Initiation Of Cannabis Use Research Articles

Cannabis Use and Age-Related Changes in Cognitive Function From Early Adulthood to Late Midlife in 5162 Danish Men.

Cannabis is by far the most widely used and abused drug listed on the Drug Enforcement Administration's Schedule I, which includes drugs with a high potential for abuse. There is evidence of short-term negative effects of cannabis use on cognition, but only a limited number of studies have explored the association between cannabis use and age-related cognitive decline. The aim of the present study was to investigate the relationship between cannabis use and age-related cognitive decline from early adulthood to late midlife. The study population consisted of 5162 men who had participated in Danish follow-up studies on cognitive aging. These studies included scores on the military intelligence test Børge Prien's Prøve from both the conscription assessment (mean age=20years; p1 and p99: 18 and 26years) and from the follow-up (mean age=64years; p1 and p99: 55 and 72years) as well as extensive data on lifestyle and health from the follow-up questionnaires. The association between cannabis use and age-related cognitive decline was investigated in linear regression models. Men with a history of cannabis use had less cognitive decline from early adulthood to late midlife compared to men without a history of cannabis use. Among cannabis users, neither age of initiation of cannabis use nor frequent use was significantly associated with a greater age-related cognitive decline. In a sample of more than 5000 men followed for a mean of 44years, we found no significant harmful effects of cannabis use on age-related cognitive decline.

Post-legalization shifts in cannabis use among young adults in Georgia-A nationally representative study.

In 2018, the country of Georgia legalized cannabis for recreational use and decriminalized limited possession. This study aimed to assess whether cannabis use increased among young adults (ages 18-29 years) in Georgia after national policy changes and to evaluate whether perceived access became easier after legalization and current risk factors of young adult cannabis use. We used data from the Georgian nationally representative survey administered in 2015 (n = 1308) and 2022 (n = 758), before and after decriminalization. We performed appropriate bivariate analyses and multivariable linear and logistic regressions to assess the following: legalization's impact on cannabis use; perceived difficulty to obtain cannabis; age of first use; differences in use between females and males; and factors associated with current use. Among young adults lifetime prevalence of cannabis use was similar in 2015 (17.3%) and 2022 (18.1%) [Odds Ratio (95% confidence interval) = 1.1 [0.7, 1.6], P = 0.726). Annual prevalence (7% in 2015 vs 7.7% in 2022) was also similar (1.1 [0.7, 2.0], P = 0.650). In 2022 it was less difficult to obtain cannabis than in 2015 (0.5 [0.4, 0.8], P = 0.021). The age of first use increased statistically significantly (18.1years in 2015 vs 19.1 in 2022, P = 0.003). In 2022, annual prevalence of use was lower among females (1.9% vs 13.1%; OR = 0.1 [0.0, 0.3], P < 0.0001) and higher among those who gambled (11.7% vs 4.4%; OR = 3.2 [1.5, 6.8], P < 0.003). Males initiated cannabis use at an earlier age (19.1years vs 20.6 for females, P = 0.03), and could obtain cannabis easier than females (P < 0.0001). There was a minimal shift of cannabis use in young adults following implementation of recreational cannabis use legalization in Georgia. Males and people who gambled were at higher risk of cannabis use.

Edible cannabis for chronic low back pain: associations with pain, mood, and intoxication.

Cannabis, commonly known for both therapeutic and intoxicating effects, is gaining accessibility on legal markets and traction as a potential alternative therapy for pain mediation, particularly in those suffering from chronic low back pain. However, the effectiveness in this population of legal market forms of cannabis, particularly commonly used edibles, is unknown. Therefore, this study utilized a naturalistic prospective design where participants with chronic low back pain with intentions to initiate cannabis use for treatment were recruited and self-selected edible cannabis products containing varying amounts of delta- 9 tetrahydrocannabinol (THC) and cannabidiol (CBD). Products were categorized as CBD-dominant, THC-dominant, or combined THC and CBD (THC + CBD). 249 participants [140 female (56.62%), mean (SD) age of 46.30 (16.02), 90% White] were tracked over 2weeks of ad libitum use and assessed during a naturalistic acute cannabis administration session on changes in pain, mood, and subjective drug effects. During acute administration, a significant correlation between THC dose and short-term pain relief was found, suggesting that higher THC doses were associated with greater pain reduction (p < .05). In addition, THC was associated with higher levels of subjective cannabis drug effects (p < .001), regardless of whether CBD was also in the edible product. Acute CBD dose was primarily associated with short-term tension relief (p < .05); however, there were no associations between CBD dose and acute pain. Over the 2-week ad libitum administration period results suggested pain reductions across participants using all forms of cannabis. However, trends suggested that more frequent use of CBD-dominant edible cannabis may be associated with greater reductions in perceived pain over the 2-week observation period (p = .07). These findings support the short-term analgesic effects of THC and anxiolytic effects of CBD and further suggest that orally-administered THC and CBD should continue to be evaluated for the potential to provide both acute and extended relief from chronic low back pain. https://clinicaltrials.gov/study/NCT03522324?locStr=Boulder,%20CO&country=United%20States&state=Colorado&city=Boulder&cond=chronic%20low%20back%20pain&intr=Cannabis&rank=1, identifier NCT03522324.

The Impact of Recreational Cannabis Markets on Cannabis Use Among Adolescents and Adults: A Synthetic Control Analysis

Objective: To assess the longer-term impacts of recreational cannabis markets on cannabis use among adolescents and adults across five U.S. states. Method: Drawing on state-level data from the National Survey on Drug Use and Health, this study uses a novel method of causal inference called the synthetic control method with staggered treatment adoption to estimate the pooled effect of recreational markets on prevalence and initiation of use in Colorado, Washington, Oregon, Alaska, and Nevada. Three separate models were used for those 12-17, 18-25, and 26 and older. Pre-treatment state-level characteristics and trends in cannabis use were used to generate synthetic control weights. Confidence intervals were constructed using a leave-one-out jackknifing method. Results: Synthetic controls and treated states were similar in terms of sociodemographic characteristics, prevalence of other drug use, and trends in cannabis use prior to the implementation of recreational markets. The study results revealed moderate increases in prevalence and initiation of use among adolescents aged 12-17 (11% and 13%, respectively), and large increases in prevalence and initiation of use among young adults aged 18-25 (17% and 33%, respectively) and older adults aged 26 and older (33% and 82%, respectively) 2-4 years after dispensaries became operational. Conclusions: The findings of this study suggest recreational cannabis markets have increased prevalence and initiation of cannabis use among adolescents and adults. These increases may lead to adverse health outcomes depending on factors such as frequency of use and characteristics of users.

Alerta Cannabis: A Tailored-Computer Web-Based Program for the Prevention of Cannabis Use in Adolescents: A Cluster-Randomized Controlled Trial Protocol

BackgroundThe growing use of cannabis in adolescence is a public health problem that must be addressed through prevention. In Spain, the average age of initiation of cannabis use in the adolescent population is 14.8 years. At 14 years, the lifetime prevalence of cannabis use is 11.7%, which increases to 51.,5% at the age of 18; the prevalence of cannabis use in the population aged 14 to 18 years is 28.6%, a figure that must be tried to reduce, that is why this school prevention program is proposed: Alerta Cannabis.MethodsThe Alerta Cannabis research project consists of design, implementation, and evaluation. In the first phase, a computer-tailored eHealth program (Alerta Cannabis) is developed based on the I-Change Model, an integrated model based on three main behavioral change processes: awareness, motivation, and action. This program consists of four 30-minute sessions that will provide culturally adapted and personalized advice to motivate students not to use cannabis through text feedback, animations, and gamification techniques. This phase will also include usability testing. In the implementation phase, secondary school students from Western Andalusia, Spain (Seville, Cádiz, Huelva, and Córdoba) and Eastern Andalusia (Jaén, Málaga, and Granada) will be randomized to an experimental condition (EC) or a control condition (CC) for a cluster randomized clinical trial (CRCT). Each condition will have 35 classes within 8 schools. GI will receive the online intervention Alerta Cannabis. EC and CC will have to fill out a questionnaire at baseline, six months, and twelve months of follow-up. In the last phase, the effect of Alerta Cannabis is evaluated. The primary outcomes are the lifetime prevalence of cannabis use and its use in the last 30 days and at 6 months. At 12 months of follow-up, the prevalence in the last 12 months will also be assessed. The secondary outcome is the intention to use cannabis.DiscussionThe study tests the effect of the innovative program specifically aimed to reduce the use of cannabis in the adolescent population through eHealth in Spain. The findings aim to develop and implement evidence-based cannabis prevention interventions, which could support school prevention, for instance, the assistance of school nurses. If the program proves to be effective, it could be useful to prevent cannabis use on a national and international scale.Trial registrationNCT05849636. Date of registration: March 16, 2023.

Perceptions, Experiences, and Patterns of Cannabis Use in Individuals with Mood and Anxiety Disorders in the Context of Cannabis Legalization and Medical Cannabis Program in Canada - A Qualitative Study.

Perceptions of cannabis as a potential medical treatment for mood and anxiety disorders have been increasing in the context of legalizations, availability, and medical cannabis programs, though current evidence predominately indicates risks and negative effects of cannabis use (CU) on mental health outcomes. This study aims to understand motivations, perceptions, effects, and patterns of CU in individuals with mood and anxiety disorders. Thirty-six adult patients diagnosed with mood or anxiety disorders, obsessive-compulsive disorder, or posttraumatic stress disorder who were currently using cannabis completed an in-depth qualitative interview on individual motivations, perceptions, experiences, effects, and patterns of their CU. The thematic analysis focused on phases of CU and sources of cannabis products and information. Reported motivations for initiation of CU included curiosity, peer pressure, and dissatisfaction with conventional treatments. Factors such as psychotropic effects and coping with mental health symptoms and insomnia contributed to the continuation of CU. More negative effects, including cognitive dysfunction, worsening of mood, and anxiety symptoms, were acknowledged with ongoing CU. Concerning findings included common initiation of CU before age 18, combined medical and recreational CU, rare consultation of medical professionals on CU, and potential effects and harms. Findings indicate individual complexity of motivations, perceptions, and patterns of CU in the study population. The reported potential beneficial effects of specific cannabis products should be further investigated. Findings emphasize patient-provider dialogue on both CU and conventional treatments. Information from this study can contribute to and inform the development of education, prevention, and intervention strategies.

Cannabis And College Students: Self-Perceived Mental Health Prior to, During, and After the Pandemic.

College students demonstrated changes in levels of mental wellbeing as they and the world experienced new levels of stress and anxiety due to the COVID-19 pandemic. As access to healthcare became limited, students turned to alternative methods of coping, which included cannabis use. To determine if an association between cannabis use and self-perceived mental wellbeing during the pandemic among college students exists. A paired samples t-Test was used to compare self-reported mental wellbeing at different times during the pandemic, a one-way ANOVA to compare self-reported mental health between respondents' cannabis use status, and a Tukey-Kramer post-hoc analysis was used to determine between group significance. All data collected were from participants at a single time point (retrospective self-report during April 2022). Of 103 self-reported college students, the most significant differences in mental wellbeing were reported prior to and during the pandemic. Consistent significant differences were observed between each of the college student groups derived from those students who entirely avoided cannabis use or cessation of use (highest rating), p = .018, as compared to those who initiated cannabis use prior to and during the pandemic (lowest rating) p = .045. Post pandemic mental wellbeing demonstrated a higher level of mental wellbeing among those who had some exposure to cannabis compared to those who avoided cannabis entirely. It cannot be concluded that mental wellbeing was lower due to cannabis use. However, it is possible those with lower self-perceived mental wellbeing turned to cannabis use.

Using Task-fMRI to Explore the Relationship Between Lifetime Cannabis Use and Cognitive Control in Individuals With First-Episode Schizophrenia.

While continued cannabis use and misuse in individuals with schizophrenia is associated with a variety of negative outcomes, individuals with a history of use tend to show higher cognitive performance compared to non-users. While this is replicated in the literature, few studies have used task-based functional magnetic resonance imaging (fMRI) to evaluate whether the brain networks underpinning these cognitive features are similarly impacted. Forty-eight first-episode individuals with schizophrenia (FES) with a history of cannabis use (FES + CAN), 28 FES individuals with no history of cannabis use (FES-CAN), and 59 controls (CON) performed the AX-Continuous Performance Task during fMRI. FES+CAN showed higher cognitive control performance (d'-context) compared to FES-CAN (P < .05, ηp 2 = 0.053), and both FES+CAN (P < .05, ηp 2 = 0.049) and FES-CAN (P < .001, ηp 2 = 0.216) showed lower performance compared to CON. FES+CAN (P < .05, ηp 2 = 0.055) and CON (P < 0.05, ηp 2 = 0.058) showed higher dorsolateral prefrontal cortex (DLPFC) activation during the task compared to FES-CAN, while FES+CAN and CON were not significantly different. Within the FES+CAN group, the younger age of initiation of cannabis use was associated with lower IQ and lower global functioning. More frequent use was also associated with higher reality distortion symptoms at the time of the scan. These data are consistent with previous literature suggesting that individuals with schizophrenia and a history of cannabis use have higher cognitive control performance. For the first time, we also reveal that FES+CAN have higher DLPFC brain activity during cognitive control compared to FES-CAN. Several possible explanations for these findings are discussed.

Sociodemographic differences and experienced effects of young adults who use cannabis mainly for self-medication versus recreationally in Finland

PurposeCannabis use continues to increase worldwide, and a number of nation states are changing their cannabis policies. Policy changes require research into key populations, namely, people who use cannabis. This study aims to examine sociodemographic differences of young Finns who reported using cannabis mainly for self-medication versus mainly recreationally, as well as their reported effects of cannabis use.Design/methodology/approachThe data come from an anonymous online survey (N = 247, 70.0% males, 25.9% females, 4.1% other) that was analysed using multiple logistic regression. The authors focused on whether various demographic indicators differed between those who reportedly used cannabis mainly for recreational purposes and mainly for self-medicinal purposes. The authors also qualitatively examined the respondents’ experienced effects of cannabis, both desired and undesired.FindingsBeing older and female, living in a smaller city and earlier age of initiation of cannabis use were statistically significant in predicting the medicinal use of cannabis. The majority of recreational effects were related to themes such as relaxation and pleasure, but many participants also reported desired medical effects. Similarly, many participants reported several undesired effects.Research limitations/implicationsUnderstanding especially young people’s motivations to use cannabis, which include using it for various medical effects, can improve the design of harm reduction and treatment programmes as well as enhance the well-being of people who use cannabis.Originality/valueThis study gives a nuanced account of sociodemographic factors and motivations of young people who use cannabis in Finland as well as the reported effects it has on them, which complements data from national drug surveys.

Analysing the effects of using cannabis on youth mental health

Analysing the effects of using cannabis on youth mental health Mary Cannon, Professor of Psychiatric Epidemiology and Youth Mental Health at RCSI University of Medicine and Health Sciences, investigates the effects of using cannabis on young people’s mental health. Cannabis is the most widely used drug among young people globally. The average age of initiation of cannabis use is mid-teens, and use tends to fall off later in life. Unfortunately, the peak period of cannabis use coincides with the peak time for brain development which continues up to age 25. The main adverse effects of using cannabis during adolescence fall under three broad categories: dependence, underachievement and mental health problems (DUM). Let us deal with each of these in turn.

Views on and experiences with medicinal cannabis among Canadian veterans who live with pain: A qualitative study

ABSTRACT Background During fiscal year 2021–2022, Veterans Affairs Canada (VAC) reimbursed 18,388 veterans for medicinal cannabis at a cost of $153 million. Yet, it is not known whether the reimbursement program is producing a net benefit for veterans. Aims This study investigated the views and experiences Canadian that veterans who live with pain have about medicinal cannabis use, including its use for the management of chronic pain, poor sleep, and emotional distress. Methods Twelve Canadian veterans who live with pain—eight men, four women; split across four focus groups—were recruited to participate in a semistructured discussion around their experiences with medicinal cannabis use. Results Using inductive thematic analysis, seven broad categories were identified: (1) cannabis use behaviors, (2) reasons for cannabis use, (3) outcomes from cannabis use, (4) facilitators of cannabis use, (5) barriers to cannabis use, (6) stigma around cannabis use, and (7) questions and concerns about cannabis use. Conclusions Most veterans initiated cannabis use to manage the symptoms of preexisting medical and/or mental health conditions. Despite some negative side effects, most veterans reported improvements in their overall quality of life, sleep, relationships, mood, and pain. Concern remains around the discrepancy between veterans’ qualitative reports of beneficial outcomes from medicinal cannabis use and equivocal findings around the benefit-to-harm ratio in the wider literature. Currently, the VAC reimbursement program remains challenged by unclear indication for which veterans, with what condition(s), at what dose, and in what form medical cannabis is most beneficial.

Association of cannabis use with depression among cancer patients

The rate of cannabis use by cancer patients is climbing. However, as the risk of mental illness caused by cannabis use in cancer patients has not been effectively evaluated, this study will analyze the association between cannabis use and depression in cancer patients. This study collected data from respondents to the National Health and Nutrition Examination Survey from 2005 to 2018. A total of 22,181 respondents self-reported information about cannabis use in questionnaire, of which 893 were diagnosed with cancer. We found that the rate of cannabis use among cancer patients increased each year from 2005 to 2018. We analyzed the association between cannabis use and depression in cancer patients by multivariable logistic regression. Results found that the current cannabis use had a significant positive correlation with increased risk of depression in cancer patients (OR = 2.135, 95% CI = 1.21–3.777, p = 0.009). In our stratified analysis, current cannabis use was associated with an increased risk of depression in cancer patients who were female, had a history of cocaine use, and initiated cannabis use after age 17. (OR = 1.981, 95% CI = 1.024–3.85, P = 0.043; OR = 3.19, 95% CI = 1.61–6.41, P < 0.001; OR = 2.236, 95% CI = 1.018–4.967, P = 0.045). In conclusion, the use of cannabis by cancer patients has an associated risk of depression and the cancer patients who currently use cannabis are more likely to have depression.

Pandemic-related life changes and adolescent initiation of cannabis and tobacco/nicotine use

BackgroundThe COVID-19 pandemic required the public to alter their daily lives drastically. For adolescents, school closures and social isolation added further challenges to a stressful stage of life, potentially increasing the likelihood of substance use initiation. This study explored the relationship between adolescent substance use initiation and negative life changes due to COVID-19. MethodsStudents from 9 high schools (N = 2478) in Los Angeles County were surveyed as 9th graders in the 2019–2020 school year and re-surveyed in 10th and 11th grades as part of an ongoing longitudinal study. Two logistic regression models were conducted to test hypotheses that negative life changes due to the COVID-19 pandemic increases the odds of initiation of both tobacco/nicotine products and cannabis products, controlling for sex, age, and race/ethnicity. ResultsThe final analytic sample included adolescents in 10th grade who were never-users of tobacco/nicotine (N = 809) and cannabis (N = 837). The odds of initiating cannabis use increased by 6.42% for every 1 standard deviation increase in the COVID-19 negative daily life changes index [AOR: 1.063; 95% CI: 1.010, 1.121]. The association between the COVID-19 negative daily life changes index and tobacco/nicotine use initiation was not significant. DiscussionAdolescents who experienced life changes due to COVID-19 were more likely to initiate cannabis use, but not tobacco/nicotine use. Results identify a need for early intervention efforts to promote effective coping skills and prevent cannabis initiation among adolescents during a wide-scale stressor, such as COVID-19.

Cannabis and Palliative Care Utilization among Non-Terminal Cancer Patients in the Illinois Medical Cannabis Program

High-quality palliative care has been shown to provide benefits for cancer patients, including greater longevity when initiated earlier in treatment. Previous research conducted among terminal patients in the Illinois Medical Cannabis Program has suggested that cannabis may be used as a complement to palliative care and as an alternative to prescription opioid medications. However, there is little research exploring this phenomenon among non-terminal cancer patients receiving palliative care. In this study, we used primary cross-sectional survey data to (1) identify the factors associated with the utilization of palliative care, (2) examine the associations between the utilization of palliative care and self-reported improvements in physical and psychological symptoms, and (3) estimate the differences in the average 30-day pain levels for non-terminal cancer patients receiving palliative care who reported using opioids compared with other non-terminal cancer patients in palliative care who did not report using opioids. In our sample, 87 out of 542 (16%) non-terminal cancer patients were receiving palliative care, and of these 87 patients, 54 (62%) reported opioid use in the past 12 months. Non-terminal cancer patients in the sample who reported low psychological well-being, frequent gastrointestinal symptoms, and prescription opioid use in the past 12 months had greater odds of palliative care utilization. Palliative care utilization was also positively associated with self-reported improvements in gastrointestinal symptoms. The concurrent use of cannabis and prescription opioids was associated with higher average 30-day pain levels and with higher average pain levels at the initiation of cannabis use among those non-terminal cancer patients engaged in palliative care services.

Early-onset smoking and vaping of cannabis: Prevalence, correlates and trends in New Zealand 14-15-year-olds.

Initiating cannabis use at an early age elevates risk of harm. Cannabis vaping is an emerging issue, and it is unknown whether the patterning and correlates of early-onset cannabis vaping differ from those of cannabis smoking. We used repeat cross-sectional data from a nationally representative biennial survey (2012-2018) of students aged 14-15 years in New Zealand (N=11,405), response rate 65% (2012), 64% (2014-2016) and 59% (2018). Between 2012 and 2018 lifetime cannabis use decreased, but regular use (past month, weekly, daily) was stable. Prevalence of past month, weekly and daily use in 2016-2018 (pooled) was 8.6%, 3.4% and 1.5%, respectively. Cannabis vaping was reported by 24% of past month cannabis users. The demographic profile of early-onset cannabis smokers and vapers was similar, with elevated use of both modes among Māori (Indigenous), same- or both-sex attracted students and those in low decile (high-deprivation) schools. Correlates were similar for both modes. Cannabis use was strongly associated with tobacco and alcohol use. The next strongest associations (after adjustment) were exposure to second-hand smoke at home, student income >$50/week and low parental monitoring of whereabouts. Past week social media use, psychological distress and low parental monitoring of spending were also associated with both modes. Early-onset cannabis use is much higher in structurally disadvantaged groups, and among those who use tobacco and alcohol. Comprehensive multisubstance approaches to prevention are indicated in this age group. Efforts to reduce socio-economic inequity and exposure to other risk factors may reduce cannabis-related harm.

A comprehensive evaluation of adverse childhood experiences, social-emotional impairments, and neurodevelopmental disorders in cannabis-use disorder: Implications for clinical practice.

Adverse childhood experiences (ACEs), social-emotional impairments (SEIs), and neurodevelopmental disorders (NDs) are frequent in psychiatric disorders, including substance-use disorders. We aimed to determine the prevalence of ACE, SEI, or ND in individuals with cannabis-use disorder (CUD). We compared individuals with preCUD-onset ACE, SEI, or ND to those without. We crosssectionally studied 323 inpatients or outpatients with a history of past or current CUD, aged 12-35 years (mean age 22.94 ± 4.79), 64.5% of whom were male. The sample was divided into two groups: the non-premorbid (N = 52) and the premorbid ACE/SEI/ND group (N = 271). Within the premorbid group, further subgroups were based on ACEs, SEI, and NDs. We also analyzed other substance use and psychiatric symptoms/diagnoses based on the non-premorbid-premorbid dichotomy in the CUD sample. Pre-CUD ACE-SEI-ND had higher prevalence of bipolar, schizoaffective, borderline personality, and attention-deficit/hyperactivity disorders, and a history of agitation, hallucinations, and self-injury. The ACE group had higher rates of agitation, depression, delusions, hallucinations, eating disorders, and use of cocaine, amphetamines, and hallucinogens than the SEI or ND. Patients in the premorbid group initiated cannabis use at an earlier age, experienced the first comorbid psychiatric episode earlier, and were hospitalized earlier than those in the non- premorbid ACE-SEI-ND group. PreCUD-onset ACE, SEI, or ND conditions in individuals with CUDare linked to earlier onset of comorbid mental illness. Furthermore, ACEs contribute to significant and potentially severe clinical symptoms, as well as the use of substances other than cannabis.

Factors Associated with Initiating Cannabis Use After Legalization in Canada: A Cross-Sectional Study.

Background: Cannabis use has increased since the Government of Canada legalized nonmedical use in October 2018. We investigated demographic factors associated with initiating cannabis use after legalization. Materials and Methods: We used data from the 2018 and 2019 National Cannabis Survey and constructed multivariable regression models. Respondents' data were weighted and bootstrapped. We report relative measures of association as adjusted odds ratios (ORs) and absolute measures of association as adjusted risk increases (RIs). Results: Among the 58,195 households surveyed, 28,566 provided complete data (49%) and our weighted analysis represented 27,904,258 Canadians aged ≥ 15 years. Approximately one in five Canadians endorsed use of cannabis (19.8%), predominantly for nonmedical (9.5%) or combined medical and nonmedical (5.8%) reasons. Those who initiated cannabis use in the past 3 months (1.9%) were more likely to be younger (25-34 years vs. ≥ 65 years; adjusted OR 1.7, 95% confidence interval [CI] 1.1-2.8; adjusted RI 1.1%, 95% CI 0.1-2.0%), endorse poor to fair versus good to excellent physical health (adjusted OR 2.0, 95% CI 1.3-3.1; adjusted RI 1.7%, 95% CI 0.3-3.1%), and reside outside of Quebec (adjusted OR 1.4, 95% CI 1.1-2.0; adjusted RI 0.1%, 95% CI 0.6-1.1%). The 1% of Canadians who endorsed initiating use of cannabis due to legalization were more likely to reside outside of Quebec (adjusted OR 1.9, 95% CI 1.1-3.2; adjusted RI 0.5%, 95% CI 0.2-0.9%). Conclusion: Canadians initiating cannabis use after nonmedical legalization were likely to be younger and endorse worse physical health, and half of those using cannabis reported therapeutic use. Stricter policies, lower social acceptance, and less availability of cannabis in Quebec appear to have curtailed initiation of use after legalization.

U.S. Trends in Age of Cigar Smoking Initiation by Race/Ethnicity and Education

Younger age of initiating cigar smoking is associated with greater nicotine dependence and current use. Age of initiating cigarette smoking has increased over time, whereas trends in age of initiating cigar smoking remain understudied. These trends were examined by race/ethnicity, by education, and at their intersection. The analytic sample included U.S. Hispanic, Black, and White cigar-ever-smokers aged 24‒25 years (n=29,715) from the 2002‒2019 National Survey on Drug Use and Health. Participants reported their age, race/ethnicity, sex, education (≤high school; some college; ≥bachelor's degree), age of initiating cannabis use, and cigar smoking. Weighted multivariable linear regressions adjusted for sex and age of cannabis use initiation were used to examine trends in age of initiating cigar smoking by race/ethnicity, education, and education Χ year interactions within racial/ethnic groups. Age of initiating cigar smoking comparisons across race/ethnicity and education were examined using the most recent 2019 data. During 2002‒2019, across education, White cigar-ever-smokers started smoking cigars at an older age, whereas it remained unchanged among Hispanic cigar-ever-smokers. Among Black cigar-ever-smokers, age of initiating cigar smoking did not change among those with ≤high school and some college, and was older among those with ≥bachelor's degree. In 2019, age of initiating cigar smoking did not vary by educational level among Hispanic and White cigar-ever-smokers. Black cigar-ever-smokers with ≥bachelor's degree initiated cigar smoking at older ages than their White counterparts. Black individuals experienced widening education-related disparities, and Hispanic individuals had no progress in delaying age of initiating cigar smoking. Regulatory action banning cigar flavors may impact these trends.

The Relationship Between Cannabis, Cognition, and Schizophrenia: It's Complicated.

The consequences of cannabis use, especially in the context of schizophrenia, have gained increased importance with the legalization of cannabis in North America and across the globe. Cannabis use has multifaceted impacts on cognition in schizophrenia patients and healthy subjects. Healthy subjects, particularly those who initiated cannabis use at earlier ages and used high-potency cannabis for longer durations, exhibited poorer cognition mainly in working memory and attention. Cannabis use in schizophrenia has been associated with symptom exacerbation, longer and more frequent psychotic episodes, and poorer treatment outcomes. However, cannabis-using patients have better overall cognitive performance compared to patients who were not cannabis users. Interestingly, these effects were only apparent in lifetime cannabis users, but not in current (or within last 6months) users. Moreover, higher frequency and earlier age of cannabis use initiation (i.e., before 17years of age) were associated with better cognitive performance, although they had an earlier illness onset. Three possible hypotheses seem to come forward to explain this paradox. First, some components of cannabis may have antipsychotic or cognitive-enhancing properties. Secondly, chronic cannabis use may alter endocannabinoid signaling in the brain which could be a protective factor for developing psychosis or cognitive impairments. A third explanation could be their representation of a phenotypically distinct patient group with more intact cognitive functioning and less neurodevelopmental pathology. Multiple factors need to be considered to understand the complex relationship between cannabis, cognitive function, and schizophrenia. In short, age at initiation, duration and rate of cannabis use, abstinence duration, co-use of substances and alcohol, prescribed medications, relative cannabinoid composition and potency of cannabis, presence of genetic and environmental vulnerability factors are prominent contributorsto the variability in outcomes. Animal studies support the disruptive effects of Δ9-tetrahydrocannabinol (THC) administration during adolescence on attention and memory performance. They provide insights about interaction of cannabinoid receptors with other neurotransmitter systems, such as GABA and glutamate, and other regulatory molecules, such as PSD95 and synaptophysin. Cannabidiol (CBD), on the other hand, can improve cognitive deficits seen in neurodevelopmental and chemically-induced animal models of schizophrenia. Future studies focusing on bridging the translational gaps between human and animal studies, through the use of translationally relevant methods of exposure (e.g., vaping), consistent behavioral assessments, and congruent circuit interrogations (e.g., imaging) will help to further clarify this complex picture.

Understanding cannabis use in Singapore: profile of users and drug progression.

Cannabis has consistently been the third most commonly abused drug among drug arrestees in Singapore over the past few years. Accordingly, this study aimed to understand the profile of cannabis users in Singapore and explore the effects of cannabis use on drug progression. A total of 450 participants who had used cannabis at least once in their lifetime were recruited from the National Addictions Management Service, prisons, the Community Rehabilitation Centre and halfway houses from August 2017 to May 2018. A face-to-face questionnaire was administered and descriptive analyses were conducted. The mean participant age was 40.9 ± 14.51 years, and 93.1% of them were male. The participants generally initiated cannabis use during adolescence, at a mean onset age of 16.5 ± 4.46 years. Most (89.6%) were introduced to cannabis by peers. Approximately half of them (46.9%) had used cannabis before other illicit drugs and 42.1% of them had used heroin as the succeeding drug. In Singapore, cannabis use is often initiated during adolescence, largely under peer influence. Cannabis users may progress to other illicit drugs, particularly heroin, later in life.