Children born to moms who smoked or ingested marijuana during pregnancy suffer higher rates of depression, hyperactivity, and inattention. Yet, Seventy percent of women in the United States believe that there is “slight or no risk of harm” in using can­nabis during pregnancy.

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The documents offer unprecedented insight into the challenges of establishing and regulating an industry where the product is traditionally ­illegal. Picture: AFP

SEAN PARNELL 12:00AM JANUARY 7, 2019

High demand for a stake in Australia’s medicinal cannabis industry — including from people with links to organised crime — has caught the regulator unprepared and under-resourced, an internal audit has found.

Documents obtained under Freedom of Information laws show independent auditors hired by the Department of Health found the level of resourcing for the Medicinal Cannabis Section in the Office of Drug Control was “unsustainable”.

The federal government anticipated there would be between one and 20 cultivators under the scheme, but in the first two years more than 30 licences have been granted and many more appli­cations have been considered.

The MCS spent much of its time over the first 18 months ­assessing applications. The documents reveal this was not only a regulatory function but also crime prevention, with “several cases where assessments have uncovered connections to ­organised crime”.

Amid a backlog of appli­cations, the auditors were not convinced that the MCS had enough resources to perform its current or future roles effectively.

“It is likely there will be further pressure on the limited resources in the future with the commencement of compliance inspections, permit application processing, regulatory adjustments, and a forecast reduction in staff as a result of department-wide funding allocations,” the auditors warned.

“MCS may not be able to effectively implement all of its roles in managing the scheme in the ­future within current resource ­restraints.”

The auditors did not comment on any risk of organised crime connections not being detected in the application process, or of drugs otherwise being diverted to the illicit market.

The department only partly accepted the auditors’ recommendation that the MCS have more clarity over its future resourcing: “Given the present fin­ancial situation of the department, it is unlikely that the effort in closely mapping the resourcing required would lead to an increase in resources for the medicinal cannabis program.”

Last month, however, the government quietly allocated a further $4.4 million over two years for “assessment and compliance activities”. It also flagged changes to cost recovery arrangements.

The department had grappled with the auditor’s suggestion that the MCS divert effort from applications assessment to other areas: “Given the end result that the number of compliance inspections, and/or the level of rigour put into application assessments, must necessarily fall under any rebalancing, there is a heightened risk of criminal diversion and criminal infiltration of the medicinal cannabis scheme.”

The documents offer unprecedented insight into the challenges of establishing and regulating an industry where the product is traditionally ­illegal.

Separate concerns that pat­ients faced unreasonable delays obtaining products prompted the Council of Australian Governments’ Health Council to agree to streamline processes.

The Therapeutic Goods Administration has approved 2339 applications under a special access scheme for medicinal cann­abis. Patients have cancer pain, chemotherapy-induced sickness, neuropathic pain, spasticity, paediatric epilepsy or terminal illnesses, conditions for which there is evidence medicinal cannabis might be of benefit.

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Abstract

BACKGROUND:

The study aims were to examine daily associations between marijuana and alcohol use and the extent to which the association differs as a function of cannabis use disorder (CUD) and/or alcohol use disorder (AUD) diagnosis.

METHODS:

Timeline Followback interview data was collected in a study of veterans (N = 127) recruited from a Veterans Affairs hospital who reported at least 1 day of co-use of marijuana and alcohol in the past 180 days (22,860 observations). Participants reported 40% marijuana use days, 28% drinking days, with 37% meeting DSM-5 criteria for CUD, 40% for AUD, and 15% for both. Use of marijuana on a given day was used to predict a 3-level gender-adjusted drinking variable (heavy: ≥5 (men)/4 (women) drinks; moderate: 1 to 4/3 drinks; or none: 0 drinks). A categorical 4-level variable (no diagnosis, AUD, CUD, or both) was tested as a moderator of the marijuana-alcohol relationship.

RESULTS:

Multilevel modeling analyses demonstrated that participants were more likely to drink heavily compared to moderately (OR = 2.34) and moderately compared to not drinking (OR = 1.61) on marijuana use days relative to nonuse days. On marijuana use days, those with AUD and those with AUD + CUD were more likely to drink heavily (OR = 1.91; OR = 2.51, respectively), but those with CUD were less likely to drink heavily (OR = 0.32) compared to moderately, nonsignificant differences between any versus moderate drinking in interaction models.

CONCLUSIONS:

Heavy drinking occurs on days when marijuana is also used. This association is particularly evident in individuals diagnosed with both AUD and CUD and AUDs alone but not in those with only CUDs. Findings suggest that alcohol interventions may need to specifically address marijuana use as a risk factor for heavy drinking and AUD.

PMID: 29656401 PMCID: PMC5984172 [Available on 2019-06-01] DOI: 10.1111/acer.13639 

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How Marijuana Legalisation Impacts Use Rates - Idho and National Comparision

Patients with encounters possibly related to cannabis were younger, more likely to be hospitalized and more likely to be admitted to the psychiatric unit than patients with encounters possibly related to alcohol. Initial and sustained effects of encounter rates possibly related to cannabis demonstrated an increased trend in slope before and after recreational marijuana legalization. The slope became more abrupt following legalization with a significant increase in trend during the post-legalization period,,

Conclusions: Additional research should identify patients at highest risk of an adverse health event related to cannabis and quantify costs associated with cannabis-related healthcare delivery.

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