The impact of cannabis use disorder on urologic oncologic surgery morbidity, length of stay, and inpatient cost: analysis of the National Inpatient Sample from 2003 to 2014.

PURPOSE: This study examined the impact of cannabis use disorder (CUD) on inpatient morbidity, length of stay (LOS), and inpatient cost (IC) of patients undergoing urologic oncologic surgery. METHODS: The National Inpatient Sample (NIS) from 2003 to 2014 was analyzed for patients undergoing prostatectomy, nephrectomy, or cystectomy (n = 1,612,743). CUD was identified using ICD-9 codes. Complex-survey procedures were used to compare patients with and without CUD. Inpatient major complications, high LOS (4th quartile), and high IC (4th quartile) were examined as endpoints. Univariable and multivariable analysis (MVA) were performed to compare groups. RESULTS: The incidence of CUD increased from 51 per 100,000 admissions in 2003 to 383 per 100,000 in 2014 (p < 0.001). Overall, 3,503 admissions had CUD. Patients with CUD were more frequently younger (50 vs. 61), male (86% vs. 78.4%), Black (21.7% vs. 9.2%), and had 1st quartile income (36.1% vs. 20.6%); all p < 0.001. CUD had no impact on any complication rates (all p > 0.05). However, CUD patients had higher LOS (3 vs. 2 days; p < 0.001) and IC ($15,609 vs. $12,415; p < 0.001). On MVA, CUD was not an independent predictor of major complications (p = 0.6). Conversely, CUD was associated with high LOS (odds ratio (OR) 1.31; 95% CI 1.08-1.59) and high IC (OR 1.33; 95% CI 1.12-1.59), both p < 0.01. CONCLUSION: The incidence of CUD at the time of urologic oncologic surgery is increasing. Future research should look into the cause of our observed phenomena and how to decrease LOS and IC in CUD patients.

Gender differences among cannabis self-cultivators in Spain. / Diferencias de género entre autocultivadores de cannabis en España.

The increase in cannabis use coincides with the proliferation of small-scale cannabis cultivation. These crops facilitate substance availability and increased use. Some investigations have studied the characteristics of small-scale cultivators; however, it is not known whether their profiles differ by gender. The aim of the present study was to analyse differences among growers regarding sociodemographic variables, patterns of use and health problems from a gender perspective. A descriptive observational study was designed with a sample of 219 cultivators (157 men and 62 women), aged between 18 and 34. Problematic use of cannabis (CPQ), cannabis dependence (SDS), patterns of abuse (CAST), risky alcohol use (AUDIT), nicotine dependence (FTND) and sociodemographic variables (ad hoc questionnaire) were analysed. The results showed convergence between men and women in some indicators: early onset and daily cannabis use, psychosocial problems deriving from use, a similar number of problematic use and cannabis dependence cases, as well as a polydrug trend. Conversely, men reported greater physical problems and more intensive use of cannabis and alcohol. Women cannabis growers presented a similar profile to their male counterparts, whereas studies of the general population have shown cannabis use to be higher among men than women. This fact supports the relevance of researching specific risk factors related to gender, which can exert a differential influence on the intensity of use, and their relationship with small-scale cultivation. Implications of these results for planning preventive strategies and treatment are discussed from a gender perspective.

El incremento en el consumo de cannabis coincide con la proliferación del cultivo de cannabis a pequeña escala. Estos cultivos favorecen la disponibilidad de la sustancia e incrementan su consumo. Investigaciones previas han dejado entrever las características definitorias de poblaciones de cultivadores, pero se desconoce si su perfil difiere en función del género. El objeto del presente estudio fue analizar las diferencias de género en autocultivadores en relación con variables sociodemográficas, patrones de consumo y problemáticas de salud. Se diseñó un estudio observacional descriptivo, con una muestra de 219 cultivadores (157 hombres y 62 mujeres), con edades entre 18 y 34 años. Se analizaron problemas de consumo (CPQ), dependencia del cannabis (SDS), patrones de abuso(CAST), consumo de riesgo de alcohol (AUDIT), dependencia de la nicotina (FTND) y variables sociodemográficas (cuestionario ad hoc). Los resultados mostraron convergencia entre hombres y mujeres en los indicadores: inicio temprano y consumo diario de cannabis, problemáticas psicosociales derivadas del consumo, un número similar de casos de consumo problemático y dependencia del cannabis y tendencia al policonsumo. Contrariamente, los varones refirieron mayores problemas físicos, consumo intensivo de cannabis y de alcohol. A diferencia de los estudios en población general, donde el consumo de cannabis es mayor en hombres que en mujeres, las mujeres autocultivadoras presentan un perfil similar a los autocultivadores hombres. Este hecho sugiere la necesidad de investigar sobre los factores de riesgo específicos al género que pueden estar influyendo diferencialmente en el consumo intensivo y su relación con el autocultivo. Se discuten las implicaciones de los resultados en la planificación de estrategias preventivas y de tratamiento, desde una perspectiva de género.

An economic analysis of different cannabis decriminalization scenarios.

BACKGROUND: Cannabis is the most widely used illegal drug in European countries. In countries with repressive cannabis policies, prevalence is not lower than in those with tolerant laws. Repressive policies not only have uncertain benefits but they are also expensive. Economists tend to believe that good public policies minimize social costs; that is, they help to improve collective wellbeing at a lower cost. METHOD: The paper draws on a review of international literature on cannabis legislative models around the world. After a description of some of the fundamental concepts of a market economy, several existing policy scenarios will be presented and analyzed from an economic perspective. Strength and weaknesses will be summarized for each alternative. RESULTS: In addition to consumption tolerance in countries such as the Netherlands, recent decriminalization of domestic markets in the Unites States and Uruguay present alternatives to reduce the negative impact of cannabis on society. Earlier initiation age and rise in consumption are unintended potential consequences of decriminalization that need to be addressed by public authorities when designing a liberalized cannabis policy environment. Price is a key variable that needs to be addressed to prevent a rise in consumption. CONCLUSION: Repressive cannabis policies are expensive and have limited impact on consumption. Consumption legalization significantly reduces expenses for repression and law enforcement, allowing for the allocation of more resources to other targets such as education and prevention. With legalization of supply along with consumption, repression and law enforcement costs are reduced even further. Moreover, a legal market would create employment and generate tax revenues that could be allocated to the prevention of increased consumption. Legalizing cannabis would not lead to a sudden rise in consumption, providing the duty imposed by the state kept the product at its current price.

Can price get the monkey off our back? A meta-analysis of illicit drug demand.

Because of the increased availability of price data over the past 15 years, several studies have estimated the demand for illicit drugs, providing 462 estimates of the price elasticity. Results from estimating several meta-regressions reveal that these price elasticity estimates are influenced by a number of study characteristics. For instance, the price elasticity differs across drugs, with its absolute value being smallest for marijuana, compared with cocaine and heroin. Furthermore, price elasticity estimates are sensitive to whether demand is modeled in the short-run or the long-run, measures of quantity and price, whether or not alcohol and other illicit drugs are included in the specification of demand, and the location of demand. However, a number of other factors, including the functional form of demand, several specification issues, the type of data and method used to estimate demand, and the quality of the publication outlet, have less influence on the price elasticity.

The effects of cannabis use on major adverse cardiovascular outcomes, mortality, cost of hospitalization, and cardiac arrhythmias: A Retrospective analysis using the national inpatient sample.

As cannabis use is rising and federal restrictions are easing, it is important to recognize its potential adverse cardiovascular effects for better risk stratification and informed guidance. We conducted a retrospective study using the National Inpatient Sample database from 2016 to 2019, where 39,992 subjects were enrolled. The extracted population was classified into two groups based on the presence of cannabis-related disorders. The primary outcomes of the study were cardiovascular-related adverse events, in-hospital mortality, total cost of hospitalization, and cardiac dysrhythmias. The study concluded that cannabis use disorder was not significantly associated with the likelihood of having a cardiovascular adverse event, cardiac dysrhythmias, or with the cost of hospitalization when controlling for other variables (p = 0.257, p=0.481 & p = 0.481, respectively). However, it was significantly associated with the likelihood of mortality (p < 0.0001). Further randomized trials are needed to confirm these findings and elaborate on identified associations.

Adult work commitment, financial stability, and social environment as related to trajectories of marijuana use beginning in adolescence.

BACKGROUND: The objective of this study is to examine trajectories of marijuana use among African Americans and Puerto Ricans from adolescence to adulthood, with attention paid to work commitment, financial stability, drug use, and violence. METHODS: Participants (N = 816) completed in-class questionnaires as students in the East Harlem area of New York City at the first wave and provided follow-up data at 4 additional points in time (mean ages = 14, 19, 24, 29, and 32 years). Among 816 participants, there were 60% females, 52% African American, and 48% Puerto Ricans. RESULTS: The chronic marijuana user trajectory group compared with the none or low, increasing, and/or moderate marijuana user trajectory group was associated with negative aspects of work commitment, financial stability, and the social environment. The chronic marijuana user group was similar to the increasing marijuana user group on work commitment and financial stability. CONCLUSIONS: These results suggest that treating marijuana use in late adolescence may reduce difficulty in the assumption of adult roles. Because chronic marijuana users experienced the most adverse effects in each of the domains, they require more intense clinical intervention than moderate marijuana users.

Association between cannabis and psychiatric hospitalization.

OBJECTIVE: To investigate the relationship between cannabis use and mental health. METHOD: A cross-sectional analysis in a sample of 17 698 individuals with a mean age of 22 years (SD: 4.2). Participants provided information on the amount and initial age of cannabis use and history of psychiatric hospitalizations through a web-based questionnaire. To quantify Δ(9) -tetrahydrocannabinol exposure, we operationalized cannabis use as the amount of money spent on cannabis per week over the last month. The odds ratio of having a history of psychiatric hospitalizations was the primary outcome measure. RESULTS: We found a dose-response relationship between the amount of cannabis use and the odds for psychiatric hospitalization. Adjusted odds ratios for hospitalization increased with the amount of cannabis consumed from 1.6 (95% CI: 1.1-2.3) in incidental users to 6.2 (95% CI: 4.3-8.9) in heavy users (>€25/week). Our data suggested that concomitant drug use was an intermediate factor. Exposure to cannabis before the age of 12 years was found to carry a 4.8 (95% CI: 2.9-7.8) times increased odds for past psychiatric hospitalizations. CONCLUSION: We conclude that early and heavy uses of cannabis are each and independently associated with poor mental health in its users.

Does the EQ-5D measure quality of life in schizophrenia?

BACKGROUND: Most health economic evaluations in mental care include outcome measures aimed at specific aspects of health, like symptom improvement, functional improvement and quality of life instead of generic preference based outcome measures. The health economic guidelines (NICE) recommend to include a generic preference based outcome measure, like EQ-5D, in health economic evaluations in order to allow for comparisons of health related quality of life of patient groups across different diseases, providing information particular useful to support health policy decisions and cost-effectiveness analysis. Although the EQ-5D is by far the most widespread outcome measure within the context of economic evaluations, its validity in psychiatric populations has not yet been established unambiguously. An increasing number of articles have tested the validity of the EQ-5D in comparisons with clinical measures in mental health, but only few studies have addressed the correlation between the EQ-5D and a condition-specific quality of life measure in mental health. AIMS OF THE STUDY: The aim of the article is to test for a potential correlation between the preferred generic outcome measure in health economic evaluations EQ-5D and Manchester Short Assessment of Quality of Life (MANSA) in order to assess to what extent quality of life dimensions measured by a psychiatric quality of life measure are captured in the EQ-5D in a population of patients with schizophrenia and cannabis abuse. METHODS: Data analysed is a part of a study of 103 patients with schizophrenia and abuse of cannabis participating in a randomized controlled trial testing a specialized addiction intervention during the period 2008-09. The correlation of the EQ-5D and scores of MANSA was assessed using the Spearman's correlation coefficient. In addition, we tested how the EQ-5D and MANSA correlated with PANSS, GAF and WHO-DAS in order to make comparisons with earlier studies. RESULTS: We found moderate, statistically significant correlations between the EQ-5D index score and MANSA total score (rho = 0.358**). The dimensions 'Mobility', 'Self-Care' and 'Pain/discomfort' on the EQ-5D were overall not sensitive in this population, while the dimensions 'Usual activities' and 'Anxiety/depression' were moderately correlated with MANSA. The EQ-5D and MANSA both showed statistically significant moderate correlations with the clinical measures in the study PANSS, GAF and WHO-DAS. DISCUSSION: Our results suggest that the EQ-5D and MANSA are complementary measures rather than substitutes. IMPLICATIONS FOR HEALTH POLICIES: Mental health interventions often seek to improve the patients' quality of life in a broader perspective, like improving the patients' relationship with family, friends and other network, financial situation, employment and accommodation. If the EQ-5D is used as a single outcome in health economic evaluations of e.g. mental health community interventions, these factors may be overlooked. Based on a relatively small sample, we therefore recommend applying the EQ-5D together with condition-specific quality of life measures in future health economic evaluations in mental health.

Substitution and complementarity in the face of alcohol-specific policy interventions.

AIM: Policy responses to the growing burden of alcohol-related disease fail to consider the interrelated nature of substance misuse and the potential for complex interactions in response to alcohol-specific interventions. This paper considers possible aggregate level responses to the alcohol policy and whether alcohol policy can be expected to reduce overall harm. METHODS: A review and discussion of the relevant literature was conducted. RESULTS: Evidence indicates that those at greatest risk consume stronger alcoholic beverages more frequently, that they are likely to complement their consumption with a range of intoxicants and that they are more likely to substitute alcohol with other substances. CONCLUSIONS: Policies aimed at reducing alcohol consumption can be successful. However, evidence suggests a significant minority of consumers are likely to substitute or complement consumption with a range of intoxicants suggesting that policy is unlikely to reduce all-cause mortality and morbidity. Further research into the nature of substitution and complementarity is required.

The costs and benefits of cannabis control policies
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As is the case for most drugs, cannabis use has costs and benefits, and so do the policies that attempt to minimize the first and maximize the second. This article summarizes what we know about the harmful effects of recreational cannabis use and the benefits of medical cannabis use under the policy of prohibition that prevailed in developed countries until 2012. It outlines three broad ways in which cannabis prohibition may be relaxed, namely, the depenalization of personal possession and use, the legalization of medical use, and the legalization of adult recreational use. It reviews evidence to date on the impacts of each of these forms of liberalization on the costs and benefits of cannabis use. It makes some plausible conjectures about the future impacts of the commercialization of cannabis using experience from the commercialization of the alcohol, tobacco, and gambling industries. Cannabis policy entails unavoidable trade-offs between competing social values in the face of considerable uncertainty about the effects that more liberal cannabis policies will have on cannabis use and its consequences for better or worse.
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El consumo de cannabis, como se da con la mayoría de las drogas, tiene costos y beneficios ; igual ocurre con las políticas que intentan minimizar los primeros y maximizar los segundos. Este artículo resume lo que conocemos acerca de los daños provocados por el consumo recreativo de cannabis y los beneficios de su empleo medicinal según la política de prohibición que prevaleció en los países desarrollados hasta 2012. Se describen tres principales formas en las que la prohibición de cannabis se puede mitigar: la despenalización de la posesión y uso personal, la legalización del uso médico, y la legalización del uso recreativo en adultos. Se revisa la evidencia hasta la fecha sobre los impactos de cada una de estas formas de liberalización en los costos y beneficios del consumo de cannabis. Se hacen algunas posibles conjeturas acerca de los impactos futuros de la comercialización de cannabis utilizando la experiencia al respecto de las industrias del alcohol, el tabaco y de los juegos de azar. Se sabe poco sobre el impacto de la liberalización del consumo de cannabis, así como de sus consecuencias positivas o negativas. Cualquier política sobre este tema implica compromisos inevitables entre valores sociales opuestos.

Comme pour la plupart des drogues, la consommation de cannabis a ses coûts et ses bénéfices. Tout comme les politiques qui s'efforcent de minimiser les premiers et de maximiser les seconds.. Nous résumons dans cet article nos connaissances sur les dangers de l'usage récréatif du cannabis et les bénéfices de son usage médical dans le cadre de la politique d'interdiction qui a prévalu dans les pays développés jusqu'en 2012. Nous y décrivons trois grandes voies d'assouplissement de l'interdiction du cannabis, à savoir la dépénalisation de la possession et de la consommation personnelles, la légalisation de l'utilisation médicale et la légalisation de la consommation récréative par des adultes. Chacune de ces formes de libéralisation influe sur les coûts et les bénéfices de la consommation de cannabis, générant des données analysées ici. En nous inspirant de l'expérience acquise dans le cadre de la commercialisation de l'alcool et la légalisation des jeux de hasard, nous émettons des hypothèses sur les possibles conséquences de la commercialisation du cannabis. L'impact de la libéralisation du cannabis sur sa consommation est peu connu, de même que ses conséquences pour le meilleur ou pour le pire, et toute politique menée à ce sujet implique des compromis inévitables entre des valeurs sociales opposées.

Will the Current COVID-19 Pandemic Impact on Long-term Cannabis Buying Practices?

: The COVID-19 pandemic and the response to have resulted in an increase in sales activity levels on darknet markets during the first 3 months of 2020, mainly related to cannabis products. One key question is whether more people will become used to this form of purchasing their drugs and will they continue with it post COVID-19 lockdown. As one-to-one encrypted communication services or social media apps are increasingly being used, monitoring and interdiction will become much more challenging.

Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health Surveys.

BACKGROUND: Alcohol, tobacco, and illegal drug use cause considerable morbidity and mortality, but good cross-national epidemiological data are limited. This paper describes such data from the first 17 countries participating in the World Health Organization's (WHO's) World Mental Health (WMH) Survey Initiative. METHODS AND FINDINGS: Household surveys with a combined sample size of 85,052 were carried out in the Americas (Colombia, Mexico, United States), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), Middle East and Africa (Israel, Lebanon, Nigeria, South Africa), Asia (Japan, People's Republic of China), and Oceania (New Zealand). The WHO Composite International Diagnostic Interview (CIDI) was used to assess the prevalence and correlates of a wide variety of mental and substance disorders. This paper focuses on lifetime use and age of initiation of tobacco, alcohol, cannabis, and cocaine. Alcohol had been used by most in the Americas, Europe, Japan, and New Zealand, with smaller proportions in the Middle East, Africa, and China. Cannabis use in the US and New Zealand (both 42%) was far higher than in any other country. The US was also an outlier in cocaine use (16%). Males were more likely than females to have used drugs; and a sex-cohort interaction was observed, whereby not only were younger cohorts more likely to use all drugs, but the male-female gap was closing in more recent cohorts. The period of risk for drug initiation also appears to be lengthening longer into adulthood among more recent cohorts. Associations with sociodemographic variables were consistent across countries, as were the curves of incidence of lifetime use. CONCLUSIONS: Globally, drug use is not distributed evenly and is not simply related to drug policy, since countries with stringent user-level illegal drug policies did not have lower levels of use than countries with liberal ones. Sex differences were consistently documented, but are decreasing in more recent cohorts, who also have higher levels of illegal drug use and extensions in the period of risk for initiation.

The incremental inpatient costs associated with marijuana comorbidity.

In this paper we examine the incremental cost of marijuana comorbidity for alcohol, mood and thought diagnoses in hospital settings. We use data from the 1993-2000 National Hospital Discharge Survey to examine the effect on length of stay and the 1995-2000 Florida Hospital Discharge Data to examine charges. General linear modeling (GLM) and propensity score methods are employed to deal with concerns stemming from the distribution of the dependent variables and statistically significant differences in the baseline characteristics of marijuana users versus non-users. Marijuana comorbidity is associated with longer length of stays and higher charges for patients suffering from a primary diagnosis of an alcohol problem. We also find higher average charges for patients suffering from mood disorders, though the finding is not robust across all model specifications. We do not find any significant effects for thought disorders. Findings from this study suggest that a marijuana comorbidity increases the cost of treating patients with alcohol problems and mood disorder diagnoses, implying that there may be real health consequences associated with marijuana abuse and dependence and more work considering this possibility is warranted.

The effects of perceived quality on the behavioural economics of alcohol, amphetamine, cannabis, cocaine, and ecstasy purchases.

Previous research has indicated that non-dependent polydrug users are willing to pay more money to buy good quality drugs as their income increased. This study sought to examine whether altering the perceived quality of controlled drugs would affect drug purchases if the monetary price remained fixed. A random sample of 80 polydrug users were recruited. All participants were administered an anonymous questionnaire consisting of the Drug Abuse Screening Test for Adolescents (DAST-A), the Severity of Dependence Scale for cannabis (SDS), the Alcohol Use Disorders Identification Test (AUDIT), the Hospital Anxiety and Depression Scale (HADS), and questions about their drug use. Participants then completed a simulation of controlled drug purchases where the price of alcohol, amphetamine, cannabis, cocaine, and ecstasy remained the same but their perceived quality changed (i.e. unit price increased as the perceived quality decreased). The demand for alcohol was quality inelastic and alcohol quality had no effects on the purchase of any other controlled drug. Demand for cannabis was quality elastic and alcohol substituted for cannabis as its unit price increased. Demand for cocaine was quality elastic and alcohol, cannabis, and ecstasy substituted for cocaine as its unit price increased. Demand for ecstasy was quality elastic and alcohol and cocaine both substituted for ecstasy as its unit price increased. These results suggest that perceived quality influences the demand for controlled drugs and that monitoring the perceived quality of controlled drugs may provide a warning of potential public health problems in the near future.

Understanding clinical complexity in delinquent youth: comorbidities, service utilization, cost, and outcomes.

This study describes the extent and severity of multiple comorbidities in ajuvenile detention center population, and explores how these numerous problems impact the utilization of treatment services, costs, and outcomes including those for substance abuse, mental illness, and criminal activity. Cluster analyses of the outcome scales at intake yielded two groups: youth high (42%) and youth lower (58%) on all factors. Girls experienced the most significant impairments across emotional problems, behavior complexity, internal mental distress, and victimization domains, utilized significantly more units of residential treatment,individual counseling and case management, and had the highest treatment costs. The total cost of services ($1,171,290, N = 114) was significantly related to substance problems in the past year (r = .219, p < .05), emotional problems (r = .237, p < .05), behavior complexity (r = .318, p < .05), internal mental distress (r = .263, p < .05), environmental risk (r = .205, p < .05), and conflict tactics (r = .240, p < .05). Despite initial differences in measures of baseline severity, high and low cluster youth, and boys and girls in general, achieved similar results on the key outcome variables 12 months later. Study implications include a need for co-occurring, integrated treatment efforts that address family, emotional, and mental health problems of delinquent youth (especially females) in order to improve their ability to successfully attend to substance abuse problems and interpersonal conflicts.

The three betrayals of the medical cannabis growing activist: From multiple victimhood to reconstruction, redemption and activism.

While cannabis has been widely used in the UK for over 50 years, it is only in recent decades that domestic cultivation has become established. Public concern, media reporting and policing policy has emphasised the role of profit motivated criminal organisations often working on a large scale and with coerced labour. However, increasingly, another population are growing for medical reasons, to help themselves and others treat or manage difficult, poorly understood, or incurable conditions. Our study sought to further understand the motives, techniques and interactions of cannabis cultivators through interviews with 48 growers and supplementary ethnographic work. As well as those motivated to grow for personal use, social and commercial supply purposes we identified a cohort growing to provide themselves and others with cannabis used for therapeutic purposes. This paper draws primarily on interviews with a sub-group of sixteen medically-motivated growers who were not only involved in treatment, but also embraced the label "activist". Rather than develop techniques of deception they were organising to effect a change in legislation. Rejecting the image of criminal perpetrators, they presented themselves as victims of unjust government policy, an indifferent medical establishment, and brutal and immoral criminal markets. Through cultivation, association, self-healing and apomedication, they have found voice and are shifting the debate over the status of growers and of cannabis itself. The ambiguity of their position as both producers and patients challenges the assumptions underlying legal distinctions between suppliers and users, with potentially profound implications for policy.

The cost-effectiveness of four treatments for marijuana dependence.

AIM: To analyze data from a randomized clinical trial to determine the cost-effectiveness of using contingency management (CM) and motivational/skills building therapy (motivational enhancement therapy/cognitive-behavioral therapy: MET/CBT) to treat young adults with marijuana dependence. PARTICIPANTS, DESIGN AND MEASUREMENTS: A total of 136 marijuana-dependent young adults, all referred by the criminal justice system, were randomized to one of four treatment conditions: MET/CBT with CM, MET/CBT without CM, drug counseling (DC) with CM and DC without CM. Patient outcome measures include the longest duration of confirmed marijuana abstinence (LDA) during treatment and the total number of marijuana-free urine specimens provided during treatment. Costs were collected retrospectively from the provider and include the costs of therapy, patient drug testing, and those associated with the incentives component (value of vouchers, time to administer the voucher system). SETTING: Out-patient substance abuse clinic in New Haven, Connecticut, USA. FINDINGS: Which treatment is the most cost-effective depends on the threshold values of an additional week of LDA or an additional marijuana-free urine specimen. For example, the most effective treatment, MET/CBT with CM, was also the most cost-effective treatment at the highest threshold values, while the least effective treatment, DC, was the most cost-effective at the lowest values. Because consensus threshold values for these patient outcomes do not exist, results are presented showing the ranges of values over which each treatment would be considered cost-effective compared to the others. Acceptability curves are presented to show the decision uncertainty associated with these ranges. The results are shown to be robust to (i) sensitivity analyses on several key cost parameters and (ii) patient outcomes measured during the 6-month follow-up period. CONCLUSIONS: This study uses incremental cost-effectiveness ratios and acceptability curves to shed light on the relative cost-effectiveness of four interventions for treating young adults with marijuana dependence. Given the relatively small and specialized nature of our study sample, and the fact that we examined a CM procedure with a single reinforcement schedule, additional studies are warranted to determine the reliability and generalizability of our results both to alternative marijuana-using populations and to CM procedures with alternative incentive parameters. Nevertheless, the relative durability of effects of MET/CBT compared to DC through the 6-month follow-up, and its cost-effectiveness over a comparatively wide range of threshold values, underscores the promise of this approach.

Retail marijuana purchases in designer and commercial markets in New York City: sales units, weights, and prices per gram.

This paper documents the bifurcation of the market for commercial marijuana from the market for designer marijuana in New York City. Commercial marijuana is usually grown outdoors, imported to NYC, and of average quality. By contrast, several varities of designer marijuana are usually grown indoors from specially bred strains and carefully handled for maximum quality. The mechanisms for marijuana sales include street/park sellers, delivery services, private sales, and storefronts. Retail sales units vary from 5 dollars to 50 dollars and more, but the actual weights and price per gram of retail marijuana purchases lacks scientific precision. Ethnographic staff recruited marijuana purchasers who used digital scales to weigh a purposive sample of 99 marijuana purchases. Results indicate clear differences in price per gram between the purchases of commercial (average 8.20 dollars/g) and designer (average 18.02 dollars/g) marijuana. Designer purchases are more likely to be made by whites, downtown (Lower East Side/Union Square area), via delivery services, and in units of 10 dollar bags, 50 dollar cubes, and eighth and quarter ounces. Commercial marijuana purchases are more likely to be made by blacks, uptown (Harlem), via street dealers, and in units of 5 dollar and 20 dollar bags. Imported commercial types Arizona and Chocolate were only found uptown, while designer brand names describing actual strains like Sour Diesel and White Widow were only found downtown. Findings indicate clear divisions between commercial and designer marijuana markets in New York City. The extent that these differences may be based upon different THC potencies is a matter for future research.

How much for a dime bag? An exploration of youth drug markets.

Relatively little is known about how youth obtain marijuana and other drugs. The Drugs, Alcohol and Violence International (DAVI) study explored youthful drug markets among samples of school students, detained youth, and school dropouts (ages 14-17 years) in the greater metropolitan areas of Philadelphia, Toronto, Montreal, and Amsterdam. Students frequently reported sharing drugs, either getting them from others or giving them to others for free. Sharing was less common among the more drug-involved detainees and dropouts. Marijuana was typically obtained either outdoors or in a house or apartment. Few youth reported getting marijuana at school. In Amsterdam, where marijuana can be purchased in small quantities in coffeeshops, this was the most common place to get marijuana, even though 18 is the legal age for purchase. Alcohol was also most likely to be obtained in stores or restaurants across all the sites, even though none were of legal age except those in Amsterdam age 16 or older. Youth most often reported purchasing marijuana in nickel, dime or other small bags, which are not standardized units. The exception again was Amsterdam, where youth most often reported quantities in grams or joints, which is how it is sold in coffeeshops. The lack of standardization of units makes economic cost estimates suspect. Even standardized units such as alcohol present problems since youth report a wide range of 'typical purchases.' Survey data can, however, more aptly describe drug market characteristics such as general location of purchase, and relationship with the seller.