The expansion in private insurance coverage as a result of the ACA may result in more treatment completion in residential settings. Changes to the Medicaid program resulting from the ACA, including coverage of substance use treatment as an essential health benefit and greater support for housing, education, and employment, may also contribute to more residential discharges ending in treatment completion.

Objective: Cigarettes, alcohol, cannabis, inhalants and cocaine are the most commonly used substances among high school students in Jamaica. However, there is limited evidence on their co-use and whether the use of one drug predicts the use of the others (multiple substance use). This study aimed to determine whether cannabis use predicts the co-use of the other substances. Methods: We analysed data from the National Secondary School Survey 2013, Jamaica, using inferential statistics to determine associations. Results: Lifetime cannabis use was significantly associated with lifetime cigarette use for males (X 2 = 282.72, p = 0.000) and females (X 2 = 434.32, p = 0.000). Similarly, it was significantly associated with: (a) lifetime use of alcohol for males (X 2 = 88.62, p = 0.000) and females (X 2 = 99.48, p = 0.000); (b) lifetime use of inhalants for males (X 2 = 13.28, p = 0.00) and females (X 2 = 49.56, p = 0.00); and (c) lifetime cocaine use for males (X 2 = 9.78, p = 0.00) and females (X 2 = 64.54, p = 0.00). Past-month (recent) use of cannabis was significantly associated with past-month use of cigarettes and alcohol, but not inhalants, for males and females. Logistic regression results showed that lifetime cannabis use was a risk factor for lifetime use of cigarettes (adjusted odds ratio [AOR]: 11.38; 95% confidence interval [CI]: 9.02, 14.37) and alcohol (AOR: 5.84; 95% CI: 4.11, 8.30), but a strong protective factor against lifetime use of inhalants and cocaine. Past-month use of cannabis was a strong protective factor against pastmonth use of cigarettes and alcohol. Conclusion: Lifetime cannabis use was significantly associated with multiple substance use and was shown to be a risk factor for lifetime use of cigarettes and of alcohol. However, adolescents who reported recent (past-month) use of cannabis were less likely to report recent use of alcohol and cigarettes. These findings suggest the need for research to further explore the role cannabis plays in multiple drug use and offer more concrete explanations for its role.

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Ribozymes are RNAs that can be designed to catalyze the specific cleavage or ligation of target RNAs. We have explored the possibility of using ribozymes in maize to downregulate the expression of the stearoyl-acyl carrier protein (Delta9) desaturase gene. Based on site accessibility and catalytic activity, several ribozyme constructs were designed and transformed into regenerable maize lines. One of these constructs, a multimer hammerhead ribozyme linked to a selectable marker gene, was shown to increase leaf stearate in two of 13 maize lines. There were concomitant decreases in Delta9 desaturase mRNA and protein. The plants with the altered stearate phenotype were shown to express ribozyme RNA. The ribozyme-mediated trait was heritable, as evidenced by stearate increases in the leaves of the R1 plants derived from a high-stearate line. The increase in stearate correlated with the presence of the ribozyme gene. A catalytically inactive version of this ribozyme did not produce any significant effect in transgenic maize. This is evidence that ribozymes can be used to modulate the expression of endogenous genes in maize.

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