Societal issues and policy implications related to the use of cannabinoids, cannabis, and cannabis-based medicines for pain management.

Background: Adolescents and young adults have high rates of cannabis use. Although a sizeable portion of youth report that they use cannabis for medicinal reasons (Wardell et al., 2020; Wardell, in press), most research on youth cannabis use tends to focus on recreational use. It is important to understand how youth who use cannabis for medicinal reasons differ from those who use for recreational reasons. We aimed to review the limited research comparing youth engaging in medicinal cannabis use to those engaging in recreational cannabis use. Methods: A systematic literature search of three databases (PsychInfo, PubMed, MEDLINE) was conducted to identify studies that compared adolescents and/or young adults who engage in medicinal cannabis to those who engage in recreational cannabis use. Studies that defined medicinal cannabis use either as self-reported use of cannabis for therapeutic reasons or as obtaining authorization/prescription for medical cannabis from a healthcare provider were included. Only quantitative research studies published in a peer-reviewed journal were included. After conducting the initial search and removing duplicates, 748 abstracts were reviewed independently by two researchers. Any discrepancies were resolved by consensus in consultation with a third researcher. Results: A total of 13 articles met inclusion criteria. Outcome variables reported in the literature included cannabis use (frequency and amount), cannabis-related problems, use of other substances including illicit drug use or prescription medication misuse, and health-related variables such as mental health symptoms or physical pain. Overall, the literature suggests that youth who use cannabis medicinally are more likely to use greater amounts of cannabis, to use more frequently, and to use a variety of different forms of cannabis, relative to youth who use cannabis recreationally. Further, several studies reported that medicinal cannabis use among youth was associated with problems related to cannabis use, such as the risk for cannabis use disorder and problematic behaviour (e.g., driving under the influence). Several studies also found that medicinal (vs. recreational) cannabis use was related to poorer mental or physical health, although a couple of studies did not support this finding. However, the results were mixed regarding the associations between medicinal cannabis use and the likelihood of using other drugs. Conclusion: There is evidence that using cannabis for medicinal reasons is associated with greater cannabis consumption, cannabis-related problems, and negative health-related correlates among youth. Although there was some consistency in findings across studies, the limited number of studies make it difficult to draw firm conclusions. Causal inferences are difficult to make owing to the frequent reliance on cross-sectional designs. The findings are further complicated by the heterogeneous definition of medicinal cannabis use (i.e., self-report vs. medically authorized). Given that many young people engage in both medicinal and recreational cannabis use, it is difficult to fully disentangle the differences. Additional research is needed for a complete understanding of the unique outcomes associated with medical cannabis use among youth.

Ensuring access to safe, effective, and affordable cannabis-based medicines.

A longitudinal examination of daily patterns of cannabis and alcohol co-use among medicinal and recreational veteran cannabis users

Medicinal cannabis in Thailand: 1-year experience after legalization.

Background: In 2016, California transitioned from legalized medical cannabis use to adult-use. Little is known about how this policy change affected medicinal cannabis use among young adults. Objectives: To identify longitudinal groups of medicinal cannabis users and concurrent changes in health- and cannabis use-related characteristics among young adults in Los Angeles between 2014 and 2021. Methods: Cannabis users (210 patients and 156 non-patients; 34% female; ages 18–26 at baseline) were surveyed annually across six waves. Longitudinal latent class analysis derived groups from two factors – cannabis patient status and self-reported medicinal use. Trajectories of health symptoms, cannabis use motives, and cannabis use (daily/near daily use, concentrate use, and problematic use) were estimated across groups. Results: Three longitudinal latent classes emerged: Recreational Users (39.3%) – low self-reported medicinal use and low-to-decreasing patient status; Recreational Patients (40.4%) – low self-reported medicinal use and high-to-decreasing patient status; Medicinal Patients (20.3%) – high self-reported medicinal use and high-to-decreasing patient status. At baseline, Medicinal Patients had higher levels of physical health symptoms and motives than recreational groups (p < .05); both patient groups reported higher level of daily/near daily and concentrate use (p < .01). Over time, mental health symptoms increased in recreational groups (p < .05) and problematic cannabis use increased among Recreational Patients (p < .01). Conclusions: During the transition to legalized adult-use, patterns of medicinal cannabis use varied among young adults. Clinicians should monitor increases in mental health symptoms and cannabis-related problems among young adults who report recreational – but not medicinal – cannabis use.

PC-FACS

Legal concerns and perceptions among women with gynecologic malignancies using prescribed medical cannabis: a single-institution, survey-based study

Cannabis has been used for thousands of years for recreational, medicinal, or religious purposes and the therapeutic potential of medicinal Cannabis was demonstrated in various medical conditions. The legalization of Cannabis is an important source of economic growth as it contributes to the growing revenue tax, and the creation of new workplaces. The maturity of the Cannabis market varies across the globe mainly due to differing legal environments and public attitudes towards Cannabis. Some countries such as Canada and the United States have adopted fully regulated frameworks that allow the cultivation, consumption, and retail distribution of various Cannabis products. Uruguay became the first country in the world to legalize the production, distribution and consumption of cannabis in 2013. The Cannabis market in Canada and the USA is experiencing rapid growth due to the country's legalization of recreational use. Regulations can also differ regarding how cannabis is used. However, the use, cultivation, and marketing of Medical Cannabis sativa (drug or Marijuana type ) is banned and prohibited in India due to the presence of high levels of psychoactive principle THC (Narcotic drug). On the other hand, Industrial Cannabis sativa (seed or fiber type) Hemp was legalized in 2021 by The Food Safety and Standards Authority of India (FSSAI), Government of India, New Delhi. In Azerbaijan, Cannabis is not available for medical or recreational use. Recreational Cannabis and medical marijuana are illegal in Azerbaijan. Marijuana is illegal for medical and recreational purposes in China. There is still a huge prejudice in society about medical Cannabis due to its recreational use. However, this scenario is changing, and the social resistance is decreasing for the medicinal use of Cannabis. The Cannabis (Hemp) market in India is predicted to experience a substantial revenue growth, with projections indicating that it will reach ₹US$100.80m by 2024. The Cannabis market worldwide is projected to reach a revenue of US$60.79bn in 2024. The global legal marijuana market size is expected to reach USD 73.6 billion by 2027 and is anticipated to expand at a CAGR of 18.1% during the forecast period.

BackgroundDementia is a broad term that covers multiple conditions which affect the brain, such as Alzheimer's disease and Frontotemporal dementia. The collection of symptoms caused by these disorders vary and can include disrupted mood, apathy, agitation, aggression, disinhibition, and/or sleep. There has been increasing interest in exploring potential benefits of cannabis‐derived medicine in alleviating neuropsychiatric symptoms of dementia. We examined the attitudes towards the use of cannabinoids for symptomatic treatment of dementia among Australian adults diagnosed with different dementia types, their caregivers, and healthy controls.MethodPatients with a diagnosis of dementia, their caregivers, and healthy controls from the FRONTIER research database, at the University of Sydney, completed an online questionnaire assessing attitudes toward medicinal cannabis and cannabinoid use. The questionnaire inquired about the perceived benefits and risks of cannabis use; experience with cannabis use; and interest in participating in a hypothetical clinical trial using medicinal cannabis for the symptomatic treatment of dementia. There were 77 respondents to the questionnaire: 22 dementia patients, 30 study partners, and 25 healthy controls.ResultOf respondents with a diagnosis of dementia, 73% said they would consider participating in a clinical trial exploring the potential therapeutic effects of medicinal cannabis. Out of all participants who completed the survey, 80% said they would consider participating in such a trial. While only 24% of the participants reported previous recreational or medicinal cannabis use, there remains a strong general interest in exploring the potential benefits of cannabinoids through clinical trials.ConclusionThe results from this questionnaire show that there is a strong interest from Australian dementia patients and their caregivers to participate in future clinical trials that would assess the effectiveness of medicinal cannabis in alleviating dementia symptoms. As evidenced by this and other studies, there is growing support for the consideration of cannabis‐derived products as medical treatments. We propose that robustly designed clinical trials with clearly defined outcome measures would be of interest and have the potential to expand symptomatic treatment options to those living with dementia.

This study examined the feasibility of using ecological momentary assessment (EMA) to disentangle medicinal cannabis use (MCU) from recreational cannabis use (RCU) among people living HIV (PLWH). Over a 14-day period, PLWH (N = 29) who engaged in both MCU and RCU completed a smartphone-based survey before and after every cannabis use event assessing general motivation for cannabis use (MCU-only, RCU-only, or mixed MCU/RCU), cannabis use behavior, and several antecedents and outcomes of cannabis use. A total of 739 pre-cannabis surveys were completed; 590 (80%) of the prompted post-cannabis surveys were completed. Motives for cannabis use were reported as MCU-only on 24%, RCU-only on 30%, and mixed MCU/RCU on 46% of pre-cannabis surveys. Mixed effects models examined within-person differences across MCU-only, RCU-only, and mixed MCU/RCU events. Results showed that relative to RCU-only events, MCU-only events were more likely to involve symptom management and drug substitution motives, physical and sleep-related symptoms, solitary cannabis use, and use of cannabis oils and sprays; MCU-only events were less likely to involve relaxation, happiness, and wellness motives, cannabis flower use, and positive cannabis consequences. Differences between mixed MCU/RCU and RCU-only events were similar, except that mixed MCU/RCU events were additionally associated with stress reduction motives and symptoms of anxiety and depression. Findings support the feasibility of partially disentangling MCU and RCU behavior among PLWH who engage in concurrent MCU and RCU. This study highlights the need for more EMA studies isolating MCU from RCU to inform ongoing changes to cannabis policies.

BackgroundSince 2001, Canadians have been able to obtain cannabis for medical purposes, initially through the Access to Cannabis for Medical Purposes Regulations (ACMPR). The Cannabis Act (Bill C-45) came into force on October 17, 2018, replacing the ACMPR. The Cannabis Act enables Canadians to possess cannabis purchased from a licensed retailer without authorization for either medical or nonmedical purposes. The Cannabis Act is currently the guiding legislation which governs both medical and nonmedical access. The Cannabis Act contains some improvements for patients but is essentially the same as its previous legislation. Beginning in October 2022, the federal government is conducting a review of the Cannabis Act and is questioning whether a distinct medical cannabis stream is still required, given the ease of access to cannabis and cannabis products. Although there is overlap in the reasons for medical and recreational cannabis use, the distinct legislation of medical versus recreational use of cannabis in Canada may be under threat.Main bodyA large segment of the medical, academic, research, and lay communities agree that there is a need for distinct medical and recreational cannabis streams. Perhaps most importantly, separation of these streams is necessary to ensure that both medical cannabis patients and healthcare providers receive the required support needed to optimize benefits while minimizing risks associated with medical cannabis use. Preservation of distinct medical and recreational streams can help to ensure that needs of different stakeholders are met. For example, patients require guidance in the form of assessing the appropriateness of cannabis use, selection of appropriate products and dosage forms, dosing titration, screening for drug interactions, and safety monitoring. Healthcare providers require access to undergraduate and continuing health education as well as support from their professional organizations to ensure medical cannabis is appropriately prescribed. Although there are challenges in conducing research, as motives for cannabis use frequently straddle boundaries between medical versus recreational cannabis use, maintenance of a distinct medical stream is also necessary to ensure adequate supply of cannabis products appropriate for medical use, to reduce stigma associated with cannabis in both patients and providers, to help enable reimbursement for patients, to facilitate removal of taxation on cannabis used for medical purposes, and to promote research on all aspects of medical cannabis.ConclusionCannabis products for medical and recreational purposes have different objectives and needs, requiring different methods of distribution, access, and monitoring. HCPs, patients, and the commercial cannabis industry would serve Canadians well to continue to advocate to policy makers to ensure the continued existence of two distinct streams and must strive to make ongoing improvements to the current programs.

Since California legalised medical use of cannabis in 1996, 29 other US states have done so. Eight US states have legalised the retail sale of cannabis to adults over the age of 21 years since 2012. Critics of these policy changes have suggested that they will increase the prevalence of cannabis use and cannabis use disorders. This paper (1) briefly describes the types of regulatory regimes for medical and recreational cannabis use in the USA, (2) describes possible effects of these policies on cannabis use and (3) assesses the impacts to date of the legalisation of medical and recreational cannabis use on the prevalence of cannabis use and cannabis use disorders in the US population. We (1) describe the regulatory regimes for medical and recreational cannabis use in the USA, (2) make predictions about their possible effects on the price and availability of cannabis, (3) conduct a review to summarise studies of the effects of legalising medical cannabis use in the USA on rates of cannabis use and cannabis use disorders and (4) assess early indications of the effects of legalising recreational cannabis use on cannabis use and cannabis use disorders. Liberal forms of medical cannabis regulation have probably reduced prices and increased the availability of cannabis. Analyses of survey data suggest that these changes have increased the prevalence and frequency of cannabis use among adults over the age of 21 years, but they have not to date increased rates of cannabis use among adolescents. Two series of epidemiological studies over a decade following the introduction of medical cannabis laws have produced inconsistent results on the effects of policy changes on the prevalence of cannabis use disorders in adults. One study found that the prevalence had increased; the other did not find an increase. An analysis of data on treatment seeking for cannabis use disorders showed an increase in states with medical cannabis laws in the number of adults seeking treatment who were not under legal coercion. There are major limitations with these studies, many of which have mistakenly assumed that all states with medical cannabis laws have similarly liberal policies. It may be a decade or more before we can fully assess the effects of liberalisation of cannabis policies on cannabis use and cannabis use disorders in the USA. It is critical that the effects of these policy changes are evaluated to ensure that cannabis is regulated in ways that minimise the harmful effects of its regular use, especially among young people.

Background: Beyond the legal use of medical cannabis in Denmark for selected patient groups, a large unregulated use of medicinal (non-prescribed) cannabis occurs. However, little is known about the paths to becoming a medicinal cannabis user and the role that previous recreational experience plays in this process. Aim: Inspired by Becker’s social learning approach to becoming a cannabis user, this study explores sources of inspiration for medicinal cannabis use, the social control factors related to use, and the relevance of recreational experience (RE) with cannabis. Methods: An anonymous survey was made available online to a convenience sample of 2,281 adults (≥18 years) who self-medicate with non-prescribed cannabis. Logistic regression analysis compared users with no RE (46.1%) to users with occasional RE (27.4%) and regular RE (26.5%) in terms of user characteristics, initiation of medicinal use, and experiences with social control factors. Results: Compared to users with RE, users with no RE were significantly more likely to be women, older, more frequent users, and to treat somatic conditions and use low potency CBD-oil. Users with no RE were more likely to rely on social networks for information on medicinal cannabis, use online sources for supply, and find supply stable. Moreover, users with no RE were less likely to keep use secret and find use problematic. Also, when medicinal use develops on a gradual transition from recreational use it is associated with increased odds of treating mental health conditions and with use of smoking as form of intake. Conclusion: The heterogeneity among medicinal cannabis users in Denmark, in terms of demographics, motives for use, and patterns of use, is related to the level of previous recreational experience and to whether medicinal use developed on a gradual transition from recreational use.

Introduction and Aims: Increasingly more Australians are in favor of legalizing medical and recreational cannabis use. This paper explored the personal characteristics of those who supported each of these policies in Australia.Design: Cross-sectional national survey.Methods: This study included 21,729 participants aged 18 years and above who responded to the 2016 National Drug Strategy Household Survey. Participants were provided the assurance of confidentiality for their participations. Logistic regression models were used to examine the relationships between personal characteristics and support for the legalization of medical and recreational cannabis.Results: Overall, 77 and 40% of participants supported the legalization of medical and recreational cannabis respectively. People of older age were more likely to support medical cannabis legalization while those who supported legalization of recreational cannabis use were more likely to be younger. Medical cannabis supporters were more likely to report chronic pain (OR = 1.44, 95% CI: 1.04, 2.00) while recreational cannabis supporters were more likely to suffer high level of psychological distress (OR = 1.28, 95% CI: 1.14, 1.43). Experience with cannabis use was strongly associated with supportive attitudes, with recent cannabis users almost 14 times (OR = 14.13, 95% CI: 5.37, 37.20) and 34 times (OR = 33.74, 95% CI: 24.22, 47.01) more likely to support the legalization of medical and recreational cannabis use, respectively.Discussion and Conclusions: The majority of Australians approve the legalization of cannabis for medicinal purposes but most remain cautious about legalizing recreational cannabis use. The sociodemographic and clinical profile of supporters of medical and recreational legalization suggests a potential interaction of self-interests and beliefs about the harms of cannabis use.

Background The past two decades have seen significant debate around cannabis legalization globally, including in India. Since there is no data on professionals’ attitudes toward cannabis legalization; we aimed to assess early-career psychiatrists (ECP) views on cannabis legalization. Methods An online survey consisting of questions regarding personal and socio-demographic details, attitudes toward legalization of medicinal cannabis and recreational cannabis, and potential indications of medicinal cannabis use was distributed to ECPs. Data from 105 respondents were analyzed using descriptive statistics, chi-square test, and t-test. Results More respondents agreed with the legalization of medical cannabis (55%) as compared to recreational cannabis (23%). More than 80% ECPs considered cannabis to be associated with psychosis and adverse mental health outcomes; however, those in favor of legalization considered cannabis to be less harmful. ECP with past cannabis use was more likely to have a permissive attitude toward the legalization of recreational cannabis (χ2 =6.79, p < .05) but not for medicinal cannabis use (χ2 =1.96, p > .05). Conclusion ECP in India are open to the idea of legalizing cannabis for medicinal purposes but not for recreational purposes.