By Charles A. Warnock, Ashlin R. Ondrusek, E. Jennifer Edelman, Trace Kershaw, Jessica L. Muilenburg

Cannabis use is increasingly pervasive throughout the U.S. People in treatment for substance use disorders (SUD) may be especially at-risk of harm due to this changing context of cannabis in the U.S. This study’s objective was to qualitatively describe experiences and beliefs around cannabis among people who had entered treatment for any SUD in the past 12-months.

Methods

From May to November of 2022, we conducted 27 semi-structured interviews (n=16 in Georgia, n=11 in Connecticut) with individuals in treatment for SUD in Georgia and Connecticut. Interviews were recorded, transcribed, and thematically analyzed using an emergent approach.

Results

All participants had used cannabis in the past. Four themes emerged from the interviews. Participants: (1) perceived cannabis as an important contributor to non- cannabis substance use initiation in adolescence; (2) viewed cannabis as a substance with the potential to improve health with fewer side effects than prescription medications; (3) expressed conflicting opinions regarding cannabis as a trigger or tool to manage cravings for other non-cannabis substances currently; and 4) described concerns related to negative legal, social service, and treatment-related consequences as well as negative peer perception relating to the use of cannabis.

Conclusion

Although participants described cannabis’s important role as an initiatory drug in adolescence and young adulthood, many felt that cannabis was a medicinal substance for a range of health problems. These findings suggest SUD treatment clinicians should address medicinal beliefs related to cannabis among their clients and emphasizes the need for research on cannabis use and SUD treatment outcomes.

Drug and Alcohol Dependence Reports. Online First, March 2024

Eric L. Sevigny, Jared Greathouse, Danye N. Medhin

Background. Globally, cannabis laws and regulations are rapidly changing. Countries are increasingly permitting access to cannabis under various decriminalization, medicalization, and legalization laws. With strong economic, public health, and social justice incentives driving these domestic cannabis policy reforms, liberalization trends are bound to continue. However, despite a large and growing body of interdisciplinary research addressing the policy-relevant health, safety, and socioeconomic consequences of cannabis liberalization, there is a lack of robust primary and systematic research that comprehensively investigates the consequences of these reforms.

Objectives. This evidence and gap map (EGM) summarizes the empirical evidence on cannabis liberalization policies. Primary objectives were to develop a conceptual framework linking cannabis liberalization policies to relevant outcomes, descriptively summarize the empirical evidence, and identify areas of evidence concentration and gaps.

Search Methods. We comprehensively searched for eligible English-language empirical studies published across 23 academic databases and 11 gray literature sources through August 2020. Additions to the pool of potentially eligible studies from supplemental sources were made through November 2020.

Selection Criteria. The conceptual framework for this EGM draws upon a legal epidemiological perspective highlighting the causal effects of law and policy on population-level outcomes. Eligible interventions include policies that create or expand access to a legal or decriminalized supply of cannabis: comprehensive medical cannabis laws (MCLs), limited medical cannabidiol laws (CBDLs), recreational cannabis laws (RCLs), industrial hemp laws (IHLs), and decriminalization of cultivations laws (DCLs). Eligible outcomes include intermediate responses (i.e., attitudes/behaviors and markets/environments) and longer-term consequences (health, safety, and socioeconomic outcomes) of these laws.

Data Collection and Analysis. Both dual screening and dual data extraction were performed with third person deconfliction. Primary studies were appraised using the Maryland Scientific Methods Scale and systematic reviews were assessed using AMSTAR 2.

Main Results. The EGM includes 447 studies, comprising 438 primary studies and nine systematic reviews. Most research derives from the United States, with little research from other countries. By far, most cannabis liberalization research focuses on the effects of MCLs and RCLs. Studies targeting other laws—including CBDLs, IHLs, and DCLs—are relatively rare. Of the 113 distinct outcomes we documented, cannabis use was the single most frequently investigated. More than half these outcomes were addressed by three or fewer studies, highlighting substantial evidence gaps in the literature. The systematic evidence base is relatively small, comprising just seven completed reviews on cannabis use (3), opioid-related harms (3), and alcohol-related outcomes (1). Moreover, we have limited confidence in the reviews, as five were appraised as minimal quality and two as low quality.

Authors’ Conclusions. More primary and systematic research is needed to better understand the effects of cannabis liberalization laws on longer-term—and arguably more salient—health, safety, and socioeconomic outcomes. Since most research concerns MCLs and RCLs, there is a critical need for research on the societal impacts of industrial hemp production, medical CBD products, and decriminalized cannabis cultivation. Future research should also prioritize understanding the heterogeneous effects of these laws given differences in specific provisions and implementation across jurisdictions

Systematic Reviews, vol. 19(4), 2023.

By Christopher B.R. Smith

Examining the interdependent nature of substance, space, and subjectivity, this book constitutes an interdisciplinary analysis of the intoxication indigenous to what has been termed "our narcotic modernity." The first section – Drug/Culture – demonstrates how the body of the addict and the social body of the city are both inscribed by "controlled" substance. Positing addiction as a "pathology (out) of place" that is specific to the (late-)capitalist urban landscape, the second section – Dope/Sick – conducts a critique of the prevailing pathology paradigm of addiction, proposing in its place a theoretical reconceptualization of drug dependence in the terms of "p/re/in-scription." Remapping the successive stages or phases of our narcotic modernity, the third section –Narco/State – delineates three primary eras of narcotic modernity, including the contemporary city of "safe"/"supervised" consumption. Employing an experimental, "intra-textual" format, the fourth section –Brain/Disease – mimics the sense, state or scape of intoxication accompanying each permutation of narcotic modernity in the interchangeable terms of drug, dream and/or disease. Tracing the parallel evolution of "addiction," the (late-)capitalist cityscape, and the pathological project of modernity, the four parts of this book thus together constitute a users’ guide to urban space.

London; New York: Routledge, 2016. 252p.

By B.C.Tefft, and L.S.. & Arnold,

Washington State Initiative 502 (I-502), effective Dec. 6, 2012, legalized possession of small amounts of cannabis for recreational use by adults aged 21 years and older. It also included a prohibition against driving with 5 or more nanograms of delta-9-tetrahydrocannabinol (THC) per milliliter of blood, along with a zero tolerance prohibition for drivers younger than 21 years of age. THC is the main psychoactive component in cannabis and detection of THC in blood is suggestive of recent use. A previous study by the AAA Foundation for Traffic Safety examined data from drivers involved in fatal crashes in Washington State in years 2010-2014 and estimated that the proportion of drivers with detectable THC approximately doubled several months after I-502 became effective (Tefft et al., 2016). The research reported here updates the previous study with three additional years of data, post-legalization. Multiple imputation was used to estimate the proportion of drivers who were THC-positive among those who were not tested for drugs or whose test results were unavailable. Results indicate that five years after I-502, the proportion of fatal-crash-involved drivers who are THC-positive has remained approximately double the level observed before I-502. An estimated 21% of all drivers involved in fatal crashes in Washington State in 2017 were THC-positive, higher than in any other year in the 10-year period examined

Washington, D.C.: AAA Foundation for Traffic Safety , 2020. 6p.