Smoking,vaping, eating: Is legalization impacting the way people use cannabis?

BackgroundIn the context of the shifting legal landscape of medical cannabis, different methods of cannabis administration have important public health implications. How medical marijuana laws (MML) may influence patterns of use of alternative methods of cannabis administration (vaping and edibles) compared to traditional methods (smoking) is unclear. The purpose of this study was to determine if the prevalence of use of alternative methods of cannabis administration varied in relation to the presence of and variation in MMLs among states in the United States.MethodUsing Qualtrics and Facebook, we collected survey data from a convenience sample of n = 2838 individuals who had used cannabis at least once in their lifetime. Using multiple sources, U.S. states were coded by MML status, duration of MML status, and cannabis dispensary density. Adjusted logistic and linear regression analyses were used to analyze outcomes of ever use, preference for, and age of initiation of smoking, vaping, and edibles in relation to MML status, duration of MML status, and cannabis dispensary density.ResultsIndividuals in MML states had a significantly higher likelihood of ever use of vaping (OR: 2.04, 99% CI: 1.62–2.58) and edibles (OR: 1.78, 99% CI: 1.39–2.26) than those in states without MMLs. Longer duration of MML status and higher dispensary density were also significantly associated with ever use of vaping and edibles.ConclusionsMMLs are related to state-level patterns of utilization of alternative methods of cannabis administration. Whether discrepancies in MML legislation are causally related to these findings will require further study. If MMLs do impact methods of use, regulatory bodies considering medical or recreational legalization should be aware of the potential impact this may have on cannabis users.     

Self-reported driving after marijuana use in association with medical and recreational marijuana policies

BackgroundA common concern surrounding increasingly permissive marijuana policies in the US is that they will lead to more dangerous behavior, including driving after marijuana use. Although there is considerable research on the effects of marijuana policies on behaviours, few studies have examined self-reported driving after marijuana use. In this study, we use data from the Traffic Safety Culture Index (TSCI) to model self-reported past-year driving after marijuana use in association with medical and recreational marijuana policies.MethodsWe analysed individual responses to annual administrations of TSCI from years 2013–2017 using a multiple logistic regression model. Our outcome variable was self-reported past-year driving after marijuana use (at least once vs. never), and our primary explanatory variable was the respondents’ state medical marijuana (MM) and recreational marijuana (RM) policy. Additional explanatory variables include policies that specify thresholds for marijuana-intoxicated driving, year, and demographic factors.ResultsDrivers in states that legalized MM but not RM had marginally higher odds of self-reporting driving after marijuana use compared to drivers in states where both RM and MM were illegal (adjusted OR 1.29; 95% CI 0.98, 1.70; p = 0.075). However, we found little evidence that drivers in states that legalized both RM and MM had higher odds of driving after marijuana use compared to drivers in states where both RM and MM were illegal (adjusted OR 1.06; 95% CI 0.71, 1.56; p = 0.784). Per-se or THC threshold laws were associated with lower self-reported driving after marijuana use (adjusted OR 0.74; 95% CI 0.57, 0.95; p = 0.018).ConclusionAlthough we found some evidence of an association between MM legalization and self-reported driving after marijuana use, our results provide only mixed support for the hypothesis that permissive marijuana policies are associated with higher odds of self-reported driving after marijuana use.     

Severity of DSM-5 cannabis use disorders in a nationally representative sample of sexual minorities

Abstract

Background: Our study is the first using a national sample to examine the severity of Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) cannabis use disorder (CUD) in sexual minorities. Drawing from current literature, we expected that bisexual individuals would have the highest prevalence of CUD and the most severe form of CUD. Methods: The National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III; 2012–2013) provides a nationally representative adult sample (N?=?36,309), including one of the largest samples of sexual minorities. The NESARC-III is large enough to compare subpopulations of sexual minorities on dimensions of substance use disorder severity. Results: Lesbians and gay men were more likely to report mild CUD, whereas bisexuals and respondents “not sure” of their sexual identity were more likely to report severe CUD when compared with heterosexuals. Sexual minorities and heterosexuals who reported lifetime use of medical cannabis had higher odds of having a severe CUD. Sexual minorities had significantly higher odds of lifetime medical cannabis use (adjusted odds ratio [AOR]?=?2.39, 95% confidence interval [CI]?=?1.42–3.66, P?<?.001) when compared with heterosexuals, with bisexuals having the highest odds (AOR?=?2.81, 95% CI?=?1.66–4.75, P?<?.001). Conclusions: Sexual minorities have the highest odds compared with heterosexuals of developing any CUD. Moreover, the higher rates of severe CUD among bisexuals and those “not sure” have implications for drug prevention with these particularly high-risk groups. It appears that lifetime medical marijuana use may play a role in the development of CUD, although more rigorous measures of medical marijuana use are needed to determine the nature of the relations.     

Community-based environmental strategies to prevent the non-medical use of marijuana: A review of the literature

Aims: To summarize published evidence for environmental strategies to prevent the non-medical use of marijuana (NMUM).

Methods: Four databases (PSYCHINFO, SocINDEX, PsycARTICLES and Academic Search Complete) were searched for articles examining environmental strategies for NMUM prevention. Articles included were peer-reviewed, published in English between 2003 and 2013 and had full-text availability. The references listed in retrieved articles were included when they met selection criteria.

Findings: Twenty articles met inclusion criteria. Seven described evaluations of media strategies to prevent marijuana use; eight examined the impact of policy on marijuana use (six described the impact of medical marijuana laws on use; two explored the impact of national-level policy and enforcement on use); and five explored price and availability and their impact on marijuana demand and use.

Conclusions: Media prevention campaigns for NMUM work best when they are well-targeted and bolstered by community-level support. Marijuana-related policy studies on medical marijuana laws (MML) show inconsistent findings about their impact on NMUM. Unique distribution characteristics of marijuana make its use relatively insensitive to price fluctuations compared to other illicit drugs. Future research should focus on evaluation of: (a) policies that expand beyond MMLs, (b) marijuana enforcement strategies and (c) other types of state or local-level environmental strategies.     

Factors driving the diffusion of medical marijuana legalisation in the United States

Abstract

In the past 20 years, the drive to legalise medical marijuana (cannabis) has gained national attention with the public and policy makers. Beginning in 1996 states started implementing MMLs (medical marijuana laws), and by the end of 2015, 23 states and the District of Columbia had adopted laws legalizing marijuana use for medical purposes. We find that measures of policy diffusion and political culture are important drivers of adoption. However, the relative effects of positive pressure from neighbouring states and negative pressure from the ideological distance between adopting and non-adopting states is such that complete diffusion is unlikely.     

Sexual identity and prevalence of alcohol and other drug use among Australians in the general population

BackgroundInternational research assessing differences in the prevalence of alcohol and other drug (AOD) use among Lesbian Gay Bisexual and Transgender (LGBTI) and heterosexual populations shows elevated prevalence rates of substance use among LGBTI people. To date no research has been published investigating these differences at a population level among both men and women in Australia.MethodsThe 2013 National Drug Strategy Household Survey, a multistage stratified population sample collecting data on AOD use in the Australian population over 14 years of age, was analysed for differences between gay and bisexual (GB) men and lesbian/gay and bisexual (LGB) women and their heterosexual counterparts in: (1) the prevalence of lifetime and past year tobacco and AOD use; (2) age of initiation of tobacco and AOD use; and (3) frequency of alcohol and cannabis use, and history of AOD treatment.ResultsThere were elevated rates of past year cannabis (22.4%), ecstasy (11.8%) and methamphetamine (9.7%) use among GB men compared to heterosexual men (12.4%, 2.9% and 2.5%). LGB women also reported elevated rates of past year use (tobacco – 23.7%; cannabis – 24.6%) compared to heterosexual women (10.6% and 7.1%). LGB women initiated tobacco (15.2 years) and alcohol (15.5 years) at an earlier age than heterosexual women (16.6 and 17.7 years), and were significantly more likely to report daily alcohol consumption (OR 3.2, 95% CI: 2.1, 5.1), and weekly or more frequent cannabis use (OR 1.7, 95%CI: 1.1, 3.1).ConclusionsThese findings are indicative of the need for more responsive and targeted AOD harm reduction and treatment services for LGBTI communities in Australia. Of concern is the elevated risk among LGB women for earlier initiation of substance use, and the development of problematic consumption patterns. Further research, investigating the risk and protective factors for AOD use among LGB women is warranted.     

Prevalence of marijuana use does not differentially increase among youth after states pass medical marijuana laws: Commentary on and reanalysis of US National Survey on Drug Use in Households data 2002–2011

There is considerable interest in the effects of medical marijuana laws (MML) on marijuana use in the USA, particularly among youth. The article by Stolzenberg et al. (2015) “The effect of medical cannabis laws on juvenile cannabis use” concludes that “implementation of medical cannabis laws increase juvenile cannabis use”. This result is opposite to the findings of other studies that analysed the same US National Survey on Drug Use in Households data as well as opposite to studies analysing other national data which show no increase or even a decrease in youth marijuana use after the passage of MML. We provide a replication of the Stolzenberg et al. results and demonstrate how the comparison they are making is actually driven by differences between states with and without MML rather than being driven by pre and post-MML changes within states. We show that Stolzenberg et al. do not properly control for the fact that states that pass MML during 2002–2011 tend to already have higher past-month marijuana use before passing the MML in the first place. We further show that when within-state changes are properly considered and pre-MML prevalence is properly controlled, there is no evidence of a differential increase in past-month marijuana use in youth that can be attributed to state MML.     

The effect of cannabis laws on opioid use

BackgroundMany Americans rely on opioids at varying dosages to help ameliorate their suffering. However, empirical evidence is mounting that opioids are ineffective at controlling non-cancer related chronic pain, and many argue the strategies meant to relieve patient suffering are contributing to the growing opioid epidemic. Concurrently, several states now allow the use of medical cannabis to treat a variety of medical conditions, including chronic pain. Needing more exploration is the impact of cannabis laws on general opioid reliance and whether chronic pain sufferers are opting to use cannabis medicinally instead of opioids.MethodsThis study investigates the effect of Medical Marijuana Laws (MML)s on opioid use and misuse controlling for a number of relevant factors using data from several years of the National Survey on Drug Use and Health and multivariate logistic regression and longitudinal analysis strategies.ResultsResults provide evidence that MMLs may be effective at reducing opioid reliance as survey respondents living in states with medical cannabis legislation are much less apt to report using opioid analgesics than people living in states without such laws, net other factors. Results further indicate that the presence of medicinal cannabis legislation appears to have no influence over opioid misuse.ConclusionMMLs may ultimately serve to attenuate the consequences of opioid overreliance.     

Understanding Daily Depression,Drinking, and Marijuana Use Among Homeless Youth Using Short Message Service Surveying

Abstract

We used short message service surveying (SMS) with 150 homeless youths to examine the time ordering of feeling depressed with drinking alcohol, using marijuana, and using substances with friends. Multilevel binary logistic regression results revealed that youths who were depressed earlier in the day were more likely to drink alcohol later that day. Among depressed youths, heterosexual youths were less likely to drink alcohol than lesbian, gay, and bisexual (LGB) youths. Depressed youths had increased odds of using marijuana by a factor of 1.6, while heterosexual youths, compared to LGB youths, were 80% less likely to use marijuana. Females were 82% less likely and heterosexual youths 75% less likely to use substances with friends compared to males and LGB youths, respectively. These findings improve upon prior retrospective studies by using SMS to understand time ordering between feeling depressed and substance use in the same day.     

The Application of Minority Stress Theory to Marijuana Use Among Sexual Minority Adolescents

Previous research indicates that lesbian, gay, and bisexual (LGB) adolescents are at increased risk for substance use, including heightened rates of marijuana use. Minority stress theory suggests that difficult social situations create a state of chronic stress that leads to poor health outcomes for LGB adults; however, the applicability of this model has not been well explored in relation to substance use among LGB adolescents. The current study is a secondary analysis of the OutProud survey, conducted in 2000. The original study used purposive sampling to collect data from 1,911 LGB adolescents (age 12–17) across the United States, and represents the largest known study to explore experiences specific to identifying as LGB, such as homophobia and gay-related victimization. We used structural equation modeling (SEM) to explore the feasibility of applying a minority stress framework to understand marijuana use in this population. The final structural model for marijuana use in the LGB adolescent sample displayed excellent fit and modest explanatory power for marijuana use. Two of the five factors, community connectedness and internalized homophobia, were significantly (p < .05) associated with marijuana use. Findings suggest that minority stress theory may be appropriately applied to marijuana use in this population; however, better measurement of minority stress concepts for LGB adolescents is needed.