1
|
Ogburn T, Chaudhry I, Knight LD. When Vaping Isn't Actually Safer: A Death From Toxic Alcohol Contaminated Vape Juice. Am J Forensic Med Pathol 2024:00000433-990000000-00190. [PMID: 38833354 DOI: 10.1097/paf.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
ABSTRACT Vape juice is a diluent for e-cigarette active ingredients, nicotine or tetrahydrocannabinol (THC). Lack of strict regulation in vape juice production is a concern as ingredients and their concentrations may vary widely from the labeling.A 43-year-old woman was transported via ambulance to the hospital after ingesting homemade vape juice, presenting unresponsive with decerebrate posturing. She reportedly made a tincture combining a vape juice purchased online (containing "ethylene glycol") and THC for "endometriosis-related pain relief." Laboratory evaluation revealed anion gap metabolic acidosis, elevated serum lactate, and high serum osmolality. Urine fluoresced under Wood's lamp, and fomepizole was administered as an ethylene glycol antidote, but she expired the following afternoon. Clinical serum toxicology results returned after death revealed 235 mg/dL of methanol, and no ethylene glycol.Autopsy findings included ischemic changes of the gastrointestinal tract and cerebral edema with herniation. Postmortem toxicology performed on hospital admission blood revealed methanol (220 mg/dL), propylene glycol (59 mg/dL), Δ-9 THC and metabolites, and medications administered during hospitalization. The medical examiner determined the cause of death to be methanol and propylene glycol toxicity.To our knowledge, this is the first report of accidental death from ingestion of vape juice contaminated with toxic alcohol.
Collapse
Affiliation(s)
- Timothy Ogburn
- From the University of Nevada-Reno School of Medicine, Reno, NV
| | - Irfan Chaudhry
- Washoe County Regional Medical Examiner's Office, and Department of Pathology, University of Nevada-Reno School of Medicine, Reno, NV
| | - Laura D Knight
- Washoe County Regional Medical Examiner's Office, and Departments of Pathology and Pediatrics, University of Nevada-Reno School of Medicine, Reno, NV
| |
Collapse
|
2
|
Silver J, Ford BT, Pavano CJ, Bellas N, Hewitt C, Solomito M, McCarthy C. Cannabis Use Is Associated With Fewer Filled Opioid Prescriptions After Treatment of Proximal Humerus Fractures. Orthopedics 2024; 47:147-151. [PMID: 37921529 DOI: 10.3928/01477447-20231027-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
The purpose of this study was to use a large claims database to determine if there is a difference in opioid use after operative intervention for proximal humerus fractures in patients with known cannabis use compared with those who do not report cannabis use. The PearlDiver database was queried to find all patients who underwent proximal humerus open reduction and internal fixation. A group of patients with reported cannabis use or dependence was matched to a cohort without known cannabis use. Between the two groups, differences in the number of opioid prescriptions filled in the postoperative period (within 3 days), the morphine milligram equivalents (MMEs) prescribed in total and per day, and the number of opioid prescription refills were explored. There were 66,445 potential control patients compared with 1260 potential study patients. After conducting the propensity score match, a total of 1245 patients were included in each group. The patients in the cannabis group filled fewer opioid prescriptions (P=.045) and were prescribed fewer total MMEs (P=.044) in the first 3 days postoperatively. Results of this study indicate that patients who use cannabis products may use fewer opioids after proximal humerus open reduction and internal fixation. [Orthopedics. 2024;47(3):147-151.].
Collapse
|
3
|
Yang S, Cotter LM, Lu L, Kriss LA, Minich M, Liu J, Silver LD, Cascio CN. Countering online marketing and user endorsements with enhanced cannabis warning labels: An online experiment among at-risk youth and young adults. Prev Med 2024; 180:107877. [PMID: 38266719 DOI: 10.1016/j.ypmed.2024.107877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/20/2023] [Accepted: 01/20/2024] [Indexed: 01/26/2024]
Abstract
As cannabis legalization expands and online marketing intensifies, this study examines whether online social cues can amplify youth-targeted cannabis advertising and whether cannabis warning labels (CWLs) can counteract these influences. A U.S. online sample of 970 adolescents and 1776 young adults susceptible to cannabis use were recruited from Qualtrics in summer 2022. Each participant was randomly assigned to one of the 3 (CWLs: none vs. textual vs. pictorial) by 3 (comments: none vs. anti-cannabis vs. pro-cannabis) conditions in an online experiment. Participants were exposed to three online marketing posts promoting marijuana edibles (randomly selected from a large pool, N = 1260), each with either no warning label, a textual warning, or a pictorial warning (text and picture), and with either five comments (pro- or anti-cannabis in valence) or none. Results showed that among adolescents, pro-cannabis comments increased product appeal (vs. anti-cannabis comments: b = 0.18, p = .025; vs. no comments: b = 0.21, p = .021), and did so more than young adults. For adolescents, only pictorial warnings reduced product appeal (b = -0.20, p = .028). For young adults, both pictorial (b = -0.18, p = .002) and textual warnings (b = -0.12, p = .029) reduced product appeal. Furthermore, both textual (adolescents: b = -0.20, p = .004; young adults: b = -0.15, p = .005) and pictorial (adolescents: b = -0.30, p < .001; young adults: b = -0.18, p = .001) warnings reduced cannabis use intentions. Findings support requiring enhanced CWLs accompany online marketing ads.
Collapse
Affiliation(s)
- Sijia Yang
- School of Journalism and Mass Communication, University of Wisconsin, Madison, WI, United States of America.
| | - Lynne M Cotter
- School of Journalism and Mass Communication, University of Wisconsin, Madison, WI, United States of America
| | - Linqi Lu
- School of Journalism and Mass Communication, University of Wisconsin, Madison, WI, United States of America
| | - Lauren A Kriss
- School of Journalism and Mass Communication, University of Wisconsin, Madison, WI, United States of America; UT Center for Health Communication, Austin, TX, United States of America
| | - Matt Minich
- School of Journalism and Mass Communication, University of Wisconsin, Madison, WI, United States of America
| | - Jiaying Liu
- Department of Communication, University of California, Santa Barbara, CA, United States of America
| | - Lynn D Silver
- Public Health Institute, Oakland, CA, United States of America
| | - Christopher N Cascio
- School of Journalism and Mass Communication, University of Wisconsin, Madison, WI, United States of America
| |
Collapse
|
4
|
Neu P. [Legalization of Recreational Cannabis use in Germany - Implications Based on Experiences in Uruguay, Canada und USA: a Narrative Review]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:397-403. [PMID: 37567249 DOI: 10.1055/a-2125-9106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
The current government of Germany has agreed on legalizing the recreational use of cannabis in their coalition agreement. Legalization will be implemented in 2023. This issue has continuously been a subject of controversial discussion including most parts of society, executive authorities and science. This article refers to the experiences of other countries (Uruguay, Canada, USA) yet having legalized Cannabis in the past and tries to discuss implications for Germany.
Collapse
Affiliation(s)
- Peter Neu
- Klinik für Psychiatrie und Psychotherapie, Jüdisches Krankenhaus Berlin, Berlin, Germany
| |
Collapse
|
5
|
Silver J, Pavano C, Bellas N, Hewitt C, Torre B, Solomito M, Kostyun R, Esmende S. Cannabis use is associated with decreased opioid prescription fulfillment following single level anterior cervical discectomy and fusion (ACDF). NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 14:100226. [PMID: 37440986 PMCID: PMC10333711 DOI: 10.1016/j.xnsj.2023.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/23/2023] [Accepted: 04/23/2023] [Indexed: 07/15/2023]
Abstract
Background Recently, there has been increasing legalization of marijuana within the United States, however data are mixed with respect to its efficacy in treating acute pain. Our goal was to identify a difference in opioid utilization in patients with known cannabis use before anterior cervical discectomy and fusion (ACDF) compared with those that report no cannabis use. Methods This study was a retrospective case-control design using PearlDiver. Patients who underwent a single level ACDF between January 2010 and October 2020, were included. Patients were placed in the study group if they had a previous diagnosis of cannabis use, dependence, or abuse. Patients were excluded if they were under the age of 18 or if they had filled an opioid prescription within 3 months of their procedure. A control group was then created using a propensity score match on age, gender, and Charleston comorbidity index (CCI), and had no diagnosis of cannabis use. The primary outcome was the number of morphine milliequivalents (MME) dispensed per prescription following surgery. Results A total of 1,339 patients were included in each group. The number of patients filling prescriptions was lower in the cannabis group than in the control group at 3 days postoperatively (p<.001). The average total MME per day as prescribed was lower in the cannabis group than the control group at 60 days post-op (48.5 vs. 59.4, respectively; p=.018). Conclusions Patients who had a previous diagnosis of cannabis use, dependence or abuse filled fewer opioid prescriptions postoperatively (at 3 days postoperatively) and required lower doses (reduced average daily MME, at 60 days postoperatively) when compared with the control group.
Collapse
Affiliation(s)
- Jacob Silver
- UConn Health Center, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States
| | - Colin Pavano
- UConn Health Center, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States
| | - Nicholas Bellas
- UConn Health Center, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States
| | - Cory Hewitt
- UConn Health Center, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States
| | - Barrett Torre
- UConn Health Center, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States
| | | | - Regina Kostyun
- Hartford Hospital, Bone and Joint Institute, Hartford, CT
| | - Sean Esmende
- Hartford Hospital, Bone and Joint Institute, Hartford, CT
| |
Collapse
|
6
|
Boyle HK, Singh S, López G, Carey KB, Jackson KM, Merrill JE. A qualitative examination of the decision-making process of simultaneous alcohol and cannabis use: Intentions and willingness. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:168-179. [PMID: 36480451 PMCID: PMC10275144 DOI: 10.1111/acer.14982] [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: 06/08/2022] [Revised: 10/28/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Alcohol and cannabis use are common among young adults and most young adults who use both substances have used them simultaneously (i.e., using both substances so their effects overlap). Because simultaneous use is associated with a greater number and severity of consequences than single substance use, research is needed to examine the decision-making process of engaging in this high-risk behavior. We conducted a qualitative examination of intentions (i.e., plans) and willingness (i.e., one's openness to engage in the behavior if an opportunity presents itself) to engage in simultaneous use from the perspective of young adults who frequently report this substance use behavior. METHODS We recruited 36 young adults who reported simultaneous use and heavy drinking (4+/5+ drinks for women/men; 64% women, ages 18 to 25) to participate in semi-structured interviews. All interviews were double coded for thematic analysis and both novel and a priori themes were found. RESULTS Young adults distinguished between intending to engage in simultaneous use and being willing to engage in simultaneous use. They reported that intentions and willingness varied from occasion to occasion. They also reported that context and alcohol consumption influenced their willingness to engage in simultaneous use. Peer pressure or offers increased their willingness to use cannabis while drinking and having current or next-day responsibilities decreased their willingness to engage in simultaneous use. Additionally, planned simultaneous use occasions were characterized as being special events where young adults consumed more substances, but were more likely to monitor their use than unplanned occasions. CONCLUSIONS Intentions and willingness may be important proximal predictors of simultaneous use of alcohol and cannabis. Building off this qualitative work, quantitative research should identify which factors influence the decision-making process to engage in simultaneous use and determine when intentions and willingness are most predictive of risky simultaneous use behavior.
Collapse
Affiliation(s)
- Holly K Boyle
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, Rhode Island, USA
| | - Samyukta Singh
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, Rhode Island, USA
| | - Gabriela López
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, Rhode Island, USA
| | - Kate B Carey
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, Rhode Island, USA
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, Rhode Island, USA
| | - Jennifer E Merrill
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, Rhode Island, USA
| |
Collapse
|
7
|
Abstract
Purpose of Review To explore relations between behavioral economic demand for cannabis and cannabis use disorder (CUD). Prior reviews have focused on drug demand in relation to use outcomes more generally. Complementing and enhancing prior work synthesizing research on cannabis demand, the present review endeavors to determine whether specific demand indices derived from the marijuana purchase task are most reliably related to CUD. Additionally, sociodemographic characteristics of participants in these studies were reviewed to identify whether certain populations were underrepresented in behavioral economic cannabis research. Recent Findings Behavioral economic demand is related to CUD; intensity and elasticity of cannabis demand were consistently associated with CUD diagnosis and severity. However, frequently, only select demand indices were assessed or reported, precluding the ability to confirm which indices are superior for denoting CUD risk. Further, most studies enrolled samples that were predominately young adults, Caucasian, and male. Summary As CUD becomes more prevalent in the wake of cannabis legalization, identification of robust predictors of CUD risk is paramount. Cannabis demand is consistently associated with CUD; however, individual indices of import in this relationship remain ambiguous. Subsequent research is needed to confirm index-specific markers of disordered cannabis use, and whether links between demand and CUD generalize across diverse populations.
Collapse
Affiliation(s)
- Elizabeth R. Aston
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box GS121-5, Providence, RI 02912, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Heath, Providence, RI 02912, USA
| | - Benjamin L. Berey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box GS121-5, Providence, RI 02912, USA
| |
Collapse
|
8
|
Laudanski K, Wain J. Considerations for Cannabinoids in Perioperative Care by Anesthesiologists. J Clin Med 2022; 11:jcm11030558. [PMID: 35160010 PMCID: PMC8836924 DOI: 10.3390/jcm11030558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 02/07/2023] Open
Abstract
Increased usage of recreational and medically indicated cannabinoid compounds has been an undeniable reality for anesthesiologists in recent years. These compounds’ complicated pharmacology, composition, and biological effects result in challenging issues for anesthesiologists during different phases of perioperative care. Here, we review the existing formulation of cannabinoids and their biological activity to put them into the context of the anesthesia plan execution. Perioperative considerations should include a way to gauge the patient’s intake of cannabinoids, the ability to gain consent properly, and vigilance to the increased risk of pulmonary and airway problems. Intraoperative management in individuals with cannabinoid use is complicated by the effects cannabinoids have on general anesthetics and depth of anesthesia monitoring while simultaneously increasing the potential occurrence of intraoperative hemodynamic instability. Postoperative planning should involve higher vigilance to the risk of postoperative strokes and acute coronary syndromes. However, most of the data are not up to date, rending definite conclusions on the importance of perioperative cannabinoid intake on anesthesia management difficult.
Collapse
Affiliation(s)
- Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA 19104, USA
- Correspondence: (K.L.); (J.W.)
| | - Justin Wain
- School of Osteopathic Medicine, Campbell University, Buies Creek, NC 27506, USA
- Correspondence: (K.L.); (J.W.)
| |
Collapse
|
9
|
Bhagianadh D, Arora K. Legalization of Medical Cannabis and Site of Death: Evidence From National Vital Statistics Mortality Data. J Appl Gerontol 2021; 41:806-816. [PMID: 34930063 DOI: 10.1177/07334648211058720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We examined whether Medical Marijuana Legislation (MML) was associated with site of death. Using state-level data (1992-2018) from the National Vital Statistics System (NVSS), we employed difference-in-differences method to compare changes in death rate among older adults at four sites-nursing home (NH), hospital, home, hospice/other-over time in states with and without MML. Heterogeneity analyses were conducted by timing of MML adoption, and by decedent characteristics. Results show a negative association between MML implementation and NH deaths. Among early adopters (states with weakly regulated programs) and decedents with musculoskeletal disorders, there was a positive association between MML implementation and hospital deaths, whereas among late adopters (states with "medicalized" programs), there was a positive association between MML implementation and hospice deaths. Decline in NH deaths may reflect increased likelihood of transfers due to threat of Federal enforcement, penalties for poor outcomes, and liability concerns. Future studies should examine these associations further.
Collapse
Affiliation(s)
- Divya Bhagianadh
- Department of Health Management and Policy, University of Iowa, Iowa City, IA, USA
| | - Kanika Arora
- Department of Health Management and Policy, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
10
|
Wang GS, Buttorff C, Wilks A, Schwam D, Tung G, Pacula RL. Changes in Emergency Department Encounters for Vomiting After Cannabis Legalization in Colorado. JAMA Netw Open 2021; 4:e2125063. [PMID: 34533572 PMCID: PMC8449280 DOI: 10.1001/jamanetworkopen.2021.25063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE Cannabis hyperemesis syndrome is an emerging clinical issue associated with cannabis use. Legalization of cannabis has led to an increase in vomiting-related illnesses in health care settings. OBJECTIVE To examine whether legalization of cannabis in Colorado has been associated with increases in vomiting-related emergency department (ED) visits. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional design was used to assess the increase in ED claims for vomiting reported to the Colorado Hospital Association between January 1, 2013, and December 31, 2018, in counties that had no prior cannabis dispensaries before legalization compared with those that did. A total of 820 778 patients seeking care through Colorado EDs were included in the analysis. EXPOSURES The number of medical and recreational cannabis dispensaries per county per quarter. MAIN OUTCOMES AND MEASURES County per capita rate of vomiting-related ED claims per quarter. RESULTS Vomiting-related ED health care encounters increased from 119 312 in 2013 to 153 699 in 2018 (29% increase). Over this period, 203 861 patients (25%) were aged 0 to 18 years; 114 201 (14%) were aged 19 to 25 years, and 502 771 (61%) were aged 26 years or older; 510 584 patients (62%) were female. Additional recreational dispensaries were associated with increased vomiting-related ED visits (incidence rate ratio, 1.03; 95% CI, 1.01-1.05), but counties with high baseline medical dispensary exposure experienced smaller increases in vomiting-related ED visits than counties with no baseline medical dispensary exposure (incidence rate ratio, 0.97; 95% CI, 0.95-0.99). Counties with a high number of medical marijuana dispensaries had increases at a 5.8% slower rate than counties with none. CONCLUSIONS AND RELEVANCE The findings of this study suggest that cannabis legalization in Colorado is associated with an increase in annual vomiting-related health care encounters with regard to exposure to these markets. It may be useful for health care clinicians to be aware of cannabis hyperemesis syndrome and inquire about cannabis use when appropriate.
Collapse
Affiliation(s)
- George Sam Wang
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora
| | | | - Asa Wilks
- RAND Corporation, Santa Monica, California
| | | | - Gregory Tung
- Department of Health Systems, Management & Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus
| | - Rosalie Liccardo Pacula
- Sol Price School of Public Policy, Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
| |
Collapse
|
11
|
Manu E, Douglas M, Ntsaba MJ, Tarkang EE. Perspectives of illicit marijuana growers and traders on commercial legalisation of marijuana in South Africa: considerations for policy formulation. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:54. [PMID: 34174921 PMCID: PMC8236131 DOI: 10.1186/s13011-021-00391-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/16/2022]
Abstract
Background Over the years, there has been a clarion call for legalising marijuana cultivation and trading for commercial purposes in South Africa. Proponents of the call argue that the criminalisation of commercial marijuana cultivation and trading has failed to halt illicit marijuana cultivation and trading. However, the views of those who economically benefit from the illicit marijuana trade on its legalisation remain empirically unsolicited. Objective This study aimed to solicit the views of illegal marijuana growers and traders from two selected communities in the Eastern Cape Province of South Africa regarding the commercial legalisation of marijuana cultivation and trading to inform policy on the debate. Methods In-depth key informant interview approach was used to interview 18 purposively sampled participants that were selected through the snowball sampling technique. The data were analysed using the thematic content analysis approach. Results Participants had both positive and negative perceptions of the possible legalisation of marijuana cultivation and trading. On the positive side, participants indicated freedom from police, the opportunity to grow marijuana on a larger scale, capital acquisition for commercial marijuana cultivation and trading, and regulation of marijuana prices through unionisation as some of the benefits they would derive from the commercial legalisation of marijuana cultivation and trading. On the negative side, loss of their source of livelihood, fall in the price of marijuana and perceived increase in school drop-out rates were the concerns raised. Conclusion While participants relished improvement in their economic fortunes upon commercial legalisation of marijuana cultivation and trading, they were also apprehensive about this policy due to the perceived consequences it may have on their livelihoods and communities. We, therefore, recommend that future discussions of the commercial legalisation of marijuana cultivation and trading in South Africa should be done in consultation with illicit marijuana growers and traders to ensure that their interests are safeguarded by such a policy. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-021-00391-w.
Collapse
Affiliation(s)
- Emmanuel Manu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
| | - Mbuyiselo Douglas
- Department of Public Health, Walter Sisulu University, Nelson Mandela Drive, Mthatha, South Africa
| | - Mohlomi Jafta Ntsaba
- Department of Nursing, Walter Sisulu University, Nelson Mandela Drive, Mthatha, South Africa
| | - Elvis Enowbeyang Tarkang
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW Marijuana use presents a unique challenge to bariatric surgery programs. We review the recent evidence examining marijuana use on outcomes following bariatric surgery. RECENT FINDINGS Recent studies have not demonstrated an increased risk of short-term surgical complications or differences in up to 2-year weight loss following surgery among marijuana users. However, studies have demonstrated increased risks in two areas: pain management and problematic eating behaviors. Additionally, preoperative marijuana use has been linked to increased postoperative marijuana use which may undermine weight loss and increase risk for weight regain. There are still many unanswered questions regarding marijuana use and bariatric surgery, and the limited literature base has produced mixed results when considering marijuana as a contraindication for bariatric surgery. Programs must take into consideration the laws of their state, individual patterns of use, and route of administration when considering whether marijuana is a contraindication for surgery.
Collapse
Affiliation(s)
- Allyson Diggins
- Cleveland Clinic Bariatric & Metabolic Institute, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Leslie Heinberg
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Bariatric & Metabolic Institute, Cleveland, OH, USA
| |
Collapse
|
13
|
Alon L, Bruce D, Blocker O, Bouris AM, Reirden DH, Schneider JA. Perceptions of quality and safety in cannabis acquisition amongst young gay and bisexual men living with HIV/AIDS who use cannabis: Impact of legalisation and dispensaries. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 88:103035. [PMID: 33310342 DOI: 10.1016/j.drugpo.2020.103035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 10/13/2020] [Accepted: 10/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Upwards of 35% of young gay and bisexual men living with HIV report daily use of cannabis in the U.S. The effects of legalisation of recreational and medical cannabis on the acquisition of cannabis products amongst a group with such high prevalence of use is largely unknown. METHODS We investigated potential effects of recent legalisation and changes in distribution venues/networks in U.S. jurisdictions (Denver and Chicago) with different legal statuses regarding medical and recreational cannabis. We conducted semi-structured interviews with 30 young gay and bisexual men living with HIV recruited from adolescent HIV clinics and service sites in the two cities. RESULTS Findings indicate four domains in which the acquisition of cannabis from medical or recreational dispensaries was differentiated by participants from acquisition from illicit drug distribution networks: quality of information, perceived quality of products, safety of acquisition, and safety of products. Some participants expressed reservations in becoming involved with requirements for accessing legal distribution of medical and recreational cannabis. CONCLUSIONS Our findings indicate that young men living with HIV in Denver perceive benefits from legalisation of cannabis in terms of quality of information and products and safety of acquisition for a range of medical, therapeutic, and recreational uses. Participants in Chicago report mixed levels of knowledge of potential benefits through the medical cannabis dispensaries in their area, and continue to be exposed to safety risks associated with street-based acquisition. Concerns regarding institutional involvement in medical cannabis registries and dispensaries may inhibit the uptake of legal means of acquisition in sub-populations of young men living with HIV.
Collapse
Affiliation(s)
- Leigh Alon
- Chicago Center for HIV Elimination, University of Chicago, 1525 E 55th st, Chicago, IL, 60615, United States.
| | - Douglas Bruce
- Department of Health Sciences, DePaul University, 1110W. Belden Ave., Chicago, IL, 60614, United States
| | - Olivia Blocker
- Chicago Center for HIV Elimination, University of Chicago, 1525 E 55th st, Chicago, IL, 60615, United States; School of Social Service Administration, University of Chicago, 969 E 60th st Chicago, IL, 60637, United States
| | - Alida M Bouris
- Chicago Center for HIV Elimination, University of Chicago, 1525 E 55th st, Chicago, IL, 60615, United States; School of Social Service Administration, University of Chicago, 969 E 60th st Chicago, IL, 60637, United States
| | - Daniel H Reirden
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO, 80045, United States
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, 1525 E 55th st, Chicago, IL, 60615, United States; Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, United States; Department of Public Health Sciences, University of Chicago, 5841 S Maryland Ave Chicago, IL, 60637, United States
| |
Collapse
|
14
|
Lichtenberg NT, Thompson AB, Iguchi MY, Evans CJ, Romero‐Calderón R. An Undergraduate Student-Led Neuroscience Outreach Program Shows Promise in Shifting Teen Attitudes About Drugs. MIND, BRAIN AND EDUCATION : THE OFFICIAL JOURNAL OF THE INTERNATIONAL MIND, BRAIN, AND EDUCATION SOCIETY 2020; 14:387-399. [PMID: 33381224 PMCID: PMC7756680 DOI: 10.1111/mbe.12261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 06/12/2023]
Abstract
Drug Outreach, Promoting Awareness (DOPA) is an undergraduate outreach program for local high school students designed to convey the neurobiological basis, risks, and addictive potential of commonly abused drugs. Here we describe DOPA and evaluate the program, including its impact on high school student attitudes about drug harm risk and addiction. Undergraduate neuroscience students versed in the neurobiology, physiology, and policy of drugs are trained in active learning methods, enabling them to create engaging and interactive classroom-based educational materials. Survey results showed that participation in DOPA increased high school student perceptions of the addictive potential and harm risk of drugs, which studies have shown to be inversely correlated with drug-taking. High school students also responded positively to the interactive nature of the program. These findings demonstrate how extensively trained undergraduates who are close peers to high school students can effectively lead science outreach initiatives and shift adolescent attitudes about drugs.
Collapse
Affiliation(s)
| | | | | | - Christopher J. Evans
- Brain Research InstituteUCLA, Gonda (Goldschmied) Neuroscience and Genetics Research CenterUSA
- Hatos Center for NeuropharmacologySemel Institute for Neuroscience and Human Behavior, UCLAUSA
| | - Rafael Romero‐Calderón
- Brain Research InstituteUCLA, Gonda (Goldschmied) Neuroscience and Genetics Research CenterUSA
- Interdepartmental Program for NeuroscienceUCLA, Gonda (Goldschmied) Neuroscience and Genetics Research CenterUSA
| |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW We present information on cannabis policy, demand, and supply in the Asia-Pacific region. METHOD A systematic review of peer-reviewed articles using PubMed, MEDLINE, and reliable sources was conducted. We classified the policy implemented in each country into conducting research, legalization of medical and recreational use, decriminalization, cultivation, and others. RECENT FINDINGS In Australia, New Zealand, and Thailand, medical use has been approved, whereas it is limited in South Korea and Singapore and illegal in other countries. Except Australia, none of the Asia-Pacific region countries allows recreational use. China and Japan are expected to approve medical use, whereas Australia and New Zealand work on decriminalization. Most cultivation is allowed and regulated for medical use. Cannabis seizures have changed in accordance with these policies. Although the national surveys of four countries, that is, Australia, New Zealand, Japan, and Thailand were conducted in different years, the use of cannabis among the general population has increased. SUMMARY Any change in the legal status of cannabis must be undertaken with caution and fully evaluated at each stage to determine the extent to which these changes are leading to increased numbers of users, oversupply, and health risks including cannabis-related harm.
Collapse
|
16
|
Grewal JK, Loh LC. Health considerations of the legalization of cannabis edibles. CMAJ 2020; 192:E1-E2. [PMID: 31907227 DOI: 10.1503/cmaj.191217] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jasleen K Grewal
- Department of Family and Community Medicine (Grewal), University of Toronto, Toronto, Ont.; Public Health, Region of Peel (Loh), Mississauga, Ont.; Dalla Lana School of Public Health (Loh), University of Toronto, Toronto, Ont
| | - Lawrence C Loh
- Department of Family and Community Medicine (Grewal), University of Toronto, Toronto, Ont.; Public Health, Region of Peel (Loh), Mississauga, Ont.; Dalla Lana School of Public Health (Loh), University of Toronto, Toronto, Ont.
| |
Collapse
|
17
|
Fischer B, Russell C, Rehm J, Leece P. Assessing the public health impact of cannabis legalization in Canada: core outcome indicators towards an 'index' for monitoring and evaluation. J Public Health (Oxf) 2020; 41:412-421. [PMID: 29860521 DOI: 10.1093/pubmed/fdy090] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/13/2018] [Accepted: 05/02/2018] [Indexed: 12/31/2022] Open
Abstract
The legalization of non-medical cannabis use and supply is impending in Canada. This constitutes a major policy change with the declared objective of improving public health outcomes, which requires rigorous monitoring and evaluation. While numerous different aspects associated with legalization will be examined, a focused perspective is required for effective policy evaluation purposes. To these ends, we have identified a set of 10 core indicators associated with cannabis-related risk/harm outcomes-based on current best evidence-that are expected to measure the primary impacts of legalization on public health outcomes. We briefly review these indicators, and their respective data availability in Canada. As ideally an integrated outcome assessment of cannabis legalization's impact on public health will be available, we further propose options to merge the individual indicators into an integrated, weighted 'index', considering their expected relative impact for public health. One possible approach to undertake this is 'multi-criteria decision analysis' as a method to weight the relative indicator impact on public health; alternative approaches are proposed. The integrated 'public health index' for cannabis legalization will allow for scientifically comprehensive, while focused, monitoring and evaluation of the effects of legalization in Canada for the benefits of science and evidence-based policy alike.
Collapse
Affiliation(s)
- Benedikt Fischer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Canada.,Centre for Criminology & Sociolegal Studies, University of Toronto, Toronto, Canada.,Department of Psychiatry, Federal University of São Paulo (UNIFESP), 785 05403-903 São Paulo, Brazil
| | - Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
| | - Pamela Leece
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
| |
Collapse
|
18
|
White AE, Van Tubbergen C, Raymes B, Contreras AE, Scallan Walter EJ. Cannabis-Infused Edible Products in Colorado: Food Safety and Public Health Implications. Am J Public Health 2020; 110:790-795. [PMID: 32298168 PMCID: PMC7204451 DOI: 10.2105/ajph.2020.305601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 11/04/2022]
Abstract
Cannabis-infused "edibles" are a popular means of cannabis use, and the variety of edible food products available to consumers continues to grow. Although there has been much discussion on dose standardization, childproof packaging, and the prevention of overconsumption, the important topic of food safety has received less attention.We discuss potential food safety hazards associated with cannabis-infused edible food products, drawing on examples from Colorado, and describe edible-associated foodborne illness outbreaks and other contamination events.It is important for public health agencies, particularly environmental health and enteric disease programs, to be familiar with the cannabis industry, including regulatory partners, signs and symptoms of cannabis ingestion, the scope of edible products sold and consumed, and the food safety risks unique to cannabis products.
Collapse
Affiliation(s)
- Alice E White
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Christine Van Tubbergen
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Brianna Raymes
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Alexandra Elyse Contreras
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Elaine J Scallan Walter
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Reboussin BA, Wagoner KG, Sutfin EL, Suerken C, Ross JC, Egan KL, Walker S, Johnson RM. Trends in marijuana edible consumption and perceptions of harm in a cohort of young adults. Drug Alcohol Depend 2019; 205:107660. [PMID: 31704375 PMCID: PMC7008857 DOI: 10.1016/j.drugalcdep.2019.107660] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/07/2019] [Accepted: 09/14/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Rates of marijuana legalization have increased rapidly in recent years resulting in the marketing of alternative products like edibles that do not involve inhaling smoke. Edibles however pose unique public health challenges due to their greater risk for over-intoxication. METHODS 1858 young adults were surveyed every six months from 2016 to 2018. Logistic regression models examined trends in use and perceptions of harm. Chi-squared tests compared demographic and behavioral characteristics of edible users and non-users by frequency of marijuana use. RESULTS Perceptions of no harm from edibles increased (25.4%, 27.3%, 26.7%, 28.4%, 29.6%; p = 0.006) while it declined for smoking marijuana (12.2%, 13.5%, 11.7%, 10.6%, 9.1%; p < 0.001). Among non-daily marijuana users, edible use increased (20.3%, 24.8%, 30.5%, 36.2%, 36.6%; p < 0.001) while smoking marijuana declined for both daily and non-daily users. Among daily users, edible users were more likely to use all modes of consumption than non-edible users. Among non-daily users, edible users were less likely to smoke marijuana and perceive harm from edibles and were more likely to perceive harm from smoking marijuana and have visited a dispensary than non-edible users. CONCLUSIONS Edibles are increasingly consumed and perceived to not be harmful, despite the greater danger of over-intoxication. However, daily use of edibles alone is uncommon. The finding that edible users were more likely to have visited a dispensary provides a potential intervention point for consumer education. Strong scientific evidence is needed to guide policymakers in best practices for communicating knowledge and potential harms of these products.
Collapse
Affiliation(s)
- Beth A Reboussin
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States.
| | - Kimberly G Wagoner
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States
| | - Erin L Sutfin
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States
| | - Cynthia Suerken
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States
| | - Jennifer Cornacchione Ross
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States
| | - Kathleen L Egan
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States
| | - Stephannie Walker
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States
| | - Renee M Johnson
- Wake Forest School of Medicine, Department of Biostatisticals and Data Science, Medical, Center Boulevard, Winston-Salem, NC 27157, United States
| |
Collapse
|
21
|
Aydelotte JD, Mardock AL, Mancheski CA, Quamar SM, Teixeira PG, Brown CVR, Brown LH. Fatal crashes in the 5 years after recreational marijuana legalization in Colorado and Washington. ACCIDENT; ANALYSIS AND PREVENTION 2019; 132:105284. [PMID: 31518764 DOI: 10.1016/j.aap.2019.105284] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/15/2019] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
Colorado and Washington legalized recreational marijuana in 2012, but the effects of legalization on motor vehicle crashes remains unknown. Using Fatality Analysis Reporting System data, we performed difference-in-differences (DD) analyses comparing changes in fatal crash rates in Washington, Colorado and nine control states with stable anti-marijuana laws or medical marijuana laws over the five years before and after recreational marijuana legalization. In separate analyses, we evaluated fatal crash rates before and after commercial marijuana dispensaries began operating in 2014. In the five years after legalization, fatal crash rates increased more in Colorado and Washington than would be expected had they continued to parallel crash rates in the control states (+1.2 crashes/billion vehicle miles traveled, CI: -0.6 to 2.1, p = 0.087), but not significantly so. The effect was more pronounced and statistically significant after the opening of commercial dispensaries (+1.8 crashes/billion vehicle miles traveled, CI: +0.4 to +3.7, p = 0.020). These data provide evidence of the need for policy strategies to mitigate increasing crash risks as more states legalize recreational marijuana.
Collapse
Affiliation(s)
- Jayson D Aydelotte
- Division of Acute Care Surgery, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas Austin, 1500 Red River St., Austin, TX 78701, USA
| | - Alexandra L Mardock
- UCLA David Geffen School of Medicine, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Christine A Mancheski
- Division of Emergency Medicine, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas Austin, 1400 N IH35, Suite 2.230, Austin, TX 78701, USA
| | - Shariq M Quamar
- University of Texas, c/o Division of Emergency Medicine, 1400 N IH35, Suite 2.230, Austin, TX 78701, USA
| | - Pedro G Teixeira
- Division of Acute Care Surgery, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas Austin, 1500 Red River St., Austin, TX 78701, USA
| | - Carlos V R Brown
- Division of Acute Care Surgery, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas Austin, 1500 Red River St., Austin, TX 78701, USA
| | - Lawrence H Brown
- Division of Emergency Medicine, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas Austin, 1400 N IH35, Suite 2.230, Austin, TX 78701, USA.
| |
Collapse
|
22
|
Subritzky T, Lenton S, Pettigrew S. Cannabis and youth protection in Colorado's commercial adult-use market: A qualitative investigation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:116-126. [PMID: 31586774 DOI: 10.1016/j.drugpo.2019.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/05/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Arguments both for and against the legalization of cannabis often include the issue of youth protection. At the time of writing 5-years after the implementation of the Coloradan recreational cannabis market (CRCM), no statistically significant increase in consumption had been identified. This paper aimed to provide a thick descriptive account of youth prevention objectives stipulated in the pre-implementation phase of the CRCM and compare these with the real-world experience of regulators and other stakeholders involved with market implementation. METHODOLOGY AND METHODS A qualitative descriptive methodology was used that involved the following methods: document analysis, deductive coding, thematic analysis, and thick description. Two data sets relevant to youth protection in the context of a legal cannabis market in Colorado were examined. Data set 1 (DS1) examined government documents (n = 13) related to the pre-implementation phase from November 2012 - December 2013. Data set 2 (DS2) consisted of semi-structured face-to-face interviews conducted with key stakeholders (n = 32) in 2016 and 2017. RESULTS Five themes emerged including advertising restrictions (DS1), education (DS1), appropriation of funds (DS2), impact assessment (DS2), and evolving messages in prevention education campaigns (DS2). DISCUSSION Multiple lessons for other jurisdictions were highlighted in the study.
Collapse
Affiliation(s)
- Todd Subritzky
- National Drug Research Institute, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Simon Lenton
- National Drug Research Institute, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Simone Pettigrew
- National Drug Research Institute, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| |
Collapse
|
23
|
Wolf LA, Perhats C, Clark PR, Frankenberger WD, Moon MD. The perceived impact of legalized cannabis on nursing workload in adult and pediatric emergency department visits: A qualitative exploratory study. Public Health Nurs 2019; 37:5-15. [DOI: 10.1111/phn.12653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Lisa A. Wolf
- Institute for Emergency Nursing Research Emergency Nurses Association Schaumburg IL USA
| | - Cydne Perhats
- Institute for Emergency Nursing Research Emergency Nurses Association Schaumburg IL USA
| | - Paul R. Clark
- University of Louisville School of Nursing Louisville KY USA
- Norton Healthcare Institute for Nursing Louisville KY USA
| | - Warren D. Frankenberger
- Department of Nursing and Clinical Care Services Children’s Hospital of Philadelphia Philadelphia PA USA
| | | |
Collapse
|
24
|
Abstract
OBJECTIVES The aim of the study was to describe use of oral or sublingual cannabis oil (CO) by adolescent and young adult patients with inflammatory bowel disease (IBD). METHODS A descriptive study of IBD patients 13 to 23 years of age seen between January 2015 through December 2017 at Children's Hospital Colorado. Information obtained included chart abstraction, electronic and interview self-report, and serum cannabinoid levels. We compared CO users and cannabis non-users for clinical characteristics and perceptions of risk. Users of CO provided information on routes, patterns, motivations, and perceived benefits and problems with use. RESULTS The 15 users and 67 non-users were similar for clinical characteristics and pain and appetite scores. 9 of 15 (60%) CO users had used in the past 30 days, an average of 22 ± 9 times; and 4 used daily. A variety of strengths and CBD:THC ratios were reported. Most common perceived effect of use was on sleep quality, nausea, and increase in appetite. Of the 15 users, 6 used only CO and no additional forms of cannabis. Of these 6 CO only users, 5 reported a medical reason for use, most commonly to relieve pain. CONCLUSIONS Adolescent and young adults with IBD used oral CO and many used other cannabis products as well. Users perceived some medical benefit. Care teams should strive for open communication about use until further information on safety and efficacy becomes available.
Collapse
|
25
|
Karbakhsh M, Smith J, Pike I. "Where does the high road lead?" Potential implications of cannabis legalization for pediatric injuries in Canada. Canadian Journal of Public Health 2018; 109:752-755. [PMID: 30264194 PMCID: PMC6267639 DOI: 10.17269/s41997-018-0137-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/30/2018] [Indexed: 11/17/2022]
Abstract
The purpose of this commentary is to discuss how legalization of non-medical marijuana (LNMM) in Canada can potentially influence child and adolescent unintentional injuries based on evidence from states (American) and jurisdictions that have already legalized cannabis for recreational purposes. Although the evidence is still not conclusive, LNMM can bring about higher exposure, lower perceived harms, and higher prevalence of cannabis use by minors through role modeling and normalization of behaviour within the household and the community, and higher rates of driving under the influence of cannabis, which can contribute to a higher burden of road traffic injuries. Experience of American states with LNMM shows higher rates of emergency visits for pediatric poisoning due to unintentional ingestion of cannabis-containing foods and severe burns due to explosions during the course of home-based cannabis extraction. While the justification for legalization has created a strict legal framework for improved control of cannabis in Canada, the implications for health and safety of children and adolescents necessitate further study, communication with policy-makers and public health practitioners, and evidence-based education of parents, caregivers, and youth.
Collapse
Affiliation(s)
- Mojgan Karbakhsh
- BC Injury Research and Prevention Unit, BC Children's Hospital Research, F508 4480 Oak St, Vancouver, British Columbia, V6H 3V4, Canada. .,Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Jennifer Smith
- BC Injury Research and Prevention Unit, BC Children's Hospital Research, F508 4480 Oak St, Vancouver, British Columbia, V6H 3V4, Canada.,The Community Against Preventable Injuries, Vancouver, British Columbia, Canada
| | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children's Hospital Research, F508 4480 Oak St, Vancouver, British Columbia, V6H 3V4, Canada.,The Community Against Preventable Injuries, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
26
|
Jones CB, Meier MH, Pardini DA. Comparison of the locations where young adults smoke, vape, and eat/drink cannabis: Implications for harm reduction. Addict Behav Rep 2018; 8:140-146. [PMID: 30302367 PMCID: PMC6174524 DOI: 10.1016/j.abrep.2018.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/28/2018] [Accepted: 09/10/2018] [Indexed: 11/28/2022] Open
Abstract
Background Cannabis vaping and edible use are increasingly popular methods of cannabis use. These discreet methods could increase risk of cannabis-related problems by facilitating cannabis use in a wider range of settings. Methods A sample of 1018 college students were recruited to complete a survey about their health and behavior. Participants who used cannabis in the past year (35.1%, n = 357) answered questions about their cannabis use, including where they were the last time they smoked, vaped, or ate/drank cannabis, and their experience of cannabis-related problems. Results Compared with cannabis smoking, participants were more likely to have vaped cannabis (15.8% smoked vs. 24.6% vaped; X2 = 4.59, p = .032), and were slightly, but not statistically significantly, more likely to have used cannabis edibles (17.5% smoked vs. 24.2% used edibles; X2 = 3.57, p = .059), in locations other than a private residence. For example, participants were more likely to have vaped cannabis in a car than to have smoked cannabis in a car (8.8% vaped vs. 3.5% smoked; X2 = 4.26, p = .039). More frequent cannabis vaping was associated with driving while high on cannabis, even after accounting for overall frequency of cannabis use and other covariates (OR = 1.22, p = .047). More frequent cannabis vaping and edible use were associated with various cannabis-related problems, but, in general, these associations became statistically non-significant after accounting for overall frequency of cannabis use. Conclusions Cannabis vaporizers and edibles facilitate cannabis use in locations that require discretion. Increased availability of cannabis vaporizers and edibles could increase risk of cannabis-related problems by enabling use in more settings. Compared with cannabis smoking, participants were more likely to vape and use edibles outside a private residence. More frequent cannabis vaping was associated with driving under the influence of cannabis after accounting for covariates. More frequent cannabis vaping and edible use were associated with cannabis-related problems.
Collapse
Affiliation(s)
- Connor B Jones
- Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ 85287-1104, USA
| | - Madeline H Meier
- Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ 85287-1104, USA
| | - Dustin A Pardini
- School of Criminology and Criminal Justice, Arizona State University, 411 N Central Ave, Suite 600, University Center, Phoenix, AZ 85004, USA
| |
Collapse
|
27
|
Marijuana Use by Adolescents and Young Adults with Inflammatory Bowel Disease. J Pediatr 2018; 199:99-105. [PMID: 29673723 DOI: 10.1016/j.jpeds.2018.03.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 02/15/2018] [Accepted: 03/15/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate marijuana use by adolescents and young adults with inflammatory bowel disease (IBD). STUDY DESIGN This descriptive cross-sectional study of patients seen between December 2015 through June 2017 at Children's Hospital Colorado for IBD enrolled patients 13-23 years of age, independent of marijuana use status. Information obtained consisted of chart review, electronic and interview self-report, and serum cannabinoid levels. Marijuana ever-users were compared with never-users for clinical characteristics and perceptions of risk with use; users provided information on routes, patterns, motivations, and perceived benefits and problems with use. RESULTS Of 99 participants, ever-use was endorsed by 32% (32 of 99) and daily or almost daily use by 9% (9 of 99). Older age was the only characteristic related to endorsing marijuana use. Twenty-nine ever-users completed all questionnaires. After adjusting for age, users were 10.7 times more likely to perceive low risk of harm with regular use (P < .001). At least 1 medical reason for use was endorsed by 57% (17 of 30), most commonly for relief of physical pain (53%, 16 of 30) (2 did not complete all questionnaires). Problems from use were identified by 37% (11 of 30), most commonly craving/strong urge to use. Most common route of use was smoking (83%) followed by edibles (50%), dabbing (40%), and vaping (30%). CONCLUSIONS Marijuana use by adolescents and young adults with IBD is common and perceived as beneficial. Guidelines for screening, testing, and counseling of marijuana use should be developed for patients with IBD.
Collapse
|
28
|
Yates D, Speer J. Over and under-regulation in the Colorado Cannabis industry - A data-analytic perspective. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:63-66. [PMID: 30015248 DOI: 10.1016/j.drugpo.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 11/25/2022]
Abstract
With the State of California legalizing recreational cannabis sales on January 1, 2018, the regulatory process is once more in the forefront of cannabis research. Colorado, often held up as a model of legalization policy, was the first state to implement retail sale of recreational cannabis on January 1st, 2014. However, a combination of subsequent under-regulation and over-regulation, inconsistently applied across issues such as retail licencing, chemical testing, cannabis derivatives, municipality approval for growers, and financing, have not only held back the industry in Colorado but also negatively impacted public health, oversight, and have potentially increased the availability of illegal cannabis. We argue that a data-analytic approach to the industry is potentially the most effective way to resolve these concerns, since in the absence of consistent and reliable data, policymakers are apt to satisfy individual policy concerns without considering the industry as a whole. In this paper we present a data-analytic framework for the cannabis industry, offering a theoretically-driven justification for our approach, and describe implications for research on drug and information policy. The framework may serve as a model for other states or countries contemplating cannabis legalisation. As four new states legalised recreational cannabis in 2016, the implications of this research for policymakers has dramatically increased.
Collapse
Affiliation(s)
- Dave Yates
- University of Denver, Business Information & Analytics, 2101 S. University Blvd Suite 580, Denver, CO 80208 United States.
| | - Jessica Speer
- University of Denver, Business Information & Analytics, 2101 S. University Blvd Suite 580, Denver, CO 80208 United States.
| |
Collapse
|
29
|
Salottolo K, Peck L, Tanner Ii A, Carrick MM, Madayag R, McGuire E, Bar-Or D. The grass is not always greener: a multi-institutional pilot study of marijuana use and acute pain management following traumatic injury. Patient Saf Surg 2018; 12:16. [PMID: 29946360 PMCID: PMC6007004 DOI: 10.1186/s13037-018-0163-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/24/2018] [Indexed: 12/26/2022] Open
Abstract
Background Widespread legislative efforts to legalize marijuana have increased the prevalence of marijuana use and abuse. The effects of marijuana on pain tolerance and analgesic pain management in the acute pain setting have not been reported. Although marijuana has been shown to have antinociceptive effects and is approved for medical use to treat chronic pain, anecdotal evidence suggests marijuana users admitted with traumatic injuries experience poorer pain control than patients who do not use marijuana. We hypothesized that marijuana users would report higher pain scores and require more opioid analgesia following traumatic injury. Methods This retrospective pilot study included all patients involved in motor vehicle crashes, consecutively admitted to four trauma centers from 1/1/2016–4/30/2016. Marijuana status was examined as non-use and use, and was further categorized as chronic and episodic use. We performed a repeated measures mixed model to examine the association between marijuana use and a) average daily opioid consumption and b) average daily pain scores (scale 0–10). Opioid analgesics were converted to be equianalgesic to 1 mg IV hydromorphone. Results Marijuana use was reported in 21% (54/261), of which 30% reported chronic use (16/54). Marijuana use was reported more frequently in Colorado hospitals (23–29%) compared to the hospital in Texas (6%). Drug use with other prescription/street drugs was reported in 9% of patients. Other drug use was a significant effect modifier and results were presented after stratification by drug use. After adjustment, marijuana users who did not use other drugs consumed significantly more opioids (7.6 mg vs. 5.6 mg, p < 0.001) and reported higher pain scores (4.9 vs. 4.2, p < 0.001) than non-marijuana users. Conversely, in patients who used other drugs, there were no differences in opioid consumption (5.6 mg vs. 6.1 mg, p = 0.70) or pain scores (5.3 vs. 6.0, p = 0.07) with marijuana use compared to non-use, after adjustment. Chronic marijuana use was associated with significantly higher opioid consumption compared to episodic marijuana use in concomitant drug users (11.3 mg vs. 4.4 mg, p = 0.008) but was similar in non-drug users (p = 0.41). Conclusion These preliminary data suggest that marijuana use, especially chronic use, may affect pain response to injury by requiring greater use of opioid analgesia. These results were less pronounced in patients who used other drugs.
Collapse
Affiliation(s)
- Kristin Salottolo
- 1Trauma Research Department, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO 80113 USA.,2Trauma Research Department, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO 80228 USA.,Trauma Research Department, Medical City Plano, 3901 West 15th Street, Plano, TX 75075 USA.,4Trauma Research Department, Penrose Hospital, 2222 N Nevada Drive, Colorado Springs, CO 80907 USA
| | - Laura Peck
- 5Trauma Services Department, Swedish Medical Center, 499 E. Hampden Ave, Englewood, CO 80113 USA
| | - Allen Tanner Ii
- 6Trauma Services Department, Penrose Hospital, 2222 N Nevada Drive, Colorado Springs, CO 80907 USA
| | - Matthew M Carrick
- Trauma Services Department, Medical City Plano, 3901 W 15th St, Plano, TX 75075 USA
| | - Robert Madayag
- 8Trauma Services Department, St. Anthony Hospital, 11600 West 2nd Place, Lakewood, CO 80228 USA
| | - Emmett McGuire
- 5Trauma Services Department, Swedish Medical Center, 499 E. Hampden Ave, Englewood, CO 80113 USA
| | - David Bar-Or
- 1Trauma Research Department, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO 80113 USA.,2Trauma Research Department, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO 80228 USA.,Trauma Research Department, Medical City Plano, 3901 West 15th Street, Plano, TX 75075 USA.,4Trauma Research Department, Penrose Hospital, 2222 N Nevada Drive, Colorado Springs, CO 80907 USA
| |
Collapse
|
30
|
Midgley LS, Murphy S, Moore G, Hewitt G, White J. Multilevel population-based cross-sectional study examining school substance-misuse policy and the use of cannabis, mephedrone and novel psychoactive substances among students aged 11-16 years in schools in Wales. BMJ Open 2018; 8:e020737. [PMID: 29903791 PMCID: PMC6009502 DOI: 10.1136/bmjopen-2017-020737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To examine whether young peoples' risk of cannabis, mephedrone and novel psychoactive substances (NPS) use is associated with school substance-misuse policy. DESIGN A cross-sectional survey of secondary school students combined with a School Environment Questionnaire and independently coded school substance-misuse policies (2015/6). SETTING 66 secondary schools in Wales. PARTICIPANTS Students aged 11-16 years (n=18 939). RESULTS The prevalence of lifetime, past 30-day and daily cannabis use was 4.8%, 2.6% and 0.7%, respectively; lifetime prevalence of mephedrone use was 1.1% and NPS use was 1.5%. Across 66 schools, 95.5% (n=63) reported having a substance-misuse policy, 93.9% (n=62) reported having a referral pathway for drug using students, such that we were insufficiently powered to undertake an analysis. We found little evidence of a beneficial association between lifetime cannabis use and involving students in policy development including student council consultation (OR=1.24, 95% CI 0.89 to 1.73), other student consultation (OR=1.42, 95% CI 0.94 to 2.14) or with the use of isolation (OR=0.98, 95% CI 0.67 to 1.43), with similar results for cannabis use in past 30 days, daily and the lifetime use of mephedrone and NPS. The School Environment Questionnaires found that 39.4% (n=26) schools reported no student involvement in policy development, 42.4% (n=28) reported student council consultation, 18.2% (n=12) used other student consultations and 9.7% (n=3) mentioned isolation. The independently coded content of policies found that no school policy recommended abstinence, one mentioned methods on harm minimisation, 16.1% (n=5) policies mentioned student involvement and 9.7% (n=3) mentioned isolation. CONCLUSIONS Policy development involving students is widely recommended, but we found no beneficial associations between student involvement in policy development and student drug use. This paper has highlighted the need for further contextual understanding around the policy-development process and how schools manage drug misuse.
Collapse
Affiliation(s)
- Luke S Midgley
- School of Social Sciences, Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
- School of Medicine, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Simon Murphy
- School of Social Sciences, Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Graham Moore
- School of Social Sciences, Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Gillian Hewitt
- School of Social Sciences, Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - James White
- School of Medicine, Centre for Trials Research, Cardiff University, Cardiff, UK
| |
Collapse
|
31
|
Sarvet AL, Wall MM, Fink DS, Greene E, Le A, Boustead AE, Pacula RL, Keyes KM, Cerdá M, Galea S, Hasin DS. Medical marijuana laws and adolescent marijuana use in the United States: a systematic review and meta-analysis. Addiction 2018; 113:1003-1016. [PMID: 29468763 PMCID: PMC5942879 DOI: 10.1111/add.14136] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/14/2017] [Accepted: 12/01/2017] [Indexed: 12/14/2022]
Abstract
AIMS To conduct a systematic review and meta-analysis of studies in order to estimate the effect of US medical marijuana laws (MMLs) on past-month marijuana use prevalence among adolescents. METHODS A total of 2999 papers from 17 literature sources were screened systematically. Eleven studies, developed from four ongoing large national surveys, were meta-analyzed. Estimates of MML effects on any past-month marijuana use prevalence from included studies were obtained from comparisons of pre-post MML changes in MML states to changes in non-MML states over comparable time-periods. These estimates were standardized and entered into a meta-analysis model with fixed-effects for each study. Heterogeneity among the study estimates by national data survey was tested with an omnibus F-test. Estimates of effects on additional marijuana outcomes, of MML provisions (e.g. dispensaries) and among demographic subgroups were abstracted and summarized. Key methodological and modeling characteristics were also described. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS None of the 11 studies found significant estimates of pre-post MML changes compared with contemporaneous changes in non-MML states for marijuana use prevalence among adolescents. The meta-analysis yielded a non-significant pooled estimate (standardized mean difference) of -0.003 (95% confidence interval = -0.012, +0.007). Four studies compared MML with non-MML states on pre-MML differences and all found higher rates of past-month marijuana use in MML states pre-MML passage. Additional tests of specific MML provisions, of MML effects on additional marijuana outcomes and among subgroups generally yielded non-significant results, although limited heterogeneity may warrant further study. CONCLUSIONS Synthesis of the current evidence does not support the hypothesis that US medical marijuana laws (MMLs) until 2014 have led to increases in adolescent marijuana use prevalence. Limited heterogeneity exists among estimates of effects of MMLs on other patterns of marijuana use, of effects within particular population subgroups and of effects of specific MML provisions.
Collapse
Affiliation(s)
- Aaron L. Sarvet
- Department of Psychiatry, College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- New York State Psychiatric InstituteNew YorkNYUSA
| | - Melanie M. Wall
- Department of Psychiatry, College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- New York State Psychiatric InstituteNew YorkNYUSA
- Department of Biostatistics, Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - David S. Fink
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Emily Greene
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Aline Le
- New York State Psychiatric InstituteNew YorkNYUSA
| | - Anne E. Boustead
- School of Government and Public PolicyUniversity of ArizonaTucsonAZUSA
| | | | - Katherine M. Keyes
- Department of Psychiatry, College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Magdalena Cerdá
- Department of Emergency MedicineUniversity of California, DavisSacramentoCAUSA
| | - Sandro Galea
- Boston School of Public HealthBoston UniversityBostonMAUSA
| | - Deborah S. Hasin
- Department of Psychiatry, College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- New York State Psychiatric InstituteNew YorkNYUSA
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
| |
Collapse
|
32
|
Moon AS, Smith W, Mullen S, Ponce BA, McGwin G, Shah A, Naranje SM. Marijuana use and mortality following orthopedic surgical procedures. Subst Abus 2018; 40:378-382. [PMID: 29558287 DOI: 10.1080/08897077.2018.1449054] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: The association between marijuana use and surgical procedures is a matter of increasing societal relevance that has not been well studied in the literature. The primary aim of this study is to evaluate the relationship between marijuana use and in-hospital mortality, as well as to assess associated comorbidities in patients undergoing commonly billed orthopedic surgeries. Methods: The National Inpatient Sample (NIS) database from 2010 to 2014 was used to determine the odds ratios for the associations between marijuana use and in-hospital mortality, heart failure (HF), stroke, and cardiac disease (CD) in patients undergoing 5 common orthopedic procedures: total hip (THA), total knee (TKA), and total shoulder (TSA) arthroplasties, spinal fusion, and traumatic femur fracture fixation. Results: Of 9,561,963 patients who underwent one of the 5 selected procedures in the 4-year period, 26,416 (0.28%) were identified with a diagnosis of marijuana use disorder. In hip and knee arthroplasty patients, marijuana use was associated with decreased odds of mortality compared with no marijuana use (P < .0001) and increased odds of HF (P = .018), stroke (P = .0068), and CD (P = .0123). Traumatic femur fixation patients had the highest prevalence of marijuana use (0.70%), which was associated with decreased odds of mortality (P = .0483), HF (P = .0076), and CD (P = .0003). For spinal fusions, marijuana use was associated with increased odds of stroke (P < .0001) and CD (P < .0001). Marijuana use in patients undergoing total shoulder arthroplasty was associated with decreased odds of mortality (P < .001) and stroke (P < .001). Conclusions: In this study, marijuana use was associated with decreased mortality in patients undergoing THA, TKA, TSA, and traumatic femur fixation, although the significance of these findings remains unclear. More research is needed to provide insight into these associations in a growing surgical population.
Collapse
Affiliation(s)
- Andrew S Moon
- Tufts University School of Medicine, Boston, Massachusetts, USA.,Department of Orthopaedics, University of Alabama at Birmingham, UAB Highlands, Birmingham, Alabama USA
| | - Walter Smith
- Department of Orthopaedics, University of Alabama at Birmingham, UAB Highlands, Birmingham, Alabama USA
| | - Sawyer Mullen
- Department of Orthopaedics, University of Alabama at Birmingham, UAB Highlands, Birmingham, Alabama USA
| | - Brent A Ponce
- Department of Orthopaedics, University of Alabama at Birmingham, UAB Highlands, Birmingham, Alabama USA
| | - Gerald McGwin
- Department of Orthopaedics, University of Alabama at Birmingham, UAB Highlands, Birmingham, Alabama USA.,Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama USA
| | - Ashish Shah
- Department of Orthopaedics, University of Alabama at Birmingham, UAB Highlands, Birmingham, Alabama USA
| | - Sameer M Naranje
- Department of Orthopaedics, University of Alabama at Birmingham, UAB Highlands, Birmingham, Alabama USA
| |
Collapse
|
33
|
Abstract
Following the legalization and regulation of marijuana for recreational purposes in states with medical markets, policymakers and researchers seek empirical evidence on how, and how fast, supply and demand changed over time. Prices are an indication of how suppliers and consumers respond to policy changes, so this study uses a difference-in-difference approach to exploit the timing of policy implementation and identify the impacts on marijuana prices 4-5 months after markets opened. This study uses unique longitudinal survey data of prices paid by consumers and a web-scraped dataset of dispensary prices advertised online for three U.S. medical marijuana states that all eventually legalized recreational marijuana. Results indicate there were no impacts on the prices paid for medical or recreational marijuana by state-representative residents within the short 4- to 5-months window following legalization. However, there were differences in how much people paid if they obtained marijuana for recreational purposes from a recreational store. Further analysis of advertised prices confirms this result, but further demonstrates heterogeneous responses in prices across types of commonly advertised strains; prices either did not change or increased depending on the strain type. A key implication of our findings is that there are both supply and demand responses at work in the opening of legalized markets, suggesting that evaluations of immediate effects may not accurately reflect the long run impact of legalization on consumption.
Collapse
|
34
|
Powell D, Pacula RL, Jacobson M. Do medical marijuana laws reduce addictions and deaths related to pain killers? JOURNAL OF HEALTH ECONOMICS 2018; 58:29-42. [PMID: 29408153 PMCID: PMC7867411 DOI: 10.1016/j.jhealeco.2017.12.007] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 08/15/2017] [Accepted: 12/30/2017] [Indexed: 05/19/2023]
Abstract
Recent work finds that medical marijuana laws reduce the daily doses filled for opioid analgesics among Medicare Part-D and Medicaid enrollees, as well as population-wide opioid overdose deaths. We replicate the result for opioid overdose deaths and explore the potential mechanism. The key feature of a medical marijuana law that facilitates a reduction in overdose death rates is a relatively liberal allowance for dispensaries. As states have become more stringent in their regulation of dispensaries, the protective value generally has fallen. These findings suggest that broader access to medical marijuana facilitates substitution of marijuana for powerful and addictive opioids.
Collapse
Affiliation(s)
| | | | - Mireille Jacobson
- NBER Cambridge, MA, United States; University of California, Irvine, United States
| |
Collapse
|
35
|
Russell C, Rueda S, Room R, Tyndall M, Fischer B. Routes of administration for cannabis use – basic prevalence and related health outcomes: A scoping review and synthesis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 52:87-96. [DOI: 10.1016/j.drugpo.2017.11.008] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 01/10/2023]
|
36
|
Borodovsky JT, Budney AJ. Legal cannabis laws, home cultivation, and use of edible cannabis products: A growing relationship? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 50:102-110. [PMID: 29102847 DOI: 10.1016/j.drugpo.2017.09.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 09/16/2017] [Accepted: 09/26/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Over half of U.S. states have enacted legal cannabis laws (LCL). In parallel, edible cannabis products (i.e., edibles) have presented new regulatory challenges. LCL provisions that dictate access to cannabis (e.g., home cultivation (HC) or dispensaries (DSP)) may impact edible production and use. This study examined relationships among HC and DSP provisions, cannabis cultivation, and edible use. METHODS An online cannabis use survey was distributed using Facebook. Data were collected from 1813 cannabis-using adults. U.S. states were classified as states without LCL (Non-LCL) or LCL states that: (1) only permit DSP (LCL DSP-only), (2) only permit HC (LCL HC-only), or (3) permit HC and DSP (LCL HC+DSP). Analyses tested associations among these classifications, cannabis growing, and edible use and procurement. RESULTS Individuals in LCL HC-only and LCL HC+DSP states were more likely to report currently growing cannabis at home (OR: 3.3, 95% CI: 1.7, 6.2; OR: 3.9, 95% CI: 2.4, 6.3, respectively) and past-month edible use (OR: 2.1, 95% CI: 1.4, 3.4; OR: 2.9, 95% CI: 2.2, 3.9, respectively) than individuals in LCL DSP-only states. Regardless of state, those who had grown cannabis were more likely to have made edibles than those who had never grown cannabis (OR: 2.2, 95% CI: 1.8, 2.6). Individuals in LCL HC-only states were more likely to have made edibles in the past month than individuals from Non-LCL (OR: 2.75, 95% CI: 1.5, 5.3) and DSP-only states (OR: 2.1, 95% CI: 1.0, 4.4). Individuals in LCL HC+DSP states were more likely to have purchased edibles in the past month than individuals from Non-LCL (OR: 3.7, 95% CI: 2.4, 5.6) and DSP-only states (OR: 3.2, 95% CI: 1.8, 5.5). CONCLUSION Specific LCL provisions may differentially affect individuals' propensity to grow cannabis and make, buy, and use edible cannabis products. Permitting home cultivation contributes to a greater likelihood of growing cannabis. Those who grow cannabis economize the plant by creating homemade edible cannabis products. Conversely, permitting dispensaries increases the likelihood of purchasing edibles. The psychoactive effects of edibles with unknown and variable cannabinoid content will be unpredictable. Policymakers should carefully consider how specific LCL provisions can affect patterns of cannabis edible product access and quality.
Collapse
Affiliation(s)
- Jacob T Borodovsky
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States; The Dartmouth Institute for Health Policy and Clinical Practice, 74 College St., Hanover, NH 03755, United States.
| | - Alan J Budney
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States
| |
Collapse
|
37
|
Ghosh TS, Vigil DI, Maffey A, Tolliver R, Van Dyke M, Kattari L, Krug H, Reed JK, Wolk L. Lessons learned after three years of legalized, recreational marijuana: The Colorado experience. Prev Med 2017; 104:4-6. [PMID: 28232101 DOI: 10.1016/j.ypmed.2017.02.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/16/2017] [Accepted: 02/18/2017] [Indexed: 11/24/2022]
Abstract
In November 2012 Colorado voters approved legalized recreational marijuana. On January 1, 2014 Colorado became the first state to allow legal sales of non-medical marijuana for adults over the age of 21. Since that time, the state has been monitoring potential impacts on population health. In this paper we present lessons learned in the first three years following legal sales of recreational marijuana. These lessons pertain to health behaviors and health outcomes, as well as to health policy issues. Our intent is to share these lessons with other states as they face the prospect of recreational marijuana legalization.
Collapse
Affiliation(s)
- Tista S Ghosh
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States; Colorado Department of Public Health and Environment, Laboratory Services Division, 8100 Lowry Boulevard, Denver, CO 80230, United States.
| | - Daniel I Vigil
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Ali Maffey
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Rickey Tolliver
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Mike Van Dyke
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Leonardo Kattari
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Heather Krug
- Colorado Department of Public Health and Environment, Laboratory Services Division, 8100 Lowry Boulevard, Denver, CO 80230, United States.
| | - Jack K Reed
- Colorado Department of Public Safety, Division of Criminal Justice, 700 Kipling Street, Suite 1000, Lakewood, CO 80215, United States.
| | - Larry Wolk
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States; Colorado Department of Public Health and Environment, Laboratory Services Division, 8100 Lowry Boulevard, Denver, CO 80230, United States.
| |
Collapse
|
38
|
Sokoya M, Eagles J, Okland T, Coughlin D, Dauber H, Greenlee C, Winkler AA. Patterns of facial trauma before and after legalization of marijuana in Denver, Colorado: A joint study between two Denver hospitals. Am J Emerg Med 2017; 36:780-783. [PMID: 29031478 DOI: 10.1016/j.ajem.2017.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/26/2017] [Accepted: 10/06/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The effect of marijuana on human health has been studied extensively. Marijuana intoxication has been shown to affect performance, attention span, and reaction time. The public health relationship between trauma and cannabis use has also been studied, with mixed conclusions. In this report, the effect of marijuana legalization on many aspects of facial trauma at two hospitals in Denver, Colorado is examined. METHODS A retrospective review of the electronic medical records was undertaken. Mann-Whitney U tests were used to compare age of patients before and after legalization, and chi squared analyses were used to compare mechanism of injury, and fracture types before and after recreational marijuana legalization in Denver, Colorado. Geographical location of patients was also considered. RESULTS No significant increase was found in race before and after marijuana legalization (p=0.19). A significant increase in age was found before (M=39.54,SD=16.37), and after (M=41.38,SD=16.66) legalization (p<0.01). Maxillary and skull base fracture proportions significantly increased following legalization (p<0.001 and p<0.001respectively). No significant differences were seen in the proportion of patients who lived in urban and rural counties before and after legalization (p>0.05). CONCLUSION Public health efforts should be directed towards educating residents and visitors of Colorado on the effects and toxicology of marijuana. More epidemiologic studies are needed for further assessment of the long-term effects of the legalization of marijuana on the population.
Collapse
Affiliation(s)
- Mofiyinfolu Sokoya
- University of Colorado School of Medicine Department of Otolaryngology, United States.
| | - Justin Eagles
- University of Colorado School of Medicine, United States
| | - Tyler Okland
- University of Colorado School of Medicine, United States
| | - Dylan Coughlin
- University of Colorado School of Medicine, United States
| | - Hannah Dauber
- University of Colorado School of Medicine Department of Otolaryngology, United States
| | - Christopher Greenlee
- University of Colorado School of Medicine Department of Otolaryngology, United States
| | - Andrew A Winkler
- University of Colorado School of Medicine Department of Otolaryngology, United States
| |
Collapse
|
39
|
Badowski ME. A review of oral cannabinoids and medical marijuana for the treatment of chemotherapy-induced nausea and vomiting: a focus on pharmacokinetic variability and pharmacodynamics. Cancer Chemother Pharmacol 2017; 80:441-449. [PMID: 28780725 PMCID: PMC5573753 DOI: 10.1007/s00280-017-3387-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 07/07/2017] [Indexed: 12/15/2022]
Abstract
Purpose Oral cannabinoids (i.e., dronabinol, nabilone) containing the active component of marijuana, delta(Δ)9-tetrahydrocannabinol (THC), are available for the treatment of chemotherapy-induced nausea and vomiting (CINV) in patients with cancer who have failed to adequately respond to conventional antiemetic therapy. The aim of this article is to provide an overview of the efficacy, pharmacokinetics (PK), pharmacodynamics (PD), and safety of oral cannabinoids for patients with CINV. Methods A PubMed search of the English-language literature available through 4 January 2017 was conducted to identify relevant articles for inclusion in the review. Results Oral cannabinoids have been shown to have similar or improved efficacy compared with conventional antiemetics for the resolution of nausea and/or vomiting in patients with cancer. However, oral THC has high PK variability, with variability in oral dronabinol peak plasma concentrations (Cmax) estimated between 150 and 200%. A new oral dronabinol solution has decreased intraindividual variability (area under the curve) vs oral dronabinol capsules. Further, oral THC has a slower time to Cmax compared with THC administered intravenously (IV) or by smoking, and a lower systemic availability than IV or smoked THC. The PD profile (e.g., “high”) of oral THC differs from that of IV or smoked THC in healthy individuals. Oral cannabinoids are associated with greater incidence of adverse effects compared with conventional antiemetic therapy or placebo (e.g., dizziness, hypotension, and dysphoria or depression). Conclusions A new formulation of oral cannabinoids (i.e., dronabinol oral solution) minimized the PK/PD variability currently observed with capsule formulations.
Collapse
Affiliation(s)
- Melissa E Badowski
- Chicago College of Pharmacy, University of Illinois, 833 S. Wood St M/C 886, Room 164, Chicago, IL, 60612, USA.
| |
Collapse
|
40
|
Melchior M, Bolze C, Fombonne E, Surkan PJ, Pryor L, Jauffret-Roustide M. Early cannabis initiation and educational attainment: is the association causal? Data from the French TEMPO study. Int J Epidemiol 2017; 46:1641-1650. [DOI: 10.1093/ije/dyx065] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Maria Melchior
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Camille Bolze
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Eric Fombonne
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura Pryor
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | | |
Collapse
|
41
|
Cohn AM, Johnson AL, Rose SW, Rath JM, Villanti AC. Support for Marijuana Legalization and Predictors of Intentions to Use Marijuana More Often in Response to Legalization Among U.S. Young Adults. Subst Use Misuse 2017; 52:203-213. [PMID: 27976988 DOI: 10.1080/10826084.2016.1223688] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND As of 2015, more than half of U.S. states have legalized, medicalized, or decriminalized marijuana. OBJECTIVE This study examined the prevalence and correlates of support for marijuana legalization in a national sample of young adults and the intention to use marijuana more frequently if it were legalized. METHODS Data were from Wave 7 (weighted N = 3532) of the Truth Initiative Young Adult Cohort, a national sample of men and women aged 18-34. We assessed demographics, past 30-day substance (alcohol, tobacco, marijuana, other drug use), depression and anxiety, social smoking, marijuana harm perceptions (relative to cigarettes), and state-level marijuana policies as correlates of support for marijuana legalization and intentions to use marijuana more often if it were legalized. Multivariable models of correlates of support for legalization and intentions to use marijuana were conducted separately for the full sample and for nonmarijuana users. RESULTS Weighted estimates showed that 39% of the full sample and 9% of nonmarijuana users supported marijuana legalization. Multivariable models showed that lower marijuana harm perceptions and lifetime and past 30-day tobacco use were common predictors of support for marijuana legalization and intentions to use marijuana among non-users of marijuana. Conclusions/Importance: Over a third of the sample supported marijuana legalization. Tobacco use and perceptions that marijuana is less harmful than cigarettes were robust risk correlates of support for marijuana legalization and intentions to use more frequently among nonusers. Public health campaigns should target these factors to deter marijuana-related harm in susceptible young adults.
Collapse
Affiliation(s)
- Amy M Cohn
- a The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative , Washington , DC , USA.,b Department of Oncology , Georgetown University Medical Center , Washington , DC , USA.,c Cancer Prevention and Control Program , Georgetown Lombardi Comprehensive Cancer Center , Washington , DC , USA
| | - Amanda L Johnson
- a The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative , Washington , DC , USA
| | - Shyanika W Rose
- a The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative , Washington , DC , USA
| | - Jessica M Rath
- d Department of Evaluation Science and Research , Truth Initiative , Washington , DC , USA.,e Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Andrea C Villanti
- a The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative , Washington , DC , USA.,e Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| |
Collapse
|
42
|
Cavazos-Rehg PA, Zewdie K, Krauss MJ, Sowles SJ. "No High Like a Brownie High": A Content Analysis of Edible Marijuana Tweets. Am J Health Promot 2017; 32:880-886. [PMID: 29214836 DOI: 10.1177/0890117116686574] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate tweets about marijuana edibles for surveillance into the content of edibles-related tweets among individuals socially networking about this topic on Twitter. DESIGN Cross-sectional analysis of tweets containing edible marijuana-related key words during 1 month. SETTING Twitter. PARTICIPANTS Tweets sent during January 1 to 31, 2015. METHODS A random sample of 5000 tweets containing edibles-related key words was coded for sentiment (positive, negative, and neutral) by crowdsourced workers. Tweets normalizing or promoting edibles use were further analyzed, and demographic characteristics of the Twitter handles sending these tweets were inferred. RESULTS Of the 5000 tweets, 4166 (83%) were about marijuana edibles, and of those 75% (3134 of 4166) normalized or encouraged edibles use. Nearly half (48%, 1509 of 3134) of the tweets normalizing edibles mentioned wanting or planning to consume, currently consuming, or recently consuming edibles, and 12% (378 of 3134) described the intense or long-lasting effects following use. Individuals whose tweets promoted/encouraged edibles use were more likely to be young (between 17 and 24 years old) and of a racial/ethnic minority (52% black; 12% Hispanic) when compared to the Twitter average. CONCLUSION Tweets that normalize edibles use have the potential to increase their popularity. The prevalence of tweets about edibles' intense high could have implications for tailoring prevention messages that could be important for youth and young adult minorities who were inferred to be disproportionately socially networking about edibles on Twitter.
Collapse
Affiliation(s)
| | - Kidist Zewdie
- 1 Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Melissa J Krauss
- 1 Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Shaina J Sowles
- 1 Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| |
Collapse
|
43
|
Cambron C, Guttmannova K, Fleming CB. State and National Contexts in Evaluating Cannabis Laws: A Case Study of Washington State. JOURNAL OF DRUG ISSUES 2016; 47:74-90. [PMID: 28458396 DOI: 10.1177/0022042616678607] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As of January 2016, 23 U.S. states and the District of Columbia have legalized medical or nonmedical cannabis, with more likely to follow. This dynamic policy context represents a substantial challenge for policy evaluation. Part I of this article provides a summary of state-level cannabis policy components across states and federal action regarding state-level policies. Part II presents a detailed history of cannabis policies in Washington State from 1998 to 2015 and analyzes the potential impacts of the policy changes on cannabis supply and demand. As an early adopter of both medical and nonmedical cannabis policies, Washington State provides an excellent example of the key elements to be considered in evaluating the relationship between policy changes and cannabis use. We highlight the importance of the interplay of federal enforcement priorities and previously adopted state-level cannabis regimes in interpreting the potential impacts of new cannabis policies.
Collapse
Affiliation(s)
- Christopher Cambron
- Social Development Research Group, School of Social Work, University of Washington, 9725 3 Ave NE, Suite 401, Seattle, WA 98115.,Center for Studies in Demography & Ecology, University of Washington
| | - Katarina Guttmannova
- Center for the Study of Health and Risk Behavior, Department of Psychiatry and Behavioral Sciences, University of Washington.,Center for Studies in Demography & Ecology, University of Washington
| | - Charles B Fleming
- Center for the Study of Health and Risk Behavior, Department of Psychiatry and Behavioral Sciences, University of Washington.,Family & Child Nursing, University of Washington
| |
Collapse
|
44
|
Keyes KM, Wall M, Cerdá M, Schulenberg J, O’Malley PM, Galea S, Feng T, Hasin DS. How does state marijuana policy affect US youth? Medical marijuana laws, marijuana use and perceived harmfulness: 1991-2014. Addiction 2016; 111:2187-2195. [PMID: 27393902 PMCID: PMC5222836 DOI: 10.1111/add.13523] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/13/2016] [Accepted: 07/05/2016] [Indexed: 11/26/2022]
Abstract
AIMS To test, among US students: (1) whether perceived harmfulness of marijuana has changed over time, (2) whether perceived harmfulness of marijuana changed post-passage of state medical marijuana laws (MML) compared with pre-passage; and (3) whether perceived harmfulness of marijuana statistically mediates and/or modifies the relation between MML and marijuana use as a function of grade level. DESIGN Cross-sectional nationally representative surveys of US students, conducted annually, 1991-2014, in the Monitoring the Future study. SETTING Surveys conducted in schools in all coterminous states; 21 states passed MML between 1996 and 2014. PARTICIPANTS The sample included 1 134 734 adolescents in 8th, 10th and 12th grades. MEASUREMENTS State passage of MML; perceived harmfulness of marijuana use (perceiving great or moderate risk to health from smoking marijuana occasionally versus slight or no risk); and marijuana use (prior 30 days). Data were analyzed using time-varying multi-level regression modeling. FINDINGS The perceived harmfulness of marijuana has decreased significantly since 1991 (from an estimated 84.0% in 1991 to 53.8% in 2014, P < 0.01) and, across time, perceived harmfulness was lower in states that passed MML [odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.75-0.97]. In states with MML, perceived harmfulness of marijuana increased among 8th graders after MML passage (OR = 1.21, 95% CI = 1.08-1.36), while marijuana use decreased (OR = 0.81, 95% CI = 0.72-0.92). Results were null for other grades, and for all grades combined. Increases in perceived harmfulness among 8th graders after MML passage was associated with ~33% of the decrease in use. When adolescents were stratified by perceived harmfulness, use in 8th graders decreased to a greater extent among those who perceived marijuana as harmful. CONCLUSIONS While perceived harmfulness of marijuana use appears to be decreasing nationally among adolescents in the United States, the passage of medical marijuana laws (MML) is associated with increases in perceived harmfulness among young adolescents and marijuana use has decreased among those who perceive marijuana to be harmful after passage of MML.
Collapse
Affiliation(s)
- Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA,Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Melanie Wall
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Magdalena Cerdá
- Department of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento, CA
| | - John Schulenberg
- Department of Psychology University of Michigan, Ann Arbor, Michigan, USA,Institute for Social Research, University of Michigan, Ann Arbor, USA
| | | | - Sandro Galea
- Boston School of Public Health, Boston University, Boston, MA, USA
| | - Tianshu Feng
- Research Foundation of Mental Hygiene, New York, New York, USA
| | - Deborah S. Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA,Department of Psychiatry, Columbia University Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| |
Collapse
|
45
|
Vin-Raviv N, Akinyemiju T, Meng Q, Sakhuja S, Hayward R. Marijuana use and inpatient outcomes among hospitalized patients: analysis of the nationwide inpatient sample database. Cancer Med 2016; 6:320-329. [PMID: 27891823 PMCID: PMC5269570 DOI: 10.1002/cam4.968] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/18/2016] [Accepted: 10/21/2016] [Indexed: 12/30/2022] Open
Abstract
The purpose of this paper is to examine the relationship between marijuana use and health outcomes among hospitalized patients, including those hospitalized with a diagnosis of cancer. A total of 387,608 current marijuana users were identified based on ICD‐9 codes for marijuana use among hospitalized patients in the Nationwide Inpatient Sample database between 2007 and 2011. Logistic regression analysis was performed to determine the association between marijuana use and heart failure, cardiac disease, stroke, and in‐hospital mortality. All models were adjusted for age, gender, race, residential income, insurance, residential region, pain, and number of comorbidities. Among hospitalized patients, marijuana use was associated with a 60% increased odds of stroke (OR: 1.60, 95% CI: 1.44–1.77) compared with non‐users, but significantly reduced odds of heart failure (OR: 0.78, 95% CI: 0.75–0.82), cardiac disease (OR: 0.86, 95% CI: 0.82–0.91), or in‐hospital mortality (OR: 0.41, 95% CI: 0.38–0.44). Among cancer patients, odds of in‐hospital mortality was significantly reduced among marijuana users compared with non‐users (OR: 0.44, 95% CI: 0.35–0.55). Hospitalized marijuana users were more likely to experience a stroke compared with non‐users, but less likely to experience in‐hospital mortality. Prospective studies will be needed to better characterize the health effects of marijuana use, especially among older, sicker, and/or hospitalized patients. In the meantime, conversations regarding marijuana use/misuse may be warranted in the clinical setting in order for patients and healthcare providers to adequately weigh the anticipated benefits of marijuana use with potentially significant health risks.
Collapse
Affiliation(s)
- Neomi Vin-Raviv
- University of Northern Colorado Cancer Rehabilitation Institute, Greeley, Colorado.,School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado
| | - Tomi Akinyemiju
- Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama.,Comprehensive Cancer Center, University of Alabama School of Public Health, Birmingham, Alabama
| | - Qingrui Meng
- Department of Biostatistics, University of Alabama School of Public Health, Birmingham, Alabama
| | - Swati Sakhuja
- Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama
| | - Reid Hayward
- University of Northern Colorado Cancer Rehabilitation Institute, Greeley, Colorado.,School of Sport and Exercise Science, University of Northern Colorado, Greeley, Colorado
| |
Collapse
|
46
|
Brooks-Russell A, Levinson A, Li Y, Roppolo RH, Bull S. What Do Colorado Adults Know About Legal Use of Recreational Marijuana After a Media Campaign? Health Promot Pract 2016; 18:193-200. [DOI: 10.1177/1524839916677210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Colorado is among the first states to legalize the recreational sale of marijuana and therefore among the first to develop regulations outlining the purchase, possession, consumption, and enforcement, and penalties. Colorado legislators set aside funds for a statewide informational media campaign to educate Colorado residents on legal use of marijuana. Method. This study evaluated the effectiveness of the mass media campaign to increase awareness of the law through a prospective cohort surveyed before and 6 months after the launch of the campaign ( n = 798). Results. A total of 28.0% reported recall of the Good to Know campaign. There was a significant positive change in accurate knowledge of marijuana laws from baseline to follow-up for each of the four primary indicators of knowledge of the marijuana laws. Among those who had inaccurate knowledge of the laws at baseline, those who reported seeing the campaign at least once or more were 2.53 (95% confidence interval = 1.29-4.95) times as likely to report accurate knowledge of the laws at follow-up compared with those who did not recall seeing the campaign, particularly among marijuana users. Conclusions. Those individuals who reported recall of the campaign were more likely to increase their accurate knowledge of marijuana laws.
Collapse
Affiliation(s)
| | | | - Yaqiang Li
- Colorado School of Public Health, Aurora, CO, USA
| | | | - Sheana Bull
- Colorado School of Public Health, Aurora, CO, USA
| |
Collapse
|
47
|
Malouff JM, Johnson CE, Rooke SE. Cannabis Users' Recommended Warnings for Packages of Legally Sold Cannabis: An Australia-Centered Study. Cannabis Cannabinoid Res 2016; 1:239-243. [PMID: 28861495 PMCID: PMC5531364 DOI: 10.1089/can.2016.0029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Although cannabis use creates health risks, governments have recently been legalizing either medical use or leisure use. These governments can mandate health warnings on cannabis packages. Prior research examined recommended warnings of cannabis experts. The aim of this study was to obtain suggested cannabis health and safety warnings from cannabis users. Methods: We used a media release, Facebook postings, and announcements in university classes to seek individuals who had used cannabis at least once according to their own report. Using online data collection software that keeps participants anonymous, we asked the individuals to suggest a warning that governments could mandate on cannabis packages. Results: In total, 288 users suggested warnings. Categorizing the warnings into content categories led to six warning topics: (1) risk of harm to mental health and psychological functioning; (2) risk of operating machinery while under the influence; (3) short-term physical side effects; (4) responsible use; (5) long-term negative physical effects; and (6) dependence, addiction, or abuse. The user-suggested warnings overlapped with six expert-recommended warnings identified in prior survey research and included two content areas that did not feature in expert-recommended warnings: short-term physical side effects and the importance of responsible use. Conclusions: The results are consistent with prior findings that some youths perceive cannabis use as potentially harmful. The current findings provide possible new content for warnings on cannabis packages.
Collapse
Affiliation(s)
- John M Malouff
- Department of Psychology, University of New England, Armidale, Australia
| | - Caitlin E Johnson
- Department of Psychology, University of New England, Armidale, Australia
| | | |
Collapse
|
48
|
Gallo T, Shah VN. An Unusual Cause of Recurrent Diabetic Ketoacidosis in Type 1 Diabetes. Am J Med 2016; 129:e139-40. [PMID: 27012856 DOI: 10.1016/j.amjmed.2016.02.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
Affiliation(s)
| | - Viral N Shah
- Departments of Pediatrics and Medicine, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora.
| |
Collapse
|
49
|
Lamy FR, Daniulaityte R, Sheth A, Nahhas RW, Martins SS, Boyer EW, Carlson RG. "Those edibles hit hard": Exploration of Twitter data on cannabis edibles in the U.S. Drug Alcohol Depend 2016; 164:64-70. [PMID: 27185160 PMCID: PMC4893972 DOI: 10.1016/j.drugalcdep.2016.04.029] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/20/2016] [Accepted: 04/22/2016] [Indexed: 11/22/2022]
Abstract
AIMS Several states in the U.S. have legalized cannabis for recreational or medical uses. In this context, cannabis edibles have drawn considerable attention after adverse effects were reported. This paper investigates Twitter users' perceptions concerning edibles and evaluates the association edibles-related tweeting activity and local cannabis legislation. METHODS Tweets were collected between May 1 and July 31, 2015, using Twitter API and filtered through the eDrugTrends/Twitris platform. A random sample of geolocated tweets was manually coded to evaluate Twitter users' perceptions regarding edibles. Raw state proportions of Twitter users mentioning edibles were ajusted relative to the total number of Twitter users per state. Differences in adjusted proportions of Twitter users mentioning edibles between states with different cannabis legislation status were assesed via a permutation test. RESULTS We collected 100,182 tweets mentioning cannabis edibles with 26.9% (n=26,975) containing state-level geolocation. Adjusted percentages of geolocated Twitter users posting about edibles were significantly greater in states that allow recreational and/or medical use of cannabis. The differences were statistically significant. Overall, cannabis edibles were generally positively perceived among Twitter users despite some negative tweets expressing the unreliability of edible consumption linked to variability in effect intensity and duration. CONCLUSION Our findings suggest that Twitter data analysis is an important tool for epidemiological monitoring of emerging drug use practices and trends. Results tend to indicate greater tweeting activity about cannabis edibles in states where medical THC and/or recreational use are legal. Although the majority of tweets conveyed positive attitudes about cannabis edibles, analysis of experiences expressed in negative tweets confirms the potential adverse effects of edibles and calls for educating edibles-naïve users, improving edibles labeling, and testing their THC content.
Collapse
Affiliation(s)
- Francois R Lamy
- Center for Interventions, Treatment, and Addictions Research (CITAR), Department of Community Health, Wright State University Boonshoft School of Medicine, 3171 Research Blvd., Suite 124, Dayton, OH 45420-4006, United States; Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), Department of Computer Science and Engineering, Wright State University, Dayton, OH, United States.
| | - Raminta Daniulaityte
- Center for Interventions, Treatment, and Addictions Research (CITAR), Department of Community Health, Wright State University Boonshoft School of Medicine, 3171 Research Blvd., Suite 124, Dayton, OH 45420-4006, United States
| | - Amit Sheth
- Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), Department of Computer Science and Engineering, Wright State University, Dayton, OH, United States
| | - Ramzi W Nahhas
- Center for Global Health, Department of Community Health, Wright State University Boonshoft School of Medicine, Dayton, OH, United States; Department of Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, OH, United States
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Edward W Boyer
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Robert G Carlson
- Center for Interventions, Treatment, and Addictions Research (CITAR), Department of Community Health, Wright State University Boonshoft School of Medicine, 3171 Research Blvd., Suite 124, Dayton, OH 45420-4006, United States
| |
Collapse
|
50
|
Ranganathan M, Skosnik PD, D'Souza DC. Marijuana and Madness: Associations Between Cannabinoids and Psychosis. Biol Psychiatry 2016; 79:511-3. [PMID: 26970361 DOI: 10.1016/j.biopsych.2016.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 01/30/2023]
Affiliation(s)
- Mohini Ranganathan
- Psychiatry Service, VA Connecticut Healthcare System, West Haven; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Patrick D Skosnik
- Psychiatry Service, VA Connecticut Healthcare System, West Haven; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Deepak Cyril D'Souza
- Psychiatry Service, VA Connecticut Healthcare System, West Haven; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
| |
Collapse
|