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Sources of cannabis among young adults and associations with cannabis-related outcomes
Abstract
Background
The ways in which young people learn about cannabis product availability and where they obtain cannabis products are important to understand for prevention and intervention efforts.
Methods
Young adults who reported past month cannabis use (N = 758) completed an online survey in 2018–2019 on how they obtained cannabis and the products they used in a newly legalized market in Los Angeles (mean age 21.6; 44% Hispanic, 27% white, 15% Asian).
Results
Overall, 59.1% obtained cannabis from recreational cannabis retailers (RCRs), 51.5% from family or friends, 39.1% from medical cannabis dispensaries (MCDs), and 5.5% from strangers or dealers in the past month. Compared to those getting cannabis from family or friends, those getting cannabis from MCDs or RCRs spent more money, used more cannabis products, were more likely to use alone, used greater quantities of bud/flower, and reported more consequences from use. Further, those obtaining cannabis from MCDs were more likely to screen positive for cannabis use disorder (CUD). For type of products, those obtaining cannabis from MCDs or RCRs were more likely to use joints, bongs, pipes, dabs, vape, and consume edibles relative to those obtaining from family or friends. Subgroup differences were found for both source patterns and cannabis-related outcomes. Males and those with a cannabis medical card reported spending more money on cannabis, using more types of products, and indicated more frequent use and greater CUD symptoms and consequences. Compared to Whites, Blacks spent more money on cannabis and used more products, and Hispanics reported using more products and greater quantities of cannabis bud/flower.
Conclusions
Findings highlight the different ways that young adults obtain cannabis, and how young adults with a medical cannabis card may be at greater risk for problems compared to young adults who use cannabis recreationally.
... Consistent with our findings, a lower prevalence of cannabis use and complications has been reported for Asian and Hispanic/Latino individuals [32][33][34], whereas Black/African Americans were reported with the highest prevalence [32][33][34][35]. Such racial/ethnic difference was also observed in the ways of cannabis use and purchase [32,36,37], expense on cannabis [37,38], and cannabis -associated medical conditions [34,39]. Notably, a higher risk was not found for Black race in other addictive substance use, such as alcohol and cocaine [33]. ...
... Consistent with our findings, a lower prevalence of cannabis use and complications has been reported for Asian and Hispanic/Latino individuals [32][33][34], whereas Black/African Americans were reported with the highest prevalence [32][33][34][35]. Such racial/ethnic difference was also observed in the ways of cannabis use and purchase [32,36,37], expense on cannabis [37,38], and cannabis -associated medical conditions [34,39]. Notably, a higher risk was not found for Black race in other addictive substance use, such as alcohol and cocaine [33]. ...
Purpose:
To examine the epidemiology and factors of cannabis use among open-angle glaucoma (OAG) patients.
Methods:
In this cross-sectional study, OAG participants in the All of Us database were included. Cannabis ever-users were defined based on record of cannabis use. Demographic and socioeconomic data were collected and compared between cannabis ever-users and never-users using Chi-Square tests and logistic regression. Odds ratios (OR) of potential factors associated with cannabis use were examined in univariable and multivariable models.
Results:
Among 3723 OAG participants, 1436 (39%) were cannabis ever-users. The mean (SD) age of never-users and ever-users was 72.9 (10.4) and 69.2 (9.6) years, respectively (P < 0.001). Compared to never-users, Black (34%) and male (55%) participants were better represented in ever-users, while Hispanic or Latino participants (6%) were less represented (P < 0.001). Diversity was also observed in socioeconomic characteristics including marital status, housing security, and income/education levels. A higher percentage of ever-users had a degree ≥12 grades (91%), salaried employment (26%), housing insecurity (12%), and history of cigar smoking (48%), alcohol consumption (96%), and other substance use (47%) (P < 0.001). In the multivariable analysis, Black race (OR [95% CI] = 1.33 [1.06, 1.68]), higher education (OR = 1.19 [1.07, 1.32]), and history of nicotine product smoking (OR: 2.04-2.83), other substance use (OR = 8.14 [6.63, 10.04]), and alcohol consumption (OR = 6.80 [4.45, 10.79]) were significant factors associated with cannabis use. Increased age (OR = 0.96 [0.95, 0.97]), Asian race (OR = 0.18 [0.09, 0.33]), and Hispanic/Latino ethnicity (OR = 0.43 [0.27, 0.68]) were associated with decreased odds of use (P < 0.02).
Conclusions:
This study elucidated the previously uncharacterized epidemiology and factors associated with cannabis use among OAG patients, which may help to identify patients requiring additional outreach on unsupervised marijuana use.
... One longitudinal study showed that obtaining cannabis from family or friends was associated with reduced odds of experiencing cannabis problems compared to purchasing cannabis for medicinal or recreational purposes. 101 In a cross-sectional study, the number of friends reported using cannabis mediated the relationship between cannabis onset age use and CRNCs. 102 Social norms. ...
... One recent longitudinal study found that increases in the total number of cannabis sources (dispensary, retailer, family, friend, stranger/dealer) was associated with increases in CRNCs and cannabis use disorder symptoms. 101 Moreover, the researchers noted that the total number of consequences was significantly greater for persons acquiring cannabis from strangers/dealers or institutions relative to family and friends. A cross-sectional study 110 found that availability and exposure to consumption situations was associated with problematic cannabis use among men, but not women. ...
Objective
Numerous reviews have examined risk and protective factors for alcohol-related negative consequences, but no equivalent review of risk and protective factors exists for cannabis-related negative consequences (CRNCs)-a gap filled by the present study. This scoping review examined survey-based research of risk and protective factors for CRNCs such as neglecting responsibilities, blacking out, or needing more cannabis.
Methods
Three databases (PubMed, PsycINFO, and Google Scholar) were searched for peer-reviewed manuscripts published between January 1, 1990, and December 31, 2021. A qualitative synthesis was performed using the matrix method and the results were organized using the socioecological model as a framework.
Results
Eighty-three studies were included in the review. There was considerable variation in measures and operationalizations of CRNCs across studies. Risk factors were identified in the intrapersonal (depression, social anxiety, PTSD, impulsivity, sensation seeking, motives, expectancies), interpersonal/community (trauma, victimization, family and peer substance use, social norms), and social/policy (education, employment, community attachment, legalization, availability of substances) domains of influence. Protective behavioral strategies were a robust protective factor for CRNCs. Males consistently reported more CRNCs than females, but there were no differences observed across race.
Conclusions
Future research should identify person- and product-specific patterns of CRNCs to refine theoretical models of cannabis misuse and addiction. Public health interventions to reduce the risk of negative consequences from cannabis should consider utilizing multilevel interventions to attenuate the cumulative risk from a combination of psychological, contextual, and social influences.
... This study gives greater insight into the behaviors of adolescents and emerging adults who use e-cigarettes as they relate to cannabis use generally, and specific insights into the use of added flavors in various cannabis products and the demographic factors associated with more frequent use of blunts and LCV. This study adds to a growing body of literature exploring the intersection of tobacco and cannabis use, [43][44][45][46][47][48] demonstrating higher rates of multiple substance use among this high-risk population than generally observed in studies prior to Covid-19, 48,49 and offering important new findings for policy makers and prevention professionals. ...
... This study gives greater insight into the behaviors of adolescents and emerging adults who use e-cigarettes as they relate to cannabis use generally, and specific insights into the use of added flavors in various cannabis products and the demographic factors associated with more frequent use of blunts and LCV. This study adds to a growing body of literature exploring the intersection of tobacco and cannabis use, [43][44][45][46][47][48] demonstrating higher rates of multiple substance use among this high-risk population than generally observed in studies prior to Covid-19, 48,49 and offering important new findings for policy makers and prevention professionals. ...
Concurrent use of e-cigarettes and cannabis among adolescents and emerging adults is a growing public health concern. More research is needed describing cannabis use among adolescents and emerging adults who vape. The objective of this study was to characterize cannabis use among adolescents and emerging adults (age 14-20) who reported e-cigarette ever-use, particularly their use of blunts and liquid cannabis vape (LCV) products. Using cross-sectional data from a national online survey, we describe their patterns of cannabis use, detail their use of flavored cannabis and tobacco products, and estimate associations of demographic factors and other current substance use behaviors with levels of blunt and LCV use. Of the 2253 respondents in the sample, 1379 (61 %) reported some form of cannabis use in the past 30 days, among whom 80 % used flavored cannabis (including edibles). Significant associations with current cannabis use were observed on several demographic measures, with current cannabis blunt use more frequent among participants not in school, non-Hispanic Blacks, multiracial respondents, and those whose incomes do not meet their expenses. Other than income, demographic characteristics were generally not associated with LCV use frequency. Use of other substances was associated with more frequent use of both blunts and LCV in the past 30 days, and enrollment in college or the military seems somewhat protective for emerging adults. These findings suggest a need for tailored prevention efforts among high-risk adolescents and emerging adults, potential regulation of added flavors in commercialized cannabis products, and stronger enforcement of retail restrictions for individuals under age 21 more broadly.
... Until recently, the term "marijuana" had the same meaning for scientists and cannabis users, because marijuana flower was the main cannabis preparation available. Now, researchers use the terms "buds" or "flower" to differentiate herbal marijuana from other cannabis preparations, such as concentrates and edibles (Bidwell et al. 2020;D' Amico et al. 2020;Fedorova et al. 2019;Kilmer et al. 2013;Kruger and Kruger 2019). For example, two recent studies asked, "On a typical use day, how much marijuana flower/bud do you personally consume?" (D' Amico et al. 2020;Kilmer et al. 2013). ...
... Now, researchers use the terms "buds" or "flower" to differentiate herbal marijuana from other cannabis preparations, such as concentrates and edibles (Bidwell et al. 2020;D' Amico et al. 2020;Fedorova et al. 2019;Kilmer et al. 2013;Kruger and Kruger 2019). For example, two recent studies asked, "On a typical use day, how much marijuana flower/bud do you personally consume?" (D' Amico et al. 2020;Kilmer et al. 2013). Yet, it is unknown if "buds" and "flower" are terms that are familiar to cannabis users. ...
Background
Cannabis legalization has resulted in the proliferation of cannabis products. Participants’ familiarity with terms for these products may have implications for assessment, as unfamiliarity with particular terms may result in under-reports of use.
Methods
A convenience sample of 861 college students from one U.S. university completed a survey in the spring of 2020 about their familiarity with a variety of cannabis product terms and use of a variety of cannabis products.
Results
Participants varied in their familiarity with cannabis product terms. For example, with regard to terms for cannabis concentrates with very high concentrations of THC, 85% of participants reported being familiar with the term “wax pen or THC oil,” but only 27% reported being familiar with the term “butane hash oil (BHO)” (i.e., the oil that composes most concentrates). Moreover, of participants who reported use of concentrates based on selecting pictures of the products they had used ( n = 324, 40%), 99% ( n = 322) reported having seen a “wax pen or THC oil” based on a written list of product terms, whereas only 20% ( n = 65) reported having seen “butane hash oil (BHO).” This suggests that asking about use of “butane hash oil” use may result in lower rates of cannabis concentrate use than asking about use of “wax pen/THC oil.” With regard to terms for marijuana flower, 29% of participants ( n = 248) reported being unfamiliar with the term marijuana “buds or flowers.” Of participants who reported use of marijuana flower based on selecting pictures of the products they had used (38% of the sample, n = 329), only 86% ( n = 282) reported having seen marijuana “buds or flowers” based on a written list of product terms. This suggests that asking about use of marijuana “buds or flowers” use could result in under-reporting due to lack of familiarity with that term. Finally, when asked to select pictures of the cannabis product(s) that participants thought constituted “marijuana,” participants most commonly selected pictures of marijuana flower (93%), followed by wax pen/THC oil (57%) and edibles (49%).
Conclusions
Young adults vary in their familiarity with cannabis product terms, and some may under-report cannabis use in surveys that rely on written cannabis product terms. Young adults also differ in terms of which cannabis products they think constitute “marijuana.” Although participants’ familiarity with specific cannabis product terms in this sample may not generalize to other populations, results highlight the need for standardized surveys of cannabis use that incorporate pictures of cannabis products to overcome issues related to variability in familiarity with cannabis product terms.
... Although research on cannabis use modalities has increased, much of this work has focused on youth and specific products such as vaping or smoking (D' Amico et al. 2020;Krauss et al. 2017;Peters et al. 2018;Wadsworth et al. 2022), and there is limited understanding of the use of other cannabis use modalities as well as the factors that influence modality choices, particularly among adult populations Subbaraman & Kerr 2021). Additionally, more research is needed on novel cannabis products such as drops, lozenges, and pills . ...
Purpose
Following the legalization of cannabis in several U.S. states, the cannabis market has expanded, leading to a wider range of products including smoked, edible, and vape products which have variable health effects. This proliferation highlights the need for more research on patterns of current cannabis use among U.S. adults.
Methods
We used combined data on adults who currently use (i.e., past 30-day use) cannabis ( n = 16,999) from the 2022 and 2023 National Survey on Drug Use and Health. We analyzed whether seven cannabis use modalities including smoking, vaping, dabbing, consuming edibles, taking pills, applying topicals, and absorbing sublingually/orally varied by age, sex, race and ethnicity, sexual orientation, education, income, geographic location, and state medical cannabis laws status by generating weighted proportion estimates and conducting multivariable logistic regression. Additionally, in a subanalysis, we examined differences in blunt use among U.S. adults who reported current cannabis use ( n = 12,355), employing similar methods to explore associations with demographic and socioeconomic factors.
Results
Among adults who currently use cannabis, smoking was the most common cannabis use method (77.33%), followed by edibles (37.31%), vaping (34.75%), dabbing (15.01%), applying topicals (5.93%), absorbing sublingually/orally (4.53%), and taking pills (2.11%). Edibles were popular among adults aged 35–49 years (29.57%), whereas vaping was most common among young adults aged 18–25 years (29.80%). Females (vs. males) had lower odds of smoking cannabis (OR: 0.65; 95% CI: 0.57–0.75) and higher odds of applying topicals (OR: 2.92; 95% CI: 2.23–3.83). Non-Hispanic Black (vs. non-Hispanic White) respondents had higher odds of smoking cannabis (OR: 2.03; 95% CI: 1.51–2.74) and lower odds of consuming edibles (OR: 0.66; 95% CI: 0.56–0.77). Adults aged 50 + years (vs. 18–25) had greater odds of absorbing sublingually/orally (OR: 2.45; 95% CI: 1.59–3.76). In the subanalysis, we found that Non-Hispanic Black (vs. non-Hispanic White) adults had higher odds of blunt use (OR: 5.31; 95% CI: 4.23–6.65).
Conclusions
Use modality disparities among adults who currently use cannabis highlight the need for tailored public health education and interventions, given the distinct health risks associated with each method of use.
... Current prevalence of cannabis and tobacco in a hookah was also higher. The more frequent use of some cannabis products among non-Hispanic Black young adults aligns with greater monthly spending on cannabis products and flower cannabis consumption along with no differences in purchasing source (D'Amico et al., 2020). ...
Background
Use of cannabis and nicotine is at record levels among young adults, and health consequences vary by route of administration. However, there is a paucity of research characterizing use of both substances, especially among individuals of racial/ethnic minoritized identities.
Method
Participants (N = 1,032; age 18–25 years) completed a cross-sectional survey administered through an online panel in 2021 in eight U.S. states where cannabis was legal for both recreational and medical use and eight states where cannabis was not legal for medical or recreational purposes. Sampling was stratified by race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White) and gender (male, female). Survey weighting was based on state-level gender and race/ethnicity data in the 2021 U.S. Census Bureau.
Results
Over one third (37.9%) of respondents reported current use of both cannabis and tobacco, more than double the proportion using tobacco (12.1%) or cannabis (4.1%) only. Vaporization was the most common method for using nicotine (40.2%). Disposable nicotine vape products were used more than any other method (27.1%). Smoking was the most common route of administration for cannabis (35.7%). Simultaneous use of tobacco and cannabis was common (27.0%) overall and greater among those who identify as non-Hispanic Black than non-Hispanic White. There were few differences in product use by gender or state legality.
Discussion
Dual cannabis and tobacco use is prevalent among young adults. Given the dynamic regulatory landscape, continued monitoring of specific cannabis formulations and tobacco products is recommended. Trends in simultaneous use of cannabis and tobacco and associated adverse effects warrant continued assessment.
... An outer situational context of one's cannabis use includes how one obtains cannabis products. In the early days of recreational cannabis legalization in Los Angeles (i.e., 2016-2017), young adults who purchased products from cannabis dispensaries (compared to obtaining from family or friends) reported spending more money on cannabis, using more distinct cannabis products, using more frequently, using higher quantities, using alone more often, and experienced higher negative cannabis-related consequences and cannabis use disorder symptoms (D'Amico et al., 2020). ...
Objective: Due to little knowledge regarding the contextual factors related to cannabis use, we aimed to provide descriptive statistics regarding contextual factors related to use and examine the predictive ability of contextual factors. Method: We included college student participants (n = 5700; male = 2893, female = 3702, other gender identity = 48, missing = 57) from three multi-site studies in our analyses. We examined the means and standard deviations of contextual factors related to cannabis use (social context/setting, form of cannabis, route of administration, source of purchase, and proxies of use). Additionally, we tested the predictive ability of the contextual factors on cannabis use consequences, protective behavioral strategies, and severity of cannabis use disorder, via an exploratory machine learning model (random forest). Results: Descriptive statistics and the correlations between the contextual factors and the three outcomes are provided. Exploratory random forests indicated that contextual factors may be helpful in predicting consequences and protective behavioral strategies and especially useful in predicting the severity of cannabis use disorder. Conclusions: Contextual factors of cannabis use warrants further exploration, especially considering the difficulty in assessing dosage when individuals are likely to consume in a group context. We propose considering measuring contextual factors along with use in the past 30 days and consequences of use.
... One of the only studies of young adults, conducted in 2017 indicated that concurrent use of cannabis types (plant, concentrate, and/or edible) was common (Gunn et al., 2020). Another study indicated that young adults living in a legalized cannabis market and who currently used cannabis used an average of 3.2 cannabis products in the past month in -2019(D'Amico et al., 2020. A study of 18-34-year-olds conducted in 2015 indicated that when using multiple cannabis products, young adults most often reported using two primary combinations of cannabis products: plant-based cannabis products with cannabis concentrates or plant-based cannabis products with edibles (Krauss et al., 2017). ...
... Some papers mentioned the applicability of behavioral economics to CUD, which would be one MOBC to address these dysfunctional reward processes. The study found evidence that when cannabis is accessible and desired, CUD is more likely to occur; namely, that delay discounting (i.e., a tendency to estimate the benefits of postponed rewards as lesser than immediate rewards) predicted dependence and demand (i.e., the desire to use cannabis) predicted frequency and quantity of use [98,112,113]. As such, applying behavioral economics to treat CUD is preliminary and limited, but promising given the theoretical rationale, application to other substances, and other recent findings [98]. ...
Purpose of Review
The rising prevalence of cannabis use disorder (CUD) has prompted an urgent need for effective behavioral treatments to reduce the global public health burden. However, the chances of achieving lifetime abstinence or symptom remission remain low. To address this limitation, we delineated the current research on mechanisms of behavior change (MOBC) for functional impairments in CUD treatments, including new developments, preliminary evidence, and theoretical considerations for unstudied MOBCs.
Recent Findings
MOBC studies were sparse, and intervention studies produced modest, inconsistent improvements to functional impairment. Three well-studied MOBCs appear in the literature: a) contingency-incentivized prolonged abstinence, which produced the largest effects; b) motivational enhancement, which is the most popular and disseminated; and c) coping skills, which produced the most consistent effects. Preliminary work supported cannabis use reductions and behavioral economics as MOBCs, and theoretical considerations support the potential of reducing cue-induced cravings and promoting positive constructs to improve functioning.
Summary
MOBCs for functional impairment in CUD treatments is an emerging area of research. Hypotheses are abundant, but direct evidence is sparse; several significant questions remain. Evidence-based preventive measures, harm reduction strategies, and CUD treatments may become more pertinent in the immediate future, so this area of study is crucial to address the public health consequences of CUD.
... In this vein, it is possible that accessing cannabis through legal dispensaries rather than through street dealers deters cannabis use due to restricted store hours, limited quantity allowed per person, or lack of anonymity. Furthermore, young populations declare having a drug dealer in their neighborhood (D'Amico et al., 2020), and a sizeable number of young students inform of social supply (namely friends) as their primary purchasing sources (Bennett & Holloway, 2019), which indeed may work as a driver for cannabis use given it may represent loyalty to supplier, especially if the person is a friend. Relatedly, there is a traditional cannabis culture (rituals, symbols, and values) linked to recreational and illicit use in Spain, which may lead young people to think that the experience of taking cannabis in the context of an authorized seller differs from the experience of taking it on the illicit market (Sandberg, 2012). ...
Background
In October 2021, a legal framework that regulates cannabis for recreational purposes in Spain was proposed, but research on its potential impacts on cannabis use is currently limited.
This study examined the reliability and discriminant validity of two Marijuana Purchase Tasks (MPTs) for measuring hypothetical legal and illegal cannabis demand, and to examine differences in demand of both commodities in young adults at hazardous vs. non-hazardous cannabis use risk levels.
Methods
A total of 171 Spanish young adults [Mage= 19.82 (SD=1.81)] with past-month cannabis use participated in a cross-sectional study from September to November 2021. Two 27-item MPTs were used to estimate hypothetical demand for legal and illegal cannabis independently. The Cannabis Use Disorder Identification Test (CUDIT-R) was used to assess hazardous cannabis use and test for discriminant validity of the MPTs. Reliability analyses were conducted using Classical Test Theory (Cronbach’s alpha) and Item Response Theory (Item Information Functions).
Results
The MPT was reliable for measuring legal (α=.94) and illegal (α=.90) cannabis demand. Breakpoint (price at which demand ceases), and Pmax (price associated with maximum expenditure) were the most sensitive indicators to discriminate participants with different levels of the cannabis reinforcing trait. No significant differences between legal and illegal cannabis demand in the whole sample were observed, but hazardous vs. non-hazardous users showed higher legal and illegal demand, and decreased Breakpoint and Pmax if cannabis were legal vs illegal.
Conclusion
The MPT exhibits robust psychometric validity and may be useful to inform on cannabis regulatory science in Spain.
... Prior research has shown that purchasing factors, such as source (i.e., cannabis supplier/provider/seller) and product availability, are associated with different cannabis use outcomes. Specifically, in a newly legalized market in Los Angeles, young adults who obtained cannabis from medical or non-medical retailers spent more money, used more cannabis products, and reported more consequences from use than young adults who obtained cannabis from family and friends (D'Amico et al., 2020). Results from a recent study in Canada indicated that living in closer proximity to legal cannabis retail outlets was associated with a higher likelihood of purchasing dried flower . ...
Introduction:
The legal landscape surrounding purchasing cannabis without a medical cannabis card (i.e., without MCC) is changing rapidly, affecting consumer access and purchasing behaviors. Cannabis purchasing behaviors are related to subsequent use and experiencing greater cannabis-related negative consequences. However, purchasing behaviors of individuals who use cannabis without MCC are understudied.
Methods:
The current study analyzed qualitative data from focus groups with adults who use cannabis without MCC (n = 5 groups; 6-7 participants/group; n = 31 total participants). Focus groups followed a semi-structured agenda, and were audio recorded and transcribed. Two coders applied thematic analysis to summarize topics pertaining to cannabis purchasing attitudes and behaviors. Focus groups occurred in 2015 and 2016 in Rhode Island, when purchasing and use of cannabis without MCC was decriminalized but still considered illegal.
Results:
On average, participants (72% male) were 26 years old (SD = 7.2) and reported using cannabis 5 days per week (SD = 2.1). Thematic analysis revealed three key themes related to cannabis purchasing behaviors: (1) regular purchasing routines (i.e., frequency, schedule, amount of purchases), (2) economic factors (i.e., financial circumstances), and (3) contextual factors (i.e., quality of cannabis, convenience/availability) were perceived to influence purchasing decisions. Dealers' recommendations affected participants' purchases, who also reported minimal legal concerns. Participants reported saving money and using more cannabis when buying in bulk.
Discussion:
Purchasing behaviors were found to vary and were perceived to be affected by individual-level (e.g., routines) and contextual factors (e.g., availability) that, in turn, may impact use patterns. Future research should consider how factors (e.g., availability) that differ across contexts (e.g., location) and demographic groups interact to affect purchasing behaviors.
... A study by D'Amico et al. (2020) found that the most common source of cannabis was recreational cannabis retailers (59.1%), followed by family or friends (51.5%), medical cannabis dispensaries (31.8%), and strangers or dealers (5.5%) [18]. In a study conducted by McCabe et al. (2019), high school students were asked from where they had procured prescription medications (such as opioids, stimulants, and anxiolytics) without a doctor's prescription. ...
Sexualized substance use (SSU) is the practice of psychotropic substance use before or during sex to increase sexual pleasure. The growing use of SSU has a strong association with sexually transmitted infections (STIs). Community health mobilizers (CHMs) are agents who assist in decreasing the global burden of disease in the communities they serve. They work as unit managers, counselors, or field workers. The managers and counselors have a minimum of a bachelor’s degree, and field workers have a minimum of a higher secondary education. This study aimed to qualitatively assess the knowledge gaps regarding SSU among CHMs. In-depth interviews (IDIs) were conducted in New Delhi, India with nineteen CHMs. Majority of the CHMs were men (n = 9, 47%) followed by transgender (TG) persons (TG females n = 5, 26.3%; TG males n = 1, 5.2%), and women (n = 4, 21.1%). Knowledge gaps were identified among the CHMs regarding different types of sexualized substances, drug procurement, human immunodeficiency virus (HIV) infection prevention, and complex health issues associated with SSU. It suggested the need for periodic workshops and training for upgradation of existing knowledge and practices among the CHMs. This formative research may help social scientists to develop protocols for conducting multi-centric, community-based studies across the country for further validation and exploration.
Keywords: community health mobilizers (CHMs); formative research; human immunodeficiency virus (HIV); in-depth interviews (IDIs); sexually transmitted infections (STIs); transgender (TG) persons
... A study by D'Amico et al. (2020) found that the most common source of cannabis was recreational cannabis retailers (59.1%), followed by family or friends (51.5%), medical cannabis dispensaries (31.8%), and strangers or dealers (5.5%) [18]. In a study conducted by McCabe et al. (2019), high school students were asked from where they had procured prescription medications (such as opioids, stimulants, and anxiolytics) without a doctor's prescription. ...
Background: Sexualized substance use (SSU) is the practice of psychotropic substance usage, before or during sexual intercourse in order to increase sexual pleasure and arousal. It has a strong association with sexually transmitted infections (STIs). The present study aimed to assess knowledge, attitudes, and practices of the community health mobilizers about SSU through qualitative approach. Methodology: In-depth interviews (IDIs) were conducted with a total of nineteen community health mobilizers engaged in counselling of sexualized substance users. A semi-structured open-ended questionnaire with socio-demographic information and probes related to SSU was administered. Informed consent was taken from each participant prior to data collection. Results: Gender-wise distribution indicated that 47% of the community mobilizers are men, followed by transgender persons (32%), and women (21%). Responses of participants highlighted that alcohol consumption was the most observed form of SSU. The findings indicated that drug administration through injection was most common, followed by sniffing and swallowing. Sources of drug procurement enlisted by participants included peddlers, peer groups, sexual parties, medical and liquor stores. Only 63% of participants had fair knowledge about STIs such as HIV, viral hepatitis, syphilis, and gonorrhoea. All were familiar with the administration of naloxone injections and the locations of nearby hospitals where patients could be transported in the event of an overdose. Conclusions: This formative research demonstrated a knowledge gap in the community mobilizers regarding the latest substances of abuse, such as designer drugs, drug procurement sources, and various health issues associated with SSU. However, they were well aware of the drug overdose-related complications and basic first-aid procedures. The findings of the current study should be validated through multi-centric community-based research across the country.
... The quantity of cannabis used and rates of problematic cannabis use were also higher among the younger consumers (Haug et al., 2017). The medical cannabis scheme in the USA has been criticised for the ease of access by youth who could obtain cannabis for recreational use (D'Amico et al., 2020). ...
Objective
It is important to know the prevalence and source of medicinal cannabis use in the population because non-prescribed medicinal use of cannabis products places individuals at higher risk of harms. We estimated the prevalence and correlates of the use of cannabis for medicinal purposes in Australia, three years after Australians were given legal access.
Design
Cross-sectional
Setting
The 2019 Australian National Drug Strategy Household Survey.
Participants
Participants were 22,015 Australians aged 14 or above.
Outcome measure
Self-reported cannabis use in the last 12 months for medicinal purposes only, both medicinal/recreational reasons, or recreationally only. Those who reported medicinal use were asked if it had been prescribed by a doctor. Prevalence estimates were weighted to the population and multinomial logistic regression examined the correlates.
Results
The prevalence of any medicinal cannabis use in the past year was 2.6%. Only 0.8% of the sample reported using cannabis solely for medicinal reasons, 95.9% of whom did not have a prescription. A self-reported diagnosis of cancer was associated with medicinal use only. Self-reported chronic pain was associated with both medicinal only and medicinal/recreational use. Medicinal cannabis use was associated with opioids use.
Conclusions
In 2019, the prevalence of cannabis use solely for medicinal reasons remains under 1%, was more common among people with specific medical conditions, but most individuals do not have a prescription. The prevalence of self-reported medicinal cannabis use in Australia is low and there is limited use of the legal pathway for medicinal cannabis.
... Other less studied correlates of cannabis vaping included alcohol use [170, 174, 197•, 198, 200], non-medical prescription use [174], and illicit drug use [170,188]; greater impulsivity [174,179] and attention-related factors (e.g., inattention, perseverance) [174]; openness to new experiences [182] and sensation seeking [170,189]; psychiatric symptoms (e.g., depressive symptoms, conduct problems) [174,182]; delinquent behavior [196]; low grade point average and skipping class [167]; internalizing and externalizing problems [197•, 198]; more exposure to e-cigarette marketing (see "Marketing" section, below) [179]; school urbanicity (urban and suburban being greater risk versus rural) [24,198]; using cannabis in a vehicle [170]; obtaining cannabis from dispensaries or recreational retailers versus from friends and family [171]; low disapproval of nicotine [167] and of smoking cannabis regularly, [182] lower perceived risk of cannabis use [167]; lower perceived addictiveness of e-cigarettes [163]; and earlier age of initiation of cannabis use, in any form [170,200]. ...
Purpose of Review
The purpose of this review was to describe the state-of-the-literature on research specific to cannabis vaping among youth and young adults.
Recent Findings
Out of 1801 records identified, a total of 202 articles met eligibility criteria for inclusion in this review. Most of this literature (46.0% of studies) was specific to the health effects of cannabis vaping, particularly EVALI (e-cigarette and vaping associated lung injury). Other research areas identified in the review included the etiology (24.3%) and epidemiology (24.8%) of cannabis vaping, in addition to articles on regulation (8.4%) and marketing (5.5%) of the same.
Summary
Cannabis vaping is increasingly common among youth and young adults and more prevalent is settings where recreational use for adults has been legalized. The literature documents a number of negative health effects of cannabis vaping for young people, along with risk factors and reasons for the same.
... A growing body of literature also suggests that African American/Black cannabis smokers are more likely to consume their cannabis through blunts (hollowed out little cigars or cigarillos that are filled with cannabis) than other racial/ethnic groups [45,46,47,48,49,50]. Further, recent studies have also found that African American/Black individuals spend more money on their cannabis and use different types of cannabis products (e.g., edibles, bongs, dabs) relative to their White peers [51,52], and highlighted an increase in cannabis-associated emergency department visits among African American/ Blacks [53]. Unfortunately, disparities are also observed in the enforcement of cannabis use and possession laws in the African American/Black community, with more sales and possession charges [54,55] and arrest rates [6, 56], even in cases where the rates of cannabis use/possession are similar to or less than that of their White counterparts. ...
Purpose of Review
Heavy and prolonged use of cannabis is associated with several adverse health, legal, and social consequences. Although cannabis use impacts all US racial/ethnic groups, studies have revealed racial/ethnic disparities in the initiation, prevalence, prevention, and treatment of cannabis use and cannabis use disorder (CUD). This review provides an overview of recent studies on cannabis and CUD by race/ethnicity and a discussion of implications for cannabis researchers.
Recent Findings
The majority of studies focused on cannabis use and CUD among African American/Black individuals, with the smallest number of studies found among Native Hawaiians/Pacific Islanders. The limited number of studies highlights unique risk and protective factors for each racial/ethnic group, such as gender, mental health status, polysubstance use, and cultural identity.
Summary
Future cannabis studies should aim to provide a deeper foundational understanding of factors that promote the initiation, maintenance, prevention, and treatment of cannabis use and CUD among racial/ethnic groups. Cannabis studies should be unique to each racial/ethnic group and move beyond racial comparisons.
... Among those reporting past-month marijuana use, heaviness of use was assessed by asking the number of times per day they used any type of marijuana on a typical use day (response options 0-99), regardless of type of product(s) used. Individuals who endorsed past month use of marijuana products also indicated the types of products or ways they consumed marijuana as follows: joint, blunt, hand pipe, bong, dabs, edibles, personal vaporizer, and beverage (D'Amico et al., 2020). Responses were recoded to indicate any or no use of each type of marijuana (0/1) and summed to create a poly-marijuana use variable (i.e., number of different modes of administration; range 1-8). ...
Objective
Cannabis-derived products containing cannabidiol with no or minimal levels of delta 9-tetrahydrocannabinol (CBD products) are widely available in the United States and use of these products is common among young adults and those who use marijuana. The purpose of this study was to examine patterns and correlates of CBD product use and co-use with marijuana in a sample of young adults.
Method
The study used cross-sectional survey data collected in 2019-2020 from a cohort of young adults (n=2,534; mean age 23) based primarily in California. The survey assessed lifetime, past-year, and past-month frequency and type of CBD products used, frequency and amount of marijuana consumption and indicators of marijuana use-related problems. Linear, Poisson, and logistic regression models compared individuals reporting past month CBD-only use, marijuana-only use, concurrent CBD+marijuana use (co-use), and use of neither product. Among those reporting co-use, we examined associations between CBD use frequency and marijuana use frequency and heaviness of use (occasions per day) and indicators of problem marijuana use (e.g., Cannabis Use Disorder Identification Test Short-Form, solitary use, marijuana consequences).
Results
Approximately 13% of respondents endorsed past-month CBD use; of these, over three-quarters (79%) indicated past-month co-use of marijuana. Among individuals reporting co-use, more frequent CBD use was associated with more frequent and heavier marijuana use but was not associated with marijuana use-related problems.
Conclusions
CBD use was common and associated with higher levels of marijuana consumption in this sample. Routinely assessing CBD use may provide a more comprehensive understanding of individuals’ cannabis product consumption.
Purpose: Following the legalization of cannabis in several U.S. states, the cannabis market has expanded, leading to a wider range of products including smoked, edible, and vape products which have variable health effects. This proliferation highlights the need for more research on patterns of current cannabis use among U.S. adults. Methods: We used combined data on adults who currently use (i.e., past 30-day use) cannabis (n=16,999) from the 2022 and 2023 National Survey on Drug Use and Health. We analyzed whether seven cannabis use modalities including smoking, vaping, dabbing, consuming edibles, taking pills, applying topicals, and absorbing sublingually/orally varied by age, sex, race and ethnicity, sexual orientation, education, income, geographic location, and state medical cannabis laws status by generating weighted proportion estimates and conducting multivariable logistic regression. Additionally, in a subanalysis, we examined differences in blunt use among U.S. adults who reported current cannabis use (n=12,355), employing similar methods to explore associations with demographic and socioeconomic factors. Results: Among adults who currently use cannabis, smoking was the most common cannabis use method (77.33%), followed by edibles (37.31%), vaping (34.75%), dabbing (15.01%), applying topicals (5.93%), absorbing sublingually/orally (4.53%), and taking pills (2.11%). Edibles were popular among adults aged 35-49 years (29.57%), whereas vaping was most common among young adults aged 18-25 years (29.80%). Females (vs. males) had lower odds of smoking cannabis (OR: 0.65; 95% CI: 0.57-0.75) and higher odds of applying topicals (OR: 2.92; 95% CI: 2.23-3.83). Non-Hispanic Black (vs. non-Hispanic White) respondents had higher odds of smoking cannabis (OR: 2.03; 95% CI: 1.51-2.74) and lower odds of consuming edibles (OR: 0.66; 95% CI: 0.56-0.77). Adults aged 50+ years (vs. 18-25) had greater odds of absorbing sublingually/orally (OR: 2.45; 95% CI: 1.59-3.76). In the subanalysis, we found that Non-Hispanic Black (vs. non-Hispanic White) adults had higher odds of blunt use (OR: 5.31; 95% CI: 4.23-6.65). Conclusions: Use modality disparities among adults who currently use cannabis highlight the need for tailored public health education and interventions, given the distinct health risks associated with each method of use.
As rates of students using cannabis continue to rise, simultaneous use of alcohol and cannabis (such that their effects overlap; commonly referred to as simultaneous alcohol and marijuana [SAM] use) is prevalent among college students who use both substances. Although research focusing on SAM use and related cognitions and consequences continues to grow, there are no common established measures, as approaches vary across studies. This narrative review identifies current methods for assessing SAM use and measures of SAM‐related consequences and cognitions (motives and expectancies) among college students, evaluates how they were developed, identifies gaps in the literature, and provides recommendations for future directions of assessment. We conclude that the assessment of SAM use is limited by difficulties in the assessment of cannabis quantity and potency. However, and the lack of a psychometrically validated measure of SAM consequences. However, measures of SAM motives and expectancies have been published with support from psychometric examinations such as exploratory factor analysis, confirmatory factor analysis, and measurement invariance. Research is needed that incorporates qualitative approaches in the development of SAM use measures so that unique items specific to SAM use rather than single‐substance use can be identified. Additionally, validation of these measures is needed across different samples that vary demographically, such as by race and gender or sex. Future research should consider the development of a measure of protective behavioral strategies specific to SAM use to inform interventions that target the reduction of negative consequences of SAM use.
Objective:
Characterization of population subgroups based on where they acquire cannabis is unexplored. We examine relationships between sociodemographic characteristics, cannabis use modality, risky cannabis use, and source of cannabis.
Methods:
Analyzing a representative sample (unweighted n=8,089) of US adults living in medical cannabis permitting states with past-year cannabis use from the 2021 National Survey on Drug Use and Health (NSDUH), we determined source of last cannabis used. Outcome groups were: purchased from a dispensary, purchased from another source, or non-purchased source. Incorporating the complex survey design, descriptive statistics and adjusted multinomial logistic regressions evaluated associations between sociodemographic, individual cannabis use characteristics, and source of cannabis. Secondary analyses described cannabis purchasing characteristics among the subsample who last purchased cannabis.
Results:
Purchasing from a dispensary was the most common source of cannabis (42.5%). Significant relationships between sociodemographic characteristics, cannabis use modality, risky cannabis use, and source of cannabis were found. Recent cannabis initiates and those with cannabis vaporizer use had increased likelihood of purchasing cannabis from a dispensary. Purchasing from a non-dispensary source was most likely among those with daily cannabis use, past-month blunt use, past-year driving under the influence, cannabis use disorder, and cannabis and alcohol co-use. Among those purchasing cannabis, joints and other forms of cannabis were more likely to be purchased from a dispensary than purchased from other sources, respectively.
Conclusion:
We identified key sociodemographic and cannabis use characteristics that may influence where individuals obtain cannabis, which are important for cannabis behavior surveillance and cannabis use prevention and intervention strategies to consider.
Introduction:
Young adults' cannabis and alcohol use patterns have changed following state recreational cannabis legalization (RCL) according to studies based on college samples but not nationally representative samples. Associations between RCL and changes in cannabis and alcohol use outcomes among young adults were examined, including differences by college enrollment and minor status (ages 18-20 vs. 21-23 years).
Methods:
Repeated cross-sectional data (2008-2019) were collected from 18-23 year-old college-eligible participants in the National Survey on Drug Use and Health. Self-reported past-month cannabis use and frequent use (≥20 days), and a proxy for past-year DSM-5 cannabis use disorder (CUD) were primary outcomes; past-month frequent alcohol use and binge drinking were secondary outcomes. Multilevel logistic regression models quantified changes in outcome prevalence from the study years before to after RCL adjusting for secular trends. Analyses were conducted March 22, 2022.
Results:
Prevalence increased from before to after RCL for past-month cannabis use (21% to 25%) and past-year proxy CUD (11% to 13%); these increases were 20% [adjusted odds ratio (AOR) (95% CI) = 1.20 (1.08-1.32)] and 14% [AOR (95% CI) = 1.14 (1.003-1.30)] greater, respectively, post-RCL vs. pre-RCL. Increases were detected for young adults who were not in college, and who were ages 21-23 years. RCL effects were not detected for secondary outcomes.
Conclusions:
Some young adults appear sensitive to state RCL, including in terms of CUD risk. Additional prevention efforts should be directed to young adults who are not in college, and timed to occur before age 21 years.
Background: Many individuals who use cannabis report doing so for medicinal reasons. Few studies have explored heterogeneity within this population, which may be important to inform targeted interventions. This study used latent class analysis to identify subgroups of people who use cannabis for medicinal reasons and their sociodemographic and cannabis-risk-related correlates.
Method: Data were drawn from the 2019 Canadian Alcohol and Drugs Survey, which is a representative survey of Canadians ages 15 years and older. Data from 814 individuals reporting past-year use of cannabis for medicinal or mixed medicinal and non-medicinal reasons were included. Latent class analysis was conducted with forms of cannabis used, cannabis use frequency, concurrent non-medicinal cannabis use, and the medical conditions and symptoms cannabis was used to manage as indicators.
Results: Four distinct latent classes of medicinal cannabis use were identified: a non-daily cannabis flower for mental health and sleep class (39.56% of the sample), a non-daily cannabis flower for pain class (26.41% of the sample), a non-daily cannabis oil for physical health class (20.15% of the sample), and a daily multi-form cannabis for mental health and non-medical reasons class (13.88% of the sample). Sociodemographic factors and risk level for cannabis-related harms were associated with latent class membership.
Conclusions: Results of this study reveal considerable heterogeneity among people reporting medicinal cannabis use and suggest that the distinct patterns of cannabis use behaviors and motives observed may be important for understanding risk for cannabis-related harms in this population. Findings underscore a need for harm reduction interventions tailored toward specific patterns of medicinal cannabis use.
Background:
The COVID-19 pandemic required the public to alter their daily lives drastically. For adolescents, school closures and social isolation added further challenges to a stressful stage of life, potentially increasing the likelihood of substance use initiation. This study explored the relationship between adolescent substance use initiation and negative life changes due to COVID-19.
Methods:
Students from 9 high schools (N = 2478) in Los Angeles County were surveyed as 9th graders in the 2019-2020 school year and re-surveyed in 10th and 11th grades as part of an ongoing longitudinal study. Two logistic regression models were conducted to test hypotheses that negative life changes due to the COVID-19 pandemic increases the odds of initiation of both tobacco/nicotine products and cannabis products, controlling for sex, age, and race/ethnicity.
Results:
The final analytic sample included adolescents in 10th grade who were never-users of tobacco/nicotine (N = 809) and cannabis (N = 837). The odds of initiating cannabis use increased by 6.42% for every 1 standard deviation increase in the COVID-19 negative daily life changes index [AOR: 1.063; 95% CI: 1.010, 1.121]. The association between the COVID-19 negative daily life changes index and tobacco/nicotine use initiation was not significant.
Discussion:
Adolescents who experienced life changes due to COVID-19 were more likely to initiate cannabis use, but not tobacco/nicotine use. Results identify a need for early intervention efforts to promote effective coping skills and prevent cannabis initiation among adolescents during a wide-scale stressor, such as COVID-19.
Background
Simultaneous alcohol and cannabis (SAC) use is associated with more negative consequences than independent use of alcohol or cannabis. Contextual characteristics of drinking episodes are associated with the quantity of alcohol consumed and related risk. This study examined whether drinking contexts may also be associated with SAC use.
Methods
National Survey on Drug Use and Health (NSDUH) 2010-2019 data from past 30-day drinkers aged 12-20 (n=39,456) were used. A weighted multivariable logistic regression model examined associations between contextual characteristics (alcohol source, number of people, drinking location) and SAC use during their most recent drinking occasion. Models adjusted for survey year, heavy episodic drinking, age, sex, race/ethnicity, student status, and metropolitan area status.
Results
More than one-in-five drinkers reported SAC use. Compared to getting alcohol from parents/family, those who took it from a home (OR=1.51,95%CI=1.24,1.84), got it for free another way (OR=2.30,95%CI=2.05,2.59), paid someone else for it (OR=2.83,95%CI=2.46,3.25), or purchased it themselves (OR=3.12,95%CI=2.66,3.67) had higher odds of SAC use. Compared to drinking alone, drinking with more than one person was associated with higher odds of SAC use (OR=1.36,95%CI=1.12,1.66). Compared to drinking in their home, drinking in a bar (OR=0.51,95%CI=0.41,0.64) had lower odds of SAC use, whereas drinking in someone else’s home (OR=1.12,95%CI=1.02,1.22), a car (OR=1.36,95%CI=1.04,1.77), or multiple locations (OR=1.29,95%CI=1.09,1.53) had higher odds of SAC use.
Conclusions
Findings suggest that alcohol-related contextual characteristics are associated with SAC use among underage drinkers. Laws addressing underage alcohol consumption, including social host liability and sales to minors laws, may also decrease simultaneous cannabis use.
Background
Cannabis is obtained from a variety retail and illicit sources, with unknown implications for youth cannabis use. This study assessed whether source of obtaining cannabis was associated with future cannabis use among adolescents.
Methods
High-schoolers (N=835) completed 3 semiannual surveys, reporting use of 7 cannabis sources (i.e., free, [online/brick-and-mortar] medical dispensary with/without valid card, bought from someone, self-grown; separate dichotomous exposure variables) at wave 1 (n=621; M[SD] age=17.14[.40]) or wave 2 (n=622; M[SD] age=17.51[.39]). Past-6-month (yes/no) and number of past-30-day (0-30) non-medical use of any cannabis product, combustible, edible, and vaporized cannabis, blunts, and concentrates (i.e., dabs) were reported at waves 2-3. Random-effect time-lagged repeated-measures regression was used to test longitudinal associations of youth’s cannabis source (waves 1-2; time-varying exposure) with cannabis use outcomes 6 months later (waves 2-3).
Results
Most youth (72.1%) received cannabis for free; 50.9% bought cannabis from someone, 15.9% used a valid medical card at a brick-and-mortar dispensary, and 3.9% grew cannabis. Buying cannabis from someone (OR=1.46, 95% CI: 1.07-1.99, p=.02) or using a valid medical card (OR=1.99, 95% CI: 1.20-3.31, p=.008) conferred greater odds of any cannabis product use 6 months later. Buying from someone predicted subsequent past-30-day use frequency (RR=1.25, 95% CI:1.05-1.48, p=.01). Some associations between particular cannabis sources and products were observed.
Conclusions
Adolescents may access cannabis from several sources. Those who purchase cannabis illicitly from someone or from a brick-and-mortar dispensary using a valid medical card may be at increased risk for more persistent and frequent patterns of non-medical cannabis use.
Introduction: Increasing marijuana use among young adults is a concern due to substantial acute and chronic health risks. More widespread use of marijuana may also lead to increased use of nicotine and tobacco products. California legalized commercial sales of marijuana for recreational use as of January 2018. To our knowledge no studies to date have examined subsequent changes in marijuana use. The goal of this study was to test the hypothesis that marijuana use frequency increased following legalization of recreational sales. We also hypothesized that increased marijuana frequency would predict greater frequency of nicotine/tobacco consumption.
Methods: The study was a secondary analysis of a longitudinal study of tobacco use among non-daily cigarette smokers. Participants were 563 young adults (aged 18-24) enrolled in 2015-16 and followed quarterly for 3 years.
Results: A piecewise multilevel regression model indicated that marijuana use frequency did not change over time, including following legalization. More frequent use was associated with younger age and identifying as white (ps<.001, which did not change after legalization. Marijuana frequency was moderated by sex (p<.001), with women reporting increasing and men decreasing use over time. It was also associated with tobacco use, and particularly with e-cigarette use following legalization (ps<.05).
Conclusions: Findings suggest legalization of recreational marijuana sales had a negligible overall impact on days of use among young adults, but may have prompted increased interest in marijuana among some, particularly women and e-cigarette users. The continuously evolving landscape around these products indicates that ongoing surveillance is critical.
Background:
An increasing number of states have laws for the legal sale of recreational and medical cannabis out of brick-and-mortar storefront locations. Given the proliferation of cannabis outlets and their potential for impact on local economies, neighborhood structures, and individual patterns of cannabis use, it is essential to create practical and thorough methods to capture the location of such outlets for research purposes. However, methods used by researchers vary greatly between studies and often do not include important information about the retailer's license status and storefront signage.
Objective:
The aim of this study was to find methods for locating and observing cannabis outlets in Los Angeles County after the period when recreational cannabis retailers were granted licenses and allowed to be open for business.
Methods:
The procedures included searches of online cannabis outlet databases, followed by methods to verify each outlet's name, address, license information, and open status. These procedures, conducted solely online, resulted in a database of 531 outlets. To further verify each outlet's information and collect signage data, we conducted direct observations of the 531 identified outlets.
Results:
We found that 80.9% (430/531) of these outlets were open for business, of which 37.6% (162/430) were licensed to sell cannabis. Unlicensed outlets were less likely to have signage indicating the store sold cannabis, such as a green cross, which was the most prevalent form of observed signage. Co-use of cannabis and tobacco/nicotine has been found to be a substantial health concern, and we observed that 40.6% (175/430) of cannabis outlets had a tobacco/nicotine outlet within sight of the cannabis outlet. Most (350/430, 81.4%) cannabis outlets were located within the City of Los Angeles, and these outlets were more likely to be licensed than outlets outside the city.
Conclusions:
The findings of this study suggest that online searches and observational methods are both necessary to best capture accurate and detailed information about cannabis outlets. The methods described here can be applied to other metropolitan areas to more accurately capture the availability of cannabis in an area.
Objective:
To test reciprocal associations among internalizing symptoms (depression and social anxiety), using alcohol and cannabis to cope, and use-related problems.
Method:
The study utilized a community sample (N = 387, 55% female; majority non-Hispanic Caucasian (83.1%) or African American (9.1%) and a longitudinal design that spanned 17 to 20 years of age, and distinguished within- and between-person associations using latent curve models with structured residuals.
Results:
Reciprocal prospective within-person associations were supported for alcohol, such that elevated depression symptoms were associated with increased alcohol coping motivates 1 year later, which, in turn, was associated with subsequent increased depression symptoms. Bidirectional associations were not supported for social anxiety, although high levels of social anxiety were associated with elevated levels of coping drinking 1 year later. Cannabis coping motives were associated with exacerbation of depression, but not social anxiety symptoms, 1 year later. Between- and within-person contemporaneous associations suggested that depression and social anxiety were more strongly associated with coping than social/enhancement motives, and that coping motives were associated with use-related problems.
Conclusion:
Findings suggest that alcohol coping motivates exacerbate rather than ameliorate depression symptoms, which, in turn, leads to greater reliance on alcohol to cope. There was more consistent support for associations with substance use-related problems for depression than for social anxiety. Both between- and within-person associations may be useful for identifying targets and timing of coping-oriented interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
High-risk drinking events (e.g., Mardi Gras) are associated with heavy and problematic drinking behaviors in college students. Online personalized normative feedback (PNF) interventions have been found to reduce college drinking, yet few studies have investigated the effect of event-specific PNF on drinking. The present study investigated the impact of a Mardi Gras-specific PNF intervention on Mardi Gras drinking and normative beliefs. Undergraduate students who reported intending to drink during Mardi Gras were randomly assigned to receive PNF ( n = 74) or nondrinking control feedback ( n = 73), both delivered online. Compared to those in the control condition, those in the PNF condition reported lower normative beliefs at follow-up. Follow-up beliefs mediated the relation between condition and peak estimated blood alcohol content (eBAC) during Mardi Gras such that the PNF condition was related to lower follow-up maximum estimated eBAC via lower follow-up normative beliefs. Baseline drinking moderated treatment effects such that the PNF was related to lower follow-up eBAC among heavier but not lighter baseline drinkers. This is the first known study to find that an event-specific stand-alone PNF intervention administered online in anticipation of a universitywide holiday associated with drinking can result in decreased event-specific drinking via changes in event-specific normative beliefs.
Importance
Use of electronic cigarettes (e-cigarettes) is increasing. Measures of exposure to known tobacco-related toxicants among e-cigarette users will inform potential health risks to individual product users.
Objectives
To estimate concentrations of tobacco-related toxicants among e-cigarette users and compare these biomarker concentrations with those observed in combustible cigarette users, dual users, and never tobacco users.
Design, Setting, and Participants
A population-based, longitudinal cohort study was conducted in the United States in 2013-2014. Cross-sectional analysis was performed between November 4, 2016, and October 5, 2017, of biomarkers of exposure to tobacco-related toxicants collected by the Population Assessment of Tobacco and Health Study. Participants included adults who provided a urine sample and data on tobacco use (N = 5105).
Exposures
The primary exposure was tobacco use, including current exclusive e-cigarette users (n = 247), current exclusive cigarette smokers (n = 2411), and users of both products (dual users) (n = 792) compared with never tobacco users (n = 1655).
Main Outcomes and Measures
Geometric mean concentrations of 50 individual biomarkers from 5 major classes of tobacco product constituents were measured: nicotine, tobacco-specific nitrosamines (TSNAs), metals, polycyclic aromatic hydrocarbons (PAHs), and volatile organic compounds (VOCs).
Results
Of the 5105 participants, most were aged 35 to 54 years (weighted percentage, 38%; 95% CI, 35%-40%), women (60%; 95% CI, 59%-62%), and non-Hispanic white (61%; 95% CI, 58%-64%). Compared with exclusive e-cigarette users, never users had 19% to 81% significantly lower concentrations of biomarkers of exposure to nicotine, TSNAs, some metals (eg, cadmium and lead), and some VOCs (including acrylonitrile). Exclusive e-cigarette users showed 10% to 98% significantly lower concentrations of biomarkers of exposure, including TSNAs, PAHs, most VOCs, and nicotine, compared with exclusive cigarette smokers; concentrations were comparable for metals and 3 VOCs. Exclusive cigarette users showed 10% to 36% lower concentrations of several biomarkers than dual users. Frequency of cigarette use among dual users was positively correlated with nicotine and toxicant exposure.
Conclusions and Relevance
Exclusive use of e-cigarettes appears to result in measurable exposure to known tobacco-related toxicants, generally at lower levels than cigarette smoking. Toxicant exposure is greatest among dual users, and frequency of combustible cigarette use is positively correlated with tobacco toxicant concentration. These findings provide evidence that using combusted tobacco cigarettes alone or in combination with e-cigarettes is associated with higher concentrations of potentially harmful tobacco constituents in comparison with using e-cigarettes alone.
Venue-based distribution of marijuana has become the normative model in the United States to obtain marijuana. This study examines one-time purchase behaviors at medical marijuana dispensaries (MMDs) to identify potential venue- and individual-level targets for prevention. We used a two-stage, venue-based sampling approach to randomly select patrons exiting 16 MMDs in Los Angeles, California during the spring of 2013. Patrons (N = 595) reported their discrete purchase behaviors during their most recent visit to the sampled MMD. We used hierarchical linear modeling to examine the amount spent on marijuana products, regressed on characteristics of the sampled dispensaries and their patrons. We used hierarchical generalized linear modeling to examine the likelihood of purchasing specific types of marijuana products and total grams of loose-leaf buds purchased. Patrons spent US0–$330. We observed significant variation in purchase behaviors across MMDs and associations between venues located within high median income census tracts and a higher total amount spent and lower odds of purchasing only loose-leaf buds. The networked distance between a patron’s home and the sampled MMD was positively associated with the total amount spent and total quantity of buds purchased. We also found significant relationships between medical conditions reported for use in three models: total amount spent, purchase of pre-rolled joints, and total grams of buds purchased. Policy makers may want to explore regulating the availability of specialty items that may be attractive to naïve users, such as pre-rolled joints or edibles, or high-concentration products that may be sought out by regular, heavy users.
Objective:
The primary care (PC) setting provides a unique opportunity to address adolescent alcohol and other drug (AOD) use.
Method:
We conducted a randomized controlled trial in 4 PC clinics from April 2013 to November 2015 to determine whether a 15-min brief motivational interviewing (MI) AOD intervention, delivered in PC, reduced alcohol and marijuana use and consequences. Adolescents ages 12-18 who came for an appointment during the 2.5-year study period were asked to be in the study and screened using the National Institute of Alcohol Abuse and Alcoholism Screening Guide. Those identified as at risk were randomized to the CHAT intervention or usual care (UC). Adolescents completed 4 web-based surveys at baseline and 3, 6, and 12 months postbaseline.
Results:
The sample (n = 294) was 58% female and 66% Hispanic, 17% Black, 12% White, 5% multiethnic or other, with an average age of 16 years. Compared to UC adolescents, CHAT adolescents reported significantly less perceived peer use of alcohol and marijuana at 3 months (alcohol: p < .0001; marijuana p = .01) and 6 months (alcohol: p = .04; marijuana p = .04). CHAT adolescents also reported marginally fewer negative alcohol consequences experienced at 6 months (p = .08). At 12 months, compared to UC, CHAT adolescents reported less perceived peer alcohol (p = .04) and marijuana (p < .01) use and fewer negative consequences from alcohol (p = .03) and marijuana (p = .04) use.
Conclusions:
A brief MI intervention delivered in PC reduced negative consequences from alcohol and marijuana use 1 year later. Findings emphasize that adolescents can benefit from PC interventions that briefly and effectively address both alcohol and marijuana use. (PsycINFO Database Record
Purpose of Review
There is not one answer to address whether marijuana use has increased, decreased, or stayed the same given changes in state legalization of medical and non-medical marijuana in the USA.
Recent Findings
Evidence suggests some health benefits for medical marijuana; however, initiation of marijuana use is a risk factor for developing problem cannabis use. Though use rates have remained stable over recent years, about one in three 10th graders report marijuana use, most adolescents do not view the drug as harmful, and over 650,000 youth aged 12 to 17 struggle with cannabis use disorder.
Summary
Although the health benefits of medical marijuana are becoming better understood, more research is needed. Intervention and prevention programs must better address effects of marijuana, acknowledging that while there may be some benefits medically, marijuana use can affect functioning during adolescence when the brain is still developing.
Cannabis use is steadily rising in the United States. As the popularity of marijuana rises, new varieties of cannabis-related products are becoming available. Dabs are cannabis concentrates gaining notoriety for their significant amounts of tetrahydrocannabinol (THC) that are ultimately vaporized and inhaled for their effect. Herein, we provide an overview of recent cases of dabbing to bring awareness to the clinicians, of the significant adverse effects associated with dabs including psychosis, neurotoxicity, and cardiotoxicity.
Purpose:
Brief intervention to reduce cannabis is a promising technique that could be adapted for use in primary care, but it has not been well studied in this setting. We tested the efficacy of a brief intervention conducted by general practitioners among cannabis users aged 15 to 25 years.
Methods:
We performed a cluster randomized controlled trial with 77 general practitioners in France. The intervention consisted of an interview designed according to the FRAMES (feedback, responsibility, advice, menu, empathy, self-efficacy) model, while the control condition consisted of routine care.
Results:
The general practitioners screened and followed up 261 young cannabis users. After 1 year, there was no significant difference between the intervention and control groups in the median number of joints smoked per month among all users (17.5 vs 17.5; P = .13), but there was a difference in favor of the intervention among nondaily users (3 vs 10; P = .01). After 6 months, the intervention was associated with a more favorable change from baseline in the number of joints smoked (-33.3% vs 0%, P = .01) and, among users younger than age of 18, smoking of fewer joints per month (12.5 vs 20, P = .04).
Conclusions:
Our findings suggest that a brief intervention conducted by general practitioners with French young cannabis users does not affect use overall. They do, however, strongly support use of brief intervention for younger users and for moderate users.
This article describes a small efficacy trial of the Living in 2 Worlds (L2W) substance use prevention curriculum, a culturally adapted version of keepin’ it REAL (kiR) redesigned for urban American Indian (AI) middle school students. Focused on strengthening resiliency and AI cultural engagement, L2W teaches drug resistance skills, decision making, and culturally grounded prevention messages. Using cluster random assignment, the research team randomized three urban middle schools with enrichment classes for AI students. AI teachers of these classes delivered the L2W curriculum in two schools; the remaining school implemented kiR, unadapted, and became the comparison group. AI students (N = 107) completed a pretest questionnaire before they received the manualized curriculum lessons, and a posttest (85% completion) 1 month after the final lesson. We assessed the adapted L2W intervention, compared to kiR, with paired t tests, baseline adjusted general linear models, and effect size estimates (Cohen’s d). Differences between the L2W and kiR groups reached statistically significant thresholds for four outcomes. Youth receiving L2W, compared to kiR, reported less growth in cigarette use from pretest to posttest, less frequent use of the Leave drug resistance strategy, and less loss of connections to AI spirituality and cultural traditions. For other substance use behaviors and antecedents, the direction of the non-significant effects in small sample tests was toward more positive outcomes in L2W and small to medium effect sizes. Results suggest that evidence-based substance use prevention programs that are culturally adapted for urban AI adolescents, like L2W, can be a foundation for prevention approaches to help delay initiation and slow increases in substance use. In addition to study limitations, we discuss implementation challenges in delivering school-based interventions for urban AI populations.
Introduction: Rates of cannabis use disorder (CUD) among vulnerable populations have increased in recent years, highlighting a need to equip providers with an efficient screening tool.
Materials and Methods: A short form of the Cannabis Use Disorder Identification Test-Revised (CUDIT-R) was developed by using item response theory and traditional statistical methods, with data from two community samples of cannabis users representing two countries. Four item selection methods (Rasch regression, test characteristic curve, logistic regression, discriminant function analysis) were employed to identify the optimal three-item shortened version. The diagnostic ability of the short form was evaluated by using receiver operating characteristic curves.
Results: Using a cut score of 2, the 3-item CUDIT-Short Form (CUDIT-SF; reliability alpha = 0.66, Sample 1; 0.80, Sample 2) identified 78.26% of participants in Sample 1 and 78.31% of participants in Sample 2 who met DSM-5 criteria for CUD, with 98% agreement in Sample 1 and 93% agreement in Sample 2 with the full CUDIT-R on CUD classifications using a cut score of 13. Specificity was 76.70 and 78.00 in Samples 1 and 2, respectively.
Conclusions: The CUDIT-SF may be useful in busy clinical settings for a stepwise screening. Further validation of this shortened version with larger samples and in different settings is warranted.
Aims:
To describe patterns of cannabis use, the degree of overlap between medicinal and recreational users, and their differential use patterns, modes of consumption and sources of cannabis.
Design:
An ongoing probability-based internet panel maintained by the market research firm GfK Group.
Setting:
Households in Colorado, Washington, Oregon and New Mexico, USA.
Participants:
2009 individuals from Washington (n=787), Oregon (n=506), Colorado (n=503), and New Mexico (N=213). Post stratification sampling weights were provided so that estimates could be made representative of the household population in each of these states. Respondents were between 18 and 91 years old with a mean age of 53.
Methods:
We compare patterns of cannabis consumption for medicinal and recreational users as well as simultaneous use of alcohol and cannabis. We also examine the extent to which patterns of use differ across states that chose to legalize (Washington and Colorado) and those that did not (New Mexico and Oregon).
Findings:
Rates of lifetime medical cannabis use are similar in Colorado and Washington (8°8% and 8°2%) but lower in Oregon and New Mexico (6.5% and 1%). Recreational use is considerably higher than medical use across all states (41%) but highest in Oregon and Washington. About 86% of people who report ever using cannabis for medicinal purposes also use it recreationally. Medical users are more likely to vaporize and consume edibles, and report a higher amount (in grams) consumed, and spend more money per month than recreational users. Individuals who use cannabis do not commonly use it with alcohol, irrespective of whether they are consuming cannabis recreationally or medically. Fewer than 1 in 5 recreational users report simultaneous use of alcohol and cannabis most or all of the time and less than 3% of medicinal users report frequent simultaneous use of alcohol and cannabis.
Conclusions:
In the USA, the degree of overlap between medicinal and recreational cannabis users is 86%. Medicinal and recreational cannabis users favour different modes and amounts of consumption. Only a small proportion (12%) of cannabis users usually consume cannabis and alcohol simultaneously, while concurrent use is common among recreational users. This article is protected by copyright. All rights reserved.
Cannabis concentrates are gaining rapid popularity in the California medical cannabis market. These extracts are increasingly being consumed via a new inhalation method called ‘dabbing’. The act of consuming one dose is colloquially referred to as “doing a dab”. This paper investigates cannabinoid transfer efficiency, chemical composition and contamination of concentrated cannabis extracts used for dabbing. The studied concentrates represent material available in the California medical cannabis market. Fifty seven (57) concentrate samples were screened for cannabinoid content and the presence of residual solvents or pesticides. Considerable residual solvent and pesticide contamination were found in these concentrates. Over 80% of the concentrate samples were contaminated in some form. THC max concentrations ranged from 23.7% to 75.9% with the exception of one outlier containing 2.7% THC and 47.7% CBD. Up to 40% of the theoretically available THC could be captured in the vapor stream of a dab during inhalation experiments. Dabbing offers immediate physiological relief to patients in need but may also be more prone to abuse by recreational users seeking a more rapid and intense physiological effect.
There are many mandated school-based programs to prevent adolescent alcohol and drug (AOD) use, but few are voluntary and take place outside of class time. This cluster randomized controlled trial evaluates CHOICE, a voluntary after-school program for younger adolescents, which reduced both individual- and school-level alcohol use in a previous pilot study. We evaluated CHOICE with 9,528 students from 16 middle schools. The sample was 51% female; 54% Hispanic, 17% Asian, 15% white, 9% multiethnic and 3% African American. Fifteen percent of students attended CHOICE. All students completed surveys on alcohol beliefs and use at baseline and 6-7 months later. We conducted intention-to-treat (ITT) school-level analyses and propensity-matched attender analyses. Lifetime alcohol use in the ITT analysis (i.e., school level) achieved statistical significance, with an odds ratio (OR) of 0.70 and a NNT of 14.8. The NNT suggests that in a school where CHOICE was offered, 1 adolescent out of 15 was prevented from initiating alcohol use during this time period. Although not statistically significant (p = .20), results indicate that past month alcohol use was also lower in CHOICE schools (OR = 0.81; NNT = 45). Comparisons of attenders versus matched controls yielded results for lifetime use similar to school-wide effects (OR = 0.74 and NNT = 17.6). Initial results are promising and suggest that a voluntary after-school program that focuses specifically on AOD may be effective in deterring alcohol use among early adolescents; however, further research is needed as program effects were modest.
There is growing evidence associating adolescent marijuana use with developmental and societal consequences. Noncombustible marijuana use products are more accessible, but data on use trends compared with smoking marijuana have not been available. Vaping has increased rapidly among adolescents,¹ and although pot brownies are not new, commercially manufactured marijuana edibles are now available. The extent to which these products are used by adolescents nationally is unknown. Regional data suggest boys vape more than girls.²⁻⁴ There are conflicting reports of sex differences in edible use⁴,5 and differences across modes of use for race/ethnicity²,4 and socioeconomic status (SES).³,4 We document prevalence and trends from 2015 to 2018 in noncombustible marijuana use and differences by use frequency and sociodemographic characteristics (ie, sex, race/ethnicity, SES, and school urbanicity).
The changing legal landscape of cannabis in the USA has coincided with changes in how cannabis is used, including its co-use with other substances. This study analyzed 10 years of data from a diverse cohort of youth (N = 2429; 54% Hispanic, 16% Asian, 16% white, 3% black, 10% multiracial) to examine predictors in early and late adolescence of co-use of alcohol with cannabis (AC) and tobacco with cannabis (TC) at age 21. Two forms of co-use were examined: concurrent (use of both substances in past month) and sequential (use of one substance right after the other). Analyses focused on four predictor domains: individual (e.g., resistance self-efficacy), peer (e.g., time spent around peers who use), family (e.g., sibling use), and neighborhood (i.e., perceived alcohol and drug problems in neighborhood). For each co-use combination (AC or TC), we estimated parallel process piecewise latent growth models in a structural equation modeling framework using Mplus v8. The final AC and TC co-use models included all predictor variables from the four domains. Increases in positive expectancies and time spent around peers who use AC, as well as steeper decreases in resistance self-efficacy, were all related to a greater likelihood of AC co-use in young adulthood. Increases in sibling TC use and time spent around peers who use TC, as well as steeper decreases in resistance self-efficacy, were all related to a greater likelihood of TC co-use in young adulthood. Overall, findings highlight the importance of addressing peer influence in prevention programming during both early and late adolescence.
Objective:
Studies have documented greater risk for heavy marijuana use and consequences among adolescents and young adults who have acquired medical marijuana cards. With the cards, they are enrolled in their state's medical marijuana program and granted access to medical marijuana dispensaries. It is unknown, however, what factors influence young people to acquire medical marijuana cards, such as whether they seek out medical marijuana cards for the mental and physical health concerns that marijuana is targeted to address or whether they seek out medical marijuana cards solely because they are heavier users.
Method:
There were 264 participants (54% female) in the current study, which used longitudinal data (Time 1 and Time 2, 1 year later) to compare young adult marijuana users who did not have a medical marijuana card at either time point (n = 215) with marijuana users who reported acquiring a medical marijuana card by Time 2 (n = 49; 19% of the sample). We used logistic regression to predict participants' acquisition of a medical marijuana card at Time 2 from Time 1 demographic factors, mental health symptoms of anxiety and depression, reports of poor physical health and symptoms, and frequency of use.
Results:
Analyses indicated that young adults who were male (odds ratio = 2.91) and who reported more frequent marijuana use (odds ratio = 1.07) were at greater odds of acquiring a medical marijuana card over the study period. None of the mental or physical health concerns predicted card acquisition.
Conclusions:
Findings suggest that more frequent use, not necessarily mental and physical health concerns, is a main influence on medical marijuana card acquisition.
Importance
The prevalence of e-cigarette use among US youth increased from 2011 to 2018. Continued monitoring of the prevalence of e-cigarette and other tobacco product use among youth is important to inform public health policy, planning, and regulatory efforts.
Objective
To estimate the prevalence of e-cigarette use among US high school and middle school students in 2019 including frequency of use, brands used, and use of flavored products.
Design, Setting, and Participants
Cross-sectional analyses of a school-based nationally representative sample of 19 018 US students in grades 6 to 12 participating in the 2019 National Youth Tobacco Survey. The survey was conducted from February 15, 2019, to May 24, 2019.
Main Outcomes and Measures
Self-reported current (past 30-day) e-cigarette use estimates among high school and middle school students; frequent use (≥20 days in the past 30 days) and usual e-cigarette brand among current e-cigarette users; and use of flavored e-cigarettes and flavor types among current exclusive e-cigarette users (no use of other tobacco products) by school level and usual brand. Prevalence estimates were weighted to account for the complex sampling design.
Results
The survey included 10 097 high school students (mean [SD] age, 16.1 [3.0] years; 47.5% female) and 8837 middle school students (mean [SD] age, 12.7 [2.8] years; 48.7% female). The response rate was 66.3%. An estimated 27.5% (95% CI, 25.3%-29.7%) of high school students and 10.5% (95% CI, 9.4%-11.8%) of middle school students reported current e-cigarette use. Among current e-cigarette users, an estimated 34.2% (95% CI, 31.2%-37.3%) of high school students and 18.0% (95% CI, 15.2%-21.2%) of middle school students reported frequent use, and an estimated 63.6% (95% CI, 59.3%-67.8%) of high school students and 65.4% (95% CI, 60.6%-69.9%) of middle school students reported exclusive use of e-cigarettes. Among current e-cigarette users, an estimated 59.1% (95% CI, 54.8%-63.2%) of high school students and 54.1% (95% CI, 49.1%-59.0%) of middle school students reported JUUL as their usual e-cigarette brand in the past 30 days; among current e-cigarette users, 13.8% (95% CI, 12.0%-15.9%) of high school students and 16.8% (95% CI, 13.6%-20.7%) of middle school students reported not having a usual e-cigarette brand. Among current exclusive e-cigarette users, an estimated 72.2% (95% CI, 69.1%-75.1%) of high school students and 59.2% (95% CI, 54.8%-63.4%) of middle school students used flavored e-cigarettes, with fruit, menthol or mint, and candy, desserts, or other sweets being the most commonly reported flavors.
Conclusions and Relevance
In 2019, the prevalence of self-reported e-cigarette use was high among high school and middle school students, with many current e-cigarette users reporting frequent use and most of the exclusive e-cigarette users reporting use of flavored e-cigarettes.
In a well-regulated drug market, consumers should be able to understand and titrate their dose with little difficulty. In the cannabis market, despite substantial increases in THC levels over time, users have had limited information on the strength of their products. In principle, cannabis legalization provides greater opportunity to communicate clear, accurate information to consumers through packaging and labelling standards. However, jurisdictions that have legalized cannabis have experienced an increase in adverse events from higher strength products, particularly from edibles and other concentrates. What little research exists suggests that current regulatory practices of labelling THC levels on packages may be ineffective due to consumer difficulties understanding numbers (e.g., mg vs. percentage), and the different ways THC levels are communicated across product categories. In particular, current labelling practices provide little guidance in terms of 'dose expression'-how THC 'dose' translates into consumption amounts for specific products. The current paper identifies five principles to guide cannabis labelling and packaging regulations, including considerations for numeric THC labelling, the use of standard servings or dose across different product forms, strategies to communicate 'dose expression', and 'dose-unit packaging'. Overall, there is a need for regulated cannabis markets to develop more effective packaging and labelling standards to allow consumers to effectively titrate their THC intake, with the goal of promoting lower-risk cannabis use.
Objectives. To assess the relationship between adult cannabis use and time-varying local measures of retail cannabis market presence before and after legalization (2012) and market opening (2014) in Washington State.
Methods. We used 2009 to 2016 data on 85 135 adults’ current (any) and frequent (20 or more days) past-month cannabis use from the Washington Behavioral Risk Factor Surveillance System linked to local retailer proximity and density. Multilevel models predicted use over time, accounting for nesting within communities.
Results. Current and frequent cannabis use grew significantly between 2009 and 2016; use did not significantly change immediately after legalization but increased subsequently with greater access to cannabis retailers. Specifically, current use increased among adults living in areas within 18 miles of a retailer and, especially, within 0.8 miles (odds ratio [OR] = 1.45; 95% confidence interval [CI] = 1.24, 1.69). Frequent use increased among adults living within 0.8 miles of a retailer (OR = 1.43; 95% CI = 1.15, 1.77). Results related to geospatial retailer density were consistent.
Conclusions. Increasing cannabis retail access was associated with increased current and frequent use.
Public Health Implications. Policymakers might consider density limits as a strategy for preventing heavy cannabis use among adults.
Background and objectives:
The primary care (PC) setting provides an opportunity to address adolescent alcohol and marijuana use. We examined moderators of effectiveness for a PC brief motivational intervention on adolescents' alcohol and marijuana use and consequences 1 year later.
Methods:
We conducted a randomized controlled trial in 4 PC clinics from April 2013 to November 2015 and followed adolescents using Web-based surveys. We examined whether demographic factors and severity of use moderated 12-month outcomes. Adolescents aged 12 through 18 were screened by using the National Institute on Alcohol Abuse and Alcoholism Screening Guide. Those identified as at risk were randomly assigned to the intervention (CHAT) or to usual care (UC).
Results:
The sample (n = 294) was 58% female, 66% Hispanic, 17% African American, 12% white, and 5% multiethnic or of other race with an average age of 16 years. After controlling for baseline values of outcomes, teens in CHAT who reported more negative consequences from drinking or had an alcohol use disorder at baseline reported less alcohol use, heavy drinking, and consequences 1 year later compared with teens in UC. Similarly, teens in CHAT with more negative consequences from marijuana use at baseline reported less marijuana use 1 year later compared with teens in UC; however, teens in CHAT who reported fewer marijuana consequences at baseline reported greater marijuana use 1 year later compared with teens in UC.
Conclusions:
A brief intervention can be efficacious over the long-term for adolescents who report problems from alcohol and marijuana use. Findings emphasize the importance of both screening and intervention in at-risk adolescents in PC.
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, California, USA.
Participants:
1,887 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:
Nearly 85% of respondents had 10 or more MMDs within 4 miles of their homes. Multiple linear regression analyses that adjusted for individual-level sociodemographic characteristics and neighborhood socioeconomic 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% 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.
Laws regulating cannabis have changed radically in the U.S. and abroad. Historically, users smoked dried cannabis flowers that contained Δ9-tetrahydrocannabinol (THC), the primary psychoactive component of cannabis, as the principal product constituent. Coincident with cannabis legalization and increased interest in medicinal use of the plant, there is now an expansive retail cannabis marketplace with novel cannabis products, formulations, and methods of administration. In this review, we describe emergent cannabis product chemotypes (e.g. THC-dominant, CBD-dominant, balanced or ‘hybrid’ with high concentrations of THC and CBD), product formulations (e.g. edibles, concentrates), and methods of administration (e.g. smoked, vaporized, orally ingested). Psychologists can play a pivotal role in studying the health impact of cannabis legalization and conducting research to inform product regulation.
Introduction and Aims
Given the increase in cannabis availability and use in North America, identification of risk factors for cannabis use and dependence is paramount. One factor that may be associated with various cannabis‐related adverse outcomes is the context in which it is used. This secondary analysis study sought to examine the extent to which the social context of cannabis use is related to patterns of use and associated harms.
Design and Methods
One hundred and eighty‐eight adult cannabis users were community‐recruited in Halifax, Canada. Participants took part in a face‐to‐face structured interview where they provided information about the social context of their most recent cannabis‐using occasion and about their patterns of, and motives for, cannabis use.
Results
Compared to individuals reporting their most recent cannabis‐using occasion as social, solitary users (n = 55) were significantly more likely to screen positive for psychosis, endorse more symptoms of cannabis abuse/dependence, report using cannabis to cope, and use cannabis on more days within the previous 30 days. On the other hand, social users were significantly more likely to report using alcohol in addition to cannabis during their most recent cannabis‐using occasion (all P < 0.05).
Discussion and Conclusions
Results suggest that solitary cannabis use may be associated with specific motives for use and future adverse consequences. Findings from this study serve as a guide for future investigations which could ultimately inform public policy and the development of targeted harm‐reduction strategies.
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.
Purpose:
We aimed to examine the availability of medical marijuana dispensaries, price of medical marijuana products, and variety of medical marijuana products in school neighborhoods and their associations with adolescents' use of marijuana and susceptibility to use marijuana in the future.
Methods:
A representative sample of 8th, 10th, and 12th graders (N = 46,646) from 117 randomly selected schools in California participated in the cross-sectional 2015-2016 California Student Tobacco Survey (CSTS). Characteristics of medical marijuana dispensaries in California were collected and combined with school locations to compute availability, price, and product variety of medical marijuana in school neighborhoods. Multilevel logistic regressions with random intercepts at school level were conducted to test the associations, accounting for individual and school socioeconomic characteristics.
Results:
The distance from school to the nearest medical marijuana dispensary (within 0- to 1-mi and 1- to 3-mi bands) was not associated with adolescents' use of marijuana in the past month or susceptibility to use marijuana in the future, nor was the weighted count of medical marijuana dispensaries within the 3-mi band of school. Neither the product price nor the product variety in the dispensary nearest to school was associated with marijuana use or susceptibility to use. The results were robust to different specifications of medical marijuana measures.
Conclusions:
There was no evidence supporting the associations of medical marijuana availability, price, or product variety around school with adolescents' marijuana use and susceptibility to use.
Background:
Marijuana use during adolescence is associated with neurocognitive deficits and poorer functioning across several domains. It is likely that more states will pass both medical and recreational marijuana legalization laws in the coming elections; therefore, we must begin to look more closely at the longitudinal effects of medical marijuana (MM) advertising on marijuana use among adolescents so that we can better understand effects that this advertising may have on their subsequent marijuana use and related outcomes.
Methods:
We followed two cohorts of 7th and 8th graders (mean age 13) recruited from school districts in Southern California from 2010 until 2017 (mean age 19) to examine effects of MM advertising on adolescents' marijuana use, cognitions, and consequences over seven years. Latent growth models examined trajectories of self-reported exposure to medical marijuana ads in the past three months and trajectories of use, cognitions, and consequences.
Results:
Higher average exposure to MM advertising was associated with higher average use, intentions to use, positive expectancies, and negative consequences. Similarly, higher rates of change in MM advertising exposure were associated with higher rates of change in use, intentions, expectancies, and consequences over seven years.
Conclusions:
Results suggest that exposure to MM advertising may not only play a significant role in shaping attitudes about marijuana, but may also contribute to increased marijuana use and related negative consequences throughout adolescence. This highlights the importance of considering regulations for marijuana advertising, similar to regulations in place for the promotion of tobacco and alcohol in the U.S.
Aims:
To test the hypothesis that among non-treatment-seeking emerging adults (EA) who both use marijuana and have alcohol binges, a brief, longitudinally-delivered, developmentally-based motivational intervention would show greater reductions in the use of these two substances compared with a health education control condition.
Design:
Parallel, two group, randomized controlled trial with follow-up interventions conducted at 1, 3, 6, and 9 months and final assessments at 12 and 15 months.
Setting:
Hospital-based research unit in the United States.
Participants:
Community-based 18-25 year olds who reported at least monthly binge drinking and at least weekly marijuana use.
Intervention:
Motivational intervention focused primarily on themes of emerging adulthood (identity exploration, instability, self-focus, feeling in-between, a sense of possibilities) and the subjects' relationship to substance use (n=110) compared with an attention-matched health education control condition (n=116).
Measurements:
The primary outcomes were days of binge alcohol, marijuana and dual use day as measured using the Timeline Followback Method analyzing the treatment by time interaction to determine relative differences in the rate of change between intervention arms.
Findings:
At baseline, the mean rate (days / 30) of binge drinking was 5.23 (± 4.31), of marijuana use was 19.4 (± 10.0), and of dual (same day) use was 4.11 (± 4.13). Relative to baseline, there were reductions in the rate of binge alcohol use, marijuana use, and days of combined binge alcohol and marijuana use (p < .001) at all follow-up assessments. However, the treatment by time interaction was not statistically significant for alcohol (p = .37), for marijuana (p=.07), or for dual use (p=.55). Averaged over all follow-ups, mean reductions in binge, marijuana, and dual use days were 1.16, 1.45, and 1.08, respectively, in the health education arm, and 1.06, 1.69, and 0.96 in MI. Bayes factors were < .01 for frequency of binge alcohol use and frequency of dual binge alcohol and marijuana, and .016 for marijuana use.
Conclusions:
A brief, longitudinally-delivered, developmentally-based motivational intervention for young adults did not produce reductions in binge alcohol, marijuana use, or dual use days relative to a control condition.
Background: Because marijuana is becoming more accessible and perceived norms of use are becoming increasingly more favorable, research is needed to understand characteristics of marijuana acquisition among adolescents. Purpose: The study purpose was to examine whether sources and locations where adolescent users obtain and use marijuana differed based on past month use, age of first use, time since last used, number of days used in the past month, perceived ease of access, perceived peer use, and demographics. Methods: We conducted a secondary data analysis (n = 3102) of the National Survey on Drug Use and Health. Univariate and multivariable logistic regression models were performed. Results: Adolescents at highest risk for buying marijuana were male, older, used in the past month, and older when they first used. Adolescents at highest risk for buying marijuana inside a home/apartment/dorm were more likely to have used in the past month. Adolescents at highest risk for buying marijuana outside in a public area were African American and used 6–19 days in the past month. Discussion: Because marijuana is becoming more accessible, preventionists should continue monitoring acquisitions. Translation to Health Education Practice: Findings can be used to assist health educators to more thoroughly understand marijuana acquisition among adolescents.
Background and objectives:
Individuals with elevated social anxiety are seven times more likely to meet criteria for cannabis use disorders, yet social anxiety is unrelated to more frequent cannabis use. The lack of relation to cannabis use frequency may be at least partially due to lack of attention to cannabis use context. It may be that socially anxious persons engage in frequent solitary cannabis use, perhaps using before social situations in the hope that being intoxicated during the social event will help them feel less anxious. In fact, using cannabis alone has been associated with experiencing more cannabis-related problems in prior work.
Methods:
The current study sought to identify whether solitary cannabis use frequency mediated the relationship between social anxiety and cannabis-related problems among 276 current cannabis using undergraduates who completed an online survey of putative predictors of substance use.
Results:
Social anxiety was robustly related to more frequent solitary (but not social) cannabis use and solitary cannabis use frequency uniquely mediated the relation of social anxiety to cannabis use and related problems.
Discussion and conclusions:
Frequent solitary use appears to play an important role in the experience of cannabis-related problems among socially anxious persons.
Scientific significance:
Intervention strategies may benefit from targeting frequent solitary cannabis use, particularly among at-risk users such as those with elevated social anxiety. (Am J Addict 2016;XX:1-6).
To examine adolescents' annual use of medical marijuana and determine if legal medical marijuana users are at lower risk for frequent marijuana use and other substance use when compared to adolescents who use diverted medical marijuana or from an illicit source.
Public access Monitoring the Future data were used for this secondary analysis. The total weighted sample size was 4394 12th graders.
Users of medical marijuana and diverted medical marijuana had notable odds of using daily, using prescription drugs, and using illicit drugs among other substance use behaviors. Medical marijuana users had much higher odds of using medical marijuana because of being "hooked" when compared to diverted medical users and illicit users.
This study is the first to provide nationally representative data on three groups of adolescent marijuana users. Although most adolescents use illicit sources, more adolescents appear to be using diverted medical marijuana, than using medical marijuana legally.
Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
This study analyzed the dose accuracy of labels from edibile medical cannabis products dispensed in 3 US cities.
As the use of cannabis (marijuana) for medical purposes has expanded, a variety of edible products for oral consumption has been developed. An estimated 16% to 26% of patients using medical cannabis consume edible products.¹,2 Even though oral consumption lacks the harmful by-products of smoking, difficult dose titration can result in overdosing or underdosing, highlighting the importance of accurate product labeling.
Purpose
Middle school students with a history of solitary substance use are at elevated risk for substance problems by young adulthood. Understanding how these students differ from social-only users on substance use behaviors and consequences, normative beliefs, social influences, and attitudes can inform efforts to reduce solitary use and its related negative consequences.
Methods
Sixth- to seventh-grade students completed an in-school survey. We compared those with a history of solitary versus social-only alcohol use (n = 202 and n = 616, respectively) and marijuana use (n = 92 and n = 208, respectively) on a range of substance use–related characteristics.
Results
Any solitary use was reported by 25% of lifetime alcohol users and 31% of lifetime marijuana users. Those with a history of solitary use of either substance were more likely to hold positive expectancies about their use but also reported more negative consequences during the past year. Solitary users tended to have greater exposure to substance-using peers and more difficulty resisting offers to use. Compared with social-only drinkers, those with a history of solitary drinking perceived that more of their peers were alcohol users. Significant group differences were not found on negative outcome expectancies or attempts to cut down on substance use.
Conclusions
Solitary use is an important, yet, overlooked problem among middle school students who have just begun drinking or using marijuana. Results suggest that positive expectancies, peer influences, resistance self-efficacy, and normative beliefs may be important areas to target in reducing solitary use and the risk it poses for problematic use in young adulthood.
Frequent cannabis users are at high risk of dependence, still most (near) daily users are not dependent. It is unknown why some frequent users develop dependence, whereas others do not. This study aims to identify predictors of first-incidence DSM-IV cannabis dependence in frequent cannabis users.
A prospective cohort of frequent cannabis users (aged 18-30, n=600) with baseline and two follow-up assessments (18 and 36 months) was used. Only participants without lifetime diagnosis of DSM-IV cannabis dependence at baseline (n=269) were selected. Incidence of DSM-IV cannabis dependence was established using the Composite International Diagnostic Interview version 3.0. Variables assessed as potential predictors of the development of cannabis dependence included sociodemographic factors, cannabis use variables (e.g., motives, consumption habits, cannabis exposure), vulnerability factors (e.g., childhood adversity, family history of mental disorders or substance use problems, personality, mental disorders), and stress factors (e.g., life events, social support).
Three-year cumulative incidence of cannabis dependence was 37.2% (95% CI=30.7-43.8%). Independent predictors of the first incidence of cannabis dependence included: living alone, coping motives for cannabis use, number and type of recent negative life events (major financial problems), and number and type of cannabis use disorder symptoms (impaired control over use). Cannabis exposure variables and stable vulnerability factors did not independently predict first incidence of cannabis dependence.
In a high risk population of young adult frequent cannabis users, current problems are more important predictors of first incidence cannabis dependence than the level and type of cannabis exposure and stable vulnerability factors.
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