Observed Trajectories of Cannabis Use and Concurrent Longitudinal Outcomes in Youth and Young Adults Receiving Coordinated Specialty Care for Early Psychosis.

Cannabis use is present and persistent in young adults with early psychosis receiving Coordinated Specialty Care (CSC) in the United States. While CSC programs are effective in improving quality of life, helping individuals reach goals, and promoting recovery, cannabis use may limit the extent of these improvements. This study extended upon previous findings to examine trajectories of cannabis use among individuals with early psychosis. The sample consisted of 1325 CSC participants enrolled for more than one year at OnTrackNY and followed up to two years, categorized into three groups: no use, reduced use, and persistent use. Baseline demographic and clinical differences were compared across groups and associations between clinical and psychosocial outcomes at 12 months and 24 months were examined across groups. Of the sample, 40 % remained persistent users over two years while 12.8 % reduced their use. At baseline, persistent users were younger (p = 0.011), more likely to be male (p < 0.001), had lower education levels (p = 0.019), and were more likely to have had past legal issues prior to admission (p < 0.001) than non-users. At 2 years, persistent users had significantly worse symptom scores than non-users (p = 0.0003) and reduced users (p = 0.0004). These findings highlight the presence of persistent cannabis use being common in this population and the need to improve substance use treatment offered to allow more CSC participants to achieve improved outcomes.

A pilot trial of a brief intervention for cannabis use supplemented with a substance-free activity session or relaxation training.

OBJECTIVE: Cannabis use is increasing among college students and commonly co-occurs with anxiety symptoms in this age group. Interventions that reduce anxiety may also reduce cannabis use. Behavioral economic theory suggests that substance use reductions are most likely when there is an increase in substance-free reinforcement. This randomized pilot trial evaluated the efficacy of a brief motivational intervention (BMI) for cannabis supplemented by either a substance-free activity session (SFAS) or a relaxation training (RT) session for reducing cannabis use, problems, craving, and anxiety symptoms. METHOD: One hundred thirty-two college students (Mage = 19.9; 54% female; 67% White, 31% Black) who reported five or more past-month cannabis use days were randomized to: (a) assessment-only (AO); (b) BMI plus SFAS; or (c) BMI plus RT. Participants in the BMI conditions received two individual counselor-administered sessions plus a brief phone booster session. Outcomes were evaluated 1- and 6-months postintervention. RESULTS: Relative to assessment, both BMI + SFAS and BMI + RT were associated with significant reductions in cannabis problems and craving at 1-month follow-up, and significant reductions in anxiety at 6-month follow-up. Relative to AO, BMI + RT was associated with significant reductions in cannabis use at 1-month follow-up. There were no differences between BMI conditions. CONCLUSIONS: This pilot trial was not adequately powered to conclusively evaluate relative efficacy but provides preliminary support for the short-term efficacy of both two-session interventions for reducing anxiety and cannabis-related risk among nontreatment seeking emerging adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

¿Es posible crear la adecuada sensación de riesgo entre los consumidores de cannabis medicinal? / Can we increase risk perception among medical cannabis users?

Es cada vez mayor el número de investigaciones relacionadas con las posibles aplicaciones terapéuticas de los cannabinoides. Aunque en algunas enfermedades los resultados obtenidos son esperanzadores, la investigación en desarrollo está en sus etapas iniciales. Para algunos síntomas se ha probado la efectividad medicinal de los cannabinoides. Pero, en muchos casos no se dispone todavía de la adecuada evidencia al respecto, ni son suficientes los datos existentes sobre los riesgos asociados al consumo de cannabis medicinal. (AU)

Increasing collaboration and translation in epidemiology and intervention research.

Epidemiologic research serves as an important foundation for intervention research. In this way, it can contribute to vast improvements in public health. However, to fully capitalize on what is learned through epidemiology, collaborations must ensure the translation of epidemiologic findings into both treatment and prevention interventions. This commentary suggests some ways in which epidemiology can inform intervention research and how intervention research can be backtranslated so that epidemiological studies are designed to better inform intervention design. The commentary does this by using as examples the original contributions in this special section on the intergenerational transmission of cannabis use. These studies identify several ways in which epidemiology can inform intervention and discuss mechanisms of risk transmission from one generation to the next, such as parental monitoring, parent norms around substance use or parenting strategies, poor inhibitory control, or perceptions of harm from substance use. Targeting these mechanisms could be important for effective intervention. The papers further explore factors that might mitigate or amplify the association between parental and offspring use of cannabis, such as active coping or harsh parenting. Finally, to ensure bridging between substance abuse epidemiology and intervention research, this article considers research training practices. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Marijuana Legalization and Youth.

Various states have legalized marijuana for medical purposes and/or decriminalized recreational marijuana use. These changes coincide with a decrease in perceived harmfulness of the drug and an increase in its use among youth. This change is of critical concern because of the potential harmful impact of marijuana exposure on adolescents. Marijuana use has been associated with several adverse mental health outcomes, including increased incidence of addiction and comorbid substance use, suicidality, and new-onset psychosis. Negative impacts on cognition and academic performance have also been observed. As the trend toward legalization continues, the pediatric community will be called on to navigate the subsequent challenges that arise with changing policies. Pediatricians are uniquely positioned to provide innovative care and educate youth and families on the ever-evolving issues pertaining to the impact of marijuana legalization on communities. In this article, we present and analyze the most up-to-date data on the effects of legalization on adolescent marijuana use, the effects of adolescent use on mental health and cognitive outcomes, and the current interventions being recommended for use in pediatric office settings.

A web-based episodic specificity and future thinking session modulates delay discounting in cannabis users.

Episodic future thinking (EFT), a brief intervention involving mental simulation of positive future events, improves delay discounting (DD) in nicotine and alcohol dependent individuals. This study is the first to assess effects of a single-session, online episodic training (ET) on constructs that might impact cannabis use and cannabis use disorder. A sample of 200 active cannabis users recruited via Amazon Mechanical Turk were randomized to an EFT group (n = 102) or an episodic recent thinking control group (ERT; n = 98). A novel episodic specificity induction (ES) was included to enhance quality of episodic thinking for the ET group, and an ES attention control was provided to the ERT group (control training group; CT). Quality and manipulation ratings of event excitement, vividness, importance, and enjoyment of trainings were collected in addition to DD tasks (gains and losses) and readiness to change cannabis use. The ET group reported higher overall quality and manipulation ratings than did the CT group (p < .001, d = 0.79). DD of gains was lower in the ET relative to those of the CT group after controlling for relevant variables (p = .003, d = 0.48), unlike DD of losses (p = .50, d = 0.11). The ET group showed larger pre/post increases in readiness to change, but they were not statistically significant (p = .069, d = 0.26). These effects, following a session of online ET, suggests that ET may positively impact factors related to reduction in cannabis use. Differential effects of EFT and ES components on DD and the development of ET as an adjunctive mHealth intervention targeting reduction in cannabis use appears warranted. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Marijuana Use in Patients With Cardiovascular Disease: JACC Review Topic of the Week.

Marijuana use is increasing as more states are legalizing cannabis for both medicinal and recreational purposes. National survey data estimate that >2 million Americans with established cardiovascular diseases currently use or have used marijuana in its variety of forms, including inhalation and vaping. Cannabinoid receptors are distributed in multiple tissue beds and cells, including platelets, adipose tissue, and myocytes. Observational data suggest associations between marijuana and a broad range of adverse cardiovascular risks. Marijuana is becoming increasingly potent, and smoking marijuana carries many of the same cardiovascular health hazards as smoking tobacco. Synthetic cannabinoids have been linked to more sustained and deleterious pharmacodynamic effects. Marijuana is classified as a Schedule I substance, thus limiting its rigorous study for cardiovascular health effects. This review summarizes cardiovascular considerations related to marijuana use, pharmacological interactions, and future steps to provide clearer guidance regarding its cardiovascular safety. Screening for marijuana use is encouraged, especially in young patients presenting with cardiovascular disease.

A randomized clinical trial of motivational interviewing plus skills training vs. Relaxation plus education and 12-Steps for substance using incarcerated youth: Effects on alcohol, marijuana and crimes of aggression.

BACKGROUND: Motivational Interviewing plus Cognitive Behavior Therapy (MI/CBT) has been used to reduce adolescent substance use, but has rarely been applied in youth correctional settings. This trial compared MI/CBT against Relaxation Training plus Substance-Education/12-Steps (RT/SET) to reduce substance use and crime among incarcerated youth. METHODS: Participants (N = 199) were incarcerated juveniles (64.8 % non-White, 10.1 % girls, mean age of 17.1 years). Two individual sessions of MI (or RT) were followed by 10 group sessions of CBT (or SET). Youth were randomized to condition with follow-ups at 3- and 6-months after release. Major outcomes included alcohol, marijuana and crimes involving aggression. RESULTS: A marginal treatment by time interaction was found for percent heavy drinking days, with follow-up tests indicating less alcohol use in RT/SET than MI/CBT at 6 months, and increased use within MI/CBT from 3 to 6 months. A significant treatment by time interaction was found for alcohol-related predatory aggression, with follow-up tests indicating fewer youth engaged in this behavior from 3 to 6 months within RT/SET, and weak evidence favoring MI/CBT over RT/SET at 3 months. General predatory aggression decreased from 3 to 6-months for both treatments. CONCLUSIONS: Although weak evidence was found favoring MI/CBT with respect to alcohol-related predatory aggression, results generally support RT/SET in reducing percent heavy drinking days.

Working memory training and high magnitude incentives for youth cannabis use: A SMART pilot trial.

The purpose of this sequential multiple-assignment randomization treatment pilot study was to examine if (a) adding working memory training to contingency management (CM) for youth with cannabis use disorder (CUD) and (b) switching nonresponding youth to higher magnitude CM incentives boosts outcomes. In Phase 1, youth with CUD (n = 59, M age = 16, male = 71%) attending an intensive outpatient program were randomly assigned to 14 weeks of CM only or CM plus working memory training (WMT). In Week 4, a Phase 2 treatment was assigned. Those with negative urine drug tests (responders) continued in their Phase 1 treatment. Those who were drug positive (nonresponders) were randomly assigned to remain in their Phase 1 treatment or to higher magnitude CM. Zero-inflated negative binomial models comparing those assigned to CM versus CM + WMT indicated no differences in the likelihood of having ≥ 1 week of continuous abstinence or longer abstinence duration. Those assigned to WMT showed greater but nonsignificant improvements in working memory (n = 35; ß = .69, p = .06). Working memory improvements were associated with achieving any abstinence (odds ratio = 3.50, 95% CI [1.01, 12.10], p = .05). Phase 2 randomization to higher magnitude CM did not boost outcomes. Overall results suggest that WMT appears promising, but the sample size was small, attrition was high, and replication is important. Alternative strategies should continue to be explored to improve outcomes for adolescent substance use disorders, such as different approaches for nonresponders, tailoring to other baseline or response characteristics, or more robust first-line interventions. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Patterns of marijuana use and physical health indicators among Canadian youth.

We examine how trajectories of marijuana use in Canadian youth (ages 15 to 28) are related to physical health indicators in adolescence and young adulthood. Youth were initially recruited in 2003 (N = 662; 48% male; ages 12 to 18) and followed for six waves. Five trajectories of marijuana use (Abstainers-29%, Occasional users-27%, Decreasers-14%, Increasers-20% and Chronic users-11%) were identified. Chronic users reported more physical symptoms, poorer physical self-concept, less physical activity, poorer eating practices, less sleep, and higher number of sexual partners during adolescence than other classes. Decreasers also reported poorer physical self-concept and poorer eating practices than abstainers. Other trajectory classes showed few significant health problems. Chronic users also reported more acute health problems (i.e. serious injuries, early sexual debut, higher number of sexual partners, greater likelihood of having a STI) in young adulthood than all other classes contributing to costs of healthcare. Youth who engage in early, frequent and continued use of marijuana from adolescence to young adulthood are at-risk of physical health problems in adolescence and young adulthood.

Is cannabis use associated with tobacco cessation outcome? An observational cohort study in primary care.

BACKGROUND: Some studies suggest cannabis use negatively affects tobacco cessation outcomes, but findings have been mixed. We examined whether cannabis use was associated with tobacco cessation outcomes in a real-world primary care setting. METHODS: The analytic dataset consisted of 35,246 patients who enrolled between 2014 and 2016 in a primary care-based smoking cessation program in Ontario, Canada. Past 30-day cannabis use, for recreational or medical purposes, was self-reported at enrollment. Thirty-day point prevalence tobacco smoking abstinence was self-reported via online or telephone survey at 6 months post-enrollment. RESULTS: Thirty days prior to enrollment, 79.9 % of patients had not used cannabis, 16.3 % used cannabis for recreational purposes only, and 3.8 % used cannabis for medical purposes. Unadjusted and adjusted odds of tobacco cessation at 6 months were reduced for patients using cannabis compared to non-users (ORs = 0.76-0.86, ps<0.05). When cannabis use was categorized by purpose, both unadjusted and adjusted odds of cessation were significantly lower for recreational users (ORs = 0.77-0.84, ps<0.05). Medical users had decreased odds of cessation in unadjusted analysis (OR = 0.74, 95 % CI = 0.61-0.89, p = 0.001), but not after adjustment for potential confounders. However, post-estimation contrasts did not indicate a significant difference between the effect of recreational and medical cannabis use. CONCLUSIONS: In a large real-world sample of patients seeking smoking cessation treatment, concurrent cannabis use was associated with decreased success with quitting smoking. Recreational cannabis use was consistently related to poorer cessation outcomes, but medical use was not. Additional research is needed to inform treatment strategies for this growing sub-population of smokers.

Conhecimento dos profissionais de enfermagem acerca de fitoterápicos a base de canabinoides: Uma revisão integrativa / Knowledge of nursing professionals about canabinoid based phytotherapes: an integrative review

Introdução: Considerada a primeira planta cultivada pelo homem, a Cannabis apresenta registros históricos datados de 4000 a.C. Acredita-se que tenha origem das regiões temperadas e tropicais da Ásia. Com o decorrer do tempo, a planta vem se destacando devido ao seu alto potencial terapêutico para diversas patologias, levando assim a uma necessidade de compreensão, por parte dos profissionais de saúde, em relação a suas aplicações, focando na qualidade do cuidado oferecido ao paciente que faz uso de seus fitoterápicos, sendo eles a base dos principais canabinoides da planta, Canabidiol (CBD) e Tetrahidrocanabinol (THC). Objetivo: Revisar a literatura científica sobre o conhecimento dos profissionais de enfermagem relaciona do ao cuidado de pacientes que utilizam à terapia medicamentosa a base de canabinoides. Métodos: Revisão integrativa de literatura, buscando reunir resultados e desenvolver uma explicação sobre o tema, com os descritores "Cannabis", "Maconha" ou "CBD/THC", combinados com "Enfermagem" ou "Nurse". Resultados: A amostra final contou com 13 artigos, divididos em dois tópicos, sendo o primeiro relacionado ao conhecimento dos profissionais da enfermagem e, o segundo, apresentando a visão dos profissionais sobre o uso da Cannabis como tratamento medicinal. Conclusão: Notou-se uma concordância entre estudos revisados em ambos os tópicos, principalmente relacionados à necessidade de ampliar o conhecimento especifico dos profissionais sobre Cannabis para fins terapêuticos. Fornecer uma melhoria na qualidade do ensino relacionado à Cannabis medicinal, assim como cursos complementares para profissionais já formados, buscando garantir uma melhora na qualidade do cuidado para com os pacientes.

Introduction: Considered the first plant cultivated by man, Cannabis has historical records dating from 4000 B.C. It is believed to have originated in the temperate and tropical regions of Asia. Over time, the plant has stood out due to its high therapeutic potential for various pathologies, thus leading to a need for health professionals to understand its applications, focusing on the quality of care offered to the patient that makes use of its phytotherapics, being they the base of the main cannabinoids of the plant, Cannabidiol (CBD) and Tetrahydrocannabinol (THC). Objective: To review the scientific literature on the knowledge of nursing professionals related to the care of patients who use cannabinoid-based drug therapy. Methods: Integrative literature review, seeking to gather results and develop an explanation on the topic, with the keywords "Cannabis", "Marijuana" or "CBD / THC", combined with "Nursing" or "Nurse". Results: The final sample consisted of 13 articles, divided into two topics, the first related to the knowledge of nursing professionals and the second, presenting the professionals' view on the use of Cannabis as a medicinal treatment. Conclusion: There was an agreement between studies reviewed on both topics, mainly related to the need to expand the specific knowledge of professionals about Cannabis for therapeutic purposes. Provide an improvement in the quality of teaching related to medical Cannabis, as well as complementary courses for trained professionals, seeking to ensure an improvement in the quality of care for patients.

O autocultivo de Cannabis e a tecnologia social / Cannabis self-cultivation and social technology

Resumo O objetivo deste trabalho é analisar o autocultivo de Cannabis para fins medicinais no Brasil, avaliando em que medida a prática poderia ser enquadrada como uma tecnologia social, na formulação de Renato Dagnino. Com base em dados coletados em trabalho de campo (entrevistas semiestruturadas) em dois centros urbanos no Brasil (São Paulo, Rio de Janeiro) e de uma participante nos Estados Unidos, identificam-se características dessas práticas que as aproximam de uma tecnologia social, como a adaptação a pequena escala, o atendimento a demandas sociais por meio de trabalho cognitivo, a participação ativa de produtores e usuários em seu desenvolvimento, e a ausência de diferenciação entre patrão e empregado. Pondera-se, entretanto, que a noção de tecnologia social está bastante ligada a um objetivo de transformação do setor produtivo, o que talvez limite a aplicação desse conceito em situações de produção não-comercial, para atendimento de necessidades diretas; e que a consideração dos riscos na produção de medicamentos talvez torne pouco aconselhável a generalização de práticas caseiras como a do autocultivo. Propõe-se que essa situação poderia ser remediada com o emprego de estratégias de ciência aberta e cidadã, envolvendo o diálogo com instituições públicas do campo tecnológico e científico.

Abstract The objective of this study is to analyze Cannabis self-cultivation for medicinal purposes in Brazil, evaluating to what extent the practice may fit into the framework of what Renato Dagnino termed a social technology. Based on data collected during fieldwork (semi-structured interviews) carried out in two Brazilian urban centers (São Paulo and Rio de Janeiro) and from a participant in the United States, we identified characteristics of these practices that make them akin to a social technology: adaptation to small-scale production, use of cognitive labor to meet social demands, active participation of producers and users in the practice's development, and lack of differentiation between boss and employee. It is worth noting, however, that the notion of social technology is closely linked to the objective of transforming the productive sector. This may limit the application of this concept to non-commercial production aimed at satisfying direct needs. Moreover, given the risks involved in the production of medicines, the generalization of homemade practices such as self-cultivation may not be advisable. These issues could be remedied by the use of open, democratic and citizen-oriented scientific strategies, involving dialogue with public institutions in the technological and scientific field.

Marijuana and alcohol use among injured drivers evaluated at level I trauma centers in Arizona, 2008-2014.

BACKGROUND: We examined marijuana and alcohol use trends among drivers aged ≥16 years evaluated at Level I trauma centers before and after Arizona legalized medical marijuana in April 2011. METHODS: We conducted interrupted time series (ITS) analysis of urine drug screens for marijuana metabolites and blood alcohol concentration (BAC) data from the 2008-2014 Arizona State Trauma Registry. RESULTS: Among 30,083 injured drivers, 14,710 had marijuana test results, and 2590 were positive for marijuana; of these, 1087 (42%) also tested positive for alcohol. Among 23,186 drivers with BAC results, 5266 exceeded the legal limit for their age. Compared with prelaw trends (models if law had not been enacted), postlaw models showed small but significant annual increases in the proportions of drivers testing positive for either substance. By the end of 2014, the proportion of drivers testing positive for marijuana was 9.6% versus a projected 5.6% if the law had not been enacted, and the proportion of drivers with illegal BACs was 15.7% versus a projected 8.2%. When ITS was restricted to only substance-tested drivers, no significant differences were detected. CONCLUSIONS: Despite the small annual postlaw increases in the proportion of marijuana-positive drivers compared with the prelaw trend, alcohol-impaired driving remains a more prevalent threat to road safety in Arizona.

"Debt on Me Head": A Qualitative Study of the Experience of Teenage Cannabis Users in Treatment.

BACKGROUND: Cannabis is the most commonly used illicit drug in most western countries. In Ireland, it now accounts for most new presentations to substance use treatment services. Cannabis use for most of these people commenced during adolescence. Although a significant amount of research has been conducted on the effects of cannabis on physical and mental health, less is known about the experiences of young cannabis users. OBJECTIVE: The aim of this study was to understand more about the experience of young, treatment-seeking, cannabis users. METHODS: This descriptive qualitative study interviewed eight adolescents who were attending outpatient treatment services for cannabis misuse in Dublin, Ireland. Data were analyzed using thematic analysis. RESULTS: Six themes were identified incorporating the early onset of cannabis and heavy use, involvement in criminality including drug dealing to pay for cannabis, ambivalence, experience of treatment, and damage to relationships. These themes are discussed in light of emerging literature. CONCLUSION: Young cannabis users in treatment can clearly identify many negative aspects of their cannabis use but are particularly ambivalent toward cannabis. Reluctance to aim for abstinence is common.

Online personalized feedback intervention for cannabis-using college students reduces cannabis-related problems among women.

There is growing evidence that college cannabis use is associated with use-related problems, yet efforts to reduce cannabis-related problems via online personalized feedback interventions (PFIs) have had limited success in significantly reducing risky cannabis use among college students. However, men and women may respond differently to such interventions and failure to examine effects of gender may obfuscate intervention effects. Thus, the current study tested intervention effects (moderated by gender) of an online, university-specific PFI for high-risk cannabis users (i.e., past-month cannabis users with at least one recent cannabis-related problem) who were randomly assigned to an online PFI (n = 102) or an online personalized normative feedback-only condition (PNF-only; n = 102). Gender moderated the relationship between condition and one-month follow-up problems, such that women in the PFI condition reported fewer cannabis-related problems at follow-up than women in the PNF-only condition. Men in the PFI condition did not significantly differ from men in the PNF-only condition on use-related problems at follow-up. Cannabis PFIs may be efficacious for reducing cannabis use-related problems among undergraduate women (but not men) and women may benefit from online interventions that include problem-focused components.