1
|
Winfield-Ward L, Hammond D. Social Norms for Cannabis Use After Nonmedical Legalization in Canada. Am J Prev Med 2024; 66:809-818. [PMID: 38128676 DOI: 10.1016/j.amepre.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Social norms play an important role in cannabis use; however, there is little evidence on how social norms change in jurisdictions that legalize cannabis. This study examined trends in social norms before and after legalization of nonmedical cannabis in Canada in 2018. METHODS Data are from the International Cannabis Policy Study, a series of cross-sectional surveys conducted annually with Canadian respondents aged 16-65 years. Analyses were conducted in 2023 and included data from 58,045 respondents across 4 waves: the year immediately before legalization (2018) and 3 post-legalization waves (2019-2021). Regression models examined trends in injunctive norms (perceived approval of cannabis) and comfort in using cannabis in six different social contexts, adjusting for cannabis use frequency, medical authorization, and sociodemographic covariates. RESULTS Perceived social approval of cannabis use and comfort using cannabis in different social contexts was highest among males, frequent cannabis consumers, and those who reported medical authorization (p<0.05 in all cases). No changes in perceived approval were observed across years, except a temporary decrease in 2020 versus 2018 (OR=0.87, 95% CI=0.80, 0.95). Modest increases in comfort of using cannabis in 6 different social contexts were observed in 2019 (ß=0.10, p=0.001), 2020 (ß=0.10, p=0.001), and 2021 (ß=0.12, p<0.001) versus in 2018. CONCLUSIONS Social norms have remained relatively stable after nonmedical legalization in Canada, with only modest increases in comfort of using cannabis in different social settings. The findings may reflect widespread cannabis use in Canada prior to nonmedical legalization in 2018 as well as comprehensive restrictions on promotion and advertising.
Collapse
Affiliation(s)
- Lauren Winfield-Ward
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| |
Collapse
|
2
|
Maillet MA. Individual differences in legal and illicit cannabis purchasing behaviour in British Columbia, Canada: Findings from a 2021 cross-sectional survey. Int J Drug Policy 2024; 126:104363. [PMID: 38401174 DOI: 10.1016/j.drugpo.2024.104363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Despite thousands of licensed cannabis retail stores operating across Canada, there remains a significant illicit cannabis market. Some cannabis users continue to buy cannabis from dealers, illicit stores, and/or illicit online retailers. METHODS Data are from the 2021 British Columbia Cannabis Use Survey. Respondents (n = 8473) were 19 years or older, lived in British Columbia at the time of the survey, and reported using cannabis in the past 12 months. RESULTS Buying cannabis from all types of illicit sources was more common among younger cannabis users, those who use cannabis more frequently and started using cannabis before the age of 17 (vs. 19 or older), and among those who co-use cannabis with other drugs. Specifically, buying cannabis from a dealer was more common among men, those with lower educational attainment, and those who seek the lowest prices when buying cannabis. In contrast, those using cannabis for medical (vs. non-medical) purposes were more likely to report getting cannabis from illicit retail stores, while buying cannabis from illicit websites was more common among people who use edible cannabis products. CONCLUSION Consistent with other studies, younger and more frequent cannabis users were more likely to report buying cannabis from illicit sources. However, these findings suggest there is significant heterogeneity among those who buy cannabis from different types of illicit sources, which should be carefully considered when developing policies and strategies aimed at encouraging consumers to transition to legal sources.
Collapse
Affiliation(s)
- Myles A Maillet
- B.C. Ministry of Public Safety and Solicitor General, Canada
| |
Collapse
|
3
|
Harlow AF, Miech RA, Leventhal AM. Adolescent Δ8-THC and Marijuana Use in the US. JAMA 2024; 331:861-865. [PMID: 38470384 PMCID: PMC10933714 DOI: 10.1001/jama.2024.0865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/19/2024] [Indexed: 03/13/2024]
Abstract
Importance Gummies, flavored vaping devices, and other cannabis products containing psychoactive hemp-derived Δ8-tetrahydrocannabinol (THC) are increasingly marketed in the US with claims of being federally legal and comparable to marijuana. National data on prevalence and correlates of Δ8-THC use and comparisons to marijuana use among adolescents in the US are lacking. Objective To estimate the self-reported prevalence of and sociodemographic and policy factors associated with Δ8-THC and marijuana use among US adolescents in the past 12 months. Design, Setting, and Participants This nationally representative cross-sectional analysis included a randomly selected subset of 12th-grade students in 27 US states who participated in the Monitoring the Future Study in-school survey during February to June 2023. Exposures Self-reported sex, race, ethnicity, and parental education; census region; state-level adult-use (ie, recreational) marijuana legalization (yes vs no); and state-level Δ8-THC policies (regulated vs not regulated). Main Outcomes and Measures The primary outcome was self-reported Δ8-THC and marijuana use in the past 12 months (any vs no use and number of occasions used). Results In the sample of 2186 12th-grade students (mean age, 17.7 years; 1054 [48.9% weighted] were female; 232 [11.1%] were Black, 411 [23.5%] were Hispanic, 1113 [46.1%] were White, and 328 [14.2%] were multiracial), prevalence of self-reported use in the past 12 months was 11.4% (95% CI, 8.6%-14.2%) for Δ8-THC and 30.4% (95% CI, 26.5%-34.4%) for marijuana. Of those 295 participants reporting Δ8-THC use, 35.4% used it at least 10 times in the past 12 months. Prevalence of Δ8-THC use was lower in Western vs Southern census regions (5.0% vs 14.3%; risk difference [RD], -9.4% [95% CI, -15.2% to -3.5%]; adjusted risk ratio [aRR], 0.35 [95% CI, 0.16-0.77]), states in which Δ8-THC was regulated vs not regulated (5.7% vs 14.4%; RD, -8.6% [95% CI, -12.9% to -4.4%]; aRR, 0.42 [95% CI, 0.23-0.74]), and states with vs without legal adult-use marijuana (8.0% vs 14.0%; RD, -6.0% [95% CI, -10.8% to -1.2%]; aRR, 0.56 [95% CI, 0.35-0.91]). Use in the past 12 months was lower among Hispanic than White participants for Δ8-THC (7.3% vs 14.4%; RD, -7.2% [95% CI, -12.2% to -2.1%]; aRR, 0.54 [95% CI, 0.34-0.87]) and marijuana (24.5% vs 33.0%; RD, -8.5% [95% CI, -14.9% to -2.1%]; aRR, 0.74 [95% CI, 0.59-0.94]). Δ8-THC and marijuana use prevalence did not differ by sex or parental education. Conclusions and Relevance Δ8-THC use prevalence is appreciable among US adolescents and is higher in states without marijuana legalization or existing Δ8-THC regulations. Prioritizing surveillance, policy, and public health efforts addressing adolescent Δ8-THC use may be warranted.
Collapse
Affiliation(s)
- Alyssa F. Harlow
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles
- Institute for Addiction Science, University of Southern California, Los Angeles
- USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Richard A. Miech
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Adam M. Leventhal
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles
- Institute for Addiction Science, University of Southern California, Los Angeles
- USC Norris Comprehensive Cancer Center, Los Angeles, California
| |
Collapse
|
4
|
Ataiants J, Wong CF, Odejimi OA, Fedorova EV, Conn BM, Lankenau SE. Medicinal cannabis use among young adults during California's transition from legalized medical use to adult-use: a longitudinal analysis. Am J Drug Alcohol Abuse 2024; 50:229-241. [PMID: 38407837 DOI: 10.1080/00952990.2024.2308098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024]
Abstract
Background: In 2016, California transitioned from legalized medical cannabis use to adult-use. Little is known about how this policy change affected medicinal cannabis use among young adults.Objectives: To identify longitudinal groups of medicinal cannabis users and concurrent changes in health- and cannabis use-related characteristics among young adults in Los Angeles between 2014 and 2021.Methods: Cannabis users (210 patients and 156 non-patients; 34% female; ages 18-26 at baseline) were surveyed annually across six waves. Longitudinal latent class analysis derived groups from two factors - cannabis patient status and self-reported medicinal use. Trajectories of health symptoms, cannabis use motives, and cannabis use (daily/near daily use, concentrate use, and problematic use) were estimated across groups.Results: Three longitudinal latent classes emerged: Recreational Users (39.3%) - low self-reported medicinal use and low-to-decreasing patient status; Recreational Patients (40.4%) - low self-reported medicinal use and high-to-decreasing patient status; Medicinal Patients (20.3%) - high self-reported medicinal use and high-to-decreasing patient status. At baseline, Medicinal Patients had higher levels of physical health symptoms and motives than recreational groups (p < .05); both patient groups reported higher level of daily/near daily and concentrate use (p < .01). Over time, mental health symptoms increased in recreational groups (p < .05) and problematic cannabis use increased among Recreational Patients (p < .01).Conclusions: During the transition to legalized adult-use, patterns of medicinal cannabis use varied among young adults. Clinicians should monitor increases in mental health symptoms and cannabis-related problems among young adults who report recreational - but not medicinal - cannabis use.
Collapse
Affiliation(s)
- Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Carolyn F Wong
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Omolola A Odejimi
- Department of Educational Psychology, Leadership and Higher Education, College of Education, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Ekaterina V Fedorova
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Bridgid M Conn
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
5
|
Dapari R, Mahfot MH, Mohd Nazan AIN, Hassan MR, Che Dom N, Syed Abdul Rahim SS. Acceptance towards decriminalization of medical marijuana among adults in Selangor, Malaysia. PLoS One 2022; 17:e0262819. [PMID: 35143493 PMCID: PMC8830660 DOI: 10.1371/journal.pone.0262819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The issue of decriminalization of medical marijuana has gained public attention globally due to the decisions of various governments in developed and developing countries who have decriminalized marijuana for medical purposes. The action was the result of the change in perception towards medical marijuana use, which is now believed to be safe, acceptable, and should be decriminalized. Due to the progress of modernization and the wide access to information, the change in perception towards medical marijuana seems to be inevitable and might have already permeated among the public in Malaysia. However, at the moment there is no baseline data to determine any of this claim. Objective To determine the prevalence and factors associated with acceptance towards decriminalization of medical marijuana among adults in Selangor, Malaysia. Methodology The study was a cross-sectional study conducted in year 2021 among 462 adults aged 18 years old and above in Selangor, Malaysia. The respondents were sampled using a multistage random sampling. The data was collected via self-administered questionnaires and has been analyzed using SPSS version 25. Result More than half of the respondents in this study (64.7%) show acceptance towards the decriminalization of medical marijuana in Malaysia. The results of statistical tests indicate that there are significant associations between age (p < 0.001), gender (p = 0.005), ethnicity (p < 0.012), level of education (p < 0.011), employment status (p = 0.001), ever smoked (p < 0.001), given up smoking (p = 0.002), ever used substance (p < 0.001), current substance use (p < 0.001), given up substance (p < 0.001), exposure to medical marijuana-related content (p < 0.001), perceived risk associated with medical marijuana use (p < 0.001), perceived risk of harm of medical marijuana use (p < 0.001), and perceived approval of medical marijuana use (p < 0.001) with acceptance towards decriminalization of medical marijuana. The predictors for acceptance towards decriminalization of medical marijuana are perceived high approval of medical marijuana use (aOR = 7.023, p < 0.001, 95%CI = 3.534,13.955), perceived low risk of medical marijuana (aOR = 5.716, p < 0.001, 95%CI = 2.828,11.554), perceived low risk of harm from medical marijuana use (aOR = 3.480, p = 0.001, 95%CI = 1.702,7.114), current substance use (aOR = 2.264, p = 0.050, 95%CI = 1.001,5.118), and ever used substance (aOR = 2.005, p = 0.004, 95% CI = 0.054,0.576). Conclusion The results of the survey show that the current acceptance level towards decriminalization of medical marijuana is considerably high. However, the acceptance is mainly among those who are exposed to the substance and those who perceive low risk of medical marijuana. Thus, a further exploration of this phenomenon is needed, especially by increasing the sample size and expanding the study location to other states.
Collapse
Affiliation(s)
- Rahmat Dapari
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- * E-mail:
| | - Mohd Hafizuddin Mahfot
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Ahmad Iqmer Nashriq Mohd Nazan
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Nazri Che Dom
- Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Syed Sharizman Syed Abdul Rahim
- Public Health Medicine Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| |
Collapse
|
6
|
Vuolo M, Lindsay SL, Kelly BC. Further Consideration of the Impact of Tobacco Control Policies on Young Adult Smoking in Light of the Liberalization of Cannabis Policies. Nicotine Tob Res 2022; 24:60-68. [PMID: 34272870 PMCID: PMC8666115 DOI: 10.1093/ntr/ntab149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Changing patterns of cannabis consumption related to the liberalization of cannabis policies may have a countervailing effect on tobacco use. We analyzed whether cannabis policies have tempered the effects of tobacco control policies as well as the extent to which they were associated with young adult cigarette smoking. AIMS AND METHODS Combining data on tobacco and cannabis policies at the state, county, and city levels with the nationally-representative geocoded National Longitudinal Survey of Youth 1997 and Census data, we use multilevel regression and fixed effect analyses to examine the impact of cannabis policies on any past 30-day cigarette smoking, frequency of smoking, and past 30-day near-daily smoking among young adults while accounting for community and individual covariates. RESULTS Tobacco control policies, including significant effects of comprehensive smoking bans, total vending machine restrictions, single cigarette sale restrictions, and advertising restrictions, remain robust in reducing young adult smoking, net of cannabis policy liberalization, including the legal status of possession, penalties for sale, and medical cannabis. Cannabis policies do not directly affect young adult smoking patterns in an adverse way. CONCLUSIONS This paper provides evidence that the liberalization of cannabis laws has not adversely affected the efficacy of tobacco control efforts. IMPLICATIONS While the effects of tobacco control policies on smoking are well-established, little research has considered how the liberalization of cannabis policies may affect these relationships, which is important given the co-use of these substances. This paper provides evidence that the liberalization of cannabis laws has not adversely affected tobacco control efforts.
Collapse
Affiliation(s)
- Mike Vuolo
- Department of Sociology, Ohio State University, Columbus, OH, USA
| | - Sadé L Lindsay
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
| | - Brian C Kelly
- Department of Sociology, Purdue University, West Lafayette, IN, USA
| |
Collapse
|
7
|
Greenberg R, Goldberg A, Anthony S, Buchman DZ, Delaney S, Gruben V, Holdsworth S, Le Foll B, Leung M, Lien D, Lynch MJ, Selzner N, Chandler JA, Fortin MC. Canadian Society of Transplantation White Paper: Ethical and Legal Considerations for Alcohol and Cannabis Use in Solid Organ Listing and Allocation. Transplantation 2021; 105:1957-1964. [PMID: 33587429 PMCID: PMC8376271 DOI: 10.1097/tp.0000000000003618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
Alcohol and cannabis use as a contraindication to organ transplantation is a controversial issue. Until recently, patients in Canada with alcohol-associated liver disease were required to demonstrate abstinence for 6 mo to receive a liver transplant. There is no equivalent rule that is applied consistently for cannabis use. There is some evidence that alcohol and cannabis use disorder pretransplant could be associated with worse outcomes posttransplantation. However, early liver transplantation for patients with alcohol-associated liver disease in France and in the United States has led to challenges of the 6-mo abstinence rule in Canada in the media. It has also resulted in several legal challenges arguing that the rule violates human rights laws regarding discrimination in the provision of medical services and that the rule is also unconstitutional (this challenge is still before the court). Recent legalization of cannabis use for adults in Canada has led to questions about the appropriateness of limiting transplant access based on cannabis use. The ethics committee of the Canadian Society of Transplantation was asked to provide an ethical analysis of cannabis and alcohol abstinence policies. Our conclusions were as follows: neither cannabis use nor the 6-mo abstinence rule for alcohol use should be an absolute contraindication to transplantation, and transplant could be offered to selected patients, further research should be conducted to ensure evidence-based policies; and the transplant community has a duty not to perpetuate stigma associated with alcohol and cannabis use disorders.
Collapse
Affiliation(s)
- Rebecca Greenberg
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Aviva Goldberg
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Samantha Anthony
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada
| | - Daniel Z. Buchman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | | | - Vanessa Gruben
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Sandra Holdsworth
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Bernard Le Foll
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Dale Lien
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Marie-Josee Lynch
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Research Institute, Toronto, ON, Canada
| | - Nazia Selzner
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Toronto General Research Institute, Toronto, ON, Canada
| | - Jennifer A. Chandler
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Chantal Fortin
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Centre de recherche du CHUM, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, QC, Canada
| |
Collapse
|
8
|
Kanniah G, Kumar S. Cannabis legalisation: should doctors be concerned? N Z Med J 2021; 134:84-90. [PMID: 34239164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A referendum on the Cannabis Legalisation and Control Bill was held in New Zealand. The Bill was meant to oversee government control over the production, supply and use of cannabis and reduce cannabis-related harm. Public health control was proposed over cannabis market by imposing licenses and cultivation, the quality and strength of marketed cannabis, and sale restrictions. Under this Bill, cannabis was only meant to be available to adults aged over 20 years through licenced stores. The potency of cannabis was to be limited. Cannabis use and was going to be permitted in private homes and specifically licensed premises. The Electoral Commission announced on 6 November 2020 that 50.7% of voters opposed the Bill and 48.4% supported it. Despite the outcome of the referendum, legalisation of cannabis may remain a live issue for many people, and doctors need to have an informed view about the impact of legalisation on mental health conditions. Experience from other countries shows that access to and potency of cannabis increased with legalisation. Despite the intent to prevent harm, cannabis legislation has been associated with adverse effects on mental health, emergency hospital presentations and crime. Public health strategies, including educating public about harm associated with cannabis, surveillance of potency and labelling, increasing minimal age for legal recreational cannabis use and bolstering treatment capacity for problematic cannabis use, including those with psychiatric disorders, should be funded by revenue generated from cannabis legislation.
Collapse
Affiliation(s)
- Guna Kanniah
- M.Clin.Pharm.,PG Cert.Psychopharmacotherapy, Senior Clinical Pharmacist, Mental Health and Addictions Services, Waikato Hospital, PO Box 3200 Hamilton, New Zealand
| | - Shailesh Kumar
- FRANZCP, MRCPsych, MPhil (London), DPM, Dip CBT, MD (Auck), Consultant Psychiatrist, Midland Regional Forensic Psychiatric Service, Honorary Clinical Associate Professor, University of Auckland
| |
Collapse
|
9
|
Melaragno JI, Bowman LJ, Park JM, Lourenco LM, Doligalski CT, Brady BL, Descourouez JL, Chandran MM, Nickels MW, Page RL. The Clinical Conundrum of Cannabis: Current Practices and Recommendations for Transplant Clinicians: An Opinion of the Immunology/Transplantation PRN of the American College of Clinical Pharmacy. Transplantation 2021; 105:291-299. [PMID: 32413017 DOI: 10.1097/tp.0000000000003309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cannabis, or marijuana, comprises many compounds with varying effects. It has become a treatment option for chronic diseases and debilitating symptoms, and evidence suggests that it has immunomodulatory and antiinflammatory properties. Transplant centers are more frequently facing issues about cannabis, as indications and legalization expand. As of February 2020, 33 states and the District of Columbia have legalized medical cannabis, and 14 have legalized recreational cannabis. Moreover, 8 states have passed legislation prohibiting the denial of transplant listing solely based on cannabis use. Studies demonstrate the potential for significant pharmacokinetic and pharmacodynamic interactions between cannabis and immunosuppression. Additionally, safety concerns include increased risk of myocardial infarction, ischemic stroke, tachyarrhythmias, malignancy, neurocognitive deficits, psychosis, other neuropsychiatric disorders, cannabis use disorder, respiratory symptoms, and infection. A recent retrospective database study found a negative association between documented cannabis use disorder and graft survival, but little additional evidence exists evaluating this relationship. In the absence of robust clinical data, transplant centers need a clear, reasoned, and systematic approach to cannabis. The results of our national survey, unfortunately, found little consensus among institutions. As both recreational and medicinal cannabis become more ubiquitous nationwide, transplant centers will need to develop comprehensive policies to address its use.
Collapse
Affiliation(s)
| | | | - Jeong M Park
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Laura M Lourenco
- Department of Pharmacy Services, University of Chicago Medicine, Chicago, IL
| | | | - Bethany L Brady
- Department of Pharmacy, Indiana University Health University Hospital, Indianapolis, IN
| | | | - Mary M Chandran
- Department of Pharmacy, Children's Hospital Colorado, Aurora, CO
| | - Mark W Nickels
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Robert L Page
- Department of Clinical Pharmacy, University of Colorado, Aurora, CO
| |
Collapse
|
10
|
Abstract
As is the case for most drugs, cannabis use has costs and benefits, and so do the policies that attempt to minimize the first and maximize the second. This article summarizes what we know about the harmful effects of recreational cannabis use and the benefits of medical cannabis use under the policy of prohibition that prevailed in developed countries until 2012. It outlines three broad ways in which cannabis prohibition may be relaxed, namely, the depenalization of personal possession and use, the legalization of medical use, and the legalization of adult recreational use. It reviews evidence to date on the impacts of each of these forms of liberalization on the costs and benefits of cannabis use. It makes some plausible conjectures about the future impacts of the commercialization of cannabis using experience from the commercialization of the alcohol, tobacco, and gambling industries. Cannabis policy entails unavoidable trade-offs between competing social values in the face of considerable uncertainty about the effects that more liberal cannabis policies will have on cannabis use and its consequences for better or worse.
.
Collapse
Affiliation(s)
- Wayne Hall
- The National Centre for Youth Substance Use Research; The Queensland Alliance for Environmental Health Sciences; The University of Queensland, Australia
| |
Collapse
|
11
|
Abstract
BACKGROUND Cannabis is the most widely used drug in Canada. We examined the trends in past-year cannabis consumption by sociodemographic and geographic characteristics. METHODS We conducted a repeated cross-sectional analysis of the Canadian Tobacco Use Monitoring Survey, the Canadian Tobacco, Alcohol and Drugs Survey and the Canadian Alcohol and Drug Use Monitoring Survey from 2004 to 2017. Respondents were aged 15 years and older. Past-year cannabis use was analyzed using multivariable logistic regression and segmented logistic regression. RESULTS We analyzed 289 823 respondents (51% female) between 2004 and 2017. Between 2004 and 2017, the overall prevalence of cannabis use increased from 12.2% (95% confidence interval [CI] 11.0%-13.5%) to 18.7% (95% CI 16.2%-21.5%) among men and from 6.6% (95% CI 5.9%-7.4%) to 11.1% (95% CI 9.4%-13.0%) among women. The crude rate of change was greater between 2011 and 2017 than that between 2004 and 2011 in men (odds ratio [OR] per annual change: 1.08, 95% CI 1.05-1.11) and women (OR 1.11, 95% CI 1.07-1.15). After adjustment for age, education, tobacco smoking and province, the 2011-2017 trend was stronger in men (adjusted OR 1.24, 95% CI 1.05-1.46), but not in women (adjusted OR 1.13, 95% CI 0.93-1.37). Cannabis use was associated with tobacco smoking (OR 4.94, 95% CI 4.65-5.25). Heterogeneity was found in cannabis use trends by age, education and province. Cannabis use decreased among respondents aged 15-19 years and increased in other age groups. INTERPRETATION Cannabis consumption in Canada has increased and varies by sex, age, level of education and geography. Increases vary by sociodemographic factors and may be faster among certain groups. Further studies are warranted post-legalization.
Collapse
Affiliation(s)
- Dana E Lowry
- Ottawa Hospital Research Institute (Lowry, Corsi), University of Ottawa; Faculty of Medicine (Corsi), School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont
| | - Daniel J Corsi
- Ottawa Hospital Research Institute (Lowry, Corsi), University of Ottawa; Faculty of Medicine (Corsi), School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont.
| |
Collapse
|
12
|
Lintzeris N, Mills L, Suraev A, Bravo M, Arkell T, Arnold JC, Benson MJ, McGregor IS. Medical cannabis use in the Australian community following introduction of legal access: the 2018-2019 Online Cross-Sectional Cannabis as Medicine Survey (CAMS-18). Harm Reduct J 2020; 17:37. [PMID: 32513180 PMCID: PMC7278204 DOI: 10.1186/s12954-020-00377-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/06/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In 2016, the Australian federal government passed legislation enabling a range of cannabis-based products to be prescribed to patients by registered healthcare professionals. An online survey conducted immediately prior to these legislative changes found that the vast majority of respondents at the time were illicitly sourcing cannabis plant matter, smoking was the preferred route of administration and mental health, chronic pain, and sleep conditions were the most frequently cited reasons for medical cannabis use. This manuscript reports the results of a follow-up survey conducted in 2018-2019, the Cannabis As Medicine Survey (CAMS-18). The goal of this second questionnaire was to examine patterns of use and consumer perspectives regarding medical cannabis use in Australia, 2 years after the introduction of legal access pathways. METHODS Anonymous online cross-sectional survey with convenience sample, recruited mainly through online media between September 2018 and March 2019. Participants were adults (18 years or over) residing in Australia who reported using a cannabis product for self-identified therapeutic reasons during the preceding 12 months. The survey measured consumer characteristics, indications and patterns of medical cannabis use, routes and frequency of administration, perceived benefits and harms, experiences and preferred models of access to medical cannabis. RESULTS Data were available for 1388 respondents. The main categories of condition being treated with medical cannabis were pain (36.4%), mental health (32.8%), sleep (9.2%), neurological (5.2%) and cancer (3.8%). Respondents reported using medical cannabis on 15.8 (11.2) days in the past 28, by inhaled (71.4%) or oral (26.5%) routes and spending AUD$82.27 ($101.27) per week. There were high levels of self-reported effectiveness, but also high rates of side effects. There was uncertainty regarding the composition of illicit cannabinoid products and concerns regarding their possible contamination. Few respondents (2.7%) had accessed legally prescribed medical cannabis, with the main perceived barriers being cost, disinterest from the medical profession and stigma regarding cannabis use. CONCLUSIONS Chronic pain, mental health and sleep remain the main clinical conditions for which consumers report using medical cannabis. Despite 2 years of legal availability, most consumers in Australia reported accessing illicit cannabis products, with uncertainty regarding the quality or composition of cannabis products.
Collapse
Affiliation(s)
- Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, Kogarah, NSW, Australia.
- Discipline of Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Llewellyn Mills
- Drug and Alcohol Services, South East Sydney Local Health District, Kogarah, NSW, Australia
- Discipline of Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Anastasia Suraev
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Maria Bravo
- Drug and Alcohol Services, South East Sydney Local Health District, Kogarah, NSW, Australia
- Discipline of Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Thomas Arkell
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Jonathon C Arnold
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Discipline of Pharmacology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Melissa J Benson
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Iain S McGregor
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
13
|
Abstract
IMPORTANCE In response to increasing public support for cannabis legalization, understanding associations of state and federal policy changes related to cannabis legalization with patterns of cannabis use is important. A challenge for public health monitoring and research is significant variation in data availability related to cannabis use behaviors and perceptions across and within states and over time, including the availability of prelegalization vs postlegalization data. OBJECTIVE To review data available on cannabis use and related behaviors over time in Massachusetts and the US. DESIGN, SETTING, AND PARTICIPANTS This case series examined state and national surveys on public health and related behaviors and outcomes to review availability of cannabis-related data for Massachusetts for 8 key indicators over time. Additionally, the Behavioral Risk Factor Surveillance System (BRFSS) and Youth Risk Behavior Surveillance System for all states were reviewed. The analysis was conducted between February 1, 2019, and March 18, 2020. EXPOSURES Surveys that enable state-level estimation of cannabis use and related behaviors. MAIN OUTCOMES AND MEASURES Eight key indicators related to cannabis use behaviors and perceptions: lifetime cannabis use, age of initiation, frequency of use, location of use, method of use, source of cannabis, perceptions of cannabis, and reason for use (ie, medical vs nonmedical). RESULTS There were 7 surveys that monitored cannabis use and related behaviors in Massachusetts for adolescents and adults. No surveys monitored all 8 indicators of interest, and availability over time was limited. In the most recent BRFSS, 24 states asked cannabis-related questions, meaning BRFSS data on cannabis use was lacking for more than half of the US adult population. In the Youth Risk Behavior Surveillance System, 36 states asked standard cannabis questions; most other states had at least 1 question related to cannabis use and frequency. CONCLUSIONS AND RELEVANCE These findings of limitations of existing surveys, and particularly the lack of national questions in the BRFSS and Youth Risk Behavior Surveillance System, suggest that available data have substantial limitations for monitoring cannabis use. As cannabis policy changes continue, there is a need to remain focused on the availability of high-quality data sources that allow for critical public health research.
Collapse
Affiliation(s)
- Kimberley H. Geissler
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst
| | - Kia Kaizer
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst
| | | | | | - Jennifer M. Whitehill
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst
| |
Collapse
|
14
|
Boden JM, Cleland L, Dhakal B, Horwood LJ. Attitudes towards cannabis and cannabis law change in a New Zealand birth cohort. N Z Med J 2020; 133:79-88. [PMID: 32438379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIMS Personal cannabis use is common across New Zealand, and an upcoming referendum will enable the public to vote on whether this should be legalised. The present research aimed to examine the attitudes of midlife New Zealand adults on cannabis use and legalisation, and to identify potential predictors of those attitudes. METHODS At age 40, 899 participants drawn from the Christchurch Health and Development Study were interviewed about the perceived harmfulness of cannabis use, opinions on legalisation for recreational use and supply, and the use of cannabis for medicinal purposes. In addition, a range of potential predictors of legislative attitudes were examined. RESULTS We identified a wide range of attitudes across the cohort, however the majority tended to hold a neutral view. More than 80% of the cohort expressed support for medicinal cannabis, while 47.8% supported decriminalisation, and 26.8% expressed support for legalisation for recreational use. The strongest predictors of support for legalisation were prior use of cannabis and other drugs, while additional positive predictors included a history of depression, Māori ancestry, parental drug use, novelty seeking and higher educational attainment. Predictors of more negative attitudes were also identified, and included female gender and having dependent children. CONCLUSIONS These findings provide insight into cannabis-related views within the New Zealand context, and may help to predict voting behaviour during the 2020 Cannabis Referendum.
Collapse
Affiliation(s)
- Joseph M Boden
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, Christchurch
| | - Lana Cleland
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, Christchurch
| | - Bhubaneswor Dhakal
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, Christchurch
| | - L John Horwood
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, Christchurch
| |
Collapse
|
15
|
Rychert M, Wilkins C, Parker K, Graydon-Guy T. Exploring medicinal use of cannabis in a time of policy change in New Zealand. N Z Med J 2020; 133:54-69. [PMID: 32438377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIMS To explore patterns of medicinal cannabis use prior to implementation of the new Medicinal Cannabis Scheme (MCS) in New Zealand. METHODS An anonymous online convenience survey of 3,634 last-year medicinal users of cannabis promoted via Facebook™ from May to August 2019. RESULTS Fifty percent of the sample were female, 18% were Māori and the median age was 38 years. The medical conditions for which cannabis was most often used were pain (81%), sleep (66%) and mental health conditions (64%). Respondents perceived cannabis to be an effective therapy and reported reducing use of other pharmaceutical medicines. Fifty-two percent reported side effects from cannabis use, including increased appetite (29%), drowsiness (12%), eye irritation (11%), dependency (10%), memory impairment (10%) and lack of energy (9%). Smoking was the dominant route of administration. Nearly half (47%) had discussed their use of cannabis with a medical professional in the previous year, while 14% had requested a prescription and 5% accessed a prescribed cannabis-based product (mostly oral CBD). CONCLUSION Respondents self-medicated with cannabis to treat a wide range of health complaints. Only half discussed medicinal cannabis use with their medical professional, and a minority requested a prescription and used a prescribed cannabis-based product.
Collapse
Affiliation(s)
- Marta Rychert
- Senior Research Officer, Shore & Whāriki Research Centre, College of Health, Massey University
| | - Chris Wilkins
- Associate Professor, Shore & Whāriki Research Centre, College of Health, Massey University
| | - Karl Parker
- Statistician, Shore & Whāriki Research Centre, College of Health, Massey University
| | - Thomas Graydon-Guy
- Technical Officer, Shore & Whāriki Research Centre, College of Health, Massey University
| |
Collapse
|
16
|
Valdes-Donoso P, Sumner DA, Goldstein R. Costs of cannabis testing compliance: Assessing mandatory testing in the California cannabis market. PLoS One 2020; 15:e0232041. [PMID: 32324781 PMCID: PMC7179872 DOI: 10.1371/journal.pone.0232041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/05/2020] [Indexed: 11/18/2022] Open
Abstract
Most U.S. states that have regulated and taxed cannabis have imposed some form of mandatory safety testing requirements. In California, the country's largest and oldest legal cannabis market, mandatory testing was first enforced by state regulators in July 2018, and additional mandatory tests were introduced at the end of 2018. All cannabis must be tested and labeled as certified by a state-licensed cannabis testing laboratory before it can be legally marketed in California. Every batch that is sold by licensed retailers must be tested for more than 100 contaminants, including 66 pesticides with tolerance levels lower than the levels allowable for any other agricultural product in California. This paper estimates the costs of compliance with mandatory cannabis testing laws and regulations, using California's testing regime as a case study. We use state government data, data collected from testing laboratories, and data collected from lab equipment suppliers to run a set of Monte Carlo simulations and estimate the cost per pound of compliance with California's new cannabis testing regulations. We find that cost per pound is highly sensitive to average batch size and testing failure rates. We present results under a variety of different assumptions about batch size and failure rates. We also find that under realistic assumptions, the loss of cannabis that must be destroyed if a batch fails testing accounts for a larger share of total testing costs than does the cost of the lab tests. Using our best estimates of average batch size (8 pounds) and failure rate (4%) in the 2019 California market, we estimate testing cost at $136 per pound of dried cannabis flower, or about 10 percent of the reported average wholesale price of legal cannabis in the state. Our findings explain effects of the testing standards on the cost of supplying legal licensed cannabis, in California, other U.S. states, and foreign jurisdictions with similar testing regimes.
Collapse
Affiliation(s)
- Pablo Valdes-Donoso
- Agricultural Issues Center, University of California, Davis, California, United States of America
- * E-mail:
| | - Daniel A. Sumner
- Agricultural Issues Center, University of California, Davis, California, United States of America
- Department of Agriculture and Resource Economics, University of California Davis, Davis, California, United States of America
| | - Robin Goldstein
- Agricultural Issues Center, University of California, Davis, California, United States of America
| |
Collapse
|
17
|
Wing C, Bradford AC, Carroll AE, Hollingsworth A. Association of State Marijuana Legalization Policies for Medical and Recreational Use With Vaping-Associated Lung Disease. JAMA Netw Open 2020; 3:e202187. [PMID: 32250431 PMCID: PMC7136834 DOI: 10.1001/jamanetworkopen.2020.2187] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This cross-sectional study evaluates the association between marijuana legalization policies and vaping-associated lung disease in states with recreational, medical, or prohibited marijuana use.
Collapse
Affiliation(s)
- Coady Wing
- O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington
| | - Ashley C. Bradford
- O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington
| | | | - Alex Hollingsworth
- O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington
| |
Collapse
|
18
|
Smyth BP, Cannon M, Molodynski A, Curran HV, Eastwood N, Winstock AR. Would decriminalising personal use of cannabis lead to higher rates of mental illness? BMJ 2020; 368:l6975. [PMID: 31941646 DOI: 10.1136/bmj.l6975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Mary Cannon
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | | |
Collapse
|
19
|
Gottlieb S. Pot Legalization Makes Vaping Deadly. Mo Med 2020; 117:9-10. [PMID: 32158031 PMCID: PMC7023940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Scott Gottlieb
- Scott Gottlieb, MD, a resident fellow at the American Enterprise Institute, served as Commissioner of the Food and Drug Administration, 2017-19. He consults with and invests in drug makers
| |
Collapse
|
20
|
McMichael BJ, Van Horn RL, Viscusi WK. The impact of cannabis access laws on opioid prescribing. J Health Econ 2020; 69:102273. [PMID: 31865260 DOI: 10.1016/j.jhealeco.2019.102273] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 07/17/2019] [Accepted: 12/07/2019] [Indexed: 05/28/2023]
Abstract
While recent research has shown that cannabis access laws can reduce the use of prescription opioids, the effect of these laws on opioid use is not well understood for all dimensions of use and for the general United States population. Analyzing a dataset of over 1.5 billion individual opioid prescriptions between 2011 and 2018, which were aggregated to the individual provider-year level, we find that recreational and medical cannabis access laws reduce the number of morphine milligram equivalents prescribed each year by 11.8 and 4.2 percent, respectively. These laws also reduce the total days' supply of opioids prescribed, the total number of patients receiving opioids, and the probability a provider prescribes any opioids net of any offsetting effects. Additionally, we find consistent evidence that cannabis access laws have different effects across types of providers, physician specialties, and payers.
Collapse
Affiliation(s)
- Benjamin J McMichael
- Assistant Professor of Law, University of Alabama School of Law, Box 870382, 101 Paul W. Bryant Drive East, Tuscaloosa, AL, 35487, United States.
| | - R Lawrence Van Horn
- Associate Professor of Management and Law, Executive Director of Health Affairs, Owen Graduate School of Management, Vanderbilt University, 401 21st Avenue South, Nashville, TN, 37203, United States.
| | - W Kip Viscusi
- University Distinguished Professor of Law, Economics, and Management, Vanderbilt University Law School. 131 21st Avenue South, Nashville, TN, 37203, United States.
| |
Collapse
|
21
|
López-Valdés JC, González-Negrete E, López-Valdés E. Marijuana in Mexico, recreational drug or medicine? Rev Colomb Psiquiatr (Engl Ed) 2020; 49:3-4. [PMID: 32081206 DOI: 10.1016/j.rcp.2019.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/08/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Julio César López-Valdés
- Departamento de Investigación, Facultad de Medicina de Tampico Dr. Alberto Romo Caballero, Universidad Autónoma de Tamaulipas, Tampico, Tamaulipas, México.
| | | | | |
Collapse
|
22
|
Berenson A. Weeding Out Dubious Marijuana Science. Mo Med 2019; 116:352. [PMID: 31645772 PMCID: PMC6797028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Alex Berenson
- Alex Berenson is a former New York Times reporter and author of 12 novels
| |
Collapse
|
23
|
Abstract
Marijuana is the most widely consumed illicit substance in the United States, and an increasing number of states have legalized it for both medicinal and recreational purposes. As it becomes more readily available, there will be a concurrent rise in the number of users and, consequently, the number of motor vehicle operators driving under the influence. This article examines the cognitive and psychomotor effects of cannabis, as well as current policy concerning driving under the influence of drugs. The authors performed a MEDLINE search on the epidemiology of cannabis use, its cognitive and psychomotor effects, and policies regarding driving under the influence of drugs. Twenty-eight epidemiological studies, 16 acute cognitive and psychomotor studies, 8 chronic cognitive and psychomotor studies, and pertinent state and federal laws and policies were reviewed. These search results revealed that marijuana use is associated with significant cognitive and psychomotor effects. In addition, the legalization of marijuana varies from state to state, as do the laws pertaining to driving under the influence of drugs. Marijuana is a commonly found illicit substance in motor vehicle operators driving under the influence of drugs. Current evidence shows that blood levels of tetrahydrocannabinol do not correlate well with the level of impairment. In addition, although acute infrequent use of cannabis typically leads to cognitive and psychomotor impairment, this is not consistently the case for chronic heavy use. To establish the framework for driving under the influence of cannabis policy, we must review the current published evidence and examine existing policy at state and federal levels.
Collapse
Affiliation(s)
- Robert M Chow
- From the Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | | | - Winfred B Abrams
- Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nathalie A Peiris
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charles A Odonkor
- Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Steven P Cohen
- Department of Anesthesiology, Neurology and Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Anesthesiology and Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| |
Collapse
|
24
|
Abstract
OBJECTIVE Canada federally legalised recreational cannabis use among adults in October 2018. The impact this will have on Canadian youth is cause for concern. The current study examined changes in youth cannabis use over the time prior to legalisation to explore the impact of the beginning federal discourse around legalisation during the 2016/2017 school year. DESIGN COMPASS, a prospective cohort study based on annual self-administered questionnaires. SETTING Ontario and Alberta during the first 6 years of the COMPASS study (2012/2013 to 2017/2018). PARTICIPANTS Canadian grade 9-12 students attending secondary schools participating in COMPASS. In total, 2 30 404 questionnaires were included in the analysis (Y1: 2012/2013, n=24 173; Y2: 2013/2014, n=45 298; Y3: 2014/2015, n=42 355, Y4: 2015/2016, n=40 436; Y5: 2016/2017, n=37 060; Y6: 2017/2018, n=34 897). PRIMARY AND SECONDARY OUTCOME MEASURES Lifetime cannabis use, past-year cannabis use, weekly cannabis use, ease of access to cannabis and age at first cannabis use. RESULTS Cannabis never-use decreased between Y5 and Y6. Changes in age at first cannabis use mirrored this trend, with male students consistently starting younger. Cannabis access rates increased from Y4, mainly led by female students. Lifetime and past-year use rates were lowest in Y4 then increased in Y5 and Y6 due to a rise in the occasional use more common among female students, who reported use increases first. Non-white students were more likely use cannabis, with black and Aboriginal students the only two groups consistently reporting more weekly than occasional use, though with opposing trajectories. Overall, Aboriginal students had the highest odds of reporting lifetime, past-year and weekly use among the demographic groups examined. CONCLUSION After a steady decrease in patterns of cannabis among youth over several years, it appears that there has been a gradual increase in cannabis use among youth following the start of discourse around cannabis legalisation, with some populations of youth being at greater risk.
Collapse
Affiliation(s)
- Alexandra M E Zuckermann
- Applied Research Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo Faculty of Applied Health Sciences, Waterloo, Ontario, Canada
| | - Katelyn Battista
- School of Public Health and Health Systems, University of Waterloo Faculty of Applied Health Sciences, Waterloo, Ontario, Canada
| | - Margaret de Groh
- Applied Research Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Ying Jiang
- Applied Research Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo Faculty of Applied Health Sciences, Waterloo, Ontario, Canada
| |
Collapse
|
25
|
Fix BV, Smith D, O'Connor R, Heckman BW, Willemsen MC, Cummings M, Fong G. Cannabis use among a nationally representative cross-sectional sample of smokers and non-smokers in the Netherlands: results from the 2015 ITC Netherlands Gold Magic Survey. BMJ Open 2019; 9:E024497. [PMID: 30833306 PMCID: PMC6443198 DOI: 10.1136/bmjopen-2018-024497] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Existing evidence shows that co-occurring use of tobacco and cannabis is widespread. Patterns of co-use of tobacco and cannabis may change as more jurisdictions legalise medicinal and/or recreational cannabis sales. This analysis examined predictors of current cannabis use and characterised methods of consumption among smokers and non-smokers in a context where cannabis use is legal. SETTING The 2015 International Tobacco Control Netherlands-Gold Magic Survey conducted between July and August 2015. PARTICIPANTS Participants (n=1599; 1003 current smokers, 283 former smokers and 390 non-smokers) were asked to report their current (past 30-day) use of cigarettes and cannabis. Cigarette smokers reported whether they primarily used factory made of roll-your-own cigarettes. Those who reported any cannabis use in the last 30 days were asked about forms of cannabis used. X2and logistic regression analyses were used to assess relationships among combustible tobacco and cannabis use. RESULTS Past 30-day cannabis use was somewhat higher among current tobacco (or cigarette) smokers (n=57/987=5.8%) than among former or never smokers (n=10/288=3.5% and n=6/316=1.9%, respectively). Joints were the most commonly used form of cannabis use for both current cigarette smokers (96.9%) and non-smokers (76.5%). Among those who smoked cannabis joints, 95% current smokers and 67% of non-smokers reported that they 'always' roll cannabis with tobacco. CONCLUSIONS In this Netherlands-based sample, most cannabis was reported to be consumed via smoking joints, most often mixed with tobacco. This behaviour may present unique health concerns for non-cigarette smoking cannabis users, since tobacco use could lead to nicotine dependence. Moreover, many non-cigarette smoking cannabis users appear to be misclassified as to their actual tobacco/nicotine exposure.
Collapse
Affiliation(s)
- Brian Vincent Fix
- Department of Health Behaviour, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Danielle Smith
- Department of Health Behaviour, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Richard O'Connor
- Department of Health Behaviour, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marc C Willemsen
- STIVORO, The Hague, The Netherlands
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Geoffrey Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| |
Collapse
|
26
|
Manolis AS, Manolis TA. Recommending marijuana use: Violation of the Hippocratic aphorism of "do good or do no harm". Eur J Intern Med 2019; 61:e14-e15. [PMID: 30686659 DOI: 10.1016/j.ejim.2019.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/10/2019] [Accepted: 01/20/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Greece.
| | | |
Collapse
|
27
|
Wilkins C, Rychert M, Romeo JS, Randerson S. Smoke in our eyes: the Sense Partners' evaluation of the legalisation of cannabis in New Zealand. N Z Med J 2019; 132:6-9. [PMID: 30789883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Chris Wilkins
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland
| | - Marta Rychert
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland
| | - Jose S Romeo
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland
| | - Steve Randerson
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland
| |
Collapse
|
28
|
Affiliation(s)
- Wayne Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Queensland, Australia; National Addiction Centre, King's College London, London, UK
| |
Collapse
|
29
|
Neu P. [Discussing possible new regulations in german cannabis policy with special regard to the experiences in the Netherlands and Colorado]. Fortschr Neurol Psychiatr 2018; 86:428-433. [PMID: 30029281 DOI: 10.1055/s-0044-100504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In Deutschland wird seit einiger Zeit zunehmend über eine neue Cannabispolitik nachgedacht. Von vielen Seiten wird die Forderung nach einer Liberalisierung oder Freigabe des Cannabis laut. Der vorliegende Artikel fasst die wichtigsten Erfahrungen der Cannabis-Politik aus den Niederlanden und dem US-Bundesstaat Colorado zusammen und versucht, daraus Schlussfolgerungen für eine mögliche Neuregulierung der Cannabispolitik in Deutschland abzuleiten.
Collapse
Affiliation(s)
- Peter Neu
- Jüdisches Krankenhaus Berlin Akademisches Lehrkrankenhaus der Charite - Universitätsmedizin Berlin
| |
Collapse
|
30
|
Parnes JE, Smith JK, Conner BT. Reefer madness or much ado about nothing? Cannabis legalization outcomes among young adults in the United States. Int J Drug Policy 2018; 56:116-120. [PMID: 29626630 DOI: 10.1016/j.drugpo.2018.03.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/24/2018] [Accepted: 03/13/2018] [Indexed: 11/15/2022]
Abstract
In 2012, Colorado became one of the first two U.S. States to legalize cannabis for recreational use for adults 21 and older. Given that cannabis use holds potential physical and mental health risks, particularly among adolescent users, concerns have grown regarding changes in use following this change in policy. Studies examining medical cannabis legalization have found inconsistent changes in cannabis use and prevalence of dependence following medical implementation. However, recreational legalization holds potential unique changes, such as increased availability and social acceptance, as well as decreased price and perceived harm of use. There also may be increased interest in moving to Colorado related to the changes in cannabis laws. Based on past literature, two hypotheses were made for this study. First, college student cannabis use would increase after recreational legalization, however just for those 21 years old and older. Second, there would be a positive relation between the influence of cannabis legislation on out-of-State student's decision to attend a Colorado university and their cannabis use. Data from 5241 undergraduate students was available to test study hypotheses using Pearson's Chi-square, negative binomial regressions, and path analysis. Results indicated that cannabis use increased since recreational legalization for all students, but more so for those over 21 years. No differences in past month use frequency were found between pre- and post-legalization. Influence of cannabis laws on non-resident student's decision to attend a Colorado college predicted lifetime and past 30-day use. Additionally, out-of-State students reported higher past 30-day use than in-State students. These findings may help inform other States considering recreational legalization of potential outcomes, as well as potential interventions.
Collapse
Affiliation(s)
- Jamie E Parnes
- Department of Psychology, Colorado State University, 1876 Campus Delivery, Fort Collins, CO 80523, USA.
| | - Joey K Smith
- Department of Psychology, Colorado State University, 1876 Campus Delivery, Fort Collins, CO 80523, USA.
| | - Bradley T Conner
- Department of Psychology, Colorado State University, 1876 Campus Delivery, Fort Collins, CO 80523, USA.
| |
Collapse
|
31
|
Barker J. Review of the public health risks of widespread cannabis use. R I Med J (2013) 2018; 101:22-25. [PMID: 29608631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article is a review of the public health risks of widespread cannabis use based on a recent review of the literature. The purpose of this article is to help physicians better educate the public about the dangers of widespread cannabis products.
Collapse
Affiliation(s)
- Jonathan Barker
- Clinical Assistant Professor of Psychiatry and Human Behavior, Alpert Medical School of Brown University; Assistant Clinical Professor of Psychiatry, Tufts University School of Medicine
| |
Collapse
|
32
|
Potvin L. Apprendre de l'expérience : Learning from experience. Can J Public Health 2018; 109:153-154. [PMID: 29981044 PMCID: PMC6964503 DOI: 10.17269/s41997-018-0093-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Louise Potvin
- École de santé publique, Université de Montréal, Montreal, QC, Canada.
| |
Collapse
|
33
|
Powell D, Pacula RL, Jacobson M. Do medical marijuana laws reduce addictions and deaths related to pain killers? J Health Econ 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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
34
|
Barker J. Clinical Challenges in the Growing Medical Marijuana Field. R I Med J (2013) 2018; 101:12-13. [PMID: 29490316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Unique clinical challenges arise with the growing number of patients who possess medical marijuana cards. Medical marijuana patients with mental disorders can have worsening symptoms with marijuana use. Often there is sparse continuity of care between the patient and the medical marijuana practitioner. Lack of communication between the patient's treating practitioners and the practitioner who has authorized the medical marijuana can be problematic. This article is a discussion of the new clinical challenges practitioners are likely to encounter with the growing number of medical marijuana patients.
Collapse
Affiliation(s)
- Jonathan Barker
- Clinical Assistant Professor of Psychiatry and Human Behavior, Alpert Medical School of Brown University; Assistant Clinical Professor of Psychiatry, Tufts University School of Medicine
| |
Collapse
|
35
|
Abstract
Science needs to drive our thinking as we navigate a new legislative environment in which many Americans have access to marijuana for therapeutic or recreational use. With the responsibility to fund, conduct, and make use of the research on marijuana, and understand the impacts of new policies, comes the obligation of not thinking in simplistic, black-and-white terms about this substance. The drug's unique harms include neurodevelopmental impacts that may be long lasting or permanent, yet some evidence suggests the drug may benefit people with certain medical conditions (e.g., chronic pain). Marijuana use is also entangled with other substance use and should not be considered in isolation. Finally, policy options are not limited to the extremes of prohibition vs. full commercialization; a spectrum of intermediate options can and should be considered and evaluated as states create new policies around this drug.
Collapse
Affiliation(s)
- Susan R B Weiss
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA.
| | - Eric M Wargo
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
36
|
Aguinaco A, Barra A. Cannabis for personal use in the Supreme Court of Mexico: Legal case and potential for policy change. Int J Drug Policy 2017; 50:9-10. [PMID: 28957741 DOI: 10.1016/j.drugpo.2017.07.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 06/29/2017] [Accepted: 07/26/2017] [Indexed: 11/19/2022]
|
37
|
Kalant H. Broad Thinking: An Interview With Harold Kalant. J Stud Alcohol Drugs 2017; 78:158-165. [PMID: 27936377 DOI: 10.15288/jsad.2017.78.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In this interview, Harold Kalant, M.D., Ph.D., professor emeritus at the University of Toronto, talks about his career in addiction science; his professional associations with E. M. Jellinek, Griffith Edwards, and other luminaries; the growth of the addiction field; and the issue of cannabis legalization in Canada, among other topics.
Collapse
|
38
|
Abstract
Cannabis use and related problems are on the rise globally alongside an increase in the potency of cannabis sold on both black and legal markets. Additionally, there has been a shift towards abandoning prohibition for a less punitive and more permissive legal stance on cannabis, such as decriminalisation and legalisation. It is therefore crucial that we explore new and innovative ways to reduce harm. Research has found cannabis with high concentrations of its main active ingredient, δ-9-tetrahydrocannabinol (THC), to be more harmful (in terms of causing the main risks associated with cannabis use, such as addiction, psychosis, and cognitive impairment) than cannabis with lower concentrations of THC. By contrast, cannabidiol, which is a non-intoxicating and potentially therapeutic component of cannabis, has been found to reduce the negative effects of cannabis use. Here, we briefly review findings from studies investigating various types of cannabis and discuss how future research can help to better understand and reduce the risks of cannabis use.
Collapse
Affiliation(s)
- Amir Englund
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Tom P Freeman
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
39
|
Dilley JA, Hitchcock L, McGroder N, Greto LA, Richardson SM. Community-level policy responses to state marijuana legalization in Washington State. Int J Drug Policy 2017; 42:102-108. [PMID: 28365192 PMCID: PMC5473373 DOI: 10.1016/j.drugpo.2017.02.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 01/26/2017] [Accepted: 02/24/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Washington State (WA) legalized a recreational marijuana market - including growing, processing and retail sales - through voter initiative 502 in November 2012. Legalized recreational marijuana retail sales began in July 2014. In response to state legalization of recreational marijuana, some cities and counties within the state have passed local ordinances that either further regulated marijuana markets, or banned them completely. The purpose of this study is to describe local-level marijuana regulations on recreational retail sales within the context of a state that had legalized a recreational marijuana market. METHODS Marijuana-related ordinances were collected from all 142 cities in the state with more than 3000 residents and from all 39 counties. Policies that were in place as of June 30, 2016 - two years after the state's recreational market opening - to regulate recreational marijuana retail sales within communities were systematically coded. RESULTS A total of 125 cities and 30 counties had passed local ordinances to address recreational marijuana retail sales. Multiple communities implemented retail market bans, including some temporary bans (moratoria) while studying whether to pursue other policy options. As of June 30, 2016, 30% of the state population lived in places that had temporarily or permanently banned retail sales. Communities most frequently enacted zoning policies explicitly regulating where marijuana businesses could be established. Other policies included in ordinances placed limits on business hours and distance requirements (buffers) between marijuana businesses and youth-related land use types or other sensitive areas. CONCLUSIONS State legalization does not necessarily result in uniform community environments that regulate recreational marijuana markets. Local ordinances vary among communities within Washington following statewide legalization. Further study is needed to describe how such local policies affect variation in public health and social outcomes.
Collapse
Affiliation(s)
- Julia A Dilley
- Multnomah County Health Department and Oregon Public Health Division, Program Design & Evaluation Services, 800 NE Oregon Street, Suite 260, Portland, OR 97232, USA.
| | - Laura Hitchcock
- Public Health-Seattle & King County Assessment, Policy Development & Evaluation Unit, 401 Fifth Avenue, Ste. 1300, Seattle, WA 98104-1823, USA
| | - Nancy McGroder
- Public Health-Seattle & King County Assessment, Policy Development & Evaluation Unit, 401 Fifth Avenue, Ste. 1300, Seattle, WA 98104-1823, USA
| | - Lindsey A Greto
- King County Assessment, Policy Development & Evaluation Unit and Chronic Disease & Injury Prevention Unit, 401 Fifth Avenue, Ste. 1300, Seattle, WA 98104-1823, USA
| | - Susan M Richardson
- Multnomah County Health Department and Oregon Public Health Division, Program Design & Evaluation Services, 800 NE Oregon Street, Suite 260, Portland, OR 97232, USA
| |
Collapse
|
40
|
Chan MH, Knoepke CE, Cole ML, McKinnon J, Matlock DD. Colorado Medical Students' Attitudes and Beliefs About Marijuana. J Gen Intern Med 2017; 32:458-463. [PMID: 28097606 PMCID: PMC5377890 DOI: 10.1007/s11606-016-3957-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/14/2016] [Accepted: 12/02/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Over the past two decades, state and local governments across the U.S. have been increasingly reforming marijuana laws. Despite growing support for marijuana as a medical treatment, little is known about medical students' perceptions of marijuana use. OBJECTIVE To assess Colorado medical students' personal and professional opinions on current and future marijuana use in a healthcare setting. DESIGN A voluntary, anonymous, online cross-sectional survey. PARTICIPANTS Medical students (n = 624) at the University of Colorado School of Medicine between January and February 2014 were invited to participate. MAIN MEASURES Numerical responses were quantified using counts and percentages, and Likert scale responses were collapsed for bivariate analysis. Items were gathered thematically and additively scored for each subscale. Internal consistency reliability statistics were calculated for each subscale to ensure that items were assessing similar constructs. Unadjusted t tests and one-way analysis of variance (ANOVA) were used to calculate mean differences in subscale scores between subgroups. KEY RESULTS We received 236 responses (37%). Students indicated support for marijuana legalization (64%), and few believed that physicians should be penalized for recommending marijuana to patients (6%). Nearly all (97%) believed that further marijuana research should be conducted, and believed marijuana could play a role in the treatment of various medical conditions. Seventy-seven percent reported that they believed marijuana use had the potential for psychological harm, and 68% indicated concern for potential physical harm. Only a minority of students would recommend marijuana to a patient under current law (29%), or if it were legally available (45%). Acceptability of marijuana for treatment of approved conditions was not correlated with age or gender, but was positively correlated with living in Colorado prior to medical school (p < 0.001) and with prior marijuana use (p < 0.001). CONCLUSIONS Medical students support marijuana legal reform, medicinal uses of marijuana, and increased research, but have concerns regarding risks of marijuana use, and appear hesitant to recommend marijuana to patients.
Collapse
Affiliation(s)
- Michael H Chan
- University of Colorado School of Medicine, 13199 E. Montview Blvd., Suite 210; Mail Stop F443, Aurora, CO, 80045, USA
- University of Texas Health Sciences Center at Houston, Houston, TX, 77030, USA
| | - Christopher E Knoepke
- University of Colorado School of Medicine, 13199 E. Montview Blvd., Suite 210; Mail Stop F443, Aurora, CO, 80045, USA
| | - Madeline L Cole
- University of Colorado School of Medicine, 13199 E. Montview Blvd., Suite 210; Mail Stop F443, Aurora, CO, 80045, USA
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - James McKinnon
- University of Colorado School of Medicine, 13199 E. Montview Blvd., Suite 210; Mail Stop F443, Aurora, CO, 80045, USA
| | - Daniel D Matlock
- University of Colorado School of Medicine, 13199 E. Montview Blvd., Suite 210; Mail Stop F443, Aurora, CO, 80045, USA.
| |
Collapse
|
41
|
|
42
|
Wang GS. Pediatric Concerns Due to Expanded Cannabis Use: Unintended Consequences of Legalization. J Med Toxicol 2017; 13:99-105. [PMID: 27139708 PMCID: PMC5330955 DOI: 10.1007/s13181-016-0552-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/04/2016] [Accepted: 04/13/2016] [Indexed: 01/11/2023] Open
Abstract
An "unintended consequence" of marijuana legalization is the impact on the pediatric population. From prenatal exposure to unintentional childhood exposures, through concerns of adolescence abuse and marijuana use for medicinal indications in children, marijuana exposure can affect pediatric patients at every stage in childhood. Regardless of the stage or reason of exposure, concerns exist about short-term and long-term consequences in a child's physical and mental health. The use of cannabidiol (CBD) may have some benefit for the treatment of epilepsy, but emphasis needs to be on rigorous clinical trials to evaluate efficacy and safety. As more states allow both medical and recreational marijuana, availability and prevalence of use will likely increase and more surveillance and research is needed to evaluate the consequences on the pediatric population.
Collapse
Affiliation(s)
- George Sam Wang
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave B251, Aurora, CO, 80045, USA.
| |
Collapse
|
43
|
Simpson R. Legalizing and regulating cannabis: Designing a framework. Can Nurse 2017; 113:35-37. [PMID: 29235818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|
44
|
Affiliation(s)
- Beau Kilmer
- From the RAND Drug Policy Research Center, Santa Monica, CA
| |
Collapse
|
45
|
French NM. Legalized Marijuana—The Popular Perspective: As a safety manager, an HR director, or a company executive, remaining confused and silent toward the issue of legal marijuana may prove to be a very costly mistake for you and your company. Occup Health Saf 2017; 86:38-39. [PMID: 30211507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
|
46
|
Abstract
BACKGROUND Growing moves in the U.S. toward relaxed laws surrounding adult use of marijuana raise concerns about concurrent increases in adolescent use of marijuana. OBJECTIVES This study collected and analyzed primary data on the relationship between marijuana legalization status in U.S. states and adolescents' marijuana use. METHODS Recruited through social networking sites and youth-services community agencies, a sample of 1,310 adolescents from 48 U.S. states and the District of Columbia reported their use of marijuana. Youths' use rates were compared with the marijuana legalization status of youths' states of residence. RESULTS Study findings failed to show a relationship between adolescents' use of marijuana and state laws regarding marijuana use. Relationships were found for increased marijuana use by older youths, females, and non-Hispanic youths. Youths whose parents completed 2 or more years of college were less likely to report marijuana use than those whose parents completed fewer than 2 years of college. CONCLUSIONS Albeit study findings do not support predictions of growing marijuana use by adolescents in states with liberalized adult use laws, further monitoring of adolescents' use with larger and more representative samples is needed.
Collapse
Affiliation(s)
- Steven Schinke
- a School of Social Work, Columbia University , New York , New York , USA
| | - Traci Schwinn
- a School of Social Work, Columbia University , New York , New York , USA
| | - Jessica Hopkins
- a School of Social Work, Columbia University , New York , New York , USA
| | - Prakash Gorroochurn
- b Mailman School of Public Health, Columbia University , New York , New York , USA
| | | |
Collapse
|
47
|
Sabia JJ, Swigert J, Young T. The Effect of Medical Marijuana Laws on Body Weight. Health Econ 2017; 26:6-34. [PMID: 26602324 DOI: 10.1002/hec.3267] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/14/2015] [Accepted: 09/08/2015] [Indexed: 06/05/2023]
Abstract
This study is the first to examine the effects of medical marijuana laws (MMLs) on body weight, physical wellness, and exercise. Using data from the 1990 to 2012 Behavioral Risk Factor Surveillance System and a difference-in-difference approach, we find that the enforcement of MMLs is associated with a 2% to 6% decline in the probability of obesity. We find some evidence of age-specific heterogeneity in mechanisms. For older individuals, MML-induced increases in physical mobility may be a relatively important channel, while for younger individuals, a reduction in consumption of alcohol, a substitute for marijuana, appears more important. These findings are consistent with the hypothesis that MMLs may be more likely to induce marijuana use for health-related reasons among older individuals, and cause substitution toward lower-calorie recreational 'highs' among younger individuals. Our estimates suggest that MMLs induce a $58 to $115 per-person annual reduction in obesity-related medical costs. Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Joseph J Sabia
- Department of Economics, San Diego State University, San Diego, CA, USA
| | - Jeffrey Swigert
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
| | - Timothy Young
- Department of Economics, San Diego State University, San Diego, CA, USA
| |
Collapse
|
48
|
Nicol G. Florida Medical Marijuana Law Now Effective. Todays FDA 2017; 29:34-35. [PMID: 30457303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
49
|
Cannabis for medical purposes: Legal implications for nurses. Can Nurse 2017; 113:30-1. [PMID: 29236416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|
50
|
Eggertson L. The challenges of medical cannabis research. Can Nurse 2017; 113:26-28. [PMID: 29236415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|