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Dacosta-Sánchez D, Michelini Y, Pilatti A, Fernández-Calderón F, Lozano ÓM, González-Ponce BM. The moderating role of sex in the relationship between cannabis use treatment admission profile and treatment processes and outcomes: A gender perspective. Addict Behav 2024; 157:108103. [PMID: 39018615 DOI: 10.1016/j.addbeh.2024.108103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Gender-specific interventions are crucial in addressing substance use disorders -particularly cannabis use disorder - as they allow for tailored therapeutic approaches and increase the likelihood of successful outcomes. However, differences in therapeutic processes and outcomes between males and females are often not observed, making the prognosis and development of such interventions more difficult. OBJECTIVE This study aimed to examine the moderating role of sex in the relationship between treatment admission profile characterized by indicators of cannabis use and sociodemographic sources of gender inequality (e.g., employment status) and adherence and outcome at discharge. METHOD A multicentric retrospective observational study was conducted with a sample of 3,814 outpatients diagnosed with cannabis use disorder. Electronic health records were used for data analysis. RESULTS The interaction between sex and the number of children, as well as pre-treatment cannabis use, predicted lower treatment adherence, particularly among females. Additionally, the interaction between sex and the number of children predicted outcomes at discharge, with females showing a higher likelihood of dropout compared to males. DISCUSSION AND CONCLUSION Enhanced comprehensive treatment with intensified contingency management programs should be prioritized for females (especially those with children) who have consumed cannabis in the month before treatment. Adopting a treatment policy framework incorporating sex/gender-sensitive therapist training and evaluative measures is essential for optimizing treatment outcomes for all patients.
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Affiliation(s)
- Daniel Dacosta-Sánchez
- Department of Clinical and Experimental Psychology, University of Huelva, Facultad de Ciencias de la Educación, 21071 Huelva, Spain; Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva 21007, Spain.
| | - Yanina Michelini
- Faculty of Psychology, National University of Cordoba, Córdoba 5000, Argentina; Institute of Psychological Research, IIPsi-CONICET-UNC, National University of Córdoba, Córdoba 5000, Argentina.
| | - Angelina Pilatti
- Faculty of Psychology, National University of Cordoba, Córdoba 5000, Argentina; Institute of Psychological Research, IIPsi-CONICET-UNC, National University of Córdoba, Córdoba 5000, Argentina.
| | - Fermín Fernández-Calderón
- Department of Clinical and Experimental Psychology, University of Huelva, Facultad de Ciencias de la Educación, 21071 Huelva, Spain; Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva 21007, Spain.
| | - Óscar M Lozano
- Department of Clinical and Experimental Psychology, University of Huelva, Facultad de Ciencias de la Educación, 21071 Huelva, Spain; Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva 21007, Spain.
| | - Bella M González-Ponce
- Department of Clinical and Experimental Psychology, University of Huelva, Facultad de Ciencias de la Educación, 21071 Huelva, Spain; Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva 21007, Spain.
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Bloomer BF, Larson ER, Tullar RL, Herms EN, Bolbecker AR, O'Donnell BF, Hetrick WP, Wisner KM. Alterations in self-reported sensory gating and interoception in individuals frequently using cannabis. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:525-535. [PMID: 38563523 DOI: 10.1080/00952990.2024.2332602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/23/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
Background: Cannabis use is associated with altered processing of external (exteroceptive) and internal (interoceptive) sensory stimuli. However, little research exists on whether subjective experiences of these processes are altered in people who frequently use cannabis. Altered exteroception may influence externally oriented attention, whereas interoceptive differences have implications for intoxication, craving, and withdrawal states.Objectives: The goal of the current study was to investigate subjective experiences of exteroceptive sensory gating and interoception in people frequently using cannabis. We hypothesized subjective impairments in sensory gating and elevations in affect-related interoceptive awareness; furthermore, such deviations would relate to cannabis use patterns.Methods: This cross-sectional study of community adults 18-40 years old included 72 individuals (50% female) who used cannabis at least twice a week (not intoxicated during study) and 78 individuals who did not use cannabis (60% female). Participants completed the Sensory Gating Inventory and the Multidimensional Assessment of Interoceptive Awareness-2 surveys. People using cannabis completed surveys on cannabis use patterns. Analyses tested group differences and associations with cannabis use.Results: People using cannabis reported impaired sensory gating (d = 0.37-0.44; all p values < 0.05) and elevations of interoceptive awareness related to detection and affect (d = 0.21-0.61; all p values < 0.05). Problematic cannabis use was associated with increased sensory gating impairments (r = 0.37, p < .05). Interoceptive awareness was unrelated to cannabis use variables.Conclusion: These findings extend literature on subjective experiences of sensory processing in people using cannabis. Findings may inform inclusion of external attentional tendencies and internal bodily awareness in assessments of risk and novel treatment approaches.
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Affiliation(s)
- Bess F Bloomer
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Eric R Larson
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
- Program in Neuroscience, Indiana University, Bloomington, IN, USA
| | - Rachel L Tullar
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Emma N Herms
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
- Cognitive Science Program, Indiana University, Bloomington, IN, USA
| | - Amanda R Bolbecker
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
- Program in Neuroscience, Indiana University, Bloomington, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Bloomington, IN, USA
| | - Brian F O'Donnell
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
- Program in Neuroscience, Indiana University, Bloomington, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Bloomington, IN, USA
| | - William P Hetrick
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
- Program in Neuroscience, Indiana University, Bloomington, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Bloomington, IN, USA
| | - Krista M Wisner
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
- Program in Neuroscience, Indiana University, Bloomington, IN, USA
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Struble CA, Borodovsky JT, Habib MI, Hasin DS, Shmulewitz D, Livne O, Walsh C, Aharonovich E, Budney AJ. Extending Gender- and Sex-Based Analyses in Cannabis Research: Findings from an Online Sample of Gender Diverse Young Adult Consumers. Cannabis Cannabinoid Res 2023. [PMID: 37594777 DOI: 10.1089/can.2023.0069] [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] [Indexed: 08/19/2023] Open
Abstract
Background: Gender and sex can influence cannabis behaviors and consequences (Cannabis Use Disorder [CUD]). Research typically examines sex and gender independently. Gender analyses often exclude transgender and gender diverse (TGD) populations. The objectives of this study were to (a) replicate less frequent cannabis use among TGD young adults compared to cisgender counterparts (b) compare severity of CUD, and (c) examine the role of sex on cannabis outcomes. Method: Online survey participants between 18 and 34 (N=1213) from the United States who reported past-week cannabis consumption provided information on cannabis practices and CUD from February to April 2022. Bivariate analyses explored gender differences across frequency (daily frequency across routes of administration [ROAs]; daily use of 2+ ROAs, use throughout the day) and CUD. Adjusted regression models provided model-estimated marginal probabilities and means to examine differences across four gender-by-sex categories (cisgender men: n=385; cisgender women: n=681; male-at-birth TGD: n=26; female-at-birth TGD: n=121). Benjamini-Hochberg adjustments (10% false discovery rate) were applied. Results: Among past-week consumers, female-at-birth TGD participants demonstrated lower probability of daily flower smoking compared to cisgender men (0.54 vs. 0.67). Cisgender men reported greater probability of daily concentrate vaping (0.55) compared to cisgender women (0.45) and female-at-birth TGD participants (0.27); they were also more likely to report daily use of 2+ ROAs (cisgender men: 0.51 vs. cisgender women: 0.39 and female at-birth TGD: 0.27). TGD participants reported greater CUD severity compared to cisgender counterparts, t(1096)=-3.69, p=0.002. Model-estimated means found lower severity among cisgender women compared to cisgender men and female-at-birth TGD participants. Stratified regression models support positive associations between daily cannabis use and CUD in both TGD in cisgender groups. Among cisgender participants, greater severity was predicted by male sex, younger age, and younger age of onset. Conclusions: The present study replicates and extends a prior finding that among past-week cannabis consumers, TGD young adults report less frequent use than cisgender counterparts. Despite this, TGD participants demonstrated greater severity of CUD. While analyses were limited by the small sample of male-at-birth TGD participants, the article highlights the importance of expanding sex- and gender-focused analyses. Future work is expanding efforts to target hard-to-reach consumers.
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Affiliation(s)
- Cara A Struble
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Jacob T Borodovsky
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Mohammad I Habib
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Ofir Livne
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Claire Walsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Alan J Budney
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
- Department of Psychiatry, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
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Gutkind S, Shmulewitz D, Hasin D. Sex differences in Cannabis use disorder and associated psychosocial problems among US adults, 2012-2013. Prev Med 2023; 168:107422. [PMID: 36641126 PMCID: PMC9974921 DOI: 10.1016/j.ypmed.2023.107422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
While men show greater prevalence of cannabis use disorder (CUD) than women, whether cannabis use frequency drives this difference is unknown, and little is known about sex differences in problems associated with CUD. We therefore assessed the association of CUD with sex, adjusted for frequency of use, and compared the association of psychosocial and health-related problems with CUD between men and women. We included US adults age ≥ 18 who reported past-year cannabis use in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 3701). Cannabis use frequency, DSM-5 CUD and problems (interpersonal, financial, legal, health-related) were assessed. Associations between psychosocial problems, sex and DSM-5 CUD were assessed using prevalence differences (PD) and 95% confidence intervals (CI) from logistic regression models, controlling for demographics and cannabis use frequency, and effect modification by sex was assessed. We found that the prevalence of CUD among men versus women was not significantly greater after adjusting for use frequency. Women had significantly higher prevalence of interpersonal, financial and health-related problems than men, adjusting for frequency of use. Women showed significantly greater association of CUD with interpersonal problems with a boss or co-workers (p < 0.05) and a neighbor, relative or friend (p < 0.05) compared to men. Lack of sex differences in CUD after adjusting for frequency of use suggests use frequency may be an important target of CUD prevention efforts. CUD showed stronger associations for interpersonal problems among women than men, suggesting the need for particular emphasis on treating interpersonal problems related to cannabis use among women.
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Affiliation(s)
- Sarah Gutkind
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Dvora Shmulewitz
- Columbia University, Department of Psychiatry, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Deborah Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University, Department of Psychiatry, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
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Aviram J, Lewitus GM, Vysotski Y, Berman P, Shapira A, Procaccia S, Meiri D. Sex differences in medical cannabis-related adverse effects. Pain 2022; 163:975-983. [PMID: 34538843 PMCID: PMC9009319 DOI: 10.1097/j.pain.0000000000002463] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 12/04/2022]
Abstract
ABSTRACT Studies have shown that women are more susceptible to adverse effects (AEs) from conventional drugs. This study aimed to investigate the differences of medical cannabis (MC)-related AEs between women and men in patients with chronic noncancer pain (CNCP). This is a cross-sectional study of adult patients licensed for MC treatment who were also diagnosed as patients with CNCP by a physician. Data included self-reported questionnaires and comprehensive MC treatment information. Simultaneously, identification and quantification of phytocannabinoids and terpenoids from the MC cultivars were performed. Comparative statistics were used to evaluate differences between men and women. Four hundred twenty-nine patients with CNCP (64% males) reported fully on their MC treatment. Subgrouping by sex demonstrated that the weight-adjusted doses were similar between men and women (0.48 [0.33-0.6] gr for men and 0.47 [0.34-0.66] gr for women). Nonetheless, women reported more than men on MC-related AEs. Further analysis revealed that women consumed different MC cultivar combinations than men, with significantly higher monthly doses of the phytocannabinoids CBD and CBC and significantly lower monthly doses of the phytocannabinoid 373-15c and the terpenoid linalool. Our findings demonstrate sex differences in MC-related AEs among patients with CNCP. Women are more susceptible to MC-related AEs, presumably because of both the inherent sex effect and the consumption of specific phytocannabinoid compositions in the MC cultivar(s). The understanding of these differences may be crucial for planning MC treatments with safer phytocannabinoid and terpenoid compositions and to better inform patients of expected AEs.
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Affiliation(s)
- Joshua Aviram
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil M. Lewitus
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yelena Vysotski
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Paula Berman
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Anna Shapira
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shiri Procaccia
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel
| | - David Meiri
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel
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6
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Brabete AC, Greaves L, Maximos M, Huber E, Li A, Lê ML. A Sex- and Gender-Based Analysis of Adverse Drug Reactions: A Scoping Review of Pharmacovigilance Databases. Pharmaceuticals (Basel) 2022; 15:ph15030298. [PMID: 35337096 PMCID: PMC8950058 DOI: 10.3390/ph15030298] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 02/05/2023] Open
Abstract
Drug-related adverse events or adverse drug reactions (ADRs) are currently partially or substantially under-reported. ADR reporting systems need to expand their focus to include sex- and gender-related factors in order to understand, prevent, or reduce the occurrence of ADRs in all people, particularly women. This scoping review describes adverse drug reactions reported to international pharmacovigilance databases. It identifies the drug classes most commonly associated with ADRs and synthesizes the evidence on ADRs utilizing a sex- and gender-based analysis plus (SGBA+) to assess the differential outcomes reported in the individual studies. We developed a systematic search strategy and applied it to six electronic databases, ultimately including 35 papers. Overall, the evidence shows that women are involved in more ADR reports than men across different countries, although in some cases, men experience more serious ADRs. Most studies were conducted in higher-income countries; the terms adverse drug reactions and adverse drug events are used interchangeably, and there is a lack of standardization between systems. Additional research is needed to identify the relationships between sex- and gender-related factors in the occurrence and reporting of ADRs to adequately detect and prevent ADRs, as well as to tailor and prepare effective reporting for the lifecycle management of drugs.
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Affiliation(s)
- Andreea C. Brabete
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada; (L.G.); (M.M.); (E.H.); (A.L.)
- Correspondence: ; Tel.: +1-514-621-8601
| | - Lorraine Greaves
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada; (L.G.); (M.M.); (E.H.); (A.L.)
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Mira Maximos
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada; (L.G.); (M.M.); (E.H.); (A.L.)
- Woodstock Hospital, Woodstock, ON N44 0A4, Canada
- School of Pharmacy, University of Waterloo, Kitchener, ON N2G 1C5, Canada
| | - Ella Huber
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada; (L.G.); (M.M.); (E.H.); (A.L.)
| | - Alice Li
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada; (L.G.); (M.M.); (E.H.); (A.L.)
| | - Mê-Linh Lê
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, MB R3M 3M1, Canada;
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Fischer B, Robinson T, Bullen C, Curran V, Jutras-Aswad D, Medina-Mora ME, Pacula RL, Rehm J, Room R, van den Brink W, Hall W. Lower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use: A comprehensive evidence and recommendations update. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103381. [PMID: 34465496 DOI: 10.1016/j.drugpo.2021.103381] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based 'Lower Risk Cannabis Use Guidelines' (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis. METHODS Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process. RESULTS A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible. CONCLUSIONS Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.
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Affiliation(s)
- Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Tessa Robinson
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Chris Bullen
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Health Innovation (NIHI), The University of Auckland, Auckland, New Zealand
| | - Valerie Curran
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Maria Elena Medina-Mora
- Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico; Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rosalie Liccardo Pacula
- Schaeffer Center for Health Policy and Economics, Sol Price School of Public Policy, University of Southern California, Los Angeles, United States
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction & Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Wim van den Brink
- Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Wayne Hall
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD 4072, Australia; National Addiction Centre, Institute of Psychiatry, Kings College London, United Kingdom
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Antequera A, Stallings E, Henry RS, Lopez-Alcalde J, Runnels V, Tudiver S, Tugwell P, Welch V. Sex and Gender Appraisal Tool-Systematic Reviews-2 and Participation-To-Prevalence Ratio assessed to whom the evidence applies in sepsis reviews. J Clin Epidemiol 2021; 142:119-132. [PMID: 34763038 DOI: 10.1016/j.jclinepi.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 10/08/2021] [Accepted: 11/03/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To revise a sex and gender appraisal tool for systematic reviews (SGAT-SR) and apply it to Cochrane sepsis reviews. STUDY DESIGN AND SETTING The revision process was informed by existing literature on sex, gender, intersectionality, and feedback from an expert advisory board. We revised the items to consider additional factors associated with health inequities and appraised sex and gender considerations using the SGAT-SR-2 and female Participation-to-Prevalence Ratio (PPR) in Cochrane sepsis reviews. RESULTS SGAT-SR-2 consists of 19 questions appraising the review's sections and use of the terms sex and gender. amongst 71 SRs assessed, 50.7% included at least one tool item, the most frequent being the number of participants by sex or gender at included study-level (24/71 reviews). Only four reviews provided disaggregated data for the full set of included trials, while two considered other equity-related factors. Reviews rarely appraised possible similarities and differences across sex and gender. In half of a subset of reviews, female participants were under-represented relative to their share of the sepsis population (PPR<0.8). CONCLUSION The SGAT-SR-2 tool and the PPR can support the design and appraisal of systematic reviews to assess sex and gender considerations, address to whom evidence applies, and determine future research needs.
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Affiliation(s)
- A Antequera
- Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - E Stallings
- Clinical Biostatistics Unit, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain. CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - R S Henry
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - J Lopez-Alcalde
- Clinical Biostatistics Unit, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain. CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
| | - V Runnels
- University of Ottawa, Ottawa, Ontario, Canada
| | - S Tudiver
- Researcher/Consultant - Gender and Health, Ottawa, Ontario, Canada
| | - P Tugwell
- Department of Medicine, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - V Welch
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Kesner AJ, Lovinger DM. Cannabis use, abuse, and withdrawal: Cannabinergic mechanisms, clinical, and preclinical findings. J Neurochem 2021; 157:1674-1696. [PMID: 33891706 PMCID: PMC9291571 DOI: 10.1111/jnc.15369] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 12/14/2022]
Abstract
Cannabis sativa is the most widely used illicit drug in the world. Its main psychoactive component is delta-9-tetrahydrocannabinol (THC), one of over 100 phytocannabinoid compounds produced by the cannabis plant. THC is the primary compound that drives cannabis abuse potential and is also used and prescribed medically for therapeutic qualities. Despite its therapeutic potential, a significant subpopulation of frequent cannabis or THC users will develop a drug use syndrome termed cannabis use disorder. Individuals suffering from cannabis use disorder exhibit many of the hallmarks of classical addictions including cravings, tolerance, and withdrawal symptoms. Currently, there are no efficacious treatments for cannabis use disorder or withdrawal symptoms. This makes both clinical and preclinical research on the neurobiological mechanisms of these syndromes ever more pertinent. Indeed, basic research using animal models has provided valuable evidence of the neural molecular and cellular actions of cannabis that mediate its behavioral effects. One of the main components being central action on the cannabinoid type-one receptor and downstream intracellular signaling related to the endogenous cannabinoid system. Back-translational studies have provided insight linking preclinical basic and behavioral biology research to better understand symptoms observed at the clinical level. This narrative review aims to summarize major research elucidating the molecular, cellular, and behavioral manifestations of cannabis/THC use that play a role in cannabis use disorder and withdrawal.
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Affiliation(s)
- Andrew J. Kesner
- Laboratory for Integrative NeuroscienceNational Institute on Alcohol Abuse and AlcoholismCenter on Compulsive BehaviorsNational Institutes of HealthBethesdaMDUSA
| | - David M. Lovinger
- Laboratory for Integrative NeuroscienceNational Institute on Alcohol Abuse and AlcoholismCenter on Compulsive BehaviorsNational Institutes of HealthBethesdaMDUSA
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Missing in Action: Sex and Gender in Substance Use Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072352. [PMID: 32244297 PMCID: PMC7177376 DOI: 10.3390/ijerph17072352] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 01/12/2023]
Abstract
Substance use and misuse is a significant global health issue that requires a sex- and gender-based analysis. Substance use patterns and trends are gendered: that is, women and men, girls and boys, and gender-diverse people often exhibit different rates of use of substances, reasons for use, modes of administration, and effects of use. Sex-specific effects and responses to substances are also important, with various substances affecting females and males differentially. Nevertheless, much research and practice in responding to substance use and misuse remains gender blind, ignoring the impacts of sex and gender on this important health issue. This special issue identifies how various aspects of sex and gender matter in substance use, illustrates the application of sex- and gender-based analyses to a range of substances, populations and settings, and assists in progressing sex and gender science in relation to substance use.
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