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Martínez P, Huynh C, Massamba V, Zefania I, Rochette L, Vasiliadis HM, Nazif-Munoz JI. Changes in the incidence of cannabis-related disorders after the Cannabis Act and the COVID-19 pandemic in Québec, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 129:104484. [PMID: 38870546 DOI: 10.1016/j.drugpo.2024.104484] [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: 11/27/2023] [Revised: 05/17/2024] [Accepted: 06/02/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND The Canadian Cannabis Act (CCA, implemented in October 2018) and the COVID-19 pandemic (April 2020) might have contributed to cannabis-related harms in Québec, known for its stringent cannabis legal framework. We explored changes in incidence rates of cannabis-related disorders (CRD) diagnoses associated with these events in Québec. METHODS We utilized linked administrative health data to identify individuals aged 15 year+ newly diagnosed with CRD during hospitalizations, emergency, and outpatients clinics across Québec, from January 2010 and March 2022 (147 months). Interrupted time-series analyses (ITSA) assessed differences (as percentage changes) in sex- and age-standardized, and sex-stratified, monthly incidence rates (per 100,000 population) attributed to the CCA and the COVID-19 pandemic, compared to counterfactual scenarios where pre-events trends would continue unchanged. RESULTS The overall monthly mean rates of incident diagnoses nearly doubled from the pre-CCA period (1.56 per 100,000 population) to the COVID-19 pandemic period (3.02 per 100,000 population). ITSA revealed no statistically significant level or slope changes between adjacent study periods, except for a decrease in the slope of incidence rates among males by 1.84 % (95 % CI -3.41 to -0.24) during the COVID-19 pandemic compared to the post-CCA period. During the post-CCA period, the trends of incidence rates in the general and male populations grew significantly by 1.22 % (95 % CI 0.08 to 2.35) and 1.44 % (0.04 to 2.84) per month, respectively. Similarly significant increases were observed for the general and female populations during the COVID-19 pandemic, with monthly rates rising by 1.43 % (95 % CI 0.75 to 2.12) and 1.75 % (95 % CI 0.13 to 3.37), respectively. These increases more than doubled pre-CCA rates. CONCLUSIONS The incidence rates of CRD diagnoses across Québec appears to have increased following the implementation of the CCA and during the COVID-19 pandemic. Our findings echo public health concerns regarding potential cannabis-related harms and are consistent with previous Canadian studies.
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Affiliation(s)
- Pablo Martínez
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke - Campus Longueuil, 150 Pl. Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; Centre de Recherche Charles-Le Moyne, 150 Pl. Charles-Le Moyne, Longueuil, QC J4K A08, Canada; Douglas Research Centre, McGill University, 6875 Bd LaSalle, Verdun, QC H4H 1R3, Canada; Institut National de Santé Publique du Québec, 945 Wolfe Av., Québec, QC G1V 5B3, Canada
| | - Chris Huynh
- Institut Universitaire sur les Dépendances, Centre Intégré Universitaire de Santé et des Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 rue Louvain Est, Montréal, QC H2M 2E8, Canada
| | - Victoria Massamba
- Institut National de Santé Publique du Québec, 945 Wolfe Av., Québec, QC G1V 5B3, Canada
| | - Isaora Zefania
- Institut National de Santé Publique du Québec, 945 Wolfe Av., Québec, QC G1V 5B3, Canada
| | - Louis Rochette
- Institut National de Santé Publique du Québec, 945 Wolfe Av., Québec, QC G1V 5B3, Canada
| | - Helen-Maria Vasiliadis
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke - Campus Longueuil, 150 Pl. Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; Centre de Recherche Charles-Le Moyne, 150 Pl. Charles-Le Moyne, Longueuil, QC J4K A08, Canada
| | - José Ignacio Nazif-Munoz
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke - Campus Longueuil, 150 Pl. Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; Centre de Recherche Charles-Le Moyne, 150 Pl. Charles-Le Moyne, Longueuil, QC J4K A08, Canada; Institut Universitaire sur les Dépendances, Centre Intégré Universitaire de Santé et des Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 rue Louvain Est, Montréal, QC H2M 2E8, Canada.
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Raifman S, Biggs MA, Rocca C, Roberts SCM. Is legal recreational cannabis associated with cannabis use during pregnancy, beliefs about safety, and perceived community stigma? Drug Alcohol Depend 2024; 255:111079. [PMID: 38183831 DOI: 10.1016/j.drugalcdep.2023.111079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Among pregnant and recently pregnant people we investigated whether legal recreational cannabis is associated with pregnancy-related cannabis use, safety beliefs, and perceived community stigma. METHODS In 2022, we surveyed 3571 currently and recently pregnant English- or Spanish-speaking adults in 37 states. Primary outcomes included cannabis use during pregnancy and two continuous scale measures of beliefs about safety and perceived community stigma. Using generalized linear models and mixed effects ordinal logistic regression with random effects for state, we assessed associations between legal recreational cannabis and outcomes of interest, controlling for state-level and individual-level covariates and specifying appropriate functional form. RESULTS Those who reported cannabis use during pregnancy were more likely to believe it is safe and to perceive community stigma compared to those who did not report use during pregnancy. Legal recreational cannabis was not associated with cannabis use during pregnancy, continuation or increase in use, frequency of use, or safety beliefs. Legal recreational cannabis was associated with lower perceived community stigma (coefficient: -0.07, 95% CI: -0.13, -0.01), including among those who reported use during (coefficient = -0.22, 95% CI: -0.40, -0.04) and prior to but not during (coefficient = -0.19, 95% CI: -0.37, -0.01) pregnancy. CONCLUSION Findings do not support concerns that legal recreational cannabis is associated with cannabis use during pregnancy or beliefs about safety. Legal recreational cannabis may be associated with lower community stigma around cannabis use during pregnancy, which could have implications for pregnant people's disclosure of use and care-seeking behavior.
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Affiliation(s)
- Sarah Raifman
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Oakland, CA 94612, USA.
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Oakland, CA 94612, USA
| | - Corinne Rocca
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Oakland, CA 94612, USA
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Oakland, CA 94612, USA
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Zaugg C, Berglas NF, Johnson R, Roberts SCM. Reaching Consensus on Politicized Topics: A Convening of Public Health Professionals to Discuss Appropriate Abortion Activities for US Health Departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:366-374. [PMID: 34750328 DOI: 10.1097/phh.0000000000001455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Public health professionals, particularly those in state and local health departments, do not always have clear understandings of their roles related to politically controversial public health topics. A process of consensus development among public health professionals that considers the best available evidence may be able to guide decision making and lay out an appropriate course of action. APPROACH In May 2020, a group of maternal and child health and family planning professionals working in health departments, representatives of schools of public health, and members of affiliated organizations convened to explore values and principles relevant to health departments' engagement in abortion and delineate activities related to abortion that are appropriate for health departments. The convening followed a structured consensus process that included multiple rounds of input and opportunities for feedback and revisions. OUTCOMES Convening participants came to consensus on principles to guide engagement in activities related to abortion, a set of activities related to abortion that are appropriate for health departments, and next steps to support implementation of such activities. LESSONS LEARNED The experience of the convening indicates that consensus processes can be feasible for politically controversial public health topics such as abortion.
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Affiliation(s)
- Claudia Zaugg
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California (Ms Zaugg and Drs Berglas and Roberts); and CityMatCH, University of Nebraska Medical Center, Omaha, Nebraska (Ms Johnson)
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Potterf JE, Unnithan NP. Post-Legalization Drug Communication: Examining a Colorado Cannabis Campaign. Subst Use Misuse 2022; 57:27-35. [PMID: 34693857 DOI: 10.1080/10826084.2021.1981385] [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] [Indexed: 10/20/2022]
Abstract
Colorado legalized marijuana use for recreational purposes by adults over 21 in 2012. Our goal is to examine the first major communication campaign (called Good-To-Know) mounted by the state government with the objective of informing the public regarding regulatory and safety precautions surrounding newly legal use. Methods: We assess the content of campaign's central messaging qualitatively by comparing its major themes in terms of criteria developed from the literature and the campaign's own goals. Results: With minor exceptions (lack of audience segmentation; limiting the focus to generating knowledge) Colorado's Good-To-Know campaign rates well when assessed against specific criteria for effective drug communication campaigns as well as its own goals. Conclusions: We conclude that although there were minor limitations to this campaign, policy makers and activists should think proactively about messaging content in states where legalization is imminent. And that more research on legal drug use messaging needs to occur.
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Affiliation(s)
- Jebadiha E Potterf
- Department of Sociology, Colorado State University, Fort Collins, Colorado, USA
| | - N Prabha Unnithan
- Department of Sociology, Colorado State University, Fort Collins, Colorado, USA
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Payán DD, Brown P, Song AV. County-Level Recreational Marijuana Policies and Local Policy Changes in Colorado and Washington State (2012-2019). Milbank Q 2021; 99:1132-1161. [PMID: 34407252 DOI: 10.1111/1468-0009.12535] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Policy Points In 2012, Colorado and Washington were the first states to legalize recreational marijuana through voter-initiated ballots. In these states, counties could restrict or ban local marijuana facilities through a variety of regulatory methods such as ordinances and zoning. County-level recreational marijuana policies in Washington and Colorado vary substantially, with 69.2% of Washington counties and 23.4% of Colorado counties allowing all types of recreational marijuana facilities as of April 1, 2019. After Colorado and Washington legalized recreational marijuana, many counties modified their marijuana policies over time, with shifts in county policy often preceded by advocacy and information-seeking activities. CONTEXT In 2012, Colorado and Washington were the first states to legalize recreational marijuana. Both allowed local governments to further regulate the availability of marijuana facilities in their jurisdictions. As early adopters, these states are important quasi-natural experiments to examine local marijuana policy and policy change processes, including key stakeholders and arguments. METHODS We conducted a policy scan of county-level recreational marijuana ordinances and regulations in Colorado and Washington. Data collected included policy documents from counties in both states and newspaper articles. We used a mixed-methods approach to describe the types of county-level recreational marijuana policies enacted by April 1, 2019; identify key policy stakeholders involved in local policy debates; and explore arguments used in support or opposition of county policies. We also selected four counties that represent three county policy environments (all marijuana facility types allowed, some marijuana facility types allowed, all marijuana facility types prohibited) and described the policy changes within these counties since recreational marijuana was legalized. FINDINGS By April 1, 2019, Colorado counties were less likely than Washington counties to allow marijuana facilities-48.4% of Colorado counties prohibited recreational marijuana facilities in their jurisdiction compared to 23.1% of Washington counties. Since state legalization, several counties in both states have made substantial marijuana facility policy modifications, often preceded by information-seeking activities. Primary stakeholders involved in policy debates included elected officials, law enforcement, individual growers/farmers, marijuana business license applicants, parents, and residents. Proponents referenced local economic gain, reduced crime, and potential health benefits of marijuana as arguments in favor of permitting local facilities, whereas opponents pointed to economic loss, negative health and public health issues, public safety concerns, and existing federal law. Both sides referenced local public opinion data to support their position. CONCLUSIONS By early 2019, a patchwork of local marijuana policies was in place in Colorado and Washington. We identify key areas of policy and public health research needed to inform future local marijuana policy decisions, including the impact of legalization on public health outcomes (particularly for youth) and public safety.
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Mahdi O, Baharuldin MTH, Nor NHM, Chiroma SM, Jagadeesan S, Moklas MAM. The Neuroprotective Properties, Functions, and Roles of Cannabis sativa in Selected Diseases Related to the Nervous System. Cent Nerv Syst Agents Med Chem 2021; 21:20-38. [PMID: 33504317 DOI: 10.2174/1871524921666210127110028] [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: 09/10/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cannabis and its extracts are now being explored due to their huge health benefits. Although, the effect they elicit, whether on humans or rodents, may vary based on the age of the animal/subject and or the time in which the extract is administered. However, several debates exist concerning the various medical applications of these compounds. Nonetheless, their applicability as therapeutics should not be clouded based on their perceived negative biological actions. METHODS Articles from reliable databases such as Science Direct, PubMed, Google Scholar, Scopus, and Ovid were searched. Specific search methods were employed using multiple keywords: ''Medicinal Cannabis; endocannabinoid system; cannabinoids receptors; cannabinoids and cognition; brain disorders; neurodegenerative diseases''. For the inclusion/exclusion criteria, only relevant articles related to medicinal Cannabis and its various compounds were considered. RESULTS The current review highlights the role, effects, and involvement of Cannabis, cannabinoids, and endocannabinoids in preventing selected neurodegenerative diseases and possible amelioration of cognitive impairments. Furthermore, it also focuses on Cannabis utilization in many disease conditions such as Alzheimer's and Parkinson's disease among others. CONCLUSION In conclusion, the usage of Cannabis should be further explored as accumulating evidence suggests that it could be effective and somewhat safe, especially when adhered to the recommended dosage. Furthermore, in-depth studies should be conducted in order to unravel the specific mechanism underpinning the involvement of cannabinoids at the cellular level and their therapeutic applications.
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Affiliation(s)
- Onesimus Mahdi
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Selangor, Universiti Putra Malaysia, Sri Serdang 43400, Malaysia
| | - Mohamad T H Baharuldin
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Selangor, Universiti Putra Malaysia, Sri Serdang 43400, Malaysia
| | - Nurul Huda M Nor
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Selangor, Universiti Putra Malaysia, Sri Serdang 43400, Malaysia
| | - Samaila M Chiroma
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Selangor, Universiti Putra Malaysia, Sri Serdang 43400, Malaysia
| | - Saravanan Jagadeesan
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Selangor, Universiti Putra Malaysia, Sri Serdang 43400, Malaysia
| | - Mohamad A M Moklas
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Selangor, Universiti Putra Malaysia, Sri Serdang 43400, Malaysia
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Trends and Related Factors of Cannabis-Associated Emergency Department Visits in the United States: 2006-2014. J Addict Med 2020; 13:193-200. [PMID: 30418337 DOI: 10.1097/adm.0000000000000479] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine national trends and contributing factors of cannabis-associated emergency department visits in the United States. METHODS This pooled serial cross-sectional study used a hierarchical multivariable analysis on emergency department visit adjusting for year, patient and hospital characteristics. We analyzed 2006 to 2014 National Emergency Department Sample data that identified cannabis-associated emergency department visits among patients aged 12 years or older (n = 265,128). RESULTS Cannabis-associated emergency department visits per 100,000 emergency department discharges increased monotonically (annually by 7%). As compared with privately insured patients, Medicare, and Medicaid, uninsured patients were over 40% more likely to visit emergency department. The age group 12 to 17 had the highest risk of emergency department visits and the risk monotonically declined as the age increased. Hospitals in the South region showed the highest cannabis-associated emergency department utilization, yet trends of cannabis-associated emergency department visits increased in the West region from 15.4% to 26% over time. CONCLUSIONS Cannabis-associated emergency department visits increase monotonically over time. Although vulnerable persons were identified, additional policy or regional factors should explore risks of emergency department visits associated with cannabis use.
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Changes in Healthcare Encounter Rates Possibly Related to Cannabis or Alcohol following Legalization of Recreational Marijuana in a Safety-Net Hospital: An Interrupted Time Series Analysis. J Addict Med 2020; 13:201-208. [PMID: 30475257 DOI: 10.1097/adm.0000000000000480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Liberalization of marijuana laws in Colorado contributed to increases in cannabis-related adverse events over time. We examined characteristics of patients with healthcare encounters possibly related to cannabis and assessed the temporal association between legalization of recreational marijuana and healthcare encounters possibly attributed to cannabis. METHODS Annual encounter rates possibly related to cannabis and alcohol were compared using negative binomial regression. Two-time intervals, pre/post-recreational marijuana legalization (January 2009 to December 2013 and January 2014 to December 2015, respectively) were used to examine changes in monthly rates of emergency encounters and hospitalizations possibly related to cannabis. Level and trend changes on encounter rates by legalization period were assessed using interrupted time series analyses. Encounters possibly related to alcohol were used as a comparator group. RESULTS Most encounters identified during the study period had alcohol-related International Classification of Diseases Diagnosis and Procedural Codes (ICD-9/10-CM) codes (94.8% vs 5.2% for cannabis). Patients with encounters possibly related to cannabis were younger, more likely to be hospitalized and more likely to be admitted to the psychiatric unit than patients with encounters possibly related to alcohol. Initial and sustained effects of encounter rates possibly related to cannabis demonstrated an increased trend in slope before and after recreational marijuana legalization. The slope became more abrupt following legalization with a significant increase in trend during the post-legalization period (β = 2.7, standard error = 0.3, ρ < 0.0001). No significant change was noted for encounters possibly related to alcohol. CONCLUSIONS Additional research should identify patients at highest risk of an adverse health event related to cannabis and quantify costs associated with cannabis-related healthcare delivery.
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Szyliowicz D, Hilsenrath P. Medical Marijuana Knowledge and Attitudes: A Survey of the California Pharmacists Association. J Prim Care Community Health 2020; 10:2150132719831871. [PMID: 30795717 PMCID: PMC6388448 DOI: 10.1177/2150132719831871] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Views on the medical efficacy and acceptability of marijuana have changed over the years. California was the first state permitting individuals to use medical marijuana. Even with a long history of use and widespread agreement around the effectiveness of medical marijuana, the literature is sparse about the role health care providers, including pharmacists, play in this interaction. The purpose of this article is to shed light on knowledge and attitudes of pharmacists regarding medical marijuana. We developed a survey for pharmacists about their level of knowledge and attitudes toward medical marijuana. The survey was distributed using SurveyMonkey. It consisted of 44 questions and an opportunity to provide comments. We collaborated with the California Pharmacists Association who provided a link to the survey in October 2017 to their members. Results from 474 responses indicate a majority of providers believe that marijuana has medical efficacy. Yet most providers report that they neither have much information about medical marijuana nor do they know where to get such information. One area of particular concern is the potential for drug interactions. Pharmacists would feel more comfortable discussing medical marijuana if it was approved by the Food and Drug Administration. Moreover, they believe more research needs to occur. The variance between California and federal policy leads to dysfunction among pharmacists providing information to patients. We believe federal policy should change.
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Geissler KH, Kaizer K, Johnson JK, Doonan SM, Whitehill JM. Evaluation of Availability of Survey Data About Cannabis Use. JAMA Netw Open 2020; 3:e206039. [PMID: 32520358 PMCID: PMC7287570 DOI: 10.1001/jamanetworkopen.2020.6039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE In response to increasing public support for cannabis legalization, understanding associations of state and federal policy changes related to cannabis legalization with patterns of cannabis use is important. A challenge for public health monitoring and research is significant variation in data availability related to cannabis use behaviors and perceptions across and within states and over time, including the availability of prelegalization vs postlegalization data. OBJECTIVE To review data available on cannabis use and related behaviors over time in Massachusetts and the US. DESIGN, SETTING, AND PARTICIPANTS This case series examined state and national surveys on public health and related behaviors and outcomes to review availability of cannabis-related data for Massachusetts for 8 key indicators over time. Additionally, the Behavioral Risk Factor Surveillance System (BRFSS) and Youth Risk Behavior Surveillance System for all states were reviewed. The analysis was conducted between February 1, 2019, and March 18, 2020. EXPOSURES Surveys that enable state-level estimation of cannabis use and related behaviors. MAIN OUTCOMES AND MEASURES Eight key indicators related to cannabis use behaviors and perceptions: lifetime cannabis use, age of initiation, frequency of use, location of use, method of use, source of cannabis, perceptions of cannabis, and reason for use (ie, medical vs nonmedical). RESULTS There were 7 surveys that monitored cannabis use and related behaviors in Massachusetts for adolescents and adults. No surveys monitored all 8 indicators of interest, and availability over time was limited. In the most recent BRFSS, 24 states asked cannabis-related questions, meaning BRFSS data on cannabis use was lacking for more than half of the US adult population. In the Youth Risk Behavior Surveillance System, 36 states asked standard cannabis questions; most other states had at least 1 question related to cannabis use and frequency. CONCLUSIONS AND RELEVANCE These findings of limitations of existing surveys, and particularly the lack of national questions in the BRFSS and Youth Risk Behavior Surveillance System, suggest that available data have substantial limitations for monitoring cannabis use. As cannabis policy changes continue, there is a need to remain focused on the availability of high-quality data sources that allow for critical public health research.
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Affiliation(s)
- Kimberley H. Geissler
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst
| | - Kia Kaizer
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst
| | | | | | - Jennifer M. Whitehill
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst
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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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Recreational Cannabis Legalization in the US and Maternal Use during the Preconception, Prenatal, and Postpartum Periods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030909. [PMID: 32024173 PMCID: PMC7037220 DOI: 10.3390/ijerph17030909] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 01/01/2023]
Abstract
In the United States (US), recreational cannabis use is on the rise. Since 2011, 11 states and the District of Columbia have legalized cannabis for adult recreational use. As additional states consider legalizing, there is an urgent need to assess associations between recreational cannabis legalization and maternal use in the preconception, prenatal, and postpartum periods—all critical windows for maternal and child health. Using cross-sectional data from the 2016 Pregnancy Risk Assessment Monitoring System, we assessed associations between state cannabis legalization and self-reported maternal cannabis use. Using logistic regression, we estimated the adjusted prevalence ratio (PR) of cannabis use during the preconception, prenatal, and postpartum period for women delivering a live-born infant in three states that had legalized recreational cannabis (Alaska, Colorado, and Washington) and three states that had not legalized (Maine, Michigan, and New Hampshire) by 2016. Our final sample size was 7258 women. We utilized 95% confidence intervals (CI) and a significance level of alpha = 0.05. After adjustment for potential confounders, women who resided in states with legalized recreational cannabis were significantly more likely to use cannabis during the preconception (PR 1.52; 95%CI ranging from 1.28–1.80; p < 0.001), prenatal (PR 2.21; 95% CI ranging from 1.67–2.94; p < 0.001), and postpartum (PR 1.73; 95%CI ranging from 1.30–2.30; p < 0.001) periods, compared to women who resided in states without legalized recreational cannabis. Although evidence about the effect of marijuana use during these periods is nascent, these findings show potential for increased incidence of child exposure to cannabis. Longitudinal research is needed to assess immediate and sustained impacts of maternal use before and after state legalization of recreational cannabis.
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Fischer B, Bullen C. Emerging prospects for non-medical cannabis legalisation in New Zealand: An initial view and contextualization. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 76:102632. [DOI: 10.1016/j.drugpo.2019.102632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 01/25/2023]
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Grigsby TM, Hoffmann LM, Moss MJ. Marijuana Use and Potential Implications of Marijuana Legalization. Pediatr Rev 2020; 41:61-72. [PMID: 32005683 DOI: 10.1542/pir.2018-0347] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Most states in the United States have legalized medical and/or recreational cannabis in response to public demand. Trends in states adopting such legislation demonstrate an increasing prevalence of cannabis use coincident to decreasing perceptions of risk of harm from cannabis products. When providing anticipatory guidance, pediatricians should be prepared to address childhood unintentional ingestion management and prevention, adolescent problem use, and cannabis as an alternative therapy for seizure disorders and other conditions.
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Affiliation(s)
- Tamara M Grigsby
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR
| | - Laurel M Hoffmann
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR
| | - Michael J Moss
- Utah Poison Center, University of Utah College of Pharmacy, Salt Lake City, UT.,Division of Emergency Medicine, University of Utah, Salt Lake City, UT
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Subritzky T, Lenton S, Pettigrew S. Cannabis and youth protection in Colorado's commercial adult-use market: A qualitative investigation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:116-126. [PMID: 31586774 DOI: 10.1016/j.drugpo.2019.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/05/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Arguments both for and against the legalization of cannabis often include the issue of youth protection. At the time of writing 5-years after the implementation of the Coloradan recreational cannabis market (CRCM), no statistically significant increase in consumption had been identified. This paper aimed to provide a thick descriptive account of youth prevention objectives stipulated in the pre-implementation phase of the CRCM and compare these with the real-world experience of regulators and other stakeholders involved with market implementation. METHODOLOGY AND METHODS A qualitative descriptive methodology was used that involved the following methods: document analysis, deductive coding, thematic analysis, and thick description. Two data sets relevant to youth protection in the context of a legal cannabis market in Colorado were examined. Data set 1 (DS1) examined government documents (n = 13) related to the pre-implementation phase from November 2012 - December 2013. Data set 2 (DS2) consisted of semi-structured face-to-face interviews conducted with key stakeholders (n = 32) in 2016 and 2017. RESULTS Five themes emerged including advertising restrictions (DS1), education (DS1), appropriation of funds (DS2), impact assessment (DS2), and evolving messages in prevention education campaigns (DS2). DISCUSSION Multiple lessons for other jurisdictions were highlighted in the study.
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Affiliation(s)
- Todd Subritzky
- National Drug Research Institute, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Simon Lenton
- National Drug Research Institute, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Simone Pettigrew
- National Drug Research Institute, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
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Howell K, Washington A, Williams PM, Mathis AL, Luque JS. Medical Marijuana Policy Reform Reaches Florida: A Scoping Review. FLORIDA PUBLIC HEALTH REVIEW 2019; 16:128-136. [PMID: 31891164 PMCID: PMC6936729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Florida became the first state in the U.S. South to legalize the use of medical marijuana to treat a variety of health conditions including chronic pain, epilepsy, and spasticity symptoms from multiple sclerosis. While there are over 200,000 medical marijuana patients in Florida, there remain financial, psychological, and insurance coverage barriers which reduce access for many patients. PURPOSE This scoping review, with a focus on state health policy, first describes some clinical studies examining the therapeutic benefits of medical marijuana. Next, there is a discussion of the Florida regulatory environment and major legislation. Also, the review describes how the current Florida policy landscape presents challenges for physicians and patients. METHODS A scoping review of the literature was conducted in PubMed and Google Scholar using the search terms, "medical marijuana" and "medical cannabis" to identify research articles, newspaper reports, and government documents. The purpose of the review was to identify research investigating the therapeutic efficacy of medical marijuana and state policies affecting physician practice. RESULTS The review concluded there was general scientific consensus of therapeutic benefits for patients, especially for chronic pain, from the use of medical marijuana. The review also identified several barriers for physicians and patients around cost, stigma, and lack of insurance coverage which constrains use and access. DISCUSSION The review discusses several directions for future medical marijuana policy and research with the aim to improve therapeutic benefits for Florida patients.
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Affiliation(s)
- Khadesia Howell
- Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health. Tallahassee, FL
| | - Alexandria Washington
- Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health. Tallahassee, FL
| | - Paula M Williams
- Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health. Tallahassee, FL
| | - Arlesia L Mathis
- Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health. Tallahassee, FL
| | - John S Luque
- Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health. Tallahassee, FL
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Robertson AG, Swartz MS. Thinking Carefully About Marijuana Legalization: Public Health Considerations for State Policy Makers. Psychiatr Serv 2019; 70:629-630. [PMID: 31056004 DOI: 10.1176/appi.ps.201900124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Allison G Robertson
- Department of Psychiatry and Behavioral Sciences and Division of Social and Community Psychiatry, Duke University School of Medicine, Durham, North Carolina
| | - Marvin S Swartz
- Department of Psychiatry and Behavioral Sciences and Division of Social and Community Psychiatry, Duke University School of Medicine, Durham, North Carolina
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Kowitt SD, Osman A, Meernik C, Zarkin GA, Ranney LM, Martin J, Heck C, Goldstein AO. Vaping cannabis among adolescents: prevalence and associations with tobacco use from a cross-sectional study in the USA. BMJ Open 2019; 9:e028535. [PMID: 31196904 PMCID: PMC6585821 DOI: 10.1136/bmjopen-2018-028535] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Previous research suggests that some adolescents are using e-cigarette devices to vaporise ('vaping') cannabis in the form of hash oil, tetrahydrocannabinol (THC) wax or oil, or dried cannabis buds or leaves. However, it is unclear how adolescents who vape cannabis use other tobacco products. This study examined the extent to which adolescents reported ever vaping cannabis and investigated how demographic variables and tobacco behaviours were associated with use. DESIGN We used cross-sectional data from adolescents (total response rate 64.5%) who participated in the 2017 North Carolina Youth Tobacco Survey. SAS logistic regression survey procedures were used to account for the complex survey design and sampling weights. SETTING North Carolina, USA. PARTICIPANTS Adolescents in high school (n=2835). PRIMARY OUTCOME AND MEASURE Adolescents were asked to indicate whether they had ever used an e-cigarette device with marijuana, THC or hash oil, or THC wax. RESULTS Approximately 1 in 10 high school students reported ever vaping cannabis in the overall sample (9.6%). In multivariable models, adolescents who reported using cigars (adjusted OR (aOR) 3.76, 95% CI 2.33 to 6.07), waterpipe (aOR 2.32, 95% CI 1.37 to 3.93) or e-cigarettes (aOR 3.18, 95% CI 2.38 to 4.25) in the past 30 days had higher odds of reporting ever vaping cannabis compared with their counterparts. There was no significant association between use of smokeless tobacco (aOR 0.89, 95% CI 0.42 to 1.91) or use of cigarettes (aOR 1.27, 95% CI 0.71 to 2.29) in the past 30 days and odds of reporting ever vaping cannabis. CONCLUSIONS These findings provide evidence that large numbers of high school students who use tobacco products have vaped cannabis. As tobacco control policies-such as communication campaigns or smoke-free laws-increasingly focus on e-cigarettes, attention to understanding how adolescents use e-cigarettes to vape substances other than nicotine is essential.
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Affiliation(s)
- Sarah D Kowitt
- Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amira Osman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Nursing, Zefat Academic College, Zefat, Israel
| | - Clare Meernik
- Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gary A Zarkin
- Behavioral Health Research Division, RTI International, Research Triangle Park, North Carolina, USA
| | - Leah M Ranney
- Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jim Martin
- North Carolina Department of Health and Human Services, Tobacco Prevention and Control Branch, Raleigh, USA
| | - Courtney Heck
- North Carolina Department of Health and Human Services, Tobacco Prevention and Control Branch, Raleigh, USA
| | - Adam O Goldstein
- Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Parental views on state cannabis laws and marijuana use for their medically vulnerable children. Drug Alcohol Depend 2019; 199:59-67. [PMID: 30999251 DOI: 10.1016/j.drugalcdep.2018.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/15/2018] [Accepted: 12/01/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Given a rapidly changing policy landscape, we sought to characterize the effects of state marijuana laws on parents' views of marijuana use by their teenage children. METHODS Data are from 595 respondents to a nationally administered, web-based survey of parents of adolescents (ages 13-18 years) with any of three chronic conditions (type 1 diabetes, rheumatic disease, attention-deficit/hyperactivity disorder). Multivariate ordinal logistic regression was used to model the effects of parents' reports of state cannabis laws on their views toward marijuana use by their child. RESULTS While 89.9% said any marijuana use was risky for their child, 27.9% would approve of its use if prescribed as medicine. Parents reporting marijuana decriminalization (11.1%) were more amenable to teenage use, less concerned about how marijuana might impact their child's condition, more accepting of the safety of marijuana as medicine, and approved its use with a prescription. Parents reporting legal medical (35.6%) or recreational (5.7%) use were more likely to report that their child has tried or used marijuana regularly. Parents reporting legal recreational use were less likely to agree that marijuana has medical benefits for their child. CONCLUSIONS Among parents of medically vulnerable children, perceiving state marijuana policies as more permissive is strongly associated with lower perceived riskiness of marijuana use for their children. State marijuana policies are changing with implications for how parents of medically vulnerable youth view and potentially govern marijuana use by their medically vulnerable children.
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Marx GE, Chen Y, Askenazi M, Albanese BA. Syndromic Surveillance of Emergency Department Visits for Acute Adverse Effects of Marijuana, Tri-County Health Department, Colorado, 2016-2017. Public Health Rep 2019; 134:132-140. [PMID: 30721641 PMCID: PMC6410484 DOI: 10.1177/0033354919826562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES In Colorado, legalization of recreational marijuana in 2014 increased public access to marijuana and might also have led to an increase in emergency department (ED) visits. We examined the validity of using syndromic surveillance data to detect marijuana-associated ED visits by comparing the performance of surveillance queries with physician-reviewed medical records. METHODS We developed queries of combinations of marijuana-specific International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes or keywords. We applied these queries to ED visit data submitted through the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) syndromic surveillance system at 3 hospitals during 2016-2017. One physician reviewed the medical records of ED visits identified by ≥1 query and calculated the positive predictive value (PPV) of each query. We defined cases of acute adverse effects of marijuana (AAEM) as determined by the ED provider's clinical impression during the visit. RESULTS Of 44 942 total ED visits, ESSENCE queries detected 453 (1%) as potential AAEM cases; a review of 422 (93%) medical records identified 188 (45%) true AAEM cases. Queries using ICD-10 diagnostic codes or keywords in the triage note identified all true AAEM cases; PPV varied by hospital from 36% to 64%. Of the 188 true AAEM cases, 109 (58%) were among men and 178 (95%) reported intentional use of marijuana. Compared with noncases of AAEM, cases were significantly more likely to be among non-Colorado residents than among Colorado residents and were significantly more likely to report edible marijuana use rather than smoked marijuana use ( P < .001). CONCLUSIONS ICD-10 diagnostic codes and triage note keyword queries in ESSENCE, validated by medical record review, can be used to track ED visits for AAEM.
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Affiliation(s)
- Grace E. Marx
- Emergency Preparedness, Response, and Communicable Disease Surveillance, Tri-County Health Department, Greenwood Village, CO, USA
- Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yushiuan Chen
- Emergency Preparedness, Response, and Communicable Disease Surveillance, Tri-County Health Department, Greenwood Village, CO, USA
| | - Michele Askenazi
- Emergency Preparedness, Response, and Communicable Disease Surveillance, Tri-County Health Department, Greenwood Village, CO, USA
| | - Bernadette A. Albanese
- Emergency Preparedness, Response, and Communicable Disease Surveillance, Tri-County Health Department, Greenwood Village, CO, USA
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Callaghan RC, Allebeck P, Akre O, McGlynn KA, Sidorchuk A. Cannabis Use and Incidence of Testicular Cancer: A 42-Year Follow-up of Swedish Men between 1970 and 2011. Cancer Epidemiol Biomarkers Prev 2018; 26:1644-1652. [PMID: 29093004 DOI: 10.1158/1055-9965.epi-17-0428] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/20/2017] [Accepted: 08/22/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Given current drug policy reforms to decriminalize or legalize cannabis in numerous countries worldwide, the current study assesses the relation between cannabis use and the development of testicular cancer.Methods: The study included a population-based sample (n = 49,343) of young men ages 18-21 years who underwent conscription assessment for Swedish military service in 1969-1970. The conscription process included a nonanonymous questionnaire eliciting information about drug use. Conscription information was linked to Swedish health and administrative registry data. Testicular cancers diagnosed between 1970 and 2011 were identified by International Classification of Diseases-7/8/9/10 testicular cancer codes in the Swedish National Patient Register, the Cancer Register, or the Cause of Death Register. Cox regression modeling was used to estimate the hazards associated with cannabis use and time to diagnosis of testicular cancer.Results: No evidence was found of a significant relation between lifetime "ever" cannabis use and the subsequent development of testicular cancer [n = 45,250; 119 testicular cancer cases; adjusted HR (aHR), 1.42; 95% confidence interval (CI), 0.83-2.45]. "Heavy" cannabis use (defined as usage of more than 50 times in lifetime, as measured at conscription) was associated with the incidence of testicular cancer (n = 45,250; 119 testicular cancer cases; aHR 2.57; 95% CI, 1.02-6.50).Conclusions: The current study provides additional evidence to the limited prior literature suggesting cannabis use may contribute to the development of testicular cancer.Impact: Emerging changes to cannabis drug policy should consider the potential role of cannabis use in the development of testicular cancer. Cancer Epidemiol Biomarkers Prev; 26(11); 1644-52. ©2017 AACR.
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Affiliation(s)
- Russell C Callaghan
- Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada.
| | - Peter Allebeck
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Anna Sidorchuk
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Peterson AB, Sauber-Schatz EK, Mack KA. Ability to monitor driving under the influence of marijuana among non-fatal motor-vehicle crashes: An evaluation of the Colorado electronic accident reporting system. JOURNAL OF SAFETY RESEARCH 2018; 65:161-167. [PMID: 29776525 PMCID: PMC5992600 DOI: 10.1016/j.jsr.2018.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 06/02/2023]
Abstract
INTRODUCTION As more states legalize medical/recreational marijuana use, it is important to determine if state motor-vehicle surveillance systems can effectively monitor and track driving under the influence (DUI) of marijuana. This study assessed Colorado's Department of Revenue motor-vehicle crash data system, Electronic Accident Reporting System (EARS), to monitor non-fatal crashes involving driving under the influence (DUI) of marijuana. METHODS Centers for Disease Control and Prevention guidelines on surveillance system evaluation were used to assess EARS' usefulness, flexibility, timeliness, simplicity, acceptability, and data quality. We assessed system components, interviewed key stakeholders, and analyzed completeness of Colorado statewide 2014 motor-vehicle crash records. RESULTS EARS contains timely and complete data, but does not effectively monitor non-fatal motor-vehicle crashes related to DUI of marijuana. Information on biological sample type collected from drivers and toxicology results were not recorded into EARS; however, EARS is a flexible system that can incorporate new data without increasing surveillance system burden. CONCLUSIONS States, including Colorado, could consider standardization of drug testing and mandatory reporting policies for drivers involved in motor-vehicle crashes and proactively address the narrow window of time for sample collection to improve DUI of marijuana surveillance. Practical applications: The evaluation of state motor-vehicle crash systems' ability to capture crashes involving drug impaired driving (DUID) is a critical first step for identifying frequency and risk factors for crashes related to DUID.
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Affiliation(s)
- Alexis B Peterson
- Division of Unintentional Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States; Division of Analysis, Research, and Practice Integration, Centers for Disease Control and Prevention, Atlanta, GA, United States; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Erin K Sauber-Schatz
- Division of Unintentional Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States; United States Public Health Service, United States
| | - Karin A Mack
- Division of Analysis, Research, and Practice Integration, Centers for Disease Control and Prevention, Atlanta, GA, United States
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23
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Santos-Burgoa C. [Regulatory elements on marijuana, for the effective population health protection]. SALUD PUBLICA DE MEXICO 2017; 59:592-600. [PMID: 29267657 DOI: 10.21149/8503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 07/05/2017] [Indexed: 11/06/2022] Open
Abstract
When discussing the public health approach to the use of marijuana, the complexity of rigorous regulatory interventions for population protection is omitted. Using the experience of governments where these practices already exist, regulation is introduced as an essential public health function, spelling out seven purposes for controlling marijuana. The technical elements of institutional capacity -including the technical and financial capacity- and of governance that must be covered by any rigorous regulation of its use are detailed below. The difficulty of regulating psychoactive substances is addressed when considering the capacity to control other legal substances manifested with their increased consumption. It is concluded that for an effective regulation of marijuana, the need for strengthening the institutional and governance aspects of the regulatory authority should not be minimized.
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Affiliation(s)
- Carlos Santos-Burgoa
- Professor, Global Health and Environmental and Occupational Health, Program of Global Health Policy, Department of Global Health, Milken Institute School of Public Health, George Washington University. Washington DC, Estados Unidos
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Phillips KT, Lalonde TL, Phillips MM, Schneider MM. Marijuana use and associated motives in Colorado university students. Am J Addict 2017; 26:830-837. [DOI: 10.1111/ajad.12640] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 10/20/2017] [Accepted: 10/22/2017] [Indexed: 01/17/2023] Open
Affiliation(s)
- Kristina T. Phillips
- School of Psychological Sciences; University of Northern Colorado; Greeley Colorado
| | - Trent L. Lalonde
- Department of Applied Statistics and Research Methods; University of Northern Colorado; Greeley Colorado
| | - Michael M. Phillips
- School of Psychological Sciences; University of Northern Colorado; Greeley Colorado
| | - Maryia M. Schneider
- Department of School Psychology; University of Northern Colorado; Greeley Colorado
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25
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Ghosh TS, Vigil DI, Maffey A, Tolliver R, Van Dyke M, Kattari L, Krug H, Reed JK, Wolk L. Lessons learned after three years of legalized, recreational marijuana: The Colorado experience. Prev Med 2017; 104:4-6. [PMID: 28232101 DOI: 10.1016/j.ypmed.2017.02.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/16/2017] [Accepted: 02/18/2017] [Indexed: 11/24/2022]
Abstract
In November 2012 Colorado voters approved legalized recreational marijuana. On January 1, 2014 Colorado became the first state to allow legal sales of non-medical marijuana for adults over the age of 21. Since that time, the state has been monitoring potential impacts on population health. In this paper we present lessons learned in the first three years following legal sales of recreational marijuana. These lessons pertain to health behaviors and health outcomes, as well as to health policy issues. Our intent is to share these lessons with other states as they face the prospect of recreational marijuana legalization.
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Affiliation(s)
- Tista S Ghosh
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States; Colorado Department of Public Health and Environment, Laboratory Services Division, 8100 Lowry Boulevard, Denver, CO 80230, United States.
| | - Daniel I Vigil
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Ali Maffey
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Rickey Tolliver
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Mike Van Dyke
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Leonardo Kattari
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Heather Krug
- Colorado Department of Public Health and Environment, Laboratory Services Division, 8100 Lowry Boulevard, Denver, CO 80230, United States.
| | - Jack K Reed
- Colorado Department of Public Safety, Division of Criminal Justice, 700 Kipling Street, Suite 1000, Lakewood, CO 80215, United States.
| | - Larry Wolk
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States; Colorado Department of Public Health and Environment, Laboratory Services Division, 8100 Lowry Boulevard, Denver, CO 80230, United States.
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Roberts SCM, Fuentes L, Berglas NF, Dennis AJ. A 21st-Century Public Health Approach to Abortion. Am J Public Health 2017; 107:1878-1882. [PMID: 29048963 DOI: 10.2105/ajph.2017.304068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In the United States, groups advocating for and against abortion rights often deploy public health arguments to advance their positions. Recently, these arguments have evolved into state laws that use the government health department infrastructure to increase law enforcement and regulatory activities around abortion. Many major medical and public health associations oppose these new laws because they are not evidence-based and do not protect women's health. Yet state health departments have been defending these laws in court. We propose a 21st-century public health approach to abortion based in an accepted public health framework. Specifically, we apply the Centers for Disease Control and Prevention's 10 Essential Public Health Services framework to abortion to describe how health departments should engage with abortion. With this public health framework as our guide, we argue that health departments should be facilitating women's ability to obtain an abortion in the state and county where they reside, researching barriers to abortion care in their states and counties, and promoting the use of a scientific evidence base in abortion-related laws, policies, regulations, and implementation of essential services.
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Affiliation(s)
- Sarah C M Roberts
- Sarah C. M. Roberts and Nancy F. Berglas are with ANSIRH, Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland. At the time of the study, Liza Fuentes was with Ibis Reproductive Health, Oakland, CA. Amanda J. Dennis was with Ibis Reproductive Health, Cambridge, MA
| | - Liza Fuentes
- Sarah C. M. Roberts and Nancy F. Berglas are with ANSIRH, Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland. At the time of the study, Liza Fuentes was with Ibis Reproductive Health, Oakland, CA. Amanda J. Dennis was with Ibis Reproductive Health, Cambridge, MA
| | - Nancy F Berglas
- Sarah C. M. Roberts and Nancy F. Berglas are with ANSIRH, Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland. At the time of the study, Liza Fuentes was with Ibis Reproductive Health, Oakland, CA. Amanda J. Dennis was with Ibis Reproductive Health, Cambridge, MA
| | - Amanda J Dennis
- Sarah C. M. Roberts and Nancy F. Berglas are with ANSIRH, Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland. At the time of the study, Liza Fuentes was with Ibis Reproductive Health, Oakland, CA. Amanda J. Dennis was with Ibis Reproductive Health, Cambridge, MA
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Kepple NJ, Freisthler B. Place over traits? Purchasing edibles from medical marijuana dispensaries in Los Angeles, CA. Addict Behav 2017; 73:1-3. [PMID: 28412327 DOI: 10.1016/j.addbeh.2017.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/05/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine discrete purchasing behaviors of marijuana-infused edibles from medical marijuana dispensaries with the aim to identify potential venue- and individual-level targets for prevention. METHODS Two-stage, venue-based sampling approach was used to randomly select patrons exiting 16 medical marijuana dispensaries in Los Angeles, California during Spring 2013. Hierarchical generalized linear modeling was used to examine the likelihood of purchasing edibles among 524 patrons reporting a discrete purchase regressed on characteristics of the sampled dispensaries and their patrons. RESULTS At a venue level, patrons were more likely to purchase edibles from dispensaries located within Census tracts with higher median incomes or in close proximity to a higher number of dispensaries. At an individual level, patrons who identified as Black or Hispanic were associated with a lower likelihood of purchasing edibles when compared to patrons who identified as other non-White, non-Hispanic race/ethnicity. CONCLUSIONS Place-based policies focused on regulating edible sales through dispensaries may be fruitful in influencing access to edibles. Additionally, social marketing campaigns may benefit from targeting both locations where edible purchases are more likely and populations who are more likely to purchase edibles.
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Affiliation(s)
- Nancy Jo Kepple
- University of Kansas, School of Social Welfare, 1545 Lilac Lane, Lawrence, KS 66045, United States.
| | - Bridget Freisthler
- The Ohio State University, College of Social Work, 1947 College Road, Columbus, OH 43210, United States.
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State and Local Health Department Activities Related to Abortion: A Web Site Content Analysis. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 24:255-262. [PMID: 28857971 PMCID: PMC5895165 DOI: 10.1097/phh.0000000000000647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Context: Recent legislation in states across the United States has required governmental health agencies to take on new and different roles in relation to abortion. While there has been media attention to health department roles in regulating abortion providers, there has been no systematic investigation of the range of activities in which state and local health departments are engaged. Objective: To systematically investigate health department activities related to abortion. Methods: We searched state health department Web sites of the 50 states and District of Columbia using key words such as “abortion” and “pregnancy termination”. Two trained coders categorized 6093 documents using the 10 Essential Public Health Services (EPHS) framework. We then applied these methods to 671 local health department documents. Setting: State and local health department Web sites. Participants: N/A. Results: On average, states engaged in 5.1 of 10 Essential Services related to abortion. Most (76%-98%) state health departments engaged in activities to Monitor Health Status (EPHS1), Enforce Laws (EPHS6), and Evaluate Effectiveness, Accessibility, and Quality (EPHS9). Many (47%-69%) engaged in activities to Inform and Educate (EPHS3), Develop Policies (EPHS5), and Link to Services (EPHS7). A minority (4%-29%) engaged in activities to Diagnose and Investigate Health Problems (EPHS2), Mobilize Community Partnerships (EPHS4), and Assure Competent Workforce (EPHS8). No state engaged in Innovative Research (EPHS10). Few local health departments engaged in abortion-related activities. Conclusions: While most state health departments engage in abortion-related activities, they appear to reflect what the law requires rather than the range of core public health activities. Additional research is needed to assess whether these services meet quality standards for public health services and determine how best to support governmental health agencies in their growing tasks. These findings raise important questions about the role of public health agencies and professionals in defining how health departments should be engaging with abortion.
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Allen JA, Davis KC, Duke JC, Nonnemaker JM, Bradfield BR, Farrelly MC. New product trial, use of edibles, and unexpected highs among marijuana and hashish users in Colorado. Drug Alcohol Depend 2017; 176:44-47. [PMID: 28514695 DOI: 10.1016/j.drugalcdep.2017.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study examines the relationships between trial of new marijuana or hashish products and unexpected highs, and use of edible products and unexpected highs. METHODS We conducted an online survey of 634 adult, past-year marijuana users in Colorado. We used logistic regression models to examine the relationship between new product trial or edible use and unexpected highs. RESULTS In the first year that recreational marijuana was legal in Colorado, 71.4% of respondents tried a new marijuana or hashish product, and 53.6% used an edible product. Trial of new products was associated with greater odds of experiencing an unexpected high after controlling for age, gender, education, mental health status, current marijuana or hashish use, and mean amount of marijuana or hashish consumed in the past month (OR=2.13, p<0.001). Individuals who reported having used edibles had greater odds of experiencing an unexpected high, after controlling for the same set of variables (OR=1.56, p<0.05). CONCLUSION People who try new marijuana or hashish products, or use edible marijuana or hashish products, are at greater risk for an unexpected high. It is possible that some negative outcomes associated with marijuana use and unexpected highs may be averted through a better understanding of how to use product packaging to communicate with consumers.
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Affiliation(s)
- Jane A Allen
- RTI International,3040 E.Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA.
| | - Kevin C Davis
- RTI International,3040 E.Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA
| | - Jennifer C Duke
- RTI International,3040 E.Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA
| | - James M Nonnemaker
- RTI International,3040 E.Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA
| | - Brian R Bradfield
- RTI International,3040 E.Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA
| | - Matthew C Farrelly
- RTI International,3040 E.Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA
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Johnson RM, LaValley M, Schneider KE, Musci RJ, Pettoruto K, Rothman EF. Marijuana use and physical dating violence among adolescents and emerging adults: A systematic review and meta-analysis. Drug Alcohol Depend 2017; 174:47-57. [PMID: 28314193 PMCID: PMC5521998 DOI: 10.1016/j.drugalcdep.2017.01.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/09/2016] [Accepted: 01/08/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND As restrictions on marijuana are loosened, there is concern of a coming increase in marijuana use among adolescents and emerging adults, which could be coupled with commensurate increases in behavioral problems associated with use, such as physical dating violence (PDV). To summarize what is known about the association between marijuana use and PDV victimization and perpetration among 11-21year olds, we conducted a systematic review and meta-analysis of the relevant literature published between 2003 and 2015. METHODS Candidate articles were identified with a systematic search, and we used inclusion and exclusion criteria to review titles, abstracts, and the full text of studies for consideration. There were 13 articles examining marijuana in association with PDV; five addressed victimization and 11 addressed perpetration. RESULTS Findings suggest that marijuana use is associated with a 54% increase in the odds PDV victimization, and a 45% increase in the odds of perpetration. CONCLUSIONS Findings suggest that dating violence is a correlate of marijuana use, and that association is strongest among adolescents (vs. emerging adults) and girls (vs. boys). Therefore, it should be routinely included as a core data item in marijuana surveillance systems, so as to allow for behavioral monitoring.
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Affiliation(s)
- Renee M Johnson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Michael LaValley
- Boston University School of Public Health, Boston, MA, United States
| | - Kristin E Schneider
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Rashelle J Musci
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kayley Pettoruto
- Boston University School of Public Health, Boston, MA, United States
| | - Emily F Rothman
- Boston University School of Public Health, Boston, MA, United States
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Strokes are possible complications of cannabinoids use. Epilepsy Behav 2017; 70:355-363. [PMID: 28237318 DOI: 10.1016/j.yebeh.2017.01.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 12/21/2016] [Accepted: 01/07/2017] [Indexed: 01/09/2023]
Abstract
It is critically important to identify all factors that may play a role in the recent increase of the incidence of stroke among the young population. Considering the worldwide use of cannabinoids (cannabis and synthetic cannabinoids), the recent legalization of their consumption in some countries, and their supposed involvement in cardiovascular events, we evaluated their role in the occurrence of neurovascular complications among the young. Ninety-eight patients were described in the literature as having a cannabinoids-related stroke (85 after cannabis use and 13 after synthetic cannabinoids). The distribution by type of stroke was as follows: 4 patients with an undetermined type of stroke, 85 with an ischemic stroke and/or a transient ischemic attack, and 9 with a hemorrhagic stroke. The mean age of patients was 32.3±11.8years (range 15-63), and the majority of them were male with a sex ratio of 3.7:1. Cannabis was often smoked with tobacco in 66% of cases. Most of the patients with cannabinoids-related strokes were chronic cannabis users in 81% of cases, and for 18% of them, there was a recent increase of the amount of cannabis consumption during the days before the occurrence of stroke. Even if the prognosis of stroke was globally favorable in 46% of cases, with no or few sequelae, 5 patients died after the neurovascular event. One striking element reported in the majority of the reports was a temporal relationship between cannabinoids use, whether natural or synthetic, and the occurrence of stroke. However, a temporal correlation does not mean causation, and other factors may be involved. Cannabis may be considered as a risk factor of stroke until research shows evidence of an underlying mechanism that, alone or in association with others, contributes to the development of stroke. As of today, reversible cerebral vasoconstriction triggered by cannabinoids use may be a convincing mechanism of stroke in 27% of cases. Indeed, despite the widespread use of cannabinoids, the low frequency of neurovascular complications after their use may be due to a genetic predisposition to their neurovascular toxicity in some individuals. Further studies should focus on this point. More importantly however, this low frequency may be underestimated because the drug consumption may not be systematically researched, neither by questioning nor by laboratory screening. Besides this vascular role of cannabinoids in the occurrence of stroke, a cellular effect of cannabis on brain mitochondria was recently suggested in an experimental study. One of the mechanisms involved in young cannabis users with stroke may be the generation of reactive oxygen species leading to an oxidative stress, which is a known mechanism in stroke in humans. It is useful to inform the young population about the real potential risk of using cannabinoids. We suggest to systematically ask all young adults with stroke about their drug consumption including cannabinoids, to screen urine for cannabis or to include a specific diagnostic test to detect synthetic cannabinoids, and to obtain non-invasive intracranial arterial investigations (i.e. CT-angiography or cerebral MRA) in order to search for cerebral vasoconstriction. However, several questions remained unresolved and further research is still needed to assess the pathophysiological mechanisms involved in young cannabinoids users with stroke. This article is part of a Special Issue entitled "Cannabinoids and Epilepsy".
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Rychert M, Wilkins C, Witten K. Issues with monitoring the safety of psychoactive products under a legal regulated market for new psychoactive substances (‘legal highs’) in New Zealand. Drug Alcohol Rev 2017; 36:589-596. [DOI: 10.1111/dar.12507] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/07/2016] [Accepted: 09/26/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Marta Rychert
- SHORE & Whariki Research Centre; Massey University; Auckland New Zealand
| | - Chris Wilkins
- SHORE & Whariki Research Centre; Massey University; Auckland New Zealand
| | - Karen Witten
- SHORE & Whariki Research Centre; Massey University; Auckland New Zealand
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Rychert M, Wilkins C, Witten K. “Lost in translation”: Issues with the establishment of a legal market for “low risk” psychoactive products (“legal highs”) in New Zealand. DRUGS-EDUCATION PREVENTION AND POLICY 2017. [DOI: 10.1080/09687637.2017.1282422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Marta Rychert
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Chris Wilkins
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Karen Witten
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
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Legal high industry business and lobbying strategies under a legal market for new psychoactive substances (NPS, ‘legal highs’) in New Zealand. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 37:90-97. [DOI: 10.1016/j.drugpo.2016.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 11/18/2022]
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