Cannabis

Cannabis Use and Perceptions of Cannabis Safety, Effectiveness, and Stigma amongst older Canadians: A Cross-Sectional Survey

2024-11-07T13:13:50-05:00

Objective: Since legalization in 2018, older Canadians’ use of cannabis has increased steadily, yet little is known about their perceptions of cannabis. We aimed to determine cannabis usage, and characterize perceptions of safety, effectiveness and stigma in community dwelling older Canadians. Method: Canadians aged 50 years and older were invited to participate in an electronic survey of their experience with cannabis and perceptions of cannabis safety, effectiveness, and stigma. Data were categorized as participants reporting current use, non-use, prior use, and considering use. Perceptions were assessed with a 5-point Likert scale and open text box questions. Logistic regression models were used to assess how age, sex, cannabis usage, and education influenced perceptions. Results: One thousand six hundred fifteen participants completed the survey. Current cannabis use was reported by 44% of respondents, followed by non-use (33.2%), prior use (16.5%) and considering use (6.1%). Almost half (49.2%) perceived the risks of using cannabis to be low or very low. The greatest concerns regarding cannabis use were effects on cognition/mental health (40.8%), physical health (19.1%), and available product information (18.0%). Participants somewhat or strongly agreed that there is not enough information on cannabis safety (60.4%) and effectiveness (63.8%), and 34.7% perceived there to be a negative stigma amongst family and friends. Cannabis perceptions were influenced by age, sex, cannabis usage, and education. Conclusions:Generational and sex-based differences exist in cannabis usage and perceptions amongst older Canadians. These differences require consideration by health practitioners and public health workers to meet the educational needs of older adults.

Measuring the Association Between Cannabis Dispensary Density and Adult Consumption in a Statewide Setting: Does Urbanicity Matter?

2024-07-01T19:08:37-04:00

Objective: This study used data from early stages of non-medical cannabis legalization in Washington State to 1) Compare cannabis dispensary density measures by urbanicity, 2) Test if dispensary density was associated with cannabis use overall and by urbanicity. Method: Data are from the Privatization of Spirits in Washington Surveys (n = 2,162 adults) and licensing records. We graphed six cannabis dispensary density measures by urbanicity. Logistic regressions tested if dispensary density was associated with 1) cannabis use at least bimonthly and 2) daily/near-daily cannabis use after adjusting for urbanicity. Regressions stratified by urbanicity determined whether associations differed in urban vs. suburban/rural areas. Results: Crude counts and counts per population were higher in suburban/rural areas. Counts per land area, counts in a 3- to 5-mile buffer, proximity, and clustering detected greater densities in urban areas. Monthly/bimonthly cannabis use was associated with counts per buffer in the full sample (aOR = 1.08 [1.02, 1.14]) and urban areas (aOR = 1.08 [1.02, 1.14]). Clustering was associated with monthly/bimonthly use in suburban/rural areas (aOR = 7.85 [1.31, 47.17]). Daily/near-daily use was associated with proximity and clustering in the full sample (proximity: aOR = 0.78 [0.64, 0.97]; clustering: aOR = 2.44 [1.32, 4.51]), urban areas (proximity: aOR = 0.67 [0.49, 0.92]; clustering: aOR = 2.29 [1.22, 4.32]), and suburban/rural areas (proximity: aOR = 0.66 [0.45, 0.97]; clustering: aOR = 11.10 [1.55, 79.36]). Conclusions: In Washington’s early non-medical cannabis market, dispensary availability (counts) was associated with monthly/bimonthly use. Accessibility (proximity) and clustering were associated with daily/near-daily use. Dispensary density thresholds and minimum distances between dispensaries may reduce regular and frequent cannabis use in Washington.

Missouri College Students’ Intentions Towards Initiating or Changing Cannabis Use in a Shifting Legal Landscape

2024-08-02T12:40:04-04:00

Background: With cannabis legal in nearly half of U.S. states, important concerns about the public health impact remain, particularly for states yet to legalize. The present study, using data collected in the initial phase of cannabis legalization in Missouri, examined predictors of the intention to initiate (in the cannabis naïve) and increase use (in those with past-year use) in a representative sample of Missouri college students. Methods: Data (n_{cannabisnaïve}= 2,716; n_cannabisuse= 1,591) were collected from 25 Missouri college campuses. Four pre-registered multilevel models examined the associations of theory-driven predictors with the intention to initiate cannabis use and to increase use. Results: 33.4% of all students surveyed reported past-year cannabis use, 9.9% of cannabis naïve students reported intending to initiate cannabis use, and 22% of those with previous cannabis use reported intending to increase cannabis use. Multilevel modes found that being gay or lesbian (AOR = 3.03; CI = [1.72, 5.34]), bisexual (AOR= 3.52; CI = [2.41, 5.14]), or queer (AOR = 2.51; CI = [1.71, 3.69]) was associated with intending to initiate use, while greater flourishing (AOR = 0.98; CI = [0.96, 0.99]) was associated with decreased odds of intending to initiate use. Endorsing more cannabis motives (AOR = 1.13; CI = [1.08, 1.19]), age of first use (AOR = 1.09; CI = [1.03, 1.15]), and being gay or lesbian (AOR = 2.19; CI = [1.27, 3.76]) were associated with intending to increase use. Endorsing more cannabis-related negative consequences was associated with intending to decrease use (AOR = 0.91; CI = [0.89, 0.94]). Discussion: Multiple theory-driven factors were associated with intending to initiate or increase cannabis use following legalization. Future research should examine how intentions to change cannabis use translate to actualized behavior following legalization and factors that may create increased risk for minoritized sexual identities.

Developing a Mock Retail Cannabis Shop for Research: A Description of The CANNEX

2025-02-17T19:12:40-05:00

Objective: Cannabis retail dispensaries have proliferated in the United States in recent years, making it an important time for conducting research. Research is needed to learn more about consumer purchasing behaviors, including the impact of product marketing both inside and outside of retail spaces, and studies are needed to explore how both consumers and retail staff interpret the health benefits and potential risks associated with cannabis products within these environments. Current research on cannabis dispensaries often involves surveys or interviews with customers and dispensary staff outside of dispensary environments, but much can be learned through observational and experimental methods within dispensaries themselves. However, researchers have traditionally relied on surveillance methods, where researchers visit dispensaries to gain a deeper understanding of real-world encounters in these environments. Although these methods provide helpful insights into purchasing and selling behavior, as well as regulatory compliance, these studies are conducted in an uncontrolled environment, as products, messaging, and interactions are specific to the dispensaries in which the research is conducted. Method: We therefore created a mock cannabis dispensary to offer participants a retail experience that can be controlled and manipulated (e.g., adjustable cannabis product prices, placement of health and risk information in the dispensary, scripted interactions with dispensary staff) to help balance ecological and internal validity and answer questions about purchasing and selling behavior beyond what current methods allow. Results: We describe the process of developing and stocking the first known mock cannabis dispensary for research purposes, the Cannabis Annex (“The CANNEX”), including interior design, product selection, feedback solicitation from 20 cannabis industry workers, and plans for future research studies within the environment. Conclusions: By describing our process, we hope to aid researchers in developing their own similar mock dispensaries to continue learning about the health benefits, risks from use, and policy implications of cannabis in an increasingly legal recreational atmosphere.

Cannabis Use Characteristics and Reasons for Product Choices Among Patients Accessing Treatment for Substance Use Disorders: A Mixed-Methods Study

2024-11-04T14:19:08-05:00

Objective: The diversity and potency of cannabis products have increased in recent years, underscoring the importance of understanding which products are being used and why. Patients with substance use disorders (SUDs) use have a high prevalence of risky cannabis use, making it especially important to understand use patterns in this group. We aimed to first describe cannabis product characteristics and then explore reasons for choosing products in our sample. Method: In this mixed-methods study, 472 adults who self-reported accessing SUD treatment and lifetime cannabis use completed an online survey. A subset of 22 participants completed in-depth interviews. Quantitative results focused on describing cannabis use characteristics (e.g., product types) among participants reporting past-year cannabis use (current use group) or lifetime cannabis use but no use in past year (past use group), while qualitative descriptive analysis was used to describe reasons for choosing products among participants who were currently using cannabis. Results: Across medical and non-medical use of cannabis, dried flower and smoked cannabis formulations were most used (e.g., 89% of the current use group reported smoking cannabis for non-medical purposes), followed by edibles (e.g., 53% of the current use group used edible formulations of cannabis for non-medical purposes), though there was considerable use of higher-potency products such as concentrates and dabs (e.g., 11% of the current use group had used dabs for non-medical purposes). Our qualitative analysis found that almost all participants were motivated by THC content when purchasing products, yet sometimes perceived medical benefits or harm reduction were reasons for using certain products (especially CBD-dominant products), while sometimes other factors (e.g., convenience, familiarity) were influential. Conclusions: Cannabis use characteristics (including motives for choosing products) are complex and nuanced in patients accessing SUD treatment. More work is needed to understand longitudinal relationships between use of different cannabis products and both harms and potential benefits.

Daily Assessment of Positive and Negative Cannabis Use Expectancies in Young Adult Cannabis and Tobacco Co-Users: Differences by Sociodemographics, Mental Health Symptoms, and Possible Cannabis Use Disorder

2024-04-16T18:38:24-04:00

Objective: Expectancies play a critical role in cannabis use behavior and are influenced by sociodemographic and intrapersonal factors. This study examined daily endorsement of positive and negative cannabis use expectancies using 28 days of ecological momentary assessments (EMAs) in relation to sociodemographics, mental health symptoms, and cannabis use disorder (CUD) among young adult cannabis-tobacco co-users. Method: Ninety-seven young adult (ages 18-24) cannabis and tobacco co-users reported on anxiety symptoms, depressive symptoms, and possible CUD at baseline. During the 28 days of EMAs, participants reported on 16 positive (n = 7) and negative (n = 9) cannabis use expectancies they anticipated would occur in the next 24 hours. Descriptive statistics examined the proportion of EMA days each expectancy was endorsed. Multivariable logistic regressions examined associations of expectancies with anxiety symptoms, depressive symptoms, and possible CUD, controlling for sociodemographics. Results: The most frequently endorsed expectancies were positive (e.g., feeling good, getting along with others), while the least frequently endorsed were negative (e.g., drinking too much, having an argument). In regression models, participants endorsing more days of expecting to feel anxious displayed higher odds of anxiety and depressive symptoms; those endorsing more days of expecting to be in a bad mood displayed higher odds of depressive symptoms; those endorsing more days of expecting to feel tired or unmotivated displayed higher odds of possible CUD. Conclusions: Expectancies of cannabis benefits and consequences are heterogeneous, endorsed in different frequencies across days, and they may have important implications for mental health symptoms and cannabis use severity among young adults who co-use.

Temporal Trends in Young Adult Cannabis and Tobacco Use in States with Different Cannabis Policies

2024-08-19T13:36:02-04:00

Objective: Cannabis legalization may impact both cannabis and tobacco use, given the high prevalence of co-use (including blunt use) among young adults (YAs) in the United States. The objective of this descriptive ecological study was to examine trends in YA cannabis and tobacco use from 2002-2018 in states that passed adult and medical use (AMU) or medical use only (MUO) cannabis laws during that time (N = 16). Method: Using data from the National Survey on Drug Use and Health, we conducted a segmented regression analysis to calculate absolute percent change in past 30-day cannabis, blunt, cigarette, and cigar use between time points. We descriptively compared points of slope inflection with key legalization dates. Results: All states showed a decline in YA cigarette smoking over time, a slight decline in cigar smoking, and increases in cannabis and blunt use. Cannabis use increased following opening of MUO retail outlets and, in several states, increased following adult use law implementation and/or opening of retail outlets. For example, in Maine, cannabis use plateaued after a MUO law was adopted (2009) until about 1-2 years after retail outlets opened (2011), when YA cannabis use increased by 22.4% (95% CI: 19.0, 29.4) and continued increasing steadily after adult use was adopted (2017). Conclusions: Cannabis and blunt use increased more in states where AMU laws were in place compared to those with MUO laws, though causality was not assessed. Varying trends may correlate with cannabis policies, tobacco policies and other political, economic, or social factors at the state level.

Cannabis Use Patterns and Co-Use of Alcohol and Nicotine in Adults Over 50 by Demographic Factors and Medical Cannabis Use

2024-10-31T18:56:25-04:00

Objective: Cannabis use among adults over age 50 is increasing, but data on specific products, co-use, and cannabis-related problems in this age group are lacking. The current study assessed differences in cannabis use patterns and alcohol and nicotine co-use by select demographic factors and medical cannabis status, as well as associations with problem cannabis use, among adults over 50. Method: Adults over age 50 who used cannabis use in the past 30 days were recruited from a healthcare system and invited to complete an online survey. Results: Participants (N = 367) were 43% female, with an average age of 65.9 (SD = 8.6), and predominantly White (67.9%), Native Hawaiian or Pacific Islander (NHPI; 12.3%), or Asian (9.3%). Mean frequency of cannabis use within the past 30 days was 18.7 days (SD = 11.5), and 27% reported use of non-medical cannabis-only. Co-use of cannabis with other substances was common, especially alcohol. Although group comparisons showed several differences by age, sex, and medical cannabis status, greater differences were found by race/ethnicity. White participants were more likely than others to have a state medical cannabis card, source their cannabis solely from medical dispensaries, and report alcohol co-use. NHPI participants were most likely to smoke cannabis and use tobacco. Smoking, as compared to consuming edibles and “other” methods, and greater cannabis frequency, were associated with problem cannabis use. Conclusions: Findings illustrate patterns of cannabis and other substance use, with important demographic differences. Future research among older adults should include development of targeted interventions to address cannabis use problems and polysubstance use.

Marketing Management and Policymaking for Medical Cannabis: Overcoming Barriers and Shaping Strategies

2025-03-25T12:43:34-04:00

Objective: Medical cannabis has emerged as a promising therapeutic option, but its market acceptance faces significant regulatory, societal, and scientific challenges. This study explores pharmaceutical business managers’ perspectives on marketing strategies, brand architecture, and the value proposition of medical cannabis, aiming to identify approaches to overcome these barriers and guide policymaking. Method: Semi-structured interviews were conducted with 12 pharmaceutical managers to explore key challenges and strategies. Results: Key themes included the need for extensive scientific research, targeted communication to address stigma, effective marketing tactics, and long-term sustainability. Participants stressed the importance of rigorous, disease-specific research to establish medical cannabis’ therapeutic efficacy and build trust with healthcare providers and patients. Societal stigma was identified as a major barrier, with participants advocating for communication strategies that distinguish medical cannabis from recreational use and educate stakeholders. Marketing strategies focused on creating a unique value proposition, strong brand identity, and adaptive approaches to meet the diverse needs of healthcare professionals, regulators, and patients. Additionally, phased market entry strategies, beginning with pilot programs in regions with progressive regulatory environments, were recommended to pave the way for broader market expansion. Conclusions: This study offers valuable insights into the marketing management and policymaking necessary for integrating medical cannabis into the pharmaceutical market. By addressing regulatory uncertainties, societal stigma, and scientific gaps, pharmaceutical companies can unlock the full potential of medical cannabis as a credible therapeutic product. These findings lay the groundwork for future research and policymaking to promote sustainable growth in the emerging medical cannabis market.

Rasch Analysis of Cannabis Use Disorder in an Adult Inpatient Sample

2023-10-31T08:16:30-04:00

Objective: The Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5) defines cannabis use disorder as a polythetic unidimensional diagnosis (>2 symptoms from up to 11), but few studies have empirically evaluated the latent structure of CUD. Rasch analysis is a psychometric technique that has previously been used to validate unidimensional scales, like DSM-5 CUD. Method: In this study, the Rasch model was used to evaluate the DSM-5 CUD criteria in a clinical sample of adults receiving inpatient treatment for substance use disorder (n = 249) reporting active cannabis use at admission. The unidimensionality of the criteria was evaluated using the Martin-Löf test and the nonparametric –T₂ test of Ponocny. Model fit was assessed using the χ²goodness of fit test for individual items. Results: Results supported the unidimensional structure of the criteria. Symptom # 3 was the least endorsed, highest severity item. Conversely, symptom #9 was the most endorsed and had the lowest severity estimate. Overall, the data fit the Rasch model well, although misfit was observed for symptom # 8. Conclusions: Rasch's analysis of CUD symptoms in an inpatient sample broadly supports the DSM-5 CUD syndrome. Further examination is needed to determine if removing or revising the hazardous use symptom criterion in future DSM revisions would improve diagnostic measurement.

Estimating Cannabis Consumption in Milligrams of THC From Self-Reported Hit Size

2024-08-13T15:44:01-04:00

Objective: Estimating delta-9 tetrahydrocannabinol (mgTHC) using hits involves converting hits to grams via a grams-per-hit ratio (GPHR). Previous studies assumed a single hit size (SHS), ignoring individual hit size variations. This study investigates a multiple qualitative hit size (MQHS) approach based on self-reported hit sizes (small, medium, large) to improve mgTHC estimates. Method: Adults (N = 1,824) who used cannabis in the past week completed an online survey on cannabis consumption, reporting quantities in hits and grams, and estimating their hit sizes. We calculated mgTHC using both SHS (0.06g/hit for flower, 0.012g/hit for concentrate) and MQHS. For the MQHS approach, we calculated median GPHRs for each hit size group and assigned those medians to individuals within that group. Results: For flower, median GPHR increased with hit size (small: 0.042, medium: 0.062, large: 0.093). The MQHS estimate for mgTHC from flower was higher than SHS for large hits (95% CI:[12.4, 50.0]) but showed no difference for medium or small hits (95% CI: [-3.2, 8.1]; 95%CI: [-27.6, 3.4]). For concentrate, median GPHR was similar for small and medium hits but lower than large hits (small: 0.024, medium: 0.025, large: 0.035). MQHS estimates for mgTHC were higher than SHS for all hit sizes (95% CI: [46.3, 86.3]; 95% CI: [24.8, 45.5]; 95% CI: [11.5, 36.5] for large, medium, small hits, respectively). Conclusions: The MQHS estimates captures hit size variability for flower. The floor effect with median GPHRs for concentrates suggests further investigation is needed for MQHS estimates with concentrates. The MQHS approach illustrates a method to develop new standard GPHRs for each qualitative hit size group, after further investigation.

Budtender Perceptions and Knowledge of Cannabis and Mental Health: A Preliminary Study

2024-09-11T13:14:54-04:00

Objective: Legal cannabis dispensary employees (“Budtenders”) are a significant resource for cannabis users. Current research indicates that cannabis use may adversely impact mental health. Public perception, however, is often inconsistent with this evidence, leading to increased use and disproportionate harm towards individuals with mental health disorders. This underscores the need for a deeper understanding of how Budtenders may influence these perceptions. This preliminary cross-sectional survey assessed Budtender perceptions and knowledge of cannabis use and its implications for mental health. Method: Researchers recruited Budtenders (N = 46) from legal cannabis dispensaries (Ontario Cannabis Stores) across the Greater Toronto (Canada) Area to participate in a 15-minute online survey. The survey collected non-identifying demographic data and responses about perceptions, education and customer interactions surrounding cannabis and mental health. Results: We found that Budtender perceptions (N = 46) of cannabis’ influence on mental health vary significantly based on symptomatology assessed, and often diverge from evidence-based knowledge. Notably, 54.6% of Budtenders rated cannabis as having a beneficial effect across the outcomes assessed, with sleep and depression most frequently perceived as beneficial. Customers inquired about the mental health effects of cannabis at 21% of cannabis store visits. There was considerable variability in the sources from which Budtenders derived their knowledge. Conclusions: This study underscores significant gaps between Budtender perceptions and scientific evidence regarding cannabis use and mental health. Determining the impact of these perceptions is crucial for developing targeted, evidence-based educational interventions to mitigate the risks associated with recreational cannabis use.

Abstracts from the 2025 Research Society on Marijuana and Society for Research on Nicotine and Tobacco Post- Conference Workshop March 15, 2025

2025-04-01T17:29:24-04:00