Cannabis as a Gateway Drug for Opioid Use Disorder

Exploring Youths' Cannabis Health Literacy Post Legalization: A Qualitative Study

Legalization of non-medical cannabis in Canada was intended to protect youth health and safety by limiting access and raising awareness of safety and risks. The purpose of this qualitative research was to explore youths' perceptions of their cannabis health literacy and future educational needs. A convenience sample of youth aged 13 to 18 residing in Newfoundland and Labrador, Canada who may or may not have consumed cannabis were included. A qualitative study using virtual focus groups with semi-structured interview questions was conducted. Ethics approval was obtained. All sessions were audio-recorded and transcribed. Inductive thematic analysis used a social-ecological framework for adolescent health literacy. Six focus groups (n = 38) were conducted with youth of all ages and from rural and urban areas. Three main themes were identified: (i) micro influences (age, gender, and beliefs), (ii) meso influences, (family, peers, and school enforcement), (iii) macro influences (cannabis legalization and social media), and (iv) evidence-informed information (harm reduction and cannabis properties). They desired evidence-informed education using harm-reduction principles, integrated early, and interactive. The findings provide support for a cannabis health literacy framework that will inform youth cannabis education programs. Interactive approaches with real-world application should support their autonomy, share knowledge, and minimize stigma.

Is cannabis a slippery slope? Associations between psychological dysfunctioning, other substance use, and impaired driving, in a sample of active cannabis users

Cannabis is a gateway drug that can lead to the engagement of other substances. Psychological dysfunctioning and dependence have been highlighted as primary components to substance misuse. The purpose of this study was to investigate what aspects of cannabis use and psychological dysfunctioning are associated with the engagement of other substances and impaired driving. Subject to screening, 200 active adult cannabis users completed an online survey. Existing data involving non-cannabis users (N = 833) were also implemented as comparative data. The comparisons suggested that cannabis users were far more likely to have used other drugs in the past 12 months, compared to non-cannabis users. Bivariate correlations and multiple regressions indicated that the degree of cannabis use and likely dependence, psycho-social motives for using cannabis, emotion dysregulation, and psychopathology were positively associated with the frequency of using and driving on other substances. Finally, an ANOVA demonstrated that outside of age, there were no apparent differences in substance use behaviours, motives for using cannabis, and psychological dysfunction, between medicinal and black-market cannabis users. These findings highlight the potential benefits of incorporating self-regulatory concepts into current road safety initiatives, which aim to reduce the interconnected issue of substance misuse and impaired driving behaviours.

Fear of COVID-19 and illicit drug use during COVID-19 pandemic in Japan: a case-control study

Background

Some people use illicit drugs to relieve stress. However, these drugs cause serious damage not only to individuals but also to society as a whole. Stress caused by the COVID-19 pandemic is considerable, as the number of illicit drug users continues to increase, despite a decrease in the availability of drugs and opportunities to leave the house during the pandemic. Fear of COVID-19 causes stress; however, its association with illicit drug use is not yet understood. In this study, we examined whether the fear of COVID-19 affects the subsequent use of illicit drugs.

Methods

We conducted a retrospective longitudinal case-control study using data from an Internet survey performed annually between 2020-2022, with the 2020 survey as the baseline survey and the 2021 and 2022 surveys as follow-up surveys. Those who were illicit drug use-free at the baseline survey but had a history of drug use upon follow-up were defined as the outcome group, whereas those who remained illicit drug use-free at follow-up were defined as the no-outcome group. Logistic regression analysis was conducted between the two groups, using "the fear of COVID-19" as the explanatory variable and adjusting for the effects of confounding factors. The same analysis was conducted by dividing illicit drugs into cannabis and non-cannabis groups, then setting their use as a secondary outcome.

Results

The study included 17,800 subjects, 837 of whom used illicit drugs at follow-up and 16,963 who did not use illicit drugs at follow-up. Logistic regression analysis revealed that higher levels of fear over COVID-19 correlated with higher illicit drug use among the participants. However, our analysis of cannabis-only outcomes showed no significant differences.

Conclusions

We found that fear of COVID-19 was a contributing factor to illicit drug use. Although the exact mechanism through which fear influences illicit drug use remains unknown, previous studies have shown that fear of certain targets increases illicit drug use, and our study adds to this evidence. However, in this study, we were unable to show a statistically significant causal relationship between fear of COVID-19 and the use of cannabis alone. Further research on the relationship between fear and the use of cannabis or other drugs, for varying focuses of fear, may broaden our knowledge of the different reasons individuals have for using different drugs.

Cannabis Use Disorder Not Associated With Opioid Analgesic Use or Patient-Reported Outcomes After ACL Reconstruction: A Retrospective Matched-Cohort Analysis

BACKGROUND

The purpose of this study was to compare opioid analgesic use and patient-reported outcomes (PROs) after anterior cruciate ligament reconstruction (ACLR) between patients with and without cannabis use disorder (CUD).

HYPOTHESIS

We hypothesized that patients with CUD would have greater postoperative opioid usage with comparable improvement in PROs.

STUDY DESIGN

Retrospective matched-cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

We identified patients with CUD who underwent primary ACLR at a single center and had minimum 3-month follow-up. Patients with CUD were propensity score matched 1:1 to non-CUD controls with respect to age, sex, and follow-up time. Total refills, days supply, and morphine milligram equivalents (MMEs) of opioid analgesics prescribed were calculated for up to 1 year postoperatively. Patient-Reported Outcome Information System (PROMIS) instruments were used to assess PROs. Opioid use and outcomes were compared between CUD and control groups using Mann-Whitney U test and Fisher's exact test. P values <0.05 were considered significant.

RESULTS

A total of 104 patients with CUD were matched to 104 controls. Both groups were majority male (65.4% male, 34.6% female). The CUD group had a mean age of 29.9 years and mean follow-up time of 16.1 months. There was no significant intergroup difference in opioid prescription rates (CUD 82.7% vs control 83.7%, P ≥ 0.99). Among patients prescribed opioids, there were no significant intergroup differences in total days supply (P = 0.67), total MMEs (P = 0.71), or MMEs per day (P = 0.65). There were no significant differences in pre- to postoperative improvement in PROMIS Pain Intensity (P = 0.51), Pain Interference (P = 0.81), Mobility (P = 0.90), Mental Health (P = 0.74), or Physical Health (P = 0.94).

CONCLUSION

There were no significant differences detected in opioid usage or PRO improvement after ACLR between patients with CUD and those without. However, because a sample size was not determined a priori, a larger sample may show a difference.

CLINICAL RELEVANCE

CUD does not appear to correlate with inferior outcomes after ACLR.

A critical assessment of the abuse, dependence and associated safety risks of naturally occurring and synthetic cannabinoids

Various countries and US States have legalized cannabis, and the use of the psychoactive1 and non-psychoactive cannabinoids is steadily increasing. In this review, we have collated evidence from published non-clinical and clinical sources to evaluate the abuse, dependence and associated safety risks of the individual cannabinoids present in cannabis. As context, we also evaluated various synthetic cannabinoids. The evidence shows that delta-9 tetrahydrocannabinol (Δ9-THC) and other psychoactive cannabinoids in cannabis have moderate reinforcing effects. Although they rapidly induce pharmacological tolerance, the withdrawal syndrome produced by the psychoactive cannabinoids in cannabis is of moderate severity and lasts from 2 to 6 days. The evidence overwhelmingly shows that non-psychoactive cannabinoids do not produce intoxicating, cognitive or rewarding properties in humans. There has been much speculation whether cannabidiol (CBD) influences the psychoactive and potentially harmful effects of Δ9-THC. Although most non-clinical and clinical investigations have shown that CBD does not attenuate the CNS effects of Δ9-THC or synthetic psychoactive cannabinoids, there is sufficient uncertainty to warrant further research. Based on the analysis, our assessment is cannabis has moderate levels of abuse and dependence risk. While the risks and harms are substantially lower than those posed by many illegal and legal substances of abuse, including tobacco and alcohol, they are far from negligible. In contrast, potent synthetic cannabinoid (CB1/CB2) receptor agonists are more reinforcing and highly intoxicating and pose a substantial risk for abuse and harm. 1 "Psychoactive" is defined as a substance that when taken or administered affects mental processes, e.g., perception, consciousness, cognition or mood and emotions.

Perspectives regarding cannabis use: Results from a qualitative study of individuals engaged in substance use treatment in Georgia and Connecticut

Objective

Cannabis use is increasingly pervasive throughout the U.S. People in treatment for substance use disorders (SUD) may be especially at-risk of harm due to this changing context of cannabis in the U.S. This study's objective was to qualitatively describe experiences and beliefs around cannabis among people who had entered treatment for any SUD in the past 12-months.

Methods

From May to November of 2022, we conducted 27 semi-structured interviews (n=16 in Georgia, n=11 in Connecticut) with individuals in treatment for SUD in Georgia and Connecticut. Interviews were recorded, transcribed, and thematically analyzed using an emergent approach.

Results

All participants had used cannabis in the past. Four themes emerged from the interviews. Participants: (1) perceived cannabis as an important contributor to non-cannabis substance use initiation in adolescence; (2) viewed cannabis as a substance with the potential to improve health with fewer side effects than prescription medications; (3) expressed conflicting opinions regarding cannabis as a trigger or tool to manage cravings for other non-cannabis substances currently; and 4) described concerns related to negative legal, social service, and treatment-related consequences as well as negative peer perception relating to the use of cannabis.

Conclusion

Although participants described cannabis's important role as an initiatory drug in adolescence and young adulthood, many felt that cannabis was a medicinal substance for a range of health challenges. These findings suggest SUD treatment clinicians should address medicinal beliefs related to cannabis among their clients and emphasizes the need for research on cannabis use and SUD treatment outcomes.

Stigma-related barriers to medical cannabis as harm reduction for substance use disorder: Obstacles and opportunities for improvement

Emerging evidence on substituting cannabis for more harmful drugs has led to cannabis becoming a novel harm-reduction strategy for combating the current drug poisoning crisis. However, the authorization of medical cannabis as part of a harm-reduction approach and recovery strategy has significant implementation barriers rooted in longstanding stigma towards cannabis. Through a multi-discipline collaboration of Canadian clinicians and academic researchers, we highlighted stigma barriers and opportunities to address these barriers to elicit improved delivery of medical cannabis as a harm-reduction therapy within existing therapeutic frameworks. Evidence from existing literature and real-world experiences converged on three key themes related to stigma barriers: (1) Lack of medical cannabis education within the healthcare community, (2) lack of consensus and coordination among harm-reduction services and (3) access to medical cannabis. We highlight potential solutions to these issues, including improved healthcare education, better coordination between care teams and suggestions for improving access. Through this discussion, we hope to contribute to reducing the stigma around using medical cannabis as a harm-reduction strategy for individuals with a substance use disorder and consider new perspectives in policy development surrounding recovery services.

Second and fourth (2D:4D) digit ratio in heroin and cannabis addicted patients

The etiology of addiction has not yet been fully elucidated. The ratio between the length of the second and fourth fingers (2D:4D ratio) has been linked with prenatal androgen concentrations, but also with addictive behvaiors. Aim: The present study aimed to evaluate the differences of 2D:4D ratio of individuals with cannabis and heroin addiction by examining them together with the control group. A total of sixty two male patients (33 opiate use disorder and 29 cannabis use disorder) with substance use disorder and the twenty-nine healthy controls were included in the present investigation. We obtained the lengths of 2D and 4D of the subjects by using sensitive calipers and calculated the 2D:4D. Heroin-addicted patients had lower 2D:4D ratio in in the right hand (significant difference between control group) (p < 0.001), there was no significant difference found between heroin-cannabis (p = 0.242) and control-cannabis 2D:4D ratios (p < 0.06). In the left hand, it was significant between the heroin-control groups (p < 0.037) and the cannabis-control groups (p < 0.023), while it was not significant between the heroin-cannabis groups (p = 1). In conclusion, we suggest that heroin-and cannabis addicted patients seem to have a lower ratio of 2D:4D compared to healthy control subjects. Our findings can be considered promising as to whether prenatal hormonal factors are important in the etiopathogenesis of addiction.

Effect of Preoperative Marijuana on Patient Outcomes and Opioid Use after Lumbar Decompression

STUDY DESIGN

Retrospective Cohort Study.

OBJECTIVES

Our study aims to analyze the effect of preoperative marijuana use on outcomes and postoperative opioid use in patients who have undergone lumbar decompression without fusion.

METHODS

All patients >18 years of age who underwent lumbar decompression from 2017-2022 with documented preoperative marijuana use at our academic institution were retrospectively identified. A 3:1 propensity match incorporating demographics, procedure type, and levels decompressed was performed to compare preoperative marijuana users and non-users. 1-year preoperative and postoperative opioid consumption in milligrams of morphine equivalents and postoperative outcomes including readmissions, reoperations, and complications, were obtained. A multivariate regression model was performed to measure the effect of marijuana use on the likelihood of a spine reoperation.

RESULTS

Of the 340 included patients, 85 were preoperative marijuana users. There were no significant differences in medical complications, 90-day readmissions, or opioid consumption preoperatively or postoperatively (P > .05). We identified a trend towards patients who used marijuana having more reoperations for any cause (20.0% vs 11.37%, P = .067). Multivariate logistic regression analysis suggested that preoperative marijuana use was a significant predictor of all-spine reoperations (OR = 2.06, P = .036).

CONCLUSIONS

In lumbar decompression patients, preoperative marijuana use does not impact opioid consumption, readmissions, or medical complications, but is a significant predictor of future postoperative reoperations. Additional research is necessary to further explore the role of marijuana use in spine surgery.

Early life adversity: Epigenetic regulation underlying drug addiction susceptibility

Drug addiction is a leading cause of disability worldwide, with more than 70,000 Americans dying from drug overdose in 2019 alone. While only a small percentage of chronic drug users escalate to drug addiction, little is understood on the precise mechanisms of this susceptibility. Early life adversity is causally relevant to adult psychiatric disease and may contribute to the risk of addiction. Here we review recent pre-clinical evidence showing that early life exposure to stress and/or drugs regulates changes in behavior, gene expression, and the epigenome that persist into adulthood. We summarize the major findings and gaps in the preclinical literature, highlighting studies that demonstrate the often profound differences between female and male subjects.

Impacts of EU Tobacco Products Directive regulations on use of e-cigarettes in adolescents in Great Britain: a natural experiment evaluation

Background

E-cigarettes are a popular smoking-cessation tool. Although less harmful than tobacco, use of e-cigarettes by non-smokers should be prevented. There is concern about the use of e-cigarettes by young people and that e-cigarettes may renormalise smoking. In May 2016, Tobacco Products Directive regulations aimed to reduce e-cigarettes' appeal to young people.

Aims

To examine the effects of the Tobacco Products Directive regulations on young people's use of e-cigarettes, and the role of e-cigarettes in renormalising smoking.

Design

A mixed-method natural experimental evaluation combining secondary analyses of survey data, with process evaluation, including interviews with young people, policy stakeholders, retailers and trading standards observers, and observations of retail settings.

Settings

Wales, Scotland and England.

Participants

Survey participants were aged 13-15 years, living in England, Scotland or Wales and participated in routinely conducted surveys from 1998 to 2019. Process evaluation participants included 14- to 15-year-olds in England, Scotland and Wales, policy stakeholders, trading standards offices and retailers.

Intervention

Regulation of e-cigarettes, including bans on cross-border advertising, health warnings and restrictions on product strength.

Comparison group

Interrupted time series design, with baseline trends as the comparator.

Main outcome measures

The primary outcome was ever e-cigarette use. Secondary outcomes included regular use, ever and regular smoking, smoking attitudes, alcohol and cannabis use.

Data capture and analysis

Our primary statistical analysis used data from Wales, including 91,687 young people from the 2013-19 Health Behaviour in School-aged Children and School Health Research Network surveys. In Scotland, we used the Scottish Schools Adolescent Lifestyle and Substance Use Survey and in England we used the Smoking Drinking and Drug Use surveys. The process evaluation included interviews with 73 young people in 2017 and 148 young people in 2018, 12 policy stakeholders, 13 trading standards officers and 27 retailers. We observed 30 retail premises before and after implementation. Data were integrated using the Medical Research Council's process evaluation framework.

Results

Ever smoking continued to decline alongside the emergence of e-cigarettes, with a slight slowing in decline for regular use. Tobacco Products Directive regulations were described by stakeholders as well implemented, and observations indicated good compliance. Young people described e-cigarettes as a fad and indicated limited interaction with the components of the Tobacco Products Directive regulations. In primary statistical analyses in Wales [i.e. short (to 2017) and long term (to 2019)], growth in ever use of e-cigarettes prior to Tobacco Products Directive regulations did not continue after implementation. Change in trend was significant in long-term analysis, although of similar magnitude at both time points (odds ratio 0.96). Data from England and Scotland exhibited a similar pattern. Smoking followed the opposite pattern, declining prior to the Tobacco Products Directive regulations, but plateauing as growth in e-cigarette use stalled.

Limitations

Alternative causal explanations for changes cannot be ruled out because of the observational design.

Conclusions

Young people's ever and regular use of e-cigarettes appears to have peaked around the time of the Tobacco Products Directive regulations and may be declining. Although caution is needed in causal attributions, findings are consistent with an effect of regulations. Our analysis provides little evidence that e-cigarettes renormalise smoking. More recent data indicate that declines in smoking are plateauing.

Future work

International comparative work to understand differences in use of e-cigarettes, and tobacco, within varying regulatory frameworks is a priority.

Study registration

This study is registered as ResearchRegistry4336.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 11, No. 5. See the NIHR Journals Library website for further project information.

The Impact of Recreational Marijuana Legalization on Simple Assault in Oregon

There has been heightened public concern about the implications of recreational marijuana legalization to public safety. Prior research on this issue has primarily focused on Colorado and Washington State-the two states that first legalized recreational marijuana in the U.S.-and on legalization's impact on major crimes. This study extends this line of research to Oregon (OR, legalized in late 2014) and examines the impact of legalization on a less serious form of violent crime-simple assault. Using Uniform Crime Reporting (UCR) Program data from 2007 to 2017 and a quasi-experimental research design, this study found that counties in OR have experienced increases in simple assault rate following legalization, relative to rates in the 19 non-legalized states. Findings suggest the need for more scholarly efforts to explore the potential impact of marijuana legalization on different subtypes of violent crime in other legalized states.

Marijuana use does not affect weight loss or complication rate after bariatric surgery

INTRODUCTION

Marijuana use has been legalized in several states. It is unclear if marijuana use affects weight loss outcomes or complication rates following bariatric surgery. The purpose of this study was to determine if patients who use marijuana had higher complication rates or lower weight loss compared with non-users.

METHODS

All patients at a single institution who underwent primary bariatric surgery between July 2015 and July 2020 at a single institution after the legalization of marijuana within the jurisdiction were included. Data regarding marijuana use, weight and complications were abstracted retrospectively. Differences between groups were evaluated with Wilcoxon Rank-Sum tests and Fisher Freeman Halton test. Trends for marijuana use over time was evaluated with simple linear regression on summary data.

RESULTS

1107 patients met inclusion criteria. 798 (73.3%) were never users, 225 (19.4%) were previous users, and 84 (7.2%) were active users. The proportion of active users and previous users increased over time, with significantly more prior marijuana use reported in more recent years (p = 0.014). Active users had significantly higher pre-procedural BMIs than never users: 48.7 vs. 46.3 (p = 0.03). Any marijuana use (active and previous users) was associated with higher preoperative weight compared to never: 136.4 kg vs. 130.6 kg (p = 0.001). Overall complication rate was low in all groups, and there was no difference in the rates of any complications. Active and previous users tended to lose less weight than never users, but this was not statistically significant (p = 0.17).

CONCLUSIONS

Active and prior marijuana users tend to have higher BMIs on presentation, but use was not associated with complications or percent weight loss. The incidence of patient reported marijuana use is increasing in the study population. More studies on the effects of marijuana use in this patient population are warranted.

The dopamine transporter gene SLC6A3: multidisease risks

The human dopamine transporter gene SLC6A3 has been consistently implicated in several neuropsychiatric diseases but the disease mechanism remains elusive. In this risk synthesis, we have concluded that SLC6A3 represents an increasingly recognized risk with a growing number of familial mutants associated with neuropsychiatric and neurological disorders. At least five loci were related to common and severe diseases including alcohol use disorder (high activity variant), attention-deficit/hyperactivity disorder (low activity variant), autism (familial proteins with mutated networking) and movement disorders (both regulatory variants and familial mutations). Association signals depended on genetic markers used as well as ethnicity examined. Strong haplotype selection and gene-wide epistases support multimarker assessment of functional variations and phenotype associations. Inclusion of its promoter region's functional markers such as DNPi (rs67175440) and 5'VNTR (rs70957367) may help delineate condensate-based risk action, testing a locus-pathway-phenotype hypothesis for one gene-multidisease etiology.

Classical and Neural Network Machine Learning to Determine the Risk of Marijuana Use

Marijuana is the most commonly abused drug for military personnel tested at the Air Force Drug Testing Laboratory. A publicly available dataset of drug use, personality trait scores and demographic data was modeled with logistic regression, decision tree and neural network models to determine the extent to which marijuana use can be predicted using personality traits. While the logistic regression model had lower performance than the neural network model, it matched the sensitivity of prior work (0.80), achieved a high level of significance (p < 0.05) and yielded valuable inferences. It implied that younger, less educated individuals who exhibit sensation-seeking behavior and are open to experience tend to be at higher risk for THC use. A method for performing an iterative multidimensional neural network hyperparameter search is presented, and two iterations of a 6-dimensional search were performed. Metrics were used to select a family of 8 promising models from a cohort of 4600 models, and the best NN model’s 0.87 sensitivity improved upon the literature. The model met an f1 overfitting threshold on the test and holdout datasets, and an accuracy sensitivity analysis on a holdout-equivalent dataset yielded a 95% CI of 0.86 ± 0.04. These results have the potential to increase the efficacy of drug prevention and intervention programs.

Associations between eating disorders and illicit drug use among college students

OBJECTIVE

To estimate the associations between a positive eating disorder screen and any lifetime eating disorder diagnosis and illicit drug use among a large, diverse sample of college students.

METHOD

We analyzed data from the national (United States), cross-sectional 2018-2019 Healthy Minds Study (HMS; n = 42,618; response rate: 16%). HMS collects information on the physical, mental, and social health of college students. Multiple logistic regression analyses were used to estimate the association between a positive eating disorder screen (measured using the SCOFF) and any self-reported lifetime eating disorder diagnosis and self-reported illicit drug use in the past 30 days (any illicit drug use and use of marijuana, cocaine, heroin, methamphetamines, stimulants, ecstasy, opioids, benzodiazepines), while adjusting for potential confounders.

RESULTS

Among the sample, 54.34% (n = 28,608) were female and the mean age of participants was 23.30 (SE ± 0.05) years. Logistic regression analyses revealed unique associations between a positive eating disorder screen and any lifetime eating disorder diagnosis and illicit drug use among the sample of college student participants. A positive eating disorder screen was most strongly associated with methamphetamine use (adjusted odds ratio [AOR] 3.93, 95% confidence interval [CI] 1.43-10.78), and any lifetime eating disorder diagnosis was most strongly associated with benzodiazepine use (AOR 3.42, 95% CI 2.28-5.13).

DISCUSSION

Illicit drug use is common among college students who screen positive for an eating disorder and report any lifetime eating disorder diagnosis. The co-occurring nature of eating disorders and illicit drug use may complicate treatment and lead to compounded adverse health outcomes.

The Future of Substance Abuse Now: Relationships among Adolescent Use of Vaping Devices, Marijuana, and Synthetic Cannabinoids

Background: Substances that can be vaped include nicotine, marijuana, cocaine, heroin, and a range of synthetic drugs called new psychoactive substances (NPS). Due to the rising popularity of vaping among adolescents, it is crucial to understand the relationships between vaping and illicit drug use. Objectives: This paper examined the prevalence and trends of using vaping devices, marijuana vaping, marijuana products, synthetic cannabinoids and mist contents among youth. Methods: The study utilized 5 sets of public cross-sectional national data from the "Monitoring the Future" surveys during 2014-2018. It employed logistic regression to analyze the data. Results: There was an increase from 10.5% in 2017 to 20.8% in 2018 for the past 30-day use of vaping devices among 12^th graders. Furthermore, there was an increase from 21.6% in 2017 to 34.5% in 2018 for the past 12-month use of marijuana via vaping device among 12^th-grade marijuana users. Additionally, there were significant associations between vaping device use and marijuana vaping, between vaping device use and marijuana use, between vaping device use and synthetic cannabinoids use, and between marijuana use and synthetic cannabinoids use from 2016 to 2018. Conclusions: Vaping emerged as another major route of marijuana administration among youth. Adolescent marijuana users had higher odds of using synthetic cannabinoids. This finding highlighted the importance of understanding what adolescent substance consumption pattern would be where marijuana was legalized. It also supported the hypothesis that vaping devices use correlates with, or is associated with, marijuana and synthetic cannabinoids use.

Regulating Marijuana Use in the United States: Moving Past the Gateway Hypothesis of Drug Use

Many studies have shown that marijuana can negatively affect the cognitive development of adolescents. For some individuals, marijuana use may also initiate opioid use, dose escalation, and opioid use disorder. States that legalize marijuana should help adolescents through regulation of advertising and availability of marijuana-infused edibles. Such policies may assist in protecting neurodevelopment of the adolescent and young adult brain. The federal government should also remove its prohibition of marijuana sales and use, leaving their regulation to state law-makers.