Reported Marijuana Use Research Articles

Current Marijuana Use by Industry and Occupation - Colorado, 2014-2015.

The effects of marijuana use on workplace safety are of concern for public health and workplace safety professionals. Twenty-nine states and the District of Columbia have enacted laws legalizing marijuana at the state level for recreational and/or medical purposes. Employers and safety professionals in states where marijuana use is legal have expressed concerns about potential increases in occupational injuries, such as on-the-job motor vehicle crashes, related to employee impairment. Data published in 2017 by the Colorado Department of Public Health and Environment (CDPHE) showed that more than one in eight adult state residents aged ≥18 years currently used marijuana in 2014 (13.6%) and 2015 (13.4%) (1). To examine current marijuana use by working adults and the industries and occupations in which they are employed, CDPHE analyzed data from the state's Behavioral Risk Factor Surveillance System (BRFSS) regarding current marijuana use (at least 1 day during the preceding 30 days) among 10,169 persons who responded to the current marijuana use question. During 2014 and 2015, 14.6% of these 10,169 Colorado workers reported current marijuana use, with the highest reported prevalence among workers in the Accommodation and Food Services industry (30.1%) and Food Preparation and Serving (32.2%) occupations. Understanding the industries and occupations of adults with reported marijuana use can help direct and maximize impact of public health messaging and potential safety interventions for adults.

Differences in HIV Risk Behaviors Between Self-Identified Gay and Bisexual Young Men Who are HIV-Negative.

Young men who have sex with men (MSM) are disproportionately affected by HIV, but it remains unclear whether there are differences in HIV risk behaviors between self-identified gay and bisexual young men. To address this, the current study examined differences in condomless sex and substance use before sex with male partners between self-identified gay and bisexual young men who are HIV-negative. Additionally, we examined differences in HIV risk behaviors with male versus female partners among the bisexual men. We used four waves of data spanning 24months from a cohort of young MSM ages 16-29. At each wave, participants reported on up to four partners, allowing us to examine within-person associations. Compared to gay men, bisexual men reported more insertive condomless anal sex (CAS) with casual partners, they were more likely to report marijuana use before sex, and they were less likely to report lifetime HIV testing and PrEP use. Alcohol and marijuana use before sex were associated with CAS for both gay and bisexual men, but the association between marijuana use and insertive CAS was stronger for bisexual men. Bisexual men reported more condomless sex with female partners compared to male partners, but this was not significant after accounting for alcohol and marijuana use. Bisexual men were more likely to report alcohol and marijuana use with female partners compared to male partners, but both alcohol and marijuana use were associated with condomless sex regardless of partner gender. Findings support the need for tailored HIV prevention for self-identified bisexual men to address their lack of preventive behaviors, their increased engagement in certain risk behaviors with male partners, and their engagement in risk behaviors with female partners.

Does social context matter? An ecological momentary assessment study of marijuana use among college students

IntroductionPast research has shown that marijuana use occurs commonly in social situations for young adults, though few studies have examined the association between immediate social context and marijuana use patterns and associated problems. The current study examined the impact of demographics, marijuana use and problem use, alcohol use, craving, and social context on the likelihood of using marijuana with others via ecological momentary assessment (EMA). MethodsCollege-student marijuana users (N=56) were recruited and completed a baseline assessment and training on the two-week signal-contingent EMA protocol. Participants were sent text messages three times per day randomly for two weeks. ResultsOf the 1131 EMA instances during which participants reported using marijuana, 862 (76.22%) were labeled as being with others. Forty-five participants (80.36%) reported marijuana use with others present during at least half of the times they used marijuana. Findings from a multilevel logistic regression model showed a significant positive association between the probability of using with others and minutes spent using marijuana (b=0.047, p<0.001), social facilitation (b=0.138, p<0.001), and DSM-IV diagnosis (dependence versus no diagnosis, b=1.350, p=0.047). ConclusionsCannabis dependence, more time using marijuana in the moment, and using for social facilitation purposes were positively associated with using marijuana in the context of being with others. Daily users had more variability in terms of the social context of their use. This study illustrates the complex relationship between social context and marijuana use.

Use of Marijuana and Other Substances Among Pregnant and Parenting Women With Substance Use Disorders: Changes in Washington State After Marijuana Legalization

In 2012, possession of marijuana for nonmedical use was legalized in Washington State. This study examined how legalization affected alcohol and drug use in a sample of pregnant and parenting women with substance use disorders. Study participants from nine counties in Washington State (N = 1,359) were questioned about their substance use after completing a 3-year case management intervention program. The sample was divided into two cohorts based on whether participants had completed the program before or after legalization. Most study participants reported complete abstinence from alcohol and nonprescription drugs at program exit. Among those who were still using substances, women who completed the intervention after marijuana legalization were significantly more likely to report marijuana use at program exit compared with women who completed the intervention before marijuana legalization. Across both cohorts (pre- and post-legalization), we found a positive association of exit marijuana use with alcohol, illegal methadone, other opioids, amphetamines, and cocaine use; even when we controlled for historical period, the association with some of these substances with marijuana use remained evident. Independent of marijuana use, we saw increased use during the post-legalization period of alcohol, illicit methadone, and other opioids. Marijuana use at exit from the Parent-Child Assistance Program (PCAP) increased significantly after marijuana legalization in the state. Women who were not abstinent from marijuana at program exit were likely to report use of other substances as well. Our study design demonstrates an association but does not allow us to conclude that marijuana use leads to other substance use among this sample of women with a history of polysubstance use.

206: Maternal marijuana exposure by self-report and umbilical cord sampling in a state with legalization

To compare self-reported maternal marijuana use (survey and medical record abstraction) to quantitative biological sampling for 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-A) in umbilical cord homogenate. Cross-sectional study of women with a live, singleton pregnancy >24 weeks delivering at two urban medical centers in Colorado on 12 consecutive weekdays. Maternal marijuana exposure was estimated by (1) a survey detailing frequency and recency of marijuana use in pregnancy, (2) medical record abstraction of self-report to healthcare provider at time of admission, and (3) assay of the umbilical cord for THC-A. Cord segments were assayed for THC-A using liquid chromatography tandem mass spectrometry (LC-MS/MS). Limit of detection (LOD) for THC-A was 100 pg/g and limit of quantification (LOQ) was 200 pg/g. Women were categorized by survey-reported last use (≤30 days ago, 30 days to 1 year, more than 1 year, never), and the proportion of women with umbilical cord results positive for THC-A was reported for each group. Comparisons between groups were made using chi square. The relationship between survey-reported frequency of use in the past 30 days and quantitative THC-A cord homogenate result was evaluated using Spearman correlation. Of 166 eligible women, 136 (82%) were approached for the study; 9 declined participation, 8 cords were discarded by the clinical team prior to research collection and 2 cord samples were insufficient for assay, leaving 116 participants with surveys linked to cord assay results. Six percent of participants reported use in the last 30 days on survey whereas only 2.6% of participants reported marijuana use to healthcare providers at admission. On umbilical cord assay, 10.3% had THC-A above the LOQ and 22.4% had THC-A above the LOD. All women with survey-reported use in the last 30 days had a THC-A above the LOD, and cord results differed based on reported recency of use (Table). Survey-reported frequency of marijuana use in the past 30 days had moderate correlation with quantified umbilical cord THC-A (correlation coefficient 0.47, 95% CI 0.31-0.60, p<0.001; Figure). Umbilical cord sampling results in higher estimates of maternal cannabis use than self-report. Quantitative umbilical cord THC-A assay by mass spectrometry shows promise for measuring in utero marijuana exposure.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Trends in Self-Reporting of Marijuana Consumption in the United States

ABSTRACTTo adjust for underreporting of marijuana use, researchers multiply the proportion of individuals who reported using marijuana by a constant factor, such as the US Office of National Drug Control Policy’s 1.3. Although the current adjustments are simple, they do not account for changes in reporting over time. This article presents a novel way to explore relative changes in reporting from one survey to another simply by using data already available in a self-reported survey, the National Survey on Drug Use and Health. Using domain estimation to examine the stability in reported marijuana use by age 25 in individuals older than 25, this analysis provides estimates of the trends in marijuana reporting and standard errors, as long as the survey weights properly account for sampling variability. There was no significant evidence of an upward or downward trend in reporting changes from 1979 to 2016 for all birth cohorts, although there were significant differences in reporting between years and a slight downward trend in later years. These results suggest that individuals have become increasingly less willing to report their drug use in recent years, and thus the ONDCP likely underestimated the already drastic increase in use from 1992 to 2016.

Marijuana's Influence on Pain Scores, Initial Weight Loss, and Other Bariatric Surgical Outcomes.

Pain management can be challenging following bariatric surgery, and patients with obesity tend to increase opioid use after undergoing surgery. This report quantifies marijuana (MJ) use and its relationship to pain and other surgery-related outcomes in a population from a state that has legalized MJ. Data were collected for consecutive patients undergoing weight reduction surgeries between May 1, 2014 and July 31, 2015. Demographics, preoperative comorbidities, medications, and perioperative opioid use were analyzed. The primary outcome evaluated was inpatient opioid pain medication use quantified using natural log morphine equivalents. Secondary outcomes included percentage of total body weight loss after three months, postoperative complications, and changes in medical comorbidities. A total of 434 patients, among whom 36 (8.3%) reported MJ use, comprised the study population. Perioperative opioid requirements were significantly higher in the MJ-user group (natural log morphine equivalents of 3.92 vs 3.52, p = 0.0015) despite lower subjective pain scores (3.70 vs 4.24, p = 0.07). MJ use did not affect percentage of 90-day total body weight loss, development of postoperative complications, or improvement in medical comorbidities. Perioperative opioid use was significantly higher in the MJ-user group despite lower subjective pain scores. The difference in opioid requirements suggests an interaction between MJ use and opioid tolerance or pain threshold. The percentage of total body weight loss, improvement in medical comorbidity, and incidence of postoperative complications at 90-day follow-up were not affected by MJ use in this cohort analysis.

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marijuana, cannabinoid hyperemesis syndrome: marijuana, cannabinoid hyperemesis syndromeFigureFigureFigureA 28-year-old man presented to the ED with diffuse abdominal pain, nausea, and more than 15 episodes of non-bilious, non-bloody emesis over the previous 48 hours. His pain was worst in the morning, but improved after a hot shower. Of note, the patient had used products similar to this on a daily basis. (Photo.) This was his fourth visit to the ED for abdominal pain over the past year. Previous visits have included an extensive workup, including unremarkable abdominal CTs, labs, and upper endoscopy. What is the most appropriate diagnosis, and what are the treatment options? Find the diagnosis and case discussion on p. 16. Diagnosis: Cannabinoid Hyperemesis Syndrome Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclic episodes of moderate to severe diffuse abdominal pain, nausea, and emesis in patients endorsing frequent marijuana use. Many patients present repeatedly, and undergo multiple rounds of costly, nondiagnostic tests. The diagnosis of CHS is becoming increasingly common, and is likely due to an increase in the THC content of marijuana, the prevalence of marijuana use, and the availability of commercial marijuana. Shifts in laws and stigma about marijuana use may also be influencing the frequency with which patients report marijuana use to physicians. CHS can be separated into three phases: prodromal, hyperemetic, and recovery. The prodromal phase may last months to years, and involves low-level abdominal discomfort from frequent marijuana use. The hyperemetic phase typically lasts up to 48 hours, and involves intense episodes of non-bilious, non-bloody emesis, sometimes more than five times per hour. Episodes occur cyclically at an interval of weeks to months, and asymptomatic periods may or may not involve marijuana use. (Curr Drug Abuse Rev 2011;4[4]:241.) The pathophysiology of CHS is still an active area of investigation, but may involve CB1 receptors in the gastrointestinal tract and central nervous system. (Pharmaceuticals [Basel] 2010;3[7]:2163.) Initial use of marijuana may provide a therapeutic effect to the patient with decreased nausea and abdominal pain, while chronic use eventually tips the scale toward nausea, pain, and emesis. The recovery phase, which almost invariably coincides with marijuana cessation, is characterized chiefly by a lack of hyperemetic episodes. Confidently diagnosing CHS can be challenging. Excluding the diagnosis of cyclic vomiting syndrome is difficult because both conditions involve cyclic episodes of abdominal pain, nausea, and emesis. Some studies indicated that the only way to discriminate between the syndromes is whether marijuana cessation causes remission. (Ger Med Sci 2017;15:Doc06.) CHS is also more often associated with frequent marijuana use and symptomatic relief via hot showers. (Curr Drug Abuse Rev 2011;4[4]:241.) Up to 92 percent of patients diagnosed with CHS endorse symptomatic relief when taking hot showers. (J Med Toxicol 2017;13[1]:71.) It is important in the ED to exclude acute diagnoses such as pancreatitis, bowel obstruction, or cholecystitis while not repeating prior negative workups. Chronic diagnoses, such as irritable bowel syndrome, Crohn's, or celiac should be investigated by the primary care physician. Treatment in the ED consists primarily of IV fluids and antiemetic medications. Haloperidol (5-10 mg IV) may be beneficial because of the dopamine antagonism and interactions between CB1 and dopamine pathways. (Am J Ther 2017;24[1]:e64.) Recent research suggests that capsaicin creams applied in the ED can also provide quick symptomatic relief. A suggested mechanism of action involves TRPV1 receptors in nociceptive pathways. (Clin Toxicol [Phila] 2017;55[8]:908.) No long-term pharmacologic interventions have been shown to reduce the intensity or frequency of episodes, and cessation of marijuana use is the only intervention that has consistently demonstrated efficacy. (J Med Toxicol 2017;13[1]:71.) Broaching the topic of marijuana as a causative agent while the patient is in the ED is challenging. Many patients resist the idea that marijuana use may be causing their symptoms. Discussion of CHS should be reserved for the end of the visit when symptoms have significantly resolved. It is useful to engage the patient in a conversation on the paradoxical causative role of marijuana. Admitting that cannabis can provide nausea relief in many situations and elaborating on CHS may help reduce resistance to the diagnosis. Engaging patients in the idea that marijuana, like many other medications and remedies, may have side effects is also useful. These conversations help reduce return visits, which are common for CHS patients. This patient received treatment in the ED with IV normal saline and haloperidol with significant improvement. After engaging him in a thoughtful discussion about his cannabis use, he acknowledged that cannabis may have side effects in some patients and agreed to a trial of cannabis cessation to see if his symptoms would resolve.

Exposure to Advertisements and Marijuana Use Among US Adolescents.

IntroductionThis study examined whether exposure to marijuana advertisements was associated with current marijuana use and frequency of use among US adolescents in grades 8, 10, and 12.MethodsWeighted estimates of exposure to marijuana advertisements and marijuana use from the 2014 and 2015 Monitoring the Future studies were investigated. Factors associated with the prevalence and frequency of marijuana use were analyzed by using logistic regression and linear regression models, respectively.ResultsOf all respondents (n = 12,988), 13.8% reported marijuana use in the past 30 days. Exposure to marijuana advertisements was prevalent among adolescents, with 52.8% reporting exposure from internet advertisements, 32.1% from television advertisements, 24.1% from magazine or newspaper advertisements, 19.7% from radio advertisements, 19.0% from advertisements on storefronts, and 16.6% from billboards. In the multivariable analysis, current use of marijuana among adolescents was associated with exposure to marijuana advertisements on storefronts (adjusted odds ratio [OR] = 1.4, P < .001), magazines or newspapers (adjusted OR = 1.6, P < .001), billboards (adjusted OR = 1.4, P = .002), internet (adjusted OR = 1.8, P < .001), television (adjusted OR = 1.4, P < .001) and radio (adjusted OR = 1.7, P < .001). Exposure to marijuana advertisements from the internet was associated with increased use of marijuana (β = 0.3, P = .04).ConclusionExposure to marijuana advertisements was associated with higher odds of current marijuana use among adolescents. Regulations that limit marijuana advertisements to adolescents and educational campaigns on harmfulness of illicit marijuana use are needed.

Marijuana use is associated with hypersensitivity to multiple allergens in US adults

BackgroundThe recent legalization of marijuana use for both medical and recreational purposes in several states of the United Sates is expected to further increase the already high prevalence of marijuana use. Although allergic reactions are uncommon, the potential of marijuana use and cultivation to cause allergy should be considered. We aimed to investigate whether marijuana use is associated with the prevalence of sensitization to specific allergens. MethodsA total of 2671 adults (aged 20–59 years) who participated in the 2005–2006 National Health and Nutrition Examination Survey were included. Participants completed a questionnaire on marijuana use and underwent sensitization tests to 19 specific allergens. Those who reported marijuana use for at least 1 day in the past 30 days were considered marijuana users. ResultsNo difference was found in the history of allergy between marijuana users and non-users. Compared with marijuana non-users as a reference group, the adjusted odds ratio (AOR) of sensitization to a specific allergen among marijuana users was significantly greater for antibodies against the following: Alternaria alternata (AOR=1.67; 95% confidence interval (CI), 1.04−2.70), D. farinae (AOR=1.68; 95% CI, 1.27−2.22), D. pteronyssin (AOR=1.65; 95% CI, 1.32-2.06), ragweed (AOR=1.84; 95% CI, 1.30-2.59), rye grass (AOR=1.49; 95% CI, 1.12−1.97), Bermuda grass (AOR=1.55; 95% CI, 1.03−2.33), oak (AOR=1.76; 95% CI, 1.14−2.70), birch (AOR=2.09; 95% CI, 1.23−3.55), peanut (AOR=1.91; 95% CI, 1.25−2.92), and cat dander (AOR=1.51; 95% CI=1.13−2.03). ConclusionsWe provide preliminary findings to suggest that marijuana use is associated with sensitization to specific allergens, including molds, dust mites, plants, and cat dander.

Gender differences in substance use and psychiatric distress among medical students: A comprehensive statewide evaluation

ABSTRACTBackground: Medical student wellness has emerged as an important issue in medical education. The purpose of the present study was to obtain a comprehensive assessment of substance use, psychological distress, and help-seeking among male and female medical students in order to identify targets for continued intervention efforts. Methods: Medical students from all 9 medical schools in the state of Florida were invited via e-mail and/or announcements to complete an anonymous online questionnaire assessing their well-being. Of 5053 matriculating medical students, 1137 (57.1% female) responded to the questionnaire. Descriptive statistics, t tests, and chi-square analyses were computed using SPSS 20. Results: Over 70% of students acknowledged binge drinking, with men reporting higher frequency than women (χ2 = 13.90, P = .003), and 22.7% (n = 201) reported marijuana use during medical school, with higher rates (χ2 = 9.50, P = .02) among men (27.0%, n = 99) than women (18.9%, n = 93). A significant minority of students reported nonmedical use of prescription stimulants and prescription opioids. In addition, 3.3% of male students (n = 12) compared with 0.6% of female students (n = 3) reported problematic drug use. Further, almost 2/3 of respondents reported decreased psychological health since beginning medical school, with women noting greater reductions (χ2 = 12.39, P = .05) and higher levels of stress (χ2 = 16.30, P = .003). Over 10% of students (n = 102) endorsed “thoughts of committing suicide” during medical school, and 70.1% felt they would benefit from mental healthcare (79.3% of women vs. 59.6% of men; χ2 = 41.94, P < .001), although only 39.8% accessed help. Conclusions: Despite efforts to address medical student wellness, students continue to report concerning levels of psychological distress, suicidal ideation, and substance use. More work is needed to effectively address medical student mental health and well-being.

Marijuana Use and Perceptions of Risk and Harm: A Survey among Canadians in 2016.

Objectives:To describe marijuana use by Canadians and their perceptions of risk and harm.Design:A cross-sectional, structured, online and telephone survey.Participants:A nationally representative sample of Canadians.Methods:This survey used random probability sampling and targeted respondents based on age, sex, region and their expected response rate.Results:Of the 20% of respondents reporting marijuana use in the past 12 months, they were more likely to be younger and male. The most common form of use was smoking, 79%. When asked about harmfulness, 42% and 41% responded that they considered marijuana more harmful than helpful to mental health and to physical health, respectively. When asked about driving under the influence, 71% responded that it was the same as alcohol.Conclusion:This research is important for health providers and policy makers seeking to maximize public health through clinical and legislative reform of non-medical use of marijuana.

Marijuana use disorder symptoms among recent onset marijuana users

BackgroundWith recreational marijuana having recently been legalized in a growing number of U.S. states, as well as the increasing support for its legalization among substantial segments of the American public, an understanding of the development of symptoms associated with marijuana use disorders will assist in guiding both education and policy. MethodsThis study examined the prevalence of marijuana use disorder symptoms among a nationally representative sample of recent onset marijuana users ages 12–21 drawn from the National Survey of Drug Use and Health (N=9697). ResultsThe most frequently reported marijuana use symptoms were “tolerance”, and “time occupied acquiring, using or recovering from the effects of marijuana”. Logistic regression analyses indicated an expected positive association between marijuana use frequency and each marijuana use disorder symptom. In many cases the positive trend was quadratic or cubic, with greater increases between rates among low and moderate frequency marijuana users (i.e. 1–10days per month) than among those using at a higher frequency (i.e. >10days per month). Relationships between marijuana use frequency and marijuana use symptoms were largely consistent according to age, gender and ethnicity. ConclusionsRecognizing symptoms of marijuana use disorders among adolescents and young adults using marijuana infrequently may assist in early identification and intervention for those at risk for problem use.

Perioperative Patient Beliefs Regarding Potential Effectiveness of Marijuana (Cannabinoids) for Treatment of Pain: A Prospective Population Survey.

Cannabinoids have an expanding presence in medicine. Perioperative patients' perceptions of the effectiveness of these compounds, and acceptance if prescribed for pain, have not been previously described. Our primary objective was to describe patients' beliefs regarding the potential effectiveness of cannabinoids for the treatment of acute and chronic pain, as well as gauge patient acceptance of these compounds if prescribed by a physician. In addition, demographic and pain history data were collected to elucidate the predictors of the aforementioned patient attitudes. Secondarily, we sought to characterize the subgroup of patients who reported marijuana use. Predictors of marijuana use, effectiveness, and adverse effects were also reported for this subgroup. An anonymous questionnaire was administered to 501 patients in the preoperative registration area at Mount Sinai Hospital, New York, New York. The questionnaire was designed to collect data on patient demographics, presence of pain, pain severity, use of pain medication, history of illicit-drug use, tobacco use, cannabis use, patient beliefs about the potential effectiveness of marijuana for acute and chronic pain and their willingness to use cannabis for pain, if prescribed by a physician. Normality of distributions for continuous variables was assessed with skewness and kurtosis measures. A logistic regression model was used to assess the demographic and medical characteristics of marijuana users compared with nonusers. The effectiveness of marijuana in dealing with pain and adverse effects associated with its use were examined using exploratory principal component analysis. More than 80% of this cohort of preoperative patients believed that marijuana could be at least somewhat effective for the treatment of pain after surgery and would be willing to use cannabinoid compounds if prescribed by their physician. Predictors of positive attitudes toward marijuana included history of marijuana use, pain history, and being a marijuana nonuser of white race. Approximately 27% of the respondents reported a history of marijuana use. Younger patients, those with higher levels of pain in the last 24 hours, and those who found standard therapies to be less effective for their pain were more likely to use marijuana. Patients generally believe that marijuana could be at least somewhat effective for the management of pain and are willing to use cannabinoid compounds for this indication, if prescribed by a physician.

The Revised Inventory of the Dimensions of Emerging Adulthood (IDEA-R) and Substance Use Among College Students.

Transition-to-adulthood themes, or thoughts and feelings about emerging adulthood, have been measured by the Inventory of the Dimensions of Emerging Adulthood (IDEA) and found to be associated with substance use among emerging adults. It has been suggested, however, that the IDEA is lengthy and may not include the most unique and theoretically relevant constructs of emerging adulthood. The Revised Inventory of the Dimensions of Emerging Adulthood (IDEA-R) was developed as an alternative instrument, but research has yet to determine the relationship between the IDEA-R and substance use among emerging adults (ages 18-25 years). College students completed surveys indicating their identification with transition-to-adulthood themes and substance use. Logistic regression models examined the associations between transition-to-adulthood themes and marijuana use and binge drinking, respectively. Participants who felt emerging adulthood was a time of identity exploration were less likely to report marijuana use, while feelings of experimentation/possibility were positively associated with marijuana use and binge drinking. The IDEA-R may be useful for identifying correlates of substance use among emerging adults. Future research should evaluate the IDEA-R among representative samples of emerging adults to confirm the findings of this study. Health professionals working in substance use prevention may consider targeting the themes of identity exploration and experimentation/possibility in programs intended for emerging adults.

Marijuana use and viral suppression in persons receiving medical care for HIV-infection

ABSTRACTBackground: Marijuana use is common among persons living with HIV (PLWH), but studies on its effect on HIV clinical outcomes are limited. Objectives: We determined the association between marijuana use and HIV viral suppression among PLWH. Methods: Data came from five repeated cross-sections (2009–2013) of the Florida Medical Monitoring Project, a population-based sample of PLWH in Florida. Data were obtained via interview and medical record abstraction (MRA). Weighted logistic regression models were used to determine the association between marijuana use (past 12 months) and durable viral suppression (HIV-1 RNA value of ≤ 200 copies/milliliter in all measurements within the past 12 months). Results: Of the 1,902 PLWH receiving antiretroviral therapy, completed an interview, and had a linked MRA, 20% reported marijuana use (13% less than daily and 7% daily use) and 73% achieved durable viral suppression. In multivariable analysis, marijuana use was not significantly associated with durable viral suppression in daily [Adjusted Odds Ratio (AOR): 0.87, 95% confidence interval (CI): 0.58, 1.33] or in less than daily [AOR: 0.83, 95% CI: 0.51, 1.37] users as compared to non-users when adjusting for sociodemographic factors, time since HIV diagnosis, depressive symptoms, alcohol, cigarette and other substance use. Conclusion: In this sample of PLWH receiving medical care in Florida, there was no statistically significant association between marijuana use and viral suppression. However, as the limits of the confidence intervals include effects that may be considered to be clinically important, there is a need for additional evidence from other samples and settings that include more marijuana users.

Marijuana use and its effects in pregnancy

It is generally assumed that marijuana is one of the more widely used controlled substances during pregnancy. However, there remains a general paucity of population-based data regarding its use and subsequent perinatal morbidity. We hypothesized that direct patient query during pregnancy regarding marijuana, tobacco, and nicotine use would provide crucial initial population-based data on perinatal risk. Our study sought to examine maternal and neonatal outcomes in pregnancies with reported marijuana exposure, in isolation or in combination with maternal cigarette smoking. We applied a retrospective cohort study design to subjects (n= 12,069) with available information on marijuana use and pregnancy outcomes. Since 2011, we have routinely and directly questioned all gravidae regarding use of marijuana, tobacco, and nicotine-containing products. We examined perinatal outcomes in marijuana smokers vs nonsmokers, as well as patients reporting both marijuana and cigarette smoking. Multivariate analysis enabled determination of adjusted odds ratiosfor maternal and fetal outcomes, adjusting for confounders. Significance was determined with Mann-Whitney U, χ(2), and Fischer exact tests (as appropriate). In all, 106/12,069 reported marijuana use (0.88%), with 48/12,069 (0.4%; or 48/106, 45%) concurrently using cigarettes and marijuana. After controlling for potential confounding variables, while marijuana use alone was not associated with significant adverse outcomes, use in combination with cigarette smoking was significantly associated with increased risk of multiple adverse perinatal outcomes (increased occurrence of maternal asthma [adjusted odds ratio, 2.4; 95% confidence interval, 1.0-5.9]; preterm birth [adjusted odds ratio, 2.6; 95% confidence interval, 1.3-4.9]; decreased [<25th percentile] headcircumference [adjusted odds ratio, 2.8; 95% confidence interval, 1.3-4.3]; and decreased [<25th percentile] birthweight [adjusted odds ratio, 2.8; 95% confidence interval, 1.6-5.0]). Maternal pregnancy-related hypertension was not increased in marijuana smokers (adjustedodds ratio, 1.30; 95% confidence interval, 0.681-2.498), or in cigarette smokers (adjusted odds ratio, 1.4; 95%, confidence interval, 0.9-1.9).However, co-users had elevated rates of preeclampsia compared tononusers (adjusted odds ratio, 2.5; 95% confidence interval, 1.4-5.0). In our initial cohort analysis, after controlling for potential confounders, while marijuana exposure alone was not associated with significant perinatal adverse outcomes, co-use with cigarette smoking rendered increased risk over either alone. Due to observed prevalence of concurrent cigarette and marijuana use, it is of likely importance to counsel patients regarding use in pregnancy.

Longitudinal Relationships Among Perceived Injunctive and Descriptive Norms and Marijuana Use.

The current study uses longitudinal data to examine the relative influence of perceived descriptive and injunctive norms for proximal and distal referents on marijuana use. Participants were 740 undergraduate students (67% female) who completed web-based surveys at two time points 12 months apart. Time 1 measures included reports of marijuana use, approval, perceived descriptive norms, and perceived injunctive norms for the typical student, close friends, and parents. At Time 2, students reported on their marijuana use. Results of a path analysis suggest that, after we controlled for Time 1 marijuana use, greater perceived friend approval indirectly predicted Time 2 marijuana use as mediated by personal approval. Greater perceived parental approval was both indirectly and directly associated with greater marijuana use at follow-up. Perceived typical-student descriptive norms were neither directly nor indirectly related to Time 2 marijuana use. The findings support the role of proximal injunctive norms in predicting college student marijuana use up to 12 months later. The results indicate the potential importance of developing normative interventions that incorporate the social influences of proximal referents.

Colorado Cannabis Legalization and Its Effect on Emergency Care

Colorado legalized the use of medical marijuana in 2000, although it was not truly commercialized in the state until the US attorney general ceased the prosecution of marijuana users and suppliers in 2009. The result was striking: from January 2009 to January 2011, the number of registered medical marijuana licenses in Colorado increased from 5,051 to 118,895 (Figure 1). Figure 1 Number of active marijuana licenses in Colorado. In 2012, Colorado voted to legalize recreational marijuana beginning in 2014, making it the first state alongside Washington to permit recreational use. Several other states have recently legalized the use of medical or recreational marijuana, with other states considering similar measures (Figure 2).1 Given this trend, emergency physicians in training will likely be confronted with increasing volumes of marijuana-related emergency department (ED) visits and may learn from Colorado’s recent experience with increased availability of marijuana products. Figure 2 Marijuana legalization by state (as of May 2015). THE EPIDEMIOLOGIC EFFECT OF LEGALIZATION Although the significant increase in medical marijuana registrations does not prove its increased use, this inference is supported by various survey data. According to the National Survey on Drug Use and Health, the percentage of young Coloradan adults aged 18 to 25 years reporting marijuana use within the past year increased significantly after medical marijuana legalization (35% in 2007 to 2008 versus 43% in 2010 to 2011). Simultaneously, the percentage of adults aged 26 years or older perceiving “great risk” to marijuana use significantly decreased, from 45% to 31%.2 Interstate comparisons also show a higher prevalence of marijuana use in states in which it has been legalized versus those in which it has not. According to National Survey on Drug Use and Health responses from 2011 to 2013, the prevalence of Coloradan adults endorsing marijuana use within the last month was 19% compared with a national prevalence of 12%.3 According to data from the National Epidemiologic Survey on Alcohol and Related Conditions, residents of states with medical marijuana legalization were twice as likely to endorse marijuana use compared with residents of states without legalized medical marijuana.4

Associations Between Marijuana Use and 15 Indicators of Sexual Risk and Sexual Health Service Use

The growing number of states decriminalizing marijuana has spurred increased inquiry about the association between marijuana use and adolescent health. Past research on marijuana use and sexual risk behavior has found that adolescents who report marijuana use are more likely to report having unprotected sex, more sexual partners, and earlier initiation of sexual intercourse. Much of the research on the association between marijuana use and sexual risk among adolescents has focused on a small number of indicators of sexual health, and many have combined marijuana use with other illegal substances to create substance-use risk scales. This study examines the association between marijuana use and multiple indicators of sexual health services use (SHS) and sexual risk, including: receipt of SHS; STD testing; HIV testing; lifetime sexual experience; initiation of sexual intercourse before 14 years of age; 4 or more sexual partners; recent sexual history (past 3 months); new sexual partner past 3 months; condom use at last intercourse; condom use past three months; birth control; intentions to have sex; pregnancy; use of dual-use contraception; and history of STI.