Use patterns, beliefs, experiences, and behavioral economic demand of indica and sativa cannabis: A cross-sectional survey of cannabis users

Challenges and Insights of Cannabis Vaping Among Sexual Minority Individuals: Commentary on Maglalang et al. (2024)

BACKGROUND

This commentary focuses on assessment challenges of cannabis vaping and the need to expand the Minority Stress Theory (MST) to understand the elevated levels of cannabis vaping among sexual minority individuals. These topics are discussed as a commentary on Maglalang et. al (2024), who examined two novel measurements of cannabis vaping (i.e. recency and number of puffs). Our commentary provides an overview of relevant literature and future directions for cannabis vaping research among sexual minority individuals.

RESULTS

Elevated rates of cannabis vaping among sexual minority individuals are concerning given the elevated THC potency and greater frequency of product use, associated health concerns, and sexual minority individuals' access to health care. The existing body of literature has focused heavily on MST to explain substance use among sexual minority individuals. MST fails to consider several contextual factors (e.g. location and companions) and situational motives (situation or environment-dependent), creating a narrow lens of sexual minority individuals' use of cannabis vapes, as well as other substances.

CONCLUSIONS

This commentary underscores the growing frequency of cannabis vaping among sexual minority individuals, as reported by Maglalang et al. (2024), and the various challenges accompanied in attempts to quantify cannabis vape use frequency and quantity. In addition, the authors suggest expanding research beyond the MST to explore a more diverse set of factors influencing cannabis vape use among sexual minority individuals.

Exploring the suitability of cannabis use with next-day responsibilities: A behavioral-economic and qualitative study

Cannabis demand is sensitive to next-day responsibilities, such as job interviews; however, it is unclear how demand is affected by non-work-related responsibilities and how reported compatibility of cannabis use (i.e., how suitable one perceives cannabis use to be in a situation) influences demand. This study examined the effects of a range of responsibilities on cannabis demand in a crowdsourced sample of adults who smoked cannabis at least monthly (n = 177; 78% White; 47% women; mean age = 36.52). Participants completed hypothetical marijuana purchase tasks asking how much cannabis they would consume at escalating prices in the context of no responsibilities and next-day responsibilities spanning work, leisure, and caregiving. Cannabis demand was significantly reduced in all responsibility conditions (ps < .008; ds .28-.94), with the largest reductions for the job interview and caring-for-kids conditions. Higher ratings of suitability of cannabis use in each situation were correlated with higher demand. Finally, a qualitative thematic analysis characterized why cannabis use was considered suitable or unsuitable with each responsibility. These results suggest that demand is sensitive to next-day responsibilities. However, these effects are not uniform, and future research is needed to examine these individual differences and the timing of upcoming responsibilities.

Utility of a brief measure of cannabis demand: Day-level associations with cannabis use

BACKGROUND

Cannabis demand (i.e., relative value) is usually assessed as a trait-level risk-factor for cannabis use and consequences. This study examined within-person variability in day-level intensity (i.e., amount consumed at zero cost) and Omax (i.e., maximum cannabis expenditure) and tested hypotheses that demand would be positively associated with day-level cannabis use.

METHODS

Young adults (n=85) reporting past-month simultaneous alcohol and cannabis use completed two daily surveys for 30 days. Morning surveys assessed prior-day cannabis use and evening surveys assessed day-level demand (i.e., intensity, Omax). Multilevel models tested day-level effects of intensity and Omax on any cannabis use and flower use frequency and quantity (i.e., grams).

RESULTS

Approximately 52 % and 46 % of variability in intensity and Omax, respectively, was due to within-person change. At the day-level, higher intensity and Omax were associated with higher likelihood of any cannabis use, regardless of formulation; Omax was associated with use of flower in particular; and intensity was associated with the highest quantity of use. At the person-level, only Omax was associated with flower use likelihood, and only intensity was associated with flower quantity across days.

CONCLUSIONS

Cannabis demand demonstrated day-to-day variability, conceivably in response to various internal states and external factors. Intensity and Omax were related to elevated likelihood of using any cannabis, particularly flower, at the day-level. Overall, these data illustrate the validity and utility of brief cannabis demand measures, which might be used to further understand cannabis' reinforcing value at a fine-grained level.

Patients' knowledge about the uses, risks, and beliefs surrounding the regulation and safety of Cannabis sativa L. in Peru

In recent decades, there has been a significant rise in the utilization of medical cannabis. Understanding the various facets surrounding its usage and regulation is paramount for patients, health professionals, and policymakers. This cross-sectional study conducted at the CANNAVITAL clinic in Lima, Peru aimed to assess the basic knowledge, attitudes towards use, and beliefs regarding regulation and safety of Cannabis sativa L. Among 86 patients (mean age: 41 ± 7.8 years; 53.4% women) actively receiving medical cannabis treatment for at least one year, we utilized the 22-item KUC-22 questionnaire to evaluate their understanding of cannabis, risk factors, legislation, medical and recreational use. The average duration of medical cannabis use was 3 ± 1.2 years. Results showed that 60.2% of patients were familiar with different forms of cannabis consumption, while 77.3% recognized the importance of product quality. Chronic pain, nausea and vomiting (each 23.9%) were the primary conditions treated with cannabis, followed by cancer and epilepsy (both 21.6%). A significant correlation was found between knowledge and cannabis use (p < 0.001). Furthermore, 92% of patients believed that a medical prescription was necessary, while 84.1% engaged in self-medication practices. Concerning perceptions, 69.3% of participants perceived psychological dependence from long-term cannabis use, and 65.9% believed it could cause health damage. Significant correlations were observed between the perception of risk factors, knowledge of legislation, and cannabis use (p < 0.001). In conclusion, Peruvian patients exhibited a high level of knowledge regarding the risks, uses, and regulatory framework surrounding Cannabis sativa L. These findings provide valuable insights into patients' perspectives on medical cannabis, offering important information for medical providers and researchers aiming to enhance cannabinoid-based therapies.

Cannabis Policy and Consumption: Taking into account Substitution Effects

Background: Previous studies examining the cannabis-alcohol substitution effect have found that medical cannabis policies may result in substituting the use of cannabis in place of alcohol use. Objectives: This study adds to the literature on cannabis-alcohol substitution by analyzing the effect of decriminalization, medicinal cannabis, and adult-use legalization cannabis policies (2002-2019) on cannabis and alcohol use and substance substitution for all 50 states and the District of Columbia (N=867). Results: Results support the notion that liberalized cannabis policies can increase the prevalence of cannabis use. An adult-use legalization specific analysis yielded findings suggesting a complex and heterogenous effect of such laws on cannabis-alcohol complementation. Conclusion: Given the lack of clarity and heterogenous effects of cannabis laws, policy makers should carefully take into consideration the benefits of medical cannabis laws, along with the risks of decriminalization and adult-use legalization.

An Ecological Examination of Indica Versus Sativa and Primary Terpenes on the Subjective Effects of Smoked Cannabis: A Preliminary Investigation

Background: The legal cannabis landscape has greatly outpaced scientific knowledge. Many popular cannabis claims, such as cultivar (colloquially referred to as strain) classification and terpene content producing different subjective effects, are unsubstantiated. This study examined, for the first time, whether cultivar classification (sativa/indica) and terpene content (caryophyllene, limonene, myrcene, pinene, and terpinolene) were associated with subjective cannabis effects (i.e., pain levels, low-arousal ["indica-like"] effects, high-arousal ["sativa-like"] effects, and negative effects). Methods: Regular cannabis users (n=101) took part in a 2-week long ecological momentary assessment study in which they responded to questions about their cannabis use, stated their preference for sativa versus indica, and reported their in-the-moment subjective effects within 30 min of smoking cannabis. Cultivars were coded for sativa versus indica classification and primary terpene content using Leafly, a popular search engine. Linear mixed-effect models then examined subjective response by sativa/indica and primary terpene. Covariates included demographics (age, sex, race, income), cannabis use (medical use, cannabis use frequency, stated preference for sativa/indica, global expected cannabis effects), morning pain ratings, and specific smoked cannabis occasions (hour of day, minutes since use, context, number of hits, and tetrahydrocannabinol). Results: The majority of participants (78.3%) had a preference for either sativa or indica and reported reasons for their preference that aligned with industry claims. After controlling for covariates, findings revealed that cultivars classified as indica dominant were associated with greater low-arousal (e.g., sluggish, slow) effects relative to the unweighted mean of all cannabis cultivars (b = 0.44, SE=0.16, p=0.01). Cultivars with primary caryophyllene were associated with greater pain ratings (b = 0.53, SE=0.24, p=0.03) and negative effects (b = 0.22, SE=0.08, p=0.01) relative to the mean of all other terpene types. Cultivars with primary pinene were associated with less negative effects (b = -0.35, SE=0.18, p=0.04). Conclusions: Cultivars classified as indica dominant were associated with greater low-arousal effects in models that accounted for both within- and between-person variation, despite the scientific challenges distinguishing between sativa and indica. Preliminary findings also suggest terpenes may play a role in subjective effects. These results emphasize the need for further research, particularly controlled lab studies.

Concurrent validity of the marijuana purchase task: a meta-analysis of trait-level cannabis demand and cannabis involvement

BACKGROUND AND AIMS

The Marijuana Purchase Task (MPT) is increasingly used to measure cannabis reinforcing value and has potential use for cannabis etiological and regulatory research. This meta-analysis sought to evaluate for the first time the MPT's concurrent validity in relation to cannabis involvement.

METHODS

Electronic databases and pre-print repositories were searched for MPT studies that examined the cross-sectional relationship between frequency and quantity of cannabis use, problems, dependence, and five MPT indicators: intensity (i.e. unrestricted consumption), Omax (i.e. maximum consumption), Pmax (i.e. price at which demand becomes elastic), breakpoint (i.e. first price at which consumption ceases), and elasticity (i.e. sensitivity to rising costs). Random effects meta-analyses of cross-sectional effect sizes were conducted, with Q tests for examining differences by cannabis variables, meta-regression to test quantitative moderators, and publication bias assessment. Moderators included sex, number of MPT prices, variable transformations, and year of publication. Populations included community and clinical samples.

RESULTS

The searches yielded 14 studies (n = 4077, median % females: 44.8%: weighted average age = 29.08 [SD = 6.82]), published between 2015 and 2022. Intensity, Omax , and elasticity showed the most robust concurrent validity (|r's| = 0.147-325, ps < 0.014) with the largest significant effect sizes for quantity (|r| intensity = 0.325) and cannabis dependence (|r| Omax  = 0.320, |r| intensity = 0.305, |r| elasticity = 0.303). Higher proportion of males was associated with increased estimates for elasticity-quantity and Pmax -problems. Higher number of MPT prices significantly altered magnitude of effects sizes for Pmax and problems, suggesting biased estimations if excessively low prices are considered. Methodological quality was generally good, and minimal evidence of publication bias was observed.

CONCLUSIONS

The marijuana purchase task presents adequate concurrent validity to measure cannabis demand, most robustly for intensity, Omax , and elasticity. Moderating effects by sex suggest potentially meaningful sex differences in the reinforcing value of cannabis.

On offer to Ontario consumers three years after legalization: A profile of cannabis products, cannabinoid content, plant type, and prices

INTRODUCTION

Cannabis was legalized in Canada in October 2018, regulating the production, distribution, sale, and possession of dried cannabis and cannabis oils. Additional products were legalized 1 year later, including edibles, concentrates, and topicals, with new lines of commercial products coming to market. Ontario is the most populous province in Canada and has the largest cannabis market with the highest number of in-person retail stores and the most cannabis products available online. This study aims to create a profile of products available to consumers three years after legalization by summarizing types of products, THC and CBD potency, plant type, and prices of product sub-categories.

METHODS

We extracted data from the website of the Ontario Cannabis Store (OCS)-the public agency overseeing the only online store and sole wholesaler to all authorized in-person stores-in the first quarter of 2022 (January 19-March 23). We used descriptive analyses to summarize the data. A total of 1,771 available products were mapped by route of administration into inhalation (smoking, vaping, and concentrates), ingestible (edibles, beverages, oils, and capsules) and topical.

RESULTS

Most inhalation products included ≥20%/g THC (dried flower: 94%; cartridges: 96%; resin: 100%) while ingestible products had similar proportions of THC and CBD content. Indica-dominant products tend to be more prominent in inhalation products while sativa-dominant products tend to be more prominent in ingestible products. The average sale price of cannabis was 9.30 $/g for dried flower, 5.79 $/0.1g for cartridges, 54.82 $/g for resin, 3.21 $/unit for soft chews, 1.37 $/ml for drops, 1.52 $/unit for capsules, and 39.94 $/product for topicals.

DISCUSSION

In summary, a wide variety of cannabis products were available to Ontarians for different routes of administration and provides numerous indica-dominant, sativa-dominant, and hybrid/blend options. The current market for inhalation products however is geared towards the commercialization of high-THC products.

Metabolic effects of medical cannabis treatment

Cannabis has a wide range of favorable clinical effects on pain, sleep, mood, gastrointestinal symptom, appetite and physical activity, factors that may affect the metabolic profile of the consumer. In this study, we prospectively evaluated patients recently starting medical cannabis treatment. All patients from the rheumatology clinic, who were just approved for medical cannabis treatment for resistant chronic pain, were recruited. After consent, demographic and clinical parameters were documented, including indication for medical cannabis treatment, way of consumption, type of cannabis and monthly dose of medical cannabis. Fasting morning blood glucose, hemoglobin A1c, insulin, lipid profile, cortisol and uric acid levels, in addition to body weight, were obtained just prior to and 3 months following cannabis consumption. Wilcoxon' sign rank test was used to compare baseline levels to those obtained 3 months later. Twenty-eight patients completed the study. Mean age of the patients was 47.8±9.1 years and ~70% were female patients. 75% of all the patients had fibromyalgia. Mean monthly consumed cannabis amount was 22.21±3.6 g, and 21 (75%) patients used extracts (oil). There was no significant change in any parameter evaluated. The results of our study seem to indicate that medical cannabis, mainly extracts, have no significant effect on any parameter of the metabolic profile of patients with chronic pain syndrome, during 3 months of initial use.

The Use of Cannabinoids for Insomnia in Daily Life: Naturalistic Study

Background

Insomnia is a prevalent condition that presents itself at both the symptom and diagnostic levels. Although insomnia is one of the main reasons individuals seek medicinal cannabis, little is known about the profile of cannabinoid use or the perceived benefit of the use of cannabinoids in daily life.

Objective

We conducted a retrospective study of medicinal cannabis users to investigate the use profile and perceived efficacy of cannabinoids for the management of insomnia.

Methods

Data were collected using the Strainprint app, which allows medicinal cannabis users to log conditions and symptoms, track cannabis use, and monitor symptom severity pre- and postcannabis use. Our analyses examined 991 medicinal cannabis users with insomnia across 24,189 tracked cannabis use sessions. Sessions were analyzed, and both descriptive statistics and linear mixed-effects modeling were completed to examine use patterns and perceived efficacy.

Results

Overall, cannabinoids were perceived to be efficacious across all genders and ages, and no significant differences were found among product forms, ingestion methods, or gender groups. Although all strain categories were perceived as efficacious, predominant indica strains were found to reduce insomnia symptomology more than cannabidiol (CBD) strains (estimated mean difference 0.59, SE 0.11; 95% CI 0.36-0.81; adjusted P<.001) and predominant sativa strains (estimated mean difference 0.74, SE 0.16; 95% CI 0.43-1.06; adjusted P<.001). Indica hybrid strains also presented a greater reduction in insomnia symptomology than CBD strains (mean difference 0.52, SE 0.12; 95% CI 0.29-0.74; adjusted P<.001) and predominant sativa strains (mean difference 0.67, SE 0.16; 95% CI 0.34-1.00; adjusted P=.002).

Conclusions

Medicinal cannabis users perceive a significant improvement in insomnia with cannabinoid use, and this study suggests a possible advantage with the use of predominant indica strains compared with predominant sativa strains and exclusively CBD in this population. This study emphasizes the need for randomized placebo-controlled trials assessing the efficacy and safety profile of cannabinoids for the treatment of insomnia.

Patterns, Consequences, and Motives in Simultaneous Use of Prescription Stimulant Medication with Alcohol and Marijuana

Nonmedical use of prescription stimulants (NPS) continues to be a concern on college campuses. Previous research demonstrates a strong link between NPS and use of other substances, particularly alcohol and marijuana among college students. Simultaneous use of NPS with other substances has become an increasing concern. Given the high rates of NPS and simultaneous NPS with other substances, research examining substance use patterns and motives among students is warranted. Method: This study evaluated group differences in alcohol and marijuana use patterns, consequences, and motives among college students: a) with no NPS history (No NPS); b) engaged in NPS with no simultaneous use (Non-Sim NPS); and c) engaged in simultaneous NPS with alcohol and/or marijuana (Sim NPS). Participants included 1,108 students from three universities who reported past-year marijuana and alcohol use. Results: Overall, 32.8% reported lifetime NPS with 12.5% indicating NPS in the previous 3 months, of which 51.1% reported simultaneous NPS with alcohol and 40.2% with marijuana. Significant group differences for all drinking and marijuana outcomes were found, with heaviest rates among the Sim NPS group, followed by the Non-Sim NPS group, and the No NPS group. The Sim NPS group reported greater motives for using marijuana to alter the effects of other substances. Conclusions: College students engaged in simultaneous NPS with alcohol and marijuana are a high-risk group that should be the focus of prevention and intervention programs in the campus setting.