults, however little is known about the patterns of pain in this group. This study identified pain profiles among young adult cannabis users and examined related antecedents and distal outcomes. METHODS Past 30-day cannabis users aged 18-26, both medical cannabis patients and non-patients, were enrolled in Los Angeles in 2014-2015. A latent class analysis was used to identify pain classes based on history of chronic pain conditions and recent non-minor pain. The study assessed the predictors of membership in pain classes and examined the association of classes with recent mental health characteristics, cannabis use motives and practices. RESULTS Three classes were identified: Low pain (56.3%), Multiple pain (27.3%), and Nonspecific pain (16.4%). In adjusted models, lifetime insomnia was associated with membership in Multiple pain and Nonspecific pain classes versus the Low pain class. Medical cannabis patients and Hispanics/Latinos were more likely to belong to the Multiple pain class than the other classes. Regarding recent outcomes, the Multiple pain and Nonspecific pain classes were more likely than the Low pain class to use cannabis to relieve physical pain. Additionally, the Multiple pain class had a higher probability of psychological distress, self-reported medical cannabis use, consuming edibles, and using cannabis to sleep compared to one or both other classes. CONCLUSION Findings suggest that young adult cannabis users can be separated into distinct groups with different pain profiles. The Multiple pain profile was associated with medically-oriented cannabis use motives and practices.
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Affiliation(s)
- Janna Ataiants
- Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ekaterina V Fedorova
- Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, USA
| | - Carolyn F Wong
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Ellen Iverson
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Jeffrey I Gold
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Psychiatry & Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Anesthesiology Critical Care Medicine, The Saban Research Institute at Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Stephen E Lankenau
- Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, USA
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16
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Fedorova EV, Schrager SM, Robinson LF, Roth AM, Wong CF, Iverson E, Lankenau SE. Developmental trajectories of illicit drug use, prescription drug misuse and cannabis practices among young adult cannabis users in Los Angeles. Drug Alcohol Rev 2020; 39:743-752. [PMID: 32390280 PMCID: PMC7652718 DOI: 10.1111/dar.13078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 03/27/2020] [Accepted: 04/05/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Young adults have the highest rates of drug use and contribute significantly to the growing population of medical cannabis patients (MCP). This study examined relationships between longitudinal patterns of illicit/prescription drug use/misuse and cannabis practices among young adult cannabis users. DESIGN AND METHODS In 2014-2015, 210 young adult MCP and 156 nonpatient users were recruited in Los Angeles and surveyed annually over four waves. The analytical sample was limited to completers of all four waves (n = 301). Distinct developmental trajectories of illicit drug use and prescription drug misuse were identified. Fixed effects regression analysis evaluated changes in cannabis practices by trajectory groups. RESULTS Results supported two-trajectory solutions (high/low) for illicit drug use and prescription drug misuse. Decreases in use within all four trajectories occurred by wave 4. Low illicit drug use trajectory members were more likely to self-report medical cannabis use. Membership in both types of high-use trajectories was associated with use of concentrates and edibles. The prevalence of MCP, edibles use and cannabis days decreased significantly by wave 4. DISCUSSION AND CONCLUSIONS While alternative cannabis forms use was associated with membership in high drug use trajectories, self-reported medical cannabis use (not MCP) was negatively associated with high illicit drug use trajectory membership. Reductions in the prevalence of MCP, cannabis days, edibles use and other drug use by wave 4 alongside stable levels of self-reported medical cannabis use might reflect the changing legal status of cannabis in California, maturing out phenomenon and safer patterns of cannabis use.
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Affiliation(s)
- Ekaterina V Fedorova
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Sheree M Schrager
- Department of Research and Sponsored Programs, California State University Northridge, Los Angeles, USA
| | - Lucy F Robinson
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Alexis M Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Carolyn F Wong
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA
- Division of Adolescent Medicine, Children's Hospital Los Angeles, Los Angeles, USA
- Division of Research on Children, Youth, and Families, Children's Hospital Los Angeles, Los Angeles, USA
| | - Ellen Iverson
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA
- Division of Adolescent Medicine, Children's Hospital Los Angeles, Los Angeles, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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17
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Goodhines PA, LaRowe LR, Gellis LA, Ditre JW, Park A. Sleep-Related Cannabis Expectancy Questionnaire (SR-CEQ): Initial Development among College Students. J Psychoactive Drugs 2020; 52:401-411. [PMID: 32772641 DOI: 10.1080/02791072.2020.1800151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A growing body of literature demonstrates that cannabis is commonly used to aid sleep. Consistent with social cognitive theory, there is a vast literature documenting the role of outcome expectancies in the initiation, progression, and maintenance of cannabis use. Despite the readily endorsed belief that cannabis will help improve sleep, sleep-related expectancies have not been included in widely used cannabis expectancy measures. This study aimed to develop and provide preliminary psychometric evaluation of the Sleep-Related Cannabis Expectancy Questionnaire (SR-CEQ). Cross-sectional data were drawn from N= 166 college students (M age = 18.83 [SD = 1.06; range: 18-24], 34% male, 71% White). Students completed an online survey including demographics and the 12-item SR-CEQ. Exploratory Factor Analysis identified two factors representing Negative Sleep-Related Cannabis Expectancies and Positive Sleep-Related Cannabis Expectancies. Confirmatory Factor Analysis demonstrated adequate fit of the two-factor measurement model to observed data (SRMR = 0.08). Students endorsed greater positive (versus negative) sleep-related cannabis expectancies on average, and male students reported significantly greater negative expectancies (but not positive expectancies) compared to female students. The SR-CEQ is the first cannabis expectancy assessment tool specific to sleep-related cannabis outcomes. Ongoing psychometric validation of the SR-CEQ is needed to assess convergent/predictive validity and replicate findings among relevant clinical samples.
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Affiliation(s)
| | - Lisa R LaRowe
- Department of Psychology, Syracuse University , Syracuse, NY, USA
| | - Les A Gellis
- Department of Psychology, Syracuse University , Syracuse, NY, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University , Syracuse, NY, USA
| | - Aesoon Park
- Department of Psychology, Syracuse University , Syracuse, NY, USA
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18
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Depression level, not pain severity, is associated with smoked medical marijuana dosage among chronic pain patients. J Psychosom Res 2020; 135:110130. [PMID: 32417435 DOI: 10.1016/j.jpsychores.2020.110130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The use of medical marijuana (MM) for the treatment of chronic pain is rapidly growing in the United States and Europe; however there is concern regarding the specificity of its therapeutic effects and the motivation underlying its use. While research indicates that among chronic pain prescribed opioids, depression has been associated with increased opioid dosage (regardless of pain levels), the extent to which depression and pain each contribute to MM dose among chronic pain patients is yet unknown. METHODS This cross-sectional study included 209 chronic pain patients prescribed smoked MM, in flower or other plant form, with no concurrent opioid treatment. Ordinal regression analyses were performed in order to explore the unique contribution of mean pain level (1-10 scale), depression severity (measured by the Patient Health Questionnaire (PHQ-9)) and anxiety severity (measured by the Generalized Anxiety Disorder scale (GAD-7)) to doses of MM, while taking into account additional sociodemographic and clinical factors. RESULTS Individuals with mild depression and those with moderate to severe depression were at significantly increased odds for using higher doses of MM in grams per month(Adjusted Odds Ratio(AOR) = 2.06,95% Confidence Interval(CI) = 1.05-4.01, and AOR = 5.95,95% CI = 1.97-17.98, respectively) compared to those without depression. In addition, individuals with mild depression were at significantly increased odds for smoking more MM joints daily(AOR = 2.07, 95% CI = 1.01-4.23) compared to individuals without depression. Mean levels of pain or anxiety severity were not significantly associated with either dose measures. CONCLUSIONS Depression and MM dose are highly correlated and should be concurrently addressed during chronic pain treatment.
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19
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Woo JJ, van Reekum EA, Rosic T, Samaan Z. Children and Youth Who Use Cannabis for Pain Relief: Benefits, Risks, and Perceptions. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2020; 11:53-61. [PMID: 32547283 PMCID: PMC7247732 DOI: 10.2147/ahmt.s254264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/24/2020] [Indexed: 12/16/2022]
Abstract
We provide up-to-date perspectives on the benefits and risks of medical cannabis for pain management in children and youth. To date, only two studies (a case report and a small observational study) have examined the effects of medical cannabis on pain in children and youth. No controlled trial has commented on long-term safety of medical cannabis. Findings from the recreational cannabis literature reveal significant potential short- and long-term risks of regular cannabis use, including impaired driving, depression, suicidality, psychosis, and tolerance. Despite this, many children and youth are self-medicating with cannabis, and perceive regular cannabis use to be safe. There is a need for better education and counselling of patients regarding the benefits and risks of medical cannabis use.
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Affiliation(s)
- Julia J Woo
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Tea Rosic
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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20
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Abstract
In the current study we use a synthetic control group design to estimate the causal effect of a medical marijuana initiative on suicide risk. In 1996, California legalized marijuana use for medical purposes. Implementation was abrupt and uniform, presenting a "natural experiment." Utilizing a panel dataset containing annual frequencies of Total, gun, and non-gun suicides aggregated by state for the years 1970-2004, we construct a control time series for California as a weighted combination of the 41 states that did not legalize marijuana during the analysis period. Post-intervention differences for California and its constructed control time series can be interpreted as the effects of the medical marijuana law on suicide. Significance of the effects were assessed with permutation tests. Our findings suggest that California's 1996 legalization resulted in statistically significant (p<.05) reductions in suicides and gun suicides, but only a non-significant reduction in non-gun suicides (p≥.488). Since the effect for non-gun suicides was indistinguishable from chance, we infer that the overall causal effect was realized through gun suicides. The mechanism could not be determined, however. Participation in the medical marijuana program legally disqualifies participants from purchasing guns. But since most suicides involve guns, it is possible that the effect on total suicide is driven by gun suicide alone.
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Affiliation(s)
- Bradley J Bartos
- Criminology, Law and Society, University of California, Irvine, CA, USA
| | - Charis E Kubrin
- Criminology, Law and Society, University of California, Irvine, CA, USA
| | - Carol Newark
- Criminology, Law and Society, University of California, Irvine, CA, USA
| | - Richard McCleary
- Criminology, Law and Society, University of California, Irvine, CA, USA
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21
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Who's Buying What and How Much? Correlates of Purchase Behaviors From Medical Marijuana Dispensaries in Los Angeles, California. J Prim Prev 2019; 39:571-589. [PMID: 30414021 DOI: 10.1007/s10935-018-0528-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Venue-based distribution of marijuana has become the normative model in the United States to obtain marijuana. This study examines one-time purchase behaviors at medical marijuana dispensaries (MMDs) to identify potential venue- and individual-level targets for prevention. We used a two-stage, venue-based sampling approach to randomly select patrons exiting 16 MMDs in Los Angeles, California during the spring of 2013. Patrons (N = 595) reported their discrete purchase behaviors during their most recent visit to the sampled MMD. We used hierarchical linear modeling to examine the amount spent on marijuana products, regressed on characteristics of the sampled dispensaries and their patrons. We used hierarchical generalized linear modeling to examine the likelihood of purchasing specific types of marijuana products and total grams of loose-leaf buds purchased. Patrons spent US$41.73 on average, with a range of $0-$330. We observed significant variation in purchase behaviors across MMDs and associations between venues located within high median income census tracts and a higher total amount spent and lower odds of purchasing only loose-leaf buds. The networked distance between a patron's home and the sampled MMD was positively associated with the total amount spent and total quantity of buds purchased. We also found significant relationships between medical conditions reported for use in three models: total amount spent, purchase of pre-rolled joints, and total grams of buds purchased. Policy makers may want to explore regulating the availability of specialty items that may be attractive to naïve users, such as pre-rolled joints or edibles, or high-concentration products that may be sought out by regular, heavy users.
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22
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Mader J, Smith JM, Afzal AR, Szeto ACH, Winters KC. Correlates of lifetime cannabis use and cannabis use severity in a Canadian university sample. Addict Behav 2019; 98:106015. [PMID: 31233947 DOI: 10.1016/j.addbeh.2019.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/22/2019] [Accepted: 06/05/2019] [Indexed: 11/30/2022]
Abstract
This study aimed to broaden previous investigations of correlates of lifetime cannabis use and problematic cannabis use among post-secondary students by examining the novel and contemporary issues of medicinal use and deep inhalation practices. The sample included 2212 undergraduate and graduate post-secondary students from Alberta, Canada, who completed the University of Calgary's Campus Experience with Cannabis Survey (average age 23.2, SD = 5.2). Nine variables were entered into the binary logistic regression to examine their differentiation of lifetime users from non-users. A multiple regression model was completed with past six-month users (n = 697), where the continuous dependent variable was cannabis use severity as measured by total scores on the Cannabis Use Disorder Identification Test-Revised. Twenty independent variables were entered simultaneously. Varsity athlete status, family mental illness, severity of alcohol use, greater support for legalization and lower perceived risk associated with regular cannabis use, differentiated lifetime users from non-users. Higher rates of religiosity and living with parents or relatives were associated with lower-lifetime rates. Male gender, earlier age of first cannabis use, cannabis use motives (including coping, enhancement and expansion), past six-month medicinal use and increased frequency of deep inhalation during consumption, were found to be significant correlates of severity. Different factors seem to predict lifetime cannabis use versus severity, and these differences may help inform the development and delivery of prevention efforts. Given that medicinal use and male gender were the largest correlates of severity, populations representing these groups may benefit most from targeted education and prevention.
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Affiliation(s)
- Joel Mader
- University of Calgary, Faculty of Nursing, Univeristy Dr NW, Calgary, AB, Canada.
| | - Jacqueline M Smith
- University of Calgary, Faculty of Nursing, Univeristy Dr NW, Calgary, AB, Canada
| | - Arfan R Afzal
- Alberta Health Services, Government of Alberta, 1331 29 St NW, Calgary, AB, Canada
| | - Andrew C H Szeto
- University of Calgary, 2500 University Dr NW, Calgary, AB, Department of Psychology and Office of the Provost, Canada
| | - Ken C Winters
- Oregon Research Institute (MN Branch), 1575 Northrop St. Falcon Heights, MN 55108, USA
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Kosiba JD, Maisto SA, Ditre JW. Patient-reported use of medical cannabis for pain, anxiety, and depression symptoms: Systematic review and meta-analysis. Soc Sci Med 2019; 233:181-192. [PMID: 31207470 DOI: 10.1016/j.socscimed.2019.06.005] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 05/17/2019] [Accepted: 06/03/2019] [Indexed: 12/20/2022]
Abstract
RATIONALE Certifications for medical cannabis are generally restricted to a small number of specific medical conditions, yet patients frequently report symptoms of pain, anxiety, and depression as reasons for use. This is a critical concern for researchers, healthcare providers, and policymakers, yet research in this area is currently obstructed by the lack of a focused review or empirical synthesis on patient-reported reasons for medical cannabis use. OBJECTIVES AND METHOD: The first aim of this project was to conduct the first systematic review and meta-analysis of empirical studies of patient-reported symptoms of pain, anxiety, and depression as reasons for medical cannabis use. The second aim was to conduct an empirical assessment of the methodological quality of extant research, test for publication bias, and test sex composition and quality scores of individual studies as possible sources of observed heterogeneity. RESULTS Meta-analytic results indicated that pain (64%), anxiety (50%), and depression/mood (34%) were common reasons for medical cannabis use. No evidence for publication bias was detected, despite heterogeneity in prevalence rates. A comprehensive assessment of study quality identified a number of specific methodological limitations of the existing research, including challenges in patient recruitment, use of restrictive sampling frames, and a lack of randomized recruitment methods and validated assessment measures. CONCLUSION Findings are discussed with regard to possible explanations for current results, clinical considerations, and areas of future research that are needed to move the field forward.
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Affiliation(s)
- Jesse D Kosiba
- Department of Psychology, Syracuse University, United States.
| | | | - Joseph W Ditre
- Department of Psychology, Syracuse University, United States
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24
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Fedorova EV, Schrager SM, Robinson LF, Cepeda A, Wong CF, Iverson E, Lankenau SE. Illicit drug use and prescription drug misuse among young adult medical cannabis patients and non-patient users in Los Angeles. Drug Alcohol Depend 2019; 198:21-27. [PMID: 30861391 PMCID: PMC7336713 DOI: 10.1016/j.drugalcdep.2019.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 01/09/2019] [Accepted: 01/13/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Young adults have the highest rates of cannabis and other drug use, as compared to other age groups, and contribute a significant proportion to the total population of medical cannabis patients (MCP). However, little is known about the relationships between various cannabis practices and illicit drug use/prescription drug misuse among young adult cannabis users with and without legal access to medical cannabis. METHODS 210 MCP and 156 non-patient cannabis users (NPU) aged 18-26 were recruited in Los Angeles in 2014-15 for a longitudinal study assessing the impact of medical cannabis on health and substance use among emerging adults. For the present analysis, only quantitative baseline survey data were used. Logistic regression was used to examine the associations between past 90-day cannabis practices and other drug use, including illicit drug use and prescription drug misuse. RESULTS Illicit drug use was associated with being non-Hispanic white (AOR = 3.0, 95% CI 1.8-5.1), use of cannabis concentrates (AOR = 2.8, 95% CI 1.6-4.9), while self-reported medical cannabis use was associated with lower probability of illicit drug use (AOR = 0.5, 95% CI 0.3-0.9). The odds of prescription drug misuse were increased for participants who reported use of cannabis edibles (AOR = 2.0, 95% CI 1.1-3.5), and decreased with age (AOR = 0.9, 95% CI 0.8-1.0) and for those who used cannabis alone (AOR = 0.5, 95% CI 0.3-0.9). CONCLUSION Use of alternative cannabis forms, but not cannabis use frequency, were associated with greater odds of other drug use. Self-reported medical cannabis use, but not MCP status, decreased probability of illicit drug use.
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Affiliation(s)
- Ekaterina V Fedorova
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, United States.
| | - Sheree M Schrager
- Department of Research and Sponsored Programs, California State University Northridge, University Hall 275, 18111 Nordhoff Street, Northridge, CA 91330-8222, United States.
| | - Lucy F Robinson
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, United States.
| | - Alice Cepeda
- School of Social Work, University of Southern California, Montgomery Ross Fisher Building, 669 West 34th Street, Los Angeles, CA 90089, United States.
| | - Carolyn F Wong
- Department of Pediatrics, Keck School of Medicine, University of Southern California, 4650 Sunset Blvd., Los Angeles, CA 90027, United States; Division of Adolescent Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United States; Division of Research on Children, Youth, and Families, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United States.
| | - Ellen Iverson
- Department of Pediatrics, Keck School of Medicine, University of Southern California, 4650 Sunset Blvd., Los Angeles, CA 90027, United States; Division of Adolescent Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United States.
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, United States.
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Chronic Pediatric Pain Management: a Review of Multidisciplinary Care and Emerging Topics. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-0211-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
The evolving legal cannabis landscape in the US continues to present novel regulatory challenges that necessitate the development of a Cannabis Regulatory Science. Two specific issues of concern within Cannabis Regulatory Science are (1) the impact that cannabis use has on the incidence, prevalence, and severity of mental disorders, and (2) how cannabis laws and regulations modify this impact. This paper first provides several conceptual points that are useful for evaluating the relationship between cannabis use and mental disorders. Second, it selectively reviews and comments on data relevant to the relationship between cannabis use and depression, several forms of anxiety, post-traumatic stress disorder, schizophrenia, and bipolar disorder. Next, regulatory and public health parallels between the nascent cannabis industry and the pharmaceutical, tobacco, and alcohol industries are discussed. The focus is on specific types of industry practices that may harm those with or at risk for mental disorders. Recommendations are then offered for legal cannabis regulations that could mitigate this harm. Last, future research goals are discussed for building the field of Cannabis Regulatory Science and addressing the potential negative impact of cannabis on those with mental disorders.
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Affiliation(s)
- Jacob T. Borodovsky
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States,The Dartmouth Institute for Health Policy and Clinical Practice, 74 College St. Hanover, NH 03755, United States
| | - Alan J. Budney
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States
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Kim J, Coors ME, Young SE, Raymond KM, Hopfer CJ, Wall TL, Corley RP, Brown SA, Sakai JT. Cannabis use disorder and male sex predict medical cannabis card status in a sample of high risk adolescents. Drug Alcohol Depend 2018; 183:25-33. [PMID: 29223914 PMCID: PMC6043896 DOI: 10.1016/j.drugalcdep.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 11/21/2017] [Accepted: 11/25/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To examine if a substance use disorder (SUD), especially cannabis use disorder in adolescence, predicts future medical cannabis card status among high-risk youth. METHODS Data collection occurred in Denver and San Diego. We recruited adolescents, with or at high risk for SUD and conduct problems (hereafter probands) and their siblings (n=654). Baseline (Wave 1) assessments took place between 1999 and 2008, and follow-up (Wave 2) took place between 2010 and 2013. In initial bivariate analyses, we examined whether baseline DSM-IV cannabis abuse/dependence (along with other potential predictors) was associated with possessing a medical cannabis card in young adulthood (Wave 2). Significant predictors were then included in a multiple binomial regression. Self-reported general physical health was also evaluated at both time points. Finally, within Wave 2, we tested whether card status was associated with concurrent substance dependence. RESULTS About 16% of the sample self-reported having a medical cannabis card at follow-up. Though bivariate analyses demonstrated that multiple predictors were significantly associated with Wave 2 card status, in our multiple binomial regression only cannabis abuse/dependence and male sex remained significant. At Wave 2, those with a medical cannabis card were significantly more likely to endorse criteria for concurrent cannabis dependence. There was no significant difference in self-reported general physical health. CONCLUSIONS Cannabis abuse/dependence and male sex positively predicted future medical cannabis card holder status among a sample of high risk adolescents. Physicians conducting evaluations for medical cannabis cards should carefully evaluate and consider past and concurrent cannabis addiction.
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Affiliation(s)
- Janet Kim
- University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO, United States, 80045-2559
| | - Marilyn E. Coors
- University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO, United States, 80045-2559
| | - Susan E. Young
- University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO, United States, 80045-2559
| | - Kristen M. Raymond
- University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO, United States, 80045-2559
| | - Christian J. Hopfer
- University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO, United States, 80045-2559
| | - Tamara L. Wall
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA, United States, 92093-0001
| | - Robin P. Corley
- University of Colorado, Boulder, I.B.G. 447 UCB, 1480 30th St, Boulder CO, United States, 80309-0447
| | - Sandra A. Brown
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA, United States, 92093-0001
| | - Joseph T. Sakai
- University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO, United States, 80045-2559
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Lankenau SE, Kioumarsi A, Reed M, McNeeley M, Iverson E, Wong CF. Becoming a medical marijuana user. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 52:62-70. [PMID: 29247863 DOI: 10.1016/j.drugpo.2017.11.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 11/10/2017] [Accepted: 11/14/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Since marijuana became legal for medical use in California in 1996, reasons for medical use among medical marijuana patients (MMP) have become increasingly well described in qualitative studies. However, few studies have detailed how the use of marijuana for medical purposes fits into the broader career trajectories of either becoming a marijuana user or becoming a MMP, including the social influences on medical use. METHODS Young adult MMP (N=40) aged 18 to 26 years old were recruited in Los Angeles, CA in 2014-15 and administered a semi-structured interview that included questions focusing on marijuana use practices before and after becoming MMP. RESULTS MMP were categorized into three trajectory groups: primarily medical users (n=30); primarily non-medical users (n=3); and medical users who transitioned to non-medical users (n=7). Most medical users discovered medicinal effects from marijuana in the context of non-medical use as adolescents prior to becoming MMP. Becoming a mature MMP followed interactions with dispensary staff or further self-exploration of medical uses and often involved a social process that helped confirm the legitimacy of medical use and identity as a medical user. In some cases, MMP transitioned back to non-medical users as health conditions improved or remained primarily non-medical users even after becoming MMP for reasons unrelated to health, e.g., protection against arrest. CONCLUSION Becoming a medical marijuana user was an important career trajectory that was influenced by early discoveries of effective medicinal use, interaction with proponents of medical use at dispensaries, experiences with new kinds of medical use, and the demands of particular health condition requiring more or less treatment with marijuana.
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Affiliation(s)
- Stephen E Lankenau
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA 19104, United States.
| | - Avat Kioumarsi
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA 19104, United States.
| | - Megan Reed
- Drexel University, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA 19104, United States.
| | - Miles McNeeley
- Children's Hospital Los Angeles, Division of Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United States.
| | - Ellen Iverson
- University of Southern California, Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, United States; Children's Hospital Los Angeles, Division of Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United States.
| | - Carolyn F Wong
- University of Southern California, Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, 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, United States.
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Meacham MC, Ramo DE, Kral AH, Riley ED. Associations between medical cannabis and other drug use among unstably housed women. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 52:45-51. [PMID: 29227883 DOI: 10.1016/j.drugpo.2017.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 11/11/2017] [Accepted: 11/16/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several studies suggest that U.S. state-level legalization of cannabis for medical purposes may be associated with reductions in opioid use; yet its relationship with stimulant use, particularly in high-risk populations like unstably housed women, has received less attention. The purpose of this study was to estimate independent associations between medical and non-medical use of cannabis and use of stimulants and opioids among unstably housed women. METHODS Cross-sectional data were analyzed from 245 women in the SHADOW study, a community based cohort in San Francisco, CA, in which HIV+ women were oversampled (126 HIV+ and 119 HIV-). RESULTS Compared to no cannabis use in the past 6 months (51%), non-medical cannabis use (28%) was associated with a higher adjusted odds of using stimulants (Adjusted Odds Ratio [AOR]=4.34, 95% confidence interval [CI]: 2.17-8.70) and opioids (AOR=3.81, 95% CI: 1.78-8.15). Compared to no cannabis use, medical cannabis use (21%) was not significantly associated with stimulant or opioid use. Compared to non-medical cannabis use, however, medical cannabis use was associated with lower adjusted odds of using stimulants (AOR=0.42, 95% CI: 0.18-0.96). These associations were not modified by HIV status. CONCLUSIONS Associations between use of cannabis and "street drugs" depend on whether the cannabis is obtained through a medical context. Interventions, research, and policy considering the influence of cannabis on the use of other drugs may benefit by distinguishing between medical and non-medical cannabis use.
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Affiliation(s)
- Meredith C Meacham
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
| | - Danielle E Ramo
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Elise D Riley
- Division of HIV, Infectious Disease & Global Medicine, University of California, San Francisco, CA, USA
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