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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]

Background: Cannabis species have a propensity to bioaccumulate toxic heavy metals from their growth media. Increased testing for these metals is required to improve the safety of the legal medical and recreational cannabis industries. However, the current methods used for mandated heavy metals tests are not efficient for a large framework. As a result, there is limited testing capacity, high testing costs, and long wait times for results across North America. Objective: This study aimed to demonstrate that pooling strategies can be used to increase the throughput in cannabis testing labs and reduce some of the strain on the industry. Methods: This paper presents an algorithm to simulate different pooling strategies. The algorithm was applied to real world data sets collected from Washington and California state testing labs. Results: Using a single pooling method, a pool size of three samples on average resulted in a 23.8% reduction in tests required for 100 samples for the Washington lab. For the California lab, pooling four samples on average resulted in a 54.1% reduction in tests required for 100 samples. Conclusion: The algorithms generated from the Washington and California lab data demonstrated that pooled testing strategies can be developed on a case-by-case method to reduce the time, effort, and costs associated with heavy metals tests. Highlights: The benefits of pooled testing will vary depending on the region and rate of contamination seen in each testing lab. Overall, our results demonstrate pooled testing has the potential to reduce the fiscal costs of testing through increased efficiency, allowing increased testing, leading to greater safety. [ABSTRACT FROM AUTHOR]

The multibillion-dollar California cannabis (Cannabis sativa, marijuana) industry employs an unknown number of seasonal workers, including many immigrants. Most production occurs in the remote, rural, far-northern counties where farms may be hours by vehicle from the nearest town. While licenses for cannabis cultivation became available following legalization in California for adult recreational use in 2016, most cannabis— about 80%—is still grown on unlicensed farms. Cannabis is a labor-intensive crop, and the skilled and time-consuming task of hand-trimming flowers is the most common seasonal job in the industry. Some immigrant workers return for multiple cannabis harvest seasons and are attracted to the work by an interest in the cannabis culture and consumption or the opportunity to earn enough money in several months to live the rest of the year in their home country. Others are farmworkers moving from work in traditional crops for the relatively higher pay in the cannabis industry. Seasonal cannabis workers are exposed to many of the physical hazards found in all agricultural workplaces, like dust, pesticides, and injuries; another commonality with California’s traditional agricultural workforce is vulnerability to structural violence stemming from factors related to race, gender, immigration status, and employer/employee power imbalance. Cannabis workers are also uniquely affected by the intersections of these structural factors with the isolated and remote nature of cannabis farms and the ongoing criminalization of the industry. In this article we present the results of a qualitative study of the occupational health and safety of Mexican and South American immigrant seasonal cannabis workers who have previous cannabis industry-specific skills and experience. Workers were recruited using a peer-recruitment method, with 25 participants in three online focus group discussions on a range of occupational health and safety topics. This qualitative descriptive analysis is focused on experiences of structural violence and wage theft. [ABSTRACT FROM AUTHOR]

We examined the effects of California's 2016 law legalizing cannabis for recreational use among young adult medical cannabis patients (MCP) and non-patient users (NPU). Three groups of young adult cannabis users (n = 30) were qualitatively interviewed in Los Angeles between 2020-21: current MCP (n = 3), who always had a medical cannabis recommendation, NPU (n = 6), who never had a recommendation, and MCP-to-NPU (n = 21), who had a recommendation in the past. MCP remained MCP due to greater acceptance of cannabis and lower prices afforded to MCP. MCP-to-NPU and NPU remained NPU due to increased acceptance of cannabis use within their community, greater legal security, and no compelling need for a medical cannabis recommendation. Price increases drove many to purchasing cannabis from unregulated black-market dispensaries. The legalization of cannabis for recreational use led to decisions to transition out of MCP status, destigmatization of cannabis use, increased prices of cannabis, and increased sourcing of cannabis from the black-market. [ABSTRACT FROM AUTHOR]

• First study on distribution of cannabis policies using an intersectional approach. • Black residents in privileged areas were most likely to live where retail was allowed. • Equity provisions were rare but most common for Black residents in privileged areas. • Strict ad policies were most common for Latinx and Black residents in poorer areas. • The impact of cannabis policy disparities on public health remains uncertain. Policies governing legal cannabis commerce can vary widely within a U.S. state when local control exists. Disproportionate distribution of policies allowing retail sale, protecting public health, or promoting equity in licensing may contribute to differences in health and economic outcomes between sociodemographic subgroups. This cross-sectional study jointly examined racial, ethnic, and neighborhood socioeconomic characteristics of Californians subject to specific local cannabis policies to identify such disparities. Local laws in effect January 1, 2020, governing retail cannabis sales (bans, expanding buffers from youth-serving sites, restricting advertising, promoting equity in licensing, and capping outlets) were determined for California's 539 jurisdictions. The number of Asian, Black, Latinx, and white residents in socioeconomic advantaged versus disadvantaged neighborhoods (Census block groups) was determined using 2015–2019 American Community Survey data. We estimated proportions of the sociodemographic subpopulations covered by specific policies based on the block group's jurisdiction. To ascertain disparities in coverage proportions were compared across subgroups using Z-tests with the Bonferroni correction. Residents of socioeconomically advantaged neighborhoods were more likely to live in jurisdictions allowing retail cannabis commerce than those in disadvantaged neighborhoods (61.7 % versus 54.8 %). Black residents in advantaged neighborhoods were most likely to live where retailing was allowed (69 %), and white residents in disadvantaged neighborhoods least likely (49 %). Latinx and Black populations from disadvantaged neighborhoods were most likely to live in jurisdictions with stronger advertising restrictions (66 %). Equity in licensing policy was more prevalent for Black residents living in advantaged neighborhoods (57 %) than disadvantaged neighborhoods (49 %). Local cannabis policies potentially protecting public health and social equity are unequally distributed across race, ethnicity, and socioeconomic characteristics in California. Research examining whether differential policy exposure reduces, creates, or perpetuates cannabis-related health and socioeconomic disparities is needed. [ABSTRACT FROM AUTHOR]

BACKGROUND: The presence of contaminants in cannabis presents a potential health hazard to recreational users and susceptible patients with medical conditions. Because of the federally illegal status of cannabis, there are no unified regulatory guidelines mitigating the public health risk of cannabis contaminants. OBJECTIVE: To inform further research and provide solutions to the public health risk of cannabis contaminants at a national level, we examined the current landscape of state-level contaminant regulations, and cannabis contaminants of concern, as well as patient populations susceptible to contaminants. METHODS: We examined the regulatory documents for medical and recreational cannabis in all legalized U.S. jurisdictions and compiled a complete list of regulated contaminants, namely, pesticides, inorganics, solvents, microbes, and mycotoxins. We data mined the compliance testing records of 5,654 cured flower and 3,760 extract samples that accounted for ~6% of California's legal cannabis production in 2020-2021. We also reviewed the publicly available medical cannabis use reports to tabulate the susceptible patient populations. RESULTS: As of 18 May 2022, 36 states and the District of Columbia listed a total of 679 cannabis contaminants as regulated in medical or recreational cannabis, including 551 pesticides, 74 solvents, 12 inorganics, 21 microbes, 5 mycotoxins, and 16 other contaminants. Different jurisdictions showed significant variations in regulated contaminants and action levels ranging up to four orders of magnitude. A failure rate of 2.3% was identified for flowers and 9.2% for extracts in the California samples. Insecticides and fungicides were the most prevalent categories of detected contaminants, with boscalid and chlorpyrifos being the most common. The contaminant concentrations fell below the regulatory action levels in many legalized jurisdictions, indicating a higher risk of contaminant exposure. Cannabis use reports indicated usage in several patient populations susceptible to contamination toxicity, including cancer (44,318) and seizure (21,195) patients. DISCUSSION: Although individual jurisdictions can implement their policies and regulations for legalized cannabis, this study demonstrates the urgent need to mitigate the public health risk of cannabis contamination by introducing national-level guidelines based on conventional risk assessment methodologies and knowledge of patients' susceptibility in medical use. [ABSTRACT FROM AUTHOR]

Marijuana use among pregnant and breastfeeding women is on the rise and carries risks for infant health and well-being. Decisions to use marijuana while pregnant and breastfeeding are motivated by beliefs that use poses minimal risk to infants and offers benefits to maternal users. Misperceptions and usage trend higher among disadvantaged populations. This study surveyed 401 community residents on beliefs about risks and benefits of marijuana use by pregnant and breastfeeding women. The study utilized techniques to enhance recruitment of Latino and disadvantaged residents of rural communities in California, a state where recreational marijuana use is legal. Analyses revealed substantial endorsement of beliefs about benefits and low risks of marijuana use while pregnant and breastfeeding, many of which run counter to current evidence. Misperceptions were particularly prevalent for cannabis users and male respondents. Trends in valid beliefs, while modest, were higher for Latinos and parents. [ABSTRACT FROM AUTHOR]

California law allows an employer to refuse to hire an applicant or discharge an employee for consuming medical cannabis in order to treat a serious medical condition, even if an individual consumes cannabis at home during non-working hours. For example, in 2001, employer RagingWire Telecommunications fired its newly hired employee—Gary Ross, a United States Veteran who sustained injuries while serving his country— for using medical cannabis at home during non-working hours to relieve the pain those injuries caused. Mr. Ross challenged his termination, and the California Supreme Court sided with RagingWire, finding that California’s Compassionate Use Act did not protect medical cannabis patients from termination by their employers. In contrast to California’s lack of protection for medical cannabis patients, sixteen states provide some form of statutory protection for individuals like Mr. Ross. In order to protect employees, the California Legislature must enact legislation prohibiting employers from discriminating against qualified patients under California’s Compassionate Use Act. Enacting legislation to protect medical cannabis patients will restore California’s place as a leader in the cannabis arena. More importantly, it will protect medical cannabis patients like Mr. Ross, who—without such legislation—will continue to have to make the impossible choice of choosing between treating their disabilities and keeping their job. [ABSTRACT FROM AUTHOR]

Cannabis use among adolescents may have detrimental effects and use among this age group is increasing. It is important to understand how expansion of laws permitting cannabis sales may impact adolescent use. Much of the current research has explored how state-level policy decisions may impact adolescents' use behaviors; however, there is a gap in the understanding of how differences in local jurisdictional policies may also influence underage cannabis use. Procedures: The present study cross-sectionally assesses local variation in cannabis policies to explore the potential effects of local policy on underage use behaviors. Data were collected from (N = 1,573) adolescents representing 120 different localities across California, collected as a part of Project Cal Teens. Linear regression models were used to assess associations between local jurisdiction's allowance of retail sale of cannabis for adult-use and past 30-day use of non-medical (adult use) cannabis and perceived access to cannabis products. Local policy allowing cannabis retail was associated with adolescents' significantly higher past 30-day use of cannabis (β = 0.25 95% CI = 0.08, 0.42) and perceived access (β = 0.60 95% CI = 0.27, 0.94). Results highlight the impact of local cannabis policies on adolescent cannabis use and perception. Considering the effects of cannabis use on adolescent development, this is an important public health concern because 14 states have already legalized recreational retail sales and growing numbers of local jurisdictions are allowing the retail sale of recreational cannabis. [ABSTRACT FROM AUTHOR]

The changing legal status of marijuana in the United States has increased access to the drug through medical marijuana dispensaries. Limited research exists that examines the effects of these dispensaries on social problems including child maltreatment. The current study examines how medical marijuana dispensaries may affect referrals for child abuse and neglect investigations. Data are analyzed from 2,342 Census tracts in Los Angeles County, California. Locations of medical marijuana dispensaries were obtained through Weedmaps.com. Using conditionally autoregressive models, local and spatially lagged dispensaries show a positive relationship to rates of referrals in the unadjusted models. However, when we adjust for alcohol outlet density and measures of social disorganization, this relationship is no longer significant. Although this study does not find a relationship between medical marijuana dispensaries and referrals for investigations of child maltreatment, it should not be considered a definitive finding of this relationship. The increasing number of states that are allowing marijuana to be used for medical and recreational purposes is resulting in more people using the drug and the effects on parenting are still unknown. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about the possible impacts of recreational marijuana legalization on alcohol and marijuana co-use among underage youth. This study examines the association between recreational marijuana legalization in California in 2016 and alcohol and marijuana co-use among adolescents. Additional analyses investigate the associations between recreational marijuana legalization and co-use among past 30-day drinkers and marijuana users and the frequency of alcohol and marijuana use among co-users.Methods: This study used annual cross-sectional data from 7th, 9th, and 11th graders (N=3,319,329) who participated in the California Healthy Kids Survey from 2010-2011 to 2018-2019. Measures included past 30-day alcohol and marijuana use and student demographic characteristics, survey year, pre-post recreational marijuana legalization, and urbanicity. Multilevel regression analyses were conducted in 2021.Results: Recreational marijuana legalization was associated with greater odds of past 30-day alcohol and marijuana co-use in the total sample (OR=1.06, 95% CI=1.05, 1.07). Recreational marijuana legalization was more strongly associated with co-use among adolescents who reported past 30-day alcohol use (OR=1.58, 95% CI=1.52, 1.62) and heavy drinking (OR=1.25, 95% CI=1.21, 1.29) but was inversely related to co-use among past 30-day marijuana users (OR=0.76, 95% CI=0.74, 0.78). Among past 30-day co-users, there was a positive association with the frequency of marijuana use (β=0.36, SE=0.07).Conclusions: Recreational marijuana legalization may increase the risk of alcohol and marijuana co-use among adolescents. Greater restrictions on the numbers of alcohol and marijuana retail outlets and hours of operation and advertising and higher taxes on alcohol and marijuana products may help reduce the availability of these substances to adolescents. [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]

Biomedicine controls seizures for many children with epilepsy – but not all. In such cases, parents struggle in the wake of various structural, cultural, and corporeal ruptures. Continued use of ineffective medications can lead, iatrogenically, to frightening and serious symptoms and debilitations whose effects, along with those of uncontrolled seizures, ripple outward in challenging ways. Using data from 25 Californian (US) parents who favored providing cannabis to their ill children to meet the iatrogenic burdens of biomedical epilepsy treatments in 2015, well before cannabis's present destigmatization, this paper explores parental refiguration of the effects of clinical iatrogenesis as inevitable – and as productive of evidence necessary to finding better options. In attending to the generative dimensions of iatrogenesis, this paper strives to help clarify the dilemma for parents who critique biomedicine's isolating, materialist, and sometimes apparently haphazard approach to their children, but depend on biomedical and associated systems for their family's well-being nonetheless. Along the way, this paper underscores raced and gendered dimensions of their experiences. Rather than rejecting biomedicine, most hung on tightly, blaming the uncontrolled seizures and their aftermath on a lag in 'the science' and pointing to the cultural idea that every child is unique in explaining their own children's non-responsiveness to treatment thus far. Likewise, they worked to determine effective cannabis regimens with scientised rigour. However, in the end – and in keeping with a culture of (male) Whiteness – stigmatisation, fatigue from chronic care provision, faith in science, and a need for a biomedically-mediated form of social belonging underwrote a majority desire for cannabis's incorporation into the official biomedical pharmacopeia. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Use of cannabis is increasing in a variety of populations in the United States; however, few investigations about how and for what reasons cannabis is used in older populations exist. DESIGN: Anonymous survey. SETTING: Geriatrics clinic. PARTICIPANTS: A total of 568 adults 65 years and older. INTERVENTION: Not applicable. MEASUREMENTS: Survey assessing characteristics of cannabis use. RESULTS: Approximately 15% (N = 83) of survey responders reported using cannabis within the past 3 years. Half (53%) reported using cannabis regularly on a daily or weekly basis, and reported using cannabidiol‐only products (46%). The majority (78%) used cannabis for medical purposes only, with the most common targeted conditions/symptoms being pain/arthritis (73%), sleep disturbance (29%), anxiety (24%), and depression (17%). Just over three‐quarters reported cannabis "somewhat" or "extremely" helpful in managing one of these conditions, with few adverse effects. Just over half obtained cannabis via a dispensary, and lotions (35%), tinctures (35%), and smoking (30%) were the most common administration forms. Most indicated family members (94%) knew about their cannabis use, about half reported their friends knew, and 41% reported their healthcare provider knowing. Sixty‐one percent used cannabis for the first time as older adults (aged ≥61 years), and these users overall engaged in less risky use patterns (e.g., more likely to use for medical purposes, less likely to consume via smoking). CONCLUSION: Most older adults in the sample initiated cannabis use after the age of 60 years and used it primarily for medical purposes to treat pain, sleep disturbance, anxiety, and/or depression. Cannabis use by older adults is likely to increase due to medical need, favorable legalization, and attitudes. [ABSTRACT FROM AUTHOR]

Background: As of May 2023, 23 states and Washington, DC have legalized the sale of cannabis for adults aged 21+, and 38 states, three territories, and D.C. have legalized medical cannabis. Exposure to cannabis retailers could increase adolescent cannabis use. Few studies have examined the impact of residential proximity to cannabis retailers on adolescent cannabis use, and previous findings are inconsistent. Methods: This study examined associations between proximity to cannabis retailers and past 30-day cannabis use. Data were from Project Cal Teens, a statewide survey of California adolescents regarding cannabis-related opinions/behaviors ( N  = 1406, mean age = 15.5 years, 48% female, 38% Hispanic/Latinx, 33% White, 15% Asian/Pacific Islander, 10% Black/African American, 5% Other/Multiracial). Participants were recruited via schools/social media in 2018-2020. Results: For every additional 5 driving miles to the nearest cannabis retailer, the risk of past 30-day cannabis use was reduced by 3.6% [IRR: 0.964; 95% CI: 0.935-0.994]. For every additional 5 miles from a licensed retailer, the risk of past 30-day cannabis use was reduced by 4.3% [IRR: 0.957; 95% CI: 0.926-0.989]. Interaction analyses revealed that among Hispanic/Latinx students, every 5 miles from a licensed retailer was associated with an 11.9% reduction in the risk of past 30-day cannabis use [IRR: 0.881; 95% CI: 0.820-0.945]. Conclusions: As the number of cannabis retailers in the U.S. increases with the continued legalization of adult cannabis use, research examining the effects of these policies on underage use is crucial. Interventions could include enforcement of zoning laws in/near residential areas to reduce accessibility of adolescents to cannabis retailers.

Introduction and Aims: Young adults have the highest rates of drug use and contribute significantly to the growing population of medical cannabis patients (MCP). This study examined relationships between longitudinal patterns of illicit/prescription drug use/misuse and cannabis practices among young adult cannabis users.Design and Methods: In 2014-2015, 210 young adult MCP and 156 nonpatient users were recruited in Los Angeles and surveyed annually over four waves. The analytical sample was limited to completers of all four waves (n = 301). Distinct developmental trajectories of illicit drug use and prescription drug misuse were identified. Fixed effects regression analysis evaluated changes in cannabis practices by trajectory groups.Results: Results supported two-trajectory solutions (high/low) for illicit drug use and prescription drug misuse. Decreases in use within all four trajectories occurred by wave 4. Low illicit drug use trajectory members were more likely to self-report medical cannabis use. Membership in both types of high-use trajectories was associated with use of concentrates and edibles. The prevalence of MCP, edibles use and cannabis days decreased significantly by wave 4.Discussion and Conclusions: While alternative cannabis forms use was associated with membership in high drug use trajectories, self-reported medical cannabis use (not MCP) was negatively associated with high illicit drug use trajectory membership. Reductions in the prevalence of MCP, cannabis days, edibles use and other drug use by wave 4 alongside stable levels of self-reported medical cannabis use might reflect the changing legal status of cannabis in California, maturing out phenomenon and safer patterns of cannabis use. [ABSTRACT FROM AUTHOR]

As the post-1980s revanchist drug war transformed US cities, another spatial formation was materializing: exurbia. The final roost of suburban white flight, exurbia also formed via the spatial–racial dynamics of the drug war. The "exurban fortress" projected an imaginary of urban danger and rural security that (1) solidified an anti-drug constituency among (older, white) property owners and disciplinarily transitioned racially marked and poor white residents from an industrial to postindustrial service economy and (2) ameliorated key contradictions implicit to the production, consumption, and governance of exurbia. Taking the case of Calaveras County, California, this article shows how cannabis prohibition politically stabilized spatial meanings and capital accumulation during a period bookended by recessionary crises in housing production (1992–2010). It also shows how medical cannabis activists reimagined the urban and rural in capacious ways, thus catalyzing a local transformation that mirrored national trends around drugs, penality and Rightist politics. This case illuminates a neglected dimension of drug war geographies and their activist-driven transformation and urges attention to new bordering practices emerging from exurbian spatial imaginaries. [ABSTRACT FROM AUTHOR]

Objectives: This paper reports a quasi-experimental evaluation of California's 1996 medical marijuana law (MML), known as Proposition 215, on statewide motor vehicle fatalities between 1996 and 2015. Methods: To infer the causal impact of California's MML enactment on statewide motor vehicle fatalities, we construct a synthetic control group for California (i.e., California had it NOT enacted MMLs) as a weighted sum of annual traffic fatality time series from a donor pool of untreated (no MML) states. The post-MML difference between California and its constructed counterfactual reflects the net effect of MMLs on statewide traffic fatalities. The synthetic control group design avoids the problematic homogeneity assumptions intrinsic to panel regression models, which have been employed in prominent studies of this topic. Results: California's 1996 MML appears to have produced a large, sustained decrease in statewide motor vehicle fatalities amounting to an annual reduction between 588 and 900 vehicle fatalities. This finding is consistent across a wide range of model specifications and donor pool restrictions. In-sample placebo test results suggest that the estimated intervention effect is unlikely to be a spurious artifact and the "leave-one-out" sensitivity analysis demonstrates that the effect is not being driven by an individual or ensemble of influential donor pool states. Conclusions: Our focus on California as a case study limits our ability to generalize our estimate of the MML intervention on motor vehicle fatalities in California to other MML states; however, state-level MML interventions have major differences in their policy dimensions that seem unlikely to "average out" through aggregation. [ABSTRACT FROM AUTHOR]

In the current study we use a synthetic control group design to estimate the causal effect of a medical marijuana initiative on suicide risk. In 1996, California legalized marijuana use for medical purposes. Implementation was abrupt and uniform, presenting a "natural experiment." Utilizing a panel dataset containing annual frequencies of Total, gun, and non-gun suicides aggregated by state for the years 1970-2004, we construct a control time series for California as a weighted combination of the 41 states that did not legalize marijuana during the analysis period. Post-intervention differences for California and its constructed control time series can be interpreted as the effects of the medical marijuana law on suicide. Significance of the effects were assessed with permutation tests. Our findings suggest that California's 1996 legalization resulted in statistically significant (p<.05) reductions in suicides and gun suicides, but only a non-significant reduction in non-gun suicides (p≥.488). Since the effect for non-gun suicides was indistinguishable from chance, we infer that the overall causal effect was realized through gun suicides. The mechanism could not be determined, however. Participation in the medical marijuana program legally disqualifies participants from purchasing guns. But since most suicides involve guns, it is possible that the effect on total suicide is driven by gun suicide alone. [ABSTRACT FROM AUTHOR]

While a range of sources exist for marijuana users to acquire marijuana for medical or personal use, prior research on marijuana sources primarily focused on single sources. In this analysis, we longitudinally examined characteristics of multiple sources selected by marijuana users, motivations to use sources, and how a blend of marijuana sources accommodated users' needs. Young adult marijuana users (n = 60) in Los Angeles, CA, where marijuana has been legal for medical use since 1996, completed two annual qualitative interviews on marijuana use practices and sources between 2014 and 2016. Approximately two-thirds were medical marijuana patients and one-third was non-patient users. Participants reported acquiring marijuana from the following primary sources across two interviews: dispensaries and delivery services, private sellers in the illicit market, friends and family, and marijuana events/conferences. While patients with legal medical access to marijuana typically purchased marijuana from dispensaries or delivery services, they often supplemented from other illicit sources. Non-patients often accessed marijuana through dispensary diversion but also other sources. As patients became non-patients and vice versa during the study period, source type changed too. Broad access to marijuana via legal and illicit sources in this sample is indicative of societal trends towards normalization of marijuana use. [ABSTRACT FROM AUTHOR]

Aims: We investigated associations between the density of medical marijuana dispensaries (MMDs) around young adults' homes and marijuana use outcomes. Design Secondary data analysis. Setting: Los Angeles County, CA, USA. Participants: A total of 1887 participants aged 18–22 years, surveyed online in 2016–17. Measurements Outcomes were past‐month marijuana use (number of days used, number of times each day), positive expectancies and perceived peer use. Density was measured as the total number of MMDs and number of MMDs with storefront signage indicative of marijuana sales, within 4 miles of respondents' homes. Findings Eighty‐four per cent of respondents had 10 or more MMDs within 4 miles of their homes. Multiple linear regression analyses that adjusted for individual‐level socio‐demographic characteristics and neighborhood socio‐economic status indicated that living near a higher number of MMDs was associated with greater number of days used in the past month [β = 0.025; 95% confidence interval (CI) = 0.001, 0.049; P = 0.04] and higher positive marijuana expectancies (β = 0.003; 95% CI = 0.001, 0.007; P = 0.04). Living near more MMDs with storefront signage had a four‐ to six‐fold larger effect on number of times used per day and positive expectancies, respectively, compared with associations with the total MMD count. Adjusting for medical marijuana card ownership attenuated the association with number of days used in the past month and positive expectancies, and an unexpected association emerged between higher MMD density and fewer number of times used each day (β = −0.005; 95% CI = –0.009, −0.001; P = 0.03). Conclusions: For young adults in Los Angeles County, living near more medical marijuana dispensaries (MMDs) is positively associated with more frequent use of marijuana within the past month and greater expectations of marijuana's positive benefits. MMDs with signage show stronger associations with number of times used each day and positive expectancies. [ABSTRACT FROM AUTHOR]

During the regulatory drafting process, California considered allowing police officers to become licensed owners of cannabis businesses, an action that would have codified a conflict of interest (COI), allowing police to exert influence in two market strata, enforcement and licensure. Up until then, no state specifically excepted law enforcement from COI prohibitions, making California's proposed medical cannabis regulation unique. We performed two 50-state surveys and examined 298 public comments submitted to the Bureau of Cannabis Control during the initial medical cannabis rulemaking process in June 2017. After public comments, the Bureau withdrew this provision. However, that the exception was even considered is cause for concern in this new area of policy development. The progression from proposed medical cannabis rules to emergency rule adoption and now, into proposed final regulations, highlights the value of civic engagement with the rulemaking process. Jurisdictions should adopt bright-line COI rules within their cannabis codes that limit the relationships that law enforcement may have with the private cannabis markets. [ABSTRACT FROM AUTHOR]

Background: While tobacco and alcohol studies have focused on density of outlets as a determinant of consumption, research has begun examining the effects of medical marijuana (MM) dispensaries on marijuana use. Objectives: Examine the relationship between density of MM dispensaries and frequency of marijuana use among young adult medical marijuana patients (MMP) and nonpatient users (NPU). Methods: Young adult marijuana users (n = 329) aged 18- to 26-year old were sampled in Los Angeles in 2014–2015 and separated into MMP (n = 198) and NPU (n = 131). In 2014, 425 operational MM dispensaries were identified within the City of Los Angeles. Sequential multilevel Poisson random effect models examined density of MM dispensaries per square mile and 90 d marijuana use among MMP and NUP at the ZIP code level while controlling for demographic, behavioral, and community characteristics. Results: Density of MM dispensaries was not related to 90 d use of marijuana (days of use or hits per day) among either MMP or NPU. MMP reported significantly greater days of marijuana use in the past 90 d compared to NPU but no differences were found for hits per day. African–Americans reported significantly greater hits per day compared to whites. Hispanics reported significantly fewer hits per day compared to non-Hispanics. Conclusion: Concentration of MM dispensaries surrounding young adult marijuana users in Los Angeles was unrelated to days of marijuana use irrespective of having a MM recommendation or not. Rather, individual factors related to consumer choices and behaviors were more important in determining recent marijuana use among MMP and NPU. [ABSTRACT FROM AUTHOR]

Background: The number of jurisdictions allowing access to medicinal cannabis has been steadily increasing since the state of California introduced legislation in 1996. Although there is a high degree of legislative heterogeneity across jurisdictions, the involvement of a health professional is common among all. This places health professionals at the forefront of therapy, yet no systematic review of literature has offered insight into the beliefs, knowledge, and concerns of health professionals regarding medicinal cannabis. Methods: Using a predetermined study protocol, PubMed, EMBASE, PsycINFO, CINAHL, and Scopus databases were searched for studies indexed up to the 1st August 2018. Pre-defined inclusion and exclusion criteria were applied uniformly. Screening for relevancy, full-text review, data extraction, and risk of bias were completed by two independent investigators. Risk of bias was assessed using CASP criteria (qualitative) and a modified domain-based risk assessment tool (quantitative). Results: Of the 15,775 studies retrieved, 106 underwent full-text review and of these, 26 were included. The overall risk of bias was considered low across all included studies. The general impression was that health professionals supported the use of medicinal cannabis in practice; however, there was a unanimous lack of self-perceived knowledge surrounding all aspects of medicinal cannabis. Health professionals also voiced concern regarding direct patient harms and indirect societal harms. Conclusion: This systematic review has offered a lens through which to view the existing literature surrounding the beliefs, knowledge, and concerns of health professionals regarding medicinal cannabis. These results are limited, however, by the implicit common-sense models of behaviour utilised by the included studies. Before strategies can be developed and implemented to change health professional behaviour, a more thorough understanding of the factors that underpin the delivery of medicinal cannabis is necessary. [ABSTRACT FROM AUTHOR]

Background: This study compared young adults with and without a medical marijuana (MM) recommendation from a provider ("MM card") on their developmental trajectories of frequent marijuana use and marijuana-related problems in young adulthood.Methods: The analytic sample consists of young adult past month marijuana users (N = 671) who were part of a larger, diverse, and predominantly California cohort. Analyses are based on data from seven surveys completed from ages 13-19.Results: At age 19, 28% of participants reported having an MM card to legally purchase marijuana from an MM dispensary. A multiple group latent growth model indicated that young adults who had an MM card showed steeper increases in frequent marijuana use (i.e., 20-30 days of use in the past month) from ages 13-19 compared to young adults who did not have an MM card. Logistic regression models that matched MM cardholders and non-MM cardholders on individual sociodemographic characteristics found that MM cardholders were more likely to report marijuana negative consequences, selling marijuana/hashish, and driving under the influence of marijuana in the past year. In addition, MM cardholders were more likely to have tried cutting down or quitting in the past 3-months.Conclusions: Among young adult marijuana users, those with an MM card had a higher risk profile for marijuana use and related problems compared to those without an MM card. Given expanding state legalization of MM, this issue warrants further attention. [ABSTRACT FROM AUTHOR]

Background: Although there are an increasing number of states exploring the legalization of medical and/or recreational cannabis, little research has explored whether and how people are medically using cannabis along with the broader implications of this potential change in policy. Objectives: This study seeks to explore reasons for use and experience with use among users of a medical cannabis delivery service. Methods: In this cross-sectional study, a convenience sample of users (n = 21) of a medical cannabis delivery service were recruited and interviewed. Semi-structured interviews were used to gather qualitative data for thematic analysis. Results: Five themes for cannabis use emerged from our research: distrust for the medical field, side effects of prescription drugs, clinical failure, addiction treatment, and cannabis as a prescription drug substitution. Conclusion: People are seeking cannabis to be delivered to them as an alternative to receiving traditional medical treatments, including as a substitute for opioids in treatment for chronic pain. Findings from this formative research suggest future research should be conducted on whether and how cannabis is being used as a substitute for medical treatments along with the implications of this effect on future healthcare and health policy. [ABSTRACT FROM AUTHOR]

Background and Aims: There are concerns that availability of recreational cannabis dispensaries (RCDs) and point-of-sale marketing may lead to increased cannabis use in jurisdictions where cannabis retail sale is legal. This paper examined whether the availability RCDs and the presence of storefront signage indicative of cannabis and signs promoting health benefits in RCDs were associated with cannabis use and risk perceptions., Design: Cross-sectional, secondary data analysis., Setting: California, USA., Participants: A representative sample of 3385 adults in California who participated in the 2020 probability-based Marijuana Use and Environment Survey., Measurements: Binary outcomes included past-month overall cannabis use, perceiving cannabis smoking as harmful and past-month cannabis use by purpose (medical only, recreational only and dual). The objectively assessed predictors included proximity and density of RCDs and presence of storefront signage indicative of cannabis and signs promoting health benefits in RCDs., Findings: In terms of proximity, thepresence of storefront signage in the nearest RCD was associated with smaller odds of perceiving cannabis smoking as harmful [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.39, 0.99] if the RCD was located within 2 miles of home. Presence of health benefit signs in the nearest RCD was associated with greater odds of overall cannabis use (OR = 2.45, 95% CI = 1.17, 5.16) and recreational use (OR = 3.50, 95% CI = 1.027, 11.91) if the RCD was located within 2-4 miles of home. In terms of density, count of RCDs, count of RCDs with storefront signage and count of RCDs with health benefit signs within 2 miles of home were each separately associated with greater odds of overall cannabis use and cannabis use for dual purposes., Conclusions: The availability of recreational cannabis dispensaries within 2 miles of one's home and the presence of storefront signage indicating the availability of cannabis and signs promoting health benefits of cannabis appear to be associated with increased cannabis use and reduced risk perceptions among adults in California, USA., (© 2023 Society for the Study of Addiction.)

The current study assesses how characteristics of medical marijuana use are related to general health status and past year change in health. An analytic sample of 312 patients were recruited from 16 medical marijuana dispensaries across Los Angeles, California. Patients completed a short intercept survey and a longer patient survey. Surveys asked information about health, marijuana use behaviors, preferred ways to use marijuana, marijuana recommendation, and sociodemographic information. Data were analyzed using hierarchical linear modeling of patients nested within dispensaries. For general health status, patients who smoke marijuana, have more medical conditions for which they received their medical marijuana recommendation, and use marijuana more times per day report lower levels of general health. The number of days using marijuana per month was related to worse health in the past year. Medical marijuana use does not appear to improve overall health status according to the results presented here, but is limited by the cross-sectional nature of the study. As the legalization of medical marijuana use continues to grow across the United States, identifying how marijuana is related to health will allow physicians to better determine who may benefit from its use. [ABSTRACT FROM AUTHOR]

Tobacco shops, medical marijuana dispensaries (MMD), and off-sale alcohol outlets are legal and prevalent in South Los Angeles, California-a high-crime, low-income urban community of color. This research is the first to explore the geographic associations between these three legal drug outlets with surrounding crime and violence in a large low-income urban community of color. First, spatial buffer analyses were performed using point-location and publically accessible January-December 2014 crime data to examine the geography of all felony property and violent crimes occurring within 100, 200, 500, and 1000-foot buffers of these three legal drug outlet types across South Los Angeles. Next, spatial regression analyses explored the geographic associations between density of these outlets and property and violent crimes at the census tract level. Results indicated that mean property and violent crime rates within 100-foot buffers of tobacco shops and alcohol outlets-but not MMDs-substantially exceeded community-wide mean crime rates and rates around grocery/convenience stores (i.e., comparison properties licensed to sell both alcohol and tobacco). Spatial regression analyses confirmed that tobacco shops significantly positively associated with property and violent crimes after controlling for key neighborhood factors (poverty, renters, resident mobility, ethnic/racial heterogeneity). Thus, study findings provide the first empirical evidence that tobacco shops may constitute public health threats that associate with crime and violence in U.S. low-income urban communities of color. Implementing and enforcing control policies that regulate and monitor tobacco shops in these communities may promote community health by improving public safety. [ABSTRACT FROM AUTHOR]

Background: Several studies suggest that U.S. state-level legalization of cannabis for medical purposes may be associated with reductions in opioid use; yet its relationship with stimulant use, particularly in high-risk populations like unstably housed women, has received less attention. The purpose of this study was to estimate independent associations between medical and non-medical use of cannabis and use of stimulants and opioids among unstably housed women.Methods: Cross-sectional data were analyzed from 245 women in the SHADOW study, a community based cohort in San Francisco, CA, in which HIV+ women were oversampled (126 HIV+ and 119 HIV-).Results: Compared to no cannabis use in the past 6 months (51%), non-medical cannabis use (28%) was associated with a higher adjusted odds of using stimulants (Adjusted Odds Ratio [AOR]=4.34, 95% confidence interval [CI]: 2.17-8.70) and opioids (AOR=3.81, 95% CI: 1.78-8.15). Compared to no cannabis use, medical cannabis use (21%) was not significantly associated with stimulant or opioid use. Compared to non-medical cannabis use, however, medical cannabis use was associated with lower adjusted odds of using stimulants (AOR=0.42, 95% CI: 0.18-0.96). These associations were not modified by HIV status.Conclusions: Associations between use of cannabis and "street drugs" depend on whether the cannabis is obtained through a medical context. Interventions, research, and policy considering the influence of cannabis on the use of other drugs may benefit by distinguishing between medical and non-medical cannabis use. [ABSTRACT FROM AUTHOR]

Background: Since marijuana became legal for medical use in California in 1996, reasons for medical use among medical marijuana patients (MMP) have become increasingly well described in qualitative studies. However, few studies have detailed how the use of marijuana for medical purposes fits into the broader career trajectories of either becoming a marijuana user or becoming a MMP, including the social influences on medical use.Methods: Young adult MMP (N=40) aged 18 to 26 years old were recruited in Los Angeles, CA in 2014-15 and administered a semi-structured interview that included questions focusing on marijuana use practices before and after becoming MMP.Results: MMP were categorized into three trajectory groups: primarily medical users (n=30); primarily non-medical users (n=3); and medical users who transitioned to non-medical users (n=7). Most medical users discovered medicinal effects from marijuana in the context of non-medical use as adolescents prior to becoming MMP. Becoming a mature MMP followed interactions with dispensary staff or further self-exploration of medical uses and often involved a social process that helped confirm the legitimacy of medical use and identity as a medical user. In some cases, MMP transitioned back to non-medical users as health conditions improved or remained primarily non-medical users even after becoming MMP for reasons unrelated to health, e.g., protection against arrest.Conclusion: Becoming a medical marijuana user was an important career trajectory that was influenced by early discoveries of effective medicinal use, interaction with proponents of medical use at dispensaries, experiences with new kinds of medical use, and the demands of particular health condition requiring more or less treatment with marijuana. [ABSTRACT FROM AUTHOR]

The article evaluates the compliance of edible products under California, Assembly Bill No. 266 as part of the Medical Marijuana Regulation and Safety Act related to Marijuana labeling and packaging requirements. Topics discussed include a table depicting compliance of edible marijuana products to applicable AB-266; legalization of recreational marijuana; and laws made by U.S. Federal Drug Enforcement Agency related to the same.

Objective: To examine if a substance use disorder (SUD), especially cannabis use disorder in adolescence, predicts future medical cannabis card status among high-risk youth.Methods: Data collection occurred in Denver and San Diego. We recruited adolescents, with or at high risk for SUD and conduct problems (hereafter probands) and their siblings (n=654). Baseline (Wave 1) assessments took place between 1999 and 2008, and follow-up (Wave 2) took place between 2010 and 2013. In initial bivariate analyses, we examined whether baseline DSM-IV cannabis abuse/dependence (along with other potential predictors) was associated with possessing a medical cannabis card in young adulthood (Wave 2). Significant predictors were then included in a multiple binomial regression. Self-reported general physical health was also evaluated at both time points. Finally, within Wave 2, we tested whether card status was associated with concurrent substance dependence.Results: About 16% of the sample self-reported having a medical cannabis card at follow-up. Though bivariate analyses demonstrated that multiple predictors were significantly associated with Wave 2 card status, in our multiple binomial regression only cannabis abuse/dependence and male sex remained significant. At Wave 2, those with a medical cannabis card were significantly more likely to endorse criteria for concurrent cannabis dependence. There was no significant difference in self-reported general physical health.Conclusions: Cannabis abuse/dependence and male sex positively predicted future medical cannabis card holder status among a sample of high risk adolescents. Physicians conducting evaluations for medical cannabis cards should carefully evaluate and consider past and concurrent cannabis addiction. [ABSTRACT FROM AUTHOR]

Cannabis is an increasingly sought-after remedy for US children with intractable (biomedically uncontrollable) epilepsy. However, like other complementary-alternative medicine (CAM) modalities, and particularly as a federally illegal, stigmatized substance, it is unsanctioned by mainstream medicine. Parents are largely on their own when it comes to learning about, procuring, dispensing, and monitoring treatments. Exploring how they manage is crucial to better assist them. Moreover, it can illuminate how ‘research’ done on the ground by laypeople variously disrupts and reinforces lay–expert and science–non-science divides. To those ends, in 2016, 25 Southern California parents who used, had used, or sought to use cannabis pediatrically for epilepsy/seizures were interviewed regarding their evidentiary standards, research methods, and aims when trying the drug. Parents generally described their work as experimentation; they saw their efforts as adhering to authorized scientific practices and standards, and as contributing to the authorized medical cannabis knowledge base. Findings subverted assumptions, based on an outdated stereotype of CAM, that cannabis - using parents do not believe in biomedicine. Indeed, parents' desire for their children's biomedical demarginalization, combined with biomedical dependency and a high caregiver burden, fueled a collaborative stance. Implications for understanding the boundaries of science are explored, as are norms for parent agency as ill children's care managers, radicalization among people affected by contested illnesses, and the future of ‘medical marijuana.’ [ABSTRACT FROM AUTHOR]

Background: Little is known about young adult medical marijuana patients (MMP) and their marijuana using patterns and practices, which includes frequency of use, sourcing of marijuana products, forms/modes of administration, and patterns of illicit/prescription drug misuse, compared to non-patient marijuana users (NPU).Methods: Young adults (N=366) aged 18-26 years old were sampled in Los Angeles in 2014-15 and segmented into NPU (n=156), marijuana users who never had a medical marijuana (MM) recommendation, and MMP (n=210), marijuana users with a current, verified MM recommendation. Differences regarding self-reported marijuana and other drug use during the past 90days are expressed as unadjusted risk ratios or differences in means.Results: MMP reported significantly greater mean days of use (76.4 vs. 59.2, p<0.001) and mean dollars spent on marijuana products (564.5 vs. 266.9, p<0.001) than NPU. Approximately one-quarter (22.6%) of both MMP and NPU report selling marijuana obtained from a dispensary to someone else in the past 90days. MMP were more likely to report vaporization modalities for concentrates (URR=1.5, 95% C.I.=1.2, 2.0) and for marijuana (URR=1.5, 95% C.I.=1.1, 2.1) than NPU. Though not significant, trends toward lower misuse of prescription drugs in the past 90days were observed among MMP compared to NPU.Conclusion: MMP reported greater access to marijuana via dispensaries, more frequent and intensive use of marijuana, and greater use of non-combustible forms of marijuana compared to NPU. MMP reported less recent misuse of prescription drugs compared to NPU. [ABSTRACT FROM AUTHOR]

The article discusses the social and economic impact of the cannabis industry in California. Topics discussed include a brief overview on the popularity of cannabis in the state which gained momentum in the 1970's which helped the local economy after its timber and fishing industry downfall, and highlights the significance of cannabis in medicine and the environment.

Aims To determine whether the density of marijuana dispensaries in California, USA, in 2012-13 was related to violent and property crimes, both locally and in adjacent areas, during a time in which local law enforcement conducted operations to reduce the number of storefront medical marijuana dispensaries. Design Data on locations of crimes and medical marijuana dispensaries as well as other covariates were collected for a sample of 333 Census block groups. Setting Long Beach, California, USA from January 2012 to December 2013. Observations A total of 7992 space-time observations (from 333 Census block groups over 24 time-points). Measurements Outcome measures focused on block-group counts of violent and property crimes. Predictors were numbers of local and adjacent-area medical marijuana dispensaries. Covariates included markers of alcohol availability as well as area demographic and economic characteristics. Findings After adjustment for covariates, density of medical marijuana dispensaries was unrelated to property and violent crimes in local areas but related positively to crime in spatially adjacent areas [incident rate ratio (IRR) = 1.0248, CI (1.0097, 1.0402) for violent crime, IRR = 1.0169, CI (1.0071, 1.0268) for property crime]. Conclusions Using law enforcement to reduce medical marijuana dispensaries in California appears to have reduced crime in residential areas near to, but not in, these locations. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Little is known about the spatial distribution of medical marijuana dispensaries, particularly whether or not sites are disproportionately located in minority or communities with younger populations. This paper will assess if there is a relationship between medical marijuana dispensaries and neighbourhood characteristics.Design and Methods: This study used an ecological, cross-sectional design of 1000 census tracts from Los Angeles city in 2012 to explore the relationship between neighbourhood sociodemographics, structural features of neighbourhoods and density of medical marijuana dispensaries. Locations of dispensaries were obtained through a premise survey of all listed dispensaries. Data on neighbourhood characteristics were obtained from Geolytics. The study used Bayesian conditionally autoregressive models that include controls for spatial heterogeneity to analyse the data.Results: Findings show that dispensaries are located in areas that allow for commercial establishments. Results indicate a positive relationship between dispensaries and percent commercially zoned, areas with highway ramp access, density of on- and off-premise alcohol outlets and percent Hispanic residents.Discussion and Conclusions: In sum, the findings suggest that, likely because of zoning regulations, dispensaries were located in primarily commercially zoned areas with greater road access (as measured by the presence of highway ramps). Given that areas with higher densities of dispensaries also have higher densities of alcohol outlets, future work should examine how this co-location affects neighbourhood problems such as crime and violence. [Thomas C, Freisthler B. Examining the locations of medical marijuana dispensaries in Los Angeles. Drug Alcohol Rev 2016;35:334-337]. [ABSTRACT FROM AUTHOR]

An interview with U.S. physician Rober Bonakdar is presented. When asked about his specialization in helping patients in pain, Bonakdar mentioned that his interest in the field started when he was in Iran where traditional medicines are commonly used. He added that his expertise allows him to help people manage their diseases and other conditions better.

The article discusses the court case Olive v. Commissioner on internal revenue code. Topics discussed include District of Columbia had legalized medical marijuana under varying restrictions and regulations, California legalized the use of medical marijuana in the state, and dispensaries in California provides medical marijuana to patients in California.

Marijuana purchasing behaviors vary by the purchaser’s individual characteristics; however, little is known about patients’ purchasing behaviors when buying from medical marijuana dispensaries (MMDs). Our objective was to explore whether patient characteristics were associated with amount spent during one financial transaction at medical marijuana dispensaries. We conducted a pilot study of four purposively sampled MMD locations in Long Beach, California, in 2012. A total of 132 medical marijuana patients (33 patients per dispensary) participated in an exit survey about their demographic characteristics, conditions for their medical marijuana recommendation, amount spent at the dispensary, and cross-streets of where they lived. The sample reported amounts spent on discrete purchases of marijuana buds averaging $40.82 (ranging from $10 to $255). Multivariate regression analyses indicated average amount spent differed significantly by patient age and condition. An increase in 10 years of age was associated with a 10% higher amount spent. Receiving a recommendation for anxiety and/or sleeping problems or other nonspecified conditions was related to higher discrete purchase amounts than chronic pain. This pilot suggests that variations in patient purchasing behaviors from MMDs exist. These purchase behaviors can provide insight into variations in how patients use dispensaries, consume products, and allocate personal resources. [ABSTRACT FROM PUBLISHER]

The article presents abstracts on headache research including the impact of applied massage on patients with recurrent tension-type headache, the effectiveness of osteopathic treatment in chronic migraine and the use of medical marijuana in California.

This study aimed to investigate the interactive influence of problematic cannabis use on the relation between sleep quality and posttraumatic stress symptoms (PTSS). Hypotheses were tested cross-sectionally among 151 medical cannabis users with PTSS. Consistent with hypotheses, we found sleep quality to be associated with PTSS severity. In addition, results indicated a significant interaction such that individuals with poor sleep quality and problematic cannabis use had the highest PTSS severity (particularly hyperarousal symptoms). Results suggest that medical cannabis users with the greatest risk of severe PTSS may be those with a combination of poor sleep quality and problematic cannabis use. [ABSTRACT FROM AUTHOR]

Introduction and Aims. The US Drug Enforcement Agency classifies marijuana as an illegal substance, yet in 22 states marijuana is legal for medicinal use. In 1996, California legalised the use of marijuana for medicinal purposes, but population-based data describing medical marijuana users in the state has not been available. Our aim was to examine the demographic differences between users and non-users of medical marijuana in California utilising population-based data. Design and Methods. We used data from the California Behavioral Risk Factor Surveillance System 2012, an annual, random-digit-dial state-wide telephone survey that collects health data from a representative adult sample (n = 7525). Age-adjusted prevalence rates were estimated. Results. Five percent of adults in California reported ever using medical marijuana, and most users believed that medical marijuana helped alleviate symptoms or treat a serious medical condition. Prevalence was similar when compared by gender, education and region. Prevalence of ever using medical marijuana was highest among white adults and younger adults ages 18-24 years, although use was reported by every racial/ethnic and age group examined in our study and ranged from 2% to 9%. Conclusions. Our study's results lend support to the idea that medical marijuana is used equally by many groups of people and is not exclusively used by any one specific group. As more states approve marijuana use for medical purposes, it is important to track medical marijuana use as a health-related behaviour and risk factor. [ABSTRACT FROM AUTHOR]