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1.
BJOG ; 127(1): 8-16, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31529594

RESUMO

BACKGROUND: With expanding recreational cannabis legalisation, pregnant women and their offspring are at risk of potentially harmful consequences. OBJECTIVES: To assess the prevalence of recreational cannabis use among pregnant women, health outcomes associated with prenatal recreational cannabis use, and the potential impact of recreational cannabis legalisation on this population. SEARCH STRATEGY: Five databases and the grey literature were systematically searched (2000-2019). SELECTION CRITERIA: Human studies published in English or French reporting on the prevalence of prenatal recreational cannabis use in high-income countries. DATA COLLECTION AND ANALYSIS: Data on study characteristics, prenatal substance use, and health outcomes were extracted and qualitatively synthesised. MAIN RESULTS: Forty-one publications met our inclusion criteria. The overall prevalence of prenatal cannabis use varied substantially (min-max: 0.24-22.6%), with the greatest use in the first trimester. In the three studies with temporal data available, rates of prenatal cannabis use increased across years. Only 7/41 and 5/41 studies provided information on gestational age of exposure and frequency of use, respectively. The concomitant use of alcohol, illicit drugs, and tobacco was higher among cannabis users than nonusers. Prenatal cannabis use was associated with select neonatal, but not maternal, health outcomes. There were insufficient data to compare prenatal cannabis use between the pre- and post-legalisation periods. CONCLUSION: Cannabis use among pregnant women is prevalent and may be associated with adverse neonatal outcomes. Future studies should assess the gestational age and frequency of cannabis exposure, and usage patterns prior to and following legalisation. TWEETABLE ABSTRACT: Women who consume cannabis during pregnancy could risk predisposing their newborns to poor birth outcomes.


Assuntos
Uso da Maconha/efeitos adversos , Complicações na Gravidez/etiologia , Países Desenvolvidos , Métodos Epidemiológicos , Feminino , Idade Gestacional , Humanos , Renda , Recém-Nascido de Baixo Peso , Terapia Intensiva Neonatal/estatística & dados numéricos , Uso da Maconha/epidemiologia , Uso da Maconha/legislação & jurisprudência , Saúde Materna , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/etiologia
2.
N Z Med J ; 132(1488): 7-10, 2019 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-31851656

RESUMO

At the present time there are continuing debates on the legal status of cannabis in New Zealand. Many of these debates have not given sufficient consideration to evidence concerning cannabis-related harm, much of which has been gathered here in New Zealand by the Christchurch Health and Development Study (CHDS) and the Dunedin Multidisciplinary Health and Development Study (DMHDS). We present a summary of this evidence, and recommendations for a cautious path forward for changing cannabis laws in New Zealand that aims at reducing cannabis-related harm.


Assuntos
Uso da Maconha/efeitos adversos , Uso da Maconha/legislação & jurisprudência , Acidentes , Cannabis , Depressão , Humanos , Nova Zelândia , Gestão de Riscos
3.
Lancet ; 394(10208): 1580-1590, 2019 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-31657733

RESUMO

We assess the current and describe possible future public health impacts of the legalisation of cannabis production, sale, and use in the Americas. First, we describe global patterns of cannabis use and their most probable adverse health effects. Second, we summarise evidence regarding the effectiveness of cannabinoids for medicinal use and describe approaches that have been used to regulate the use of medicinal cannabis and how these approaches might have affected medicinal and recreational use and harms (eg, road crashes). Third, we describe how jurisdictions that have legalised recreational use have regulated production and sale of cannabis. Fourth, we evaluate the effects of cannabis legalisation on cannabis use and harms and on the use of alcohol, tobacco, and other drugs. Fifth, we use alcohol and tobacco policy examples to identify possible long-term public health effects of cannabis legalisation. Finally, we outline policy approaches that could minimise harms to public health arising from the legalisation of a commercial cannabis industry.


Assuntos
Cannabis , Uso da Maconha/epidemiologia , Maconha Medicinal/administração & dosagem , Saúde Pública/legislação & jurisprudência , Comércio/economia , Feminino , Humanos , Legislação de Medicamentos/economia , Masculino , Uso da Maconha/efeitos adversos , Uso da Maconha/legislação & jurisprudência , Maconha Medicinal/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
4.
MMWR Morb Mortal Wkly Rep ; 68(39): 845-850, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581164

RESUMO

Use of marijuana at an early age can affect memory, school performance, attention, and learning; conclusions have been mixed regarding its impact on mental health conditions, including psychosis, depression, and anxiety (1-3). Medical marijuana has been legal in Washington since 1998, and in 2012, voters approved the retail sale of marijuana for recreational use to persons aged ≥21 years. The first retail stores opened for business in July 2014. As more states legalize marijuana use by adults aged ≥21 years, the effect of legalization on use by youths will be important to monitor. To guide planning of activities aimed at reducing marijuana use by youths and to inform ongoing policy development, Public Health-Seattle & King County assessed trends and characteristics of past 30-day marijuana use among King County, Washington, public school students in grades 6, 8, 10, and 12. This report used biennial data for 2004-2016 from the Washington State Healthy Youth Survey. Among grade 6 students there was a decreasing trend in self-reported past 30-day marijuana use from 2004 to 2016, while the percentage of grade 8 students who had used marijuana during the past 30 days did not change during that period. Among students in grades 10 and 12, self-reported past 30-day use of marijuana increased from 2004 to 2012, then declined from 2012 to 2016. In 2016, the percentage of students with past 30-day marijuana use in King County was 0.6% among grade 6, 4.1% among grade 8, 13.9% among grade 10, and 25.5% among grade 12 students. Among grade 10 students, 24.0% of past 30-day marijuana users also smoked cigarettes, compared with 1.3% of nonusers. From 2004 to 2016 the prevalence of perception of great risk of harm from regular marijuana use decreased across all grades. Continued surveillance using consistent measures is needed to monitor the impact of marijuana legalization and emerging public health issues, given variable legislation approaches among jurisdictions.


Assuntos
Uso da Maconha/epidemiologia , Uso da Maconha/tendências , Setor Público , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/psicologia , Adolescente , Criança , Comércio/legislação & jurisprudência , Feminino , Inquéritos Epidemiológicos , Humanos , Legislação de Medicamentos/estatística & dados numéricos , Masculino , Uso da Maconha/efeitos adversos , Uso da Maconha/legislação & jurisprudência , Prevalência , Medição de Risco , Estudantes/estatística & dados numéricos , Washington/epidemiologia
5.
Accid Anal Prev ; 132: 105284, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31518764

RESUMO

Colorado and Washington legalized recreational marijuana in 2012, but the effects of legalization on motor vehicle crashes remains unknown. Using Fatality Analysis Reporting System data, we performed difference-in-differences (DD) analyses comparing changes in fatal crash rates in Washington, Colorado and nine control states with stable anti-marijuana laws or medical marijuana laws over the five years before and after recreational marijuana legalization. In separate analyses, we evaluated fatal crash rates before and after commercial marijuana dispensaries began operating in 2014. In the five years after legalization, fatal crash rates increased more in Colorado and Washington than would be expected had they continued to parallel crash rates in the control states (+1.2 crashes/billion vehicle miles traveled, CI: -0.6 to 2.1, p = 0.087), but not significantly so. The effect was more pronounced and statistically significant after the opening of commercial dispensaries (+1.8 crashes/billion vehicle miles traveled, CI: +0.4 to +3.7, p = 0.020). These data provide evidence of the need for policy strategies to mitigate increasing crash risks as more states legalize recreational marijuana.


Assuntos
Acidentes de Trânsito/mortalidade , Uso da Maconha/legislação & jurisprudência , Colorado/epidemiologia , Estudos Controlados Antes e Depois , Feminino , Humanos , Washington/epidemiologia
7.
N Z Med J ; 132(1500): 82-88, 2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31415502

RESUMO

With rapidly changing legislation designed to improve access to cannabis-based medicinal products, we assess the obligations of the law and professional bodies on the proposed prescribers of these products. We argue that the current legal and professional obligations may limit prescribing practices despite legislative change, and that without the usual licensing processes of Medsafe being applied to these products, prescribers and their professional bodies must engage in the process of change to ensure short- and long-term patient safety and to maintain professional standards.


Assuntos
Uso da Maconha/legislação & jurisprudência , Maconha Medicinal , Padrões de Prática Médica/legislação & jurisprudência , Humanos , Nova Zelândia , Segurança do Paciente , Papel do Médico , Médicos
8.
Am J Public Health ; 109(9): 1294-1301, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31318588

RESUMO

Objectives. To assess the relationship between adult cannabis use and time-varying local measures of retail cannabis market presence before and after legalization (2012) and market opening (2014) in Washington State.Methods. We used 2009 to 2016 data on 85 135 adults' current (any) and frequent (20 or more days) past-month cannabis use from the Washington Behavioral Risk Factor Surveillance System linked to local retailer proximity and density. Multilevel models predicted use over time, accounting for nesting within communities.Results. Current and frequent cannabis use grew significantly between 2009 and 2016; use did not significantly change immediately after legalization but increased subsequently with greater access to cannabis retailers. Specifically, current use increased among adults living in areas within 18 miles of a retailer and, especially, within 0.8 miles (odds ratio [OR] = 1.45; 95% confidence interval [CI] = 1.24, 1.69). Frequent use increased among adults living within 0.8 miles of a retailer (OR = 1.43; 95% CI = 1.15, 1.77). Results related to geospatial retailer density were consistent.Conclusions. Increasing cannabis retail access was associated with increased current and frequent use.Public Health Implications. Policymakers might consider density limits as a strategy for preventing heavy cannabis use among adults.


Assuntos
Cannabis , Uso da Maconha/epidemiologia , Uso da Maconha/legislação & jurisprudência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Legislação de Medicamentos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Washington , Adulto Jovem
13.
Medicine (Baltimore) ; 98(28): e16169, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305399

RESUMO

We aim to examine temporal trends of orthopedic operations and opioid-related hospital stays among seniors in the nation and states of Oregon and Washington where marijuana legalization was accepted earlier than any others.As aging society advances in the United States (U.S.), orthopedic operations and opioid-related hospital stays among seniors increase in the nation.A serial cross-sectional cohort study using the healthcare cost and utilization project fast stats from 2006 through 2015 measured annual rate per 100,000 populations of orthopedic operations by age groups (45-64 vs 65 and older) as well as annual rate per 100,000 populations of opioid-related hospital stays among 65 and older in the nation, Oregon and Washington states from 2008 through 2017. Orthopedic operations (knee arthroplasty, total or partial hip replacement, spinal fusion or laminectomy) and opioid-related hospital stays were measured. The compound annual growth rate (CAGR) was used to quantify temporal trends of orthopedic operations by age groups as well as opioid-related hospital stays and was tested by Rao-Scott correction of χ for categorical variables.The CAGR (4.06%) of orthopedic operations among age 65 and older increased (P < .001) unlike the unchanged rate among age 45 to 64. The CAGRs of opioid-related hospital stays among age 65 and older were upward trends among seniors in general (6.79%) and in Oregon (10.32%) and Washington (15.48%) in particular (all P < .001).Orthopedic operations and opioid-related hospital stays among seniors increased over time in the U.S. Marijuana legalization might have played a role of gateway drug to opioid among seniors.


Assuntos
Analgésicos Opioides/uso terapêutico , Controle de Medicamentos e Entorpecentes , Artropatias/tratamento farmacológico , Idoso , Estudos Transversais , Custos de Cuidados de Saúde , Hospitalização/tendências , Humanos , Artropatias/economia , Artropatias/cirurgia , Uso da Maconha/legislação & jurisprudência , Pessoa de Meia-Idade , Oregon , Procedimentos Ortopédicos , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos , Washington
14.
Rev. esp. drogodepend ; 44(2): 96-102, abr.-jun. 2019.
Artigo em Espanhol | IBECS | ID: ibc-184432

RESUMO

La literatura científica referente al uso de cannabis incluye en su corpus una extensa investigación sobre los efectos dañinos derivados de su consumo, habiéndose centrado los estudios a este respecto en la denominada psicosis cannábica. Menos se ha analizado, sin embargo, su vertiente terapéutica, a pesar de que muchos pacientes con una amplia diversidad de alteraciones reconocen en consulta consumir cannabis de forma frecuente para mejorar su estado de salud. Ante esta situación, el objetivo del presente artículo es reflexionar sobre el potencial terapéutico del cannabis en diferentes trastornos, con especial énfasis en aquellos referidos a la salud mental. Para ello, se ha realizado una breve revisión de artículos que muestran los efectos que el consumo de cannabis podría tener ante el padecimiento de ciertas patologías. En este sentido, se mencionan algunos sesgos existentes en las investigaciones sobre psicosis cannábica y se analizan los efectos, tanto positivos como negativos, que el consumo de cannabis podría producir en trastornos del estado de ánimo y en los diferentes trastornos de ansiedad, siendo especialmente relevante el caso del trastorno por estrés postraumático


The scientific literature regarding the use of cannabis includes in its corpus extensive research on the harmful effects derived from its consumption, having focused the studies in the cannabis psychosis. Less has been analyzed, however, its therapeutic side, despite the fact that many patients with a wide variety of alterations recognize in consultation to consume cannabis frequently to improve their health status. Given this situation, the objective of this article is to reflect on the therapeutic potential of cannabis in different disorders, with special emphasis on those related to mental health. For this, a brief review of articles showing the effects that cannabis use could have on the condition of certain pathologies has been carried out. In this regard, some existing biases in research on cannabis psychosis are mentioned and the effects, both positive and negative, that cannabis use can produce in mood disorders and in different anxiety disorders are analyzed, being especially relevant the case of post-traumatic stress disorder


Assuntos
Humanos , Canabidiol/uso terapêutico , Uso da Maconha/legislação & jurisprudência , Depressão/tratamento farmacológico , Transtornos de Ansiedade/tratamento farmacológico
15.
N Z Med J ; 132(1494): 49-56, 2019 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-31048824

RESUMO

As New Zealand considers cannabis legal reform, we ask: what exactly is medicinal cannabis, and why does this matter? Cannabis is not a single entity but comes in diverse forms with various active ingredients. This contrasts with the legal and pharmaceutical definitions of medicines, with wide-ranging implications for quality control, prescriber practice and the assessment of clinical evidence. We argue that what is considered a medicine in the legal and pharmaceutical sense should not be changed in an ad hoc way to accommodate cannabis, but that cannabis products should be held to the same standards as other medicines.


Assuntos
Uso da Maconha/legislação & jurisprudência , Maconha Medicinal , Humanos , Nova Zelândia
17.
Int J Drug Policy ; 67: 72-78, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30959412

RESUMO

The legalisation of cannabis on the American continent in recent years has reinvigorated calls for cannabis law reform in many countries. Yet researchers have described potentially negative public health and social impacts of profit driven commercial markets for cannabis. Consequently, they have suggested exploring a number of alternative regulatory options, such as "not-for-profit" or "for-benefit" organisations. However, many of these new models are yet to be developed in detail. This paper presents a "community enterprise" model for recreational cannabis based on the alcohol licensing trusts which have existed in New Zealand for many decades. Alcohol licensing trusts are community-owned entities which operate alcohol retail outlets and return a portion of their profits back to local communities in the form of grants, loans and donations. The principal benefits of the "community trust" model are suppressing the commercial incentive to expand the market, establishing statutory obligations to distribute revenue back to the community, and establishing community governance over alcohol sales. The removal of a strong commercial incentive and community accountability may also contribute to lower levels of availability, higher prices and less harm. A further benefit is providing the local community with some oversight of a trust's commercial activities via community elections of the trust board and the ability to call a "community poll" to vote on the future existence of the trust. Our proposed community cannabis licensing trust model seeks to address some of the challenges experienced by alcohol licensing trusts in New Zealand, including the lack of general oversight and balancing the commercial and social aims of the trusts. A limitation of this model includes a lack of research and evaluation of the existing alcohol licensing trusts and further research in this area would inform the application of the model to cannabis.


Assuntos
Participação da Comunidade/economia , Controle de Medicamentos e Entorpecentes/métodos , Licenciamento , Uso da Maconha/legislação & jurisprudência , Humanos , Nova Zelândia
18.
Drug Alcohol Depend ; 199: 59-67, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30999251

RESUMO

BACKGROUND: Given a rapidly changing policy landscape, we sought to characterize the effects of state marijuana laws on parents' views of marijuana use by their teenage children. METHODS: Data are from 595 respondents to a nationally administered, web-based survey of parents of adolescents (ages 13-18 years) with any of three chronic conditions (type 1 diabetes, rheumatic disease, attention-deficit/hyperactivity disorder). Multivariate ordinal logistic regression was used to model the effects of parents' reports of state cannabis laws on their views toward marijuana use by their child. RESULTS: While 89.9% said any marijuana use was risky for their child, 27.9% would approve of its use if prescribed as medicine. Parents reporting marijuana decriminalization (11.1%) were more amenable to teenage use, less concerned about how marijuana might impact their child's condition, more accepting of the safety of marijuana as medicine, and approved its use with a prescription. Parents reporting legal medical (35.6%) or recreational (5.7%) use were more likely to report that their child has tried or used marijuana regularly. Parents reporting legal recreational use were less likely to agree that marijuana has medical benefits for their child. CONCLUSIONS: Among parents of medically vulnerable children, perceiving state marijuana policies as more permissive is strongly associated with lower perceived riskiness of marijuana use for their children. State marijuana policies are changing with implications for how parents of medically vulnerable youth view and potentially govern marijuana use by their medically vulnerable children.


Assuntos
Doença Crônica/psicologia , Legislação de Medicamentos , Uso da Maconha/legislação & jurisprudência , Uso da Maconha/psicologia , Pais/psicologia , Populações Vulneráveis/psicologia , Adolescente , Adulto , Cannabis , Doença Crônica/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Fumar Maconha/efeitos adversos , Fumar Maconha/legislação & jurisprudência , Fumar Maconha/psicologia , Uso da Maconha/efeitos adversos , Pessoa de Meia-Idade , Inquéritos e Questionários
19.
Evid. actual. práct. ambul ; 22(1): e001119, abr. 2019. ilus, tab.
Artigo em Espanhol | LILACS | ID: biblio-1014994

RESUMO

Esta revisión analiza la situación actual de la utilización del como herramienta terapéutica dentro del ámbito de la salud en Argentina, haciendo referencia a los distintos actores involucrados y dilemas futuros que pueden presentarse. Paracomprender en su totalidad el marco social, cultural e histórico, se desarrollan distintos aspectos, como la descripción química y biológica del , evolución del consumo a través de la historia, las repercusiones del consumo y las distintas aplicaciones que tiene en el campo de la medicina. También se describen las diferentes realidades que hay en el mundo, así como las legislaciones de otros países y la comparación de estas con la que tenemos en nuestro país. Finalmente se mencionan los desafíos pendientes y sus posibles abordajes.(AU)


This review analyzes the current situation of the use of cannabis as a therapeutic tool in the field of health in Argentina,referring to the different actors involved and future dilemmas that may arise. To fully understand the social, cultural andhistorical framework, different aspects can be defined, such as the chemical and biological description of cannabis, theevolution of consumption throughout history, the repercussions of recreational consumption and the different applicationsthat it has on the medical field. It also describes the different realities that exist in the world, as well as the laws of othercountries and the comparison of these with the one we have in our country. Finally, the pending challenges and theirpossible approaches, are mentioned.(AU)


Assuntos
Humanos , Masculino , Feminino , História Medieval , História do Século XX , Maconha Medicinal/uso terapêutico , Uso da Maconha/legislação & jurisprudência , Uso da Maconha/tendências , Argentina , Dronabinol/efeitos adversos , Dronabinol/farmacologia , Canabidiol/efeitos adversos , Canabidiol/farmacologia , Canabinoides/classificação , Cannabis/classificação , Cannabis/química , Drogas Ilícitas , Saúde Pública/tendências , Uso da Maconha/história , Uso da Maconha/terapia
20.
J Emerg Med ; 56(4): 398-404, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30846215

RESUMO

BACKGROUND: Washington State was one of the first states to legalize recreational marijuana. Increased availability of marijuana may result in more unintentional pediatric exposure, which often presents as altered mental status with unknown cause. OBJECTIVES: To quantify unintentional pediatric marijuana exposures reported to the Washington Poison Center (WAPC) prior to and after legalization and commercial availability of recreational marijuana. METHODS: Data were obtained from the WAPC database, toxiCALL®. Patients ≤ 9 years old with a reported marijuana exposure between July 2010 and July 2016 were included in the analysis. Patient and exposure characteristics were summarized and median exposure frequencies were calculated for the periods prior to and after legalization. RESULTS: There were 161 cases meeting the inclusion criteria that occurred between July 2010 and July 2016. Of these, 130 (81%) occurred in the 2.5-year period after legalization of recreational marijuana in January 2013. The median age of exposed children was 2 years (range 0-9 years). Eighty-one percent of the exposures occurred in the child's own home. The number of exposures per month increased after recreational marijuana was legalized in November 2012, and increased further once recreational marijuana shops were legally allowed to open in July 2014. CONCLUSION: Reported unintentional pediatric marijuana exposure has increased in the state of Washington since recreational marijuana was legalized. As marijuana becomes more available, clinicians should be aware of the risk of unintentional pediatric marijuana exposure, and this should inform lawmakers regarding regulations around childhood exposure to marijuana.


Assuntos
Ingestão de Alimentos , Uso da Maconha/efeitos adversos , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Lactente , Masculino , Uso da Maconha/legislação & jurisprudência , Pediatria/métodos , Centros de Controle de Intoxicações/organização & administração , Centros de Controle de Intoxicações/estatística & dados numéricos , Estudos Retrospectivos , Washington
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