Typology of Adolescents Exposed to Non-medical Cannabis Marketing and Associations with Consumption Patterns

Clinician perspectives on barriers and facilitators to the treatment of adolescent cannabis use: A qualitative study

INTRODUCTION

Cannabis use among adolescents is prevalent, and clinicians who work with adolescents have unique insights about how to treat cannabis use in this population.

METHODS

This qualitative study interviewed 32 clinicians from addiction medicine recovery services (AMRS), the emergency department (ED), mental health (MH), and pediatrics in an integrated healthcare system to understand their perspectives and experiences regarding barriers and facilitators to treating adolescent cannabis use. The analysis was developed using thematic analysis of interviews.

RESULTS

Thirty-two clinicians (Mean age = 45.9, SD =7.6; 56.3 % Female; 56.3 % White) were recruited from AMRS (n = 13; 41.6 %), the ED (n = 7; 21.9 %), MH (n = 7; 21.9 %) and pediatrics (n = 5; 15.6 %). Clinicians discussed several key barriers and facilitators of treating adolescent cannabis use. Facilitators include the use of multiple screening tools for adolescent cannabis use (i.e., self-report and toxicology testing) which provide more comprehensive information; patient-centered treatment approaches; and discussing cannabis use in the context of adolescents' mental health. Barriers discussed included adolescents' and parents' minimization of adolescent cannabis use risks. Several factors were discussed as potential facilitators or barriers, depending on context, including the influence of peers, virtual treatment, and parental involvement or lack thereof in treatment.

CONCLUSIONS

Interviews with clinicians who work with adolescents across settings highlighted factors that serve as barriers and facilitators to treating adolescent cannabis use. These findings have important implications for guiding future research and intervention efforts, including the inclusion of universal screening practices, addressing stigma, reducing adolescents' and parents' minimization of cannabis use-related harms, and improving adolescent and parent engagement in treatment.

The Züri Can study: Can regulated cannabis sales promote lower-risk cannabis use? Mini-review and study protocol

BACKGROUND AND AIMS

Recreational use of cannabis is illegal in most countries. Despite this, it is the third most commonly used psychoactive substance worldwide. As a result of this discrepancy, a growing number of countries have begun to reassess their legal approach to cannabis in recent years. While the health risks of cannabis and potential harm reduction measures are increasingly well understood, there are still significant gaps in knowledge about which regulatory and supply models are effective in promoting lower-risk cannabis use. In this paper, we outline the Züri Can study, which implements and evaluates a regulatory framework for cannabis sales in the city of Zurich, Switzerland, between 2023 and 2026. In addition, we illustrate how the study addresses current knowledge gaps to provide further insight into the potential future regulation of cannabis in Switzerland. To embed the study in the present scientific and political context, we first provide a brief overview of the state of knowledge on cannabis-related health risks and means of reducing them, along with lessons learned from other countries that have implemented varying regulatory systems.

DESIGN AND MEASUREMENTS

2,100 participants will be able to legally purchase cannabis either at a pharmacy, a cannabis social club, or the municipal drug information center over a three-year period. As part of this observational study, participants will be evaluated regarding their cannabis use habits and motives, their knowledge of lower-risk use, and their mental and physical health, among other parameters. Established harm reduction strategies are implemented as an integral part of the study design.

COMMENTS

The study will contribute to a better understanding of the impact of different cannabis distribution models on cannabis use patterns and related health outcomes. The results are expected to assist Swiss and international policy makers in developing evidence-based and public health-oriented regulatory frameworks for cannabis.

Cannabis-Derived Product Types, Flavors, and Compound Types From an E-Commerce Website

Importance

Cannabis-derived products (CDPs) are widely available and diverse. A classification of product and flavor types is necessary to establish a foundation for comparative research, although research aiming to classify cannabis in its variety of products, flavors, and cannabinoid compounds based on public online e-commerce data is lacking.

Objective

To analyze data from a large cannabis e-commerce marketplace to identify and characterize cannabis product types, flavors, and compound types.

Design, Setting, and Participants

This qualitative study was conducted in 2 phases: (1) data mining of the cannabis e-commerce website Weedmaps for product listings in the US between September 1 and November 30, 2023 and (2) grouping CDPs into product, flavor, and cannabinoid compound categories.

Exposures

Cannabis product listings.

Main Outcomes and Measures

Product listings and descriptions were extracted from the platform. Coding was performed for specific product characteristics, routes of administration (ROAs), and characterization of flavors.

Results

A total of 573 854 unique US CDP sales listings from the platform were collected; after removing 72 842 nonconsumable items, 501 012 were analyzed. Product ROAs included multisystem (205 637 [41.04%]), respiratory (185 296 [36.98%]), digestive (98 941 [19.75%]), epidermal (9487 [1.89%]), and oral (1651 [0.33%]). Nearly half (210 575 [42.03%]) of all product listings included at least 1 flavor, with 247 762 instances of flavors. The 3 most common flavors were lemon (22 106 [8.92%]), cake (19 463 [7.86%]), and strawberry (13 961 [5.63%]). The most common cannabinoid compound type was Δ9-tetrahydrocannabinol (54 699 [63.30%]).

Conclusions and Relevance

This qualitative study categorized more than half a million CDPs for product and flavor types. Results are needed for comparative studies on product and market availability and can help in assessing concerns about appealing characteristics. The results can also inform future market surveillance efforts aimed at identifying new and emerging products as cannabis policy continues to move toward greater legalization.

Patterns in Tobacco, E-Cigarette, and Cannabis Advertising Exposure Among California Adolescents and Associations With Future Use Expectations

BACKGROUND

Exposure to tobacco, e-cigarette, or cannabis marketing is associated with adolescent use. Few studies have examined advertising exposure prevalence and patterns across these products concurrently.

METHODS

This study assessed past 30-day recalled exposure to promotional messages about tobacco, e-cigarettes ("vapes" on the survey), and cannabis ("marijuana") from various sources among California adolescents (ages 12-17) in the 2022 Teens, Nicotine, and Tobacco Online Survey (N = 2530). Principal components analysis (PCA) was conducted to examine the underlying structure and patterns in advertising exposure sources. Multivariable logistic regression was used to evaluate associations between any advertising exposure and future use expectations (a susceptibility measure) in one year and at age 25 among current never-users.

RESULTS

Overall, 65.9% of participants recently noticed at least one tobacco (52.5%), vape (51.5%), or marijuana (45.6%) advertisement. Gas stations or convenience stores were the most common source for tobacco or vape ads; billboards were for marijuana ads. In PCA, advertising exposure patterns correlated with advertising source, not the type of product. Exposures from tobacco-specific sources and nearer point of sale were associated with current use, older age, LGBTQ + identity, and sensation seeking. Among never-users, advertising exposure was associated with one-year and age-25 use expectations for cigarettes (one-year expectations adjusted odds ratio: 1.7; 95% CI: 1.1, 2.5), vapes (2.3; 1.5, 3.5), and marijuana (2.1; 1.5, 3.0).

CONCLUSION

California adolescents' exposure to tobacco, e-cigarette, and cannabis marketing is common, follows similar patterns, and is associated with use susceptibility. Comprehensive restrictions on marketing accessible to adolescents could help prevent youth use.