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2.
Addiction ; 2021 Nov 17.
Artículo en Inglés | MEDLINE | ID: mdl-34791767

RESUMEN

BACKGROUND AND AIMS: Cannabis withdrawal is a well characterized phenomenon that occurs in approximately half of regular and dependent cannabis users after abrupt cessation or significant reductions in cannabis that contains Δ9 -tetrahydrocannabinol (THC). This review describes the diagnosis, prevalence, course and management of cannabis withdrawal and highlights opportunities for future clinical research. METHODS: Narrative review of literature. RESULTS: Symptom onset typically occurs 24-48 hours after cessation and most symptoms generally peak at days 2-3, with some symptoms lasting up to 3 weeks in heavy cannabis users. The most common features of cannabis withdrawal are anxiety, irritability, anger or aggression, disturbed sleep/dreaming, depressed mood and loss of appetite. Less common physical symptoms include chills, headaches, physical tension, sweating and stomach pain. Despite limited empirical evidence, supportive counselling and psychoeducation are the first line approaches in the management of cannabis withdrawal. There are no medications currently approved specifically for medically assisted withdrawal (MAW). Medications have been used to manage short-term symptoms (e.g., anxiety, sleep, nausea). A number of promising pharmacological agents have been examined in controlled trials but these have been underpowered and positive findings not reliably replicated. Some (e.g., cannabis agonists) are used 'off label' in clinical practice. While inpatient admission is rarely required for MAW, psychiatric comorbidities and polysubstance use and dependence can require additional management to avoid severe complications. CONCLUSIONS: The clinical significance of cannabis withdrawal is that its symptoms may precipitate relapse to cannabis use. Complicated withdrawal may occur in persons with concurrent mental health and polysubstance use.

3.
JAMA Pediatr ; 2021 Oct 25.
Artículo en Inglés | MEDLINE | ID: mdl-34694342

RESUMEN

Importance: Vaping products were initially designed to deliver nicotine as a tobacco cigarette substitute (eg, electronic cigarettes) but are now frequently used to deliver psychoactive substances, such as cannabis and its derivatives. Large, nationally representative surveys, such as Monitoring the Future, found that approximately 1 in 3 grade-12 students vaped cannabis in 2018 alone. Objective: To summarize the findings of epidemiological studies that reported the global prevalence of cannabis vaping in adolescents by survey year and school grades. Data Sources: PubMed, PsycINFO, Scopus, and Web of Science were searched systematically on August 19, 2020, for studies published globally between January 1, 2003, and August 19, 2020. Study Selection: Publications that reported the prevalence of cannabis vaping in adolescents in the general population were included. Data Extraction and Synthesis: Study characteristics and prevalence estimates were extracted from each article. Random-effects meta-analysis based on the DerSimonian and Laird method and meta-regression were performed on lifetime, 12-month, and 30-day prevalence estimates. Meta-regression was also conducted using survey year and school grades as moderators. Main Outcomes and Measures: Prevalence of cannabis vaping. Results: Seventeen studies met the eligibility criteria (n = 198 845 adolescents). Although no restrictions were imposed on study location, all 17 studies were from the US and Canada. Across all school grades, the pooled prevalence increased for lifetime use (6.1% in 2013-2016 to 13.6% in 2019-2020), use in the past 12 months (7.2% in 2017-2018 to 13.2% in 2019-2020), and use in the past 30 days (1.6% in 2013-2016 to 8.4% in 2019-2020). Heterogeneity across studies was large. The limited evidence from studies using similar survey and study designs suggested that adolescents' preference for cannabis products other than dried herbs, which usually contain higher Δ9-tetrahydrocannabinol levels, may have shifted over time. Conclusions and Relevance: The findings of this study suggest that the prevalence of cannabis vaping has increased among adolescents in the US and Canada and that more effective preventive and response measures are required. Trial Registration: PROSPERO Identifier: CRD42020219644.

4.
Psychol Med ; : 1-6, 2021 Oct 21.
Artículo en Inglés | MEDLINE | ID: mdl-34670633

RESUMEN

BACKGROUND: Advocates of the therapeutic use of psychedelic drugs have argued that a promising approach to treatment was prematurely abandoned in the 1960s primarily because of Richard Nixon's 'War on Drugs'.This paper (1) briefly describes research in the 1950s and 1960s in North America on the use of LSD to treat alcohol dependence, anxiety in terminal illness, and anxiety and depression; and (2) discusses the factors that led to its abandonment. METHOD: An analysis of historical scholarship on psychedelic research in the 1950s, 1960s and 1970s in North America. RESULTS: Research on psychedelic drugs in psychiatry was abandoned for a number of reasons that acted in concert. A major factor was that clinical research on psychedelic drugs was caught up in the tighter regulation of pharmaceutical research after the Thalidomide disaster in 1963. Psychedelic drugs also presented special challenges for randomised, placebo-controlled clinical trials in the 1970s that were not as positive as the claims made by their advocates in the 1950s and 1960s. Clinical research became more difficult after 1965 when Sandoz ceased providing psychedelic drugs for research and their nonmedical use was prohibited in 1970. CONCLUSIONS: The demise of psychedelic drug research was not solely due to the 'War on Drugs'. It was hastened by tighter regulation of pharmaceutical research, the failure of controlled clinical trials to live up to the claims of psychedelic advocates, and the pharmaceutical industry's lack of interest in funding clinical trials.

5.
Addiction ; 2021 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-34636121
6.
Subst Abuse Treat Prev Policy ; 16(1): 77, 2021 10 07.
Artículo en Inglés | MEDLINE | ID: mdl-34620191

RESUMEN

BACKGROUND: Canada implemented the legalization and regulation of non-medical cannabis use, production and sale in 2018 aiming to improve public health and safety. While outcomes from legalization reforms in other jurisdictions mostly rely on US-based data have been assessed to be mixed, Canadian data are only emerging. We compiled select population-level data on key indicators to gauge initial developments from pre- to post-legalization of cannabis in Canada. METHODS: We examined indicators data focusing on the following topics: prevalence of cannabis use, frequency of use, methods/products of consumption, driving after cannabis use, and cannabis sourcing. Indicator data were obtained mostly from national and some provincial population surveys. Prevalence or percentages for the indicators pre- and post-legalization (e.g., 2017- 2020), including confidence intervals were reported, with changes noted, as available in and indicated by the data sources. RESULTS: Data suggested selected increases in cannabis use prevalence, mostly among mid- and older- but possibly also younger (e.g., under legal use age) users. Frequency of use and driving after cannabis use among active users do not appear to have changed. Methods of cannabis use show diversifying trends, with decreases in smoking and increases in alternatives use modes (e.g., edibles, vaping). There is a clearly increasing trend towards accessing cannabis from legal sources among adults, while under-legal-use-age youth do not appear to experience heightened barriers to obtaining cannabis in legalization contexts. CONCLUSIONS: Preliminary indicators on cannabis legalization in Canada show a mixed picture, some similar to US-based developments. While some use increases are observed, these do not necessarily represent indications of increases in cannabis-related harm, also since key (e.g., hospitalization or injury) data are lacking to date. There is a gradual embracing of legal supply sources of cannabis among users, which can be expected to serve public health and safety objectives. At the same time, cannabis use and access among under-age users as a principally vulnerable group do not appear to be hindered or reduced by legalization.


Asunto(s)
Cannabis , Adolescente , Adulto , Canadá/epidemiología , Humanos , Legislación de Medicamentos , Prevalencia , Salud Pública
7.
Addiction ; 2021 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-34590359

RESUMEN

BACKGROUND: The lack of an agreed international minimum approach to measuring cannabis use hinders the integration of multidisciplinary evidence on the psychosocial, neurocognitive, clinical and public health consequences of cannabis use. METHODS: A group of 25 international expert cannabis researchers convened to discuss a multidisciplinary framework for minimum standards to measure cannabis use globally in diverse settings. RESULTS: The expert-based consensus agreed upon a three-layered hierarchical framework. Each layer-universal measures, detailed self-report and biological measures-reflected different research priorities and minimum standards, costs and ease of implementation. Additional work is needed to develop valid and precise assessments. CONCLUSIONS: Consistent use of the proposed framework across research, public health, clinical practice and medical settings would facilitate harmonisation of international evidence on cannabis consumption, related harms and approaches to their mitigation.

8.
Int J Drug Policy ; : 103381, 2021 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-34465496

RESUMEN

BACKGROUND: Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based 'Lower Risk Cannabis Use Guidelines' (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis. METHODS: Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process. RESULTS: A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible. CONCLUSIONS: Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.

9.
Artículo en Inglés | MEDLINE | ID: mdl-34411375

RESUMEN

OBJECTIVE: In June 2020, the Australian Government announced that personal importation of nicotine vaping products (NVP) would be prohibited, pending a 12-month classification and regulation review by the Therapeutic Goods Administration. This brief report examines the themes of responses on Twitter to this announcement. METHODS: Simple random sampling was used to retrieve tweets containing keywords from 19 to 26 June 2020. Tweets were manually coded and descriptive statistics calculated for themes and policy position. RESULTS: The vast majority of the 1,168 tweets were anti-policy. Themes included: criticism towards government (59.8%), activism against NVP restriction (38%), potential adverse consequences (30.8%) and support for NVP restriction (1.4%). Tweets that identified potential adverse consequences of NVP restriction cited: smoking relapse for individuals currently using NVPs (75.6%); the impact of policy enforcement (8.6%); illicit market (8.3%); panic buying (3.6%); difficulty obtaining prescriptions (2.8%); and impacts on NVP businesses (2.8%). CONCLUSION: Tweets predominately objected to the policy announcement. Approximately three-quarters of tweets that cited potential adverse consequences of the policy mentioned smoking relapse as their primary concern. Implications for public health: User-generated content on Twitter was primarily used to lobby against the proposed policy, which was subsequently amended.

12.
Addict Behav ; 123: 107073, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34364109

RESUMEN

INTRODUCTION: An increase in electronic cigarette (EC) use among US youth has raised concerns that their use may increase conventional cigarette smoking. METHODS: Repeated cross-sectional data from two large nationally representative samples of US youth were drawn from the National Youth Tobacco Survey (NYTS) and Monitoring the Future (MTF). Students from grade 6-12 of the NYTS (N = 98,454-132,003) and students from grade 12 of the MTF (N = 17,870-30,981) were included in the analyses. Trends in smoking behavior, intention to smoke in the future and perceived smoking harms among youth who do and do not use ECs were estimated from 2014 to 2020 using weighted multinomial logistic regression and predicted marginal probabilities. RESULTS: The prevalence for regular smoking decreased among youth who regularly use ECs. For example, among regular EC users, smoking prevalence decreased from 27.8% to 6.7% (-21%; 99.67% CI:[-32.3%, -9.9%]) in the NYTS between 2014 and 2020 and from 31.8% to 10.6% (-21.2%, 99.67% CI:[-35.0%, -7.3%]) in the MTF between 2014 and 2018. Intent to smoke in the future and perceiving smoking as harmless decreased or remained unchanged during the same period. For example, among regular EC users, there was no significant change in intention to smoke next year in the NYTS between 2014 and 2018; intention to smoke in the next 5 years decreased significantly from 30.7% to 11.2% (-19.5%, 99.67% CI:[-37.7%, -1.3%]) in the MTF. CONCLUSIONS: In two national samples of US youth, smoking prevalence declined by a sizeable relative percentage. Intent to smoke in the future and harm perceptions of smoking declined or remained unchanged while EC use increased. Results provide little evidence that EC use has increased conventional cigarette smoking among youth.


Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Vapeo , Adolescente , Estudios Transversales , Humanos , Intención , Humo , Fumar/epidemiología , Encuestas y Cuestionarios , Tabaco , Estados Unidos/epidemiología
13.
Addict Behav ; 123: 107059, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34365087

RESUMEN

AIM: We examine age-related trends in past-year cannabis use in a series of nationally representative surveys in Australia. METHODS: We analysed data from the largest nationally representative survey in Australia collected between 2001 and 2019 (National Drug Strategy Household Survey [NDSHS]; N = 157,151). Prevalence of past-year daily/occasional (non-daily)/non-use of cannabis use were estimated using weighted multinomial logistic regression and predicted marginal probabilities. Difference-in-difference analysis was used to examine if trends of cannabis use across age groups were different. RESULTS: The youngest age group (14-17 s) witnessed the largest increase in past-year abstinence rate from 79% to 92% from 2001 to 2019 (p < .003); the increase in abstinent rate among the 18-24 and 25-39 were relatively moderate (from 68 to 76% and from 81% to 84% respectively; p < .003). The abstinent rate among the 40-54 s and 55-74 s decreased significantly from 93% to 90% and from 99% to 95% respectively (p < .003). There were similar diverging trends in occasional and daily cannabis use, with decreases in both patterns of use observed among the younger age group (14-17 s and 18-25 s) but increases among the older age group (40-54 s and 55-74 s). CONCLUSION: There is a diverging trend in cannabis use among younger and older age groups in Australia between 2001 and 2019. Cannabis use substantially decreased among the youngest age group (14-17 s) but modestly increased among older people (55-74 s).


Asunto(s)
Cannabis , Anciano , Australia/epidemiología , Humanos , Modelos Logísticos , Prevalencia , Encuestas y Cuestionarios
14.
JAMA ; 326(1): 56-64, 2021 07 06.
Artículo en Inglés | MEDLINE | ID: mdl-34228066

RESUMEN

Importance: Cytisine is more effective than placebo and nicotine replacement therapy for smoking cessation. However, cytisine has not been tested against the most effective smoking cessation medication, varenicline, which is associated with adverse events known to lead to discontinuation of therapy. Objective: To examine whether standard cytisine treatment (25 days) was at least as effective as standard varenicline treatment (84 days) for smoking cessation. Design, Setting, and Participants: This noninferiority, open-label randomized clinical trial with allocation concealment and blinded outcome assessment was undertaken in Australia from November 2017 through May 2019; follow-up was completed in January 2020. A total of 1452 Australian adult daily smokers willing to make a quit attempt were included. Data collection was conducted primarily by computer-assisted telephone interview, but there was an in-person visit to validate the primary outcome. Interventions: Treatments were provided in accordance with the manufacturers' recommended dosage: cytisine (n = 725), 1.5-mg capsules taken 6 times daily initially then gradually reduced over the 25-day course; varenicline (n = 727), 0.5-mg tablets titrated to 1 mg twice daily for 84 days (12 weeks). All participants were offered referral to standard telephone behavioral support. Main Outcomes and Measures: The primary outcome was 6-month continuous abstinence verified using a carbon monoxide breath test at 7-month follow-up. The noninferiority margin was set at 5% and the 1-sided significance threshold was set at .025. Results: Among 1452 participants who were randomized (mean [SD] age, 42.9 [12.7] years; 742 [51.1%] women), 1108 (76.3%) completed the trial. Verified 6-month continuous abstinence rates were 11.7% for the cytisine group and 13.3% for the varenicline group (risk difference, -1.62% [1-sided 97.5% CI, -5.02% to ∞]; P = .03 for noninferiority). Self-reported adverse events occurred less frequently in the cytisine group (997 events among 482 participants) compared with the varenicline group (1206 events among 510 participants) and the incident rate ratio was 0.88 (95% CI, 0.81 to 0.95; P = .002). Conclusions and Relevance: Among daily smokers willing to quit, cytisine treatment for 25 days, compared with varenicline treatment for 84 days, failed to demonstrate noninferiority regarding smoking cessation. Trial Registration: anzctr.org.au Identifier: ACTRN12616001654448.


Asunto(s)
Alcaloides/uso terapéutico , Agentes para el Cese del Hábito de Fumar/uso terapéutico , Cese del Hábito de Fumar/métodos , Vareniclina/uso terapéutico , Adulto , Alcaloides/efectos adversos , Azocinas/efectos adversos , Azocinas/uso terapéutico , Sueños , Femenino , Humanos , Masculino , Persona de Mediana Edad , Náusea/inducido químicamente , Quinolizinas/efectos adversos , Quinolizinas/uso terapéutico , Agentes para el Cese del Hábito de Fumar/efectos adversos , Resultado del Tratamiento , Vareniclina/efectos adversos
15.
Tob Control ; 2021 Jul 26.
Artículo en Inglés | MEDLINE | ID: mdl-34312317

RESUMEN

INTRODUCTION: The rising popularity of TikTok among adolescents may influence their awareness and perceptions of e-cigarette use via user-generated content. This study aimed to examine how e-cigarette/vaping-related videos are portrayed on TikTok. METHODS: The nine most viewed hashtag based keywords were used to identify popular e-cigarette/vaping-related videos on TikTok (n=1000) from its inception (earliest upload date: January 2019) to November 2020. Five researchers independently coded the number of views, likes, user category and theme. RESULTS: A final sample of 808 e-cigarette/vaping-related videos that met study criteria were included. Collectively, these videos were viewed over 1.5 billion times, with a median view count of 1 000 000 (range 112 900-78 600 000) and a median 'likes' count of 143 000 (range 10 000-1 000 000). A majority of the videos portrayed e-cigarette use positively (63%; collectively viewed over 1.1 billion times). Neutral depictions of e-cigarette use were viewed a total of 290 million times (24%) and negative depictions of e-cigarettes were viewed a total of 193 million times (13%). The video themes included (not mutually exclusively): 'comedy and joke' (52%; total of 618 million views), 'lifestyle and acceptability' (35%; 459 million), 'marketing' (29%; 392 million), 'vaping tricks' (20%; 487 million), 'nicotine and addiction' (20%; 194 million), 'creativity' (16%; 322 million) and 'warning' (11%; 131 million). CONCLUSION: Our findings illustrated that positively framed e-cigarette and vaping-related postings available without age restrictions on TikTok-a rising video-sharing platform that is popular among adolescents-have been viewed many times. Effective age restrictions are needed to reduce adolescents' potential exposure to videos that portray vaping positively.

16.
Sci Total Environ ; 789: 148047, 2021 May 26.
Artículo en Inglés | MEDLINE | ID: mdl-34323839

RESUMEN

The medical and societal consequences of the misuse of pharmaceuticals clearly justify the need for comprehensive drug utilization research (DUR). Wastewater-based epidemiology (WBE) employs the analysis of human metabolic excretion products in wastewater to monitor consumption patterns of xenobiotics at the population level. Recently, WBE has demonstrated its potential to evaluate lifestyle factors such as illicit drug, alcohol and tobacco consumption at the population level, in near real-time and with high spatial and temporal resolution. Up until now there have been fewer WBE studies investigating health biomarkers such as pharmaceuticals. WBE publications monitoring the consumption of pharmaceuticals were systematically reviewed from three databases (PubMed, Web of Science and Google Scholar). 64 publications that reported population-normalised mass loads or defined daily doses of pharmaceuticals were selected. We document that WBE could be employed as a complementary information source for DUR. Interest in using WBE approaches for monitoring pharmaceutical use is growing but more foundation research (e.g. compound-specific uncertainties) is required to link WBE data to routine pharmacoepidemiologic information sources and workflows. WBE offers the possibility of i) estimating consumption of pharmaceuticals through the analysis of human metabolic excretion products in wastewater; ii) monitoring spatial and temporal consumption patterns of pharmaceuticals continuously and in near real-time; and iii) triangulating data with other DUR information sources to assess the impacts of strategies or interventions to reduce inappropriate use of pharmaceuticals.

17.
18.
Addiction ; 2021 Jun 29.
Artículo en Inglés | MEDLINE | ID: mdl-34184809

RESUMEN

AIM: To test if there was a reduction in alcohol consumption in wastewater samples in the Northern Territory of Australia after the implementation of a minimum unit alcohol price policy (MUP) in October 2018. DESIGN, SETTING, CASES: Between August 2016 and February 2020, wastewater samples were collected across 66 sites in the Northern Territory and all other states and territories in Australia. Samples were collected every 2 months in capital cities and every 4 months in regional places during this period. Overall, 4917 samples were taken (2816 before MUP and 2101 after). MEASUREMENTS: The number of standard drinks per 1000 people per day in the respective catchment areas was estimated based on the concentration of an alcohol-specific metabolite, ethyl sulphate in the samples (using the excretion factor of ethyl sulphate, the flow of wastewater entering the wastewater treatment plants and the population of each wastewater catchment). FINDINGS: Results from a linear mixed model showed that there was a large drop in alcohol consumption immediately after the MUP in Northern Territory [estimated drop = 1231, 99% confidence interval (CI) = 830, 1633; 38.75%]. There was no significant drop in all other states/territories except for Queensland, which showed a significant but much smaller drop (estimated drop: 310; 99% CI = 114, 550). One year after the MUP, the drop narrowed to 520 (99% CI = 189, 851) and was no longer statistically significant in February 2020 (15 months after MUP; estimated drop = 283, 99% CI = -114, 681). CONCLUSIONS: Per-capita consumption of alcohol appears to have decreased substantially in the Northern Territory of Australia immediately after the implementation of a minimum unit price but consumption steadily recovered and almost returned to the pre-MUP consumption level after 15 months.

19.
Neuropharmacology ; 193: 108610, 2021 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-34010617

RESUMEN

The legality of cannabis use has been changing in a number of jurisdictions around the world. In the U.S., it has been legalised for medicinal and/or recreational uses in 34 jurisdictions and counting. This study leverages the decades-long experience of legalisation in the U.S. to provide an overview of the associated changes in public attitudes, cannabis markets and adverse health effects. We found a broad-based warming of public attitudes toward legalisation, potentially influenced by the increasingly positive portrayal of cannabis in media and declines in cannabis risk perceptions. Potency of cannabis products increased significantly while prices fell sharply. Although adults were less responsive to price changes than adolescents, adults who use cannabis regularly were sensitive to prices, with an estimated 10% price reduction leading to about 2.5% increase in the rate of use. Overall, past-year cannabis use has increased in adults since 2002, and adults over 26 years old who resided in states with medicinal cannabis laws were more likely to have used cannabis in the past 30 days, to have used daily, and to have higher rates of cannabis use disorders than adults who resided in states without legalised medicinal cannabis. Traffic fatalities involving cannabis temporarily increased in some states post-legalisation, and there were more presentations to medical services related to chronic regular cannabis use. There is suggestive evidence that adverse health consequences have increased among people who use cannabis regularly since legalisation. More robust research is needed to determine whether these effects of legalisation are temporary or long-term.

20.
Drug Alcohol Rev ; 40(6): 882-883, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34002892
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