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Gibson LP, Mueller RL, Winiger EA, Klawitter J, Sempio C, Williams S, Bryan AD, Bidwell LC, Hutchison KE. Cannabinoid Exposure and Subjective Effects of THC and CBD in Edible Cannabis Products. Cannabis Cannabinoid Res 2024; 9:320-334. [PMID: 36378267 PMCID: PMC10874820 DOI: 10.1089/can.2022.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The popularity of edible cannabis products continues to grow in states with legal cannabis access, but few studies have investigated the acute effects of these commercially available products. The present study sought to explore the effects of three commercially available edible products with different levels of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Methods: A sample of regular cannabis users (N=99) were evaluated. Fifty participants completed the study procedures in-person, whereas 49 participants completed the study procedures remotely via Zoom. Subjective effects and plasma cannabinoid levels (in-person participants only) were assessed before and 2 h after participants self-administered one of three products ad libitum: a THC-dominant edible product, a CBD-dominant edible product, or a THC+CBD edible product. Results: At the 2-h post-use assessment, among in-person participants, plasma THC and CBD levels were robustly correlated with self-reported milligrams of THC and CBD consumed, respectively. Across all three conditions, in-person and remote participants experienced (1) an increase in subjective intoxication and elation, (2) a decrease in tension, and (3) no change in paranoia from pre-use to post-use. At post-use, participants who used a CBD product reported less intoxication relative to participants who used a THC+CBD or THC-only product. Participants who used a THC+CBD product reported consuming less THC-and displayed lower plasma THC levels (in-person participants)-relative to participants who used a THC-only product, despite reporting similar levels of positive (intoxication, elation, liking) and psychotomimetic (paranoia, tension) effects. Psychotomimetic effects were very low among both in-person and remote participants across all three conditions, and there were no post-use differences across conditions. Conclusions: Findings suggest that experienced users who consumed a THC+CBD product reported similar levels of positive and psychotomimetic effects relative to those who consumed a THC-only product, despite consuming less THC and displaying lower plasma THC concentrations. Given the potential harms associated with acute cannabis reward and long-term THC exposure, further research is needed to establish whether edible cannabis products with CBD pose less risk to users. Future studies should examine whether these effects generalize to samples of infrequent users, who may have less experience with edible cannabis use. ClinicalTrials.gov ID: NCT03522103.
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Affiliation(s)
- Laurel P. Gibson
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Raeghan L. Mueller
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Evan A. Winiger
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jost Klawitter
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, Colorado, USA
- Department of Anesthesiology, University of Colorado, Aurora, Colorado, USA
| | - Cristina Sempio
- Department of Anesthesiology, University of Colorado, Aurora, Colorado, USA
| | - Sarah Williams
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Angela D. Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - L. Cinnamon Bidwell
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, Colorado, USA
| | - Kent E. Hutchison
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Okey SA, Waddell JT, Shah RV, Kennedy GM, Frangos MP, Corbin WR. An Ecological Examination of Indica Versus Sativa and Primary Terpenes on the Subjective Effects of Smoked Cannabis: A Preliminary Investigation. Cannabis Cannabinoid Res 2023; 8:857-866. [PMID: 36648357 DOI: 10.1089/can.2022.0213] [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] [Indexed: 01/18/2023] Open
Abstract
Background: The legal cannabis landscape has greatly outpaced scientific knowledge. Many popular cannabis claims, such as cultivar (colloquially referred to as strain) classification and terpene content producing different subjective effects, are unsubstantiated. This study examined, for the first time, whether cultivar classification (sativa/indica) and terpene content (caryophyllene, limonene, myrcene, pinene, and terpinolene) were associated with subjective cannabis effects (i.e., pain levels, low-arousal ["indica-like"] effects, high-arousal ["sativa-like"] effects, and negative effects). Methods: Regular cannabis users (n=101) took part in a 2-week long ecological momentary assessment study in which they responded to questions about their cannabis use, stated their preference for sativa versus indica, and reported their in-the-moment subjective effects within 30 min of smoking cannabis. Cultivars were coded for sativa versus indica classification and primary terpene content using Leafly, a popular search engine. Linear mixed-effect models then examined subjective response by sativa/indica and primary terpene. Covariates included demographics (age, sex, race, income), cannabis use (medical use, cannabis use frequency, stated preference for sativa/indica, global expected cannabis effects), morning pain ratings, and specific smoked cannabis occasions (hour of day, minutes since use, context, number of hits, and tetrahydrocannabinol). Results: The majority of participants (78.3%) had a preference for either sativa or indica and reported reasons for their preference that aligned with industry claims. After controlling for covariates, findings revealed that cultivars classified as indica dominant were associated with greater low-arousal (e.g., sluggish, slow) effects relative to the unweighted mean of all cannabis cultivars (b = 0.44, SE=0.16, p=0.01). Cultivars with primary caryophyllene were associated with greater pain ratings (b = 0.53, SE=0.24, p=0.03) and negative effects (b = 0.22, SE=0.08, p=0.01) relative to the mean of all other terpene types. Cultivars with primary pinene were associated with less negative effects (b = -0.35, SE=0.18, p=0.04). Conclusions: Cultivars classified as indica dominant were associated with greater low-arousal effects in models that accounted for both within- and between-person variation, despite the scientific challenges distinguishing between sativa and indica. Preliminary findings also suggest terpenes may play a role in subjective effects. These results emphasize the need for further research, particularly controlled lab studies.
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Affiliation(s)
- Sarah A Okey
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Jack T Waddell
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Rishika V Shah
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Gillian M Kennedy
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Maria P Frangos
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - William R Corbin
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
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3
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Reiman A, Meisel JS, Capler R, Paulding McCready D. Medical cannabis identity and public health paternalism. PUBLIC HEALTH IN PRACTICE 2023; 5:100372. [PMID: 36937098 PMCID: PMC10017413 DOI: 10.1016/j.puhip.2023.100372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
Objectives State-dependent and variable lists of medical conditions granting access to medical cannabis in the United States may be an example of public health paternalism. While purporting to ensure that medical use is clearly defined, the variability of approved conditions has created an atmosphere of ambiguity and medical precarity. The purpose of this study is to examine the relationship between "state" and "self" medical cannabis user identities and the ways non-medical users understand their cannabis consumption. Study design This is a mixed methods study consisting of semi-structured interviews and survey data. Methods In Phase 1, we examined the relationship between self and state-sanctioned cannabis identity, drawing on the 2022 New Frontier Data Consumer Survey of current cannabis consumers (N = 4682). In Phase 2, we conducted eight semi-structured interviews with a separate sample of adults who use cannabis regularly but do not consider themselves "medical consumers". Results Self-reported cannabis identity was significantly related to the adoption of a cannabis consumer identity. Those who self-identified as solely medical or recreational consumers were more likely to reject the identity of "cannabis consumer" than those who identified as both. Self-medical identity was overshadowed by use for "wellness" among interviewees. Most interviewees, despite not identifying as medical users, report therapeutic benefit. Their identity as a cannabis consumer, is tied to the definition of "medical cannabis patient" where they live as well as the fluctuating role of cannabis related to their well-being across their lifespan. Conclusions The designation of medical vs. nonmedical use of cannabis varies from state to state, which is not the case for other medicine. This highly variable designation may be paternalistic in nature as governments attempt to differentiate between "legitimate" and "illegitimate" use in the context of federal cannabis prohibition. As a result, lines between medical use and wellness are blurred, which impacts consumer self-identity.
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Affiliation(s)
- Amanda Reiman
- New Frontier Data, 1400 I Street NW Suite 350, Washington, DC, 20005, USA
- Corresponding author.
| | | | - Rielle Capler
- School of Population and Public Health in the Faculty of Medicine at the University of British Columbia, Canada
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Nouh RA, Kamal A, Abdelnaser A. Cannabinoids and Multiple Sclerosis: A Critical Analysis of Therapeutic Potentials and Safety Concerns. Pharmaceutics 2023; 15:pharmaceutics15041151. [PMID: 37111637 PMCID: PMC10146800 DOI: 10.3390/pharmaceutics15041151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/09/2023] Open
Abstract
Multiple sclerosis (MS) is a complicated condition in which the immune system attacks myelinated axons in the central nervous system (CNS), destroying both myelin and axons to varying degrees. Several environmental, genetic, and epigenetic factors influence the risk of developing the disease and how well it responds to treatment. Cannabinoids have recently sparked renewed interest in their therapeutic applications, with growing evidence for their role in symptom control in MS. Cannabinoids exert their roles through the endogenous cannabinoid (ECB) system, with some reports shedding light on the molecular biology of this system and lending credence to some anecdotal medical claims. The double nature of cannabinoids, which cause both positive and negative effects, comes from their actions on the same receptor. Several mechanisms have been adopted to evade this effect. However, there are still numerous limitations to using cannabinoids to treat MS patients. In this review, we will explore and discuss the molecular effect of cannabinoids on the ECB system, the various factors that affect the response to cannabinoids in the body, including the role of gene polymorphism and its relation to dosage, assessing the positive over the adverse effects of cannabinoids in MS, and finally, exploring the possible functional mechanism of cannabinoids in MS and the current and future progress of cannabinoid therapeutics.
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Affiliation(s)
- Roua A. Nouh
- Department of Chemistry, School of Sciences and Engineering, The American University in Cairo, New Cairo 11835, Egypt
| | - Ahmed Kamal
- Biochemistry Department, Faculty of Science, Suez University, P.O. Box 43518, Suez 43533, Egypt
| | - Anwar Abdelnaser
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt
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5
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A naturalistic study of orally administered vs. inhaled legal market cannabis: cannabinoids exposure, intoxication, and impairment. Psychopharmacology (Berl) 2022; 239:385-397. [PMID: 34708254 DOI: 10.1007/s00213-021-06007-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
RATIONALE Published studies examining the effects of cannabis have largely utilized forms of cannabis that are not representative of the legal market products currently available. OBJECTIVES The present study aimed to characterize naturalistic use of legal market flower and edible products by examining associations among blood cannabinoids and amount of THC consumed as well as physiological, cognitive, and subjective effects in users of edible and flower forms. METHOD Eighty-four participants who used cannabis at least 1 × /week (55 flower cannabis using participants; 29 edible cannabis using participants mean age = 31.95 years, 44% female) participated. At the experimental appointment in our mobile laboratory, participants completed a blood draw to assess plasma cannabinoids, measures of heart rate, subjective drug effects, and cognition both before and after ad libitum use of legal market flower or edible cannabis. RESULTS Average self-reported THC consumed was 15.97 mg (SD = 22.40) in edible users and 51.25 mg (SD = 45.23) in flower users. In the edible group, but not the flower group, strong correlations emerged between self-reported ad libitum THC consumed and plasma THC. Plasma THC was significantly higher after use of inhaled cannabis, but similar levels of plasma THC metabolites and similar levels of subjective intoxication and verbal memory impairment were observed in both flower and edible users. CONCLUSIONS Findings support strong correlations among ad libitum THC consumed and THC plasma levels after edible cannabis use and suggest few differences in intoxication and impairment between edible and flower cannabis users after ad libitum use. This novel study provides important preliminary data on the pharmacology and effects of legal market edible cannabis.
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Astray G, Mejuto JC, Xiao J, Simal-Gandara J. Benefits, toxicity and current market of cannabidiol in edibles. Crit Rev Food Sci Nutr 2022; 63:5800-5812. [PMID: 34989307 DOI: 10.1080/10408398.2021.2024493] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The commercialization of products with cannabidiol (CBD) has undergone a significant increase. These products can be presented in different forms such as baked goods, gummies or beverages (such as kombucha, beer or teas, among others) using wide concentrations ranges. The use of CBD in edibles favors its consumption, for medicinal users, during the work week, avoid its possible social stigma and facilitates its transport. These products can be purchased on store shelves and online. There is a large number of specialized studies, in which the possible advantages of CBD consumption are described in the preclinical and clinical trials. It is also necessary to recognize the existence of other works revealing that the excessive consumption of CBD could have some repercussions on health. In this review, it is analyzed the composition and properties of Cannabis sativa L., the health benefits of cannabinoids (focusing on CBD), its consumption, its possible toxicological effects, a brief exposition of the extraction process, and a collection of different products that contain CBD in its composition.
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Affiliation(s)
- Gonzalo Astray
- Universidade de Vigo, Departamento de Química Física, Facultade de Ciencias, Ourense, España
| | - Juan C Mejuto
- Universidade de Vigo, Departamento de Química Física, Facultade de Ciencias, Ourense, España
| | - Jianbo Xiao
- Universidade de Vigo, Nutrition and Bromatology Group, Department of Analytical Chemistry and Food Science, Faculty of Science, Ourense, Spain
| | - Jesus Simal-Gandara
- Universidade de Vigo, Nutrition and Bromatology Group, Department of Analytical Chemistry and Food Science, Faculty of Science, Ourense, Spain
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Abstract
Cannabis is the most frequently used illegal psychoactive substance by older adults. With population aging, legalization and medicalization of cannabis, and changes in perceptions of older adults toward its use, recreational and medical cannabis use/misuse is on the rise in seniors. Although there are solid data related to the adverse events of cannabis in older adults, efficacy data are lacking. Older adults are at increased risk of developing cannabis use disorder alongside other medical and psychiatric comorbidities. We review the benefits and risks associated with cannabis use, and screening and management strategies for cannabis use disorder in older adults.
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Barrington-Trimis JL, Bae D, Schiff S, Davis J, Unger JB, Leventhal AM. Characterizing the predictive validity of measures of susceptibility to future use of combustible, vaporized and edible cannabis products in adolescent never-users. Addiction 2020; 115:2339-2348. [PMID: 32267589 DOI: 10.1111/add.15078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/05/2019] [Accepted: 03/27/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS The construct of susceptibility to substance use initiation (i.e. cognitive proclivity to future use) is critical for prevention efforts in adolescent populations. This study aimed to provide empirical evidence for the validity of the susceptibility construct for different cannabis products (i.e. combustible, edible or vaporized cannabis), and evaluate whether susceptibility measures are predictive of subsequent initiation. DESIGN Prospective cohort study including baseline data (Spring 2015) and four follow-up surveys administered every 6 months through Spring 2017. SETTING Ten schools in the Los Angeles, California metropolitan area. PARTICIPANTS Adolescents [n = 2100; mean age = 16.1; standard deviation (SD) = 0.41; 54% female] who reported never having used any cannabis product at baseline. MEASUREMENTS We assessed five indices of a susceptibility to use cannabis composite index at baseline, adapted from a validated tobacco use index (intention to use, willingness, curiosity and positive/negative cannabis use outcome expectancies, with four response categories, definitely not [1] to definitely yes [4]), by cannabis product (combustible, edible or vaporized). A composite index was created for each product by averaging responses across the five susceptibility items. Subsequent initiation of use of each cannabis product was assessed at each follow-up wave. FINDINGS Factorial validity for unidimensionality for each five-item index (by product) was confirmed. The composite index for susceptibility to cannabis use was greatest for combustible (mean = 1.44; SD = 0.58), moderate for edible (mean = 1.37; SD = 0.53) and lowest for vaporized cannabis (mean = 1.30; SD = 0.44). The associations of each composite susceptibility index with subsequent initiation of that product and each of the other cannabis products over follow-up (i.e. cross-product associations) were statistically significant, with hazard ratios ranging from 2.30 to 2.80 across 24 months of follow-up (all Ps < 0.05). CONCLUSIONS A five-item susceptibility to cannabis use composite index (by product) appears to be useful for characterizing and predicting youth at risk for cannabis use initiation across a spectrum of cannabis products.
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Affiliation(s)
| | - Dayoung Bae
- Department of Home Economics Education, College of Education, Korea University, Seoul, South Korea
| | - Sara Schiff
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jordan Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Psychology, University of Southern California, Los Angeles, CA, USA
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White AE, Van Tubbergen C, Raymes B, Contreras AE, Scallan Walter EJ. Cannabis-Infused Edible Products in Colorado: Food Safety and Public Health Implications. Am J Public Health 2020; 110:790-795. [PMID: 32298168 PMCID: PMC7204451 DOI: 10.2105/ajph.2020.305601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 11/04/2022]
Abstract
Cannabis-infused "edibles" are a popular means of cannabis use, and the variety of edible food products available to consumers continues to grow. Although there has been much discussion on dose standardization, childproof packaging, and the prevention of overconsumption, the important topic of food safety has received less attention.We discuss potential food safety hazards associated with cannabis-infused edible food products, drawing on examples from Colorado, and describe edible-associated foodborne illness outbreaks and other contamination events.It is important for public health agencies, particularly environmental health and enteric disease programs, to be familiar with the cannabis industry, including regulatory partners, signs and symptoms of cannabis ingestion, the scope of edible products sold and consumed, and the food safety risks unique to cannabis products.
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Affiliation(s)
- Alice E White
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Christine Van Tubbergen
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Brianna Raymes
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Alexandra Elyse Contreras
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Elaine J Scallan Walter
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
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Gould J, Greene D, Donnelly R. Marijuana Use and Achievement Motives: An Exploratory Analysis of Self-Reported Health Among Adult Cannabis Consumers. JOURNAL OF DRUG ISSUES 2020. [DOI: 10.1177/0022042620911367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to explore self-reported physical health and achievement motives in a sample of adult cannabis consumers. An online target sample ( n = 181) of adult cannabis consumers ( M = 38 yoa) was obtained from a cannabis tourism company in Colorado. Physical health and the primary benefit of cannabis use were self-reported and achievement motives were measured using the revised 10-item version of the Achievement Motives Scale (AMS). Results revealed five categories of benefit from cannabis consumption: stress/anxiety reduction (40%), pain/disease management (38.5%), thinking/introspection (11%), alternative drug (7.1%), and enhanced sociability (3%). t test results revealed no significant differences between the stress/anxiety and pain/disease groups in self-reported health (SRH), AMS dimensions, or cannabis consumption preferences. Regression results revealed that AMS factor fear of failure ( b = −0.224, p = .003), followed by cannabis spending per week ( b = −0.217, p = .024) best predicted SRH.
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Affiliation(s)
- James Gould
- University of Northern Colorado, Greeley, CO, USA
| | - David Greene
- University of Northern Colorado, Greeley, CO, USA
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11
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Fischer B, Malta M, Messas G, Ribeiro M. Introducing the evidence-based population health tool of the Lower-Risk Cannabis Use Guidelines to Brazil. ACTA ACUST UNITED AC 2020; 41:550-555. [PMID: 31116260 PMCID: PMC6899352 DOI: 10.1590/1516-4446-2018-0239] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/07/2019] [Indexed: 11/22/2022]
Abstract
Cannabis is the most commonly used illegal drug, and is associated with well-documented adverse health outcomes, both acute and chronic. Cannabis use prevalence in Brazil is lower than in high-use regions in the Americas (e.g., North America), but concentrated among young people. Frameworks for cannabis control are increasingly shifting towards public health-oriented principles, with some countries undertaking respective policy reforms. These frameworks require a continuum of population-level interventions (e.g., prevention and treatment) including targeted prevention of adverse health outcomes among users. In this context, and based on examples from other health fields, an international expert group developed the evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG), originally for Canada, including a set of 10 recommendations based on systematic data reviews and expert consensus methods. The LRCUG form a scientific population-health prevention tool to reduce adverse public health impacts for broad application among cannabis users. In Canada, the LRCUG have been formally endorsed and are supported by leading national health organizations and government authorities within the continuum of cannabis interventions. As the LRCUG are being internationalized, this paper introduces the LRCUG’s concept and content – including their original recommendations translated into Portuguese – to the Brazilian context as an evidence-based population-level intervention tool for uptake, dissemination, and discussion. Sociocultural adaptation may be required for meaningful implementation.
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Affiliation(s)
- Benedikt Fischer
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.,Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Monica Malta
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Departamento de Ciências Sociais, Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Guilherme Messas
- Departamento de Saúde Mental, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | - Marcelo Ribeiro
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Centro de Referência de Álcool, Tabaco e Outras Drogas (CRATOD), Governo do Estado de São Paulo, São Paulo, SP, Brazil
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12
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Brumbach S, Goodman SS, Baiduc RR. Behavioral Hearing Thresholds and Distortion Product Otoacoustic Emissions in Cannabis Smokers. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3500-3515. [PMID: 31525116 DOI: 10.1044/2019_jslhr-h-18-0361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Cannabis is a widely used drug both medically and recreationally. The aim of this study was to determine if cannabis smoking is associated with changes in auditory function, as measured by behavioral hearing thresholds and/or distortion product otoacoustic emissions (DPOAEs). Method We investigated hearing thresholds and 2f1-f2 DPOAEs in 20 cannabis smokers and 20 nonsmokers between 18 and 28 years old. Behavioral thresholds were obtained from 0.25 to 16 kHz. DPOAEs were measured using discrete tones between f2 of 0.5 and 19.03 kHz using an f2/f1 ratio of 1.22 and L1/L2 = 65/55 dB SPL. Thresholds and DPOAE amplitudes were compared between groups using linear mixed-effects models with sex and frequency as predictors. Results Behavioral thresholds in smokers did not differ significantly between smokers and nonsmokers (all ps > .05). Although not significant, long-term smokers exhibited poorer thresholds than short-term smokers and nonsmokers. Smokers generally exhibited lower DPOAE amplitudes than nonsmokers, although the differences were not significant. Male smokers had significantly poorer DPOAE amplitudes than male nonsmokers in the low frequencies (f2 ≤ 2 kHz; p = .0245). Conclusion Results indicate that smoking cannabis may negatively alter the function of outer hair cells in young men. This subtle cochleopathology is evident in the absence of measurable differences in behavioral hearing thresholds between cannabis smokers and nonsmokers.
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Affiliation(s)
- Samantha Brumbach
- Department of Speech, Language, and Hearing Sciences, University of Colorado Boulder
| | - Shawn S Goodman
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Rachael R Baiduc
- Department of Speech, Language, and Hearing Sciences, University of Colorado Boulder
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Russell C, Rueda S, Room R, Tyndall M, Fischer B. Routes of administration for cannabis use – basic prevalence and related health outcomes: A scoping review and synthesis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 52:87-96. [DOI: 10.1016/j.drugpo.2017.11.008] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 01/10/2023]
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Smart R, Caulkins JP, Kilmer B, Davenport S, Midgette G. Variation in cannabis potency and prices in a newly legal market: evidence from 30 million cannabis sales in Washington state. Addiction 2017; 112:2167-2177. [PMID: 28556310 PMCID: PMC5673542 DOI: 10.1111/add.13886] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/17/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Abstract
AIMS To (1) assess trends and variation in the market share of product types and potency sold in a legal cannabis retail market and (2) estimate how potency and purchase quantity influence price variation for cannabis flower. DESIGN Secondary analysis of publicly available data from Washington State's cannabis traceability system spanning 7 July 2014 to 30 September 2016. Descriptive statistics and linear regressions assessed variation and trends in cannabis product variety and potency. Hedonic regressions estimated how purchase quantity and potency influence cannabis flower price variation. SETTING Washington State, USA. PARTICIPANTS (1) A total of 44 482 176 million cannabis purchases, including (2) 31 052 123 cannabis flower purchases after trimming price and quantity outliers. MEASUREMENTS Primary outcome measures were (1) monthly expenditures on cannabis, total delta-9-tetrahydrocannabinol (THC) concentration and cannabidiol (CBD) concentration by product type and (2) excise tax-inclusive price per gram of cannabis flower. Key covariates for the hedonic price regressions included quantity purchased, THC and CBD. FINDINGS Traditional cannabis flowers still account for the majority of spending (66.6%), but the market share of extracts for inhalation increased by 145.8% between October 2014 and September 2016, now comprising 21.2% of sales. The average THC-level for cannabis extracts is more than triple that for cannabis flowers (68.7% compared to 20.6%). For flower products, there is a statistically significant relationship between price per gram and both THC [coefficient = 0.012; 95% confidence interval (CI) = 0.011-0.013] and CBD (coefficient = 0.017; CI = 0.015-0.019). The estimated discount elasticity is -0.06 (CI = -0.07 to -0.05). CONCLUSIONS In the state of Washington, USA, the legal cannabis market is currently dominated by high-THC cannabis flower, and features growing expenditures on extracts. For cannabis flower, both THC and CBD are associated with higher per-gram prices, and there are small but significant quantity discounts.
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Affiliation(s)
| | - Jonathan P. Caulkins
- RAND Corporation, Santa Monica, CA, USA
- Heinz College, Carnegie Mellon University, Pittsburgh, PA, USA
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Fischer B, Russell C, Sabioni P, van den Brink W, Le Foll B, Hall W, Rehm J, Room R. Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations. Am J Public Health 2017. [PMID: 28644037 DOI: 10.2105/ajph.2017.303818] [Citation(s) in RCA: 243] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cannabis use is common in North America, especially among young people, and is associated with a risk of various acute and chronic adverse health outcomes. Cannabis control regimes are evolving, for example toward a national legalization policy in Canada, with the aim to improve public health, and thus require evidence-based interventions. As cannabis-related health outcomes may be influenced by behaviors that are modifiable by the user, evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG)-akin to similar guidelines in other health fields-offer a valuable, targeted prevention tool to improve public health outcomes. OBJECTIVES To systematically review, update, and quality-grade evidence on behavioral factors determining adverse health outcomes from cannabis that may be modifiable by the user, and translate this evidence into revised LRCUG as a public health intervention tool based on an expert consensus process. SEARCH METHODS We used pertinent medical search terms and structured search strategies, to search MEDLINE, EMBASE, PsycINFO, Cochrane Library databases, and reference lists primarily for systematic reviews and meta-analyses, and additional evidence on modifiable risk factors for adverse health outcomes from cannabis use. SELECTION CRITERIA We included studies if they focused on potentially modifiable behavior-based factors for risks or harms for health from cannabis use, and excluded studies if cannabis use was assessed for therapeutic purposes. DATA COLLECTION AND ANALYSIS We screened the titles and abstracts of all studies identified by the search strategy and assessed the full texts of all potentially eligible studies for inclusion; 2 of the authors independently extracted the data of all studies included in this review. We created Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-charts for each of the topical searches. Subsequently, we summarized the evidence by behavioral factor topic, quality-graded it by following standard (Grading of Recommendations Assessment, Development, and Evaluation; GRADE) criteria, and translated it into the LRCUG recommendations by the author expert collective on the basis of an iterative consensus process. MAIN RESULTS For most recommendations, there was at least "substantial" (i.e., good-quality) evidence. We developed 10 major recommendations for lower-risk use: (1) the most effective way to avoid cannabis use-related health risks is abstinence, (2) avoid early age initiation of cannabis use (i.e., definitively before the age of 16 years), (3) choose low-potency tetrahydrocannabinol (THC) or balanced THC-to-cannabidiol (CBD)-ratio cannabis products, (4) abstain from using synthetic cannabinoids, (5) avoid combusted cannabis inhalation and give preference to nonsmoking use methods, (6) avoid deep or other risky inhalation practices, (7) avoid high-frequency (e.g., daily or near-daily) cannabis use, (8) abstain from cannabis-impaired driving, (9) populations at higher risk for cannabis use-related health problems should avoid use altogether, and (10) avoid combining previously mentioned risk behaviors (e.g., early initiation and high-frequency use). AUTHORS' CONCLUSIONS Evidence indicates that a substantial extent of the risk of adverse health outcomes from cannabis use may be reduced by informed behavioral choices among users. The evidence-based LRCUG serve as a population-level education and intervention tool to inform such user choices toward improved public health outcomes. However, the LRCUG ought to be systematically communicated and supported by key regulation measures (e.g., cannabis product labeling, content regulation) to be effective. All of these measures are concretely possible under emerging legalization regimes, and should be actively implemented by regulatory authorities. The population-level impact of the LRCUG toward reducing cannabis use-related health risks should be evaluated. Public health implications. Cannabis control regimes are evolving, including legalization in North America, with uncertain impacts on public health. Evidence-based LRCUG offer a potentially valuable population-level tool to reduce the risk of adverse health outcomes from cannabis use among (especially young) users in legalization contexts, and hence to contribute to improved public health outcomes.
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Affiliation(s)
- Benedikt Fischer
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Cayley Russell
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Pamela Sabioni
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Wim van den Brink
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Bernard Le Foll
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Wayne Hall
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Jürgen Rehm
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Robin Room
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Sabia JJ, Swigert J, Young T. The Effect of Medical Marijuana Laws on Body Weight. HEALTH ECONOMICS 2017; 26:6-34. [PMID: 26602324 DOI: 10.1002/hec.3267] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/14/2015] [Accepted: 09/08/2015] [Indexed: 06/05/2023]
Abstract
This study is the first to examine the effects of medical marijuana laws (MMLs) on body weight, physical wellness, and exercise. Using data from the 1990 to 2012 Behavioral Risk Factor Surveillance System and a difference-in-difference approach, we find that the enforcement of MMLs is associated with a 2% to 6% decline in the probability of obesity. We find some evidence of age-specific heterogeneity in mechanisms. For older individuals, MML-induced increases in physical mobility may be a relatively important channel, while for younger individuals, a reduction in consumption of alcohol, a substitute for marijuana, appears more important. These findings are consistent with the hypothesis that MMLs may be more likely to induce marijuana use for health-related reasons among older individuals, and cause substitution toward lower-calorie recreational 'highs' among younger individuals. Our estimates suggest that MMLs induce a $58 to $115 per-person annual reduction in obesity-related medical costs. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Joseph J Sabia
- Department of Economics, San Diego State University, San Diego, CA, USA
| | - Jeffrey Swigert
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
| | - Timothy Young
- Department of Economics, San Diego State University, San Diego, CA, USA
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17
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Lankenau SE, Fedorova EV, Reed M, Schrager SM, Iverson E, Wong CF. Marijuana practices and patterns of use among young adult medical marijuana patients and non-patient marijuana users. Drug Alcohol Depend 2017; 170:181-188. [PMID: 27987475 PMCID: PMC6540119 DOI: 10.1016/j.drugalcdep.2016.10.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 10/07/2016] [Accepted: 10/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about young adult medical marijuana patients (MMP) and their marijuana using patterns and practices, which includes frequency of use, sourcing of marijuana products, forms/modes of administration, and patterns of illicit/prescription drug misuse, compared to non-patient marijuana users (NPU). METHODS Young adults (N=366) aged 18-26 years old were sampled in Los Angeles in 2014-15 and segmented into NPU (n=156), marijuana users who never had a medical marijuana (MM) recommendation, and MMP (n=210), marijuana users with a current, verified MM recommendation. Differences regarding self-reported marijuana and other drug use during the past 90days are expressed as unadjusted risk ratios or differences in means. RESULTS MMP reported significantly greater mean days of use (76.4 vs. 59.2, p<0.001) and mean dollars spent on marijuana products (564.5 vs. 266.9, p<0.001) than NPU. Approximately one-quarter (22.6%) of both MMP and NPU report selling marijuana obtained from a dispensary to someone else in the past 90days. MMP were more likely to report vaporization modalities for concentrates (URR=1.5, 95% C.I.=1.2, 2.0) and for marijuana (URR=1.5, 95% C.I.=1.1, 2.1) than NPU. Though not significant, trends toward lower misuse of prescription drugs in the past 90days were observed among MMP compared to NPU. CONCLUSION MMP reported greater access to marijuana via dispensaries, more frequent and intensive use of marijuana, and greater use of non-combustible forms of marijuana compared to NPU. MMP reported less recent misuse of prescription drugs compared to NPU.
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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.
| | - Ekaterina V Fedorova
- 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.
| | - Sheree M Schrager
- Children's Hospital Los Angeles, Division of Hospital Medicine, 4650 Sunset Blvd., MS #94, 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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18
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Choi NG, DiNitto DM, Marti CN. Older marijuana users: Life stressors and perceived social support. Drug Alcohol Depend 2016; 169:56-63. [PMID: 27776245 DOI: 10.1016/j.drugalcdep.2016.10.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Given increasing numbers of older-adult marijuana users, this study examined the association of marijuana use and marijuana use disorder with life stressors and perceived social support in the 50+ age group. METHODS Data came from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (N=14,715 respondents aged 50+). Life stressors were measured with 12 items related to interpersonal, legal, and financial problems and being a crime victim. Perceived social support was measured with the 12-item Interpersonal Support Evaluation List. Using principal component analysis (PCA), we identified four components of life stressors. Linear regression analyses was used to test associations of past-year marijuana use and use disorder with PCA scores of each component and perceived social support. RESULTS Of the 50+ age group, 3.89% were past-year marijuana users and 0.68% had marijuana use disorder. Marijuana users, especially those with marijuana use disorder (17.54% of past-year users), had high rates of mental and other substance use disorders. Controlling for other potential risk factors for stress, including health status and mental and other substance use disorders, marijuana use and use disorder were still significantly associated with more life stressors and lower perceived social support, possibly from low levels of social integration. CONCLUSIONS A substantial proportion of older-adult marijuana users need help with mental health and substance use problems. Further examination of older marijuana users' life stressors and social support networks may aid in developing more systematic intervention strategies to address needs and reduce marijuana use.
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Affiliation(s)
- Namkee G Choi
- University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712, USA.
| | - Diana M DiNitto
- University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712, USA
| | - C Nathan Marti
- University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712, USA
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Barrus DG, Capogrossi KL, Cates SC, Gourdet CK, Peiper NC, Novak SP, Lefever TW, Wiley JL. Tasty THC: Promises and Challenges of Cannabis Edibles. METHODS REPORT (RTI PRESS) 2016; 2016. [PMID: 28127591 DOI: 10.3768/rtipress.2016.op.0035.1611] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Food products containing cannabis extract (edibles) have emerged as a popular and lucrative facet of the legalized market for both recreational and medicinal cannabis. The many formulations of cannabis extracts used in edibles present a unique regulatory challenge for policy makers. Though edibles are often considered a safe, discreet, and effective means of attaining the therapeutic and/or intoxicating effects of cannabis without exposure to the potentially harmful risks of cannabis smoking, little research has evaluated how ingestion differs from other methods of cannabis administration in terms of therapeutic efficacy, subjective effects, and safety. The most prominent difference between ingestion and inhalation of cannabis extracts is the delayed onset of drug effect with ingestion. Consumers often do not understand this aspect of edible use and may consume a greater than intended amount of drug before the drug has taken effect, often resulting in profoundly adverse effects. Written for the educated layperson and for policy makers, this paper explores the current state of research regarding edibles, highlighting the promises and challenges that edibles present to both users and policy makers, and describes the approaches that four states in which recreational cannabis use is legal have taken regarding regulating edibles.
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20
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Zhang Z, Zheng X, Zeng DD, Leischow SJ. Tracking Dabbing Using Search Query Surveillance: A Case Study in the United States. J Med Internet Res 2016; 18:e252. [PMID: 27637361 PMCID: PMC5045525 DOI: 10.2196/jmir.5802] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/15/2016] [Accepted: 08/21/2016] [Indexed: 11/30/2022] Open
Abstract
Background Dabbing is an emerging method of marijuana ingestion. However, little is known about dabbing owing to limited surveillance data on dabbing. Objective The aim of the study was to analyze Google search data to assess the scope and breadth of information seeking on dabbing. Methods Google Trends data about dabbing and related topics (eg, electronic nicotine delivery system [ENDS], also known as e-cigarettes) in the United States between January 2004 and December 2015 were collected by using relevant search terms such as “dab rig.” The correlation between dabbing (including topics: dab and hash oil) and ENDS (including topics: vaping and e-cigarette) searches, the regional distribution of dabbing searches, and the impact of cannabis legalization policies on geographical location in 2015 were analyzed. Results Searches regarding dabbing increased in the United States over time, with 1,526,280 estimated searches during 2015. Searches for dab and vaping have very similar temporal patterns, where the Pearson correlation coefficient (PCC) is .992 (P<.001). Similar phenomena were also obtained in searches for hash oil and e-cigarette, in which the corresponding PCC is .931 (P<.001). Dabbing information was searched more in some western states than other regions. The average dabbing searches were significantly higher in the states with medical and recreational marijuana legalization than in the states with only medical marijuana legalization (P=.02) or the states without medical and recreational marijuana legalization (P=.01). Conclusions Public interest in dabbing is increasing in the United States. There are close associations between dabbing and ENDS searches. The findings suggest greater popularity of dabs in the states that legalized medical and recreational marijuana use. This study proposes a novel and timely way of cannabis surveillance, and these findings can help enhance the understanding of the popularity of dabbing and provide insights for future research and informed policy making on dabbing.
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Affiliation(s)
- Zhu Zhang
- Department of Management Information Systems, The University of Arizona, Tucson, AZ, United States
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21
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Abstract
Purpose
The purpose of this paper is to study vaporizers – especially the vape pen – as a new technology in cannabis use. Until now, almost all information on the use of vaporizers or e-cigarettes for cannabis consumption has come from the internet, the popular press, and accounts by users, but not from the scientific literature. More research is needed.
Design/methodology/approach
Since scientific studies of the phenomenon are virtually non-existent, the author will also base his study on sociological reflections upon internet sites and articles published both in subcultural and mainstream media. The author will document a national estimate of the prevalence of vaping based on a recent population survey in Finland.
Findings
Vaping is an emerging trend in cannabis culture internationally. It has been seen as a healthier route of administration than traditional ways of smoking cannabis. Other images, created especially with the help of advanced high-tech machinery and stylish and fashionable designs for the vape pen, are aiming at being cool and easy to use. In Finland, 6 percent of cannabis users make regular use of a vaporizer, and around a quarter of users use one occasionally. A vape pen or e-cigarette was regularly used by 2.6 percent and occasionally by 9.1 percent of cannabis users.
Originality/value
The trend of increasing vaping and the use of new devices has not been properly recognized among researchers. The paper presents some original results from a national population survey.
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Lamy FR, Daniulaityte R, Sheth A, Nahhas RW, Martins SS, Boyer EW, Carlson RG. "Those edibles hit hard": Exploration of Twitter data on cannabis edibles in the U.S. Drug Alcohol Depend 2016; 164:64-70. [PMID: 27185160 PMCID: PMC4893972 DOI: 10.1016/j.drugalcdep.2016.04.029] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/20/2016] [Accepted: 04/22/2016] [Indexed: 11/22/2022]
Abstract
AIMS Several states in the U.S. have legalized cannabis for recreational or medical uses. In this context, cannabis edibles have drawn considerable attention after adverse effects were reported. This paper investigates Twitter users' perceptions concerning edibles and evaluates the association edibles-related tweeting activity and local cannabis legislation. METHODS Tweets were collected between May 1 and July 31, 2015, using Twitter API and filtered through the eDrugTrends/Twitris platform. A random sample of geolocated tweets was manually coded to evaluate Twitter users' perceptions regarding edibles. Raw state proportions of Twitter users mentioning edibles were ajusted relative to the total number of Twitter users per state. Differences in adjusted proportions of Twitter users mentioning edibles between states with different cannabis legislation status were assesed via a permutation test. RESULTS We collected 100,182 tweets mentioning cannabis edibles with 26.9% (n=26,975) containing state-level geolocation. Adjusted percentages of geolocated Twitter users posting about edibles were significantly greater in states that allow recreational and/or medical use of cannabis. The differences were statistically significant. Overall, cannabis edibles were generally positively perceived among Twitter users despite some negative tweets expressing the unreliability of edible consumption linked to variability in effect intensity and duration. CONCLUSION Our findings suggest that Twitter data analysis is an important tool for epidemiological monitoring of emerging drug use practices and trends. Results tend to indicate greater tweeting activity about cannabis edibles in states where medical THC and/or recreational use are legal. Although the majority of tweets conveyed positive attitudes about cannabis edibles, analysis of experiences expressed in negative tweets confirms the potential adverse effects of edibles and calls for educating edibles-naïve users, improving edibles labeling, and testing their THC content.
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Affiliation(s)
- Francois R Lamy
- Center for Interventions, Treatment, and Addictions Research (CITAR), Department of Community Health, Wright State University Boonshoft School of Medicine, 3171 Research Blvd., Suite 124, Dayton, OH 45420-4006, United States; Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), Department of Computer Science and Engineering, Wright State University, Dayton, OH, United States.
| | - Raminta Daniulaityte
- Center for Interventions, Treatment, and Addictions Research (CITAR), Department of Community Health, Wright State University Boonshoft School of Medicine, 3171 Research Blvd., Suite 124, Dayton, OH 45420-4006, United States
| | - Amit Sheth
- Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), Department of Computer Science and Engineering, Wright State University, Dayton, OH, United States
| | - Ramzi W Nahhas
- Center for Global Health, Department of Community Health, Wright State University Boonshoft School of Medicine, Dayton, OH, United States; Department of Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, OH, United States
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Edward W Boyer
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Robert G Carlson
- Center for Interventions, Treatment, and Addictions Research (CITAR), Department of Community Health, Wright State University Boonshoft School of Medicine, 3171 Research Blvd., Suite 124, Dayton, OH 45420-4006, United States
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Varlet V, Concha-Lozano N, Berthet A, Plateel G, Favrat B, De Cesare M, Lauer E, Augsburger M, Thomas A, Giroud C. Drug vaping applied to cannabis: Is "Cannavaping" a therapeutic alternative to marijuana? Sci Rep 2016; 6:25599. [PMID: 27228348 PMCID: PMC4881394 DOI: 10.1038/srep25599] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/19/2016] [Indexed: 11/09/2022] Open
Abstract
Therapeutic cannabis administration is increasingly used in Western countries due to its positive role in several pathologies. Dronabinol or tetrahydrocannabinol (THC) pills, ethanolic cannabis tinctures, oromucosal sprays or table vaporizing devices are available but other cannabinoids forms can be used. Inspired by the illegal practice of dabbing of butane hashish oil (BHO), cannabinoids from cannabis were extracted with butane gas, and the resulting concentrate (BHO) was atomized with specific vaporizing devices. The efficiency of "cannavaping," defined as the "vaping" of liquid refills for e-cigarettes enriched with cannabinoids, including BHO, was studied as an alternative route of administration for therapeutic cannabinoids. The results showed that illegal cannavaping would be subjected to marginal development due to the poor solubility of BHO in commercial liquid refills (especially those with high glycerin content). This prevents the manufacture of liquid refills with high BHO concentrations adopted by most recreational users of cannabis to feel the psychoactive effects more rapidly and extensively. Conversely, "therapeutic cannavaping" could be an efficient route for cannabinoids administration because less concentrated cannabinoids-enriched liquid refills are required. However, the electronic device marketed for therapeutic cannavaping should be carefully designed to minimize potential overheating and contaminant generation.
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Affiliation(s)
- Vincent Varlet
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine, Geneva-Lausanne, Switzerland
| | - Nicolas Concha-Lozano
- Institute for Work and Health (IST), University of Lausanne, University of Geneva, Lausanne, Switzerland
| | - Aurélie Berthet
- Institute for Work and Health (IST), University of Lausanne, University of Geneva, Lausanne, Switzerland
| | - Grégory Plateel
- Institute for Work and Health (IST), University of Lausanne, University of Geneva, Lausanne, Switzerland
| | - Bernard Favrat
- Psychology and Traffic Medicine Unit, University Centre of Legal Medicine, Lausanne, Switzerland
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - Mariangela De Cesare
- Psychology and Traffic Medicine Unit, University Centre of Legal Medicine, Lausanne, Switzerland
| | - Estelle Lauer
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine, Geneva-Lausanne, Switzerland
| | - Marc Augsburger
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine, Geneva-Lausanne, Switzerland
| | - Aurélien Thomas
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine, Geneva-Lausanne, Switzerland
- Faculty of Biology and Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Christian Giroud
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine, Geneva-Lausanne, Switzerland
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Miller BL, Stogner JM, Miller JM. Exploring Butane Hash Oil Use: A Research Note. J Psychoactive Drugs 2016; 48:44-9. [DOI: 10.1080/02791072.2015.1118173] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Krauss MJ, Sowles SJ, Mylvaganam S, Zewdie K, Bierut LJ, Cavazos-Rehg PA. Displays of dabbing marijuana extracts on YouTube. Drug Alcohol Depend 2015; 155:45-51. [PMID: 26347408 PMCID: PMC4591851 DOI: 10.1016/j.drugalcdep.2015.08.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dabbing involves heating marijuana extracts to a high temperature and inhaling the vapor. Little is known about this new method of using marijuana. YouTube, the most popular platform for sharing online videos, may be a go-to resource for individuals interested in learning about dabbing. Our objective was to explore the content of dabbing-related videos on YouTube. METHODS We searched for dabbing-related videos on YouTube using the search terms "dabbing" and "dabs" on January 22, 2015. For each term, videos were sorted by relevance and view count. A sample of 116 dabbing videos were viewed and coded for content. RESULTS The 116 videos (published by 75 unique channels) had a total of 9,545,482 views. Most (76%) of the channels had a specific focus on marijuana and 23% were located in California. Eighty-nine percent of the videos showed at least one person dabbing, and 61% of these showed someone dabbing repeatedly. Most dabbers were male (67%) and many appeared to be >25 years old (42%). Approximately 34% of the videos contained a product review, 28% provided instructions on dabbing or other educational information, and 21% contained at least a brief cautionary message. Over half (54%) of the videos referenced medical marijuana, and only 20% of the videos had an age-restriction. CONCLUSIONS Dabbing-related videos are easily found and can be readily viewed on YouTube. As marijuana use becomes more accepted by the general population, the popularity of dabbing-related videos could increase, potentially normalizing this potent form of marijuana use.
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Affiliation(s)
- Melissa J Krauss
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
| | - Shaina J Sowles
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
| | - Shalinee Mylvaganam
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
| | - Kidist Zewdie
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
| | - Patricia A Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
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Lau N, Sales P, Averill S, Murphy F, Sato SO, Murphy S. Responsible and controlled use: Older cannabis users and harm reduction. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:709-18. [PMID: 25911027 PMCID: PMC4499492 DOI: 10.1016/j.drugpo.2015.03.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/19/2015] [Accepted: 03/22/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cannabis use is becoming more accepted in mainstream society. In this paper, we use Zinberg's classic theoretical framework of drug, set, and setting to elucidate how older adult cannabis users managed health, social and legal risks in a context of normalized cannabis use. METHODS We present selected findings from our qualitative study of Baby Boomer (born 1946-1964) cannabis users in the San Francisco Bay Area. Data collection consisted of a recorded, in-depth life history interview followed by a questionnaire and health survey. Qualitative interviews were analyzed to discover the factors of cannabis harm reduction from the users' perspectives. RESULTS Interviewees made harm reduction choices based on preferred cannabis derivatives and routes of administration, as well as why, when, where, and with whom to use. Most interviewees minimized cannabis-related harms so they could maintain social functioning in their everyday lives. Responsible and controlled use was described as moderation of quantity and frequency of cannabis used, using in appropriate settings, and respect for non-users. Users contributed to the normalization of cannabis use through normification. CONCLUSION Participants followed rituals or cultural practices, characterized by sanctions that helped define "normal" or "acceptable" cannabis use. Users contributed to cannabis normalization through their harm reduction methods. These cultural practices may prove to be more effective than formal legal prohibitions in reducing cannabis-related harms. Findings also suggest that users with access to a regulated market (medical cannabis dispensaries) were better equipped to practice harm reduction. More research is needed on both cannabis culture and alternative routes of administration as harm reduction methods.
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Affiliation(s)
- Nicholas Lau
- Centre for Substance Abuse Studies, Institute for Scientific Analysis, 390
Fourth Street, Second floor, Suite D, San Francisco, CA 94107, USA
| | - Paloma Sales
- Centre for Substance Abuse Studies, Institute for Scientific Analysis, 390
Fourth Street, Second floor, Suite D, San Francisco, CA 94107, USA
| | - Sheigla Averill
- Centre for Substance Abuse Studies, Institute for Scientific Analysis, 390
Fourth Street, Second floor, Suite D, San Francisco, CA 94107, USA
| | - Fiona Murphy
- Centre for Substance Abuse Studies, Institute for Scientific Analysis, 390
Fourth Street, Second floor, Suite D, San Francisco, CA 94107, USA
| | - Sye-Ok Sato
- Centre for Substance Abuse Studies, Institute for Scientific Analysis, 390
Fourth Street, Second floor, Suite D, San Francisco, CA 94107, USA
| | - Sheigla Murphy
- Centre for Substance Abuse Studies, Institute for Scientific Analysis, 390
Fourth Street, Second floor, Suite D, San Francisco, CA 94107, USA
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