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The prevalence of tobacco smoking has declined in most high-income countries, while cannabis use has been rising. Moreover, cannabis use has been found to have increased among cigarette smokers in recent years in jurisdictions where it has been either decriminalized or legalized. This study measured trends in cannabis, tobacco and the co-use of cannabis and tobacco in Australia.Age-period-cohort analysis.Participants were n = 143 344 individuals aged 18-80 years who participated in Australia's National Drug Strategy Household Surveys (NDSHS) between 2001 and 2019.Regular (weekly/more frequently): (1) tobacco smoking only, (2) cannabis use only and (3) the co-use of cannabis and tobacco.Prevalence of only smoking tobacco decreased in all age groups (P 0.001) and birth cohorts between 2001 and 2019, but the co-use of cannabis and tobacco did not. Younger cohorts were much less likely to co-use tobacco and cannabis (P = 0.02). Period trends showed that both cannabis use only and the co-use of cannabis and tobacco have increased since 2013.There has been a consistent decrease in exclusive tobacco smoking across age, period and birth cohorts between 2001 and 2019 in Australia, although there is a recent increasing period trend in cannabis use with or without tobacco. The non-decreasing trend of co-use may reflect the strong tobacco control policies introduced over the period and changing attitudes towards cannabis use in Australia.

To (i) estimate the prevalence of adolescent vaping in 47 lower-middle, upper-middle and high-income countries, and (ii) test the association between implementation of World Health Organisation (WHO) tobacco control policies and adolescent e-cigarette use (also known as vaping) in 44 countries where implementation data were available.Cross-sectional surveys.A total of 47 lower-middle, upper-middle and high-income countries.A total of 151 960 adolescents (typically ages 13-15) who participated in WHO's Global Youth Tobacco Survey between 2015 and 2018.Prevalence of past-30-day vaping and past 30-day frequent vaping (≥10 days) were estimated from the surveys. Data on the implementation of six tobacco control measures including monitoring, smoke-free policies, cessation programs, warning about the dangers of tobacco, advertising bans and taxation were taken from WHO's report on global tobacco epidemic.The overall weighted prevalence of adolescent vaping and frequent vaping in the past 30 days was 8.6% (95% CI, 8.3-8.9) and 1.7% (95% CI, 1.6-1.8), respectively. For five of WHO's policies (monitoring, smoking-free environment, cessation programs, health warning and advertising bans), their association with adolescent vaping was inconclusive because of large variation of their effects across countries. Higher tax on combustible tobacco products was associated with higher adolescent vaping ( = 75% tax vs 25% tax; odds ratio = 2.58; 95% CI, 1.25-5.21).In 47 lower-middle, upper-middle and high-income countries from 2015 to 2018, ~1 in 12 (8.6%) adolescents reported vaping in the past 30 days, but prevalence of frequent vaping was low (1 in 60; 1.7%). A higher tobacco tax was associated with higher adolescent vaping.

Cannabis use is increasing among midlife and older adults. This study tested the hypotheses that long-term cannabis use is associated with cognitive deficits and smaller hippocampal volume in midlife, which is important because midlife cognitive deficits and smaller hippocampal volume are risk factors for dementia.Participants are members of a representative cohort of 1,037 individuals born in Dunedin, New Zealand, in 1972-1973 and followed to age 45, with 94% retention. Cannabis use and dependence were assessed at ages 18, 21, 26, 32, 38, and 45. IQ was assessed at ages 7, 9, 11, and 45. Specific neuropsychological functions and hippocampal volume were assessed at age 45.Long-term cannabis users showed IQ decline from childhood to midlife (mean=-5.5 IQ points), poorer learning and processing speed relative to their childhood IQ, and informant-reported memory and attention problems. These deficits were specific to long-term cannabis users because they were either not present or were smaller among long-term tobacco users, long-term alcohol users, midlife recreational cannabis users, and cannabis quitters. Cognitive deficits among long-term cannabis users could not be explained by persistent tobacco, alcohol, or other illicit drug use, childhood socioeconomic status, low childhood self-control, or family history of substance dependence. Long-term cannabis users showed smaller hippocampal volume, but smaller hippocampal volume did not statistically mediate cannabis-related cognitive deficits.Long-term cannabis users showed cognitive deficits and smaller hippocampal volume in midlife. Research is needed to ascertain whether long-term cannabis users show elevated rates of dementia in later life.

A systematic search was conducted for publications in PubMed, EMBASE, and PsycINFO up to October 2019. Six studies with a regionally or nationally representative adult US-based populations were included. A secondary analysis was conducted using data from the National Survey of Drug Use and Health. Hierarchical age-period-cohort analysis assessed the trends in perceived harmfulness and availability of cannabis between 1996 and 2018. Ecological comparisons were made between these perceptions and support for cannabis legalization over time.A steep growth in support for cannabis legalization began in the 1990s and continued to grow in a relatively linear manner. Most people developed more liberal views, with no evidence that changes within any one sociodemographic group was disproportionately responsible for the overall attitudinal change. Increases in the proportion of people who use cannabis, non-religious population and political liberalism may partially explain the increased support for legalization. The decline in perceived harmfulness of cannabis, as reflected in the media, may have contributed to the increased support for legalization. However, perceptions of the availability of cannabis remained stable despite significant relaxations in cannabis regulations.The US population has become more accepting of cannabis legalization. The attitudinal change is related to changes in the perceived risks and benefits of cannabis use, influenced by broader political and cultural changes over the study period.

Background Epidemiological studies show a dose–response association between cannabis use and the risk of psychosis. This review aimed to determine whether there are identifiable risk-thresholds between the frequency of cannabis use and psychosis development. Methods Systematic search of Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science for relevant studies (1 January 2010–26 April 2021). Case–control or cohort studies that investigated the relationship between cannabis use and the risk of psychosis development that reported effect estimates [odds ratios (OR), hazard ratios (HR), risk ratios (RR)] or the raw data to calculate them, with information on the frequency of cannabis consumption were included. Effect estimates were extracted from individual studies and converted to RR. Two-stage dose–response multivariable meta-analytic models were utilized and sensitivity analyses conducted. The Newcastle Ottawa Scale was used to assess the risk of bias of included studies. Results Ten original (three cohorts, seven case–control) studies were included, including 7390 participants with an age range of 12–65 years. Random-effect model meta-analyses showed a significant log-linear dose–response association between cannabis use frequency and psychosis development. A restricted cubic-splines model provided the best fit for the data, with the risk of psychosis significantly increasing for weekly or more frequent cannabis use [RR = 1.01, 95% confidence interval (CI) 0.93–1.11 yearly; RR = 1.10, 95% CI 0.97–1.25 monthly; RR = 1.35, 95% CI 1.19–1.52 weekly; RR = 1.76, 95% CI 1.47–2.12 daily] Conclusion Individuals using cannabis frequently are at increased risk of psychosis, with no significant risk associated with less frequent use. Public health prevention messages should convey these risk-thresholds, which should be refined through further work.

The liberalisation of cannabis laws, the increasing availability and potency of cannabis has renewed concern about the risk of psychosis with cannabis.The objective of the WFSBP task force was to review the literature about this relationship.Converging lines of evidence suggest that exposure to cannabis increases the risk for psychoses ranging from transient psychotic states to chronic recurrent psychosis. The greater the dose, and the earlier the age of exposure, the greater the risk. For some psychosis outcomes, the evidence supports some of the criteria of causality. However, alternate explanations including reverse causality and confounders cannot be conclusively excluded. Furthermore, cannabis is neither necessary nor sufficient to cause psychosis. More likely it is one of the multiple causal components. In those with established psychosis, cannabis has a negative impact on the course and expression of the illness. Emerging evidence also suggests alterations in the endocannabinoid system in psychotic disorders.Given that exposure to cannabis and cannabinoids is modifiable, delaying or eliminating exposure to cannabis or cannabinoids, could potentially impact the rates of psychosis related to cannabis, especially in those who are at high risk for developing the disorder.

Background: Canada legalized non-medical cannabis in October 2018. Little research has examined the change in perceived access to cannabis after legalization in Canada, including the perceived ease of purchasing cannabis in a legal market. Objectives: To: 1) describe changes in perceived ease of access to cannabis before and one year after legalization; 2) examine associations between perceived ease of cannabis access and cannabis use; and 3) examine associations between perceived ease of purchasing from cannabis stores and cannabis use. Methods: Repeat cross-sectional data come from Canadian respondents aged 16–65 (50% male) in August-October 2018 (n = 10,057) and September-October 2019 (n = 15,256). Respondents were recruited through commercial online panels. Multivariable logistic regression models examined correlates of perceived proximity to retail stores, ease of access, and ease of purchasing from retail stores. Results: Canadians who do not consume cannabis were more likely to report “easy” access to cannabis in 2019 than in 2018 (55% vs. 42%; AOR = 1.80:1.66,1.96). All cannabis consumer groups were more likely to report living 15 minutes or less from a retail store in 2019 than 2018, but the association was strongest among non-consumers in 2019 vs 2018 (AOR = 2.01:183,2.21 vs. AOR = 1.33:1.03,1.73 for daily consumers). Non-daily and daily cannabis consumers were more likely to report it was easy to purchase from an illegal (AOR ranged 1.58–2.22) or legal (AOR ranged 1.31–1.39) store than non-consumers in 2019. Conclusion: Most cannabis consumers and non-consumers perceived access to cannabis as ‘easy’ before legalization and the percentage increased one year after legalization.

Background and aim: From 1 February 2018, codeine was rescheduled from an over-the-counter (OTC) to a prescription-only medicine in Australia. We used wastewater-based epidemiology to measure changes in population codeine consumption before and after rescheduling. Methods: We analysed 3703 wastewater samples from 48 wastewater treatment plants, taken between August 2016 and August 2019. Our samples represented 10.6 million people, 45% of the Australian population in state capitals and regional areas in each state or territory. Codeine concentrations were determined by liquid chromatography–tandem mass spectrometry and converted to per-capita consumption estimates using the site daily wastewater volume, catchment populations and codeine excretion kinetics. Results: Average per-capita consumption of codeine decreased by 37% nationally immediately after the rescheduling in February 2018 [95% confidence interval (CI) = 35.3–39.4%] and substantially in all states between 24 and 51% (95% CI = 22.4–27.0% and41.8–59.4%). The decrease was sustained at the lower level to August 2019. Locations with least pharmacy access decreased by 51% (95% CI = 41.7–61.7%), a greater decrease than 37% observed for those with greater pharmacy access (95% CI = 35.1–39.4%). Regional areas decreased by a smaller margin to cities (32 versus 38%, 95%CI = 30.2–34.1% versus 34.9–40.4%, respectively) from a base per-capita usage approximately 40% higher than cities Conclusion: Wastewater analysis shows that codeine consumption in Australia decreased by approximately 37% following its rescheduling as a prescription-only medicine in 2018. Wastewater-based epidemiology can be used to evaluate changes in population pharmaceutical consumption in responses to changes in drug scheduling Refereed/Peer-reviewed

Introduction Tobacco harm reduction has potential to improve individual and population health. However, little research exists on low-intensity interventions, such as encouraging longer-term NRT or e-cigarette use. We aimed to determine whether: (1) encouraging use of nicotine products as long-term tobacco substitutes is more effective for smoking abstinence than standard treatment, and (2) offering e-cigarettes is more effective than NRT. Methods An open-label, parallel-group randomized trial was conducted in Australia between 2014 and 2015, with 1563 adult daily smokers, randomized to: (A) standard cessation advice and NRT: advice to use NRT short-term, (B) quit or substitute advice and NRT: advice to use NRT as a longer-term substitute for smoking if required to maintain smoking cessation, or (C) Quit or substitute advice and NRT and/or e-cigarettes. Participants were offered an initial supply of products they could then purchase for up to 7 months. The primary outcome was self-reported continuous smoking abstinence at 7 months. Point prevalence, dual use, and cigarette reduction were secondary outcomes. Results At 7 months, 2.8% (N = 9) of group A (N = 324) were abstinent, compared with 1.8% (N = 11) in B (N = 620) and 1.3% (N = 8) in C (N = 619) (adjusted odds ratio [ORs]: B vs. A 0.66, 95% confidence interval [CI]: 0.27−1.63; C vs. A 0.46, 95% CI: 0.17−1.21; C vs. B 0.69, 95% CI 0.27–1.73). There were no suspected unexpected serious adverse reactions associated with trial products. Conclusion A free trial of NRT and first generation e-cigarettes and advice on long-term substitution was no better for smoking abstinence than usual care. Clinical Trial Registration The trial was registered with the Australian Therapeutic Goods Administration under their Clinical Trials Notification scheme and the Australian and New Zealand Clinical Trials Registry (ACTRN12612001210864). Implications This pragmatic trial allowed the comparison of existing and alternative policy options under semi-realistic conditions, such as product choice and financial cost. All trial arms had low rates of smoking cessation. The findings suggest that providing unflavored cigalike e-cigarettes without additional support may not increase quitting compared with advice to use standard NRT in a general population of Australians who smoke. More intensive support and education, and/or opportunity to try a range of e-cigarette products, may be required to motivate quit attempts using e-cigarettes.

Canada legalized non-medical cannabis use and supply for adults in 2018. We examined developments and changes associated with the legalization policy reform on key indicators for public health, namely cannabis (including frequent/problematic) use prevalence, cannabis-related hospitalizations, cannabis-impaired driving, and cannabis sourcing. We identified peer-reviewed and "grey" study data that featured population-level or other quasi-representative samples and comparable outcome data for pre- and post-legalization periods, including possible trends of changes over time. Cannabis use has increased in select population groups, with use modes shifting away from smoking. Evidence on cannabis-related hospitalizations (e.g., for mental health) is mixed. The prevalence of cannabis-impaired driving appears to be generally steady but THC exposure among crash-involved drivers may have increased. Increasing proportions of users obtain cannabis products from legal sources but some-especially regular-users continue to use illicit sources. Overall, data suggest a mixed and inconclusive picture on cannabis legalization's impacts on essential public health indicators, including select extensions in trends from pre-legalization.

Given the rise in cannabis vaping, it is important to highlight the heterogeneity in vaping different cannabis product because of the potential differences in their health risks. This study aims to estimate the trends and socio-demographic correlates of the use of various cannabis vaping products across jurisdiction with different legal status. Data from the 2018 (n = 27,169) and 2019 (n = 47,747) waves of the International Cannabis Policy Study (ICPS) were used. Respondents aged 16–65 completed web-based surveys. In 2019, proportions of past year vaping of cannabis oil, dried flower and concentrates in the overall sample were highest in U.S. jurisdictions where cannabis was legalized for non-medical use (17.4%, 6.0%, 4.9%), followed by U.S. jurisdiction where non-medical cannabis use is illegal (13.7%, 5.8%, 2.9%), and lowest in Canada (8.1%, 4.4%, 2.1%). Vaping dried flower decreased from 2019 to 2018 in U.S. legal jurisdictions and Canada, while vaping cannabis oil and concentrates increased in all jurisdictions (p < 0.001). The odds of vaping all forms of products were higher among younger respondents (16–55 years), males, respondents with some college education, and persons with low-risk perceptions on daily cannabis vaping. In both ICPS surveys (2018 and 2019), cannabis oil was the most frequently vaped products, followed by dried flower, and concentrates. Detailed measures of product forms for cannabis vaping should be considered in future surveys.

Refereed/Peer-reviewed Is predicted that around 42 million tonnes of composite waste from wind turbine blades will need to be recycled annually worldwide by 2050. This poses a potential environmental crisis that must be timely mitigated. Therefore, this study proposes an integrated multilevel product stewardship to address the environmental impact of wind turbine blade waste. This product stewardship integrates circular economy, cleaner production, eco design, and industry 4.0 technologies. To tailor the proposed product stewardship, a systematic literature review that extracted a total of 267 studies and industry reports was performed. A large variety of technologies were identified under seven different potential pathways that can be taken and combined to address the environmental impact of wind turbine blades. Moreover, a technology roadmap and a project strategy plan composed of 5 milestones, to be achieved by 2050, were presented envisioning the maturation and adoption of the proposed solutions.

BackgroundAdvocates of the therapeutic use of psychedelic drugs have argued that a promising approach to treatment was prematurely abandoned in the 1960s primarily because of Richard Nixon's ‘War on Drugs’.This paper (1) briefly describes research in the 1950s and 1960s in North America on the use of LSD to treat alcohol dependence, anxiety in terminal illness, and anxiety and depression; and (2) discusses the factors that led to its abandonment.MethodAn analysis of historical scholarship on psychedelic research in the 1950s, 1960s and 1970s in North America.ResultsResearch on psychedelic drugs in psychiatry was abandoned for a number of reasons that acted in concert. A major factor was that clinical research on psychedelic drugs was caught up in the tighter regulation of pharmaceutical research after the Thalidomide disaster in 1963. Psychedelic drugs also presented special challenges for randomised, placebo-controlled clinical trials in the 1970s that were not as positive as the claims made by their advocates in the 1950s and 1960s. Clinical research became more difficult after 1965 when Sandoz ceased providing psychedelic drugs for research and their nonmedical use was prohibited in 1970.ConclusionsThe demise of psychedelic drug research was not solely due to the ‘War on Drugs’. It was hastened by tighter regulation of pharmaceutical research, the failure of controlled clinical trials to live up to the claims of psychedelic advocates, and the pharmaceutical industry's lack of interest in funding clinical trials.

This study examines age, time period and birth cohort trends in cannabis use intention and weekly use in Australia over a period in which medicinal cannabis was legalised.Hierarchical age-period-cohort models were used to analyse the National Drug Strategy Household Survey between 2001 and 2019, including 158,395 participants aged 18-79 years.The hierarchical age-period-cohort model demonstrated a decrease in likelihood of intending to try cannabis as age increases. Similar age effects were found in intending to use cannabis as often or less often. There was broad-based shift in attitudes for people wanting to try cannabis (2007: b = -0.51 [-0.82, -0.21]; 2019: b = 0.68 [0.38, 0.98]) or use cannabis more often (2007: b = -0.15 [-0.50, 0.20]; 2019: b = 0.83 [0.49, 1.18]). The population trend of weekly cannabis use decreased in the earlier periods but increased since 2013 (b = -0.13 [-0.25, -0.02] vs 2019: b = 0.06 [-0.09, 0.20]). This suggests that legalisation would increase uptake of cannabis and consumption among current consumers. There were distinctive inter-generation variations: people born between 1950s and 1960s had more liberal views towards cannabis use than people born before or after (p 0.05). There were indications that young people born in the 1990 s are catching up with the baby boomers in using cannabis more often if it was legal.There has been a population-based shift in Australia in favourable attitudes towards cannabis use, more so among those born in the 1950s to 1960s than other generations. Liberal attitudes and more frequent cannabis use may put certain cohorts at higher risks of cannabis dependence and related harms.

Aim: To test if there was a reduction in alcohol consumption in wastewater samples in the Northern Territory of Australia after the implementation of a minimum unit alcohol price policy (MUP) in October 2018. Design, setting, cases: Between August 2016 and February 2020, wastewater samples were collected across 66 sites in the Northern Territory and all other states and territories in Australia. Samples were collected every 2 months in capital cities and every 4 months in regional places during this period. Overall, 4917 samples were taken (2816 before MUP and 2101 after). Measurements: The number of standard drinks per 1000 people per day in the respective catchment areas was estimated based on the concentration of an alcohol-specific metabolite, ethyl sulphate in the samples (using the excretion factor of ethyl sulphate, the flow of wastewater entering the wastewater treatment plants and the population of each wastewater catchment). Findings: Results from a linear mixed model showed that there was a large drop in alcohol consumption immediately after the MUP in Northern Territory [estimated drop = 1231, 99% confidence interval (CI) = 830, 1633; 38.75%]. There was no significant drop in all other states/territories except for Queensland, which showed a significant but much smaller drop (estimated drop: 310; 99% CI = 114, 550). One year after the MUP, the drop narrowed to 520 (99% CI = 189, 851) and was no longer statistically significant in February 2020 (15 months after MUP; estimated drop = 283, 99% CI = −114, 681). Conclusions: Per-capita consumption of alcohol appears to have decreased substantially in the Northern Territory of Australia immediately after the implementation of a minimum unit price but consumption steadily recovered and almost returned to the pre-MUP consumption level after 15 months. Refereed/Peer-reviewed

Objective: In June 2020, the Australian Government announced that personal importation of nicotine vaping products (NVP) would be prohibited, pending a 12‐month classification and regulation review by the Therapeutic Goods Administration. This brief report examines the themes of responses on Twitter to this announcement. Methods: Simple random sampling was used to retrieve tweets containing keywords from 19 to 26 June 2020. Tweets were manually coded and descriptive statistics calculated for themes and policy position. Results: The vast majority of the 1,168 tweets were anti‐policy. Themes included: criticism towards government (59.8%), activism against NVP restriction (38%), potential adverse consequences (30.8%) and support for NVP restriction (1.4%). Tweets that identified potential adverse consequences of NVP restriction cited: smoking relapse for individuals currently using NVPs (75.6%); the impact of policy enforcement (8.6%); illicit market (8.3%); panic buying (3.6%); difficulty obtaining prescriptions (2.8%); and impacts on NVP businesses (2.8%). Conclusion: Tweets predominately objected to the policy announcement. Approximately three‐quarters of tweets that cited potential adverse consequences of the policy mentioned smoking relapse as their primary concern. Implications for public health: User‐generated content on Twitter was primarily used to lobby against the proposed policy, which was subsequently amended.

BACKGROUND AND AIMS: There is little information on consumption patterns across the diverse range of cannabis product types. This paper examines trends in consumption patterns in Canada and the United States (US) between 2018-2020. DESIGN: Repeat cross-sectional surveys were conducted as part of the International Cannabis Policy Study online survey in 2018 (n=27,024), 2019 (n=45,426), and 2020 (n=45,180). SETTING: Respondents were recruited from commercial panels in Canada and US states that had and had not legalized non-medical cannabis (US 'legal' and 'illegal' states, respectively). PARTICIPANTS: Respondents were male and female participants aged 16-65 years. MEASUREMENTS: Data on frequency and consumption amounts were collected for nine types of cannabis products, including dried flower and processed products (e.g., oils and concentrates). Consumers were also asked about mixing cannabis with tobacco. Socio-demographic information was collected. FINDINGS: Dried flower was the most commonly used product, although use in the past 12 months declined between 2018 and 2020 in Canada (81% to 73%), US legal (78% to 72%) and illegal states (81% to 76%; p

[Extract] "The iCannToolkit is a first important step to systematically gather evidence regarding the health effects of contemporary medical and non-medical cannabis use—over time, among licit and illicit settings, cultures and age groups—in order to inform policy development and to raise awareness concerning cannabis use-related risks and benefits."

Background and aims There has been an increase in the potency of cannabis during the last two decades and adoption of a novel method of administration-vaping. YouTube, a social media platform, has become a popular source to access cannabis-related information. This study aimed to identify cannabis vaping YouTube videos from 2016 to 2020 and examine the themes and metrics. Design Cross-sectional sample of 200 YouTube videos. Setting YouTube, an on-line video sharing platform. Measurements Videos related to cannabis vaping were identified using the search terms: 'vaping cannabis', 'vaping weed', 'vaping marijuana' and 'vaping THC' [tetrahydrocannabinol]. Videos were independently coded by two researchers. The number of views, likes, dislikes and comments were also collected. Robust regression was used to analyse the relationship between identified video themes and video metrics. Findings Six themes were identified: 'advertisement', 'product review', 'celebratory', 'reflective', 'how-to' and 'warning'. The 'how-to' and 'celebratory' videos received the highest number of views and likes. The most popular video was viewed more than 4 000 000 times. Many videos portrayed risky behaviour (e.g. vaping a whole THC cartridge in a single setting). Fifty-two percent of these videos had no age access restrictions. The robust regression model also found that engagement metric was positively associated with 'reflective' videos and negatively associated with 'advertisement' videos. Conclusions A large number of videos on cannabis vaping are available on-line without age-restriction. Videos that portrayed risky behaviour appear to be prevalent.

Pregabalin has become widely used as an alternative to opioids in treating certain types of chronic non-cancer pain, but few studies have examined its clinical efficacy outside trials. We address this gap by examining the utilization, correlates and clinical outcomes of pregabalin use among an Australian community-based cohort of people prescribed opioids for chronic non-cancer pain. Through a five-year prospective cohort study (n = 1514) we examined associations between pregabalin use and pain severity and interference, mental health, opioid dose and past month use of ambulance and emergency department services. We used fixed-effects regression models to examine within-participant differences, and random-effects regression models to examine within and between participant differences in clinical outcomes. In an analysis of cases with complete data over five-years (n = 896), the prevalence of pregabalin use ranged from 16% at cohort entry to 29% at 36- and 48-months, and 46% reported pregabalin use at any time during the five years.. Pregabalin use was associated with greater pain severity and interference and greater use of high-risk opioid doses (>90 oral morphine equivalents/day). Pregabalin use was not associated with changes in mental health symptoms, ambulance, or emergency department attendance in the fixed or random effects models. Pregabalin use was common, but for most people use was not associated with clinically meaningful improvements in pain or functioning.

To estimate the treatment rate for alcohol use disorders (AUDs) in the general adult population. Treatment rates were also considered in relation to economic differences. Systematic review and meta-analysis. We searched PubMed, EMBASE, PsycINFO, and CINAHL databases to identify studies that reported treatment rates for alcohol use disorders in the general population. Independent reviewers screened the articles based on predefined inclusion criteria. Data were extracted using a standardized data extraction form. We conducted quality assessments of the included studies. The overall treatment rates were estimated from studies that reported any treatment for AUDs from healthcare or informal non-healthcare settings (any treatment). We estimated the separate treatment rates for each diagnostic category as reported in the primary studies: AUD as a single disorder, alcohol abuse, and alcohol dependence. Data were pooled using a random-effect model. Thirty-two articles were included to estimate the treatment rates (percentage treated among the total number of people with AUDs). The pooled estimate of people with AUDs who received any treatment were 14.3% (95% CI: 9.3 - 20.3%) for alcohol abuse, 16.5% (95% CI: 12 - 21.5%) for alcohol dependence, and 17.3% (95% CI: 12.8 - 22.3%) for AUD. A subgroup analysis by World Bank economic classification of countries found that the treatment rate for AUD was 9.3% (95% CI: 4.0-15.7%) in lower-income and lower-middle-income countries. Globally, approximately one in six people with alcohol use disorders receives treatment. Treatment rates for alcohol use disorders are generally low, with even lower rates in low-income and lower-middle-income countries.

This review summarizes evidence on the effects of cannabis use on the development of adolescents and young adults. It draws on epidemiological studies, neuroimaging studies, case-control studies, and twin and Mendelian randomization studies. The acute risks include psychiatric symptoms associated with the use of high THC (tetrahydrocannabinol) products and motor vehicle accidents. Daily cannabis use during adolescence is associated with cannabis dependence and poor cognitive function, which may affect educational attainment and occupational choice. Daily use of highly potent cannabis is associated with more severe psychological symptoms, such as psychoses, mania, and suicidality. There are more mixed findings on depressive symptoms, anxiety, and violence and debates about the interpretation of these associations. Legalization of adult cannabis use may increase cannabis use and dependence among adolescents and young adults. The regulation of cannabis after legalization needs to minimize adolescent uptake and cannabis-related adverse developmental outcomes.

Cannabis use disorder (CUD) affects one-in-five cannabis users, presenting a major contributor to cannabis-associated disease burden. Epidemiological data identify the frequency of cannabis use as a risk factor for CUD. This review aimed to determine quantifiable risk-thresholds of the frequency of cannabis use for developing CUD.Systematic search of Medline, EMBASE, PsycInfo, CINAHL, and Web of Science for cohort/case-control studies that assessed the association between frequency of cannabis use and CUD from 2000 to 2022. Effect estimates were converted to risk ratios (RR). A random-effects multi-level multivariate meta-analytic approach was utilized, and sensitivity analyses conducted. Quality of included studies was assessed with the Newcastle Ottawa Scale.Six prospective cohort studies were included in this review, drawn from two main source studies. Random-effect modeling showed a significant log-linear dose-response association between the frequency of cannabis use and CUD risk (p 0.0001). The risk of CUD increased from RR:2.03 (95% CI:1.85-2.22) for 'yearly' use, to RR:4.12 (95% CI:3.44-4.95) for 'monthly" use, RR:8.37 (95% CI:6.37-11.00) for 'weekly' use, and RR:16.99 (95% CI:11.80-24.46) for 'daily' use. Multi-level modeling showed an absolute risk increase (ARI) from 3.5% (95% CI:2.6-4.7) for 'yearly' use, to 8.0% (95% CI:5.3-12.1) for 'monthly' use, to 16.8% (95% CI:8.8-32.0) for 'weekly' use, and 36% (95% CI:27.047.9) for 'daily' use.A limited risk of CUD as a potential outcome of cannabis use exists even at infrequent levels of use, but significantly increases as frequency of use increases. Corresponding information should be conveyed to cannabis users as part of targeted prevention messaging to promote safer cannabis use.

As is the case for most drugs, cannabis use has costs and benefits, and so do the policies that attempt to minimize the first and maximize the second. This article summarizes what we know about the harmful effects of recreational cannabis use and the benefits of medical cannabis use under the policy of prohibition that prevailed in developed countries until 2012. It outlines three broad ways in which cannabis prohibition may be relaxed, namely, the depenalization of personal possession and use, the legalization of medical use, and the legalization of adult recreational use. It reviews evidence to date on the impacts of each of these forms of liberalization on the costs and benefits of cannabis use. It makes some plausible conjectures about the future impacts of the commercialization of cannabis using experience from the commercialization of the alcohol, tobacco, and gambling industries. Cannabis policy entails unavoidable trade-offs between competing social values in the face of considerable uncertainty about the effects that more liberal cannabis policies will have on cannabis use and its consequences for better or worse. .El consumo de cannabis, como se da con la mayoría de las drogas, tiene costos y beneficios ; igual ocurre con las políticas que intentan minimizar los primeros y maximizar los segundos. Este artículo resume lo que conocemos acerca de los daños provocados por el consumo recreativo de cannabis y los beneficios de su empleo medicinal según la política de prohibición que prevaleció en los países desarrollados hasta 2012. Se describen tres principales formas en las que la prohibición de cannabis se puede mitigar: la despenalización de la posesión y uso personal, la legalización del uso médico, y la legalización del uso recreativo en adultos. Se revisa la evidencia hasta la fecha sobre los impactos de cada una de estas formas de liberalización en los costos y beneficios del consumo de cannabis. Se hacen algunas posibles conjeturas acerca de los impactos futuros de la comercialización de cannabis utilizando la experiencia al respecto de las industrias del alcohol, el tabaco y de los juegos de azar. Se sabe poco sobre el impacto de la liberalización del consumo de cannabis, así como de sus consecuencias positivas o negativas. Cualquier política sobre este tema implica compromisos inevitables entre valores sociales opuestos.Comme pour la plupart des drogues, la consommation de cannabis a ses coûts et ses bénéfices. Tout comme les politiques qui s’efforcent de minimiser les premiers et de maximiser les seconds.. Nous résumons dans cet article nos connaissances sur les dangers de l'usage récréatif du cannabis et les bénéfices de son usage médical dans le cadre de la politique d'interdiction qui a prévalu dans les pays développés jusqu'en 2012. Nous y décrivons trois grandes voies d'assouplissement de l'interdiction du cannabis, à savoir la dépénalisation de la possession et de la consommation personnelles, la légalisation de l'utilisation médicale et la légalisation de la consommation récréative par des adultes. Chacune de ces formes de libéralisation influe sur les coûts et les bénéfices de la consommation de cannabis, générant des données analysées ici. En nous inspirant de l'expérience acquise dans le cadre de la commercialisation de l'alcool et la légalisation des jeux de hasard, nous émettons des hypothèses sur les possibles conséquences de la commercialisation du cannabis. L’impact de la libéralisation du cannabis sur sa consommation est peu connu, de même que ses conséquences pour le meilleur ou pour le pire, et toute politique menée à ce sujet implique des compromis inévitables entre des valeurs sociales opposées.

Aim To describe an outbreak of lung injuries in 2019 among people who vaped in the United States (type of injuries, people afflicted, substances vaped and cause of the injuries) and to analyse critically the regulatory responses of public health authorities and the media reporting of the outbreak. Methods Case studies of the reporting of the e-cigarette or vaping product use associated lung injury (EVALI) outbreak. We examined data on the number of cases of lung injury provided by the US Centers for Disease Control (CDC), public advice on the causes of the outbreak provided by the CDC and the Food and Drug Administration (FDA), major media reports of the outbreak and proposed regulatory responses by governments in the United States, Australia and the United Kingdom. Results The CDC initially suggested that the cause of the outbreak was nicotine vaping because the outbreak followed a large increase in nicotine vaping among US adolescents. Case-control studies revealed that the majority of cases had vaped illicit cannabis oils that were contaminated by vitamin E acetate. The CDC's public advice and the media were slow to report the evidence on the role of cannabis vaping. Popular government regulatory proposals-bans on sales of nicotine flavours and vaporizers-were based on the assumption that nicotine vaping was the cause of the outbreak. Conclusions Media reporting in the United States, Australia and the United Kingdom of the US Centers for Disease Control's analysis of the causes of the e-cigarette or vaping product use associated lung injury outbreak contributed to regulatory over-reactions to nicotine vaping by the public health community.

Herein, the general constitutive equation of bi-phasic materials equipped with orientation tensor is presented in direct notation. The formulation is refined by some correction factors specific to ...

The aim of the current work was to illustrate the effect of the fibre area correction factor on the results of modelling natural fibre-reinforced composites. A mesoscopic approach is adopted to represent the stochastic heterogeneity of the composite, i.e. a meso-structural numerical model was prototyped using the finite element method including quasi-unidirectional discrete fibre elements embedded in a matrix. The model was verified by the experimental results from previous work on jute fibres but is extendable to every natural fibre with cross-sectional non-uniformity. A correction factor was suggested to fine-tune both the analytical and numerical models. Moreover, a model updating technique for considering the size-effect of fibres is introduced and its implementation was automated by means of FORTRAN subroutines and Python scripts. It was shown that correcting and updating the fibre strength is critical to obtain accurate macroscopic response of the composite when discrete modelling of fibres is intended. Based on the current study, it is found that consideration of the effect of flaws on the strength of natural fibres and inclusion of the fibre area correction factor are crucial to obtain realistic results.

In this brief article, we review the evidence on whether easier access to vaping could help lower smoking rates in Australia. To make a convincing case for vaping the following conditions need to be met: that vaping assists in smoking cessation; that the prevalence of vaping is high enough to produce measurable effects at a population level; and that the decline in smoking prevalence is slower in countries where vaping is less common. The evidence suggests that these criteria are satisfied.

Embedded waveguide technique is often not considered as a method for introducing ultrasonic wave for nondestructive testing (NDT). Because of the unique surface condition of wooden utility poles, the rough and uneven surface between the medium and the sensor introduces variation and signal attenuation, which impedes the use of a contact-based ultrasonic sensor. Many inspection and utility firms have adopted the use of inserting a small nail into the wooden pole for NDT. The mechanisms of excitation and reception of ultrasonic wave, however, are very different from the traditional contact-based mounting technique. Because very little research has been carried out on this methodology, this study focuses on the understanding of embedded waveguide excitation and reception in the time domain for wooden structure assessment in cylindrical symmetry. The resulted time domain waveform response is analyzed, and the associated findings will help infer important structural condition for NDT assessments. The study consists of numerical and empirical results to validate and understand the waveform characteristics and the associated energy modes that exist (Bodig 1982) in the two-dimensional wave propagation in a boundary medium