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Donnan J, Johnston K, Coombs M, Najafizada M, Bishop L. Exploring consumer preferences for cannabis edible products to support public health policy: A discrete choice experiment. PLoS One 2024; 19:e0292336. [PMID: 38753807 PMCID: PMC11098505 DOI: 10.1371/journal.pone.0292336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/22/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND In October 2019, cannabis edibles were legalized for sale in Canada for non-medical use. This move was intended to improve public safety by regulating contents (including a maximum 10 mg tetrahydrocannabinol (THC) per package) and packaging to prevent accidental ingestion or over consumption. This study aimed to explore consumer preferences for cannabis edibles to inform cannabis policy. METHODS We explored the relative importance and trade-offs consumers make for attributes of cannabis edibles using a discrete choice experiment. Attributes included type of edible, price, THC content, cannabis taste, package information, product consistency, product recommendations, and Health Canada regulation. Participants lived in Canada, were 19 years of age or older, and purchased a cannabis edible in the last 12 months. A multinomial logit (MNL) model was used for the base model, and latent class analysis to assess preference sub-groups. This study was approved by the institutional ethics committee. RESULTS Among 684 participants, the MNL model showed that potency was the most relevant attribute, followed by edible type. A two-group latent class model revealed two very distinct preference patterns. Preferences for group 1 (~65% of sample) were driven primarily by edible type, while for group 2 (~35% of sample) were driven almost entirely by THC potency. CONCLUSION This study found that consumer preferences for ~65% of consumers of cannabis edibles are being met through regulated channels. The remaining ~35% are driven by THC potency at levels that are not currently available on the licensed market. Attracting this market segment will require reviewing the risks and benefits of restricting THC package content.
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Affiliation(s)
- Jennifer Donnan
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Karissa Johnston
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Michael Coombs
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Maisam Najafizada
- Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Lisa Bishop
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
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Florimbio AR, Walton MA, Duval ER, Bauermeister JA, Young SD, McAfee J, Bonar EE. Direct and Indirect Effects of Cannabis Risk Perceptions on Cannabis Use Frequency. ADDICTION RESEARCH & THEORY 2023; 32:68-73. [PMID: 38268741 PMCID: PMC10805454 DOI: 10.1080/16066359.2023.2221029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 05/24/2023] [Indexed: 01/26/2024]
Abstract
Background Perceived risk of harm associated with cannabis use has decreased in recent decades, particularly among emerging adults who show the highest prevalence of use. Cannabis-related protective behavioral strategies (PBS) are associated with lower cannabis use and fewer consequences; however, individuals who perceive using cannabis as low risk may use cannabis PBS less often. Therefore, using cross-sectional data, we examined the associations between perceived risk of harm associated with cannabis use, cannabis PBS, and cannabis use frequency. Method Participants were 146 emerging adults between the ages of 18-25 (56.2% female) who reported consuming cannabis at least 3 times/week and completed measures of past-month cannabis use, past three-month use of cannabis PBS, and perceived risk of harm associated with cannabis use. Path analyses examined direct and indirect effects of perceived risk of cannabis-related harm on cannabis frequency through cannabis PBS. Results Most (66.4%) participants reported no perceived risk of harm associated with occasional cannabis use, whereas 30.1% reported no perceived risk of harm associated with regular cannabis use. Findings indicated a significant indirect effect between perceived risk of harm and cannabis use frequency through cannabis PBS, b = -10.23, SE = 3.80, 95% CI [-17.67, -2.80], p = .007. Conclusions Among emerging adults who consume cannabis regularly, findings suggest that a greater perceived risk of cannabis-related harm is associated with decreased cannabis use frequency via increased use of cannabis PBS. Although future analyses evaluating causal mechanisms are needed, these findings have clinical implications for harm reduction interventions focused on cannabis use.
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Affiliation(s)
- Autumn Rae Florimbio
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Elizabeth R. Duval
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd., Ann Arbor, MI 48109
| | - José A. Bauermeister
- Department of Family & Community Health, University of Pennsylvania, Philadelphia, PA 19104
| | - Sean D. Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA 92697
- Department of Emergency Medicine, University of California Irvine, CA 92697
| | - Jenna McAfee
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109
| | - Erin E. Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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Palamar JJ, Le A. Prevalence of self-reported adverse effects associated with drug use among nightclub and festival attendees, 2019-2022. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100149. [PMID: 37025564 PMCID: PMC10070077 DOI: 10.1016/j.dadr.2023.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/18/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Research investigating adverse effects from drug use has focused extensively on poisonings and mortality. This study focuses on drug-related adverse effects not necessarily resulting in hospitalization or death among a population known for high prevalence of party drug use-electronic dance music (EDM) nightclub and festival attendees. METHODS Adults entering EDM venues were surveyed in 2019-2022 (n = 1952). Those reporting past-month use of a drug were asked whether they had experienced a harmful or very unpleasant effect after use. We examined 20 drugs and drug classes with a particular focus on alcohol, cannabis, cocaine, and ecstasy. Prevalence and correlates of adverse effects were estimated. RESULTS Almost half (47.6%) of adverse effects involved alcohol and 19.0% involved cannabis. 27.6% of those using alcohol reported an adverse effect, while 19.5%, 15.0%, and 14.9% of participants reported an effect from use of cocaine, ecstasy, and cannabis, respectively. Use of less prevalent drugs, such as NBOMe, methamphetamine, fentanyls, and synthetic cathinones, tended to be associated with higher prevalence of adverse effects. The most consistent risk factor was younger age, while past-month use of a greater number of drugs was often a protective factor against adverse effects. For most drugs, taking too much was the most common perceived reason for the adverse effect, and visiting a hospital after use was most prevalent among those experiencing an adverse effect from cocaine (11.0%). CONCLUSIONS Adverse drug effects are common in this population and results can inform prevention and harm reduction in this population and the general population.
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Affiliation(s)
- Joseph J. Palamar
- New York University Grossman School of Medicine, Department of Population Health, 180 Madison Avenue, Room 1752, New York, NY 10016, USA
| | - Austin Le
- New York University Grossman School of Medicine, Department of Population Health, 180 Madison Avenue, Room 1752, New York, NY 10016, USA
- New York University College of Dentistry, New York, NY, USA
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Elliott C, Ventresca M, Truman E. The “risk object” of cannabis edibles: perspectives from young adults in Canada. HEALTH, RISK & SOCIETY 2023. [DOI: 10.1080/13698575.2023.2198558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- Charlene Elliott
- Department of Communication, Media & Film, University of Calgary, Calgary, Canada
| | - Matt Ventresca
- Department of Communication, Media & Film, University of Calgary, Calgary, Canada
| | - Emily Truman
- Department of Communication, Media & Film, University of Calgary, Calgary, Canada
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Lim CCW, Chan GCK, Wadsworth E, Stjepanović D, Chiu V, Chung JYC, Sun T, Connor J, Leung J, Gartner C, Hall W, Hammond D. Trends and Socio-Demographic Differences of Cannabis Vaping in the USA and Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14394. [PMID: 36361272 PMCID: PMC9659122 DOI: 10.3390/ijerph192114394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
Given the rise in cannabis vaping, it is important to highlight the heterogeneity in vaping different cannabis product because of the potential differences in their health risks. This study aims to estimate the trends and socio-demographic correlates of the use of various cannabis vaping products across jurisdiction with different legal status. Data from the 2018 (n = 27,169) and 2019 (n = 47,747) waves of the International Cannabis Policy Study (ICPS) were used. Respondents aged 16-65 completed web-based surveys. In 2019, proportions of past year vaping of cannabis oil, dried flower and concentrates in the overall sample were highest in U.S. jurisdictions where cannabis was legalized for non-medical use (17.4%, 6.0%, 4.9%), followed by U.S. jurisdiction where non-medical cannabis use is illegal (13.7%, 5.8%, 2.9%), and lowest in Canada (8.1%, 4.4%, 2.1%). Vaping dried flower decreased from 2019 to 2018 in U.S. legal jurisdictions and Canada, while vaping cannabis oil and concentrates increased in all jurisdictions (p < 0.001). The odds of vaping all forms of products were higher among younger respondents (16-55 years), males, respondents with some college education, and persons with low-risk perceptions on daily cannabis vaping. In both ICPS surveys (2018 and 2019), cannabis oil was the most frequently vaped products, followed by dried flower, and concentrates. Detailed measures of product forms for cannabis vaping should be considered in future surveys.
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Affiliation(s)
- Carmen C. W. Lim
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Gary C. K. Chan
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Elle Wadsworth
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Suite 500, Ottawa, ON K1P 5E7, Canada
| | - Daniel Stjepanović
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Vivian Chiu
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Jack Y. C. Chung
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Tianze Sun
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Jason Connor
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- Discipline of Psychiatry, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Coral Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Woolloongabba, QLD 4102, Australia
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
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Copycat and lookalike edible cannabis product packaging in the United States. Drug Alcohol Depend 2022; 235:109409. [PMID: 35459519 PMCID: PMC9106923 DOI: 10.1016/j.drugalcdep.2022.109409] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent media reports have highlighted copycat/lookalike cannabis edibles as a public health concern. No empirical papers have described this phenomenon. METHODS From May 2020-August 2021, we collected photos of cannabis products via an online survey of cannabis users and through personal contacts. Copycat/lookalike products are defined as those that use the same or similar brand name, logo, and/or imagery as an existing commercial non-cannabis counterpart (CNCC). We assessed each package for similarities with its CNCC with respect to brand name, product name, font, color, flavors, and brand/promotional characters. We examined cannabis content indicators including: THC content per package and serving, cannabis leaf symbol, product warnings, cannabis terms, cannabis motifs, activation time, and guidance on edible use. RESULTS We collected photos of 731 cannabis products; 267 (36%) were edibles of which 22 (8%) represented 13 unique copycat/lookalike products. Eight used exact brand/product names as existing CNCCs, and five used similar names. Packages copied or imitated a mean of 3.9 of six features and indicated cannabis content with a mean of 4.1 of eight features. Thirteen packages indicated a mean THC content of 459 mg/package. Four reported THC dose per serving, with a mean dose of 47.5 mg. CONCLUSIONS Our content analysis highlights three key concerns. First, copycat/lookalike edibles subtly indicate cannabis content while using high fidelity replication or imitation of their CNCC. Second, THC content is high and there were multiple 10 mg THC doses in the equivalent of 1 serving of a CNCC. Third, these products may be attractive to children.
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Ogle WL, Gold GJ, Coppen LE, Copriviza C. How and why adults use cannabis during physical activity. J Cannabis Res 2022; 4:24. [PMID: 35585648 PMCID: PMC9115925 DOI: 10.1186/s42238-022-00134-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/25/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND With increased legalization of cannabis, users are combining cannabis with exercise. The purpose of this study is to understand how and why people use cannabis when participating in physical activity. METHODS A convenience sample of cannabis users participated in an anonymous online survey created by the authors regarding exercise habits while under the influence of cannabis, perceived benefits, unanticipated experiences related to cannabis and exercise, and demographics. RESULTS One hundred thirty-one respondents (18-55 years) were eligible and began the survey. Nearly 60 physical activities under the influence of cannabis were reported. The most frequently reported modes of exercise included hiking (60%), yoga (58%), and aerobic machines (50%). The primary reasons for using cannabis before exercise were "helping to focus/concentrate" (66%), "helping enjoy the exercise experience" (65%), and "enhancing mind-body-spirit connection" (65%). Thirty-three participants reported "yes" or "maybe" regarding having an experience they "didn't anticipate or desire while exercising under the influence of cannabis." DISCUSSION Participants' reasons for exercising with cannabis span the physiological, psychological, neuromotor, and even spiritual domains. However, some reported an undesired experience when pairing cannabis with exercise. While this was an online survey with a small sample size, our results agree with and contribute to the growing research investigating cannabis use and physical activity participation. CONCLUSION We found considerable heterogeneity in types of physical activity participation under the influence of cannabis, as well as perceived benefits of use. This study provides directions to further explore the risks and benefits of combining cannabis with physical activity.
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Affiliation(s)
- Whitney L Ogle
- Department of Kinesiology & Recreation Administration, Cal Poly - Humboldt, 1 Harpst St., Arcata, CA, 95521, USA.
- Humboldt Institute for Interdisciplinary Marijuana Research, 1 Harpst St., Arcata, CA, 95521, USA.
| | - Gregg J Gold
- Humboldt Institute for Interdisciplinary Marijuana Research, 1 Harpst St., Arcata, CA, 95521, USA
- Department of Psychology, Cal Poly - Humboldt, 1 Harpst St., Arcata, CA, 95521, USA
| | - Lukas E Coppen
- Department of Kinesiology & Recreation Administration, Cal Poly - Humboldt, 1 Harpst St., Arcata, CA, 95521, USA
| | - Claire Copriviza
- Department of Kinesiology & Recreation Administration, Cal Poly - Humboldt, 1 Harpst St., Arcata, CA, 95521, USA
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8
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Marijuana use among US adults with cancer: findings from the 2018–2019 Behavioral Risk Factor Surveillance System. J Cancer Surviv 2022:10.1007/s11764-021-01138-z. [DOI: 10.1007/s11764-021-01138-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/10/2021] [Indexed: 10/18/2022]
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9
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Acute toxicity associated with cannabis edibles following decriminalization of marijuana in Michigan. Am J Emerg Med 2021; 46:732-735. [DOI: 10.1016/j.ajem.2020.09.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/26/2020] [Indexed: 11/17/2022] Open
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Swan C, Ferro MA, Thompson K. Does how you use matter? The link between mode of use and cannabis-related risk. Addict Behav 2021; 112:106620. [PMID: 32911353 DOI: 10.1016/j.addbeh.2020.106620] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES With the recent legalization of cannabis there are more cannabis products available to consumers today than ever before. However, little is known about the relation of distinct modes of use to cannabis-related risks. The current study estimated the prevalence of different modes of use among a sample of university students, and quantified the magnitude of association between modes of use (type and number) and cannabis-related risks (i.e., dependence, negative consequences, simultaneous use with alcohol). METHODS The sample included 368 undergraduate students (71% female) who reported using cannabis in the last 6 months. RESULTS Joints were the most commonly reported primary mode (39%), followed by bongs/water pipes (33%), hand pipes (14%), edibles (7%) and vaporizers (5%). The majority of participants were multi-mode users (88%). On average, participants reported using 2.72 (sd = 1.04) modes of cannabis regularly. Bong users had more cannabis related harms (B = 1.85, p < .001), dependence symptoms (B = 1.87, p < .001) and were twice as likely to use alcohol and cannabis simultaneously (OR = 2.09; 95% CI: 1.17-3.74) compared to joint users. However, these associations were attenuated after adjusting for sex, age and cannabis frequency. Multi-modal users reported significantly more cannabis-related harms and misuse symptoms compared to single mode users. CONCLUSION Few differences in cannabis risks were found across modes of use. Frequency of use remains the most significant predictor of cannabis related risks. However, findings suggest that multimodal may be indicative of high risk cannabis use patterns and is an important target for screening and intervention.
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Firth C, Carlini B, Dilley J, Wakefield J, Hajat A. What About Equity? Neighborhood Deprivation and Cannabis Retailers in Portland, Oregon. ACTA ACUST UNITED AC 2020. [DOI: 10.26828/cannabis.2020.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jones NS, Comparin JH. Interpol review of controlled substances 2016-2019. Forensic Sci Int Synerg 2020; 2:608-669. [PMID: 33385148 PMCID: PMC7770462 DOI: 10.1016/j.fsisyn.2020.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/23/2020] [Indexed: 12/14/2022]
Abstract
This review paper covers the forensic-relevant literature in controlled substances from 2016 to 2019 as a part of the 19th Interpol International Forensic Science Managers Symposium. The review papers are also available at the Interpol website at: https://www.interpol.int/content/download/14458/file/Interpol%20Review%20Papers%202019.pdf.
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Affiliation(s)
- Nicole S. Jones
- RTI International, Applied Justice Research Division, Center for Forensic Sciences, 3040 E. Cornwallis Road, Research Triangle Park, NC, 22709-2194, USA
| | - Jeffrey H. Comparin
- United States Drug Enforcement Administration, Special Testing and Research Laboratory, USA
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Schauer GL, Njai R, Grant-Lenzy AM. Modes of marijuana use - smoking, vaping, eating, and dabbing: Results from the 2016 BRFSS in 12 States. Drug Alcohol Depend 2020; 209:107900. [PMID: 32061947 DOI: 10.1016/j.drugalcdep.2020.107900] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence of modes of marijuana use (e.g., smoked, vaped, eaten, dabbed, etc.), and of multi-modal use has not been assessed across multiple states, and can inform marijuana prevention and education work, given that certain modes of use are associated with specific public health risks. This study aimed to assess the prevalence of different modalities of reported marijuana use among adults in 12 states. METHODS Data came from 6174 adult marijuana users age 18 and older who responded to questions about past month and mode of marijuana use on the 2016 BRFSS surveys in 12 states with varied state marijuana policies. We used weighted frequencies for descriptive analyses, and logistic regression to identify correlates of multi-modal use. RESULTS The prevalence of past month (current) marijuana use among adults in these states was 9.1 % (males = 12.0 %, females= 6.3 %). Among current marijuana users, 33.7 % reported multiple methods of marijuana use, 90.1 % reported any marijuana smoking (e.g., joints, blunts, bongs, bowls), 58.3 % reported only smoking (no other modes of consumption), 24.5 % reported any edible use, 4.5 % reported using only edibles, 19.4 % reported any marijuana vaping, 2.1 % reported only vaping, 14.5 % reported any dabbing (flash vaporization/inhalation of highly concentrated marijuana), and 0.4 % reported only dabbing. Correlates of multimodal use are also examined. CONCLUSION Multi-modal use of marijuana is common, and use of non-smoked marijuana (edibles, vaping, dabbing) often occurs in conjunction with other modes of marijuana use. Ongoing surveillance of marijuana modes of use and multi-modal use is warranted to inform public education and prevention.
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Affiliation(s)
- Gillian L Schauer
- CDC Foundation, Atlanta, GA, United States; Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.
| | - Rashid Njai
- Office of the Deputy Director for Non-Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Althea M Grant-Lenzy
- Office of the Deputy Director for Non-Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Schlienz NJ, Spindle TR, Cone EJ, Herrmann ES, Bigelow GE, Mitchell JM, Flegel R, LoDico C, Vandrey R. Pharmacodynamic dose effects of oral cannabis ingestion in healthy adults who infrequently use cannabis. Drug Alcohol Depend 2020; 211:107969. [PMID: 32298998 PMCID: PMC8221366 DOI: 10.1016/j.drugalcdep.2020.107969] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/09/2020] [Accepted: 03/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prior controlled cannabis research has mostly focused on smoked cannabis and predominantly included frequent cannabis users. Oral cannabis products ("edibles") make up a large and growing segment of the retail cannabis market. This study sought to characterize the pharmacodynamic effects of oral cannabis among infrequent cannabis users. METHODS Seventeen healthy adults who had not used cannabis for at least 60 days completed four experimental sessions in which they consumed a cannabis-infused brownie that contained 0, 10, 25, or 50 mg THC. Subjective effects, vital signs, cognitive/psychomotor performance, and blood THC concentrations were assessed before and for 8 h after dosing. RESULTS Relative to placebo, the 10 mg THC dose produced discriminable subjective drug effects and elevated heart rate but did not alter cognitive/psychomotor performance. The 25 and 50 mg THC doses elicited pronounced subjective effects and markedly impaired cognitive and psychomotor functioning compared with placebo. For all active doses, pharmacodynamic effects did not manifest until 30-60 min after ingestion, and peak effects occurred 1.5-3 h post-administration. Blood THC levels were significantly correlated with some pharmacodynamic drug effects, but were substantially lower than what is typically observed after cannabis inhalation. CONCLUSION Ingestion of oral cannabis dose-dependently altered subjective drug effects and impaired cognitive performance. Unlike inhaled forms of cannabis for which acute effects occur almost immediately, effects of oral cannabis were considerably delayed. In an era of legalization, education about the time course of drug effects for cannabis edibles is needed to facilitate dose titration and reduce acute overdose incidents.
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Affiliation(s)
- Nicolas J Schlienz
- Department of Psychology, University at Buffalo, 313 Diefendorf Hall, Buffalo, NY, 14214, USA
| | - Tory R Spindle
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Edward J Cone
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Evan S Herrmann
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - George E Bigelow
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - John M Mitchell
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Ronald Flegel
- Substance Abuse and Mental Health Services Administration (SAMHSA), Division of Workplace Programs (DWP), 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Charles LoDico
- Substance Abuse and Mental Health Services Administration (SAMHSA), Division of Workplace Programs (DWP), 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA.
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Matheson J, Le Foll B. Cannabis Legalization and Acute Harm From High Potency Cannabis Products: A Narrative Review and Recommendations for Public Health. Front Psychiatry 2020; 11:591979. [PMID: 33173527 PMCID: PMC7538627 DOI: 10.3389/fpsyt.2020.591979] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/03/2020] [Indexed: 12/12/2022] Open
Abstract
Legalization and commercial sale of non-medical cannabis has led to increasing diversity and potency of cannabis products. Some of the American states that were the first to legalize have seen rises in acute harms associated with cannabis use, e.g. Colorado has seen increases in emergency department visits for cannabis-related acute psychological distress and severe vomiting (hyperemesis), as well as a number of high-profile deaths related to ingestion of high doses of cannabis edibles. Over-ingestion of cannabis is related to multiple factors, including the sale of cannabis products with high levels of THC and consumers' confusion regarding labelling of cannabis products, which disproportionately impact new or inexperienced users. Based on our review of the literature, we propose three approaches to minimizing acute harms: early restriction of cannabis edibles and high-potency products; clear and consistent labelling that communicates dose/serving size and health risks; and implementation of robust data collection frameworks to monitor harms, broken down by cannabis product type (e.g. dose, potency, route of administration) and consumer characteristics (e.g. age, sex, gender, ethnicity). Ongoing data collection and monitoring of harms in jurisdictions that have existing legal cannabis laws will be vital to understanding the impact of cannabis legalization and maximizing public health benefits.
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Affiliation(s)
- Justin Matheson
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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16
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Monte AA, Shelton SK, Mills E, Saben J, Hopkinson A, Sonn B, Devivo M, Chang T, Fox J, Brevik C, Williamson K, Abbott D. Acute Illness Associated With Cannabis Use, by Route of Exposure: An Observational Study. Ann Intern Med 2019; 170:531-537. [PMID: 30909297 PMCID: PMC6788289 DOI: 10.7326/m18-2809] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Little is known about the relative harms of edible and inhalable cannabis products. OBJECTIVE To describe and compare adult emergency department (ED) visits related to edible and inhaled cannabis exposure. DESIGN Chart review of ED visits between 1 January 2012 and 31 December 2016. SETTING A large urban academic hospital in Colorado. PARTICIPANTS Adults with ED visits with a cannabis-related International Classification of Diseases, Ninth or 10th Revision, Clinical Modification (ICD-9-CM or ICD-10-CM), code. MEASUREMENTS Patient demographic characteristics, route of exposure, dose, symptoms, length of stay, disposition, discharge diagnoses, and attribution of visit to cannabis. RESULTS There were 9973 visits with an ICD-9-CM or ICD-10-CM code for cannabis use. Of these, 2567 (25.7%) visits were at least partially attributable to cannabis, and 238 of those (9.3%) were related to edible cannabis. Visits attributable to inhaled cannabis were more likely to be for cannabinoid hyperemesis syndrome (18.0% vs. 8.4%), and visits attributable to edible cannabis were more likely to be due to acute psychiatric symptoms (18.0% vs. 10.9%), intoxication (48% vs. 28%), and cardiovascular symptoms (8.0% vs. 3.1%). Edible products accounted for 10.7% of cannabis-attributable visits between 2014 and 2016 but represented only 0.32% of total cannabis sales in Colorado (in kilograms of tetrahydrocannabinol) during that period. LIMITATION Retrospective study design, single academic center, self-reported exposure data, and limited availability of dose data. CONCLUSION Visits attributable to inhaled cannabis are more frequent than those attributable to edible cannabis, although the latter is associated with more acute psychiatric visits and more ED visits than expected. PRIMARY FUNDING SOURCE Colorado Department of Public Health and Environment.
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Affiliation(s)
- Andrew A Monte
- University of Colorado School of Medicine, Aurora, Colorado, and Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, Colorado (A.A.M.)
| | - Shelby K Shelton
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Eleanor Mills
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Jessica Saben
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Andrew Hopkinson
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Brandon Sonn
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Michael Devivo
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Tae Chang
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Jacob Fox
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Cody Brevik
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Kayla Williamson
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
| | - Diana Abbott
- University of Colorado School of Medicine, Aurora, Colorado (S.K.S., E.M., J.S., A.H., B.S., M.D., T.C., J.F., C.B., K.W., D.A.)
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17
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Barrus DG, Lefever TW, Wiley JL. Evaluation of reinforcing and aversive effects of voluntary Δ 9-tetrahydrocannabinol ingestion in rats. Neuropharmacology 2018; 137:133-140. [PMID: 29758385 DOI: 10.1016/j.neuropharm.2018.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/10/2018] [Accepted: 04/19/2018] [Indexed: 01/21/2023]
Abstract
Edible cannabis-infused products are an increasingly popular method of using cannabis in the United States. Yet, preclinical research to determine mechanisms underlying abuse of Δ9-tetrahydrocannabinol (THC), the primary psychoactive constituent of cannabis, has focused primarily on the effects of parenteral administration. The purpose of this study was to examine the rewarding and aversive effects of oral THC in a novel rodent voluntary ingestion model. Adult male and female Sprague Dawley rats were given access to sucrose-sweetened solutions during daily sessions. A range of THC concentrations, each paired with a unique flavor previously tested alone, was introduced into these solutions for four-session exposure periods and drinking volumes were measured. Injected (i.p.) THC doses were also paired with unique flavors to compare the effects of route of THC administration on drinking. Introduction of THC into sucrose solutions dose-dependently decreased drinking upon initial exposure, though drinking generally increased in subsequent sessions. By contrast, i.p. THC produced sustained dose-dependent decreases in drinking in rats of both sexes. Subsequent exposure to paired flavors in the absence of THC resulted in further decreases in drinking, suggesting route-specific aversion. Additional testing using saccharin-sweetened solutions in a two-bottle choice paradigm was also conducted, with THC producing sustained dose-dependent decreases in drinking after initial exposure in rats of both sexes. Though self-administration of ingested THC was not demonstrated, evidence of route-specific THC aversion was observed, which suggests that certain routes and/or rates of THC administration may mitigate some of its aversive effects.
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Affiliation(s)
- Daniel G Barrus
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Timothy W Lefever
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Jenny L Wiley
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
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18
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Orenstein DG, Glantz SA. Regulating Cannabis Manufacturing: Applying Public Health Best Practices from Tobacco Control. J Psychoactive Drugs 2018; 50:19-32. [PMID: 29438634 DOI: 10.1080/02791072.2017.1422816] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
State legalization and regulation of cannabis, despite continued federal illegality, is a massive shift in regulatory approach. Manufactured cannabis, including concentrates, extracts, edibles, tinctures, topicals and other products, has received less attention than more commonly used dried flower, but represents emerging regulatory challenges due to additives, potency, consumption methods, and abuse and misuse potential. In November 2017, the California Department of Public Health (CDPH) released initial cannabis manufacturing regulations as part of a new state regulatory structure. As the largest U.S. medical cannabis market (and largest legal adult use market in the world beginning in 2018), California's regulatory approach will potentially influence national and global policy. Comparing CDPH's initial regulations to tobacco control best practices reveals that, while the regulations recognize the need to protect public health, prioritizing public health over business interests requires stronger approaches to labeling, packaging, and product formulations. Based on tobacco best practices, we recommend that cannabis regulations incorporate large and proportionately sized informational labels, a prominent universal cannabis symbol, rotating and pictorial health warnings, mandatory plain packaging, a comprehensive ban on characterizing flavors and addictive additives, and strict limits on the potency of inhalable products and those easily confused with non-cannabis products.
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Affiliation(s)
- Daniel G Orenstein
- a Postdoctoral Fellow, Center for Tobacco Control Research and Education and Philip R. Lee Institute for Health Policy Studies, University of California San Francisco , San Francisco , CA , UA
| | - Stanton A Glantz
- b Professor of Medicine, Truth Initiative Distingished Professor of Tobacco Control, Center for Tobacco Control Research and Education, Philip R. Lee Institute for Health Policy Studies, and Department of Medicine , University of California San Francisco , San Francisco , CA , USA
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19
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Ouellette L, Cearley M, Judge B, Riley B, Jones J. Cooking with cannabis: The rapid spread of (mis)information on YouTube. Am J Emerg Med 2017; 36:1300-1301. [PMID: 29096918 DOI: 10.1016/j.ajem.2017.10.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/25/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Lindsey Ouellette
- Michigan State University, College of Human Medicine, Department of Emergency Medicine, United States
| | - Mary Cearley
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States
| | - Bryan Judge
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States
| | - Brad Riley
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States
| | - Jeffrey Jones
- Michigan State University, College of Human Medicine, Department of Emergency Medicine, United States; Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States.
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