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AbstractBackgroundMethodsResultsConclusionThis study explores how cannabis has been accommodated over the last 18 years in the social world of an online forum in Poland. It considers users who operate in the context of unhurried normalization and restrictive policy that has barely changed over the last two decades. Simultaneously, these users refer to global cannabis cultures and follow progressive policy developments worldwide.Cannabis-related threads were scrapped from the biggest Polish forum, posted in the years 2006–2023, and divided into three periods marked by minor relaxation of the punitive law in 2011 and the introduction of medical cannabis in 2019. The threads were thematically analyzed to track changes in the perceived access to cannabis and shifts in the reasons users praise it.The shifts indicate the interaction of the normalization processes on both sides of the cannabis social world in Poland: among users and in society. The praise becomes less unconditional, and nuanced goals, or reflexivity of use emerges.We have recognized a consensus among forum users that there are problems associated with use. Instead of harm being neutralized as it used to be when stigmatization mattered more, it is now discussed among users who are becoming better informed, reflexive, and likely to engage with bottom-up harm reduction efforts. [ABSTRACT FROM AUTHOR]

International consensus has emerged, which proposes that the measurement and standardization of the quantity of THC potency, or dose (mgTHC), is a requisite for identifying consistent relationships between patterns of cannabis use and the risk for negative health outcomes, especially critical given the increasing number of U.S. states and European countries considering legalizing cannabis for recreational use. Despite the lack of measurement approaches that provide accurate, real-time data on THC dosage, the number of states that have implemented legal adult use cannabis markets has coincided with the use of regulatory seed-to-sale or track-and-trace systems. Seed-to-sale tracking systems are designed to track the amount of cannabis cultivated, and typically leverage biochemical testing contractors to label the THC potencies and amounts on a diverse array of cannabis products. We propose leveraging seed-to-sale tracking systems to facilitate a more objective measure of THC potency. In the current review, we will: 1) summarize the complexities of accurately measuring the multidimensional aspects of cannabis use patterns; 2) review recent advancements in quantifying THC and the importance of standardizing THC dose in measuring cannabis use; and 3) discuss the potential value of future research efforts examining how state-level seed-to-sale tracking data can inform the standard THC dose. [ABSTRACT FROM AUTHOR]

Cannabis, often criticized, has active compounds that indicate multiple medical benefits. However, before the potential decriminalization and legalization of medical cannabis, pharmacists play a crucial role in the decision-making for personalized therapy and evidence-based medicine. This study investigates pharmacists’ perspectives on medical cannabis, covering medical use, societal impact, research, legality, and regulation. This study was conducted through semi-structured interviews with pharmacists from different sectors. Interviews were conducted with 16 pharmacists, with 4 from each sector: industry, academia, community, and hospital. There was a consensus on the need for streamlined research before potential decriminalization and legalization of cannabis, highlighting concerns about abuse and misuse despite its benefits. With that in mind, all participants agree that there is a need to update the current legislation and regulations to better control the use and distribution of medical cannabis. Several participants also called to attention that education plays an important role in the potential decriminalization of medical cannabis, with cannabis-related stigma being a potential deterrent for not only the public but also healthcare professionals. As medical cannabis is a new subject in Malaysia, this study could ignite further multidisciplinary human-related research with strict regulations which will ultimately result in evidence-based medicine. [ABSTRACT FROM AUTHOR]

AbstractChronic pain and mental health issues like depression and anxiety significantly contribute to disease burden in Western countries. While cannabinoids are suggested to have analgesic, anxiolytic and antidepressant properties, evidence, especially for long-term use, is inconclusive. This 12-month observational study evaluated the effects of prescribed medicinal cannabis for 96 patients suffering from pain, as well as sleep disturbances, depression and anxiety. Treatment outcomes for pain, depression, anxiety and sleep problems were assessed at 3, 6, and 12 months using validated instruments. Significant reductions were observed in pain scores and the interference of pain on daily functions, alongside improvements in mental health and sleep. Many patients reported notable improvements in pain severity and reduced use of pain medications in the first 6 months, with a decline at 12 months. Additionally, sustained improvements in depression, anxiety, stress and sleep were observed, with about half reporting substantial improvement. Adverse effects were common but mostly mild or moderate, most commonly dry mouth and sleepiness. These results show that prescribed medicinal cannabis treatment is associated with improvements in chronic pain and mental health symptoms, such as depression, anxiety and stress. However, findings also suggest reduced effectiveness with longer-term use, emphasizing the need for additional research. [ABSTRACT FROM AUTHOR]

AbstractThis cohort study aims to assess the outcomes of fibromyalgia patients enrolled in the UK Medical Cannabis Registry prescribed a homogenous selection of cannabis-based medicinal products (CBMPs). A cohort study of fibromyalgia patients treated with oils (Adven®, Curaleaf International, UK), dried flower (Adven®, Curaleaf International, UK) or both CBMPs was performed. Primary outcomes were changes from baseline at 1, 3, 6 and 12 months in validated patient-reported outcome measures. Secondary outcomes included descriptive analysis of adverse events. One hundred and forty-eight participants were treated with oils (n = 77; 52.03%), dried flower (n = 14; 9.46%) or both (n = 57; 38.51%). Improvements in the generalized anxiety disorder-7 questionnaire, single-item sleep quality scale, fibromyalgia symptom severity score and EQ-5D-5L Index values were observed at each follow up period compared to baseline (p < 0.050). Thirty-six (24.32%) patients experienced 648 adverse events. Improvements were observed across all primary outcomes with no differences observed across different formulations of CBMPs. Adverse events were reported by one-quarter of participants and were more likely to reported by cannabis naïve patients. This present work through focusing on a homogeneous group of CBMPs can help inform randomized controlled trials after observing signals of improvement associated with a specific cultivar of CBMPs. [ABSTRACT FROM AUTHOR]

Objective: The state of Illinois' Opioid Alternative Pilot Program (OAPP) is the first and only official harm-reduction program in the US to address the opioid crisis via facilitation of safe and legal access to medical cannabis. This study evaluates the association of medical cannabis use with pain level and frequency of opioid use in the first cohort of OAPP participants in 2019. Methods: A survey was sent OAPP enrollees between February and July 2019. Cannabis users (n = 626) were compared to non-users (n = 234) to determine whether there was an association between cannabis use and self-reported (a) pain level and (b) frequency of opioid use. Backward stepwise regression models were used. Results: A total of 860 participants was included in the analysis. Overall, 75% of the study sample reported pain as their primary medical symptom, and 67% of cannabis users reported having a disability. The mean difference in pain level between cannabis users and non-users was 4.5 units (on a 100-point scale) higher among cannabis users than non-users (p = 0.03); and cannabis use was statistically associated with pain level. High-frequency opioid users had lower odds of reporting cannabis use within the past year than low/no opioid users. Conclusions: Although there was a statistical association between cannabis use and pain, the difference of 4.5 points in pain level between users and non-users was too small to reflect a clinically meaningful relative difference. This study may provide useful information to providers and clinicians about how the OAPP and similar programs may reduce opioid use and improve health outcomes. [ABSTRACT FROM AUTHOR]

AbstractAmid increasing awareness regarding opioid addiction, medical marijuana has emerged as a substitute to opioids for pain management. Concurrently, opioid manufacturers are putting significant research into making opioids safer yet effective. Interactions between these manufacturers and physicians are critical to advance existing pain management protocols. Direct payments from opioid manufacturers to physicians are established practices that often moderates such interactions. We study the effects of passage of a medical marijuana law (MML) on these direct payments to physicians. To draw causal conclusions, we develop a novel penalized synthetic control (SC) method that accommodates zero-payment related latent structures inherent in these payments. Under a truncated flexible additive mixture model, we show that the SC method has uncontrolled maximal risk without the penalty; by contrast, the proposed penalized method provides efficient estimates. Our analysis finds a significant decrease in direct payments from opioid manufacturers to pain medicine physicians as an effect of MML passage. We provide evidence that this decrease is due to medical marijuana becoming available as a substitute. Finally, our heterogeneity analyses indicate that the decrease in direct payments is comparatively higher for physicians practicing in localities with higher white populations, lower affluence, and a larger proportion of working-age residents. Supplementary materials for this article are available online, including a standardized description of the materials available for reproducing the work. [ABSTRACT FROM AUTHOR]

Objective: To investigate the level of knowledge, and attitude of society toward substance use disorder (SUD). Method: In this cross-sectional study, a questionnaire form created by the researchers was completed by individuals over the age of 18 between June and July 2022. A total of 1365 individuals (684 women, 681 men) participated in the study. Results: The mean age of the participants was 36.22 ± 10.47 years (min:18, max:75). A total of 19.2% did not consider addiction a medical disease, 37.4% thought that addiction was a moral failing, and 37.4% believed that addiction was a voluntary decision. 28.3% thought that only people with weak willpower will become addicted, 42.1% thought that trying substances would not lead to addiction, and 38.4% thought that substances can be quit without medical treatment. A total of 52.7% reported that they were afraid of people with addictions, 22.9% stated that they would not employ SUD patients in their workplace even if they had been treated. Only 36.8% of the participants had received any addiction-related training in their lifetime. Conclusion: Our findings display that the level of knowledge about addiction in society in Turkey is low, and there is substantial stigmatization and negative views on people with addictions. [ABSTRACT FROM AUTHOR]

Background: Cannabis use in young adulthood has been associated with exposure to traumatic events and posttraumatic stress disorder (PTSD). Coping motives for cannabis use represent one mechanism linking PTSD with cannabis problems, yet some individuals with PTSD consider their cannabis use to be medicinal in nature. While a medicinal orientation to cannabis overlaps conceptually with coping motives, it could be associated with unique cannabis outcomes. Objectives: This study examined trauma-related coping motives and medicinal cannabis orientation as mediators of the association between PTSD symptoms and cannabis outcomes in young adults. Method: Data came from an online survey of 212 university students (M age = 19.41; 70.3% Women; 43.4% White) who used cannabis in the past month and endorsed a traumatic life event. Path analyses examined associations of PTSD symptoms with past month cannabis frequency and problems through medicinal cannabis orientation (i.e., number of mental health symptoms that cannabis is used to manage) and trauma-related coping motives. Results: PTSD symptoms were associated with trauma-related coping motives but not with medicinal cannabis orientation. Both trauma-related coping motives and medicinal cannabis orientation were uniquely associated with greater cannabis use frequency, but only trauma-related coping motives were associated with greater cannabis problems. There were significant indirect relationships from PTSD symptoms to cannabis use frequency and problems through trauma-related coping motives but not through medicinal cannabis orientation. Conclusions: Results support unique contributions of trauma-related coping motives and medicinal cannabis orientation to cannabis outcomes and suggest that trauma-related coping motives are specifically implicated in the link between PTSD and cannabis problems. [ABSTRACT FROM AUTHOR]

Many studies have compared individuals who use cannabis for recreational versus medical purposes, but little is known about the moral norms and risk perceptions toward recreational versus medical cannabis while driving. This study aims to examine young Israeli adults’ behaviors, perceived moral norms, and perceived risk regarding driving under the influence of recreational versus medical cannabis. Methods: The study was conducted using quantitative questionnaires. Participants were 504 young adults, aged 18–30 (M = 25.26; SD = 5.40), of whom 314 (62.3%) were women. Results: Driving under the influence of medical cannabis was perceived as more moral and less risky than driving under the influence of recreational cannabis. Significant positive correlations were observed between perceived risk and perceived moral norms for both types of cannabis. Significant negative correlations were found between the frequency of driving under the influence of recreational cannabis and the perceived risk and perceived moral norms associated with both types of cannabis. Conclusion: Policymakers should promote prevention, harm reduction, and enforcement interventions to address the issue of driving under the influence of both recreational and medical cannabis. [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]

AbstractObjectiveMethodResultsConclusions\nHIGHLIGHTSTo document the prevalence and correlates of suicidal ideation (SI) among individuals seeking cannabis-based medicinal products (CBMPs); to test whether SI declines or intensifies after three months of CBMP treatment and to document 12-month trajectories of depression in those reporting SI and other patients.Observational data were available for 3781 patients at entry to treatment, 2112 at three months and 777 for 12 months. Self-reported depressed mood and SI were assessed using items from the PHQ-9. Additional data included sociodemographic characteristics and self-reported well-being.25% of the sample reported SI at treatment entry and those with SI had higher levels of depressed mood (mean = 17.4 vs. 11.3; F(1,3533) = 716.5, p < .001) and disturbed sleep (mean = 13.8 vs. 12.2, F(1,3533) = 125.9, p < .001), poorer general health (mean = 43.6 vs. 52.2, F(1,3533) = 118.3, p < .001) and lower quality of life (mean = 0.44 vs. 0.56 (F(1,3533) = 118.3, p < .001). The prevalence of SI reduced from 23.6% to 17.6% (z = 6.5, p < .001) at 3 months. Twelve-month follow-up indicated a substantial reduction in depressed mood with this reduction being more pronounced in those reporting SI (mean (baseline) = 17.7 vs. mean (12 months) = 10.3) than in other patients (mean (baseline) = 11.1 vs. mean (12 months) = 7.0).SI is common among individuals seeking CBMPs to treat a range of chronic conditions and is associated with higher levels of depressed mood and poorer quality of life. Treatment with CBMPs reduced the prevalence and intensity of suicidal ideation.Suicidal ideation is common among individuals seeking CBMPs for chronic conditionsIt is associated with higher levels of depressed mood and poorer quality of lifeTreatment with CBMPs reduced the prevalence and intensity of suicidal ideationSuicidal ideation is common among individuals seeking CBMPs for chronic conditionsIt is associated with higher levels of depressed mood and poorer quality of lifeTreatment with CBMPs reduced the prevalence and intensity of suicidal ideation [ABSTRACT FROM AUTHOR]

Background: Relations among attention-deficit/hyperactivity disorder (ADHD), sleep, and substance-related negative consequences are largely unknown. In this cross-sectional study, we examined associations among ADHD diagnosis, sleep, and alcohol-related consequences. We also evaluated the independent and interactive effects of sleep and ADHD on alcohol-related negative consequences, above and beyond levels of alcohol use. Methods: College students who drink alcohol with (n = 51) and without (n = 50) ADHD completed an assessment that included a diagnostic interview assessing ADHD, and questionnaire measures of sleep quality, substance use, and associated consequences. Analyses utilized a series of hierarchical linear regression models and explored these aims for cannabis use in a subset of participants (n = 52 participants that used cannabis). Results: College students who drink alcohol with ADHD reported significantly worse sleep quality and more alcohol-related consequences, relative to those without ADHD. When ADHD and sleep quality were included in the model, ADHD—but not sleep quality—was independently associated with alcohol consequences, but not cannabis consequences. There were no moderating effects of ADHD on the associations between sleep and substance-related consequences. Conclusions: Students who drank alcohol with ADHD may be particularly vulnerable to experiencing poor sleep and consequences from their substance use, compared to their heavy drinking peers without ADHD. Future, larger scale studies should consider longitudinal effects as well as underlying mechanisms of risk. [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]

Despite pharmacological treatments for osteoarthritis (OA), more individuals are choosing medical cannabis for OA symptom management and for mitigating opioid prescriptions for OA. This systematic review examines the global evidence of medical cannabis use on OA pain and function. The search was completed in MEDLINE (PubMed), Embase, and CINAHL within the past 10 years (2012-2022). We limited the search to English language articles. We did not include grey literature or case studies. Participant demographics included all adult individuals with OA who were using medical cannabis for OA. Study quality and risk of bias were evaluated using the Grading of Recommendations, Assessment, Development and Evaluations framework; and the Risk of Bias in Non-randomized Studies of Interventions tool. We used a narrative synthesis approach. Overall, 7 studies were included: 2 randomized controlled trials (RCT) and 5 observational studies. Only 1 of the 2 RCTs reported improvements in pain for cannabis users. All 5 observational studies reported an improvement in pain levels, reduction of opioid use, and/or improvement in overall OA function. Despite high risk of bias ratings and low study quality, the consensus across studies was that medical cannabis use was effective for a subgroup of individuals suffering from OA pain. There is low quality evidence to support medical cannabis use as a substitute for primary pharmacological treatment of OA. However, this does not negate the observations that medical cannabis may provide therapeutic relief for a subset of patients. CRD42022354026 [ABSTRACT FROM AUTHOR]

This article examines the emerging legal cannabis sector in Zimbabwe since 2018, which focuses on medicinal and industrial cannabis with unlicenced uses remaining criminalised, as well as its implications for agrarian change. It shows that the formal sector is set up in a way that prioritises those with substantial resources – marginalising small-scale farmers and illicit cultivators. While this presents the risk of corporate capture, various factors combine to undermine agribusiness' production. However, prohibition of recreational cannabis and the formal sector's focus on export markets combine to preserve illicit cannabis markets and allow continuation of illicit livelihoods. [ABSTRACT FROM AUTHOR]

Osteoarthritis accounts for 0.6% of disability-adjusted life years globally. There is a paucity of research focused on cannabis-based medicinal products (CBMPs) for osteoarthritic chronic pain management. This study aims to assess changes in validated patient-reported outcome measures (PROMs) and CBMP clinical safety in patients with osteoarthritis. A prospective case series from the UK Medical Cannabis Registry was analyzed. Primary outcomes were changes in the Brief Pain Inventory (BPI), McGill Pain Questionnaire (MPQ2), EQ-5D-5L, Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and Single-Item Sleep Quality Scale (SQS) at 1-, 3-, 6-, and 12-month follow-ups from baseline. Common Terminology Criteria for Adverse Events v.4.0 was used for adverse event (AE) analysis. Statistical significance was defined as p < 0.050. Seventy-seven patients met inclusion criteria. CBMP initiation correlated with BPI pain severity (p = 0.004), pain interference (p = 0.005), and MPQ2 (p = 0.017) improvements at all follow-ups compared to baseline. There were improvements in the EQ-5D-5L index (p = 0.026), SQS (p < 0.001), and GAD-7 (p = 0.038) up to 6 and 3 months, respectively. Seventeen participants (22.08%) recorded 76 mild AEs (34.86%), 104 moderate AEs (47.71%), and 38 severe AEs (17.43%). Though causality cannot be assumed in this observational study, results support development of randomized control trials for osteoarthritis pain management with CBMPs. [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]

Background: Delta-8 THC is a federally unregulated psychoactive cannabis product rising in popularity. However, little is known regarding its retail availability. Method: We assessed Delta-8 THC retail by calling locations with alcohol, tobacco, and/or consumable hemp retail licenses in Fort Worth, Texas, before and after Texas announced ongoing litigation surrounding Delta-8 THC legality. We linked census block area deprivation index (ADI) scores (1–10; 10 = most disadvantaged) to locations. Logistic regression models examined associations between license type, ADI, ADI*license type interaction, and Delta-8 availability at each time. Results: Retail availability was 11% at Time 1 (n = 133/1,223) and 9% at Time 2 (n = 94/1,026). Alcohol (aORTime1 = 0.18, 95%CI = 0.12,0.28; aORTime2 = 0.14, 95%CI = 0.08,0.24), tobacco (aORTime1 = 15.13, 95%CI = 6.78,33.74; aORTime2 = 12.39, 95%CI = 4.97,30.91), and consumable hemp licenses (aORTime1 = 21.85, 95%CI = 7.91,60.39; aORTime2 = 22.93, 95%CI = 6.92,75.98) were associated with Delta-8 THC retail availability; ADI scores were borderline but not statistically significant. The multiplicative interaction at Time 2 indicated locations with both high ADI scores and alcohol retail licenses had higher odds of selling Delta-8 THC. Differential associations between ADI and Delta-8 THC availability were observed based on those with (b = 0.007) or without (b = −0.023) alcohol retail licenses. Conclusions: Both timepoints had similar proportions of Delta-8 THC retailers, indicating that despite the uncertain legal landscape in Texas, interest in Delta-8 did not appear to be declining. Geographic socioeconomic disparities were observed among locations with alcohol retail licenses. Future regulations may include minimum distances from specific locations (e.g., schools), particularly in more disadvantaged areas. Increasing the compliance of Texas Delta-8 THC retailers to have the required hemp license is important for surveillance and product safety. [ABSTRACT FROM AUTHOR]

In 2022, Thailand became the first country in Asia to decriminalize the possession of cannabis. Despite the government's unwillingness to legalize recreational cannabis or promote cannabis tourism, a recreational cannabis industry fueled by tourism quickly emerged on a large scale in just a few months after decriminalization. Through the tourism worldmaking theory, the article seeks to show how cannabis tourism has taken shape in a semi-legal context following the decriminalization of cannabis in Thailand. Through a qualitative methodology combining document analysis, semi-structured interviews, and active participant observation, it is shown that following legislative changes, a recreational tourism industry has rapidly developed alongside the medical cannabis industry in which an array of cannabis products and services for tourists have emerged in the country's major tourist destinations, transforming the tourism landscape of these places. Cannabis tourism has grown rapidly despite legal restrictions and government rhetoric aimed at preventing recreational cannabis tourism. The article aims to show that after opening Pandora's box through the decriminalization of cannabis, cannabis tourism has developed on its own where many market-driven actors capitalized on this new economic opportunity following years of loss of income due to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Driving under the influence of cannabis (DUIC) is a major cause of preventable death and a growing public health concern. News media coverage of DUIC may influence public perceptions of causal factors for DUIC, risks of DUIC, and potential policy solutions. This study examines Israeli news media coverage of DUIC, and contrasts media coverage according to whether news items refer to cannabis use for medical vs. non-medical purposes. We conducted a quantitative content analysis of news articles related to driving accidents and cannabis use (N = 299) from eleven of the highest circulation newspapers in Israel between 2008 and 2020. We apply attribution theory to analyze media coverage of accidents that were linked to medical cannabis, use compared with non-medical use. News items describing DUIC in the context of non-medical (vs. medical) cannabis use were more likely to: (a) emphasize individual causes (vs. social and political); (b) describe drivers in negative terms (vs. neutral or positive); (c) refer to an increased accident risk due to cannabis use (vs. inconclusive or low risk); and (d) call for increased enforcement rather than education. Results show that Israeli news media coverage of cannabis-impaired driving varied significantly depending on whether it referred to cannabis use for medical purposes, or non-medical purposes. News media coverage may influence public perceptions of the risks of DUIC, the factors that are associated with this issue, and potential policy solutions that may reduce the prevalence of DUIC in Israel. [ABSTRACT FROM AUTHOR]

Growing evidence on medical cannabis has moved its legislation forward in various countries, which has increased research on stakeholder reactions. While various studies looked at experts and users, research on public perceptions is scarce. This study aims to (1) examine the relationships between knowledge, perceptions, and behavioral intention toward medical cannabis, and (2) identify and profile key segments within the general public. An online survey was conducted among 656 respondents in Belgium. Findings showed that both subjective and objective knowledge are relatively poor, while risk/benefit perceptions and behavioral intention are much more positive. Subjective and objective knowledge as well as social trust have a positive influence on benefit perceptions and a negative influence on risk perceptions. In turn, risk and benefit perceptions are key determinants of behavioral intention, but in opposite directions. Furthermore, cluster analysis identified a cautious (23% of the sample), positive (50%), and enthusiastic cluster (27%). In terms of socio-demographic profile, older and highly educated people were significantly more represented in the latter two clusters. While our study demonstrated that cannabis is well accepted for medical purposes, research is needed to further validate the relationships between knowledge, perceptions, and (intended) behavior in different settings and policy contexts. [ABSTRACT FROM AUTHOR]

Medical cannabis use among U.S. Veterans has continued to rise. However, data on cannabis use by older Veterans is generally less available. This study aims to understand the characteristics of older Veterans who enrolled in the Medical Cannabis Patient Program in Illinois and analyze their health outcomes and co-use of cannabis and opioids using longitudinal survey data. Overall, participants reported positive outcomes for pain, sleep, and emotional problems because of cannabis use in two survey periods. Approximately, 62% and 85% respondents reported no change in memory and falls, respectively, with only 3% and 1% reporting a negative outcome for the conditions in both surveys. About 20.4% of those who indicated cannabis use only in the initial survey started to co-use opioids in the follow-up survey, while 44.1% of those who indicated the use of both substances in the initial survey reported no longer using opioids in the follow-up survey. However, these changes were not statistically significant ($$\alpha = 0.05).$$ α = 0.05). The logistic regression showed that both clinical and contextual factors affected co-use. In conclusion, older U.S. Veterans may be using cannabis to alleviate their pain and other chronic conditions. More research is needed to understand the effect of cannabis use on reducing or substituting opioids. [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]

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. [ABSTRACT FROM AUTHOR]

The growing use of Cannabis sativa as a complementary therapy to allopathic medicine has brought about the modification of laws for its use worldwide. This entails the need to harmonize the methods of galenic preparations in pharmacies and cannabis-specialized non-governmental organizations as well as for self-provision as contemplated in some current legislation, such as that of Argentina. Thus, this work aimed to study simple and efficient methods to produce medicinal cannabis oils that require low-cost equipment and few handling steps. The final formulas allowed the obtaining of preparations of known concentrations of neutral cannabinoids, total polyphenol content, total flavonoid content, and antioxidant capacity. These methods allow for the selection of convenient vehicles and access to safe medicinal products of standardized quality. Our results show that cannabis extraction can be efficiently performed by directly using long-chain lipidic vehicles as extractants, resulting in a formulation with maximized oxidizing capacity and potentially extending its durability. [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]

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: Previous studies examining the cannabis-alcohol substitution effect have found that medical cannabis policies may result in substituting the use of cannabis in place of alcohol use. Objectives: This study adds to the literature on cannabis-alcohol substitution by analyzing the effect of decriminalization, medicinal cannabis, and adult-use legalization cannabis policies (2002-2019) on cannabis and alcohol use and substance substitution for all 50 states and the District of Columbia (N=867). Results: Results support the notion that liberalized cannabis policies can increase the prevalence of cannabis use. An adult-use legalization specific analysis yielded findings suggesting a complex and heterogenous effect of such laws on cannabis-alcohol complementation. Conclusion: Given the lack of clarity and heterogenous effects of cannabis laws, policy makers should carefully take into consideration the benefits of medical cannabis laws, along with the risks of decriminalization and adult-use legalization. [ABSTRACT FROM AUTHOR]

Background: Medical marijuana legalization (MML) has been widely implemented in the past decade. However, the debates regarding the consequences of MML persist, especially criminal behaviors. Objectives: We examined the association between MML and criminal behaviors among adults in the United States. The criminal behaviors measured three past-year offenses: whether the adult (1) have sold illegal drugs, (2) have stolen anything worth > $50 USD, or (3) have attacked someone. Methods: Using the 2015–2020 National Survey of Drug Use and Health, we included 214,505 adults in our primary analysis for 2015–2019 and 27,170 adults in 2020 for supplemental analysis (age > = 18). Weighted multivariable logistic regression models were used to examine the association between MML and three criminal behaviors. Results: In our primary analysis, we observed no statistically significant association between MML and the three outcomes of criminal behavior. Nevertheless, our supplemental analysis of the 2020 data showed MML was associated with increasing odds of the three criminal behaviors (have sold illegal drugs: AOR [adjusted odds ratio] = 1.7; have stolen anything worth > $50 USD: AOR = 1.9; have attacked someone: AOR = 1.8; all p < 0.05). Conclusion: Surveys from 2015 to 2019 did not suggest MML as a risk factor for higher incidence of criminal behaviors. However, 2020 data showed statistically significant association between MML and selected criminal behaviors. Issues related to the COVID-19 pandemic, such as the U.S. economic downturn, could potentially explain this discrepancy. Further research efforts may be warranted. [ABSTRACT FROM AUTHOR]

Background: The past two decades have seen significant debate around cannabis legalization globally, including in India. Since there is no data on professionals’ attitudes toward cannabis legalization; we aimed to assess early-career psychiatrists (ECP) views on cannabis legalization. Methods: An online survey consisting of questions regarding personal and socio-demographic details, attitudes toward legalization of medicinal cannabis and recreational cannabis, and potential indications of medicinal cannabis use was distributed to ECPs. Data from 105 respondents were analyzed using descriptive statistics, chi-square test, and t-test. Results: More respondents agreed with the legalization of medical cannabis (55%) as compared to recreational cannabis (23%). More than 80% ECPs considered cannabis to be associated with psychosis and adverse mental health outcomes; however, those in favor of legalization considered cannabis to be less harmful. ECP with past cannabis use was more likely to have a permissive attitude toward the legalization of recreational cannabis (χ2 =6.79, p < .05) but not for medicinal cannabis use (χ² =1.96, p > .05). Conclusion: ECP in India are open to the idea of legalizing cannabis for medicinal purposes but not for recreational purposes. [ABSTRACT FROM AUTHOR]

Since the shift to legalizing recreational cannabis use in Canada in 2018, there has been increased attention on the consequences of cannabis use on women's reproductive and maternal health, with particular attention to the impact of cannabis in utero and through breastfeeding. This has resulted in an intense focus on the behaviors of individuals who consume cannabis during the perinatal period, which raises questions about the impact this has on women and mothers who have historically been under the surveillance of the Canadian public health, health and social care, and legal systems. Grounded in an intersectional feminist framework that acknowledges how race, ability, class, and other social positions impact and differentiate women's experience, this paper presents findings emerging from a participatory arts-based research approach called Photovoice with 23 mothers living throughout Canada. All participants consumed cannabis during pregnancy and breastfeeding and illustrated through photographs and individual and group discussion how their experiences of intersectional stigma and surveillance by health and social care providers resulted in barriers to accessing cannabis-related information and support. Implications arising from our inquiry suggest there is a dire need for public health, perinatal care, and social care responses that run counter to the current context where stigma and fear prevent parents from accessing cannabis information and support. [ABSTRACT FROM AUTHOR]

Preclinical and experimental research have provided promising evidence that medicinal cannabis may be efficacious in the treatment of posttraumatic stress disorder (PTSD). However, implementation of medicinal cannabis into routine clinical therapies may not be straightforward. In this review, we describe some of the clinical, practical, and safety challenges that must be addressed for cannabis-based treatment of PTSD to be feasible in a real-world setting. These issues are especially prevalent if medicinal cannabis is to be combined with trauma-focused psychotherapy. Future consideration of the clinical and practical considerations of cannabis use in PTSD therapy will be essential to both the efficacy and safety of the treatment protocols that are being developed. These issues include dose timing and titration, potential for addiction, product formulation, windows of intervention, and route of administration. In particular, exposure therapy for PTSD involves recall of intense emotions, and the interaction between cannabis use and reliving of trauma memories must be explored in terms of patient safety and impact on therapeutic outcomes. [ABSTRACT FROM AUTHOR]

Health information that is acquired through information scanning has been shown to play an important role in shaping individual beliefs and health behavior. This study examines the direct and indirect effects of the breadth of scanning from media and interpersonal sources about two risk behaviors (nonmedical use of amphetamines and marijuana) on subsequent drug use behavior through changes to perceived norms. We test effects of scanning using a longitudinal online survey design with data collected at six-month intervals over three time points among 800 Israeli undergraduate students in their freshman year. Of the 800 respondents who participated in the first wave, 62.4% completed the second wave (N = 499), among which 347 (69.5%) completed a follow-up 6 months later. Results of cross-lagged structural equation models find that scanning information about amphetamines from interpersonal sources at 6 months predicted an increased likelihood of nonmedical use of amphetamines at 12-months. In addition, young adults who scanned information about marijuana from media sources at 6 months reported greater nonmedical marijuana use at 12 months. Breadth of scanning about marijuana from media sources mediated the relationship between perceived norms and marijuana use at 12 months. Results also showed indirect effects of scanning at baseline on nonmedical drug use at 12 months through scanning from the same source at 6 months. These findings contribute to our understanding of the role of information scanning and perceived norms in shaping substance use behaviors, and suggest that scanning may serve as a potential early indicator of risk. [ABSTRACT FROM AUTHOR]

Background: Although Uruguay was the first country to legalize cannabis at a national level, regulations for the medicinal component have been slow in coming. The integration of medical cannabis into the healthcare system remains a challenge, and the regulatory framework is still under review. In this context, physicians' opinions must be considered. This study aims to determine the medical community's attitudes towards cannabis. Methods: We conducted an anonymous self-administered online survey. Several national physician organizations collaborated in the dissemination process. The questionnaire inquired about cannabis-related topics such as knowledge, experience, attitudes, and the perceived barriers they encounter. Results: A total of 275 physicians responded to the survey. The vast majority stated that they had been consulted by their patients about cannabis, although only half of them had formally or informally recommended it. Finally, we found almost unanimous agreement among physicians that medical cannabis should be legal. Discussion: Uruguayan physicians have a positive view regarding the legalization of medical cannabis and are in favor of recommending its use. The main barrier to doing so is the lack of knowledge about incorporating it into their clinical practice. Medical cannabis should be addressed by public policies by providing training opportunities and institutional support. [ABSTRACT FROM AUTHOR]

Background: Medical cannabis currently dominates the U.S. cannabis advertising landscape. The public is increasingly exposed to outdoor cannabis advertising, which increases positive attitudes about and intentions to use cannabis. Research is lacking regarding outdoor cannabis advertising content. This article characterizes the content of outdoor cannabis advertising in Oklahoma, one of the fastest growing U.S. medical cannabis markets. Methods: We conducted a content analysis of cannabis advertising billboard images (n = 73) from Oklahoma City and Tulsa, photographed May 2019–November 2020. We followed a primarily inductive, iterative team approach to thematically analyze billboard content in NVIVO. We reviewed all images, identified a broad coding taxonomy, and then incorporated emergent codes and those related to advertising regulation (e.g. youth/children). We totaled frequencies of code application across billboards and reexamined billboards for final themes. Results: Major themes were social meanings related to cannabis subculture, formal medical systems, and nature, and the presence of company contact information. Minor themes related to convenience, price promotions, store proximity, U.S. affiliation, product quality, and spirituality. State advertising regulation violations were rare, with the exception of content that may promote curative or therapeutic effects (4%) and misrepresentation of product state of origin (1.4%). Conclusion: Outdoor medical cannabis advertising in Oklahoma blurs boundaries between formal medical discourses and cannabis subculture that is suspicious of messaging from authorities and regards cannabis as harmless and natural. Increased monitoring of advertising regulation compliance and greater understanding of social discourses within emerging markets is needed to promote public health within the context of cannabis advertising. [ABSTRACT FROM AUTHOR]

The motivation of this article is to address the ambivalent position of policy analysis when it intervenes in the real-world policy process through policy evaluation. It tackles the underresearched question of the challenges faced by policy analysis in relation to applied research mandates. It argues that policy analysis is constantly at risk of instrumentalisation by politico-administrative players. The article is based on the evaluation of the medical cannabis policy in Switzerland as a case study. The results point out four specific challenges faced by applied policy analysis: political pressure, scientific integrity, access to sensitive data, and epistemic legitimacy. However, applied policy analysis can contribute to de-escalating controversies by presenting a bigger and contextualised picture of the considered political issues. Policy evaluation can identify deficient implementation processes, but also wider mismatches among legislative and societal processes. Hence, although evidence is subordinated to other factors in the decision-making process, evaluations provide an outside perspective, which can help solving controversies around policies. The article contributes to the literature on the politics of policy analysis by showing that confronting policy analysis with practical problems brings both scientific and policy benefits. [ABSTRACT FROM AUTHOR]

Thailand has pioneered legalizing cannabis for medical purposes in Asia. This study focuses on drug tourism and the supply of cannabis in Phuket. Geospatial analysis reveals a notably positive association between cannabis stores and hotels, thus providing evidence of misuse of cannabis since its decriminalization. Despite advisory warnings discouraging tourists from leisure cannabis consumption, cannabis outlets could increase significantly in areas centered around hotels. The result reveals the urgency of nuanced destination management. Without regulation, suppliers are poised to primarily cater to the tourist, thus potentially distorting the purpose of decriminalization and neglecting the negative externalities imposed on the destination. [ABSTRACT FROM AUTHOR]

Cannabis is often used by people with HIV (PWH) for pain, yet study results are inconsistent regarding whether and how it affects pain. This study examines whether greater cannabis use frequency is associated with lower pain interference and whether cannabis use modifies the association of pain severity and pain interference among 134 PWH with substance dependence or a lifetime history of injection drug use. Multi-variable linear regression models examined the association between past 30-day cannabis use frequency and pain interference. Additional models evaluated whether cannabis use modified the association between pain severity and pain interference. Cannabis use frequency was not significantly associated with pain interference. However, in a model with interaction between cannabis use frequency and pain severity, greater cannabis use frequency attenuated the strength of the association between pain severity and pain interference (p = 0.049). The adjusted mean difference (AMD) in pain interference was +1.13, + 0.81, and +0.05 points for each 1-point increase in pain severity for those with no cannabis use, 15 days of use, and daily use, respectively. These findings suggest that attenuating the impact of pain severity on pain-related functional impairment is a potential mechanism for a beneficial role of cannabis for PWH. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between past 30-day nonmedical prescription stimulant use (NPSU) and past 30-day marijuana and/or alcohol use, past 30-day risky marijuana and/or alcohol use, student demographics, and student activity involvement among college students. Participants: Sample of 604 college-aged students at two large universities in the southeastern U.S. Methods: A cross-sectional survey was completed electronically. Logistic regression was used to identify and test covariates of past 30-day NPSU. Results: Over 20% of participants self-reported past NPSU. Using both marijuana and alcohol in the past 30 days (B = 3.293, p =.002, OR= 26.91, 95% CI OR= 3.42, 211.92) and engaging in both risky marijuana and alcohol use (B = 2.095, p <.001, OR = 8.13, 95% CI OR = 2.52, 25.17) were significantly related to past 30-day NPSU. Conclusions: NPSU may be indicative of broader polysubstance use problems among college-aged students. [ABSTRACT FROM AUTHOR]

Many U.S. Veterans are using cannabis for medical purposes. Modern research findings continue to point to medical cannabis as a potentially effective alternative to prescription medications for treating a range of medical conditions. While research exists on the use levels of cannabis, limited research can be found on the perceived stigma of using cannabis, especially among older Veterans. We surveyed 121 older U.S. Veterans who were enrolled in the Illinois Medical Cannabis Patient Program during Fall 2020. We then used maximum variation sampling to select a subset of 32 Veterans to partake in a phone interview. Two researchers conducted and qualitatively coded 30-minute audiotaped semi-structured interviews. Interview topics included (1) the use of cannabis, opioids, and benzodiazepines; (2) interactions with medical providers; (3) stigma regarding cannabis use; and (4) educational materials. We share findings from stigma. We identified three themes: (1) stereotypes regarding people who use cannabis, (2) media portrayal of cannabis users, and (3) hesitation in disclosing cannabis use. Stigma creates situations in which older Veterans may be hesitant to disclose their use of cannabis with physicians and friends/family, which can be dangerous and socially isolating. Additional research is needed to expand upon our findings with more generalizable methods. [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]

Smoking cannabis in medical users is associated with exposure to harmful toxins. It is important to characterize cannabis-use profiles and risk-factors for medical cannabis users who smoke cannabis. 100 members of a medical cannabis dispensary with mental health concerns were interviewed in detail about their cannabis use. Forty seven percent of participants preferred smoking only, 18% preferred vaporizing, 25% preferred both smoking and vaping, and 10% preferred oral ingestion methods. Smokers differed from other users in multiple ways, including a greater preference for THC-dominant chemovars, and more frequent and greater amount of cannabis consumption. Smoking was also associated with greater rates of alcohol use disorder. These results may inform harm-reduction approaches to decrease the number of individuals smoking cannabis and use less harmful methods of medical cannabis ingestion. [ABSTRACT FROM AUTHOR]

The present study examines the prevalence of medical cannabis as a substitute for prescription agents, and how medical cannabis use impacts the use of other prescription drugs. Four main databases were searched including Medline, Embase, PsychINFO, and Global Health to identify studies that evaluate medical cannabis use as a substitute for prescription agents in adult participants using cannabis for medicinal purposes. Of 493 studies identified, 27 relevant studies were included in the final analysis. The pooled percentage of the prevalence of substituting medical cannabis for one or more prescription drugs was 60.0% (95% CI; 50%–70%). Chronic pain and mental health conditions were prominent among the leading reasons for medical cannabis use. The most common substituted drug classes were narcotics/opioids, anxiolytics, and antidepressants. A majority supported that medical cannabis decreased prescription drug uses. People use medical cannabis as a substitute for prescription drugs. Yet, despite rigorous self-reporting from patients who attribute their reduction or cessation of prescribed medication to the use of medicinal cannabis, most results are mainly drawn from observational studies. Few good-quality randomized controlled trials (RCT) explore cannabis substitution effects. [ABSTRACT FROM AUTHOR]

The UK Medical Cannabis Registry is the largest real world data platform for medical cannabis outcomes in the UK, providing insight into clinical outcomes and monitoring safety of this novel therapy. This study aims to assess the functionality and accessibility of the online data collection platform and patient priorities for future research. Descriptive statistics were used to analyze quantitative data. For open-ended questions an inductive thematic analysis was performed. 600 responses were recorded. 554 (92.3%) patients had used the platform. 272 (90.4%) patients believed it was easy to input medications. 52 (8.67%) patients recorded an adverse event with 38 (73.1%) finding it easy to record. 535 (96.6%) patients had completed health questionnaires with 490 (91.6%) patients finding this easy to do. 553 (92.2%) patients agreed that contributing to the registry would impact the medical care of future patients. "Assessing the impact of medical cannabis on quality of life generally" was the top research priority for 357 (59.3%) patients. This study demonstrates that most enrolled patients found the platform easy to use and believed they were positively impacting future medical cannabis patient care. Future patient research priorities included assessment of quality of life and condition-specific outcomes. [ABSTRACT FROM AUTHOR]

Background: The legal landscape surrounding marijuana use in the United States (US) is ever changing. Although substantial research has investigated risk factors of use among different populations, much is to be gleaned among veteran populations, who are at heightened risk for mental and physical health problems, which may be precipitated or relieved by marijuana use. The present study investigated correlates and trends of recreational and medical marijuana use among a large national sample of US Veterans. Methods: Data from the National Survey on Drug Use and Health (2013–2019) comprised of 16,350 veterans 18 years or older were analyzed. We tested for weighted linear and quadratic trends in past-year use. Results: Weighted analyses revealed a significant increase (56%) in overall marijuana use from 2013–2019, with nearly one in 10 veterans (9.79%) reporting past-year marijuana use. Compared to 18 to 25-year-old veterans, veterans who were aged 35-49 years (aPR: 1.44, 95% CI 1.05, 1.97), 50-64 years (aPR: 1.68, 95% CI 1.11, 2.55), and 65 years or older (aPR: 1.90, 95% CI 1.24, 2.90) were more likely to report using medical marijuana in the past year. Conclusions: This increase, in the context of federal VA provider restrictions, has implications for issues of care coordination and safe supply for veterans. Given the rapidly changing and heterogenous landscape of recreational and medical marijuana policy in the US, the present study may inform harm reduction efforts and behavioral interventions. [ABSTRACT FROM AUTHOR]

Cannabis use is a growing concern in transportation and workplace incidents. Because Δ9-tetrahydrocannabinol is detectable after acute psychoactive effects have resolved, it has limitations as an indicator of recent usage or potential impairment. In an observational study of driving and psychomotor performance, we measured whole blood Δ9-tetrahydrocannabinol plus its metabolites 11-hydroxy-Δ9-tetrahydrocannabinol and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol by liquid chromatography with tandem mass spectrometry at baseline and 30 min after starting a 15-minute interval of smoking cannabis in 24 occasional and 32 daily cannabis smokers. We calculated two blood cannabinoid molar metabolite ratios: 1) [Δ9-tetrahydrocannabinol] to [11-nor-9-carboxy-Δ9-tetrahydrocannabinol] and 2) ([Δ9-tetrahydrocannabinol] + [11-hydroxy-Δ9-tetrahydrocannabinol]) to [11-nor-9-carboxy-Δ9-tetrahydrocannabinol]. We compared these to blood [Δ9-tetrahydrocannabinol] alone as indicators of recent cannabis smoking. Median Δ9-tetrahydrocannabinol concentrations increased from 0 ( 0.38). By comparison, a cut-point for Δ9-tetrahydrocannabinol of 5.3 µg/L yielded 88% specificity, 73% sensitivity, and 80% accuracy. In occasional and daily users, the blood cannabinoid molar metabolite ratios were superior to whole blood Δ9-tetrahydrocannabinol as indicators of recent cannabis smoking. We recommend measurement and reporting of Δ9-tetrahydrocannabinol, 11-hydroxy-Δ9-tetrahydrocannabinol, and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol, and their molar metabolite ratios in forensic and safety investigations. [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]

Many states in the United States have progressed towards legalization of marijuana including decriminalization, medicinal and/or recreational use. We studied the impact of legalization on cannabis-related emergency department visits in states with varying degrees of legalization. Seventeen healthcare institutions in fifteen states (California, Colorado, Connecticut, Florida, Iowa, Kentucky, Maryland, Massachusetts, Missouri, New Hampshire, Oregon, South Carolina, Tennessee, Texas, Washington) participated. Cannabinoid immunoassay results and cannabis-related International Classification of Diseases (ninth and tenth versions) codes were obtained for emergency department visits over a 3- to 8-year period during various stages of legalization: no state laws, decriminalized, medical approval before dispensaries, medical dispensaries available, recreational approval before dispensaries and recreational dispensaries available. Trends and monthly rates of cannabinoid immunoassay and cannabis-related International Classification of Diseases code positivity were determined during these legalization periods. For most states, there was a significant increase in both cannabinoid immunoassay and International Classification of Diseases code positivity as legalization progressed; however, positivity rates differed. The availability of dispensaries may impact positivity in states with medical and/or recreational approval. In most states with no laws, there was a significant but smaller increase in cannabinoid immunoassay positivity rates. States may experience an increase in cannabis-related emergency department visits with progression toward marijuana legalization. The differences between states, including those in which no impact was seen, are likely multifactorial and include cultural norms, attitudes of local law enforcement, differing patient populations, legalization in surrounding states, availability of dispensaries, various ordering protocols in the emergency department, and the prevalence of non-regulated cannabis products. [ABSTRACT FROM AUTHOR]

Past research indicates that driving after cannabis use is relatively common. However, not all cannabis users are equally likely to drive after use; frequent cannabis users and frequent drivers are most at risk. It has been suggested that this is due to a perceived lack of impact of cannabis on driving ability. The current study sought to better understand the motivation to drive after recent cannabis use. A survey was used to examine the self-reported impact of cannabis use on driving ability and, further, the amount of time cannabis users wait before driving after use. A total of 562 participants were recruited. Of these, 424 completed the survey and were included for analysis. Purposive sampling was used to screen for cannabis users who were over the age of 18 and residents of Connecticut. Cannabis use frequency was found to predict the self-reported impact of both recreational and medicinal cannabis on driving ability, such that more frequent cannabis users reported less impairment. Additionally, cannabis use frequency was predictive of wait time before driving, where more frequent users reported waiting less time before driving after cannabis use. A plurality of participants reported not waiting at all before driving after using cannabis. Notably, the self-reported impact of cannabis on driving ability was not associated with wait time before driving. Cannabis users may not wait before driving even if they think it has a negative impact on their driving ability. Other factors that potentially impact driving after using cannabis warrant investigation. [ABSTRACT FROM AUTHOR]