Cannabis legalization, regulation, & control: a review of key challenges for local, state, and provincial officials

Associations between e-cigarette marketing exposure and vaping nicotine and cannabis among U.S. adults, 2021

INTRODUCTION

Little is known about the influence of e-cigarette marketing on cannabis vaping behaviors. This study examined the associations between e-cigarette marketing exposure and nicotine and cannabis vaping among adults.

METHODS

This cross-sectional study included a U.S. nationally representative sample of adults from the Wave 6 survey of the Population Assessment of Tobacco and Health Study. We used multinomial logistic regressions to examine the associations between past 30-day e-cigarette marketing exposure and past 30-day vaping behavior (sole- and dual-vaping of nicotine and cannabis) overall and stratified by age.

RESULTS

Overall, 52.0 % of respondents reported e-cigarette marketing exposure, and 89.8 %, 5.6 %, 3.2 %, and 1.4 % reported no vaping, sole-nicotine vaping, sole-cannabis vaping, and dual-vaping, respectively. E-cigarette marketing exposure was associated with increased odds of reporting sole-cannabis vaping versus no vaping (adjusted risk ratio [aRR], 1.31; 95 % confidence interval [CI], 1.09-1.57) and dual-vaping versus no vaping (aRR, 1.26; 95 % CI, 1.01-1.57). This association was found among those aged 18-24 and 25-34 years. It was also associated with increased odds of reporting sole-cannabis vaping versus sole-nicotine vaping (aRR, 1.28; 95 % CI, 1.04-1.58). This association was found among those aged 18-24 years.

DISCUSSION

E-cigarette marketing exposure was associated with sole-cannabis vaping and dual-vaping, not sole-nicotine vaping among U.S. adults. Such associations were mainly driven by young adults aged 18-24 and 25-34 years. Greater restrictions on tobacco marketing may have reduced the influence of e-cigarette marketing on nicotine vaping, while gaps in marketing restrictions for cannabis may contribute to e-cigarette marketing influence on cannabis vaping.

Acute pediatric cannabis intoxication: A scoping review

Little is understood about the unintended consequences of cannabis liberalization on children. Subsequently, this scoping review aimed to map and identify evidence related to acute cannabis intoxication in children. We searched three medical literature databases from inception until October 2019. We identified 4644 information sources and included 158 which were mapped by topic area relating to 1) public health implications and considerations; 2) clinical management; and 3) experiences and information needs of HCPs and families. Public health implications were addressed by 129 (82%) and often reported an increased incidence of acute pediatric cannabis intoxications. Clinical information was reported in 116 (73%) and included information on signs and symptoms (n = 106, 92%), clinical management processes (n = 60, 52%), and treatment recommendations (n = 42, 36%). Few sources addressed the experiences or information needs of either HCPs (n = 5, <1%) treating children for acute cannabis intoxication or families (n = 1, <1%) seeking care. Increasing incidence of acute cannabis intoxications concurrent with liberalization of cannabis legislation is clear, however, evidence around clinical management is limited. Additionally, further research exploring HCPs and families experiences and information needs around cannabis intoxication is warranted.

Associations between e-cigarette marketing exposure and vaping nicotine and cannabis among U.S. adults, 2021

Importance

Vaping has become an increasingly common method for consuming nicotine and cannabis, a trend potentially influenced by e-cigarette marketing. However, little is known about the influence of e-cigarette marketing on cannabis vaping behaviors.

Objective

To examine the associations between e-cigarette marketing exposure and nicotine and cannabis vaping behaviors among adults.

Design Setting and Participants

This cross-sectional study included a U.S. nationally representative sample of adults (≥18 years) from the Wave 6 survey of the Population Assessment of Tobacco and Health (PATH) Study, conducted from March to November 2021.

Exposure

Past 30-day e-cigarette marketing exposure (overall and by ten marketing channels).

Main Outcomes and Measures

Past 30-day vaping behavior (sole- and dual-vaping of nicotine and cannabis) overall and stratified by age.

Results

The study included 30,516 respondents (48.0% male and 63.9% non-Hispanic White). Overall, 52.0% of respondents reported past 30-day e-cigarette marketing exposure, and 89.8%, 5.6%, 3.2%, and 1.4% reported no vaping, sole-nicotine vaping, sole-cannabis vaping, and dual-vaping, respectively. Multinominal logistic regression results show exposure to e-cigarette marketing was associated with increased odds of reporting sole-cannabis vaping versus no vaping (adjusted risk ratio [aRR], 1.31; 95% confidence interval [CI], 1.09-1.57) and dual-vaping versus no vaping (aRR, 1.26; 95% CI, 1.01-1.57). Stratification analysis found these associations among those aged 18-24 and 25-34 years but not older adults (≥35 years). Those exposed to e-cigarette marketing also had increased odds of reporting sole-cannabis vaping versus sole-nicotine vaping (aRR, 1.28; 95% CI, 1.04-1.58). Stratification analysis found this association only among those aged 18-24 years. E-cigarette marketing exposure via several channels (retail stores, billboards, events, newspapers/magazines) was associated with increased odds of reporting sole-cannabis vaping.

Conclusions and Relevance

E-cigarette marketing exposure was only associated with sole-cannabis vaping and dual-vaping, not sole-nicotine vaping among U.S. adults. Such associations were mainly driven by young adults aged 18-24 and 25-35 years and were found for multiple marketing channels. Greater restrictions on tobacco marketing may have reduced the influence of e-cigarette marketing on nicotine vaping, while gaps in such marketing restrictions for cannabis may contribute to continued influence of e-cigarette marketing on cannabis vaping.

Where can offenders be found when they are not committing crimes? A cross-sectional survey of British police officers on non-crime locations

To date, the bulk of research on place and crime has concentrated on crime scene locations and home addresses of both victims and perpetrators. Beyond these locations, less is known about where offenders can be found during regular, non-criminal activity. These 'non-crime locations' provide information about offenders' lifestyles, their relationships with co-offenders, their preferred spots, and the places beyond the spatiotemporal boundaries of the crime where they may plan, manage, or deal with the aftermath of their behaviour. Yet there is a lack of systematic evidence, with the available research relying on local ethnographic designs, small samples or both, as access to such data was limited. This study utilises a novel approach by relying on the professional experience of intelligence police officers assigned to deal with serious and organised crime in the West Midlands County of the United Kingdom to determine the whereabouts of three types of non-crime locations: (a) hangout spots, (b) recruitment spots and (c) contraband hideout spots. Results suggest that offenders frequently visit gyms, specific restaurants, or private residences (not unlike locations where normative people hang out), and new members can be recruited anywhere. Drugs and firearms are strategically hidden near vulnerable persons. According to police officers, offenders are unconcerned by surveillance in these spots and choose venues not usually owned by criminal groups. Theoretical, methodological, and practical implications are discussed.

Minor, Nonterpenoid Volatile Compounds Drive the Aroma Differences of Exotic Cannabis

Cannabis sativa L. produces a wide variety of volatile secondary metabolites that contribute to its unique aroma. The major volatile constituents include monoterpenes, sesquiterpenes, and their oxygenated derivates. In particular, the compounds ß-myrcene, D-(+)-limonene, ß-caryophyllene, and terpinolene are often found in greatest amounts, which has led to their use in chemotaxonomic classification schemes and legal Cannabis sativa L. product labeling. While these compounds contribute to the characteristic aroma of Cannabis sativa L. and may help differentiate varieties on a broad level, their importance in producing specific aromas is not well understood. Here, we show that across Cannabis sativa L. varieties with divergent aromas, terpene expression remains remarkably similar, indicating their benign contribution to these unique, specific scents. Instead, we found that many minor, nonterpenoid compounds correlate strongly with nonprototypical sweet or savory aromas produced by Cannabis sativa L. Coupling sensory studies to our chemical analysis, we derive correlations between groups of compounds, or in some cases, individual compounds, that produce many of these diverse scents. In particular, we identified a new class of volatile sulfur compounds (VSCs) containing the 3-mercaptohexyl functional group responsible for the distinct citrus aromas in certain varieties and skatole (3-methylindole) as the key source of the chemical aroma in others. Our results provide not only a rich understanding of the chemistry of Cannabis sativa L. but also highlight how the importance of terpenes in the context of the aroma of Cannabis sativa L. has been overemphasized.

Cannabis and Paternal Epigenetic Inheritance

Cannabis is the most widely used illicit drug in Western counties and its abuse is particularly high in male adolescents and young adults. Its main psychotropic component, the cannabinoid delta-9-tetrahydrocannabinol (Δ⁹-THC), interferes in the endogenous endocannabinoid system. This signaling system is involved in the control of many biological activities, including the formation of high-quality male gametes. Direct adverse effects of Δ⁹-THC in male reproduction are well known in both animal models and humans. Nevertheless, the possibility of long-term effects due to epigenetic mechanisms has recently been reported. In this review, we summarize the main advances in the field suggesting the need to pay attention to the possible long-term epigenetic risks for the reproductive health of cannabis users and the health of their offspring.

Developments and Changes in Primary Public Health Outcome Indicators Associated with the Legalization of Non-Medical Cannabis Use and Supply in Canada (2018): A Comprehensive Overview

Canada legalized non-medical cannabis use and supply for adults in 2018. We examined developments and changes associated with the legalization policy reform on key indicators for public health, namely cannabis (including frequent/problematic) use prevalence, cannabis-related hospitalizations, cannabis-impaired driving, and cannabis sourcing. We identified peer-reviewed and "grey" study data that featured population-level or other quasi-representative samples and comparable outcome data for pre- and post-legalization periods, including possible trends of changes over time. Cannabis use has increased in select population groups, with use modes shifting away from smoking. Evidence on cannabis-related hospitalizations (e.g., for mental health) is mixed. The prevalence of cannabis-impaired driving appears to be generally steady but THC exposure among crash-involved drivers may have increased. Increasing proportions of users obtain cannabis products from legal sources but some-especially regular-users continue to use illicit sources. Overall, data suggest a mixed and inconclusive picture on cannabis legalization's impacts on essential public health indicators, including select extensions in trends from pre-legalization.

Content Analysis of the Corporate Social Responsibility Practices of 9 Major Cannabis Companies in Canada and the US

IMPORTANCE

The cannabis industry has sought to normalize itself and expand its markets in the 21st century. One strategy used by companies to generate positive public relations is corporate social responsibility (CSR). It is critical to understand these efforts to influence the public and politicians given the risks of increased cannabis use.

OBJECTIVES

To analyze cannabis industry CSR behaviors, determine their characteristics, and compare their practices with those of the tobacco industry.

DESIGN, SETTING, AND PARTICIPANTS

This qualitative study of CSR activities conducted between January 1, 2012, and December 31, 2021, evaluated 9 of the 10 largest publicly traded cannabis companies in the US and Canada. Data were collected from August 1 to December 31, 2021. The 10th company was excluded because it engaged in cannabis-based pharmaceutical sales but not CSR. A systematic review of corporate websites and Nexis Uni was performed, resulting in collection of 153 news articles, press releases, and Web pages. Charitable and philanthropic actions were included. Themes were identified and interpreted using modified grounded theory.

MAIN OUTCOMES AND MEASURES

CSR activities and spending.

RESULTS

Nine major cannabis companies in the US and Canada engaged in CSR activities that encouraged increased consumption and targeted marginalized communities. Companies claimed these activities would mitigate the harms of cannabis prohibition, promote diversity, expand access to medical cannabis, and support charitable causes. They developed educational programs, sustainability initiatives, and voluntary marketing codes and used strategies similar to those used by tobacco companies to recruit public interest organizations as allies.

CONCLUSIONS AND RELEVANCE

These findings suggest that cannabis companies developed CSR strategies comparable to those used by the tobacco industry to influence regulation, suggesting that cannabis companies should be included when addressing commercial determinants of health.

A synthesis of local cigar pack policies in the US

Communities have adopted cigar pack policies to eliminate inexpensive, small packs from being sold and reduce youth use. Still, it is unclear how widespread these policies are and whether they differ based on specific policy components. This study identified and measured local cigar pack size and price policies in the US. We used a systematic 14-step process to identify, obtain, and code local cigar pack policies, including pack size and pricing. Between January and July 2021, we identified 299 local cigar pack policies in the US. Policies were (1) identified through municipal code review and requests to state tobacco control representatives, (2) obtained online or from municipality representatives, and (3) double-coded for minimum pack size, minimum price, adopted/effective/enforcement dates, cigar definitions, differences in pack size/price by cigar type, price adjustments, whether the price is before discounts, policy exclusions, and enforcement. We identified 259 municipalities with cigar pack policies, 40 of which amended the pack size or price requirements after initial adoption, resulting in 299 policies. Policies specified eight different pack size requirements ranging from 2 to 25; most prevalent were minimums of 2 (n = 116, 39.2%) and 4 (n = 67, 22.6%). Minimum prices ranged from $0.35 to $10.00 per cigar. Exclusions included cigars priced above a specified amount (n = 225, 76.0%; $2.01-$10.00) and cigars sold at adult-only or tobacco retailers (n = 45, 15.2%). This is the first comprehensive synthesis of cigar pack size and price policies within the US. Policies vary widely both between and within states.

Municipal regulation of cannabis and public health in Canada: A comparison of Alberta, Ontario, and Québec

Canada legalized nonmedical cannabis in October 2018, but significant variations in municipal regulations exist. This study explored the variations that exist and pondered their potential public health consequences. A comparative analysis was completed on the regulations and guidelines that addressed retailers' location and public consumption in the municipalities of Alberta, Ontario, and Québec. Municipal regulations that addressed the location of retailers were more numerous and extensive in Alberta and Ontario (in the context of provincial private retail models) than in Québec (government-based model). Municipalities in Alberta added more restrictions to public consumption laws as compared to municipalities in Ontario and in Québec. These additions were made to Alberta's and Ontario's provincial-level smoking and vaping bans which used tobacco-inspired frameworks, and to Québec's ban on smoking and vaping in all public spaces. The comparative analysis showed the importance of considering municipal cannabis regulations when studying the impact of legalization, given the significant variations that exist. Policy makers should be made aware of these variations in the regulation of cannabis in order to limit health harms and further social inequalities.

Geographic ecological momentary assessment methods to examine spatio-temporal exposures associated with marijuana use among young adults: A pilot study

BACKGROUND

This study demonstrates the use of geographic ecological momentary assessment (GEMA) methods among young adult marijuana users.

METHOD

Participants were 14 current marijuana users ages 21-27 living in Greater Seattle, Washington. They completed brief surveys four times per day for 14 consecutive days, including measures of marijuana use and desire to use. They also carried a GPS data logger that tracked their spatial movements over time.

RESULTS

Participants completed 80.1% of possible EMA surveys. Using the GPS data, we calculated daily number of exposures to (i.e., within 100-m of) marijuana retail outlets (mean = 3.9 times per day; SD = 4.4) and time spent per day in high poverty census tracts (mean = 7.3 h per day in high poverty census tracts; SD = 5.1).

CONCLUSIONS

GEMA may be a promising approach for studying the role spatio-temporal factors play in marijuana use and related factors.

Promoting self-change in cannabis use disorder: Findings from a randomized trial

BACKGROUND

A growing body of literature supports the efficacy of cognitive-behavioral therapy (CBT) and motivational interviewing (MI) for the treatment of problematic cannabis use, diagnostically referred to as cannabis use disorder, though most individuals do not access formal treatment. Stepped-care-type models emphasize interventions across a continuum of severity and there is a need for more treatment options across this continuum. This project focused on the evaluation of the least intensive of the individual interventions - promotion of self-directed recovery.

METHODS

Using a three-arm randomized control trial design, adults (N = 186) with problematic cannabis use and who wished to recover with minimal professional support were recruited from across Canada and randomized to receive a self-directed treatment workbook based on CBT and MI principles (WB; n = 61), the workbook plus a single MI session (WMI; n = 61) or a delayed treatment control (DT; n = 65) condition. Participants completed 3-month and 6-month follow-up assessments.

RESULTS

Across conditions, GEE modeling revealed that the baseline to 3-month slopes differed significantly from zero, ps < 0.001. Participants in the WMI condition reduced their frequency of use to a greater extent than the WB alone, p = 0.005, and DT groups, p = 0.02. Chi-square analysis revealed that participants in the WMI condition also showed greater rates of abstinence at 3-months follow-up than participants in the WB or DT condition, p = 0.046. Changes in the frequency of cannabis use between 3-months and 6-months did not differ significantly between groups, ps > 0.05. For quantity of cannabis use, a significant effect of time emerged, p = 0.002. However, no between-group effects were significant from baseline to 3-months, or from 3- to 6-months, ps > 0.06.

CONCLUSION

Overall, results support the utility of a brief self-directed workbook in combination with a single MI session at promoting changes in cannabis use. This self-directed intervention has the potential to fill an important need in that the self-directed intervention can attract individuals who wish to recover with minimal professional support.

CLINICAL TRIAL REGISTRATION

[https://www.isrctn.com/], identifier [ISRCTN426 32893].

Cannabis sales increases during COVID-19: Findings from Alaska, Colorado, Oregon, and Washington

BACKGROUND AND AIMS

Following emergency declarations related to COVID-19 in the United States, many states issued stay-at-home orders and designated essential business categories. Most states allowed medical and/or non-medical adult-use cannabis retailers to remain open. This study assesses changes in cannabis sales across Alaska, Colorado, Oregon, and Washington before and during the pandemic.

METHODS

Pre-tax sales data from cannabis marketplaces in four states were analyzed to identify trends from January 2018-December 2020. Mean monthly sales and relative percent change in mean monthly sales were compared by state from April-December (coinciding with the pandemic) in 2018, 2019, and 2020. Differences were assessed using the nonparametric Mann-Whitney-U test.

RESULTS

Mean monthly cannabis sales in all four states were higher during the pandemic period in 2020 compared to the same period in 2019. Sales reached a three-year peak in Washington in May 2020 and in Alaska, Colorado, and Oregon in July 2020. From April-December, the percent change in mean monthly sales from 2019 to 2020 was significantly higher than 2018-2019 in all four states, though Alaska saw similar increases between 2018-2019 and 2019-2020.

CONCLUSION

To date, cannabis sales in Alaska, Colorado, Oregon, and Washington have increased more during the COVID-19 pandemic than in the previous two years. In light of these increases, data monitoring by states and CDC is warranted to understand how patterns of use are changing, which populations are demonstrating changes in use, and how such changes may affect substance use and related public health outcomes.

Identification of a New Family of Prenylated Volatile Sulfur Compounds in Cannabis Revealed by Comprehensive Two-Dimensional Gas Chromatography

Cannabis sativa L. produces over 200 known secondary metabolites that contribute to its distinctive aroma. Studies on compounds traditionally associated with the scent of this plant have focused on those within the terpenoid class. These isoprene-derived compounds are ubiquitous in nature and are the major source of many plant odors. Nonetheless, there is little evidence that they provide the characteristic "skunk-like" aroma of cannabis. To uncover the chemical origins of this scent, we measured the aromatic properties of cannabis flowers and concentrated extracts using comprehensive two-dimensional gas chromatography equipped with time-of-flight mass spectrometry, flame ionization detection, and sulfur chemiluminescence. We discovered a new family of volatile sulfur compounds (VSCs) containing the prenyl (3-methylbut-2-en-1-yl) functional group that is responsible for this scent. In particular, the compound 3-methyl-2-butene-1-thiol was identified as the primary odorant. We then conducted an indoor greenhouse experiment to monitor the evolution of these compounds during the plant's lifecycle and throughout the curing process. We found that the concentrations of these compounds increase substantially during the last weeks of the flowering stage, reach a maximum during curing, and then drop after just one week of storage. These results shed light on the chemical origins of the characteristic aroma of cannabis and how volatile sulfur compound production evolves during plant growth. Furthermore, the chemical similarity between this new family of VSCs and those found in garlic (allium sativum) suggests an opportunity to also investigate their potential health benefits.

Cannabis Policy in the United States: Implications for Public Health

INTRODUCTION

As of January 2021, a total of 36 states and the District of Columbia (DC) have legalized medical cannabis use, and 14 states and DC have legalized adult nonmedical use. This manuscript qualitatively summarizes cannabis policies across states with legal adult use marketplaces.

METHODS

Data are from state laws and regulations, collected through January 2021, and have been verified with state officials as part of ongoing state policy tracking efforts.

RESULTS

State policies differ in how cannabis products are taxed, where revenues are allocated, restrictions on the types of available products, restrictions on additives and flavors, product packaging and labeling, advertising restrictions, where cannabis can be consumed, and approaches to social equity.

CONCLUSION

Timely, accurate, and longitudinal state and local cannabis policy data are needed to understand the implications of legalization. Careful study of policy differences across and within states is warranted, as differences may affect public health and consumer safety.

The Potential Impact of Legalization of Recreational Cannabis among Current Users: A Qualitative Inquiry

Given legislative initiatives in Rhode Island pertaining to consideration of cannabis legalization for recreational purpose, a qualitative inquiry was conducted regarding anticipated changes in use among recreational cannabis users in Rhode Island. Five focus groups were conducted with recreational cannabis users (N = 31; 6-7 per group). Participants were queried about anticipated impact of legalization on their use patterns. Themes were identified using applied thematic analysis. Participants discussed (1) a desire to maintain the status quo due to satisfaction with local cannabis regulations and their current use behaviors, (2) how and why cannabis use may change, including pros and cons of legalization, and (3) anticipated changes in purchasing behavior given display and legitimacy of legal dispensaries. While participants anticipate use levels and prevalence may remain relatively stable following legislation changes, findings suggest possible changes related to mode of administration and location of use. Public health concerns exist related to high-risk potencies and use of cannabis in edible form; therefore, trialing of new cannabis products has important clinical implications should legalization occur in Rhode Island.

Pharmacological properties, therapeutic potential, and legal status of Cannabis sativa L.: An overview

Marijuana, or Cannabis sativa L., is a common psychoactive plant used for both recreational and medicinal purposes. In many countries, cannabis-based medicines have been legalized under certain conditions because of their immense prospects in medicinal applications. With a comprehensive insight into the prospects and challenges associated with the pharmacological use and global trade of C. sativa, this mini-review focuses on the medicinal importance of the plant and its legal status worldwide; the pharmacological compounds and its therapeutic potential along with the underlying public health concerns and future perspective are herein discussed. The existence of major compounds including Δ⁹ -tetrahydrocannabinol (Δ⁹ -THC), cannabidiol, cannabinol, and cannabichromene contributes to the medicinal effects of the cannabis plant. These compounds are also involved in the treatment of various types of cancer, epilepsy, and Parkinson's disease displaying several mechanisms of action. Cannabis sativa is a plant with significant pharmacological potential. However, several aspects of the plant need an in-depth understanding of the drug mechanism and its interaction with other drugs. Only after addressing these health concerns, legalization of cannabis could be utilized to its full potential as a future medicine.

Assessing New Zealand's Cannabis Legalization and Control Bill: prospects and challenges

BACKGROUND

Few countries have developed detailed legislative proposals for legalizing cannabis. New Zealand recently released the Cannabis Legalization and Control Bill (CLCB) that will be the subject of a referendum in September 2020.

AIMS

To assess the CLCB, drawing on emerging evidence from cannabis legalization overseas, public health research on alcohol and tobacco and the attempt to establish a regulated market for 'legal highs' in New Zealand.

DISCUSSION

The CLCB proposes a strictly regulated commercial cannabis market that resembles the Canadian approach, but notably without on-line sales or regional heterogeneity in retail distribution. The objective of the CLCB of lowering cannabis use over time appears at odds with the largely commercial cannabis sector that will focus on expanding sales. The CLCB includes provision for home cultivation and social benefit operators, but it is not clear what priority these operators will receive. A potency cap of 15% tetrahydrocannabinol (THC) for cannabis plants is included, and this is at the high end of black-market cannabis. The proposed progressive product tax based on THC will be challenging to implement. There is no formal minimum price, but rather discretionary powers to raise the excise if the price drops too much. The CLCB includes a comprehensive ban on advertising, but non-conventional on-line promotion will be difficult to suppress. The central government cannabis authority is tasked with developing local retail outlet policies. We caution against the temptation to employ an interim regulatory regime following a positive referendum result, because a partially regulated market will expose users to health risks and undermine public support.

CONCLUSIONS

New Zealand's Cannabis Legalization and Control Bill's objective of reducing cannabis use via a commercial market will be challenging to achieve. The bill could be strengthened with formal minimum pricing, lower potency cap and greater clarity concerning social benefit operators and the role of local government.

Introduction

The everyday lives of contemporary youth are awash with chemicals to boost pleasure, energy, sexual performance, appearance, and health. What do pills, drinks, sprays, powders, and lotions do for youth? What effects are youth seeking? The ChemicalYouth ethnographies presented here, based on more than five years of fieldwork conducted in Amsterdam, Brooklyn, Cayagan de Oro, Paris, Makassar, Puerto Princesa, and Yogyakarta, show that young people try out chemicals together, compare experiences, and engage in collaborative experiments. ChemicalYouth: Navigating Uncertainty: In Search of the Good Life makes a case for examining a broader range of chemicals that young people use in their everyday lives. It focuses not just on psychoactive substances—the use of which is viewed with concern by parents, educators, and policymakers—but all the other chemicals that young people use to boost pleasure, moods, vitality, appearance, and health, purposes for using chemicals that have received far less scholarly attention. It takes the use of chemicals as situated practices that are embedded in social relations and that generate shared understandings of efficacy. More specifically, it seeks to answer the question: how do young people balance the benefits and harms of chemicals in their quest for a good life?

Trends in marijuana use in two Latin American countries: an age, period and cohort study

BACKGROUND AND AIMS

Uruguay and Chile have the highest levels of marijuana use in Latin America, and have experienced consistent increases during the last two decades. We aim to calculate separate age-period-cohort (APC) effects for past-year marijuana use in Uruguay and Chile, which have similar epidemiologica, and demographic profiles but diverging paths in cannabis regulation.

DESIGN

APC study in which period and cohort effects were estimated as first derivative deviations from their linear age trend, separately by country and gender.

SETTING

Uruguay and Chile.

PARTICIPANTS

General population between 15 and 64 years.

MEASUREMENTS

Past-year marijuana use from household surveys with five repeated cross-sections between 2001 and 2018 in Uruguay (median n = 4616) and 13 between 1994 and 2018 in Chile (median n = 15 895).

FINDINGS

Marijuana use prevalence in both countries peaked at 20-24 years of age and increased consistently across calendar years. Period effects were strong and positive, indicating that increases in use were evident across age groups. Relative to 2006 (reference year), Chilean period effects were approximately 48% lower in 1994 and approximately four times higher in 2018; in Uruguay, these effects were approximately 56% lower in 2001 and almost quadrupled in 2018. We observed non-linear cohort effects in Chile and similar patterns in Uruguay for the overall sample and women. In both countries, marijuana use increased for cohorts born between the mid-1970s and early 1990s, even in the context of rising period effects. Prevalence was consistently larger for men, but period increases were stronger in women.

CONCLUSIONS

Age-period-cohort effects on past-year marijuana use appear to have been similar in Chile and Uruguay, decreasing with age and increasing over time at heterogeneous growth rates depending on gender and cohort. Current levels of marijuana use, including age and gender disparities, seem to be associated with recent common historical events in these two countries.

The Lower-Risk Cannabis Use Guidelines' (LRCUG) recommendations: How are Canadian cannabis users complying?

•

LRCUG feature recommendations for users on how to reduce cannabis use-related risks.

•

Select cannabis use-related behavior data were identified in four Canadian surveys.

•

Except for modes of use, respective majorities of users comply with the LRCUG.

•

Substantial sub-groups of users engage in (possibly multiple) risk-behaviors.

•

Improved targeted interventions are required to lower risks and adverse outcomes.

Canada, alongside other jurisdictions, implemented non-medical cannabis legalization in 2018, partly towards improving public health. Evidence-based ‘Lower-Risk Cannabis Use Guidelines’ (LRCUG), including recommendations for cannabis users on how to decrease risk-behaviors for harms, have been developed and widely disseminated in Canada since 2017. However, knowledge on users’ compliance with the LRCUG is limited. We identified four major Canadian (three national, one provincial) population surveys presenting key data on cannabis-related behaviors: the National Cannabis Survey, Canadian Cannabis Survey, Canadian Tobacco, Alcohol & Drugs Survey, and CAMH Monitor. We scanned each survey for indicator data mapping onto either of the LRCUG’s recommendations for the years 2017 to 2019. Relevant indicator data, albeit with varying operationalizations, were found for six of the ten LRCUG’s recommendation clusters in at least some of the surveys, and were extracted and summarized. For results, substantial -- but declining -- majorities of users consumed cannabis by smoking, yet with shifts towards other use modes. Between one- to two-in-five users engaged in the risk-behaviors of using high-potency cannabis products, frequent cannabis use and cannabis-impaired driving, respectively. A small proportion of pregnant or breastfeeding women continued cannabis use during the study period. The data identified found suggested a heterogeneous picture regarding cannabis users’ compliance with the LRCUG’s recommendations. Non-compliance is highest for recommendations regarding modes-of-use, and applies to minorities of users for other risks factors. These sub-groups are at elevated risk for acute (e.g., accidents) or long-term (e.g., dependence) cannabis-related harms contributing to the public health burden. Appropriate targeted interventions in these areas require improvement.

Facing the option for the legalisation of cannabis use and supply in New Zealand: An overview of relevant evidence, concepts and considerations

ISSUES

Non-medical cannabis policies are changing, including towards legalisation-with-regulation frameworks. New Zealand will hold a public referendum on cannabis legalisation in 2020. We reviewed data on cannabis use and health/social harms; policy reform options; experiences with and outcomes of reforms elsewhere; and other relevant considerations towards informing policy choices in the upcoming referendum.

APPROACH

Relevant epidemiological, health, social, criminal justice and policy studies and data were identified and comprehensively reviewed.

KEY FINDINGS

Cannabis use is common (including in New Zealand) and associated with risks for health and social harms, mainly concentrated in young users; key harms are attributable to criminalisation. 'Decriminalisation' reforms have produced ambivalent results. Existing cannabis legalisation frameworks vary considerably in main parameters. Legalisation offers some distinct advantages, for example regulated use, products and user education, yet outcomes depend on essential regulation parameters, including commercialisation, and policy ecologies. While major changes in use are not observed, legalisation experiences are inconclusive to date, including mixed health and social outcomes, with select harms increasing and resilient illegal markets. It is unclear whether legalisation reduces cannabis exposure or social harms (e.g. from enforcement) for youth.

IMPLICATIONS/CONCLUSIONS

No conclusive overall evidence on the outcomes of legalisation elsewhere exists, nor is evidence easily transferable to other settings. Legalisation offers direct social justice benefits for adults, yet overall public health impacts are uncertain. Legalisation may not categorically improve health or social outcomes for youth. Legalisation remains a well-intended, while experimental policy option towards more measured and sensible cannabis control and overall greater policy coherence, requiring close monitoring and possible adjustments depending on setting-specific outcomes.

Access to cannabis retail stores across Canada 6 months following legalization: a descriptive study

BACKGROUND

On Oct. 17, 2018, Canada legalized recreational cannabis with the dual goals of reducing youth use and eliminating the illicit cannabis market. We examined factors associated with access to physical cannabis stores across Canada 6 months following legalization.

METHODS

We extracted the address and operating hours of all legal cannabis stores in Canada from online government and private listings. We conducted a descriptive study examining the association between private/hybrid (mixture of government and private stores) and government-only retail models with 4 measures of physical access to cannabis: store density, weekly hours of operation, median distance to the nearest school and relative availability of cannabis stores between low- and high-income neighbourhoods.

RESULTS

Six months after legalization, there were 260 cannabis retail stores across Canada: 181 privately run stores, 55 government-run stores and 24 stores in the hybrid retail system. Compared to jurisdictions with a government-run model, jurisdictions with a private/hybrid retail model had 49% (95% confidence interval 10%-200%) more stores per capita, retailers were open on average 9.2 more hours per week, and stores were located closer to schools (median 166.7 m). In both retail models, there was over twice the concentration of cannabis stores in neighbourhoods in the lowest income quintile compared to the highest income quintile.

INTERPRETATION

Marked differences in physical access to cannabis retail are emerging between jurisdictions with private/hybrid retail models and those with government-only retail models. Ongoing surveillance including monitoring differences in cannabis use and harms across jurisdictions is needed.