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Understanding differences in post-legalization patterns of marijuana between rural and urban environments has the potential to go a long way towards targeting intervention efforts aimed at reducing marijuana use disorders. Data come from the National Survey on Drug Use and Health (NSDUH, 2015–2019, N = 210,392). Survey-weighted multivariable linear and logistic regression analyses were used to assess the relationship between key marijuana-related variables and the status of medical marijuana use in each state with interaction terms for rural versus urban status. Among the entire sample, the prevalence of marijuana abuse and dependence were 0.7% and 1.8%, respectively. Among marijuana users, the average number of days on which marijuana was used was 131.3 (SD = 136.3) days. Those living in states with legalized medical marijuana reported use on a greater number of days (B = 10.69; 95% CI: 5.26, 16.13) with frequency of use increasing as rurality increased, compared to a core based statistical area (CBSA) of ≥1 million: a CBSA of <1 million residents (B = 23.02; 95% CI: 17.38, 28.66) and non-CBSA (B = 37.62; 95% CI: 22.66, 52.58). We also observed lower odds of driving under the influence of marijuana in states where medical marijuana was legal (aOR = 0.86; 95% CI: 0.77, 0.95). We observed an increase in the frequency of marijuana use and a decrease in driving under the influence of marijuana in states with legalized medical marijuana use relative to those states where it remained illegal. We also observed key moderation based on rural-urban status. This body of results suggests that problematic marijuana use may be on the rise following the legalization of marijuana use, but also that corresponding protective attitudes exist. [ABSTRACT FROM AUTHOR]

Despite the prevalence and negative outcomes associated with simultaneous alcohol and cannabis use (i.e., marijuana [SAM] use, i.e., so that the effects of both alcohol and cannabis overlap) among college students, there is no comprehensive measure of SAM use, with past research relying on single items. The present study aimed to develop the Alcohol and Cannabis Simultaneous Use Scale (ACSUS), a comprehensive self-report measure of SAM use frequency, quantity, and problems in college students. College students at two Midwestern universities who used alcohol and cannabis (Study 1: N = 534; Mean age = 19; 71% female; 88% White; Study 2: N = 258; Mean age = 21; 81% female; 85% White) completed the newly developed ACSUS. Exploratory factor analysis (Study 1) revealed that the ACSUS fits best with 9-items representing two factors: Factor 1 measures frequency and quantity of SAM use and Factor 2 measures associated problems with SAM use. Confirmatory factor analysis (Study 2) supported the two-factor structure of the ACSUS, which was positively associated with measures of alcohol use, cannabis use, simultaneous use motives, and impulsivity. These data provide initial support for the ACSUS, developed to investigate the frequency, quantity, and associated problems with SAM use in college students. [ABSTRACT FROM AUTHOR]

Many cannabis users report therapeutic benefits from cannabis consumption, even when not recommended by a physician. To date, few data on therapeutic users of cannabis in France are available. Using a cross-sectional survey held in 2020, we collected sociodemographic, health and substance use data from 4150 daily cannabis users in France. We used multivariable logistic regression to assess factors associated with exclusive therapeutic use of cannabis. Approximately 10% (n = 453) of the participants reported using cannabis exclusively for therapeutic purposes. Exclusive therapeutic users of cannabis differed from non-exclusive (i.e. recreational and mixed) users, especially regarding age (aOR [95%CI] = 1.01 [1.00–1.02]), employment (aOR = 0.61 [0.47–0.79]), urban area of residence (aOR = 0.75 [0.60–0.94]), physical (aOR = 2.95 [2.34–3.70]) and mental health condition (aOR = 2.63 [1.99–3.49]), mode of cannabis administration (non-smoked, aOR = 1.89 [1.22–2.95); smoked with little tobacco, aOR = 1.39 [1.09–1.76]), frequency of cannabis use (aOR = 1.04 [1.01–1.06]), home cultivation (aOR = 1.56 [1.13–2.15]), at-ridsk alcohol use (aOR = 0.68 [0.54–0.84]), and previous-month opiate use (aOR = 1.67 [1.22–2.30]). A greater understanding of the distinct profiles of regular cannabis users could inform harm reduction strategies and care access for this population. Further studies are needed to better understand the boundaries between therapeutic and recreational use. [ABSTRACT FROM AUTHOR]

Background: During the past two decades of cannabis legalization, the prevalence of medical cannabis (MC) use has increased and there has also been an upward trend in alcohol consumption. As less restricted cannabis laws generate more adult cannabis users, there is concern that more individuals may be simultaneously using medical cannabis with alcohol. A few studies have examined simultaneous use of medical cannabis with alcohol, but none of those studies also assessed patients' current or previous non-medical cannabis use. This paper explores simultaneous alcohol and medical cannabis use among medical cannabis patients with a specific focus on previous history of cannabis use and current non-medical cannabis use. Methods: A retrospective cohort study of MC patients (N = 319) from four dispensaries located in New York. Bivariate chi-square tests and multivariable logistic regression are used to estimate the extent to which sociodemographic and other factors were associated with simultaneous use. Results: Approximately 29% of the sample engaged in simultaneous use and a large share of these users report previous (44%) or current (66%) use of cannabis for non-medical purposes. MC patients who either previously or currently use cannabis non-medicinally, men, and patients using MC to treat a pain-related condition, were significantly more likely to report simultaneous alcohol/MC use. Conclusions: Findings indicate that there may be differential risks related to alcohol/MC use, which should be considered by cannabis regulatory policies and prevention/treatment programs. If patients are using cannabis and/or alcohol to manage pain, clinicians should screen for both alcohol and cannabis use risk factors. [ABSTRACT FROM AUTHOR]

Using cross-sectional baseline measurements from a longitudinal cohort study, we evaluated the perceived impact of the Coronavirus Disease 2019 (COVID-19) pandemic on cannabis use and emotional well-being among college students meeting cannabis use disorder (CUD) criteria (N = 150). Compared to before the pandemic, participants retrospectively reported an increase in cannabis use during the first phase of the pandemic when stay-at-home orders occurred, which was correlated with a greater number of CUD symptoms and cannabis use-related consequences since the pandemic began. Reporting greater frequency of cannabis use during the pandemic was associated with greater frequency of using amphetamine-type drugs and consumption of cannabis by dabbing since the pandemic began. There were significant differences in cannabis use-related outcomes as a function of negative emotions (e.g., feeling lonely/stressed/anxious/depressed) experienced during the pandemic. The findings elucidate the impact of the pandemic on cannabis use among college students with CUD and can inform prevention/intervention efforts in this population. [ABSTRACT FROM AUTHOR]

Purpose: The United Nations has adopted a set of 17 interlocking Sustainable Development Goals (SDGs) for 2015–2030. This commentary discusses how alcohol and other drugs have been dealt with and discussed in the context of the Goals, and issues raised by the relationship and history of how alcohol and other drug use and problems relate to development. Material and methods: A cross-section of discussions of alcohol and drugs in the context of the SDGs is considered, and evidence considered on the relationship and history of alcohol and drug use and problems to development. Results: While alcohol and narcotic drugs are mentioned in the SDG Targets, there has been little consideration of what effects attaining the goals may have on levels of alcohol and other drug consumption and problems. In cross-sectional comparisons, there are higher average levels of consumption of alcohol and controlled drugs in richer societies, and among richer than poorer individuals. But the harm per unit of use tends to be lower for richer individuals, and in richer societies. We consider how these two contrary trends may apply with socioeconomic development, given that development has often brought increases in substance use, and societal responses to limit the harms are often delayed by a generation or more, often resulting in 'long waves' of consumption and associated harms. Conclusions: To take alcohol and other drugs coherently into account in the Sustainable Development Goals, along with recognising that they are marketable and sometimes useful products, and thus involved to some extent in economic development, there needs to be action at national and international levels which recognises their double-sided nature—including market controls on commercial products to channel and limit availability and minimise harm. [ABSTRACT FROM AUTHOR]

Emerging evidence on substituting cannabis for more harmful drugs has led to cannabis becoming a novel harm‐reduction strategy for combating the current drug poisoning crisis. However, the authorization of medical cannabis as part of a harm‐reduction approach and recovery strategy has significant implementation barriers rooted in longstanding stigma towards cannabis. Through a multi‐discipline collaboration of Canadian clinicians and academic researchers, we highlighted stigma barriers and opportunities to address these barriers to elicit improved delivery of medical cannabis as a harm‐reduction therapy within existing therapeutic frameworks. Evidence from existing literature and real‐world experiences converged on three key themes related to stigma barriers: (1) Lack of medical cannabis education within the healthcare community, (2) lack of consensus and coordination among harm‐reduction services and (3) access to medical cannabis. We highlight potential solutions to these issues, including improved healthcare education, better coordination between care teams and suggestions for improving access. Through this discussion, we hope to contribute to reducing the stigma around using medical cannabis as a harm‐reduction strategy for individuals with a substance use disorder and consider new perspectives in policy development surrounding recovery services. [ABSTRACT FROM AUTHOR]

College students represent a large portion of the population, and report high rates of cannabis use and related negative outcomes, including interpersonal problems, risky behaviors, or physical dependency. The contexts in which students use cannabis (e.g., at a party, when feeling down or depressed, after a fight with a loved one) likely affect their risk of experiencing consequences. We aimed to discern profiles of cannabis use contexts and compare profiles on use frequency, consequences, and the use of cannabis protective behavioral strategies (PBS). College students were surveyed regarding their cannabis use contexts, frequency, consequences, and PBS use (n = 265; female = 72.8%). We used Latent Profile Analysis to identify patterns of cannabis use contexts and auxiliary testing to compare profiles on use frequency, consequences, and PBS use. Our examination revealed three latent profiles of cannabis use. The Social Use Profile was associated with use in predominantly social/uplifting contexts. The Physical & Emotional Pain Profile was also associated with use in these contexts but was defined by additional use in response to pain. The All Contexts Profile was associated with frequent use in all contexts, including those that were least endorsed by the other profiles. Profiles differed in cannabis use frequency, PBS use, and the number of consequences experienced, such that profiles were more likely to be associated with more frequent cannabis use, higher risk of experiencing use-consequences, and using fewer PBS as the number of use contexts increased across the profiles. The contexts in which people use cannabis are associated with cannabis risk and protection. Prevention and intervention efforts may benefit from considering contexts of cannabis use. [ABSTRACT FROM AUTHOR]

Background: To understand real-world dispensing and utilization patterns of medical cannabis (MC) and its financial impact on patients, we analyzed the database of a cannabis company licensed in New York state. Objectives: To evaluate the tetrahydrocannabinol (THC)/cannabidiol (CBD) dose ratios, association of various medical conditions to THC/CBD dose, and the cost of products in registered patients receiving MC from four licensed state dispensaries. Design: Retrospective analysis conducted on anonymized data between January 1, 2016 and December 31, 2020 listing 422,201 dispensed products from 32,845 individuals aged 18 years and older. Setting/Subjects: Adult patients with medical certification for cannabis use in New York, USA. Measurements: The database included patient's age, gender, qualifying medical condition, type and dose of product, medication directions, and amount of product dispensed. Results: Findings showed a median age of 53 years with 52% of patients female. Males were found to use more products than females (1.06:1). Pain (85%) was the most common medical condition and inhalation (57%) the most common route except when used for cancer-directed treatment and neurological conditions. Individuals received a median of six prescriptions costing a median of $50/product. Average THC:CBD ratios were 28:0.5 mg/day and 12:0.25 mg/dose. Neurological conditions demonstrated the highest average cost [mean (95% confidence interval {CI}): $73 ($71–$75)] and average CBD/dose per product [mean (95% CI): 5.89 (5.38–6.40)]. Individuals with a history of substance use disorder utilizing MC as an alternative substance displayed the highest average THC/dose [mean (95% CI): 14.25 (13.36–15.14)]. Conclusion: MC was utilized for various medical conditions with variability in THC:CBD ratio seen depending on the condition. Cost variation was also observed based on the individual's medical condition. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to assess the knowledge, attitudes, and awareness of pharmacy students toward marijuana use. Methods: Pharmacy students were asked to complete a survey that assess students' knowledge, attitudes, and awareness toward marijuana use. This study also compared students' awareness about the harmful effects of marijuana in comparing with alcohol and smoking tobacco. Participants were asked about the possibilities of marijuana-induced cancer and addiction. Results: Twenty-three percent of pharmacy students reported having used marijuana at some point in their lives. In comparison with tobacco and alcohol, most of the students agreed that tobacco (49%) and alcohol (42%) are more harmful than marijuana (P <.0001). More than sixty percent of students considered marijuana as an addictive substance (P <.02). A 45% of students opposed the possibility of marijuana-induced cancer. Thirty-six percent of the students agreed that marijuana should be legalized for both medical and recreational use with a similar percentage of the students (30 – 32%) believed that marijuana should be legalized for medical use only. Conclusion: With the prevalence of marijuana use and discrepancy among pharmacy students' responses regarding knowledge, attitudes, and awareness pharmacy schools need to adopt educational activities about the benefits and risks of marijuana. [ABSTRACT FROM AUTHOR]

Regular use of marijuana during adolescence is linked to academic underachievement, mental health problems, and delinquency. There are concerns that increased use of marijuana among adults, especially among caregivers, may increase rates of youth marijuana use. The current qualitative study used content analysis to examine what messages caregivers convey to their children about marijuana use, whether caregivers perceive barriers to such communication, whether they disclose their own use, and level of interest in supports or caregiving resources. Participants were recruited through paid Facebook and Instagram ads. Several methods were employed to achieve a gender-balanced and diverse sample of caregivers with youth aged 8–16 years, living in states with legalized marijuana, and who reported regular marijuana use (N = 70). Caregivers completed an online questionnaire including open- and closed-ended responses about their communication with their children. Results indicated that most caregivers conveyed largely positive messages about marijuana to their children, including marijuana as medicine, natural, and conditionally acceptable to use. Negative messages included caregivers instructing their teen not to use marijuana and that marijuana use is bad and/or unhealthy for children/teens. The majority of caregivers disclosed their own use to their children, and generally did not endorse barriers to communication. Approximately half of caregivers identified a desire for more tangible and applicable communication skills based on scientific evidence to facilitate conversations with their children about marijuana. Implications are discussed for future preventive interventions for those who regularly use marijuana and are caregivers of teens. Highlights: Marijuana-using caregivers presented positive attitudes and beliefs about marijuana. Marijuana-using caregivers wanted more scientific information about how to parent in marijuana-positive environments. Facebook recruiting was fast and cost-effective for collecting data on marijuana-using caregivers. Facebook recruiting was flexible for collecting diverse samples of caregivers. [ABSTRACT FROM AUTHOR]

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Background: Legal cannabis is available in more than half of the United States. Health care professionals (HCPs) rarely give recommendations on dosing or safety of cannabis due to limits imposed by policy and lack of knowledge. Customer-facing cannabis dispensary staff, including clinicians (pharmacists, nurses, physician's assistants), communicate these recommendations in the absence of HCP recommendations. Little is known about how dispensary staff approach individuals with complex medical and psychiatric comorbidities. Using responses from a national survey, we describe how cannabis dispensary staff counsel customers with medical and psychiatric comorbidities on cannabis use and examine whether state-specific cannabis policy is associated with advice given to customers. Methods: National, cross-sectional online survey study from February 13, 2020 to October 2, 2020 of dispensary staff at dispensaries that sell delta-9-tetrahydrocannabinol containing products. Measures include responses to survey questions about how they approach customers with medical and psychiatric comorbidities; state medicalization score (scale 0-100; higher score indicates more similarity to regulation of traditional pharmacies); legalized adult-use cannabis (yes/no). We conducted multiple mixed effects multivariable logistic regression analyses to understand relationships between state medicalization and dispensary employees' perspectives. Results: Of 434 eligible respondents, most were budtenders (40%) or managers (32%), and a minority were clinicians (18%). State medicalization score was not associated with responses to most survey questions. It was associated with increased odds of encouraging customers with medical comorbidities to inform their traditional HCP of cannabis use (Odds ratio [OR]=1.2, 95% confidence interval [CI] 1.0-1.4, p=0.03) and reduced odds of recommending cannabis for individuals with cannabis use disorder (CUD) (OR=0.8, 95% CI 0.7-1.0, p=0.04). Working in a state with legalized adult-use cannabis was associated with recommending traditional health care instead of cannabis in those with serious mental illness (OR 2.2, 95% CI 1.1-4.7, p=0.04). Less than half of respondents believed they had encountered CUD (49%), and over a quarter did not believe cannabis is addictive (26%). Conclusions: When managing cannabis dosing and safety in customers with medical and psychiatric comorbidity, dispensary staff preferred involving individuals' traditional HCPs. Dispensary staff were skeptical of cannabis being addictive. While state regulations of dispensaries may impact the products individuals have access to, they were not associated with recommendations that dispensary staff gave to customers. Alternative explanations for dispensary recommendations may include regional or store-level variation not captured in this analysis. [ABSTRACT FROM AUTHOR]

Cannabis use is growing among older adults to manage medical concerns including poor sleep. In this study, we characterized how patients seen at a geriatrics clinic use cannabis to address sleep disturbance. Specifically, we conducted an anonymous survey of 568 adults, including 83 who reported cannabis use within the past 3 years, to inquire about such use. We compared cannabis use characteristics between those using it for sleep disturbance versus all other conditions. We considered a p -value <.10 to be statistically significant. Among the cannabis users in our sample, 29% reported using cannabis for sleep disturbance (N = 24). They were more likely than other users to be female (p =.07), consume cannabis more frequently (p =.01), use products containing tetrahydrocannabinol (THC) (vs. cannabidiol [CBD]-only; p <.01), and use cannabis to target more symptoms (p <.01). As cannabis use continues to grow in older populations, it is essential to delineate better how cannabis may be used safely and effectively to improve older adults' sleep health. [ABSTRACT FROM AUTHOR]

Cannabis has long been widely used throughout the prenatal period. However, motives for prenatal cannabis use (PCU) have not been comprehensively examined. Stigmatization has been identified as a barrier to therapeutic cannabis use and related physician communication. Such stigma may be particularly salient in the context of PCU. One hundred and three women who reported current or past pregnancy were recruited online. Participants completed a survey querying prenatal experiences, substance use, and attitudes toward PCU. PCU was reported by 35 (34%) respondents. Treating nausea and vomiting of pregnancy was the most frequently reported reason for PCU (89%), and 24 (69%) reported substituting cannabis for pharmaceutical drugs. Sixty-two percent of PCU participants and 31% of non-PCU participants indicated discomfort discussing PCU with their physician, and 74% of PCU participants and 27% of non-PCU participants indicated they would not disclose PCU to their physician if it occurred in future pregnancies. Our findings suggest that PCU may reflect primarily therapeutic motives of relieving symptoms of morning sickness, nausea, low appetite, pain, and substituting for other prescription medications. Respondents reported discomfort discussing PCU with physicians, which was more pronounced among respondents with lived experience of PCU. Findings suggest PCU might best be evaluated within a therapeutic framework and highlight the importance of efforts to enhance patient-caregiver communication regarding PCU. [ABSTRACT FROM AUTHOR]

Background: The SARS‐CoV‐2/COVID‐19 pandemic has been associated with increased stress levels and higher alcohol use, including in pregnant and postpartum women. In the general population, alcohol use is associated with dysregulation in the autonomic nervous system (ANS), which is indexed by heart rate variability (HRV). The objectives of this study were to: (1) characterize changes in substance use during the SARS‐CoV‐2/COVID‐19 pandemic via a baseline self‐report survey followed by mobile ecological momentary assessment (mEMA) of substance use; and (2) examine the associations between momentary substance use and ambulatory HRV measures in pregnant and postpartum women. Methods: Pregnant and postpartum women were identified from the ENRICH‐2 prospective cohort study. Participants were administered a baseline structured phone interview that included the Coronavirus Perinatal Experiences (COPE) survey and ascertained the prevalence of substance use. Over a 14‐day period, momentary substance use was assessed three times daily, and HRV measurements were captured via wearable electronics. Associations between momentary substance use and HRV measures (root mean square of successive differences [RMSSD] and low frequency/high frequency [LF/HF] ratio) were examined using a mixed effects model that included within‐subject (WS) and between‐subject (BS) effects and adjusted for pregnancy status and participant age. Results: The sample included 49 pregnant and 22 postpartum women. From a combination of a baseline and 14‐day mEMA surveys, 21.2% reported alcohol use, 16.9% reported marijuana use, and 8.5% reported nicotine use. WS effects for momentary alcohol use were associated with the RMSSD (β = −0.14; p = 0.005) and LF/HF ratio (β = 0.14; p = 0.01) when controlling for pregnancy status and maternal age. No significant associations were observed between HRV measures and instances of marijuana or nicotine use. Conclusions: These findings highlight the negative effect of the SARS‐CoV‐2/COVID‐19 pandemic on the psychological health of pregnant and postpartum women associated with substance use, and in turn, ANS dysregulation, which potentially puts some women at risk of developing a substance use disorder. [ABSTRACT FROM AUTHOR]

Background: With the widespread legalization of cannabis and use among all age groups, location and source of cannabis remains to be researched, especially among minority populations. Methods: We pooled data from the 2018–2019 National Survey on Drug Use and Health and investigated differences by sexual minority status of where individuals obtained cannabis. Results: Results found that gay/lesbian and bisexual individuals who reported use were more likely to get marijuana from buying it, trading it for something else and getting it for free or sharing someone else's, compared to heterosexual individuals. Furthermore, more than one in five lesbian/gay individuals reported obtaining marijuana from someone they just met while nearly 25% of bisexual women reported obtaining marijuana from a friend. Conclusions: Findings from the present study may inform harm reduction and policy initiatives. [ABSTRACT FROM AUTHOR]

Background: Cannabis legalization has enabled increased consumption in older adults. Age-related mental, physical, and physiological changes may lead to differences in effects of cannabis in older adults compared to younger individuals. Objective: To perform a scoping review to map the evidence regarding the health effects of cannabis use for medical and non-medical purposes in older adults. Methods: Electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Library) were searched for systematic reviews (SRs), randomized controlled trials (RCTs) and non-randomized/observational studies (NRSs) assessing the health effects and associations of cannabis use (medical or non-medical) in adults ≥ 50 years of age. Included studies met age-related inclusion criteria or involved a priori identified health conditions common among older adults. Records were screened using a liberal accelerated approach and data charting was performed independently by two reviewers. Descriptive summaries, structured tables, effect direction plots and bubble plots were used to synthesize study findings. Findings: From 31,393 citations, 133 publications describing 134 unique studies (26 SRs, 36 RCTs, 72 NRSs) were included. Medical cannabis had inconsistent therapeutic effects in specific patient conditions (e.g., end-stage cancer, dementia), with a number of studies suggesting possible benefits while others found no benefit. For medical cannabis, harmful associations outnumbered beneficial, and RCTs reported more negative effects than NRSs. Cannabis use was associated with greater frequencies of depression, anxiety, cognitive impairment, substance use and problematic substance use, accidents/injuries, and acute healthcare use. Studies often were small, did not consistently assess harms, and did not adjust for confounding. Discussion: The effects of medical cannabis are inconsistent within specific patient conditions. For older adults, generally, the available evidence suggests cannabis use may be associated with greater frequencies of mental health issues, substance use, and acute healthcare use, and the benefit-to-risk ratio is unclear. Studies with a balanced assessment of benefits and harms may guide appropriate public health messaging to balance the marketing pressures of cannabis to older adults. [ABSTRACT FROM AUTHOR]

This paper examined representations of medicinal cannabis users in UK newspapers, 1990–1998. It is important to understand the significance of these newspaper articles during this early stage of the growing cultural normalisation of medicinal cannabis use, in the UK, which is not documented in the existing literature. This is a very different period in relation to access to information for members of the public because it was before the widespread use of the internet. The significance of these dates is also that I started interviewing medicinal cannabis users in 1998, which led to Coomber et al. (2003). Very significantly, almost half of the participants in that article indicated that newspapers were the source of the idea that cannabis was medicinally useful and that this accounted for why they began to use it medicinally. What was in those newspaper articles that encouraged this view? In the current article, I examined 60 newspaper articles about medicinal cannabis use, using a thematic analysis which also draws on aspects of critical discourse analysis. I report on the process of symbolic boundary work which negotiates the ambiguity of individuals portrayed as social insiders but who used cannabis. The representations within the articles emphasized the social insider characteristics of medicinal cannabis users, emphasized their genuine illnesses/impairments, but interestingly also articulated misunderstandings by the journalists which contributed to a positive portrayal. [ABSTRACT FROM AUTHOR]

This study explored perceptions of marijuana use and abstinence among urban and rural Appalachian high school students using photovoice, enabling this subset of youth to co-construct their perceptions of marijuana use and abstinence. Twelve adolescents, ages 14-17, participated in the study. Participants identified managing stress and feeling peer pressure as two reasons teens might use marijuana. Participants identified four reasons for adolescent marijuana abstinence including having positive relationships, identifying with religion/spirituality, participating in extracurricular activities, and avoiding negative outcomes. Findings suggest that participants may smoke marijuana due to peer pressure and to cope with stress. Collective approaches including families, communities, and faith organizations may be important marijuana use prevention approaches for Appalachian adolescents. [ABSTRACT FROM AUTHOR]

Marijuana (cannabis) remains a controversial drug in the 21st century. This discussion considers current research on use of cannabis sativa and its constituents such as the phytocannabinoids. Topics reviewed include prevalence of cannabis use, other drugs consumed with pot, the endocannabinoid system, use of medicinal marijuana, medical adverse effects of cannabis, and psychiatric adverse effects of cannabis use. Treatment of cannabis use disorders and withdrawal is difficult and remains mainly based on psychological therapy; current research on pharmacologic management of problems related to cannabis consumption is also considered. The potential role of specific cannabinoids for medical benefit will be further clarified as the 21st century matures. However, potential dangerous adverse effects from smoking marijuana are well known and should be clearly taught to a public often confused by a mediadriven false message and promise of benign pot consumption. Caveat emptor! [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Medical cannabis programs across the country vary and differ in their qualifying conditions for medical cannabis use. This has led to a gap in knowledge regarding the specific needs of cannabis patients, including the most common reason patients seek medical cannabis. The purpose of this study was to examine the current needs of medical cannabis patients in order to better inform future research, and to evaluate potential needs in policy changes in states with more restrictive qualifying conditions for medical cannabis use. Methods: A cross-sectional survey study was administered (n = 207) at a Laurel Harvest Labs dispensary in Pennsylvania. Participants were qualified medical cannabis users and were recruited as a convenience sample when entering the dispensary. The survey asked questions regarding participant demographics, medical cannabis qualifying conditions, usage, methods of administration, adverse effects, tolerance, and impact of medical cannabis on medication, alcohol, and tobacco use. Chi-squared or Fisher's exact tests were conducted for analyses involving categorical data. Results: The mean age of respondents was 36.7 years (SD = 12.8), and the majority were male (61.4%) and white (84.7%). Respondents self-reported that anxiety disorder was the most common qualifying medical condition and the most common comorbid condition (50.1%; 69.3%) for medical cannabis use. Additionally, approximately 95% of users reported having no adverse effects from using medical cannabis, and 90% of users preferred inhalation through vaporization as the preferred method of consumption. More than 50% of participants reported an improvement in their symptoms where only 20% of users reported being tolerant to their current dose. More than 70% of respondents reported that obtaining medical cannabis was "easy" and 54% of users reported that the cost of medical cannabis was not a barrier to access. Conclusions: Anxiety disorder is a prevalent condition for which medical cannabis is used; however, many states do not recognize anxiety disorder as a qualifying condition for medical cannabis. Further research on medical cannabis use for anxiety disorders is needed to evaluate proper dosing and responses to treatment. [ABSTRACT FROM AUTHOR]

As many states have passed laws increasing the availability of legal marijuana, a growing body of research has explored the consequences of these trends on youths' marijuana-related perceptions and behaviors. However, prior work has been mixed on the effects of county-level variation in marijuana accessibility stemming from ordinances governing dispensary operations, and previous studies have not investigated whether the robust protective effects of attachment to parents on adolescent outcomes are moderated by these contextual factors. We use individual-level data from the 2022 Florida Youth Substance Abuse Survey (N = 47,572) merged with information on Florida counties to examine the direct and interactive effects of the presence/number of marijuana dispensaries and adolescents' attachment to parents on their use of marijuana, beliefs about its perceived wrongfulness, perceived parental approval of marijuana use, and perceived harmlessness of marijuana use. Although attachment to parents was inversely associated with all four outcomes, little evidence of independent or cross-level interaction effects of marijuana dispensaries emerged. Within a state that permits medical marijuana, county-level differences in marijuana access are likely not a salient risk factor for adolescents' marijuana use, beliefs, and perceptions. Effective parenting represents a consistent protective influence across these contexts. • Attachment to parents was inversely associated with all four marijuana outcomes. • Marijuana dispensaries were not associated with any of the four marijuana outcomes. • County-level dispensaries did not moderate the effects of attachment to parents. [ABSTRACT FROM AUTHOR]

This paper uses SIDE theory and an information seeking lens to examine the types of information and support messages (N = 126,977 posts) veterans seek on the social networking site Reddit regarding medical marijuana use. A combination of automated text analysis strategies paired with thematic analysis produced eight themes: Doctor Patient Conversations, Drug Test, Legality, Legal Policy, Prescription Drug Use/Other Substance Use, Point of View, Reasons for Use, and V.A. Findings reveal that a large portion of veterans discuss how medical marijuana can be used to self-medicate for a number of issues, including PTSD, anxiety, and sleep deprivation. Results also highlighted missing topics within veterans' conversations about medical marijuana use. For instance, veterans rarely discuss the strategies they use to talk to their doctor about their medical marijuana use. Practical implications and directions for future research are offered. [ABSTRACT FROM AUTHOR]

Older adults in the U.S. are increasingly using cannabis. Theoretical perspectives of scholars who have explained cannabis use include subcultural theory, normalization thesis, and the age-period-cohort paradigm. Our study examined what influences older adults' cannabis use, and perceived outcomes of cannabis use. From April 2018 to January 2019, we conducted 12 focus groups with 82 adults aged 60 and older in Illinois, where medical cannabis was legally available beginning in 2014. We used an inductive thematic analysis to code and theme the focus group transcripts and compared the results to concepts and arguments of the three theoretical perspectives. We found four themes: cultural experiences influence older adults' choice to use cannabis; medical culture and systems impact cannabis use; participants have to navigate a costly and time-consuming state system to use medical cannabis, and; participants experience positive outcomes when using cannabis. Although elements of the three theories can be identified in our findings, subcultural influences of baby boomer counterculture were only relevant for a subset of participants, while normalization of medical cannabis use was not supported by a state system separated from traditional medicine. Medical culture, physical age effects, and prior opioid use were very important in explaining older adults' cannabis use. [ABSTRACT FROM AUTHOR]

As policies legalizing adult cannabis use increase in the United States, understanding and characterizing the proportion of individuals consuming cannabis for medical and nonmedical purposes is important to inform targeted health education efforts. Data came from 7672 adults (> = 18 years) with past month cannabis use who responded to questions about reason for cannabis use on the 2018 Behavioral Risk Factor Surveillance System survey in 14 states. State and aggregated data were analyzed using weighted frequencies for descriptive analyses, and prevalence ratios were computed to identify demographic and substance use characteristics associated with medical only use or use for both medical and nonmedical reasons (vs. nonmedical use). Overall, 28.6% (95% CI: 26.7, 30.4) of adults who use cannabis reported using cannabis medically, 34.2% (95% CI: 32.3, 36.2) nonmedically, and 37.2% (95% CI: 35.2, 39.2) both medically and nonmedically. Characteristics associated with medical only use (compared with nonmedical only use) included being female; aged > 45 years; out of work, a homemaker, or unable to work; having daily or near daily cannabis use; having past month cigarette use; having no past month alcohol use; self-reporting poor health; and ever having been diagnosed with certain chronic diseases. Medical only use of cannabis is the least prevalent reason for use; use for both medical and nonmedical reasons is the most prevalent. Monitoring reasons for cannabis use can aid states in understanding differences between medical and nonmedical cannabis users, providing context to use patterns, and targeting health education messages to appropriate audiences. [ABSTRACT FROM AUTHOR]

Recent prevalence estimates of cannabis use among individuals receiving medication treatment for OUD (MOUD) are lacking, and no study has characterized cannabis route of administration (cROA) in this population. These knowledge gaps are relevant because cannabis' effects and health outcomes vary by cROA and the availability and perceptions of cROA (e.g., vaping devices) are changing. The Vaping In Buprenorphine-treated patients Evaluation (VIBE) cross-sectional survey assessed the prevalence and correlates of cannabis use and cROA among adults receiving buprenorphine MOUD from 02/20 to 07/20 at five community health centers in Massachusetts, a state with legal recreational and medical cannabis use. Among the 92/222 (41%) respondents reporting past 30-day cannabis use, smoking was the most common cROA (75%), followed by vaping (38%), and eating (26%). Smoking was more often used as a single cROA vs. in combination others (p = 0.01), whereas vaping, eating, and dabbing were more often used in combination with another cROA (all p < 0.05). Of the 39% of participants reporting multiple cROA, smoking and vaping (61%), and smoking and eating (50%), were the most prevalent combinations. Nonwhite race (vs. white) and current cigarette smoking (vs. no nicotine use) were associated with past 30-day cannabis use in multiple logistic regression. Prevalence of past 30-day cannabis use among individuals receiving buprenorphine MOUD in Massachusetts in 2020 was nearly double the prevalence of cannabis use in Massachusetts' adult general population in 2019 (21%). Our data are consistent with state and national data showing smoking as the most common cROA. [ABSTRACT FROM AUTHOR]

The prevalence of cannabis use disorders (CUDs) in people who use cannabis recreationally has been estimated at 22%, yet there is a dearth of literature exploring CUDs among people who use medicinal cannabis. We aimed to systematically review the prevalence of CUDs in people who use medicinal cannabis. In our systematic review and meta-analysis, we followed PRISMA guidelines and searched three databases (PsychInfo, Embase and PubMed) to identify studies examining the prevalence of CUDs in people who use medicinal cannabis. Meta-analyses were calculated on the prevalence of CUDs. Prevalence estimates were pooled across different prevalence periods using the DSM-IV and DSM-5. We conducted a systematic review of 14 eligible publications, assessing the prevalence of CUDs, providing data for 3681 participants from five different countries. The systematic review demonstrated that demographic factors, mental health disorders and the management of chronic pain with medicinal cannabis were associated with an elevated risk of CUDs. Meta-analyses were conducted on the prevalence of CUDs. For individuals using medicinal cannabis in the past 6–12 months, the prevalence of CUDs was 29% (95% CI: 21-38%) as per DSM-5 criteria. Similar prevalence was observed using DSM-IV (24%, CI: 14–38%) for the same period. When including all prevalence periods and using the DSM-5, the prevalence of CUDs in people who use medicinal cannabis was estimated at 25% (CI: 18-33%). The prevalence of CUDs in people who use medicinal cannabis is substantial and comparable to people who use cannabis for recreational reasons, emphasizing the need for ongoing research to monitor the prevalence of CUDs in people who use medicinal cannabis. • The prevalence of cannabis use disorders in people who use medicinal cannabis is estimated at 25% (CI: 18-33%). • People with chronic non-cancer pain, mental health or substance use disorders may have a higher risk of cannabis use disorder. • The study highlights the need to carefully consider the risk of cannabis use disorder when prescribing medicinal cannabis. [ABSTRACT FROM AUTHOR]

Background: Mounting evidence suggests the safety and efficacy of medical marijuana (MM) in treating chronic ailments, including chronic pain, epilepsy, and anorexia. Despite incremental use of medical and recreational cannabinoids, current limited evidence shows generalized unpreparedness of medical providers to discuss or recommend these substances to their patients. Herein, the present study aims to examine internal medicine residents' knowledge of marijuana and their attitude towards its medical use. Methods: This is a descriptive cross-sectional study. A survey with 12 standardized queries was created and distributed among the internal medicine residents from Mount Sinai Morningside-West (MSMW) program from July 2020 to December 2020. Participants included preliminary and categorical residents from post-graduate years one to three. The survey consisted of self-assessment of residents' knowledge on the indication, contraindication, adverse effects of MM. Results: Eighty-six (59%) out of 145 residents completed the questionnaire. Despite most trainees (70%) having considered certifying the use of MM for their patients, over 90% reported none to little knowledge on its use. Approximately 80% of the surveyed residents expressed willingness to receive an appropriate educational curriculum. Conclusion: To the best of our knowledge, this is the first study that indicated a critical lack of medical marijuana-related knowledge in surveyed internal medicine residents. In a population with growing cannabis consumption, physician training on the indication, toxicity, and drug interaction of cannabinoids is warranted. [ABSTRACT FROM AUTHOR]

Background and Aims: The idea that cannabis is a 'gateway drug' to more harmful substances such as opioids is highly controversial, yet has substantially impacted policy, education and how we conceptualize substance use. Given a rise in access to cannabis products and opioid‐related harm, the current study aimed to conduct the first systematic review and meta‐analysis on the likelihood of transitioning from cannabis use to subsequent first‐time opioid use, opioid use disorders (OUD), dependence or abuse. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, pubMed/MEDLINE, Scopus, EMBASE, PsychINFO, Cochrane Central Register of Controlled Trials and Informit Health Collection were searched for full‐text articles assessing the likelihood of transitioning from cannabis to subsequent opioid use, and from opioid use to OUD, abuse or dependence given prior cannabis use. Analysis of subpopulations within studies were discussed narratively, and E‐values were calculated to assess the potential influence of unmeasured confounding. Findings Six studies provided relevant data from the United States, Australia and New Zealand between 1977 and 2017, a total sample of 102 461 participants. Random‐effects analysis of the adjusted pooled effect size indicates that the likelihood of transitioning from cannabis to opioid use, relative to non‐cannabis users, is odds ratio (OR) = 2.76, 95% confidence interval (CI) = 2.26–3.36, whereas the likelihood of transitioning from opioid use to OUD, abuse or dependence given prior cannabis use is OR = 2.52, 95% CI = 1.65–3.84. While the evidence was determined to be of low quality with moderate risk of bias, E‐values suggest that these findings are robust against unmeasured confounding. Conclusion: A systematic review and meta‐analysis found that while people who use cannabis are disproportionately more likely to initiate opioid use and engage in problematic patterns of use than people who do not use cannabis, the low quality of the evidence must be considered when interpreting these findings. [ABSTRACT FROM AUTHOR]

Importance: Prenatal cannabis use continues to increase, yet studies of the demographic, psychiatric, and medical characteristics associated with cannabis use in pregnancy are limited by size and use of self-report, and often do not consider cannabis use disorder (CUD) or concomitant substance use disorders (SUDs). Understanding the factors associated with CUD in pregnancy is paramount for designing targeted interventions.Objective: To examine the prevalence of co-occurring psychiatric and medical conditions of US pregnant individuals hospitalized with and without CUD by concomitant SUDs.Design, Setting, and Participants: The study analyzed restricted hospital discharge data from the 2010 to 2018 Healthcare Cost and Utilization Project State Inpatient Databases in 35 states. Data were analyzed from January to August 2021. Weighted linear regressions tested whether the prevalence of psychiatric and medical conditions differed between individuals with and without a CUD diagnosis at hospitalization. Inpatient hospitalizations of pregnant patients aged 15 to 44 years with a CUD diagnosis were identified. Pregnant patients aged 15 to 44 years without a CUD diagnosis were identified for comparison. Patients were further stratified based on concomitant SUD patterns: (1) other SUDs, including at least 1 controlled substance; (2) other SUDs, excluding controlled substances; and (3) no other SUDs.Exposures: CUD in pregnancy.Main Outcomes and Measures: Prevalence of demographic characteristics, psychiatric disorders (eg, depression and anxiety), and medical conditions (eg, epilepsy and vomiting).Results: The sample included 20 914 591 hospitalizations of individuals who were pregnant. The mean (SD) age was 28.24 (5.85) years. Of the total number of hospitalizations, 249 084 (1.19%) involved CUD and 20 665 507 (98.81%) did not. The proportion of prenatal hospitalizations involving CUD increased from 0.008 in 2010 to 0.02 in 2018. Analyses showed significant differences in the prevalence of almost every medical and psychiatric outcome examined between hospitalizations with and without CUD diagnoses, regardless of concomitant SUDs. Elevations were seen in depression (0.089; 95% CI, 0.083-0.095), anxiety (0.072; 95% CI, 0.066-0.076), and nausea (0.036; 95% CI, 0.033-0.040]) among individuals with CUD only at hospitalization compared with individuals with no SUDs at hospitalization.Conclusions and Relevance: Considerable growth was observed in the prevalence of CUD diagnoses among individuals hospitalized prenatally and in the prevalence of depression, anxiety, nausea, and other conditions in individuals with CUD at hospitalization. This study highlights the need for more screening, prevention, and treatment, particularly in populations with co-occurring CUD and psychiatric disorders. Research on the determinants and outcomes associated with CUD during pregnancy is needed to guide clinicians, policy makers, and patients in making informed decisions. [ABSTRACT FROM AUTHOR]

Although rates of substance use are higher in the Canadian territories than the provinces, there is little research on cannabis use. This exploratory study describes cannabis use and related risk behaviours among alcohol consumers in Whitehorse (Yukon) and Yellowknife (Northwest Territories), with comparisons to data from the provinces. Prior to non-medical cannabis legalisation, respondents (n = 387) aged ≥19 were recruited from a study on alcohol labelling to complete an online cannabis survey. Logistic regression was used to compare territorial and provincial data, and correlates of cannabis use in the territories. Forty-seven percent of respondents were past 12-month cannabis consumers, and 15.5% were daily/almost daily consumers, significantly higher than in the provinces (p < 0.001 for both). Dried herb (85.7%) and edibles (58.2%) were most commonly used among consumers. Use of dried herb, edibles, solid concentrates and tinctures was significantly higher than in the provinces (all p ≤ 0.01). Twenty-four percent of respondents had ridden with a driver who had used cannabis, while 31.9% of cannabis consumers had driven within 2h of cannabis use, significantly higher than the provinces (both p < 0.001). Further research should examine the impact of legalisation on cannabis use in the territories, including rural communities. [ABSTRACT FROM AUTHOR]

Substance use, a significant public health issue, is well described in the adult chronic kidney disease (CKD) population. Knowledge about substance use in the adolescent and young adult (AYA) CKD population such as prevalence, impact on kidney function, medication adherence, and psychosocial well-being remain largely unknown. Awareness of and inquiring about substance use is paramount to providing evidence-based care and preparation to transition to adult-focused health services. The authors in this review identify commonly used substances (alcohol, tobacco, marijuana, etc.) and how they impact kidney function and care of the AYA with CKD or kidney failure. Recommendations for screening and intervention strategies are provided. [ABSTRACT FROM AUTHOR]

The increasing volume of children with mental health conditions across all acute care settings high-lights the need for ED providers to be familiar with the most common mental health presentations in the pediatric population to effectively engage with and provide proper care for and disposition to this at-risk population. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic has led to increases in felt negative affect for many. This is concerning as individuals at increased risk for mental health issues are often more likely to use substances to cope with stressors. The aim of the current study is to examine whether communities reporting an increased risk for developing mental health issues showed differential patterns of legal cannabis use as the pandemic began. A secondary goal is to examine the feasibility of using anonymized location data to uncover community consumption patterns of potential concern. Anonymized location data from approximately 10% of devices in the United States provided a count of the number of visitors to 3,335 cannabis retail locations (medical and recreational) each day from December 1st 2019 through April 2020. Visitor counts were merged with the average number of mentally unhealthy days (aMUDs) reported in the Federal Information Processing Standard (FIPS) county the retailer was located along with FIPS county population and poverty rate estimates. A Poisson spline regression predicting visitors by day, aMUDs, as well as their interaction was performed, entering population and poverty rate as covariates. As the pandemic began communities reporting a greater aMUDs showed greater visitation to cannabis retailers. These results suggest that the COVID-19 pandemic may have led to increased legal cannabis use in at risk communities. They also highlight the value anonymized location data can provide policymakers and practitioners in uncovering community level trends as they confront an increasingly uncertain landscape. [ABSTRACT FROM AUTHOR]

Background/objectives: Cannabis use among older adults is increasing sharply in the United States. While the risks and benefits of cannabis use remain unclear, it is important to monitor risk factors for use, including low perception of harm. The objective of this study was to estimate recent national trends in perceived risk associated with cannabis use among older adults. Design Trend analysis. Setting/participants: A total of 18,794 adults aged 65 and older participating in the 2015–2019 National Survey on Drug Use and Health, a cross‐sectional nationally representative survey of non‐institutionalized individuals in the United States. Measurements We estimated the prevalence of older adults who believe that people who smoke cannabis once or twice a week are at great risk of harming themselves physically and in other ways. This was examined across cohort years and stratified by demographic characteristics, diagnosis of chronic disease, past‐month tobacco and binge alcohol use, and all‐cause emergency department use. Results: Between 2015 and 2019, perceived risk associated with regular use decreased from 52.6% to 42.7%, an 18.8% relative decrease (p < 0.001). Decreases in perceived risk were detected in particular among those never married (a 32.6% relative decrease), those who binge drink (a 31.3% relative decrease), use tobacco (a 26.8% relative decrease), have kidney disease (a 32.1% relative decrease), asthma (a 31.7% relative decrease), heart disease (a 16.5% relative decrease), chronic obstructive pulmonary disease (a 21.5% relative decrease), two or more chronic conditions (a 20.2% relative decrease), and among those reporting past‐year emergency department use (a 21.0% relative decrease) (ps < 0.05). Conclusions: The perceived risk of regular cannabis use is decreasing among older adults. We detected sharp decreases in risk perception among those with chronic disease and high‐risk behaviors, including tobacco and binge alcohol use. As the number of older adults who use cannabis increases, efforts are needed to raise awareness of the possible adverse effects with special emphasis on vulnerable groups. [ABSTRACT FROM AUTHOR]

Objective: To examine whether cannabis use predicts medication overuse headache (MOH) in patients with chronic migraine (CM). Methods: Electronic chart review was conducted by combining the terms "CM," "medication overuse," "cannabis," "cannabidiol," and "tetrahydrocannabinol" for patients seen at our headache clinics from 2015 to 2019. Of 729 charts consecutively screened, 368 met our inclusion criteria, that is, adult patients with CM with ≥1‐year CM duration. The following variables were extracted from the included patient charts: MOH diagnosis, age, sex, migraine frequency, current CM duration, current cannabis use duration, overused acute migraine medications, current MOH duration, and types of cannabis products used. Logistic regression was used to identify variables predicting MOH while controlling for remaining predictors. Agglomerative hierarchical clustering (AHC) was conducted to explore natural clusters using all predictor variables. Results: There were 212 patients with CM and MOH (cases; median age 43 years, interquartile range [IQR] 33–54; 177 [83%] females) and 156 patients with CM without MOH (referents; median age 40 years, IQR 31–49; 130 [83%] females). MOH was present in 81% (122/150) of current cannabis users compared with 41% (90/218) in those without cannabis use—adjusted odds ratio 6.3 (95% CI: 3.56 to 11.1, p < 0.0001). Current cannabis use was significantly associated with opioid use (Spearman's rho 0.26, p < 0.0001). Both current cannabis use (rho 0.40, p < 0.0001) and opioid use (rho 0.36, p < 0.0001) were significantly associated with MOH. Similarly, AHC revealed two major natural clusters. Cluster I patients featured 9.3 times higher current cannabis use, 9.2 times higher current opioid use, and 1.8 times higher MOH burden than those in Cluster II (p < 0.0001). Conclusion: Cannabis use was significantly associated with increased prevalence of MOH in CM. Bidirectional cannabis–opioid association was observed—use of one was associated with use of the other. Advising patients with CM and MOH to reduce cannabis use may help treat MOH effectively. [ABSTRACT FROM AUTHOR]

Introduction: Psychoactive substance use may be risky for adults with functional impairments. This study investigates cannabis use and prescription opioid and tranquilizer/sedative (mis)use among adults aged ≥50 years reporting functional impairments in the U.S.Methods: This cross-sectional analysis of adults aged ≥50 years from the 2015-2019 cohorts of the National Survey on Drug Use and Health estimates the prevalence of past-year medical and nonmedical cannabis use and prescription opioid and tranquilizer/sedative use and misuse according to the number of functional impairments reported. The adjusted odds of medical and nonmedical use or misuse of each substance in relation to any impairment, the number of impairments, and specific impairments were estimated using logistic regression. Analyses were conducted in December 2020.Results: Compared with those reporting no impairments, those reporting any impairment were more likely to report the use of cannabis and the (mis)use of prescription opioids and tranquilizers/sedatives (all p<0.05). Prevalence of (mis)use increased for each drug as the number of impairments increased (all p<0.001). Having any impairment was associated with increased odds for medical cannabis use (AOR=2.28, 95% CI=1.57, 3.30) but not for nonmedical use and with increased odds for misuse of prescription opioids (AOR=1.62, 95% CI=1.38, 1.91) and tranquilizers/sedatives (AOR=1.59, 95% CI=1.20, 2.11). Impaired thinking was associated with increased odds for the use and misuse of each substance, and impaired ability to do errands was associated with increased odds for prescription opioid misuse (AOR=1.34, 95% CI=1.01, 1.78).Conclusions: Prescription drug misuse is linked to functional impairments among adults aged ≥50 years and may pose a potential risk for this vulnerable population. [ABSTRACT FROM AUTHOR]

The objective of this study was to identify how cannabis use features within the sexual lives of young sexual minority men who use substances, and how this might intersect with features of their contemporary socio-cultural contexts in a setting where non-medical cannabis was recently legalised: Vancouver, Canada. Forty-one sexual minority men ages 15 to 30 years were recruited between January and December 2018 to participate in in-depth, semi-structured 1-2 h interviews about their experiences of using substances (e.g. cannabis) for sex. Drawing on constant comparative analytic techniques, two themes emerged with regards to participants' perceptions of, and experiences with, the sexualised use of cannabis. First, participants described how they used cannabis for sex to increase sexual pleasure and lower inhibitions. Second, participants described using cannabis for sex to reduce feelings of anxiety and shame, and foster intimacy and connection with sexual partners. These findings identify how the sexualised use of cannabis functions as a 'strategic resource' for sexual minority men to deliberately achieve both physiological and psychoactive effects, while concurrently underscoring the extent to which the contexts, patterns and motivations associated with cannabis use for sex parallel those associated with this form of Chemsex. [ABSTRACT FROM AUTHOR]

Aims: To estimate associations between both current‐ and prior‐year medical cannabis dispensary densities and hospitalizations for cannabis use disorder in California, USA between 2013 and 2016. Design Spatial analysis of ZIP code‐level hospitalization discharge data using Bayesian Poisson hierarchical space–time models over 4 years. Setting and cases: California, USA from 2013 to 2016 (6832 space–time ZIP code units). Measurements We assessed associations of annual hospitalizations for cannabis use disorder [assignment of a primary or secondary code for cannabis abuse and/or dependence using ICD‐9‐CM or ICD‐10‐CM (outcome)] with the total number of medical cannabis dispensaries per square mile in a ZIP code as well as dispensary temporal and spatial lags (primary exposures). Other exposure covariates included alcohol outlet densities, manual labor and retail sales densities and ZIP code‐level economic and demographic conditions. Findings One additional dispensary per square mile was associated with a median risk ratio of 1.021 (95% credible interval 1.001, 1.041). Prior‐year dispensary density did not appear to be associated with hospitalizations (median risk ratio = 1.006, 95% CrI = 0.986, 1.026). Higher median household income, higher unemployment, greater off‐premises alcohol outlet density and lower on‐premises alcohol outlet density and poverty were all associated with decreased ZIP code‐level risk of cannabis abuse/dependence hospitalizations. Conclusions: In California, USA, the increasing density of medical cannabis dispensaries appears to be positively associated with same‐year but not next‐year hospitalizations for cannabis use disorder. [ABSTRACT FROM AUTHOR]

Increasing positives attitudes toward medical marijuana (MM) is evident by the number of states who have authorized MM and in national surveys. Based on 177 participants responding to an anonymous electronic survey, the study found that Ohio licensed counselors and social workers hold generally positive views about MM regardless of one's license or supervisory status. Participants' attitude toward national legal adult use and opinion regarding recreational use significantly predicted participants attitude toward national legalization of MM, but age, having a chemical dependency license, and personal use of MM did not add to the prediction model. In addition, most reported having clients who use marijuana and directly asked about MM, yet nearly all had clients they believed should not use MM and would be reluctant to refer if a history of substance abuse was present. Additional concerns about MM were expressed by participants, and the training needs for practice and future directions for research are discussed. [ABSTRACT FROM AUTHOR]

Objectives: To (1) identify the reasons for which pharmacists in Connecticut use the CPMRS when dispensing opioid medications and medical marijuana products, (2) determine pharmacists' perceived value of the CPMRS when dispensing opioids or medical marijuana, and (3) compare practices and the perceived value of the CPMRS among community-based pharmacists (CBPs) and medical marijuana dispensary pharmacists (MMDPs).Methods: An online survey was administered from May 2019 to June 2019 to CBPs (n = 178) and MMDPs (n = 12). The survey included items about background, use, and attitudes about current and future use of the CPMRS.Results: Both pharmacist groups indicated that opioid use information was the most useful aspect of the CPMRS. Ninety percent of both groups checked patients' use of opioids using the CPMRS, and 81.2% of the MMDPs compared with 38.4% of the CBPs indicated that they checked for patients' use of medical marijuana. A greater percentage of MMDPs than CBPs felt that access to the marijuana use information was useful and needed for counseling. Several pharmacists recommended improvements in marijuana use information in the CPMRS and greater efficiencies for users of the system.Conclusion: Access to both marijuana and opioid use information can allow pharmacists to make specific recommendations on the basis of potential drug interactions and dose adjustments. The results from the present study highlight how integrated systems of opioid and marijuana dispensing information can be further enhanced by resolving existing pharmacy barriers involving technology, workflow, and need for systems with more detailed marijuana product information. [ABSTRACT FROM AUTHOR]