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

Interactive effects of alcohol and cannabis quantities in the prediction of same-day negative consequences among young adults

BACKGROUND

Simultaneous alcohol and cannabis use is common, but observational studies examining negative consequences of simultaneous use have rarely considered dose-related interactions between alcohol and cannabis. This study examined interactions between quantities of cannabis and alcohol consumed in predicting negative consequences on simultaneous use days.

METHODS

Young adults (N = 151; 64% female; 62% White) reporting recent simultaneous use and at least weekly alcohol and cannabis use completed 21 daily, smartphone-based surveys assessing previous day quantities of cannabis and alcohol used, types of cannabis used (flower, concentrates, edibles), and negative substance-related consequences. Multilevel models examined: (1) whether negative consequences differed within-person across simultaneous use days and single-substance use days; and (2) whether quantities of alcohol and cannabis consumed on simultaneous use days interacted, within-person, to predict negative consequences. We focused on quantities of cannabis flower (grams) in primary analyses and explored quantities of other forms of cannabis (concentrates, edibles) in supplementary analyses.

RESULTS

Participants reported fewer negative consequences on alcohol-only (243 observations) and cannabis-only (713 observations) days than they did on simultaneous use days (429 observations). On simultaneous use days involving cannabis flower use (313 observations across 81 participants), the within-person association between number of standard drinks and negative consequences was weaker on days during which larger (vs. smaller) amounts of cannabis flower were consumed. Inspection of simple slopes revealed that decreased alcohol use was associated with less of a decline in negative consequences when combined with relatively greater amounts of cannabis flower.

CONCLUSIONS

Although simultaneous use was associated with more negative consequences than alcohol-only and cannabis-only use, negative consequences on simultaneous use days varied as a function of the interaction between alcohol and cannabis quantities. As findings suggest that using larger amounts of cannabis may attenuate declines in negative consequences associated with lighter drinking, interventions for higher-risk simultaneous use patterns may benefit from a focus on quantities of both alcohol and cannabis.

Maternal Cannabis Use during Lactation and Potential Effects on Human Milk Composition and Production: A Narrative Review

Cannabis use has increased sharply in the last 20 y among adults, including reproductive-aged women. Its recent widespread legalization is associated with a decrease in risk perception of cannabis use during breastfeeding. However, the effect of cannabis use (if any) on milk production and milk composition is not known. This narrative review summarizes current knowledge related to maternal cannabis use during breastfeeding and provides an overview of possible pathways whereby cannabis might affect milk composition and production. Several studies have demonstrated that cannabinoids and their metabolites are detectable in human milk produced by mothers who use cannabis. Due to their physicochemical properties, cannabinoids are stored in adipose tissue, can easily reach the mammary gland, and can be secreted in milk. Moreover, cannabinoid receptors are present in adipocytes and mammary epithelial cells. The activation of these receptors directly modulates fatty acid metabolism, potentially causing changes in milk fatty acid profiles. Additionally, the endocannabinoid system is intimately connected to the endocrine system. As such, it is probable that interactions of exogenous cannabinoids with the endocannabinoid system might modify release of critical hormones (e.g., prolactin and dopamine) that regulate milk production and secretion. Nonetheless, few studies have investigated effects of cannabis use (including on milk production and composition) in lactating women. Additional research utilizing robust methodologies are needed to elucidate whether and how cannabis use affects human milk production and composition.

Cannabis and Driving in Older Adults

Importance

Epidemiological studies have found that cannabis increases the risk of a motor vehicle collision. Cannabis use is increasing in older adults, but laboratory studies of the association between cannabis and driving in people aged older than 65 years are lacking.

Objective

To investigate the association between cannabis, simulated driving, and concurrent blood tetrahydrocannabinol (THC) levels in older adults.

Design, Setting, and Participants

Using an ecologically valid counterbalanced design, in this cohort study, regular cannabis users operated a driving simulator before, 30 minutes after, and 180 minutes after smoking their preferred legal cannabis or after resting. This study was conducted in Toronto, Canada, between March and November 2022 with no follow-up period. Data were analyzed from December 2022 to February 2023.

Exposures

Most participants chose THC-dominant cannabis with a mean (SD) content of 18.74% (6.12%) THC and 1.46% (3.37%) cannabidiol (CBD).

Main outcomes and measures

The primary end point was SD of lateral position (SDLP, or weaving). Secondary outcomes were mean speed (MS), maximum speed, SD of speed, and reaction time. Driving was assessed under both single-task and dual-task (distracted) conditions. Blood THC and metabolites of THC and CBD were also measured at the time of the drives.

Results

A total of 31 participants (21 male [68%]; 29 White [94%], 1 Latin American [3%], and 1 mixed race [3%]; mean [SD] age, 68.7 [3.5] years), completed all study procedures. SDLP was increased and MS was decreased at 30 but not 180 minutes after smoking cannabis compared with the control condition in both the single-task (SDLP effect size [ES], 0.30; b = 1.65; 95% CI, 0.37 to 2.93; MS ES, -0.58; b = -2.46; 95% CI, -3.56 to -1.36) and dual-task (SDLP ES, 0.27; b = 1.75; 95% CI, 0.21 to 3.28; MS ES, -0.47; b = -3.15; 95% CI, -5.05 to -1.24) conditions. Blood THC levels were significantly increased at 30 minutes but not 180 minutes. Blood THC was not correlated with SDLP or MS at 30 minutes, and SDLP was not correlated with MS. Subjective ratings remained elevated for 5 hours and participants reported that they were less willing to drive at 3 hours after smoking.

Conclusions and relevance

In this cohort study, the findings suggested that older drivers should exercise caution after smoking cannabis.

Framing substance use as "recreational" is neither accurate nor helpful for prevention purposes

This debate paper discusses six reasons why the term "recreational substance use" should be avoided. (1) Social norms and beliefs are drivers of behavior; therefore, the normalized use of the term conveys injunctive norms of a fully socially acceptable substance. Injunctive norms are the most important drivers of initiation into substance use. (2) The illusion of being in control, suggesting that if consumed for leisure and recreation it can easily be controlled; (3) Idealized social representations that fuel an idealized image of an alternative glamourous or mindful consumption culture; (4) Downplaying potential harms; (5) The implicit promise of everyday pleasure, the ever-growing potency of cannabis products does not fit the narrative of its use for recreation; (6) Industry as a trojan horse branding discourse of the concept of medical cannabis to normalize the image of non-medical use: to complement "therapeutic" with "recreational". "Recreational use" is a subjective ill-defined term. This debate paper aims to find a better terminological solution, honestly denominating with a neutral, unbiased, and objective connotation what is now called "recreational use". Thus, we propose using the term "non-therapeutic" use.