Preferences of Young Adults With Psychosis for Cannabis-Focused Harm Reduction Interventions: A Cross-Sectional Study: Préférences des jeunes adultes souffrant de psychose pour les interventions de réduction des méfaits axées sur le cannabis : une étude transversale.

OBJECTIVES: Cannabis use is common in people with early-phase psychosis (EP) and is associated with worse treatment outcomes. Few targeted interventions for cannabis use behaviour in this population exist, most focusing on abstinence, none focusing on harm reduction. Many people with EP will not seek treatment for their cannabis use with current therapeutic options. Understanding preferences for cannabis-focused harm reduction interventions may be key to improving outcomes. This study aimed to determine preferences of young adults with EP who use cannabis for cannabis-focused harm reduction interventions. METHODS: Eighty-nine young adults across Canada with EP interested in reducing cannabis-related harms were recruited. An online questionnaire combining conventional survey methodology and two unique discrete choice experiments (DCEs) was administered. One DCE focused on attributes of core harm reduction interventions (DCE 1) and the second on attributes of boosters (DCE 2). We analysed these using mixed ranked-ordered logistic regression models. Preference questions using conventional survey methodology were analysed using summary statistics. RESULTS: Preferred characteristics for cannabis-focused harm reduction interventions (DCE 1) were: shorter sessions (60 min vs. 10 min, odds ratio (OR): 0.72; P < 0.001); less frequent sessions (daily vs. monthly, OR: 0.68; P < 0.001); shorter interventions (3 months vs. 1 month, OR: 0.80; P < 0.01); technology-based interventions (vs. in-person, OR: 1.17; P < 0.05). Preferences for post-intervention boosters (DCE 2) included opting into boosters (vs. opting out, OR: 3.53; P < 0.001) and having shorter boosters (3 months vs. 1 month, OR: 0.79; P < 0.01). Nearly half of the participants preferred to reduce cannabis use as a principal intervention goal (vs. using in less harmful ways or avoiding risky situations). CONCLUSIONS: Further research is required to see if technology-based harm reduction interventions for cannabis featuring these preferences translate into greater engagement and improved outcomes in EP patients.

Bisphenol A in surface waters in Germany: Part I. Reassessment of sources and emissions pathways for FlowEQ modeling.

Bisphenol A (BPA) enters the environment through various industrial and consumer-related pathways. Industrial sources include BPA manufacturing and secondary industrial uses such as the manufacturing of polymers and other substances based on or containing BPA. However, secondary sources and emissions to the environment, such as those related to the consumer use of articles containing BPA, may be more important than industrial emissions. Although readily biodegradable, BPA is widely distributed in various environmental compartments and living organisms. It is still not well understood which specific sources and pathways are responsible for releasing BPA into the environment. Therefore, we developed FlowEQ, a coupled flow network and fugacity-based fate and transport model for the assessment of BPA in surface water. The work is divided into two parts. In Part I, inputs needed to support the modeling and model validation were collected. Bisphenol A was measured at 23 wastewater treatment plants (WWTPs) and 21 landfills in Germany. In addition, the BPA content of 132 consumer articles from 27 article classes was analyzed. Bisphenol A concentrations in WWTPs ranged from 0.33 to 910 µg L-1 in influents and from less than 0.01 to 0.65 µg L-1 in effluents, resulting in removal efficiencies of 13%-100%. Average BPA concentrations in landfill leachate ranged from less than 0.01 to approximately 1400 µg L-1 . Bisphenol A concentrations measured in consumer articles varied significantly by type, ranging from less than 0.5 µg kg-1 in printing inks up to 1 691 700 µg kg-1 in articles made from recycled polyvinyl chloride (PVC). These concentrations were combined with information on use, leaching, and contact with water to develop estimates of loadings. Together with the results of the FlowEQ modeling presented in Part II, this assessment improves our understanding of the sources and emission pathways of BPA in surface water. The model considers various sources of BPA and can estimate future surface water concentrations of BPA based on changes in use. Integr Environ Assess Manag 2024;20:211-225. © 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Three noteworthy idiosyncrasies related to Canada's opioid-death crisis, and implications for public health-oriented interventions.

Canada has been experiencing a prolonged public health-crisis of high rates of overdose deaths caused by exceptionally potent/toxic, illicit opioid use. While many key features of this drug death epidemic are well-documented, several idiosyncratic aspects with relevance for public health-oriented interventions are not adequately recognised. These include: (i) the discrepant opioid patterns pan-Canada, with large majorities of opioid deaths caused by illicit fentanyl drugs in Western, but not Eastern regions where prescription-type opioid prevail; (ii) the environments of overdose deaths, where vast majorities occur in 'residential' or other shelter-type settings, presenting barriers for emergency interventions rather than health protection; and (iii) shifting drug use modes, where now majorities of overdose deaths are associated with drug 'inhalation' (instead of 'injection') in contexts of potent/toxic drug supply. We briefly describe these factors and related implications for intervention programming towards an improved response to the drug death-crisis.

Evaluation of a Cannabis Harm Reduction Intervention for People With First-Episode Psychosis: Protocol for a Pilot Multicentric Randomized Trial.

BACKGROUND: Cannabis use is highly prevalent in young people with first-episode psychosis (FEP). Most report cannabis use and are often diagnosed with a cannabis use disorder upon admission to specialized services for psychosis. Cannabis use in this population is associated with worse clinical and psychosocial outcomes, rendering it an important clinical target. Despite this, few cannabis-specific interventions have been developed for FEP and empirically evaluated through randomized controlled trials. Most evaluated interventions have targeted cannabis abstinence, with limited efficacy, but none have centered on harm reduction outcomes for people with FEP who use cannabis. Early intervention services (EIS), the standard of care for FEP, have not successfully addressed problematic cannabis use in people with FEP either. Clinical trials are needed to explore the potential of harm reduction strategies, although these should be preceded by robust pilot studies to establish optimal design and approaches. OBJECTIVE: Recognizing the need for harm reduction strategies for individuals with FEP who use cannabis and based on research on patients' preferences supporting harm reduction interventions, we developed a mobile app-based cannabis harm reduction intervention for this population. This intervention is called Cannabis Harm-reducing Application to Manage Practices Safely (CHAMPS). Here, we describe the protocol for a multicenter, 2-arm, parallel group, randomized pilot trial evaluating the acceptability of CHAMPS for people with FEP who use cannabis and the feasibility of conducting a full-scale trial in this population using CHAMPS. The impact on key clinical outcomes will also be explored. METHODS: This pilot trial aims to recruit 100 young people with FEP using cannabis from 6 Canadian EIS clinics. Participants will be randomized in a 1:1 ratio to CHAMPS+EIS or EIS-only. CHAMPS acceptability will be assessed using completion rates for the intervention arm. Trial feasibility will be assessed using a retention rate for randomized participants. Secondary outcomes will explore tendencies of change in the use of protective behavioral strategies and in motivation to change strategies. Exploratory outcomes include cannabis use-related problems, other substance use, the severity of dependence, psychotic symptoms, and health care service use. RESULTS: Recruitment began in December 2021. Data collection and analysis are expected to be completed in early 2024. Study results describing CHAMPS acceptability and trial feasibility will then be submitted for publication in a peer-reviewed journal. CONCLUSIONS: CHAMPS uniquely combines evidence-based approaches, patient perspectives, and mobile health technology to support harm reduction in people with FEP who use cannabis. Attaining adequate acceptability and feasibility through this trial may justify further exploration of harm reduction tools, particularly within the context of conducting a larger-scale randomized controlled trial. This pilot trial has the potential to advance knowledge for researchers and clinicians regarding a feasible and user-acceptable research design in the cannabis and early psychosis fields. TRIAL REGISTRATION: ClinicalTrials.gov NCT04968275, https://clinicaltrials.gov/ct2/show/NCT04968275. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53094.

"Safer Drug Supply" Measures in Canada to Reduce the Drug Overdose Fatality Toll: Clarifying Concepts, Practices and Evidence Within a Public Health Intervention Framework.

North America has been home to an unprecedented crisis of drug overdose deaths, driven largely by drug users' exposure to highly potent and toxic, illicit opioid drugs (e.g., fentanyl). Although a large and diverse menu of interventions (e.g., targeted prevention or treatment measures) has been implemented or expanded in Canada, these have not effectively managed to revert and reduce this excessive death toll. Given the fact that these interventions do not directly aim to address toxic drug exposure as the primary vector and cause of acute overdose deaths, public health-oriented "safer drug supply" measures have been initiated in local settings across Canada. These safer supply initiatives provide users with prescribed, pharmaceutical-grade drug supply with the aim of reducing overdose and death risks. These measures have been criticized but also misconstrued from several angles, e.g., as representing inadequate medical or even unethical and harmful practice. Related concerns regarding "diversion" have been raised. In this Perspective, we briefly address some of these issues and clarify selected issues of elementary concepts, practices, and evidence related to safer supply measures within a public health-oriented intervention framework. These measures are also discussed in reference to other, comparable types of public health-oriented emergency health or survival care standards, while considering the extreme contexts of an ongoing, acute drug death crisis in Canada.

Insights into the Si─H Bonding Configuration at the Amorphous/Crystalline Silicon Interface of Silicon Heterojunction Solar Cells by Raman and FTIR Spectroscopy.

In silicon heterojunction solar cell technology, thin layers of hydrogenated amorphous silicon (a-Si:H) are applied as passivating contacts to the crystalline silicon (c-Si) wafer. Thus, the properties of the a-Si:H is crucial for the performance of the solar cells. One important property of a-Si:H is its microstructure which can be characterized by the microstructure parameter R based on Si─H bond stretching vibrations. A common method to determine R is Fourier transform infrared (FTIR) absorption measurement which, however, is difficult to perform on solar cells for various reasons like the use of textured Si wafers and the presence of conducting oxide contact layers. Here, it is demonstrated that Raman spectroscopy is suitable to determine the microstructure of bulk a-Si:H layers of 10 nm or less on textured c-Si underneath indium tin oxide as conducting oxide. A detailed comparison of FTIR and Raman spectra is performed and significant differences in the microstructure parameter are obtained by both methods with decreasing a-Si:H film thickness.

Recommendations for Reducing the Risk of Cannabis Use-Related Adverse Psychosis Outcomes: A Public Mental Health-Oriented Evidence Review.

Objective: Cannabis use is increasingly normalized; psychosis is a major adverse health outcome. We reviewed evidence on cannabis use-related risk factors for psychosis outcomes at different stages toward recommendations for risk reduction by individuals involved in cannabis use. Methods: We searched primary databases for pertinent literature/data 2016 onward, principally relying on reviews and high-quality studies which were narratively summarized and quality-graded; recommendations were developed by international expert consensus. Results: Genetic risks, and mental health/substance use problem histories elevate the risks for cannabis-related psychosis. Early age-of-use-onset, frequency-of-use, product composition (i.e., THC potency), use mode and other substance co-use all influence psychosis risks; the protective effects of CBD are uncertain. Continuous cannabis use may adversely affect psychosis-related treatment and medication effects. Risk factor combinations further amplify the odds of adverse psychosis outcomes. Conclusions: Reductions in the identified cannabis-related risks factors-short of abstinence-may decrease risks of related adverse psychosis outcomes, and thereby protect cannabis users' health.

'Drug decriminalization' in Canada: a plea for a nuanced, evidence-informed, and realistic approach towards improved health outcomes.

Canada has been home to an exceptional public health crisis of illicit (mainly synthetic opioid but increasingly other) drug deaths for numerous years. Despite extensive health-oriented interventions, this crisis remains acute and devastating. Earlier this year, the federal and British Columbia governments implemented the 'drug decriminalization initiative' (DDI) which exempts drug users from criminal enforcement of small amounts of personal drug possession; this has been promoted as a 'solution' for the drug-death crisis. This commentary examines and discusses that while decriminalization of drug use is fundamentally required to align drug policy with principles of health, evidence-based consideration of the drug death crisis' essential dynamics as well as enforcement realities substantially curtail the DDI's plausible prospects to significantly reduce the drug-fatality toll. Decriminalization efforts elsewhere ('Portugal model') are set in distinct ecologies and parameters, and not readily transferable to Canadian contexts. While the DDI has symbolic value for policy reform, for decriminalization to provide tangible benefits for drug users and public health, its scope and design require fundamental reconsideration and improvement. Meanwhile, given the principally causal role of toxic drug supply for the current drug-death epidemic, more effective health and life-saving measures-specifically involving 'safer supply'-need to be urgently implemented to alleviate this crisis.

RéSUMé: Le Canada connaît depuis de nombreuses années une crise de santé publique hors du commun avec des décès liés aux drogues illégales (principalement des opioïdes synthétiques, mais de plus en plus d'autres également). Malgré de vastes interventions axées sur la santé, cette crise reste d'actualité et demeure dévastatrice. Plus tôt cette année, les gouvernements fédéral et de la Colombie-Britannique ont mis en œuvre 'l'initiative de dépénalisation des drogues' (IDD) qui exempte les consommateurs de drogues de peine pour la possession de petites quantités de drogue à des fins personnelles; cela a été mis de l'avant comme une « solution ¼ à la crise des décès liés aux drogues. Ce commentaire examine et discute du fait que, bien que la dépénalisation de l'usage de drogues soit fondamentalement nécessaire pour aligner la politique en matière de drogue sur les principes de promotion de la santé, la prise en compte basée sur les preuves des principales dynamiques de la crise ainsi que des réalités de leur application limite la capacité plausible de l'IDD de réduire considérablement le bilan des décès liés aux drogues. Les efforts de décriminalisation ailleurs ('modèle portugais') sont définis dans des situations et des paramètres distincts, et ne sont pas facilement transférables aux contextes canadiens. Bien que l'IDD ait une valeur symbolique pour la réforme des politiques, pour que la dépénalisation apporte des avantages tangibles aux consommateurs de drogues et à la santé publique, sa portée et sa conception nécessitent une ré-évaluation et des améliorations importantes. En attendant, étant donné le rôle essentiellement causal de l'approvisionnement en substances toxiques dans l'épidémie actuelle de décès liés aux drogues, des mesures de santé plus efficaces et permettant de sauver des vies­impliquant spécifiquement un « approvisionnement plus sûr ¼­doivent être mises en œuvre de toute urgence pour atténuer cette crise.

Evaluating preferences for online psychological interventions to decrease cannabis use in young adults with psychosis: An observational study.

Innovative technology-based solutions have the potential to improve access to clinically proven interventions for cannabis use disorder (CUD) in individuals with first episode psychosis (FEP). High patient engagement with app-based interventions is critical for achieving optimal outcomes. 104 individuals 18 to 35 years old with FEP and CUD from three Canadian provinces completed an electronic survey to evaluate preferences for online psychological intervention intensity, participation autonomy, feedback related to cannabis use, and technology platforms and app functionalities. The development of the questionnaire was informed by a qualitative study that included patients and clinicians. We used Best-Worst Scaling (BWS) and item ranking methodologies to measure preferences. Conditional logistic regression models for BWS data revealed high preferences for moderate intervention intensity (e.g., modules with a length of 15 min) and treatment autonomy that included preferences for using technology-based interventions and receiving feedback related to cannabis use once a week. Luce regression models for rank items revealed high preferences for smartphone-based apps, video intervention components, and having access to synchronous communications with clinicians and gamification elements. Results informed the development of iCanChange (iCC), a smartphone-based intervention for the treatment of CUD in individuals with FEP that is undergoing clinical testing.

Cannabis Use and Health-Related "Harm to Others": Toward a Conceptual Framework and Evidence Base for Public Health.

Cannabis use has become increasingly common as more jurisdictions liberalize controls, including legalization and allowing nonmedical cannabis use among adults, to better protect public health and safety. Little attention has been given to possible health-related "harm to others," as are considered in other substance use domains. We propose a framework and review evidence on public health domains in which cannabis use may produce health-related harm to others, namely from (a) interpersonal violence, (b) motor vehicle crash-related injuries, (c) pregnancy-related outcomes, and (d) secondhand exposure. These domains are associated with moderate risks of adverse outcomes that, however, may involve substantial health harm to others, and therefore warrant consideration in guiding regulations and in evaluating the public health impacts of cannabis use and different policy options for its control.

Cannabis use, risk behaviours and harms in Brazil: A comprehensive review of available data indicators.

ISSUES: Cannabis use and related health/social outcome indicator data for Brazil-where non-medical cannabis is generally illegal-are limited. APPROACH: Towards a comprehensive overview of relevant indicators, we searched primary databases by combining MeSH-index terms related to cannabis, geographic location and subtopic terms (e.g., use, health, mortality) focusing on cannabis use and key outcome indicators in Brazil since 2010. In addition, relevant 'grey literature' (e.g., survey reports) was identified. Key indicator data were mainly narratively summarised. KEY FINDINGS: Overall, cannabis use has increased somewhat since pre-2010, with (past-year) use rates measured at 2-3% for general population adults, yet 5% or higher among youth and/or (e.g., post-secondary) student populations. For key risk behaviours, the presence of tetrahydrocannabinol-positivity among motor-vehicle drivers has been measured at <2%. While the prevalence of cannabis use disorder appears to have decreased, the relative proportion of treatment provided for cannabis-related problems increased. National- and local-based studies indicated an association of cannabis use with mental health harms, including depression and suicidality. Although some non-representative and/or local studies contain information, other monitoring data, including cannabis-related risks and harms (e.g., cannabis-related driving, mortality, hospitalisations), are limited in availability. IMPLICATIONS AND CONCLUSION: The prevalence of cannabis use in Brazil is comparably low (e.g., relative to elsewhere in the Americas). Data on numerous key cannabis-related indicators is absent, or limited in scope for Brazil. Considering ongoing evolutions in cannabis control and its status as the most common illicit drug, more comprehensive surveillance of cannabis use and related outcomes is advised.

Risk-thresholds for the association between frequency of cannabis use and the development of psychosis: a systematic review and meta-analysis.

BACKGROUND: Epidemiological studies show a dose-response association between cannabis use and the risk of psychosis. This review aimed to determine whether there are identifiable risk-thresholds between the frequency of cannabis use and psychosis development. METHODS: Systematic search of Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science for relevant studies (1 January 2010-26 April 2021). Case-control or cohort studies that investigated the relationship between cannabis use and the risk of psychosis development that reported effect estimates [odds ratios (OR), hazard ratios (HR), risk ratios (RR)] or the raw data to calculate them, with information on the frequency of cannabis consumption were included. Effect estimates were extracted from individual studies and converted to RR. Two-stage dose-response multivariable meta-analytic models were utilized and sensitivity analyses conducted. The Newcastle Ottawa Scale was used to assess the risk of bias of included studies. RESULTS: Ten original (three cohorts, seven case-control) studies were included, including 7390 participants with an age range of 12-65 years. Random-effect model meta-analyses showed a significant log-linear dose-response association between cannabis use frequency and psychosis development. A restricted cubic-splines model provided the best fit for the data, with the risk of psychosis significantly increasing for weekly or more frequent cannabis use [RR = 1.01, 95% confidence interval (CI) 0.93-1.11 yearly; RR = 1.10, 95% CI 0.97-1.25 monthly; RR = 1.35, 95% CI 1.19-1.52 weekly; RR = 1.76, 95% CI 1.47-2.12 daily]. CONCLUSION: Individuals using cannabis frequently are at increased risk of psychosis, with no significant risk associated with less frequent use. Public health prevention messages should convey these risk-thresholds, which should be refined through further work.