Cannabis

The Intersection of Rurality, Unmet Treatment Need, and Cannabis Use for Adults with Chronic Pain

Hannah Appleseth, Desiree R. Azizoddin, Amy M. Cohn — Fri, 31 Jan 2025 00:00:00 -0500

Objective: Rates of chronic pain are higher among rural versus urban individuals and rural individuals experience higher levels of socioeconomic disadvantage, poor or no health insurance coverage, and unmet treatment need. Medical cannabis is legal in Oklahoma. With 40% of Oklahoma’s population living in rural areas, and nearly 17% uninsured, the medical legalization of cannabis may present as an accessible and relatively low-cost alternative treatment, particularly for those with chronic pain. This study investigated differences in cannabis use by rural (vs. urban) status and unmet (vs. met) treatment need among adults with and without chronic pain living in Oklahoma. Method: To be eligible, participants had to be 18 years or older, reside in Oklahoma, and be able to read and write English-language surveys. Results: The sample (N = 3622) was primarily made up of non-Hispanic White (70.4%) females (53.8%) in their early middle age (M = 41.80, SD = 16.88), employed full-time or part-time (53.8%), with some college/technical school (37.2%) or a bachelor’s degree (28.5%). Nearly one-fifth of the sample (18.2%) endorsed chronic pain, and individuals with chronic pain were eight times more likely to report past 30-day cannabis use. No difference was detected when only rurality (vs. urban residence) was examined. Among adults with chronic pain, those who were rural dwelling and who reported unmet treatment need were almost two times more likely to report past 30-day cannabis use, compared to urban dwelling chronic pain adults with unmet treatment need. Conclusions: In Oklahoma, adults in rural areas with unmet treatment need and chronic pain may benefit from increasing access to chronic pain treatment, as well as education on cannabis use and harm reduction strategies to inform healthcare decision-making.

Acute Stress Effect on Delay Discounting and Cannabis Demand Among Individuals Endorsing High-Frequency Cannabis Use

Yi-Chun Chang, Robin L. Rubey, Benjamin O. Ladd — Fri, 31 Jan 2025 00:00:00 -0500

Objective: Limited research examines the effect of stress on behavioral economic constructs among individuals using cannabis. This study examined whether the effects of acute stress on delay discounting differed in terms of cannabis use status and whether cannabis demand changed after stress induction. Method: Participants were two groups (n = 39 endorsing high-frequency cannabis use and n = 48 not endorsing cannabis use) of young adults (75.86% female, 67.82% White, M_age= 21.64 years). During an online Zoom session, participants completed a prestress assessment, the Trier Mental Challenge Test (TMCT) stress induction, and then a poststress assessment. Results: Subjective stress increased significantly across groups after stress induction (p < .001, ƞ_p² = .23); no group X time interaction was observed. There were no differences in delay discounting across time or groups. For the use group only, cannabis demand intensity (p = .006, d = .50), but not other demand indices, significantly increased following the acute stress induction. Coping motives did not moderate the association between the change in subjective stress and the change in delay discounting or the change in any cannabis demand indices among the use group. Conclusions: Cannabis demand might exert a more influential role than delay discounting in shaping decisions related to cannabis use while experiencing acute stress. However, the practical implications of this finding warrant further research due to the relatively small difference in hypothetical cannabis use observed. Study design limitations that could impact the findings or lead to null results are discussed to inform future research.

Posttraumatic Stress Symptoms Moderate the Relationship Between Chronic Pain and Adverse Cannabis Outcomes: A Pilot Study

Fri, 31 Jan 2025 00:00:00 -0500

Objective: Increasingly, cannabis is being prescribed/used to help manage posttraumatic stress symptoms (PTSS) or chronic pain, as cannabis has been argued to be beneficial for both types of symptoms. However, the evidence on efficacy is conflicting with evidence of risks mounting, leading some to caution against the use of cannabis for the management of PTSS and/or chronic pain. We examined the main and interactive effects of PTSS and chronic pain interference on adverse cannabis outcomes (a composite of cannabis use levels and cannabis use disorder, CUD, symptoms). We hypothesized that chronic pain interference and PTSS would each significantly predict adverse cannabis outcomes, and that chronic pain interference effects on adverse cannabis outcomes would be strongest among those with greater PTSS. Method: Forty-seven current cannabis users with trauma histories and chronic pain (34% male; mean age = 32.45 years) were assessed for current PTSS, daily chronic pain interference, past month cannabis use levels (grams), and CUD symptom count. Results: Moderator regression analyses demonstrated chronic pain interference significantly predicted the adverse cannabis outcomes composite, but only at high levels of PTSS. Conclusions: Cannabis users with trauma histories may be at greatest risk for heavier/more problematic cannabis use if they are experiencing both chronic pain interference and PTSS.

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

Samantha Marinello — Fri, 31 Jan 2025 00:00:00 -0500

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

Beyond Frequency and Quantity of Cannabis Consumption Among College Students: Context of Using Cannabis Relates to Cannabis-Related Outcomes

Matison W. McCool, Matthew R. Pearson — Fri, 31 Jan 2025 00:00:00 -0500

Objective: Due to little knowledge regarding the contextual factors related to cannabis use, we aimed to provide descriptive statistics regarding contextual factors related to use and examine the predictive ability of contextual factors. Method: We included college student participants (n = 5700; male = 2893, female = 3702, other gender identity = 48, missing = 57) from three multi-site studies in our analyses. We examined the means and standard deviations of contextual factors related to cannabis use (social context/setting, form of cannabis, route of administration, source of purchase, and proxies of use). Additionally, we tested the predictive ability of the contextual factors on cannabis use consequences, protective behavioral strategies, and severity of cannabis use disorder, via an exploratory machine learning model (random forest). Results: Descriptive statistics and the correlations between the contextual factors and the three outcomes are provided. Exploratory random forests indicated that contextual factors may be helpful in predicting consequences and protective behavioral strategies and especially useful in predicting the severity of cannabis use disorder. Conclusions: Contextual factors of cannabis use warrants further exploration, especially considering the difficulty in assessing dosage when individuals are likely to consume in a group context. We propose considering measuring contextual factors along with use in the past 30 days and consequences of use.

Medical Cannabis for Patients Over Age 50: A Multi-site, Prospective Study of Patterns of Use and Health Outcomes

Blake Pearson, Mariah Walker, Jose Tempero, Kaye Ong, Philippe Lucas — Fri, 31 Jan 2025 00:00:00 -0500

Objective: Cannabis is being used as a therapeutic option by patients around the globe, and older patients represent a rapidly growing subset of this population. This study aims to assess the patterns of medical cannabis use in patients over 50 years of age and its effect on health outcomes such as pain, sleep, quality of life, and co-medication. Method: The Medical Cannabis in Older Patients Study (MCOPS) is a multi-site, prospective observational study examining the real-world impact of medical cannabis use on patients over age 50 under the guidance of a health care provider. The study included validated instruments, with treating physicians collecting detailed data on participant characteristics, medical cannabis and co-medication use, and associated impacts on pain, sleep, quality of life, as well as adverse events. Results: Inclusion criteria were met by 299 participants. Average age of participants was 66.7 years, and 66.2% of respondents identified as female. Approximately 90% of patients used medical cannabis to treat pain-related conditions such as chronic pain and arthritis. Almost all patients reported a preference for oral cannabis products (e.g., extracts, edibles) rather than inhalation products (e.g., flower, vapes), and most preferred oral formulations high in cannabidiol and low in tetrahydrocannabinol. Over the six-month study period, significant improvements were noted in pain, sleep, and quality of life measures, with 45% experiencing a clinically meaningful improvement in pain interference and in sleep quality scores. Additionally, nearly 50% of patients taking co-medications at baseline had reduced their use by the end of the study period, and quality of life improved significantly from baseline to M3 and from baseline to M6, with an incremental cost per quality-adjusted life-year (QALY) of $25,357.20. No serious adverse events (SAEs) were reported. Conclusions: In this cohort of older patients, most of whom suffered from pain-related conditions, medical cannabis seemed to be a safe and effective treatment. Most patients experienced clinically significant improvements in pain, sleep, and quality of life and reductions in co-medication. The cost per QALY was well below the standard for traditional pharmaceuticals, and no SAEs were reported, suggesting that cannabis is a relatively safe and cost-effective therapeutic option for adults dealing with age-related health conditions.

Age-Gating and Marketing Differences Between Storefront and Non-Storefront Cannabis Retailers

Fri, 31 Jan 2025 00:00:00 -0500

Objective: The study investigated whether California storefront and non-storefront cannabis retailers are adhering to online age-gating requirements and whether differences in website marketing practices exist. Methods: Websites of 134 storefront and 115 non-storefront licensed retailers were randomly selected. Bivariate associations were tested between retailer type and website marketing, age-gating methods, and presence of age-gating at various purchase stages. Results: Among the 200 (80.3%) websites with age-gating when entering, 182 (91%) employed an ineffective method where users click either “Yes” or “No” to confirm their age. Moreover, 49 (19.68%) websites lacked age-gating when entering. Amongst those requiring photo identification during checkout (n = 100, 40.16%), 97% allowed users to proceed after uploading an irrelevant image. Significantly more storefront retailers employed combined age-gating at entry, mandatory account registration, and age-gating during checkout than non-storefront retailers, X²(1, N= 249) = 7.69, p < .01. Retailer websites frequently displayed “clean” labels (n = 200, 80.32%), followed by positive state claims (n= 198, 79.52%), physical health claims (n = 166, 66.67%), and mental health claims (n = 146, 58.63%). Significantly more storefront retailers displayed physical health claims, X²(1, N = 249) = 7.52, p < .01, and health warnings than non-storefront retailers, X² (1, N= 249) = 4.13, p = .04. Conclusions: Most cannabis retailers comply with age-gating requirements; however, methods employed are easily circumvented. Youths’ easy and unrestricted access to cannabis retailer websites may increase positive attitudes about cannabis and encourage use.

Weight Loss and Therapeutic Metabolic Effects of Tetrahydrocannabivarin (THCV)-Infused Mucoadhesive Strips

Gregory Smith — Fri, 31 Jan 2025 00:00:00 -0500

Objective: Metabolic syndrome is due to dysregulation that starts with fat accumulation, causing inflammatory response, insulin resistance, dyslipidemia, hypertension, and fatty liver disease. The endocannabinoid system, via cannabinoid receptor type 1 (CB₁), has been shown to be involved with energy homeostasis and regulation of appetitive behavior via activity in the hypothalamus, limbic forebrain and amygdala and in the peripheral tissues including adipose, liver and muscle. Therefore, two phytocannabinoids, tetrahydrocannabivarin (THCV), a CB1 neutral antagonist, and cannabidiol (CBD), a negative allosteric modulator of CB1, are expected to have therapeutic metabolic benefits, including weight loss. Method: A placebo-controlled study was conducted on 44 subjects (31 females and 13 males) with an average age of 51.75. The study evaluated the efficacy of two different doses of THCV and CBD (8 mg THCV/10 mg CBD in the lower dose and 16 mg THCV/20 mg CBD in the higher dose), taken once daily for 90 days via mucoadhesive oral strips, for weight loss and improvement of certain metabolic markers. Results: Use of the THCV/CBD strip was associated with statistically significant weight loss, decreases in abdominal girth, systolic blood pressure, and total and LDL cholesterol. The study was limited by small sample sizes in both the high dose and placebo groups. Conclusions: The 16 mg/20 mg daily dose was superior for weight loss compared to the 8 mg/10 mg daily dose; both sets of results differed from placebo in a way that was statistically significant. The results of this study were congruent with the prior unpublished studies of a hemp extract containing significant percentages of THCV, CBDV and CBD.

Recreational Cannabis Laws and Fills of Pain Prescriptions in the Privately Insured

Fri, 31 Jan 2025 00:00:00 -0500

Objective: Almost half of U.S. states have passed recreational cannabis laws as of May 2024. While considerable evidence to date indicates cannabis may be a substitute for prescription opioids in the treatment of pain, it remains unclear if patients are treating pain with cannabis alone or concomitantly with other medications. Method: Using data from a national sample of commercially insured adults, we examine the effect of recreational cannabis legalization (through two sequential policies) on prescribing of opioids, NSAIDS, and other pain medications by implementing synthetic control estimations and constructing case-study level counterfactuals for the years 2007-2020. Results: Overall, we find recreational cannabis legalization is associated with a decrease in opioid fills among commercially insured adults in the U.S., and we find evidence of a compositional change in prescriptions of pain medications more broadly. Specifically, we find marginally significant increases in prescribing of non-opioid pain medications after recreational cannabis becomes legal in some states. Once recreational cannabis dispensaries open, we find statistically significant decreases in the rate of opioid prescriptions (13% reduction from baseline, p < .05) and marginally significant decreases in the average daily supply of opioids (6.3% decrease, p < .10) and number of opioid prescriptions per patient (3.5% decrease, p < .10). Conclusions: These results suggest that substitution of cannabis for traditional pain medications increases as the availability of recreational cannabis increases. There appears to be a small shift once recreational cannabis becomes legal, but we see stronger results once users can purchase cannabis at recreational dispensaries. The decrease in opioids and marginal increase in non-opioid pain medication may reflect patients substituting opioids with cannabis and non-opioid pain medications, either separately or concomitantly. Reductions in opioid prescription fills stemming from recreational cannabis legalization may prevent exposure to opioids in patients with pain and lead to decreases in the number of new opioid users, rates of opioid use disorder, and related harms.

Association of Financial Wellness with Patterns of Medical Cannabis Use and Patient-Reported Outcomes in Adults with Cancer

Fri, 31 Jan 2025 00:00:00 -0500

Objective: Despite increasing use of medical cannabis to manage cancer-related symptoms, U.S. payers do not reimburse medical cannabis, leaving patients responsible for all associated costs. We assessed how self-reported financial well-being is associated with patterns of cannabis consumption, out-of-pocket costs, and impact on symptoms in patients with cancer. Method: From December 2021 to January 2022, we surveyed patients with cancer enrolled in the Minnesota Medical Cannabis Program. The mailed survey included cancer history, cannabis use history, symptom changes and sociodemographic questions including income and perceived financial wellness. We conducted descriptive analyses. Results: Of 797 eligible adults, 220 (28%) responded to the survey. Two hundred eleven answered a question about current household income as living comfortably (LC, 45%; n = 95) or not living comfortably (NLC, 55%; n = 116). The NLC group reported lower incomes (47% vs 8% with annual incomes <$50,000) and were typically younger, unmarried, unemployed, or disabled. NLC group purchased more vaporizers (48% vs 27%), used products high in THC (92% vs 82%), and reported higher cannabis costs (40% vs 21% spending $200+/month). The NLC group more often stopped or used cannabis less frequently than they would like (54% versus 32%), frequently citing costs as a reason (85% vs 39%). Both NLC and LC groups typically used cannabis daily and reported a high degree of symptom improvement. Conclusions: Patients with cancer using cannabis report significant improvements in cancer-related symptoms. High out-of-pocket costs for cannabis may be especially burdensome among those already financially struggling, raising questions about affordability of and equitable access to this therapy.

What Are Tolerance Breaks and Why Do Young Adults Take Them? A Qualitative Investigation of Temporary Abstinence Breaks from Cannabis

Fri, 31 Jan 2025 00:00:00 -0500

Objective: This study investigated young adults’ (YAs) experiences with tolerance breaks (temporary abstinence from cannabis; T-breaks). Method: In Study 1, 15 YAs who used cannabis completed a qualitative interview. In Study 2, 66 YAs who used cannabis at least 2x/week completed online survey items assessing T-break familiarity, definitions, motivations, and experiences. Data were analyzed using qualitative thematic analysis. Results: In Study 1, five themes were identified: (1) time frames for T-breaks were variable but brief and temporary, (2) T-breaks were motivated by tolerance reduction (3) and other motives, (4) withdrawal is an early barrier; positive outcomes occurred with longer breaks, (5) some YAs viewed T-breaks as unnecessary/unachievable. Study 2 findings demonstrated that YAs were familiar with T-breaks and most had attempted a T-break in the past year; greater variability in T-break motivations was apparent in Study 2. Conclusions: Results suggest that YAs define T-breaks as an intentional and temporary period of abstinence from cannabis, regardless of motivation.

Are Changes in Negative Cannabis Expectancies, Peer Approval, and Perceptions of Dangerousness of Driving After Cannabis Use Associated with Changes in Instances of Driving After Cannabis Use Following a Mobile-Phone Based Intervention?

Sarah N. Elder, Jenni B. Teeters — Fri, 31 Jan 2025 00:00:00 -0500

Objective: Driving after cannabis use (DACU) has become an increasing public health concern nationwide. Although previous research has linked perceived peer approval, perceptions of dangerousness, and negative effect expectancies to DACU, no previous work has examined whether these constructs can be successfully targeted in an intervention or whether changes in these variables lead to changes in DACU. The present study is a secondary data analysis to investigate within-subject change and potential mechanisms of change in a pilot trial for a mobile phone-based intervention shown to significantly reduce DACU over time. Method: Participants were 66 emerging adults who completed the mobile-based intervention and provided 3-month follow-up data. Participants completed measures that assessed rates of DACU, negative cannabis expectancies, perceptions of dangerousness, and perceived peer-approval. Results: Results indicated that negative effect expectancies significantly increased from baseline to three-month follow-up, while perceived peer approval for DACU significantly decreased from baseline to three-month follow-up. Though significant within-subject change was found for all variables of interest, none of the variables of interest significantly mediated changes in instances of DACU over time. The results of the current study suggest that key variables associated with DACU-perceived peer approval and negative cannabis expectancies can be successfully targeted in a mobile-based brief intervention. Conclusions: Continued research investigating moderators and mediators of intervention outcomes is warranted.

Cannabis Use and Self-Reported Bothersome Symptoms in People with HIV

Fri, 31 Jan 2025 00:00:00 -0500

Objective: While cannabis use is common among people with HIV (PWH), there have been few studies examining the association of use with health outcomes among PWH. We aimed to evaluate the association between cannabis use and bothersome physical and mental health symptoms using both self-report and a direct biomarker for cannabis use. Method: The Medications, Alcohol and Substance use in HIV Study (MASH) is a cross-cohort study focused on polypharmacy and substance use among PWH. Participants were enrolled from October 2018 to May 2022 in the Swiss HIV Cohort Study (SHCS), Kaiser Permanente Northern California (KPNC) HIV Cohort, and 7 sites (Atlanta, GA; Bronx, NY; Washington, DC; Houston, TX; Los Angeles, CA; New York, NY; and Nashville, TN) in the Veterans Aging Cohort Study - HIV (VACS-HIV). Participants submitted self-reported information on the presence/absence of symptoms in the prior 4 weeks, along with bothersome level, using the HIV Symptom Index, which is comprised of 20 symptoms commonly reported in PWH, including fatigue, diarrhea, fever, anxiety, and weight loss, among others. Concurrent self-reported substance use information was also collected, and participants provided nail clippings to be tested for cannabis use. We used logistic regression models, adjusted for age, sex, race/ethnicity, and cohort, to examine associations of self-report and biomarker-identified cannabis use with self-reported bothersome symptoms. Results: The analytic sample included 1,226 PWH who were predominantly male (85%), non-white (64%), with an average age of 57 years; 20% tested positive for cannabis use, and 23% reported recent cannabis use. Agreement between self-report and biomarker cannabis use was substantial (agreement 89%, kappa = 0.67). Put together, 27% either reported cannabis use or tested positive. Of the 20 symptoms included in the HIV Symptom Index, 19 were more prevalent at a bothersome level among those with cannabis use compared to those without. In adjusted models, the patterns of association remained for both self-reported and biomarker-confirmed cannabis use, and they were particularly substantial for memory, depression, anxiety, and nausea. Conclusions: Cannabis use was common among PWH and was associated with a number of bothersome symptoms. While cannabis use may be used to treat loss of appetite, nausea/vomiting, and weight loss, the associations of cannabis use with depression, anxiety, and memory loss are concerning and deserve investigation.

Exploring Differences in Cannabis Use and Harm Perceptions Among Sexual Minority and Heterosexual Females: A Brief Report

Sarah J. Ehlke, Samantha A. Fitzer, Kendra N. Rigney — Fri, 31 Jan 2025 00:00:00 -0500

Objective: Sexual minority women (SMW) have higher rates of cannabis use compared to heterosexual women, which may be partially attributed to lower harm perceptions. However, no study has examined if the association between harm perceptions and cannabis use is stronger for SMW than heterosexual women. This study examined if sexual identity (SMW vs. heterosexual woman) moderated the association between harm perceptions and past 30-day cannabis use among a sample of female young adults (18-25 years old). Method: Participants were 949 (29.8% SMW; Mean age = 24.33; 92.1% non-Hispanic White) females (99.3% cisgender) recruited from Amazon Mechanical Turk who reported weekly cannabis use. Participants reported how many days they used cannabis in the past 30-days and how harmful they perceived cannabis to be to their health (not at all/slightly/somewhat harmful vs. very/extremely harmful). An Analysis of Covariance examined the study aim. Results: A significantly larger percentage of heterosexual women perceived cannabis to be very/extremely harmful to their health than SMW (45.2% vs. 22.6%). Those who perceived cannabis to be very/extremely harmful reported more frequent cannabis use in the past-30 days. SMW who perceived cannabis to be very/extremely harmful reported more frequent cannabis use relative to those who held lower harm perceptions; there were no significant differences for heterosexual women. Conclusions: SMW may perceive cannabis as harmful because they may be experiencing health consequences from frequent use. It may be important for interventions and public health campaigns to be tailored specifically to SMW and include information about the potential harms of cannabis use.