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Pratschke J. Harm reduction strategies for cannabis-related problems: a literature review and typology. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01839-3. [PMID: 38935216 DOI: 10.1007/s00406-024-01839-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
Measures that seek to minimise the health and social consequences of substance use are an integral part of national drug strategies in many European countries. Against the backdrop of a high prevalence of cannabis use in the economically advanced countries, and increasing demand for treatment for cannabis-related problems, a range of harm reduction measures have been implemented by peers, statutory bodies and third-sector organisations. Based on a systematic review of the literature, the author describes these different forms of intervention, identifies innovative strategies and presents a simple typology that can be used when exploring existing measures or seeking to develop new policies. This typology covers different kinds of legal, socio-organisational and health-related interventions. All study designs were eligible for inclusion, with the exception of case reports, non-systematic reviews, editorials and news stories. Studies had to be published between 2011 and 2022, in English, and they had to refer to Europe, the Americas, Australia or New Zealand. A two-concept search was implemented using Embase.com and a number of other databases, combined with citation searches and manual website searching to improve coverage of research reports and advocacy documents. A total of 35 documents were deemed eligible, many of which rely on qualitative research methods.
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Affiliation(s)
- Jonathan Pratschke
- Department of Social Science, University of Naples Federico II, Vico Monte della Pietà, 1, Naples, 80138, Italy.
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Scherer JN, Vasconcelos M, Dalanhol CS, Govoni B, Dos Santos BP, Borges GR, de Gouveia GC, Viola PP, Carlson RLR, Martins AF, Costa JL, Huestis MA, Pechansky F. Reliability of roadside oral fluid testing devices for ∆ 9 -tetrahydrocannabinol (∆ 9 -THC) detection. Drug Test Anal 2024. [PMID: 38440942 DOI: 10.1002/dta.3669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/29/2024] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
Driving under the influence of cannabis (DUIC) is increasing worldwide, and cannabis is the most prevalent drug after alcohol in impaired driving cases, emphasizing the need for a reliable traffic enforcement strategy. ∆9 -tetrahydrocannabinol (THC) detection in oral fluid has great potential for identifying recent cannabis use; however, additional data are needed on the sensitivities, specificities, and efficiencies of different oral fluid devices for detecting cannabinoids at the roadside by police during routine traffic safety enforcement efforts. At the roadside, 8945 oral fluid THC screening tests were performed with four devices: AquilaScan®, Dräger DrugTest®, WipeAlyser Reader®, and Druglizer®. A total of 530 samples screened positive for THC (5.9%) and were analyzed by liquid chromatography-tandem mass spectrometry at multiple cutoff concentrations (2 ng/mL, 10 ng/mL, and manufacturers' recommended device cutoffs) to investigate device performance. Results varied substantially, with sensitivities of 0%-96.8%, specificities of 89.8%-98.5%, and efficiencies of 84.3%-97.8%. The Dräger DrugTest® outperformed the other devices with a 96.8% sensitivity, 97.1% specificity, and 97.0% efficiency at a 5-ng/mL LC-MS/MS confirmation cutoff. The WipeAlyser Reader® had good performance with a 91.4% sensitivity, 97.2% specificity, and 96.4% efficiency. AquilaScan® and Druglizer® had unacceptable performance for cannabinoid detection, highlighted by sensitivity <13%. The choice of roadside oral fluid testing device must offer good analytical performance for cannabinoids because of its high prevalence of use and impact on road safety.
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Affiliation(s)
- Juliana Nichterwitz Scherer
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Programa de Pós-Graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, Brazil
| | - Mailton Vasconcelos
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Bruna Govoni
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Bruno Pereira Dos Santos
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Gabriela Ramos Borges
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Patrícia Pacheco Viola
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Aline Franco Martins
- Campinas Poison Control Center, University of Campinas (UNICAMP), Campinas, Brazil
| | - Jose Luiz Costa
- Campinas Poison Control Center, University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Pharmaceutical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Severna Park, Maryland, USA
| | - Flavio Pechansky
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Windle SB, Socha P, Nazif-Munoz JI, Harper S, Nandi A. The Impact of Cannabis Decriminalization and Legalization on Road Safety Outcomes: A Systematic Review. Am J Prev Med 2022; 63:1037-1052. [PMID: 36167602 DOI: 10.1016/j.amepre.2022.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION There is substantial debate concerning the impact of cannabis decriminalization and legalization on road safety outcomes. METHODS Seven databases were systematically searched: Embase, MEDLINE, and PsycINFO through Ovid as well as Web of Science Core Collection, SafetyLit, Criminal Justice Database (ProQuest), and Transport Research International Documentation (from inception to June 16, 2021). Eligible primary studies examined group-level cannabis decriminalization or legalization and a road safety outcome in any population. RESULTS A total of 65 reports of 64 observational studies were eligible, including 39 that applied a quasi-experimental design. Studies examined recreational cannabis legalization (n=50), medical cannabis legalization (n=22), and cannabis decriminalization (n=5). All studies except 1 used data from the U.S. or Canada. Studies found mixed impacts of legalization on attitudes, beliefs, and self-reported driving under the influence. Medical legalization, recreational legalization, and decriminalization were associated with increases in positive cannabis tests among drivers. Few studies examined impacts on alcohol or other drug use, although findings suggested a decrease in positive alcohol tests among drivers associated with medical legalization. Medical legalization was associated with reductions in fatal motor-vehicle collisions, whereas recreational legalization was conversely associated with increases in fatal collisions. DISCUSSION Increased cannabis positivity may reflect changes in cannabis use; however, it does not in itself indicate increased impaired driving. Subgroups impacted by medical and recreational legalization, respectively, likely explain opposing findings for fatal collisions. More research is needed concerning cannabis decriminalization; the impacts of decriminalization and legalization on nonfatal injuries, alcohol and other drugs; and the mechanisms by which legalization impacts road safety outcomes.
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Affiliation(s)
- Sarah B Windle
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada; Institute for Health and Social Policy, School of Population and Global Health, McGill University, Montreal, Quebec, Canada.
| | - Peter Socha
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - José Ignacio Nazif-Munoz
- Programmes d'études et de recherche en toxicomanie, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada; Institute for Health and Social Policy, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada; Institute for Health and Social Policy, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
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Frei P, Frauchiger S, Scheurer E, Mercer-Chalmers-Bender K. Quantitative determination of five cannabinoids in blood and urine by gas chromatography tandem mass spectrometry applying automated on-line solid phase extraction. Drug Test Anal 2022; 14:1223-1233. [PMID: 35187817 PMCID: PMC9543167 DOI: 10.1002/dta.3241] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022]
Abstract
Cannabis is the most frequently consumed illegal substance worldwide. More recently, an increasing number of legal cannabis products low in psychoactive Δ9‐tetrahydrocannabinol (THC) but high in non‐intoxicating cannabidiol (CBD) are being more widely consumed. While the detection and quantification of THC and its metabolites in biological matrices is an important forensic‐toxicological task, additional detection of CBD is also important, for example, when examining the plausibility of consumer's statements. This report describes the method validation for the quantitative determination of THC and its two major metabolites, 11‐hydroxy‐THC (OH‐THC) and 11‐nor‐9‐carboxy‐THC (THC‐COOH), as well as CBD and cannabinol (CBN) in whole blood and urine. The method employs automated on‐line solid phase extraction coupled to gas chromatography tandem mass spectrometry (GC–MS/MS). The method was fully validated according to guidelines of the Swiss Society of Legal Medicine (SGRM) and the Society of Toxicological and Forensic Chemistry (GTFCh). The method fulfilled the validation criteria regarding analytical limits, accuracy and precision, extraction efficacy, and sample stability. The limits of detection (LODs) in whole blood and urine were 0.15 ng/mL for THC, OH‐THC and CBD, 0.1 ng/mL for CBN, and 1.0 ng/mL for THC‐COOH. The limits of quantification (LOQ) in whole blood and urine were 0.3 ng/mL for THC, OH‐THC and CBD, 0.2 ng/mL for CBN, and 3.0 ng/mL for THC‐COOH. The fully validated and automated method allows sensitive and robust measurement of cannabinoids in whole blood and urine. Detection of CBD provides additional information regarding consumed products.
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Affiliation(s)
- P Frei
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - S Frauchiger
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - E Scheurer
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - K Mercer-Chalmers-Bender
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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McDonald AJ, Hamilton HA, Wickens CM, Watson TM, Elton-Marshall T, Wardell JD, Rueda S, Roerecke M, Stoduto G, Mann RE. Driving under the influence of cannabis risk perceptions and behaviour: A population-based study in Ontario, Canada. Prev Med 2021; 153:106793. [PMID: 34517043 DOI: 10.1016/j.ypmed.2021.106793] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/29/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
Driving under the influence of cannabis (DUIC) is detrimental to road safety. Risk perception is a strong determinant of DUIC behaviour, yet little is known about the factors influencing DUIC risk perception in the general population. The objective of this study was to identify factors associated with risk perceptions of motor vehicle collision and legal consequences due to DUIC and examine whether these perceptions were associated with DUIC behaviour. Data were derived from the 2017 CAMH Monitor, a cross-sectional telephone survey of adults aged 18+ years in Ontario, Canada (n = 1813). Multivariable logistic regression analyses were performed. Approximately 90% of adults overall agreed that DUIC increases motor vehicle collision risk compared to 55% of those reporting past-year DUIC. Being male, less educated, and using cannabis at least monthly were associated with disagreeing that DUIC increases motor vehicle collision risk. Being male, young, and using cannabis at least monthly were associated with agreeing that DUIC is safer than driving under the influence of alcohol (DUIA). Being male and using cannabis less than monthly were associated with agreeing that the chances of getting caught for DUIC are higher than DUIA. Safety but not legal risk perceptions were associated with DUIC behaviour among cannabis-using drivers. Cannabis legalization provides a timely opportunity for DUIC prevention strategies. This study suggests that policymakers should target male cannabis users and highlight the safety risks of DUIC. Further research is needed to assess the effectiveness of prevention measures and the impact of cannabis legalization on DUIC perceptions and behaviour.
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Affiliation(s)
- André J McDonald
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Hayley A Hamilton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Christine M Wickens
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Tara Marie Watson
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Canada; Department of Epidemiology and Biostatistics, Western University, London, Canada; Department of Health Sciences, Lakehead University, Thunder Bay, Canada
| | - Jeffrey D Wardell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Psychology, York University, Toronto, Canada
| | - Sergio Rueda
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Gina Stoduto
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Robert E Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Fischer B, Lee A, Robinson T, Hall W. An overview of select cannabis use and supply indicators pre- and post-legalization in Canada. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:77. [PMID: 34620191 PMCID: PMC8496143 DOI: 10.1186/s13011-021-00405-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 12/18/2022]
Abstract
Background Canada implemented the legalization and regulation of non-medical cannabis use, production and sale in 2018 aiming to improve public health and safety. While outcomes from legalization reforms in other jurisdictions mostly rely on US-based data have been assessed to be mixed, Canadian data are only emerging. We compiled select population-level data on key indicators to gauge initial developments from pre- to post-legalization of cannabis in Canada. Methods We examined indicators data focusing on the following topics: prevalence of cannabis use, frequency of use, methods/products of consumption, driving after cannabis use, and cannabis sourcing. Indicator data were obtained mostly from national and some provincial population surveys. Prevalence or percentages for the indicators pre- and post-legalization (e.g., 2017- 2020), including confidence intervals were reported, with changes noted, as available in and indicated by the data sources. Results Data suggested selected increases in cannabis use prevalence, mostly among mid- and older- but possibly also younger (e.g., under legal use age) users. Frequency of use and driving after cannabis use among active users do not appear to have changed. Methods of cannabis use show diversifying trends, with decreases in smoking and increases in alternatives use modes (e.g., edibles, vaping). There is a clearly increasing trend towards accessing cannabis from legal sources among adults, while under-legal-use-age youth do not appear to experience heightened barriers to obtaining cannabis in legalization contexts. Conclusions Preliminary indicators on cannabis legalization in Canada show a mixed picture, some similar to US-based developments. While some use increases are observed, these do not necessarily represent indications of increases in cannabis-related harm, also since key (e.g., hospitalization or injury) data are lacking to date. There is a gradual embracing of legal supply sources of cannabis among users, which can be expected to serve public health and safety objectives. At the same time, cannabis use and access among under-age users as a principally vulnerable group do not appear to be hindered or reduced by legalization.
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Affiliation(s)
- Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400 515 W. Hastings Street, Vancouver, British Columbia, V6B 5K3, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street 8th floor, Toronto, Ontario, M5T 1R8, Canada. .,Department of Psychiatry, Federal University of São Paulo (UNIFESP), R. Dr. Ovídio Pires de Campos, São Paulo, 785 05403-90, Brazil.
| | - Angelica Lee
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400 515 W. Hastings Street, Vancouver, British Columbia, V6B 5K3, Canada
| | - Tessa Robinson
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400 515 W. Hastings Street, Vancouver, British Columbia, V6B 5K3, Canada.,Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Wayne Hall
- Centre for Youth Substance Abuse Research (CYSAR), 19 Upland Rd, St. Lucia, Queensland, 4072, Australia.,National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
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