Effects of increasing cannabis potency on adolescent health

Wilson, Jack; Freeman, Tom P.; Mackie, Clare

doi:10.1016/s2352-4642(18)30342-0

Cited by 85 publications

(53 citation statements)

References 63 publications

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“…The increasing number of studies quantifying THC and CBD concentrations in illicit cannabis markets and the use of pictorial aids (Fig. ) during substance use assessments may help to improve estimation of THC and CBD dosage in jurisdictions where cannabis use is illegal.…”

Section: Remaining Challengesmentioning

confidence: 99%

‘Standard THC units’: a proposal to standardize dose across all cannabis products and methods of administration

2019

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Background and Aims Cannabis products are becoming increasingly diverse, and vary considerably in concentrations of ∆9‐tetrahydrocannabinol (THC) and cannabidiol (CBD). Higher doses of THC can increase the risk of harm from cannabis, while CBD may partially offset some of these effects. Lower Risk Cannabis Use Guidelines currently lack recommendations based on quantity of use, and could be improved by implementing standard units. However, there is currently no consensus on how units should be measured or standardized among different cannabis products or methods of administration. Argument Existing proposals for standard cannabis units have been based on specific methods of administration (e.g. joints) and these may not capture other methods, including pipes, bongs, blunts, dabbing, vaporizers, vape pens, edibles and liquids. Other proposals (e.g. grams of cannabis) cannot account for heterogeneity in THC concentrations among different cannabis products. Similar to alcohol units, we argue that standard cannabis units should reflect the quantity of primary active pharmacological constituents (dose of THC). On the basis of experimental and ecological data, public health considerations and existing policy, we propose that a ‘standard THC unit’ should be fixed at 5 mg THC for all cannabis products and methods of administration. If supported by sufficient evidence in future, consumption of standard CBD units might offer an additional strategy for harm reduction. Conclusions Standard ∆9‐tetrahydrocannabinol (THC) units can potentially be applied among all cannabis products and methods of administration to guide consumers and promote safer patterns of use.

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Section: Remaining Challengesmentioning

confidence: 99%

‘Standard THC units’: a proposal to standardize dose across all cannabis products and methods of administration

2019

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“…First, several [2][3][4][5][6] (but not all [7]) observational studies have found associations between the potency of cannabis products and problems related to addiction and mental health. Quantifying cannabis potency is therefore a key step towards improving our understanding of the health effects of cannabis [11] and may inform policy decisions for harm minimization, such as taxation or upper limits on THC concentrations [12,13]. Thirdly, experimental studies show dose-dependent effects of THC on cognitive impairment, anxiety, psychotic-like symptoms and addiction, with higher doses causing greater harm [10].…”

Section: Introductionmentioning

confidence: 99%

“…There are only a limited number of published studies to date investigating the potency of cannabis products in international drug markets. Quantifying cannabis potency is therefore a key step towards improving our understanding of the health effects of cannabis [11] and may inform policy decisions for harm minimization, such as taxation or upper limits on THC concentrations [12,13].…”

Section: Introductionmentioning

confidence: 99%

Increasing potency and price of cannabis in Europe, 2006–16

et al. 2019

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Aims To quantify changes in (i) potency (concentration of Δ9‐tetrahydrocannabinol; %THC), (ii) price (euros/g of cannabis) and (iii) value (mg THC/euro) of cannabis resin and herbal cannabis in Europe. Design Repeated cross‐sectional study. Setting and participants Data collected from 28 European Union (EU) member states, Norway and Turkey by the European Monitoring Centre for Drugs and Drug Addiction. Measurements Outcome variables were potency, price and value for cannabis resin and herbal cannabis in Europe, 2006–16. Inflation was estimated using the Harmonised Indices of Consumer Prices. Mixed‐effects linear regression models were used to estimate linear and quadratic time trends, with a random intercept and slope fitted to account for variation across countries. Findings Resin potency increased from a mean [95% confidence interval (CI)] of 8.14% THC (6.89, 9.49) in 2006 to 17.22 (15.23, 19.25) in 2016. Resin price increased from 8.21 euros/g (7.54, 8.97) to 12.27 (10.62, 14.16). Resin increased in value, from 11.00 mg THC per euro (8.60, 13.62) to 16.39 (13.68, 19.05). Quadratic time trends for resin potency and value indicated minimal change from 2006 to 2011, followed by marked increases from 2011 to 2016. Herbal cannabis potency increased from 5.00% THC (3.91, 6.23) to 10.22 (9.01, 11.47). Herbal price increased from 7.36 euros/g (6.22, 8.53) to 12.22 (10.59, 14.03). The value of herbal cannabis did not change from 12.65 mg of THC per euro (10.18, 15.34) to 12.72 (10.73, 14.73). All price trends persisted after adjusting for inflation. Conclusions European cannabis resin and herbal cannabis increased in potency and price from 2006 to 2016. Cannabis resin (but not herbal cannabis) increased in the quantity of Δ9‐tetrahydrocannabinol per euro spent. Marked increases in resin potency and value from 2011 to 2016 are consistent with the emergence of new resin production techniques in European and neighbouring drug markets.

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“…Participants were then asked about their use of several different types of cannabis products. Each cannabis product was accompanied by a series of product-specific labelled photographs in order to improve identification by participants (Wilson et al ., 2019). Respondents were asked which of the following types they had used in the past 12 months (yes/no): sinsemilla, herbal, hashish, concentrates, kief & edibles.…”

Section: Methodsmentioning

confidence: 99%

Characterising heterogeneity in the use of different cannabis products: latent class analysis with 55 000 people who use cannabis and associations with severity of cannabis dependence

et al. 2019

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BackgroundAs new cannabis products and administration methods proliferate, patterns of use are becoming increasingly heterogeneous. However, few studies have explored different profiles of cannabis use and their association with problematic use.MethodsLatent class analysis (LCA) was used to identify subgroups of past-year cannabis users endorsing distinct patterns of use from a large international sample (n = 55 240). Past-12-months use of six different cannabis types (sinsemilla, herbal, hashish, concentrates, kief, edibles) were used as latent class indicators. Participants also reported the frequency and amount of cannabis used, whether they had ever received a mental health disorder diagnosis and their cannabis dependence severity via the Severity of Dependence Scale (SDS).ResultsLCA identified seven distinct classes of cannabis use, characterised by high probabilities of using: sinsemilla & herbal (30.3% of the sample); sinsemilla, herbal & hashish (20.4%); herbal (18.4%); hashish & herbal (18.8%); all types (5.7%); edibles & herbal (4.6%) and concentrates & sinsemilla (1.7%). Relative to the herbal class, classes characterised by sinsemilla and/or hashish use had increased dependence severity. By contrast, the classes characterised by concentrates use did not show strong associations with cannabis dependence but reported greater rates of ever receiving a mental health disorder diagnosis.ConclusionsThe identification of these distinct classes underscores heterogeneity among cannabis use behaviours and provides novel insight into their different associations with addiction and mental health.

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Effects of increasing cannabis potency on adolescent health

Cited by 85 publications

References 63 publications

‘Standard THC units’: a proposal to standardize dose across all cannabis products and methods of administration

‘Standard THC units’: a proposal to standardize dose across all cannabis products and methods of administration

Increasing potency and price of cannabis in Europe, 2006–16

Characterising heterogeneity in the use of different cannabis products: latent class analysis with 55 000 people who use cannabis and associations with severity of cannabis dependence

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