Delta-8 THC Retail Availability, Price, and Minimum Purchase Age

Background: Retail sales of Delta-8 tetrahydrocannabinol (THC) products have increased in the U.S. market since the passing of the 2018 Farm Bill, and there is currently little regulation of marketing/sales and limited related safety standards in many states. After thousands of calls to poison control centers (40% for individuals under 18 years old and 70% requiring health care facility evaluation), the Food and Drug Administration issued warnings on Delta-8 THC products, stating their psychoactive effects and that some manufacturers may synthesize Delta-8 using unsafe household chemicals. The current study describes the Delta-8 THC retail sales environment in Fort Worth, Texas. Given its relatively inexpensive manufacturing and that low prices are a major determinant of cannabis use, the price of Delta-8 THC products was examined. This study also examined whether retail outlets in areas with greater socioeconomic deprivation had higher odds of selling Delta-8 THC products. This is important because if Delta-8 THC retailers are disproportionately located in more socioeconomically deprived communities, residents of these communities can more easily access these products and may have higher risk of adverse consequences. Methods: Potential Delta-8 THC retailers were selected by identifying lists of current retail locations with alcohol, cannabidiol, and/or tobacco licenses in Fort Worth. Trained research assistants called outlets in September and October 2021 to query about sales of products containing Delta-8 THC. The response rate was 69% (n=1,223). Outlets' 9-digit zip codes were merged with Area Deprivation Index scores. Products and purported minimum age were described. Chi-squared and Student's t-tests were used. Results: Eleven percent of outlets (n=133) reported selling Delta-8 THC. Ninety-six percent sold vapes and/or "flower" (i.e., hemp leaves coated with Delta-8 THC distillate) and 76% sold edibles. Among the least expensive products available, edibles cost, on average, $8.58 less than flower/vapes (p<0.001). Outlets that sold Delta-8 THC were located in areas with greater deprivation (p=0.02). Most reported a minimum purchase age of 21; however, 4% reported 18 years or no minimum age. Conclusions: Delta-8 THC retail outlets were disproportionately located in areas with more socioeconomic deprivation. Legal intervention such as zoning, minimum age, and tax laws may help reduce Delta-8 THC-related disparities.

Accuracy Differences in Cannabis Retailer Information Ascertained from Webservices and Government-Maintained State Registries Across US States Legalizing the Sale of Cannabis in 2019

Cannabis retailer locations used to investigate geographic cannabis access are frequently ascertained from two sources: 1) webservices which provide locations of cannabis retailers (e.g., Yelp) or 2) government-maintained registries. Characterizing the operating status and location information accuracy of cannabis retailer data sources on a state-by-state level can inform research examining the health implications of cannabis legalization policies. This study ascertained cannabis retailer name and location from webservices and government-maintained registries for 26 states and the District of Columbia legalizing cannabis sales in 2019. Validation subsamples were created using state-level sequential sampling. Phone surveys were conducted by trained researchers for webservice samples (n=790, November 2019 - May 2020) and government-maintained registry (n=859, February - June 2020) to ascertain information about operating status and location. Accuracy was calculated as the percent agreement among subsample and phone survey data. For operating status and location, webservice derived data was 78% (614/790) and 79% (484/611) accurate, whereas government-maintained registry derived data was 76% (657/859) and 95% (622/655) accurate, respectively. Fifty-nine percent (15/27) of states and the District of Columbia had over 80% accuracy for operating status and 48% (13/27) states had over 80% accuracy for location information with both data sources. However, government-maintained registry derived information was more accurate in 33% (9/27) states for operating status and 41% (11/27) states for location information. Both data sources had similar operating status accuracy. Research using spatial analysis may prefer government-maintained registry derived data due to high location information accuracy, whereas studies looking at broad trends across states may prefer webservice derived. State level COVID-19 restrictions had minimal impact on ascertainment of cannabis retailer operating status and location information via phone survey derived from webservices and government-maintained registries.

Population and Neighborhood Correlates of Cannabis Dispensary Locations in Oklahoma

Background

Cannabis dispensaries have proliferated exponentially in Oklahoma since the state legalized medical cannabis in 2018. Oklahoma is unique from many other legalized states given its high number of lower income, rural, and uninsured residents, who may seek medical cannabis as an alternative to traditional medical treatment.

Methods

This study examined demographic and neighborhood characteristics associated with dispensary density (n = 1,046 census tracts) in Oklahoma.

Results

Compared to census tracts with no dispensaries, those with at least one dispensary had a higher proportion of uninsured individuals living below the poverty level and a greater number of hospitals and pharmacies. Almost half (42.35%) of census tracts with at least one dispensary were classified as a rural locale. In fully adjusted models, percent uninsured, percent of household rentals, and the number of schools and pharmacies were positively associated with greater number of cannabis dispensaries, while the number of hospitals was negatively associated. In the best fitting interaction models, dispensaries were predominant in areas with a higher percentage of uninsured residents and no pharmacies, suggesting that cannabis retailers may capitalize on the health needs of communities with limited healthcare outlets or access to medical treatment.

Conclusions

Policies and regulatory actions that seek to decrease disparities in dispensary locations should be considered. Future studies should examine whether people living in communities with a scarcity of health resources are more likely to associate cannabis with medical uses than those living in communities with more resources.

A Failure to Guide: Patient Experiences within a State-Run Cannabis Program in Pennsylvania, United States

INTRODUCTION

Medical cannabis has been available for purchase in dispensaries in Pennsylvania, United States since April 2018. Patients wanting to access medical cannabis must receive certification from physicians for a limited number of physical and psychological conditions. Despite increasing numbers of patients using cannabis in the United States, little is known about the patient experience during certification and entry into state-regulated cannabis programs and how and if they are guided by health care professionals and dispensary staff. Through focus group discussions, we sought to capture patient perspectives of certification, cannabis acquisition and cannabis use.

METHODS

Twenty-seven Pennsylvania participants took part in 7 virtual focus groups from June to July 2020. Participants were recruited statewide from the community, medical settings, and dispensaries.

RESULTS

Focus group results indicate that while the medical cannabis program is functional, policymakers and the medical community have failed to meaningfully integrate cannabis into the health care system. Participants expressed frustration around two central themes: there was no overarching education about medical use of cannabis and there was little consistency and availability for people once they found a suitable product, resulting in inadequate symptom relief and exorbitant out of pocket costs to pursue cannabis use as an adjuvant therapeutic. Participants noted a siloed experience between the certification process, accessing dispensaries, and receiving ongoing medical care. The lack of integrated care required high levels of self-reliance and experimentation with medical cannabis for participants.

CONCLUSION

We recommend that cannabis be better integrated into medical care for patients with qualifying conditions.

Locating Medical and Recreational Cannabis Outlets for Research Purposes: Online Methods and Observational Study

Background

An increasing number of states have laws for the legal sale of recreational and medical cannabis out of brick-and-mortar storefront locations. Given the proliferation of cannabis outlets and their potential for impact on local economies, neighborhood structures, and individual patterns of cannabis use, it is essential to create practical and thorough methods to capture the location of such outlets for research purposes. However, methods used by researchers vary greatly between studies and often do not include important information about the retailer’s license status and storefront signage.

Objective

The aim of this study was to find methods for locating and observing cannabis outlets in Los Angeles County after the period when recreational cannabis retailers were granted licenses and allowed to be open for business.

Methods

The procedures included searches of online cannabis outlet databases, followed by methods to verify each outlet’s name, address, license information, and open status. These procedures, conducted solely online, resulted in a database of 531 outlets. To further verify each outlet’s information and collect signage data, we conducted direct observations of the 531 identified outlets.

Results

We found that 80.9% (430/531) of these outlets were open for business, of which 37.6% (162/430) were licensed to sell cannabis. Unlicensed outlets were less likely to have signage indicating the store sold cannabis, such as a green cross, which was the most prevalent form of observed signage. Co-use of cannabis and tobacco/nicotine has been found to be a substantial health concern, and we observed that 40.6% (175/430) of cannabis outlets had a tobacco/nicotine outlet within sight of the cannabis outlet. Most (350/430, 81.4%) cannabis outlets were located within the City of Los Angeles, and these outlets were more likely to be licensed than outlets outside the city.

Conclusions

The findings of this study suggest that online searches and observational methods are both necessary to best capture accurate and detailed information about cannabis outlets. The methods described here can be applied to other metropolitan areas to more accurately capture the availability of cannabis in an area.

Establishing Credibility for Medical Marijuana: The Proposed Prometheus Dispensary Registry for Botanical Cannabis

A previous commentary in INNOVATIONS in Pharmacy argued that, given the lack of evidence for outcomes in medical marijuana, outside of a handful of randomized clinical trials and even fewer observational studies, good clinical practice points to the need for monitoring patients who received cannabis through certified medical marijuana dispensaries. The commentary noted the lack of standards for monitoring cannabis patients and the lack of feedback from the dispensary to providers. Botanical cannabis administration was occurring in, effectively, an evidence vacuum. More to the point, dispensary owners and investors seem uninterested in establishing a robust evidence base for cannabis outcomes. Given the range of conditions and symptoms presented by patients, to include the prevalence of multiple symptoms together with the range of potential cannabis formulations, dosing regimens and delivery options, a failure to monitor patients over the course of their exposure to cannabis in not acceptable. The purpose of this commentary is to report on a proposed on-line registry structure proposed by Prometheus Research for medical marijuana dispensaries in the US. The registry tracks and reports on patients over the course of treatment with botanical cannabis with the focus on severe or chronic non-cancer pain, severe nausea, persistent muscle spasms and seizures, together with prevalent comorbidities - fatigue, anxiety, depression and sleep. This is the first time a registry has been developed for dispensaries in the United States as a model for a robust evidence base to support botanical cannabis as a therapy option.

Online Methods for Locating Medical Marijuana Dispensaries: Practical Considerations for Future Research

Knowing the names, locations, and signage of medical marijuana dispensaries is critical for assessing how marijuana availability affects neighborhood quality and marijuana use, yet no detailed methods for locating and coding dispensaries are published. Limitations regarding accuracy of official records, unregulated businesses, and the size of areas where dispensaries are located make it difficult to accurately capture all open dispensaries in any area. In this study, we test a practical and feasible method to collect a point-in-time portrayal of medical marijuana dispensaries in a large urban area lacking an official record of these businesses. Using publicly-available Internet sources alone, we collected the name, address, phone number, signage, and open/closed status of medical marijuana dispensaries in Los Angeles County between October 2016 and February 2017. Data were verified by calling a subset of dispensaries and comparing data against a list of licensed dispensaries. Our methods yielded 872 unique dispensaries in Los Angeles County, of which 470 were open. Most open stores were discernable by a green cross sign; however, few had names that clearly indicated the store sold marijuana. Data verification procedures showed that Internet sources were able to locate nearly all dispensaries in the county that were then verified with non-Internet methods, such as calling the businesses to confirm information. This study is significant as it provides methodology that can be replicated in other metropolitan areas, facilitating comparisons across databases in different locations and regulatory environments. However, caution should be taken when solely using Internet sources. Accurate information on dispensary names, locations, and signage can advance research and provide important information for policy decisions. Methods for enhancing the online methods described in this study are discussed.

Medicine and Charity in Eighteenth-century Northumberland: The Early Years of the Bamburgh Castle Dispensary and Surgery, c. 1772-1802

In 1772 in Bamburgh Castle, Northumberland, a charitable institution was established by Dr John Sharp to offer medical provision to the poor of the parish, which was remote from the Newcastle and Edinburgh Infirmaries. Unlike urban institutions, which have dominated hospital historiography, the Bamburgh dispensary was small, occupying only a few rooms in the castle, and situated in a remote, coastal location. And yet, at its height, the Bamburgh dispensary treated thousands of patients per year, often exceeding dispensaries in large towns, and was equipped with the latest medical technologies. Unlike the majority of infirmaries and dispensaries it was not funded by subscription, nor run by governors, but was entirely funded by the Lord Crewe Trust, and administered by Dr Sharp. While Bamburgh is certainly an anomaly, it raises new questions about voluntary institutional medical provision for rural populations, and forms of medical philanthropy.

Examining the locations of medical marijuana dispensaries in Los Angeles

INTRODUCTION AND AIMS

Little is known about the spatial distribution of medical marijuana dispensaries, particularly whether or not sites are disproportionately located in minority or communities with younger populations. This paper will assess if there is a relationship between medical marijuana dispensaries and neighbourhood characteristics.

DESIGN AND METHODS

This study used an ecological, cross-sectional design of 1000 census tracts from Los Angeles city in 2012 to explore the relationship between neighbourhood sociodemographics, structural features of neighbourhoods and density of medical marijuana dispensaries. Locations of dispensaries were obtained through a premise survey of all listed dispensaries. Data on neighbourhood characteristics were obtained from Geolytics. The study used Bayesian conditionally autoregressive models that include controls for spatial heterogeneity to analyse the data.

RESULTS

Findings show that dispensaries are located in areas that allow for commercial establishments. Results indicate a positive relationship between dispensaries and percent commercially zoned, areas with highway ramp access, density of on- and off-premise alcohol outlets and percent Hispanic residents.

DISCUSSION AND CONCLUSIONS

In sum, the findings suggest that, likely because of zoning regulations, dispensaries were located in primarily commercially zoned areas with greater road access (as measured by the presence of highway ramps). Given that areas with higher densities of dispensaries also have higher densities of alcohol outlets, future work should examine how this co-location affects neighbourhood problems such as crime and violence. [Thomas C, Freisthler B. Examining the locations of medical marijuana dispensaries in Los Angeles. Drug Alcohol Rev 2016;35:334-337].

Inspecting Hospitals in the Russian Empire: Dr. John Harry's Account, 1805-1806

This paper examines the efforts of the Russian government to modernize medical administration and hospital services during the reign of Alexander I (1801-1825). Based on the report of the English doctor John Harry, it reviews the state of medical care in Russia and initiatives to improve clinical treatment. Based on these sources, it is argued that hospitals in Russia, as elsewhere in Europe, were undergoing a transition from being homes of refuge to institutions for the treatment of the sick. Their conditions were largely dependent on proper governance, as well as funding. Attempts by the Russian authorities to address issues of public health correlated with similar developments in Western Europe at the time.