Medical Marijuana's Public Health Lessons — Implications for Retail Marijuana in Colorado

Ghosh, Tista S.; Dyke, Mike Van; Maffey, Ali; Whitley, Elizabeth M.; Erpelding, Dana; Wolk, Larry

doi:10.1056/nejmp1500043

Cited by 73 publications

(63 citation statements)

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“…Edibles also allow the user to avoid inhaling smoke; however, it is harder to titrate the intoxicating effects due to the delayed and variable onset of effects. Consequently edibles have recently been tied to cannabis “overdose” following ingestion of additional doses because of the misperception that the initial dose had not produced the desired effect (Ghosh et al, 2015; MacCoun & Mello, 2015). Availability of edibles has also been associated with increased rates of accidental pediatric ingestion of cannabis and associated adverse effects (Ghosh et al, 2015; Wang, Roosevelt, & Heard, 2013; Wang et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, some MML states, but not all, have developed state regulated cannabis dispensary systems (i.e., stores or “pharmacies”) that provide access to novel cannabis products such as vaporizers and edibles. Dispensaries have been linked with availability of higher potency (% THC) cannabis (Ghosh et al, 2015; Sevigny, Pacula, & Heaton, 2014) increased cannabis related hospitalizations (Mair, Freisthler, Ponicki, & Gaidus, 2015), and the sale of cannabis products with highly inaccurate labeling of the active ingredients in cannabis (e.g., %THC and cannabidiol) (Vandrey et al, 2015). Among the MML states that allow for dispensaries, the number of dispensaries varies greatly, with hundreds of dispensaries permitted in some states to only a handful permitted in others (Colorado Department of Revenue Enforcement Division, 2015; State of New Jersey Department of Health).…”

Section: Introductionmentioning

confidence: 99%

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Smoking, vaping, eating: Is legalization impacting the way people use cannabis?

Borodovsky

Crosier

Lee

et al. 2016

International Journal of Drug Policy

207

158

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Background In the context of the shifting legal landscape of medical marijuana, different methods of cannabis administration have important public health implications. How medical marijuana laws (MML) may influence patterns of use of alternative methods of cannabis administration (vaping and edibles) compared to traditional methods (smoking) is unclear. The purpose of this study was to determine if the prevalence of use of alternative methods of cannabis administration varied in relation to the presence of and variation in MMLs among states in the United States. Method Using Qualtrics and Facebook, we collected survey data from a convenience sample of n=2838 individuals who had used cannabis at least once in their lifetime. Using multiple sources, U.S. states were coded by MML status, duration of MML status, and cannabis dispensary density. Adjusted logistic and linear regression analyses were used to analyze outcomes of ever use, preference for, and age of initiation of smoking, vaping, and edibles in relation to MML status, duration of MML status, and cannabis dispensary density. Results Individuals in MML states had a significantly higher likelihood of ever use of vaping (OR: 2.04, 99% CI: 1.62-2.58) and edibles (OR: 1.78, 99% CI: 1.39-2.26) than those in states without MMLs. Longer duration of MML status and higher dispensary density were also significantly associated with ever use of vaping and edibles. Conclusions MMLs are related to state-level patterns of utilization of alternative methods of cannabis administration. Whether discrepancies in MML legislation are causally related to these findings will require further study. If MMLs do impact methods of use, regulatory bodies considering medical or recreational legalization should be aware of the potential impact this may have on cannabis users.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Smoking, vaping, eating: Is legalization impacting the way people use cannabis?

Borodovsky

Crosier

Lee

et al. 2016

International Journal of Drug Policy

207

158

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“…Edible cannabis products help users avoid the health risks associated with toxins produced by smoking. However, edible cannabis use results in a delayed onset (1-3 hours) of psychoactive effects after consumption (Vandrey, et al, 2017), which, combined with increased product availability and suboptimal regulation of product packaging and content labeling, has led to an increased number of accidental edible-related overdoses and emergency room visits (Cao, Srisuma, Bronstein, & Hoyte, 2016; Ghosh, et al, 2015; MacCoun & Mello, 2015; Vandrey, et al, 2015; Wang, et al, 2014). In recent years, states with legal cannabis laws (LCL) have taken necessary regulatory steps to reduce this risk by requiring edible products to have universal warning symbols; provide consumers with knowledge about proper serving size; limit the amount of THC per serving and the total number of servings per unit; and be sealed in tamper-resistant packaging (Marijuana Enforcement Division, 2017; Oregon Liquor Control Commission, 2016).…”

Section: Introductionmentioning

confidence: 99%

Legal cannabis laws, home cultivation, and use of edible cannabis products: A growing relationship?

Borodovsky

Budney

2017

International Journal of Drug Policy

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Background Over half of U.S. states have enacted legal cannabis laws (LCL). In parallel, edible cannabis products (i.e., edibles) have presented new regulatory challenges. LCL provisions that dictate access to cannabis (e.g., home cultivation (HC) or dispensaries (DSP)) may impact edible production and use. This study examined relationships among HC and DSP provisions, cannabis cultivation, and edible use. Methods An online cannabis use survey was distributed using Facebook. Data were collected from 1813 cannabis-using adults. U.S. states were classified as states without LCL (Non-LCL) or LCL states that: (1) only permit DSP (LCL DSP-only), (2) only permit HC (LCL HC-only), or (3) permit HC and DSP (LCL HC+DSP). Analyses tested associations among these classifications, cannabis growing, and edible use and procurement. Results Individuals in LCL HC-only and LCL HC+DSP states were more likely to report currently growing cannabis at home (OR: 3.3, 95% CI: 1.7, 6.2; OR: 3.9, 95% CI: 2.4, 6.3, respectively) and past-month edible use (OR: 2.1, 95% CI: 1.4, 3.4; OR: 2.9, 95% CI: 2.2, 3.9, respectively) than individuals in LCL DSP-only states. Regardless of state, those who had grown cannabis were more likely to have made edibles than those who had never grown cannabis (OR: 2.2, 95% CI: 1.8, 2.6). Individuals in LCL HC-only states were more likely to have made edibles in the past month than individuals from Non-LCL (OR: 2.75, 95% CI: 1.5, 5.3) and DSP-only states (OR: 2.1, 95% CI: 1.0, 4.4). Individuals in LCL HC+DSP states were more likely to have purchased edibles in the past month than individuals from Non-LCL (OR: 3.7, 95% CI: 2.4, 5.6) and DSP-only states (OR: 3.2, 95% CI: 1.8, 5.5). Conclusion Specific LCL provisions may differentially affect individuals’ propensity to grow cannabis and make, buy, and use edible cannabis products. Permitting home cultivation contributes to a greater probability of growing cannabis. Those who grow cannabis economize the plant by creating homemade edible cannabis products. Conversely, permitting dispensaries increases the likelihood of purchasing edibles. The psychoactive effects of edibles with unknown and variable cannabinoid content will be unpredictable. Policymakers should carefully consider how specific LCL provisions can affect patterns of cannabis edible product access and quality.

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“…If butane is the solvent, it is called dabs. The potency of oil is thought to be up to 90 % THC [14]. Users of dabs report that there is more tolerance [average increase of 0.68 on a 4-point scale (p<0.001)] and withdrawal [average increase of 0.22 on a 4-point scale (p<0.001)] than with flower preparations [15].…”

Section: Marijuana Preparationsmentioning

confidence: 99%

An Overview of Products and Bias in Research

Gloss

2015

Neurotherapeutics

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Medical Marijuana's Public Health Lessons — Implications for Retail Marijuana in Colorado

Cited by 73 publications

References 3 publications

Smoking, vaping, eating: Is legalization impacting the way people use cannabis?

Smoking, vaping, eating: Is legalization impacting the way people use cannabis?

Legal cannabis laws, home cultivation, and use of edible cannabis products: A growing relationship?

An Overview of Products and Bias in Research

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