A survey of cost, access and outcomes for cannabinoid-based medicinal product use by Australians with endometriosis.

People with endometriosis use cannabis to manage their symptoms. This study aimed to identify costs, modes of administration, product composition, and self-reported effectiveness for those accessing medicinal cannabis in Australia. There were 192 survey responses analysed. Most (63.5%) used a 'cannabis clinic' doctor, incurring an initial consultation cost of $100-$200+ (10.2% Medicare bulk-billed) and median cannabinoid medicine costs of $300AUD per month. Cost was a major barrier to access, necessitating reducing dosage (76.1%) and/or consuming illicit cannabis (42.9%), despite a prescription. Most (77%) medical consumers used two or more cannabis products, with delta-9-tetrahydrocannabinol predominant oil and flower products most frequently prescribed.

Analysis of synthetic cannabinoids in "spice-like" herbal highs: snapshot of the German market in summer 2011.

In this study, seven commercial "spice-like" products available on the German market were analyzed. They all contained significant amounts of synthetic cannabinoids and had distinctly different compositions of these adulterants. All synthetic cannabinoids were extracted and purified by different chromatographic techniques from the respective product. The structures of all compounds were elucidated by nuclear magnetic resonance spectroscopy and further characterized by mass spectrometry (MS) and ultraviolet and infrared spectroscopy to generate a full data set of each compound. Altogether, eight compounds were identified, and one deuterium-labeled cannabinoid was used as internal standard. Four products contained only one individual compound, while three products contained mixtures of two compounds. Among the eight isolated compounds, six were already known from recent publications (JWH-081, JWH-210, JWH-122, AM2201, RCS-4, and JWH-203), but the published data were not always complete. In addition, two unknown compounds (AM2201-pMe, RCS-4-(N-Me)) were isolated. Overall, compounds from three distinct classes of synthetic cannabinoids could be identified, characterized, and compared. The MS data of the different subclasses allowed the postulation of some general key fragmentations to distinguish between these subclasses. In addition, we established a general method using an isotopically labeled internal standard (JWH-018-D(3)) to quantify synthetic cannabinoids in herbal mixtures. The total content of the synthetic cannabinoids ranged from 77.5 to 202 mg/g, while individual compounds were detected from 19.3 to 202 mg/g in these products. The spectroscopic data for all compounds mentioned here were collected and added en bloc as Electronic supplementary material to this manuscript.

[Synthetic drugs: the new low-cost landscape of drugs]. / Drogues de synthèse: le nouveau cadre low-cost des drogues.

Designer drugs include, among others, synthetic cannabinoids and synthetic cathinones. These new "legal highs" drugs are sold on line for recreational public or private use. Synthetic cannabinoids are a psychoactive herbal and chemical product that, when used, mimics the effects of cannabis. Cathinone is a naturally occurring betaketone amphetamine analogue found in the leaves of the Catha edulis plant. Synthetic cathinones are phenylalkylamines derivatives, and may possess both amphetamine-like properties. They are often sold as "bath salts" or "plant food" and labeled "not for human consumption" to circumvent drug abuse legislation. The absence of legal risks, the ease of obtaining these drugs, the moderate cost, and the avaibility via Internet are the main criteria attracting the user. There is evidence that negative health and social consequences may occur in recreational and chronic users. The addictive potential of designer drugs is not weak. Furthermore, there is a lack of epidemiological, pharmacological, animal, clinical, psychological and therapeutic data concerning these new synthetic agents.

Cannabis lighting: Decreasing blue photon fraction increases yield but efficacy is more important for cost effective production of cannabinoids.

LED technology facilitates a range of spectral quality, which can be used to optimize photosynthesis, plant shape and secondary metabolism. We conducted three studies to investigate the effect of blue photon fraction on yield and quality of medical hemp. Conditions were varied among studies to evaluate potential interactions with environment, but all environmental conditions other than the blue photon fraction were maintained constant among the five-chambers in each study. The photosynthetic photon flux density (PPFD, 400 to 700 nm) was rigorously maintained at the set point among treatments in each study by raising the fixtures. The lowest fraction of blue photons was 4% from HPS, and increased to 9.8, 10.4, 16, and 20% from LEDs. There was a consistent, linear, 12% decrease in yield in each study as the fraction of blue photons increased from 4 to 20%. Dry flower yield ranged from 500 to 750 g m-2. This resulted in a photon conversion efficacy of 0.22 to 0.36 grams dry flower mass yield per mole of photons. Yield was higher at a PPFD of 900 than at 750 µmol m-2 s-1. There was no effect of spectral quality on CBD or THC concentration. CBD and THC were 8% and 0.3% at harvest in trials one and two, and 12% and 0.5% in trial three. The CBD/THC ratio was about 25 to 1 in all treatments and studies. The efficacy of the fixtures ranged from 1.7 (HPS) to 2.5 µmol per joule (white+red LED). Yield under the white+red LED fixture (10.4% blue) was 4.6% lower than the HPS on a per unit area basis, but was 27% higher on a per dollar of electricity basis. These findings suggest that fixture efficacy and initial cost of the fixture are more important for return on investment than spectral distribution at high photon flux.

Medical cannabis in the UK: From principle to practice.

BACKGROUND: In the UK, medical cannabis was approved in November 2018, leading many patients to believe that the medicine would now be available on the NHS. Yet, to date, there have been only 12 NHS prescriptions and less than 60 prescriptions in total. In marked contrast, a recent patient survey by the Centre for Medical Cannabis (Couch, 2020) found 1.4 m people are using illicit cannabis for medical problems. AIMS: Such a mismatch between demand and supply is rare in medicine. This article outlines some of the current controversies about medical cannabis that underpin this disparity, beginning by contrasting current medical evidence from research studies with patient-reported outcomes. OUTCOMES: Although definite scientific evidence is scarce for most conditions, there is significant patient demand for access to medical cannabis. This disparity poses a challenge for prescribers, and there are many concerns of physicians when deciding if, and how, to prescribe medical cannabis which still need to be addressed. Potential solutions are outlined as to how the medical profession and regulators could respond to the strong demand from patients and families for access to medical cannabis to treat chronic illnesses when there is often a limited scientific evidence base on whether and how to use it in many of these conditions. CONCLUSIONS: There is a need to maximise both clinical research and patient benefit, in a safe, cautious and ethical manner, so that those patients for whom cannabis is shown to be effective can access it. We hope our discussion and outlines for future progress offer a contribution to this process.

Cost-effectiveness of cannabinoids for pediatric drug-resistant epilepsy: protocol for a systematic review of economic evaluations.

BACKGROUND: Drug-resistant epilepsy negatively impacts the quality of life and is associated with increased morbidity and mortality and high costs to the healthcare system. Cannabis-based treatments may be effective in reducing seizures in this population, but whether they are cost-effective is unclear. In this systematic review, we will search for cost-effectiveness analyses involving the treatment of pediatric drug-resistant epilepsy with cannabis-based products to inform decision-making by public healthcare payers about reimbursement of such products. We will also search for cost-effectiveness analyses of other pharmacologic treatments for pediatric drug-resistant epilepsy, as well as estimates of healthcare resource use, costs, and utilities, for use in a subsequent cost-utility analysis to address this decision problem. METHODS: We will search the published and gray literature for economic evaluations of cannabis-based products and other pharmacologic treatments for pediatric drug-resistant epilepsy, as well as resource utilization and utility studies. Two independent reviewers will screen the title and abstract of each identified record and the full-text version of any study deemed potentially relevant. Study and population characteristics, the incremental cost-effectiveness ratio (ICER), as well as total costs and benefits, will be extracted, and quality will be assessed by use of the Drummond and CHEERS checklists; context-specific issues will also be considered. From model-based cost-utility and cost-effectiveness analyses, we will extract and summarize the model structure, including health states, time horizon, and cycle length. From resource utilization studies, we will extract data about the frequency of resource use (e.g., neurology visits, emergency department visits, admissions to hospital). From utility studies, we will extract the utility for each health state, the source of the preferences (e.g., child, parent, patient, general public), and the method of elicitation. DISCUSSION: Drug-resistant epilepsy in children is associated with important costs to the healthcare system, and decision-makers require high-quality evidence on which to base reimbursement decisions. The results of this review will be useful to both decision-makers considering the decision problem of whether to reimburse cannabis-based products through public formularies and to analysts conducting studies in this area. SYSTEMATIC REVIEW REGISTRATION: PROSPERO no.: CRD42018099591 .

The effects of price and perceived quality on the behavioural economics of alcohol, amphetamine, cannabis, cocaine, and ecstasy purchases.

Behavioural economic models of substance use describe the relationship between changes in unit price and consumption. However, these models rarely take account of the perceived quality (i.e. potency) of controlled drugs. Therefore we investigated the effects of both price and quality on the decision to purchase controlled drugs by polysubstance misusers. Forty current polysubstance misusers (29 males, 11 females; mean age 23.8) were recruited into the study. Participants were asked to hypothetically purchase drugs from a price list of alcohol, amphetamine, cannabis, cocaine and ecstasy at different levels of quality and price (i.e. better quality drugs cost more money). The disposable income available for those purchases was systematically varied in order to determine the impact of income on the decision to purchase drugs. Demand for both normal and strong alcohol was income inelastic. Demand for both poor and average quality cannabis and ecstasy was income inelastic, but demand for good quality cannabis and ecstasy was income elastic. The demand for poor quality cocaine was income inelastic, with the demand for both average and good quality cocaine being income elastic. Participants reported too few purchases of amphetamine, which precluded behavioural economic analysis. These results suggest that, like other goods, controlled drugs are purchased based upon the consumer's interpretations of their relative value. Therefore, it is probable that the purchase and subsequent use of controlled drugs by polysubstance misusers will be heavily influenced by the economic environment.

How much for a dime bag? An exploration of youth drug markets.

Relatively little is known about how youth obtain marijuana and other drugs. The Drugs, Alcohol and Violence International (DAVI) study explored youthful drug markets among samples of school students, detained youth, and school dropouts (ages 14-17 years) in the greater metropolitan areas of Philadelphia, Toronto, Montreal, and Amsterdam. Students frequently reported sharing drugs, either getting them from others or giving them to others for free. Sharing was less common among the more drug-involved detainees and dropouts. Marijuana was typically obtained either outdoors or in a house or apartment. Few youth reported getting marijuana at school. In Amsterdam, where marijuana can be purchased in small quantities in coffeeshops, this was the most common place to get marijuana, even though 18 is the legal age for purchase. Alcohol was also most likely to be obtained in stores or restaurants across all the sites, even though none were of legal age except those in Amsterdam age 16 or older. Youth most often reported purchasing marijuana in nickel, dime or other small bags, which are not standardized units. The exception again was Amsterdam, where youth most often reported quantities in grams or joints, which is how it is sold in coffeeshops. The lack of standardization of units makes economic cost estimates suspect. Even standardized units such as alcohol present problems since youth report a wide range of 'typical purchases.' Survey data can, however, more aptly describe drug market characteristics such as general location of purchase, and relationship with the seller.

Global patterns of domestic cannabis cultivation: sample characteristics and patterns of growing across eleven countries.

BACKGROUND: This article aims to provide an overview of: demographic characteristics; experiences with growing cannabis; methods and scale of growing operations; reasons for growing; personal use of cannabis and other drugs; participation in cannabis and other drug markets; contacts with the criminal justice system for respondents to an online survey about cannabis cultivation drawn from eleven countries (N=6530). Important similarities and differences between the national samples recruited will be discussed. METHODS: This paper utilizes data from the online web survey of predominantly 'small-scale' cannabis cultivators in eleven countries conducted by the Global Cannabis Cultivation Research Consortium (GCCRC). Here we focus primarily on descriptive statistics to highlight key similarities and differences across the different national samples. RESULTS: Overall there was a great deal of similarity across countries in terms of: demographic characteristics; experiences with growing cannabis; methods and scale of growing operations; reasons for growing; use of cannabis and other drugs; participation in cannabis and other drug markets, and; contacts with the criminal justice system. In particular, we can recognise that a clear majority of those small-scale cannabis cultivators who responded to our survey are primarily motivated for reasons other than making money from cannabis supply and have minimal involvement in drug dealing or other criminal activities. CONCLUSIONS: These growers generally come from 'normal' rather than 'deviant' backgrounds. Some differences do exist between the samples drawn from different countries suggesting that local factors (political, geographical, cultural, etc.) may have some influence on how small-scale cultivators operate, although differences in recruitment strategies in different countries may also account for some differences observed.

Lessons from conducting trans-national Internet-mediated participatory research with hidden populations of cannabis cultivators.

BACKGROUND: Internet-mediated research methods are increasingly used to access hidden populations. The International Cannabis Cultivation Questionnaire (ICCQ) is an online survey designed to facilitate international comparisons into the relatively under-researched but increasingly significant phenomenon of domestic cannabis cultivation. The Global Cannabis Cultivation Research Consortium has used the ICCQ to survey over 6000 cannabis cultivators across 11 countries. In this paper, we describe and reflect upon our methodological approach, focusing on the digital and traditional recruitment methods used to access this hidden population and the challenges of working across multiple countries, cultures and languages. METHODS: Descriptive statistics showing eligibility and completion rates and recruitment source by country of residence. RESULTS: Over three quarters of eligible respondents who were presented with the survey were included in the final sample of n=6528. English-speaking countries expended more effort to recruit participants than non-English-speaking countries. The most effective recruitment modes were cannabis websites/groups (33%), Facebook (14%) and news articles (11%). While respondents recruited through news articles were older, growing practice variables were strikingly similar between these main recruitment modes. CONCLUSION: Through this process, we learnt that there are trade-offs between hosting multiple surveys in each country vs. using one integrated database. We also found that although perceived anonymity is routinely assumed to be a benefit of using digital research methodologies, there are significant limits to research participant anonymity in the current era of mass digital surveillance, especially when the target group is particularly concerned about evading law enforcement. Finally, we list a number of specific recommendations for future researchers utilising Internet-mediated approaches to researching hidden populations.

Synthetic cannabinoids as drugs of abuse.

In the last decade a number of products have appeared in various countries that contain synthetic cannabinoids. This article reviews the history of the sale of these drugs, and the evidence that they contain synthetic cannabinoids. The biochemistry of the synthetic cannabinoids identified thus far is discussed, including a discussion of chemical structures and biochemical targets. The cannabinoid receptor targets for these drugs are discussed, as well as other possible targets such as serotonin receptors. Evidence for the abuse potential of these drugs is reviewed. The toxicity of synthetic cannabinoids and cannabinoid products is reviewed and compared to that of the phytocannabinoid Δ9- tetrahydrocannabinol (THC). As cannabinoids are a structurally diverse class of drugs, it is concluded that synthetic cannabinoids should be classified by biological activity rather than by structure, and that if this isn't done, novel synthetic cannabinoids will continue to emerge that fall outside of current regulatory classification models.

Reported value of cannabis seizures in Australian newspapers: are they accurate?

INTRODUCTION AND AIMS: The news media is often touted as an important, yet inaccurate source of information about drug issues for the general public. This paper investigates the accuracy of reporting in the Australian media regarding the value of cannabis seizures made by the police. DESIGN AND METHODS: A sample of Australian newspaper articles, which featured both a direct estimate of the value of a cannabis seizure and the number of plants seized, were examined. The reported values from these articles were then compared with a range of estimates made using data on cannabis plant yield and price, taken from research literature. RESULTS: Fifteen articles were examined, referring to fourteen different seizures. The reported value of cannabis seizures in this sample of articles was highly inflated when compared with the authors' estimated value. The reported newspaper values of seizures were between 1.8 and 11.9 times higher than our middle estimate. DISCUSSION AND CONCLUSIONS: The most likely reason for the wide difference between the reported and estimated value of these seizures is the possible variability in cannabis plant yield. Whatever the reason for the discrepancy between the reported values and our estimates, greater transparency surrounding the valuations of cannabis seizures would help to better determine the true impacts of law enforcement interventions on this illicit drug supply chain

The impact of changes in UK classification of the synthetic cannabinoid receptor agonists in 'Spice'.

BACKGROUND: Spice is the iconic brand name of a smokeable herbal mixture containing synthetic cannabinoid receptor agonists. It has been available on the Internet/in head shops in Europe since at least 2006. The synthetic cannabinoid receptor agonist constituents of Spice were classified in the UK as Class B agents in December 2009. This study assessed the impact of this legislation on the synthetic cannabinoid receptor agonists present in Spice products and whether new synthetic cannabinoid receptor agonists outside of the legislation are now available. METHODS: Spice products were bought, prior to and after the change in the UK legislation, from a range of Internet legal high websites selling to UK consumers. Products were analysed using liquid chromatography high-resolution tandem mass spectrometry (LCMSMS). Identification of the synthetic cannabinoid receptor agonist(s) detected was made by comparison to existing databases or by 'in silico' methods. RESULTS: Sixteen products were purchased prior to the UK control of synthetic cannabinoid receptor agonists; all contained at least one synthetic cannabinoid receptor agonist. 20 products were purchased after the UK control; no active compounds were detected in 3 (15%). The remaining 17 (85%) all contained at least one classified synthetic cannabinoid receptor agonist. Additionally, 2 synthetic cannabinoid receptor agonists not covered under current UK generic legislation (AM-694 and the 'novel Belarus compound') were detected. CONCLUSION: Despite the UK 'Spice' classification, classified synthetic cannabinoid receptor agonists continue to be supplied over the Internet to UK users. Furthermore, new synthetic cannabinoid receptor agonists not covered by the legislation are appearing. Consideration needs to be given to reviewing the UK legislation so that suppliers cannot circumvent it by supplying legal alternatives to the classified synthetic cannabinoid receptor agonists.

From Ganja to crack: Caribbean participation in the underground economy in Brooklyn, 1976-1986. Part 2. Establishment of the cocaine (and crack) economy.

Shortages in the supply of marijuana, which became acute around 1981, caused Rastafari marijuana distributors very reluctantly to disregard religious injunctions against the use of any psychoactive substance except marijuana, and to experiment with the use and distribution of cocaine hydrochloride powder for intranasal administration and, later, for smoking (freebase and crack). This experimentation proved ruinous, and many were retired ignominiously from drug distribution. In the crack era they have been succeeded by completely new social, cultural, and economic arrangements.

Crack: new directions in drug research. Part 1. Differences between the marijuana economy and the cocaine/crack economy.

Crack use and trafficking in low-income, minority communities in New York City have pushed into prominence many aspects of drug use/misuse and distribution which had formerly received inadequate attention. For example, the generation and reinvestment of drug incomes are important determinants of how various drugs are experienced. While in retrospect marijuana trafficking appears to have been an almost benign affair, crack trafficking is fast-paced, ruthless, steeped in violence, and impoverishes everyone who becomes engaged in it. In this part the differences between rates, volumes, and methods of income generation related to the use and distribution of marijuana and cocaine are elaborated. The contrast raises a question: Do economies like drug distribution follow a particular rhythmic pattern (capital accumulation during the benign marijuana passage followed by capital depletion in the overheated crack era), and how is it related to the changing demands of the regional economy? Viewed from this perspective, drug distributors and users appear not so much as "deviant" or "alienated" or as a "reserve pool of labor," but rather as a type of labor force which does indispensable work for the whole society.