Adherence to prescription guidelines for medical cannabis in disability claimants.

OBJECTIVE: To examine a case series of 70 disability claimants who were referred to a clinic for multidisciplinary medical evaluation for physician compliance with cannabis prescription guidelines for pre-existing cannabis prescriptions. DESIGN: Retrospective case series analysis. SETTING: A private clinic in New Brunswick specializing in multidisciplinary medical assessment for institutional third-party insurers. PARTICIPANTS: All referrals for independent review of cannabis prescriptions between May 2016 and February 2018 (N = 70). MAIN OUTCOME MEASURES: Compliance with the cannabis prescription guidelines. RESULTS: Treating physicians were found to have not adhered to the guidelines in 53 of 61 patients (86.9%) who were prescribed cannabis products for pain management and in 8 of 9 patients (88.9%) who were prescribed cannabis products for treatment of posttraumatic stress disorder. Clinical assessment and radiologic review failed to identify a neuropathic cause of pain in 70.5% of pain cases. Adequate trials of noncannabinoid medications had not been attempted for 72.1% of patients with pain nor for any of the patients with posttraumatic stress disorder. Contraindications to cannabis were identified in 65.7% of cases, including evidence suggesting a past or present cannabis use disorder or currently active substance use disorder in 34.3% of cases. The prescriptions were found to be consistent with prescription guidelines in just 12.9% of cases. CONCLUSION: Very few of the reviewed cannabis prescriptions were found to be consistent with cannabis prescription guidelines. Respectful attention to guidelines might avoid unwarranted overprescribing, limit the secondary increase in comorbidity, and facilitate future scientific study and evaluation of medical cannabis.

Experienced EGM Players Know How to Control the Reinforcement Rate and Time on Device.

This experiment used motivational instructions to test whether experienced slot machine players are able to manipulate the frequency of winning outcomes and the time taken to deplete funds while playing a popular slot machine game. Twenty-four participants played in four conditions intended to motivate them to play the game as they normally do, to deplete funds quickly, to get a long losing streak, and to avoid getting a bonus round. Compared to how they normally play, participants significantly reduced the number of bought paylines when trying to get losing streaks or avoid bonus rounds. They also wagered significantly more credits per line when trying to deplete their funds quickly. This experiment shows that experienced slots gamblers have an implicit understanding of reinforcement rate and time on device, and that they are able to manipulate these game outputs at will by adjusting the number of paylines they buy and how many credits they choose to wager. When playing normally, they try to maximize reinforcement rate by purchasing the opportunity to win on many paylines. Player control over reinforcement rate and time on device does not alter payback percentage so there is no monetary advantage to manipulating these game outputs.