High Prevalence Of Cannabis Use Research Articles

Trends in cannabis use among immigrants in the United States, 2002–2017: Evidence from two national surveys

Background and aimsFindings from recent studies suggest that, among the general population of adults, the prevalence of cannabis use has increased over the last decade in the United States (US). And yet, there is much we do not know regarding the trends in cannabis use among immigrants. We address this important shortcoming by examining data on immigrants vis-à-vis US-born individuals using two national surveys. MethodsWe examine trend data from the National Epidemiologic Study on Alcohol and Related Conditions (NESARC, 2001–2013) and the National Survey on Drug Use and Health's Restricted Data Analysis System (NSDUH, 2002–2017). Main outcomes were past year cannabis use and cannabis use disorder with survey adjusted prevalence estimates generated for immigrants and US-born individuals. ResultsIn the NESARC, significant increases in the past year prevalence of cannabis use were observed both among US-born (2001–2002: 4.53%, 2012–2013: 10.74%) and immigrant participants (2001–2002: 1.67%, 2012–2013: 3.32%). We also found significant increases among immigrants arriving before age 12 and among immigrants from Latin America and Europe. In the NSDUH, we observed a significantly higher prevalence of cannabis use in 2016–2017 (6.3%) when compared to 2002–2003 (4.4%). ConclusionsFindings make clear that cannabis use among US-born individuals has consistently been higher than that of immigrants since the early 2000s. However, while rates of cannabis use have declined among US-born adolescents in recent years, the prevalence of cannabis use has remained stable among immigrant adolescents. At the same time, cannabis use increased two-fold among both US-born and immigrant adults.

Serious psychological distress and daily cannabis use, 2008 to 2016: Potential implications for mental health?

BackgroundDaily cannabis use is increasing in the United States (US). Yet, it is not known whether daily cannabis use is disproportionately common, or whether it has increased differentially over time, by mental health status. This study estimated the prevalence of daily cannabis use among adults in the US with and without past-month serious psychological distress (SPD; measured by the Kessler Psychological Distress Scale (K6)) in 2016 and estimated trends in daily cannabis use by past-30-day SPD status from 2008 to 2016. MethodsData were drawn from adults age 18 and older in the 2008–2016 National Survey on Drug Use and Health (combined total analytic sample n = 356,413). Linear time trends of daily cannabis use, stratified by SPD status, were assessed using logistic regression models with continuous year as the predictor. ResultsIn 2016, past-month daily cannabis use was significantly more common among those with past-month SPD (8.07%), compared to those without past-month SPD (2.66%). Daily cannabis use increased significantly from 2008 to 2016 among those both with and without SPD although use among those with SPD was persistently higher than use among those without SPD over the time period studied. ConclusionsDaily cannabis use is significantly more common among persons with serious psychological distress and is increasing in this group, as well as among those without. Given this increase and the high prevalence of cannabis use among those with SPD, it may be important to consider potential consequences of this increased use for those with mental health vulnerabilities.

\u201cWhere does the high road lead?\u201d Potential implications of cannabis legalization for pediatric injuries in Canada

The purpose of this commentary is to discuss how legalization of non-medical marijuana (LNMM) in Canada can potentially influence child and adolescent unintentional injuries based on evidence from states (American) and jurisdictions that have already legalized cannabis for recreational purposes. Although the evidence is still not conclusive, LNMM can bring about higher exposure, lower perceived harms, and higher prevalence of cannabis use by minors through role modeling and normalization of behaviour within the household and the community, and higher rates of driving under the influence of cannabis, which can contribute to a higher burden of road traffic injuries. Experience of American states with LNMM shows higher rates of emergency visits for pediatric poisoning due to unintentional ingestion of cannabis-containing foods and severe burns due to explosions during the course of home-based cannabis extraction. While the justification for legalization has created a strict legal framework for improved control of cannabis in Canada, the implications for health and safety of children and adolescents necessitate further study, communication with policy-makers and public health practitioners, and evidence-based education of parents, caregivers, and youth.

Medical cannabis legalization and state-level prevalence of serious mental illness in the National Survey on Drug Use and Health (NSDUH) 2008–2015

Although research has established a link between cannabis legalization and use, and cannabis use and mental health, the relationship between medical cannabis legalization and mental health remains uncharacterized. This analysis investigated the relationship between state medical cannabis laws (restrictive, i.e. covering a narrow set of medical conditions; or liberal, i.e. covering a broad range of medical conditions), whether the law permits patients to petition their physician to approve medical cannabis use for specific medical conditions, and state prevalence of serious mental illness (SMI) in the National Survey of Drug Use and Health 2008–2015. In a covariate-adjusted meta-regression, liberal laws were significantly associated with higher prevalence of SMI (Coeff = 0.003, SE = 0.001, p < .001). Restrictive laws (Coeff = 0.001, SE = 0.001, p = .285) and the ability to petition physician approval (Coeff = −0.001, SE = 0.001, p = .140) were non-significant. When added to the model, state past-year cannabis use was significantly associated with higher prevalence of SMI (Coeff = 0.037, SE = 0.015, p = .018), liberal laws remained significant (Coeff = 0.002, SE = 0.001, p = .015), and restrictive laws (Coeff = −0.0001, SE = 0.001, p = .945) and the ability to petition a physician (Coeff = 0.001, SE = 0.001, p = .290) remained non-significant. Medical cannabis laws are likely related to state mental health, and a higher prevalence of cannabis use partially explains this relationship.

T128. THE ASSOCIATION BETWEEN GENETIC RISK FOR SCHIZOPHRENIA AND PATTERNS OF CIGARETTE AND CANNABIS USE IN ADOLESCENCE

BackgroundSchizophrenia is associated with a higher prevalence of cannabis use and cigarette use. However, it is unknown to what extent these associations are due to a shared genetic aetiology. We therefore aim to examine how schizophrenia genetic risk associates with patterns of cigarette and cannabis use in adolescence.MethodsWe analysed repeated measures of cigarette and cannabis use during adolescence in a sample of 5,300 individuals in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort who had at least 3 measures of cigarette and cannabis use between ages 14–19 years. Cigarette and cannabis use data were summarised using longitudinal latent class analysis to identify longitudinal classes of substance use, and associations between polygenic scores for schizophrenia and resulting classes were assessed.ResultsThe schizophrenia polygenic score based on single nucleotide polymorphisms (SNPs) meeting a discovery sample threshold of p ≤ 0.05 was associated with late onset cannabis use as compared to non-use (OR = 1.20; 95% CI = 1.05, 1.37) but not with early onset or cigarette only use latent classes. This association persisted after excluding the CHRNA5-CHRNA3-CHRNB4 nicotinic receptor gene cluster (OR = 1.25; 95% CI = 1.08, 1.44), a locus which has previously been found to strongly associate with schizophrenia.DiscussionThis study found that genetic risk of schizophrenia (as captured by polygenic scores) is associated with late-onset cannabis use but not with other smoking phenotypes in adolescence in ALSPAC. Possible explanations for these results are that schizophrenia and cannabis use have a shared genetic aetiology or that biological risk of schizophrenia leads to cannabis use through secondary mechanisms. These secondary mechanisms may include stress of childhood behavioural problems occurring as a result of biological processes underling schizophrenia. Future analyses involving mediation models may shed some light on factors influencing patterns of substance use in individuals with a high genetic liability for schizophrenia.

Cannabis Use in Individuals With Spinal Cord Injury or Moderate to Severe Traumatic Brain Injury in Colorado

ObjectivesTo describe the prevalence of cannabis use in an adult sample with spinal cord injury (SCI) or traumatic brain injury (TBI) in Colorado, and to describe the self-reported reasons and side effects of cannabis use in this sample. DesignMixed-methods observational study, using focus group data and telephone survey. SettingCommunity. ParticipantsColorado adults who sustained SCI or moderate to severe TBI and received services through Craig Hospital. InterventionsNone. Main Outcome MeasuresSurvey. ResultsFocus group participants identified issues that were then included in the survey development. Seventy percent of the 116 participants surveyed reported cannabis use before their injury (67% SCI, 74% TBI) and 48% reported use after their injury (53% SCI, 45% TBI). Overall, the most common reason for use was recreational (67%), followed by reducing stress/anxiety (62.5%) and improving sleep (59%). Among the respondents with SCI, the most common reasons for use were to reduce spasticity (70%), recreation (63%), and to improve sleep (63%). Among those with TBI, reasons endorsed were recreational (72%), reducing stress/anxiety (62%), and improving sleep (55%). Smoking was the most common method of use. ConclusionsA majority of this sample reported using cannabis before injury, and approximately half reported using cannabis after injury. Both groups reported recreational use, whereas the group with SCI also highly endorsed using cannabis to address chronic medical conditions. Clinicians should be aware of the high prevalence of cannabis use in these populations and the impact such use may have on the individual’s medical management. Further research in this area is needed.

Predicting cannabis use among adolescents in four European Countries: combining personal values and the theory of planned behaviour

Aims: The onset and maintenance of cannabis use have been explained with reference to the Theory of Planned Behaviour (TPB). At the same time, personal values play an important role in determining appropriate behaviour during social interactions, and cannabis use is no exception. Combining Schwartz’s Theory of Human Values and the TPB offers a framework for identifying the relationship between adolescents’ personal values structure and cannabis use. The two main aims of this study are to: (1) test a predictive model that combines these two theories to explore the interaction of cultural and personal variables that influence cannabis use during adolescence; and (2) analyse the moderation effect of four European countries on the proposed model. Methods: A total of 3768 secondary school students from Spain, Italy, Romania and Portugal completed a questionnaire on personal values and the TPB applied to cannabis use intention. Direct and indirect effects were assessed using path analysis and moderation effects using multi-group analysis.Results: Collectivistic values (i.e. conformity and tradition) were associated with low cannabis intention and use, individualistic values (i.e. hedonism and power) with higher cannabis intention and use. Regarding the moderation effect of countries, the effects of attitudes on intention and cannabis use were higher among Italian participants, who also showed a high prevalence of cannabis use. Meanwhile the effect of abstinence self-efficacy was lower among Romanian and Portuguese participants, both of whom reported lower cannabis use.Conclusion: The results support the notion that personal values are background variables that affect cannabis use through the TPB variables.

Cannabis use among two national samples of Aboriginal and Torres Strait Islander tobacco smokers.

There is a concern that cannabis use is an important barrier to reducing Aboriginal and Torres Strait Islander smoking. We investigate the associations of cannabis use and tobacco smoking and quitting in two large national samples. The 2012-2013 National Aboriginal and Torres Strait Islander Health Survey was a national stratified random household survey conducted between April 2012 and February 2013, and included 2580 adult Aboriginal and Torres Strait Islander smokers. The Talking About The Smokes Project interviewed a national quota sample of 1301 Aboriginal and Torres Strait Islander adult smokers between August 2013 and August 2014. Both surveys asked about tobacco smoking and quitting, cannabis use and socio-demographic factors. Both surveys estimated that cannabis use is common among Aboriginal and Torres Strait Islander smokers (National Aboriginal and Torres Strait Islander Health Survey: 32%, Talking About The Smokes: 24%). Both surveys found a higher prevalence of cannabis use among smokers who were male, younger, unemployed or who more frequently consumed five or more alcoholic drinks in a day. However, the two surveys provided inconsistent evidence about whether cannabis use is associated with not quitting smoking tobacco. We did not find consistent evidence in this setting that cannabis use is an obstacle to quitting tobacco smoking. Nevertheless, we would still recommend that clinicians counselling Aboriginal and Torres Strait Islander tobacco smokers about quitting talk about cannabis use because its use is common and almost all mix it with tobacco.

Cannabis use in male and female first episode of non-affective psychosis patients: Long-term clinical, neuropsychological and functional differences.

BackgroundNumerous studies show the existence of a high prevalence of cannabis use among patients with psychosis. However, the differences between men and women who debut with a first episode of psychosis (FEP) regarding cannabis use have not been largely explored. The aim of this study was to identify the specific sex factors and differences in clinical evolution associated with cannabis use.MethodSociodemographic characteristics at baseline were considered in our sample of FEP patients to find differences depending on sex and the use of cannabis. Clinical, functional and neurocognitive variables at baseline, 1-year, and 3-years follow-up were also explored.ResultsA total of 549 patients, of whom 43% (N = 236) were cannabis users, 79% (N = 186) male and 21% (N = 50) female, were included in the study. There was a clear relationship between being male and being a user of cannabis (OR = 5.6). Cannabis users were younger at illness onset. Longitudinal analysis showed that women significantly improved in all three dimensions of psychotic symptoms, both in the subgroup of cannabis users and in the non-users subgroup. Conversely, subgroups of men did not show improvement in the negative dimension. In cognitive function, only men presented a significant time by group interaction in processing speed, showing a greater improvement in the subgroup of cannabis users.ConclusionDespite knowing that there is a relationship between cannabis use and psychosis, due to the high prevalence of cannabis use among male FEP patients, the results showed that there were very few differences in clinical and neurocognitive outcomes between men and women who used cannabis at the start of treatment compared to those who did not.

Cannabinoids and post-traumatic stress disorder: clinical and preclinical evidence for treatment and prevention.

There is substantial evidence from studies in humans and animal models for a role of the endocannabinoid system in the control of emotional states. Several studies have shown an association between exposure to trauma and substance use. Specifically, it has been shown that there is increased prevalence of cannabis use in post-traumatic stress disorder (PTSD) patients and vice versa. Clinical studies suggest that PTSD patients may cope with their symptoms by using cannabis. This treatment-seeking strategy may explain the high prevalence of cannabis use among individuals with PTSD. Preliminary studies in humans also suggest that treatment with cannabinoids may decrease PTSD symptoms including sleep quality, frequency of nightmares, and hyperarousal. However, there are no large-scale, randomized, controlled studies investigating this specifically. Studies in animal models have shown that cannabinoids can prevent the effects of stress on emotional function and memory processes, facilitate fear extinction, and have an anti-anxiety-like effect in a variety of tasks. Moreover, cannabinoids administered shortly after exposure to a traumatic event were found to prevent the development of PTSD-like phenotype. In this article, we review the existing literature on the use of cannabinoids for treating and preventing PTSD in humans and animal models. There is a need for large-scale clinical trials examining the potential decrease in PTSD symptomatology with the use of cannabis. In animal models, there is a need for a better understanding of the mechanism of action and efficacy of cannabis. Nevertheless, the end result of the current clinical and preclinical data is that cannabinoid agents may offer therapeutic benefits for PTSD.

High prevalence of cannabis use among Aka foragers of the Congo Basin and its possible relationship to helminthiasis.

Little is known about cannabis use in hunter-gatherers. Therefore, we investigated cannabis use in the Aka, a population of foragers of the Congo Basin. Because cannabis contains anthelminthic compounds, and the Aka have a high prevalence of helminthiasis, we also tested the hypothesis that cannabis use might be an unconscious form of self-medication against helminths. We collected self- and peer-reports of cannabis use from all adult Aka in the Lobaye district of the Central African Republic (n = 379). Because female cannabis use was low, we restricted sample collection to men. Using an immunoassay for Δ9-tetrahydrocannabinol-11-oic acid (THCA), a urinary biomarker of recent cannabis consumption, we validated cannabis use in men currently residing in camps near a logging road (n = 62). We also collected stool samples to assay worm burden. A longitudinal reinfection study was conducted among a subsample of the male participants (n = 23) who had been treated with a commercial anthelmintic 1 year ago. The prevalence of self- and peer-reported cannabis use was 70.9% among men and 6.1% among women, for a total prevalence of 38.6%. Using a 50 ng/ml threshold for THCA, 67.7% of men used cannabis. Cannabis users were significantly younger and had less material wealth than the non-cannabis users. There were significant negative associations between THCA levels and worm burden, and reinfection with helminths 1 year after treatment with a commercial anthelmintic. The prevalence of cannabis use among adult Aka men was high when compared to most global populations. THCA levels were negatively correlated with parasite infection and reinfection, supporting the self-medication hypothesis.

Age, sex and personality in early cannabis use

Previous studies analysing personality and cannabis use in adult samples suggest that cannabis users show significant higher levels of impulsivity, sensation seeking and schizotypy. However, there are few studies exploring this relationship in adolescence using psychobiological models of personality. Given the relevance of identifying individual differences that lead adolescents to early cannabis use to prevent future health problems, the present study aimed to explore the relationship between age, sex, personality and early cannabis use using a psychobiological model of personality in a sample of 415 students (51.8% boys) from 12 to 18 years. Chi2 tests showed significant higher prevalence of cannabis use in boys and in the group aged 15–18 years. Multiple analysis of variance showed significant higher scores in psychoticism, sensation seeking and in all its subscales in cannabis users group, while an interaction with age was found for extraversion and neuroticism: cannabis users scored higher than non-users in the youngest group (12–14 years) but lower in the oldest group in both dimensions. Finally, regression analysis showed that narrower traits of sensation seeking (experience seeking and disinhibition) were the most associated to early cannabis use. Results are discussed in terms of early cannabis users’ personality profiles and in terms of the self-medication theory.

The role of general parenting and cannabis-specific parenting practices in adolescent cannabis and other illicit drug use

AimsTo investigate general and cannabis-specific parenting practices in relation to adolescent cannabis and other illicit drug use. MethodsData were derived from the Dutch National School Survey on Substance Use among students (N=3209; aged 12–16 years) and one of their parents in 2011. ResultsLogistic regression analyses revealed that 1) parental cannabis use was significantly related to more adolescent lifetime and recent cannabis use, and 2) restrictive cannabis-specific parental rules were associated with less adolescent recent cannabis and lifetime use of other illicit drugs, even when controlled for sociodemographic factors, general parenting, adolescent tobacco use, and tobacco-specific parenting. In addition, no significant interaction was observed between parental cannabis use and cannabis-specific rules in their relation to adolescent cannabis and other illicit drug use, indicating that cannabis rules are evenly associated with adolescent drug use for families with and without parental cannabis experience. ConclusionsIn addition to general parenting practices, restrictive cannabis-specific rules are related to lower adolescent cannabis and other illicit drug rates. Parents who ever used cannabis have children with a higher prevalence of cannabis use. However, their restrictive cannabis-specific rules are equally related to a lower chance of adolescent cannabis use.

The Cannabis Pathway to Non-Affective Psychosis may Reflect Less Neurobiological Vulnerability.

There is a high prevalence of cannabis use reported in non-affective psychosis. Early prospective longitudinal studies conclude that cannabis use is a risk factor for psychosis, and neurochemical studies on cannabis have suggested potential mechanisms for this effect. Recent advances in the field of neuroscience and genetics may have important implications for our understanding of this relationship. Importantly, we need to better understand the vulnerability × cannabis interaction to shed light on the mediators of cannabis as a risk factor for psychosis. Thus, the present study reviews recent literature on several variables relevant for understanding the relationship between cannabis and psychosis, including age of onset, cognition, brain functioning, family history, genetics, and neurological soft signs (NSS) in non-affective psychosis. Compared with non-using non-affective psychosis, the present review shows that there seem to be fewer stable cognitive deficits in patients with cannabis use and psychosis, in addition to fewer NSS and possibly more normalized brain functioning, indicating less neurobiological vulnerability for psychosis. There are, however, some familiar and genetic vulnerabilities present in the cannabis psychosis group, which may influence the cannabis pathway to psychosis by increasing sensitivity to cannabis. Furthermore, an earlier age of onset suggests a different pathway to psychosis in the cannabis-using patients. Two alternative vulnerability models are presented to integrate these seemingly paradoxical findings

Acute and Long-Term Effects of Cannabis Use: A Review

Cannabis remains the most commonly used and trafficked illicit drug in the world. Its use is largely concentrated among young people (15- to 34-year-olds). There is a variety of cannabis use patterns, ranging from experimental use to dependent use. Men are more likely than women to report both early initiation and frequent use of cannabis. Due to the high prevalence of cannabis use, the impact of cannabis on public health may be significant. A range of acute and chronic health problems associated with cannabis use has been identified. Cannabis can frequently have negative effects in its users, which may be amplified by certain demographic and/or psychosocial factors. Acute adverse effects include hyperemesis syndrome, impaired coordination and performance, anxiety, suicidal ideations/tendencies, and psychotic symptoms. Acute cannabis consumption is also associated with an increased risk of motor vehicle crashes, especially fatal collisions. Evidence indicates that frequent and prolonged use of cannabis can be detrimental to both mental and physical health. Chronic effects of cannabis use include mood disorders, exacerbation of psychotic disorders in vulnerable people, cannabis use disorders, withdrawal syndrome, neurocognitive impairments, cardiovascular and respiratory and other diseases.

Cannabis chez les enfants et les adolescents : impacts et conséquences

A health policy for the prevention and treatment of cannabis-related disorders is urgently needed in France, given the high prevalence of cannabis use among children and adolescents. Such a policy will require a better understanding of the endo-cannabinoid system and the impact of exogenous cannabinoids in this fragile population. The brain continues to undergo significant development until the age of about 25 years, and cannabis consumption by young people therefore carries specific risks of dependence (frequency and intensity), and of neuroanatomical, cognitive and emotional damage. This article summarizes the available data and offers a medical view of the risks and consequences of cannabis use by children and adolescents.

Cannabis use in a Swiss male prison: Qualitative study exploring detainees’ and staffs’ perspectives

BackgroundSeveral studies suggest a high prevalence of cannabis use before and during imprisonment, but subjective perspectives of detainees and staff towards its use in prison are lacking. This issue was explored in the framework of an observational study addressing tobacco use in three Swiss prisons in 2009 and 2010 that involved multiple strands (quantitative and qualitative components). This article presents qualitative data on cannabis use collected in one of the settings. MethodsWe used in-depth semi-structured interviews with both detainees and staff to explore their attitudes towards cannabis in one post-trial male Swiss prison. We performed specific coding and thematic analysis for cannabis with the support of ATLAS.ti, compared detainees’ and staff's opinions, and considered the results with regard to drug policy in prison in general. Results58 participants (31 male offenders, mean age 35 years, and 27 prison staff, mean age 46 years, 33% female) were interviewed.Detainees estimated the current use of cannabis use to be as high as 80%, and staff 50%. Participants showed similar opinions on effects of cannabis use that were described both at individual and institutional levels: analgesic, calming, self-help to go through the prison experience, relieve stress, facilitate sleep, prevent violence, and social pacifier. They also mentioned negative consequences of cannabis use (sleepiness, decreased perception of danger and social isolation), and dissatisfaction regarding the ongoing ambiguous situation where cannabis is forbidden but detection in the urine was not sanctioned. However, the introduction of a more restrictive regulation induced fear of violence, increased trafficking and a shift to other drug use. ConclusionAlthough illegal, cannabis use is clearly involved in daily life in prison. A clearer and comprehensive policy addressing cannabis is needed, including appropriate measures tailored to individual users. To sustain a calm and safe environment in prison, means other than substance or medication use are required.

Perceived role legitimacy and role importance of Australian school staff in addressing student cannabis use.

The high prevalence of cannabis use by Australian secondary school students makes schools an ideal setting for the delivery of substance use prevention programs. Although efficacious school-based cannabis prevention programs exist, there is scant research investigating the perceived role legitimacy and role importance of school staff. As such, this study surveyed a sample of 1691 Australian school staff by utilizing Generation Next seminars which are attended by professionals working with young people. The self-completed survey identified that, despite elevated contact with students relative to other school staff, teachers reported the least role importance and legitimacy of all school staff. Further, teachers reported the lowest level of staff drug education training, which was an important predictor of an increased feeling of role importance and legitimacy among school staff.

2743 – Why do first-episode psychosis patients use cannabis? Case-control study

There is a high prevalence of cannabis use among patients with psychosis. Persistent cannabis use in firstepisode psychosis affects prognosis and recovery. Understanding the reasons of cannabis use may help improve psychosis outcome. Several studies suggest that cannabis is used to ameliorate symptoms related to the disorder (self-medication hypothesis). Comparing the reasons of cannabis use in first-episode patients with a control group, may help to acknowledge that question. So far few studies with a control group have been carried out. Identify the reasons of cannabis use in first-episode psychotic cannabis users and compare them to non-psychotic cannabis users. Thirty-two first-episode psychosis cannabis users and thirty-four non-psychotic cannabis users were included. They completed a self-reported reasons for use cannabis questionnaire, adapted from Dixon et al. The amount and frequency of cannabis use was higher in patients with first-episode psychosis than controls (6.47+/- 8.2 patients vs 19.59+/- 27.7 controls; p=0.024). The two groups did not differ significantly in any of the reasons for cannabis use. The main factors attracting them to use cannabis were: relaxation, sleep better, getting high and pleasurable experiences. Both first-episode psychosis and controls seem to use cannabis for the same reasons, which does not support the self-medication hypothesis. However additional research would be necessary to further investigate cannabis use correlation with symptoms to discard that hypothesis. Recognition of the actual reasons of use should help prevention strategists to develop appropriate programmes to general and specific audiences.

Cannabis Use and Traffic Injuries

Cannabis Use and Traffic Injuries