Do medical cannabis laws encourage cannabis use?

Medical cannabis is a contentious issue in the United States, with many fearing that introduction of state laws will increase use among the general population. The present study examined whether the introduction of such laws affects the level of cannabis use among arrestees and emergency department patients. Using the Arrestee Drug Abuse Monitoring system, data from adult arrestees for the period 1995-2002 were examined in three cities in California (Los Angeles, San Diego, San Jose), one city in Colorado (Denver), and one city in Oregon (Portland). Data were also analysed for juvenile arrestees in two of the California cities and Portland. Data on emergency department patients from the Drug Abuse Warning Network for the period 1994-2002 were examined in three metropolitan areas in California (Los Angeles, San Diego, San Francisco), one in Colorado (Denver), and one in Washington State (Seattle). The analysis followed an interrupted time-series design. No statistically significant pre-law versus post-law differences were found in any of the ADAM or DAWN sites. Thus, consistent with other studies of the liberalization of cannabis laws, medical cannabis laws do not appear to increase use of the drug. One reason for this might be that relatively few individuals are registered medical cannabis patients or caregivers. In addition, use of the drug by those already sick might "de-glamorise" it and thereby do little to encourage use among others.     

Engagement with medical cannabis information from online and mass media sources: Is it related to medical cannabis attitudes and support for legalization?

BackgroundThe legalization of medical and recreational cannabis is a topic of continued debate in countries around the world. It has been suggested that medical cannabis legalization influences cannabis legalization for recreational purposes through increased media attention toward the positive health effects of cannabis. However, the nature of media coverage is likely to vary across mass media and online sources (internet and social media). In addition, effects of information engagement on attitudes may vary depending on whether information was actively sought or obtained incidentally during patterns of regular media use (scanned).MethodsThis study uses data from an online survey of Israeli adults (N = 554) to test the association between information seeking and scanning about medical cannabis (from mass media and online sources) and attitudes toward medical cannabis. Furthermore, we test indirect effects of media engagement on attitudes toward cannabis legalization through medical cannabis attitudes.ResultsSeeking and scanning for information about medical cannabis from online sources, but not from mass media sources, were associated with positive attitudes toward medical cannabis. Engagement with medical cannabis information from online sources was also indirectly associated with greater support for cannabis legalization, through positive attitudes related to medical cannabis.ConclusionThe results suggest that one mechanism through which medical cannabis legalization is associated with cannabis legalization for all purposes is public engagement with information about medical cannabis in the media, particularly from the internet and social media channels. As increasingly more jurisdictions are expected to legalize medical cannabis, with resulting increase in media attention, support for recreational cannabis legalization may be expected to grow.     

Do formulation differences alter abuse liability of methylphenidate? A placebo-controlled, randomized, double-blind, crossover study in recreational drug users

The primary objective of this study was to determine if the abuse liability of methylphenidate is governed by formulation differences that affect rates of drug delivery. In this double-blind, placebo-controlled, randomized, crossover study, subjects with a history of recreational drug use received single oral doses of placebo, 60 mg of immediate-release methylphenidate (IR) and 108 mg of extended-release methylphenidate (osmotic release oral system [OROS]). Over 24 hours after dosing, blood was collected to determine plasma concentrations of methylphenidate, and subjects completed subjective assessments of abuse liability (Addiction Research Center Inventory, Drug Rating Questionnaire-Subject, and Subjective Drug Value).The abuse-related subjective effects of IR and OROS methylphenidate were statistically significantly different from placebo, confirming the overall validity of the study. Although a higher dose of OROS methylphenidate was used compared with IR methylphenidate (108 mg vs 60 mg), subjective effects were consistently lower for OROS compared with IR methylphenidate (statistically significant for 3 of 6 measures of positive effects), particularly at early time points. In general, pharmacokinetic-pharmacodynamic parameters were correlated from a poor to modest degree, with greater correlations observed for IR methylphenidate. In addition, a post hoc "qualification" method was developed, which demonstrated that pharmacological qualification might improve the assessment of subjective effects.Although requiring epidemiological confirmation, the results suggest that OROS methylphenidate, with its characteristic slow ascending plasma concentration profile, may have lower abuse potential. This conclusion is reflected by lower subjective responses during early hours as compared with the IR formulation with its rapid drug delivery and accompanying greater subjective effects.     

Why did New Zealand's referendum to legalise recreational cannabis fail?

New Zealand recently held the world's first national referendum on cannabis legalisation involving a detailed bill to regulate retail sale and supply of cannabis for recreational (non-medical) adult use (i.e. the Cannabis Legalisation and Control Bill; CLCB). The referendum generated significant domestic debate and lobbying from both sides of the issue. The CLCB was narrowly defeated, with 48.4% voting to support versus 50.7% opposed. In this commentary, we discuss the referendum campaigns and other political and social factors that may have contributed to the result. Voting patterns appeared to largely follow traditional conservative-liberal, urban–rural and age divides. The referendum format created a public campaigning environment that encouraged persuasion and selective use of evidence rather than rational discussion of all the evidence and related knowledge gaps. The self-imposed neutrality of the centre left Labour Party and its popular leader may have been a decisive factor in the narrow defeat. It did not appear to be the case that anti-CLCB groups outspent the pro-CLCB movement in online promotional advertisements, and the leading digital media appeared largely neutral or mildly in favour of reform. The recent New Zealand experience illustrates the uncertainties of attempting to achieve cannabis law reform via a public referendum vote.     

Dependent cannabis users at a music festival – Prevalence and correlates

Aim: In western countries, the most prevalent type of illicit substance-use dependence is cannabis dependence. This study aimed at estimating the prevalence of cannabis dependence among music festival visitors.

Methods: Based on a survey of 380 music festival guests, we estimated the prevalence of cannabis dependence, as defined by a score of 3 or more on the Severity of Dependence Scale (SDS), as well as characteristics of cannabis dependent visitors.

Results: 143 (38%) reported having used cannabis within the past year (past year cannabis users), and of these respondents, 21 (15%) screened positive for cannabis dependence. Compared to other cannabis users, the dependent respondents were more likely to be daily smokers, and they scored higher on self-reported sensation seeking. Compared with past-year non-users, both dependent users and non-dependent users were more likely to be men, weekly heavy drinkers, daily smokers and to score high on sensation seeking.

Conclusions: Out of the past-year cannabis users recruited at a music festival, one in seven of those respondents showed indication of cannabis dependence. This suggests a need for both available treatment options and primary prevention of dependence.     

Are dispensaries indispensable? Patient experiences of access to cannabis from medical cannabis dispensaries in Canada

BackgroundIn 2001, Canada established a federal program for cannabis for therapeutic purposes (CTP). Medical cannabis dispensaries (dispensaries) are widely accessed as a source of CTP despite storefront sales of cannabis being illegal. The discrepancy between legal status and social practice has fuelled active debate regarding the role of dispensaries. The present study aims to inform this debate by analysing CTP user experiences with different CTP sources, and comparing dispensary users to those accessing CTP from other sources.MethodsWe compared sociodemographic characteristics, health related factors and patterns of cannabis use of 445 respondents, 215 who accessed CTP from dispensaries with 230 who accessed other sources. We compared patients’ ratings of CTP sources (dispensaries, Health Canada's supplier, self-production, other producer, friend or acquaintance, street dealer) for quality and availability of product, safety and efficiency of access, cost, and feeling respected while accessing.ResultsPatients using dispensaries were older, more likely to have arthritis and HIV/AIDS, and less likely to have mental health conditions than those not using dispensaries. Those accessing dispensaries used larger quantities of cannabis, placed greater value on access to specific strains, and were more likely to have legal authorization for CTP. Dispensaries were rated equally to or more favourably than other sources of CTP for quality, safety, availability, efficiency and feeling respected, and less favourably than self-production and other producer for cost.ConclusionGiven the high endorsement of dispensaries by patients, future regulations should consider including dispensaries as a source of CTP and address known barriers to access such as cost and health care provider support. Further research should assess the impact of the addition of licensed producers on the role and perceived value of dispensaries within the Canadian medical cannabis system.     

Legal cannabis laws,home cultivation,and use of edible cannabis products: A growing relationship?

BackgroundOver half of U.S. states have enacted legal cannabis laws (LCL). In parallel, edible cannabis products (i.e., edibles) have presented new regulatory challenges. LCL provisions that dictate access to cannabis (e.g., home cultivation (HC) or dispensaries (DSP)) may impact edible production and use. This study examined relationships among HC and DSP provisions, cannabis cultivation, and edible use.MethodsAn online cannabis use survey was distributed using Facebook. Data were collected from 1813 cannabis-using adults. U.S. states were classified as states without LCL (Non-LCL) or LCL states that: (1) only permit DSP (LCL DSP-only), (2) only permit HC (LCL HC-only), or (3) permit HC and DSP (LCL HC + DSP). Analyses tested associations among these classifications, cannabis growing, and edible use and procurement.ResultsIndividuals in LCL HC-only and LCL HC + DSP states were more likely to report currently growing cannabis at home (OR: 3.3, 95% CI: 1.7, 6.2; OR: 3.9, 95% CI: 2.4, 6.3, respectively) and past-month edible use (OR: 2.1, 95% CI: 1.4, 3.4; OR: 2.9, 95% CI: 2.2, 3.9, respectively) than individuals in LCL DSP-only states. Regardless of state, those who had grown cannabis were more likely to have made edibles than those who had never grown cannabis (OR: 2.2, 95% CI: 1.8, 2.6). Individuals in LCL HC-only states were more likely to have made edibles in the past month than individuals from Non-LCL (OR: 2.75, 95% CI: 1.5, 5.3) and DSP-only states (OR: 2.1, 95% CI: 1.0, 4.4). Individuals in LCL HC + DSP states were more likely to have purchased edibles in the past month than individuals from Non-LCL (OR: 3.7, 95% CI: 2.4, 5.6) and DSP-only states (OR: 3.2, 95% CI: 1.8, 5.5).ConclusionSpecific LCL provisions may differentially affect individuals’ propensity to grow cannabis and make, buy, and use edible cannabis products. Permitting home cultivation contributes to a greater likelihood of growing cannabis. Those who grow cannabis economize the plant by creating homemade edible cannabis products. Conversely, permitting dispensaries increases the likelihood of purchasing edibles. The psychoactive effects of edibles with unknown and variable cannabinoid content will be unpredictable. Policymakers should carefully consider how specific LCL provisions can affect patterns of cannabis edible product access and quality.     

Are cannabis users exposed to other drug use opportunities? Investigation of high‐risk drug exposure opportunities among young cannabis users in London

In a study of young cannabis users attending further education colleges across London which specifically excluded young heroin users or injecting drug users, 35% were found to have been offered heroin, 36% had been present during heroin smoking, and 12% present at injecting. Factors associated with these exposure opportunities were investigated. The proportion of friends who use drugs other than cannabis was also considered, both as an indicator of risk in its own right and as a possible mechanism for high-risk drug exposure opportunities involving heroin and/or injecting. Alcohol variables and interactional problems perceived by the study subjects to be caused by their own drug use were found to be predictive of the involvement of friends in drug use other than cannabis and of exposure to heroin and injecting drug use. Non-cannabis illicit drug use among friends was also found to be associated with offers of heroin and with having been present during injecting drug use by others. Interpretations of these data are considered and the need for more detailed study with an area of increasing public policy significance is discussed.     

Do early experiences with cannabis vary in cigarette smokers?

Introduction

We examine whether regular cigarette smokers were more likely to be exposed to and use cannabis at an earlier age, and further, upon initiation, whether their initial experiences with cannabis varied from those reported by never/non-regular cigarette smokers.

Method

A sample of 3797 Australian twins and siblings aged 21–46 years was used. Survival analyses examined whether cigarette smokers were at increased likelihood of early opportunity to use cannabis and early onset of cannabis use. Logistic regression examined whether cigarette smokers reported greater enjoyment of their cannabis experience, inhaling on the first try, differing positive and negative initial subjective reactions, smoked cigarettes with cannabis the first time and were more likely to try cannabis again within a week.

Results

Regular cigarette smokers were more likely to report an earlier opportunity to use cannabis and early onset of cannabis use. Regular cigarette smokers were also considerably more likely to have enjoyed their first experience with cannabis and reported higher rates of positive initial reactions. They were more likely to report inhaling on the first try and smoking cigarettes with cannabis. Potentially negative subjective reactions were also elevated in regular cigarette smokers. Importantly, cigarette smokers were at 1.87 increased odds of smoking cannabis within a week of their initial use.

Conclusion

These findings indicate that the well-known overlap in cannabis and cigarette smoking behaviors may evolve as early as opportunity to use and extend through the course of the substance use trajectory.     

Detectability of cannabinoids in the serum samples of cannabis users: Indicators of recent cannabis use? A follow-up study

Forensic toxicologists are frequently required to predict the time of last cannabis consumption. Several studies suggested the utility of minor cannabinoids as indicators of recent cannabis use. Because several factors influence blood cannabinoid concentrations, the interpretation of serum cannabinoid concentrations remains challenging. To assess the informative value of serum cannabinoid levels in cannabis users (in total N = 117 patients, including 56 patients who stated an exact time of last cannabis use within 24 h before blood sampling), the detectability of cannabinoids, namely, delta-9-tetrahydrocannabinol (delta-9-THC), 11-hydroxy-delta-9-THC, 11-nor-9-carboxy-delta-9-THC, cannabichromene (CBC), cannabidiol (CBD), cannabinol (CBN), cannabidivarin, tetrahydrocannabivarin, cannabigerol (CBG), cannabicyclol, delta-8-THC, tetrahydrocannabinolic acid A, cannabichromenic acid, cannabidiolic acid (CBDA), cannabigerolic acid, cannabicyclolic acid (CBLA), 11-nor-9-carboxy-THCV (THCVCOOH), and 11-nor-CBN-9-COOH, was investigated. Excluding CBDA and CBLA, all investigated cannabinoids were detected in at least one analyzed sample. The interval between cannabis consumption and sample collection (reported by the patients) was not correlated with cannabinoid concentrations. Minor cannabinoids tended to be more easily detected in samples obtained shortly after consumption. However, some samples tested positive for minor cannabinoids despite an interval of several hours or even days between consumption and sampling (according to patients' statements). For instance, CBC, CBG, THCVCOOH, CBD, and CBN in certain cases could be detected more than 24 h after the last consumption of cannabis. Thus, findings of minor cannabinoids should always be interpreted with caution.     

The effects of concurrent cannabis use among ecstasy users: neuroprotective or neurotoxic?

The research evidence regarding the potential effects of ecstasy suggests that it may be neurotoxic and that its use is associated with cognitive impairment. In recent years evidence has emerged suggesting that cannabinoids, the active ingredients in cannabis, can be neuroprotective under certain conditions. Given that many ecstasy users also consume cannabis at the same time, the possibility emerges that these individuals might be less susceptible to ecstasy-related impairment. The present paper reanalyses the data from a number of previous studies, contrasting the performance of those individuals who generally consume cannabis and ecstasy at the same time with those who generally consume ecstasy on its own. The two ecstasy-using groups are compared with non-ecstasy users on a range of measures including processing speed, random letter generation, verbal and visuo-spatial working memory span, reasoning and associative learning. The two ecstasy user groups did not differ significantly from each other on any of the measures. Both user groups were significantly worse than non-ecstasy users on measures of associative learning, verbal and visuo-spatial working memory and reasoning. The results suggest that consuming cannabis at the same time as ecstasy does not reduce the likelihood of cognitive impairment.     

Do adolescent ecstasy users have different attitudes towards drugs when compared to marijuana users?

BACKGROUND: Perceived risk and attitudes about the consequences of drug use, perceptions of others expectations and self-efficacy influence the intent to try drugs and continue drug use once use has started. We examine associations between adolescents' attitudes and beliefs towards ecstasy use; because most ecstasy users have a history of marijuana use, we estimate the association for three groups of adolescents: non-marijuana/ecstasy users, marijuana users (used marijuana at least once but never used ecstasy) and ecstasy users (used ecstasy at least once). METHODS: Data from 5049 adolescents aged 12-18 years old who had complete weighted data information in Round 2 of the Restricted Use Files (RUF) of the National Survey of Parents and Youth (NSPY). Data were analyzed using jackknife weighted multinomial logistic regression models. RESULTS: Adolescent marijuana and ecstasy users were more likely to approve of marijuana and ecstasy use as compared to non-drug using youth. Adolescent marijuana and ecstasy users were more likely to have close friends who approved of ecstasy as compared to non-drug using youth. The magnitudes of these two associations were stronger for ecstasy use than for marijuana use in the final adjusted model. Our final adjusted model shows that approval of marijuana and ecstasy use was more strongly associated with marijuana and ecstasy use in adolescence than perceived risk in using both drugs. CONCLUSION: Information about the risks and consequences of ecstasy use need to be presented to adolescents in order to attempt to reduce adolescents' approval of ecstasy use as well as ecstasy experimentation.     

A nationwide survey of pharmacy students’ knowledge and perceptions regarding medical cannabis

ObjectiveThe primary objective of this study was to compare knowledge and perceptions of medical cannabis (MC) between pharmacy students who attended schools where MC was legal and illegal.DesignA nationwide anonymous survey regarding MC was distributed to pharmacy students. The survey consisted of the following sections: (1) demographics and personal factors, (2) knowledge assessment of indications and adverse effects of MC, and (3) perceptions assessment.Setting and participantsEqual numbers of pharmacy schools were selected and sent surveys based on geographical regions, private versus public universities, and the state’s legal status of MC for first through fourth-year pharmacy students to complete.Outcome measuresStudent knowledge of MC indications and adverse effects were treated as quizzes. Median percentage correct and whether students passed the quizzes (≥ 70%) were evaluated based on the state’s legal status. Students’ perceptions were similarly compared.ResultsA total of 629 students accessed the survey. Most students who completed the survey attended pharmacy schools where MC was illegal (55%), were female (68%), and had personally tried cannabis (53%). Overall, 91% of students believed that MC should be legalized nationally. A low number of students correctly identify approved indications with 14.8% of students in states with MC legalization scoring greater than 70% compared with 15.9% of students in states without MC legalization (P = 0.748). Similar findings were seen in the side effects quiz with only 6.1% of students in states with legal MC scoring greater than 70% compared with 7.4% of students where MC is illegal (P = 0.569) There were minimal differences in students’ perceptions of MC based on the states’ legal status.ConclusionOur study continues to highlight that pharmacy students lack knowledge and preparation to counsel and educate on MC. With increasing state legalizations, pharmacy schools need to address this knowledge gap to ensure optimal patient care.