Recreational Marijuana Use Research Articles

Reply to: Recreational Marijuana Use and Bowel Function.

Reply to: Recreational Marijuana Use and Bowel Function.

Youth’s Proximity to Marijuana Retailers and Advertisements: Factors Associated with Washington State Adolescents’ Intentions to Use Marijuana

The current study explored the influences of advertising exposure, numbers of marijuana retailers, distance to retailers, and constructs from the integrative model of behavioral prediction, including outcome beliefs, perceived norms, and efficacy, on youth’s intentions to use marijuana in a state in which the use of recreational marijuana is legal. A state-wide online cross-sectional survey of 350 adolescents ages 13–17, residing in Washington state, was conducted in June 2018. The results of the regression analysis suggest that exposure to marijuana advertising, positive and negative outcome beliefs, and perceived peer norms were associated with intention to use marijuana. Distances to retailers moderated the relationships between exposure to advertising and intentions, as well as between positive outcome beliefs and intentions. States that have legalized recreational marijuana should continue considering the location of retailers in relation to neighborhoods and advertising regulations to reduce the appeal to youth. Additionally, prevention efforts could aim to influence outcome beliefs and norms in an attempt to reduce adolescents’ intentions to use recreational marijuana.

Sex differences in driving under the influence of cannabis: The role of medical and recreational cannabis use

BackgroundExisting evidence suggest that cannabis may impair driving and is the most prevalent drug identified in drivers. Males exhibit an excess risk for driving under the influence of drugs or alcohol compared to females. We assessed sex differences in the association between the reason for cannabis use (medical, recreational, or both) and driving under the influence of cannabis (DUIC). MethodsA sample of 17,405 past 12-month cannabis users (18 + years old) were analyzed from the 2016–17 National Survey on Drug Use and Health. Multivariable logistic regression was used to assess the interaction of sex and reason for cannabis use on DUIC using predicted probabilities. ResultsAmong cannabis users in the sample, 88.1% used for recreational reasons, 7.8% used for medical reasons, and 4.1% used for medical and recreational reasons. The probability of DUIC was as low as 20% among female medical only users, and as high as 40% among male combined medical and recreational users. Females showed more similar probabilities of DUIC across reasons of use (range 20% to 25%s) than males (range 28% to 40%). The difference in the probability of DUIC between combined medical and recreational users and recreational only users was significantly greater among males than among females (Δ 0.1, p < 0.05). ConclusionsThe observed effects of sex and reasons for cannabis use on DUIC suggests a need for targeted educational interventions, particularly among males reporting combined medical and recreational marijuana use.

Please don't call it medical marijuana unless it is; but it probably isn't.

The drug development process of demonstrating an agent is safe, effective and pure has, with rare exception, proven an exemplary path in translational research. The basic science, the clinical trials and the chemistry, manufacturing and control have served public health well. This carefully regulated approach forms the basis of a drug label with data from these studies also used to convey risk and benefit to prescribing physicians through the channels of medical literature and drug promotion by the industry. The latter is also important to public health in that such promotion must be based in the approved indication, be truthful, not be misleading and be substantiated by sufficient evidence. Why then is the emergence of "medical marijuana" any different? While substantial evidence exists for some conditions and some related products have undergone careful investigation through to NDA approval, most claims are not substantiated by research but driven by misguided enthusiasm. While recreational use of marijuana is not at debate here, nor is the right of an individual patient to explore cannabis therapeutically; however, allowing broad unsubstantiated claims around medicinal cannabis to infiltrate the general public is a disservice. To distill the potential medical benefits through the pharmacologic understanding of the endocannabinoid system, cannabis should follow the traditional drug development process or one that improves upon it. Until then, claims should remain as stated hypothesis to accept or reject.

Beliefs and Attitudes of Graduate Gerontology Students about Medical Marijuana Use for Alzheimer’s and Parkinson’s Disease

AimsThe aims of the current study were as follows: 1) to assess gerontology graduate students’ beliefs about medical marijuana’s (MMJ) effectiveness for two common age-related conditions - Alzheimer’s (AD) and Parkinson’s disease (PD); 2) to assess students’ beliefs and attitudes toward MMJ; 3) to explore associations linking background characteristics, MMJ-related attitudes and beliefs, and beliefs about the MMJ effectiveness for AD and PD. MethodA sample of 104 (84 women and 20 men) gerontology graduate students voluntarily participated in the anonymous online survey. ResultsThe vast majority (95%) of the participants indicated they had no formal education about MMJ and reported being unprepared to answer clients’ MMJ-related questions (84.6%). Most of the participants believed that MMJ is effective for use with AD (70.2%) and PD (80.8%) patients. Participants reported favorable beliefs about MMJ benefits, concerns about risks, the need for training, and positive attitudes toward recreational marijuana use legalization. Prior marijuana use (e.g., self-use, friends or family) was found to be associated with more positive beliefs about MMJ benefits, risks, and its legalization for recreational purposes. Prior marijuana use was the only factor associated with the belief that MMJ is an effective therapy for use with AD or PD patients. ConclusionsThe study findings show the need for students’ MMJ education in order to provide future gerontology service providers with the necessary knowledge and ability to address clients’ questions about MMJ use. Efforts to develop curricula and training programs need to be promoted.

Federalism, partial prohibition, and cross-border sales: Evidence from recreational marijuana

Marijuana is partially prohibited: though banned federally, it is available to 1 in 4 U.S. adults under state statutes. We measure the size of the interstate trade generated by state-level differences in legal status with a natural experiment: Oregon allowed stores to sell marijuana for recreational use on October 1, 2015, next to Washington where stores had been selling recreational marijuana since July 2014. Using administrative data covering the universe of Washington's sales and a differences-in-discontinuities approach, we find retailers along the Oregon border experienced a 36% decline in sales immediately after Oregon's market opened. We investigate the home location of recent online reviewers of marijuana retailers and find similar cross-border patterns. By the end of Washington's 2018 fiscal year, our results imply that Washington had earned between $44 million and $75 million in tax revenue from cross-border shoppers. These cross-border incentives may create a “race to legalize.”

Higher odds and rising trends in arrhythmia among young cannabis users with comorbid depression

BackgroundCannabis (marijuana) use and depression are known to be strongly interconnected. However, amid alarming rates of mental health problems in the United States young population, the risk of arrhythmia among young cannabis users with comorbid depression has never been studied. MethodsIn-hospital encounters of arrhythmia were identified among young cannabis users (18–39 years) with or without depression using the National Inpatient Sample (2007–2014) databases and apposite ICD-9 codes. Baseline characteristics and trends in prevalence of arrhythmia were evaluated among inpatient young cannabis users with or without depression. A multivariable regression was performed after adjusting for baseline demographics, comorbidities and parallel history of substance abuse. ResultsOf 2,011,598 young cannabis users (59.6% male) admitted from 2007–2014, 190,146 (9.5%) of patients had comorbid depression, of which 6.9% of patients experienced arrhythmias with atrial fibrillation being most common. Cannabis users with depression were more likely older, white, females and frequently hospitalized in Midwest and rural hospitals. We observed a steadily rising trend in prevalence of arrhythmia in both groups, but a more rapid rise in cannabis users with depression (4.9% in 2007 to 8.5% in 2014 vs. 3.7% in 2007 to 5.7% in 2014). Correspondingly, young depressed cannabis users had higher odds of arrhythmia compared to non-depressed even after controlling for demographics and comorbidities (OR: 1.41, 95% CI: 1.38–1.44, p<0.001). ConclusionRampant recreational use of marijuana may increase the risk of arrhythmia by 40% in young cannabis users with depression as compared to non-depressed.

Secondhand marijuana exposure in a convenience sample of young children in New York City.

Biomarkers of exposure to marijuana smoke can be detected in the urine of children with exposure to secondhand marijuana smoke, but the prevalence is unclear. We studied children between the ages of 0 to 3 years who were coming in for well-child visits or hospitalized on the inpatient general pediatric unit between 2017 and 2018 at Kravis Children's Hospital at Mount Sinai. Parents completed an anonymous survey, and urine samples were analyzed for cotinine and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (COOH-THC), a metabolite of Δ9-tetrahydrocannabinol. Fifty-three children had urine samples available for analysis. COOH-THC was detectable in 20.8% of the samples analyzed and urinary cotinine was detectable in 90.2%. High levels of tobacco exposure (defined as cotinine ≥2.0 ng/ml) were significantly associated with COOH-THC detection (p < 0.01). We found that 34.8% of children who lived in attached housing where smoking was allowed within the property had detectable COOH-THC compared to 13.0% of children who lived in housing where smoking was not allowed at all. This study adds to the growing evidence that children are being exposed to marijuana smoke, even in places where recreational marijuana use is illegal. It is critical that more research be done on the impact of marijuana smoke exposure on children's health and development. We found that 20.8% of the 53 children recruited from Mount Sinai Hospital had detectable marijuana metabolites in their urine. Children with household tobacco smoke exposure and children who lived in attached housing where smoking was allowed on the premises were more likely to have detectable marijuana smoke metabolites. This study adds to the growing evidence that children are being exposed to marijuana smoke, even in places where marijuana remains illegal by state law. As states consider marijuana legalization, it is critical that the potential adverse health effects from marijuana exposure in children be taken into account.

Effects of Recreational Marijuana Legalization on College Students: A Longitudinal Study of Attitudes, Intentions, and Use Behaviors

PurposeAs legal recreational marijuana use expands rapidly across the U.S., there is growing concern that this will lead to higher rates of use among college-aged young adults. Given the limited research addressing this issue, a longitudinal study was conducted to evaluate the effects of legalizing recreational use on the attitudes, intentions, and marijuana use behaviors of college students in two different legalization contexts, Washington State and Wisconsin. MethodsSurvey data assessing marijuana attitudes, intentions, and use behavior were collected from 2011 to 2016 on a longitudinal cohort of 338 students at two large public universities in Washington and Wisconsin. Time series analyses were conducted to evaluate postlegalization changes in ever use, 28-day use, and mean attitude and intention-to-use scores in Washington state, using Wisconsin participants as the control group. ResultsEver use, attitude, and intention-to-use scores did not change significantly more in Washington after legalization than in Wisconsin. However, among prior users, the proportion using in the last 28 days rose faster in Washington after legalization that it did in Wisconsin (p < .001). ConclusionsThe findings suggest that legalization had the greatest effects on current marijuana users, who are surrounded by a climate that is increasingly supportive of its use.

Marijuana Legalization and Youth.

Various states have legalized marijuana for medical purposes and/or decriminalized recreational marijuana use. These changes coincide with a decrease in perceived harmfulness of the drug and an increase in its use among youth. This change is of critical concern because of the potential harmful impact of marijuana exposure on adolescents. Marijuana use has been associated with several adverse mental health outcomes, including increased incidence of addiction and comorbid substance use, suicidality, and new-onset psychosis. Negative impacts on cognition and academic performance have also been observed. As the trend toward legalization continues, the pediatric community will be called on to navigate the subsequent challenges that arise with changing policies. Pediatricians are uniquely positioned to provide innovative care and educate youth and families on the ever-evolving issues pertaining to the impact of marijuana legalization on communities. In this article, we present and analyze the most up-to-date data on the effects of legalization on adolescent marijuana use, the effects of adolescent use on mental health and cognitive outcomes, and the current interventions being recommended for use in pediatric office settings.

Medical Cannabinoid Products in Children and Adolescents.

1. Kathleen K. Miller, MD* 2. Jonathan D. Klein, MD, MPH† 1. *Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN 2. †University of Illinois at Chicago, Chicago, IL Cannabinoid-containing products have become increasingly ubiquitous worldwide, both through legalization of recreational marijuana and widespread use of cannabinoid derivatives in medical products. In the United States, the Centers for Disease Control and Prevention (CDC) reported that more than 1 in 3 adolescents said they have tried recreational marijuana in 2017. Pediatricians should be aware of the limitations of cannabinoids as medical treatments, and should knowledgeably counsel patients about their potential risks and benefits. Cannabinoids are derived from the cannabis plant, which contains a variety of metabolically active compounds, of which the most well-known are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is derived primarily from marijuana plants, and CBD primarily from hemp plants. THC is the primary psychoactive ingredient in marijuana and is responsible for the “high” associated with marijuana use. CBD, conversely, does not have psychoactive effects. In recent years, CBD has experienced a surge in popularity as an alternative treatment for a variety of ailments. Manufacturers have claimed that it has anxiolytic and anticonvulsant properties and that it can treat chronic pain, insomnia, and posttraumatic stress disorder. Recreational marijuana and plant derivatives of cannabis that can be smoked or ingested in edible forms contain THC in addition to other, less psychoactive cannabis-derived compounds. Only one cannabinoid derivative is Food and Drug Administration (FDA)–approved for use in children: dronabinol is approved for the treatment of nausea and vomiting induced by chemotherapy. Synthetic cannabinoids, also known as spice or K2, have neither therapeutic properties nor medical …

The association between legalization of recreational marijuana use and birth outcomes in Colorado and Washington state.

To identify trends in birth outcomes that may be associated with legalization of recreational marijuana which occurred in 2013 using vital records from Colorado and Washington states for the period of 2008-2016. Data were from birth certificates of live births (between 22 and 44 weeks gestation) of which there were 576,369 singleton births included for Colorado and 771,547 for Washington State. Outcomes included preterm birth defined as <37 completed weeks of gestation; small for gestational age (SGA) defined using <10th percentile birthweight z-score; and birth prevalence of congenital anomalies defined using a variable from the birth certificate that indicated any major defect. The outcomes of interest were analyzed using a change-point approach to logistic regression adjusting for maternal socio-demographics, body mass index, smoking, and infant sex. There was evidence of an increased birth prevalence of congenital anomalies in both Colorado and Washington State when comparing prevalence before and after legalization. Only in Colorado did we observe an increase in preterm births post legalization, and there was no association with fetal growth in either state. This time trend analysis indicates that the birth prevalence of all congenital anomalies combined in Washington and Colorado has increased in parallel with the timing of legalization of marijuana in those two states. However, this finding can only generate hypotheses as no pregnancy exposure information for marijuana was available in this dataset. More research is needed on the effect of marijuana use on birth outcomes.

Marijuana Use and Perinatal Outcomes Among Obstetric Patients in a Southern California Safety Net Hospital [22K

INTRODUCTION: Recreational marijuana use is increasing and poses a risk to both mother and the fetus. We aimed to assess marijuana use and perinatal outcomes in the local obstetric population at our hospital. METHODS: An IRB approved retrospective chart review identified a cohort of women with singleton gestations who delivered at LAC/USC hospital between 2015 and 2018. Women with self-reported marijuana use were compared with a control group. Demographic characteristics, maternal and perinatal outcomes were evaluated. Associations between these factors and marijuana use were assessed with univariate and multivariate regression. RESULTS: Of 2792 women who delivered during the study period, 151 (5.4%) had documented marijuana use. Compared to 192 non-users, marijuana users were more likely to be younger, non-Hispanic, undomiciled, unemployed and use other illicit substances. Marijuana users entered prenatal care later (14.2 vs. 22.1 weeks, P&lt;.001), were more likely to have preeclampsia (P=.046) and cesarean delivery (P=.01) and had infants with average birth weight 106 grams less (P=.02) than controls. After adjusting for confounders, marijuana use was not significantly associated with preterm birth or composite perinatal morbidity, but remained associated with 4.1-fold greater likelihood of delivering a small for gestational age (SGA) infant (95% CI 1.95-8.74). CONCLUSION: At a safety net hospital, antepartum marijuana use is significantly associated with SGA at birth. Marijuana users have higher maternal morbidity including preeclampsia and cesarean delivery, and are more likely to enter prenatal care later and report poly-substance use. Healthcare disparities associated with marijuana use make this a population of critical interest.

Smoke and Mirrors: The Recreational Marijuana Debate.

With the increasing number of states that have legalized the use of recreational marijuana, concerns regarding its negative effects are necessary. There is growing scientific evidence that the use of marijuana for recreational purposes has a wide variety of negative health effects, both physical and psychiatric.

Advising the Cannabis Client

In his State of the State address, on January 8, 2020, New York State Governor, Andrew M. Cuomo vowed to work with the legislature to legalize the sale and use of recreational marijuana in New York. If Governor Cuomo follows through on his promise, New York will be the twelfth state to legalize recreational cannabis, following Colorado which was the first. With several other states moving in the same direction and with heavy regulation existing in the states that have already legalized the substance, there is significant need and opportunity for attorneys to enter the cannabis industry. There are very good reasons for states to consider legalizing marijuana – In Colorado, alone, tax money received from the state-legal sale of retail and medical marijuana from February 2014 through December 2020 exceeded $1.6 billion – exceeding $387,000,000 in 2020. Nonetheless, while cannabis remains a schedule I drug under the Controlled Substances Act (“CSA”), any practitioners wishing to take advantage of such opportunities must be keenly aware of the associated risks. This updated article includes a discussion for lawyers practicing before federal courts and the concern that the local rules of the federal court may not provide the comfort that the state rules of professional conduct may for the practice of law in matters not legal under federal law.

Recreational Marijuana Use and Bowel Function.

Recreational Marijuana Use and Bowel Function.

Cannabis at the Crossroads: A Transdisciplinary Analysis and Policy Prescription

Cannabis has returned to the mainstream in recent years after an interlude of legal prohibition and partial societal stigmatization. 2019 U.S. state-legal cannabis sales have been estimated at 13.6 billion dollars with predictions for sales to near 30 billion by 2025. The global market for cannabis products - including a range of products produced from non-psychoactive hemp - could approach hundreds of billions of dollars annually. At the same time, the legal cannabis industry faces significant challenges in the United States; legalization has been uneven, with disparities among states, and federal law continues to impose obstacles to predictability in the nationwide market for cannabis. Conflicts between U.S. federal and state laws regarding cannabis are numerous. Federal law treats most forms of cannabis as illegal, yet 97.7 percent of the U.S. population –– located in 47 states, the District of Columbia, and 4 U.S. territories –– are living in jurisdictions where medical or recreational use of cannabis, including cannabidiol (“CBD”) oil, is now legal. This Article takes a transdisciplinary approach and proceeds in eight parts. First, we explore the history of cannabis including its earliest uses, noting periodic prohibitions. Second, we look at applicable current U.S. federal statutes, both criminal and non-criminal. Third, we consider the legalization approaches and experiences in the states. Fourth, we look at the Canadian experience including national recreational market legalization in 2018. Fifth, we examine the ethical issues around recreational and medical marijuana use. Sixth, we describe the future outlook for cannabis businesses in terms of both market potential and regulation. Seventh, we describe Congressional proposals to change federal laws on cannabis. Eighth, we then draw upon these various perspectives to arrive at a policy prescription. And last, we conclude.

The perils of recreational marijuana use: relationships with mental health among emergency department patients.

IntroductionMarijuana is a commonly used drug in the United States. Many states have legalized the recreational use of marijuana. The effects of marijuana on mental health are unknown.MethodsIn this prospective survey study, eligible participants included ED patients age 18 and older, who had ever used recreational marijuana. A survey instrument was developed, piloted, and revised. Data collected included reasons for marijuana use, marijuana's perceived effectiveness, and history of mental health conditions, including depression, anxiety, and suicidal thoughts.ResultsAmong 303 participants (86% response rate), the median age of first marijuana use was 16 ([IQR 14, 19], range 6–65). The most commonly cited reasons for marijuana use included recreational use (70%; n = 211), to treat anxiety (30%; n = 89), to treat pain (25%; n = 74), and to treat depression (17%; n = 51). Mental health issues were common in the study population. A majority of patients reported anxiety in the last 30 days (59%; n = 176), and a significant minority of patients reported serious depression in the last 30 days (46%; n = 137). Some patients reported suicidal thoughts in the last 30 days (9%; n = 29). Participants who used marijuana more frequently reported more days of anxiety (median 15.5, compared to 1; P = 0.001). Among participants with mental health conditions, most began using marijuana before the onset of the mental health conditions (77%, n = 167). Earlier age of starting to use marijuana was correlated with higher number of years of anxiety or tension in lifetime (r = −0.11, P = 0.05, n = 301). Perceived effects of marijuana use on mental health were variable. Most participants stated that marijuana improved their mental health (62%; n = 163), and some reported that marijuana did not improve their mental health (37%; n = 98).ConclusionsMany ED patients have used marijuana, either currently or in the past. Mental health conditions are also common, including anxiety, depression, and suicidal thoughts. Most participants reported marijuana use starting at an age under 18. Marijuana use preceded the onset of mental health conditions in the majority of participants.

Marijuana legalization and historical trends in marijuana use among US residents aged 12\u201325: results from the 1979\u20132016 National Survey on drug use and health

BackgroundMarijuana is the most commonly used illicit drug in the United States. More and more states legalized medical and recreational marijuana use. Adolescents and emerging adults are at high risk for marijuana use. This ecological study aims to examine historical trends in marijuana use among youth along with marijuana legalization.MethodData (n = 749,152) were from the 31-wave National Survey on Drug Use and Health (NSDUH), 1979–2016. Current marijuana use, if use marijuana in the past 30 days, was used as outcome variable. Age was measured as the chronological age self-reported by the participants, period was the year when the survey was conducted, and cohort was estimated as period subtracted age. Rate of current marijuana use was decomposed into independent age, period and cohort effects using the hierarchical age-period-cohort (HAPC) model.ResultsAfter controlling for age, cohort and other covariates, the estimated period effect indicated declines in marijuana use in 1979–1992 and 2001–2006, and increases in 1992–2001 and 2006–2016. The period effect was positively and significantly associated with the proportion of people covered by Medical Marijuana Laws (MML) (correlation coefficients: 0.89 for total sample, 0.81 for males and 0.93 for females, all three p values < 0.01), but was not significantly associated with the Recreational Marijuana Laws (RML). The estimated cohort effect showed a historical decline in marijuana use in those who were born in 1954–1972, a sudden increase in 1972–1984, followed by a decline in 1984–2003.ConclusionThe model derived trends in marijuana use were coincident with the laws and regulations on marijuana and other drugs in the United States since the 1950s. With more states legalizing marijuana use in the United States, emphasizing responsible use would be essential to protect youth from using marijuana.

Safe and Responsible Use of Marijuana in California

Californians approved The Control, Regulate and Tax Adult Use of Marijuana Act Proposition 64 in November 2016, which legalized the recreational use of marijuana. Legal use began shortly after Janu...