La importancia de los patrones de consumo: Diseño de una encuesta que permita evaluar daño relacionado al consumo de cannabis / The relevance of patterns of use: A survey to assess cannabis use-related harm

Globalmente, 192 millones de adultos han consumido cannabis alguna vezen su vida (2017), un consumo que se ha incrementado en un 16% en laúltima década. Sin embargo, seguimos sin tener información clara sobrequé cantidad y qué frecuencia de consumo va a causar daño. Por tanto, esteproyecto desarrolla una encuesta para evaluar los patrones de consumo decannabis y los daños relacionados en una muestra de consumidores. Esteartículo se centra en mostrar la factibilidad de la encuesta y la satisfacciónde los usuarios en una muestra piloto. Cuarenta usuarios de cannabis fueronreclutados (> 18 años, viviendo en España, consumo de cannabis mínimouna vez en los últimos 12 meses) entre diciembre de 2018 y enero de 2019.Los participantes respondieron una encuesta en línea (consumo cannábico,salud mental, organicidad y lesiones) y un cuestionario ad hoc para evaluarla accesibilidad, factibilidad, satisfacción, diseño y contenido. El 93,23% departicipantes estaba satisfecho con el diseño; el 94,92% estaba satisfecho conel contenido y el 94,73% estaba satisfecho con la accesibilidad de la encuesta,y fueron necesarios solo cambios menores para mejorar la factibilidad y laaccesibilidad de algunos ítems. Los participantes consumieron una medianade 1,0 Unidades de Porro Estándar por día (Rango Intercuartílico [RIQ] 1,0-2,0). El 92,5% de la muestra puntuó como mínimo en un daño relacionadoy con una mediana de 4,0 patologías (RIQ 1,25-5,0). El presente estudionos permite diseñar una encuesta en línea con determinada factibilidad quepueda ser usada en un estudio transversal a gran escala. (AU)

Lifetime prevalence of cannabis use is estimated 192 million adultsworldwide (2017) and has increased by 16% in the last decade. However,data on quantity and frequency of use that can lead to harm is lacking.We have developed a survey to assess patterns of cannabis use and relatedharms in a sample of cannabis users. This paper focuses on evaluating thefeasibility of the survey and the users’ satisfaction in a pilot sample. Fortycannabis users were recruited (>18 years old, living in Spain, cannabis use atleast once during the last 12 months) between December 2018 and January2019. Participants answered an online survey (mental health, organic harmand injury) and an ad hoc questionnaire to assess accessibility, feasibility,satisfaction, design and content appropriateness. Of the participants,93.23% (n = 37.3) were satisfied with the design, 94.92% (n = 38.2) weresatisfied with the content, and 94.73% (n = 37.0) were satisfied with theaccessibility of the survey; only minor changes were required to improvefeasibility and accessibility. Participants used a median of 1.0 Standard JointUnit per day (Interquartile Range [IQR] 1.0-2.0). Of the sample, 92.5%reported at least one related harm and suffers a median of 4.0 disorders(IQR, 1.25-5.0). The present study allows for designing a feasible onlinesurvey to conduct a cross-sectional study with a larger sample. (AU)

Early, Chronic, and Acute Cannabis Exposure and Their Relationship With Cognitive and Behavioral Harms.

Background: Cannabis is the third most consumed drug worldwide. Thus, healthcare providers should be able to identify users who are in need for an intervention. This study aims to explore the relationship of acute, chronic, and early exposure (AE, CE, and EE) to cannabis with cognitive and behavioral harms (CBH), as a first step toward defining risky cannabis use criteria. Methods: Adults living in Spain who used cannabis at least once during the last year answered an online survey about cannabis use and health-related harms. Cannabis use was assessed in five dimensions: quantity on use days during the last 30 days (AE), frequency of use in the last month (AE), years of regular use (YRCU) (CE), age of first use (AOf) (EE), and age of onset of regular use (AOr) (EE). CBH indicators included validated instruments and custom-made items. Pearson correlations were calculated for continuous variables, and Student's t-tests for independent samples were calculated for categorical variables. Effect sizes were calculated for each of the five dimensions of use (Cohen's d or r Pearson correlation) and harm outcome. Classification and Regression Trees (CART) analyses were performed for those dependent variables (harms) significantly associated with at least two dimensions of cannabis use patterns. Lastly, logistic binary analyses were conducted for each harm outcome. Results: The mean age of participants was 26.2 years old [standard deviation (SD) 8.5]. Out of 2,124 respondents, 1,606 (75.6%) reported at least one harm outcome (mean 1.8 and SD 1.5). In our sample, using cannabis on 3 out of 4 days was associated with an 8-fold probability of scoring 4+ on the Severity Dependence Scale (OR 8.33, 95% CI 4.91-14.16, p <0.001), which is indicative of a cannabis use disorder. Also, a start of regular cannabis use before the age of 25 combined with using cannabis at least once per month was associated with a higher probability of risky alcohol use (OR 1.33, 95% CI 1.12-1.57, p = 0.001). Besides, a start of regular cannabis use before the age of 18 combined with a period of regular use of at least 7.5 years was associated with a higher probability of reporting a motor vehicle accident (OR 1.81, 95% CI 1.41-2.32, p < 0.0001). Results were ambiguous regarding the role that age of first use and milligrams of THC per day of use might play regarding cannabis-related harms. Conclusions: The relationship among AE, CE, and EE with CBH indicators is a complex phenomenon that deserves further studies. The pattern of cannabis use should be carefully and widely evaluated-(not just including frequency but also other dimensions of pattern of use)-in research (preferably in longitudinal studies) to assess cannabis-related harms.

Supporting Future Cannabis Policy - Developing a Standard Joint Unit: A Brief Back-Casting Exercise.

The standardization of cannabis doses is a priority for research, policy-making, clinical and harm-reduction interventions and consumer security. Scientists have called for standard units of dosing for cannabis, similar to those used for alcohol. A Standard Joint Unit (SJU) would facilitate preventive and intervention models in ways similar to the Standard Drink (SD). Learning from the SD experiences allows researchers to tackle emerging barriers to the SJU by applying modern forecasting methods. During a workshop at the Lisbon Addictions Conference 2019, a back-casting foresight method was used to address challenges and achieve consensus in developing an SJU. Thirty-two professionals from 13 countries and 10 disciplines participated. Descriptive analysis of the workshop was carried out by the organizers and shared with the participants in order to suggest amendments. Several characteristics of the SJU were defined: (1) core values: easy-to use, universal, focused on THC, accurate, and accessible; (2) key challenges: sudden changes in patterns of use, heterogeneity of cannabis compounds as well as in administration routes, variations over time in THC concentrations, and of laws that regulate the legal status of recreational and medical cannabis use); and (3) facilitators: previous experience with standardized measurements, funding opportunities, multi-stakeholder support, high prevalence of cannabis users, and widespread changes in legislation. Participants also identified three initial steps for the implementation of a SJU by 2030: (1) Building a task-force to develop a consensus-based SJU; (2) Expanded available national-level data; (3) Linking SJU consumption to the concept of "risky use," based on evidence of harms.