CONCLUSIONS AND RELEVANCE: Considerable growth was observed in the prevalence of CUD diagnoses among individuals hospitalized prenatally and in the prevalence of depression, anxiety, nausea, and other conditions in individuals with CUD at hospitalization. This study highlights the need for more screening, prevention, and treatment, particularly in populations with co-occurring CUD and psychiatric disorders. Research on the determinants and outcomes associated with CUD during pregnancy is needed to guide clinicians, policy makers, and patients in making informed decisions.
Question Has the number of vomiting-related emergency department visits increased after recreational cannabis legalization in Colorado?
Findings In this cross-sectional study of 820 778 patients seeking care through Colorado emergency departments, cannabis legalization was associated with an increase in annual vomiting-related health care encounters. The highest increases were observed in counties without existing medical dispensaries.
Meaning These findings suggest that health care clinicians in states that have legalized cannabis should be aware of symptoms associated with cannabis hyperemesis syndrome; documentation may help ensure accurate public health surveillance on consequences associated with cannabis legalization.
Abstract
Importance Cannabis hyperemesis syndrome is an emerging clinical issue associated with cannabis use. Legalization of cannabis has led to an increase in vomiting-related illnesses in health care settings.
Objective To examine whether legalization of cannabis in Colorado has been associated with increases in vomiting-related emergency department (ED) visits.
Results Vomiting-related ED health care encounters increased from 119 312 in 2013 to 153 699 in 2018 (29% increase). Over this period, 203 861 patients (25%) were aged 0 to 18 years; 114 201 (14%) were aged 19 to 25 years, and 502 771 (61%) were aged 26 years or older; 510 584 patients (62%) were female. Additional recreational dispensaries were associated with increased vomiting-related ED visits (incidence rate ratio, 1.03; 95% CI, 1.01-1.05), but counties with high baseline medical dispensary exposure experienced smaller increases in vomiting-related ED visits than counties with no baseline medical dispensary exposure (incidence rate ratio, 0.97; 95% CI, 0.95-0.99). Counties with a high number of medical marijuana dispensaries had increases at a 5.8% slower rate than counties with none.
Conclusions and Relevance The findings of this study suggest that cannabis legalization in Colorado is associated with an increase in annual vomiting-related health care encounters with regard to exposure to these markets. It may be useful for health care clinicians to be aware of cannabis hyperemesis syndrome and inquire about cannabis use when appropriate.
LOS ANGELES — California’s cannabis market is booming nearly five years after voters legalized recreational weed. But there’s a catch: the vast majority of pot sales are still underground.
Rather than make cannabis a Main Street fixture, California’s strict regulations have led most industry operators to close shop, flee the state or sell in the state’s illegal market that approaches $8 billion annually, twice the volume of legal sales.
Local government opposition, high taxes and competition from unlicensed businessesarecomplicating California’s push to build a thriving legal market. Many of those factors are baked into California law, including rules allowing city leaders to shut out licensed cannabis enterprises. Meanwhile, the state has relaxed penalties against illegal operations in the name of racial justice.
Infighting between industry groups and lobbying dysfunction in Sacramento have stalled potential legislative fixes, with no clear end in sight. The scale of those problems has California’s iconic cannabis industry — the legal side, at least — lagging behind other states that have regulated the market.
“You don't have a real cannabis industry if the dominant portion of it has no interest in being legal,” said Adam Spiker, executive director of the Southern California Coalition, a cannabis trade association. “There's no other regulated industry in the world that I know of that operates like that.”
Licensed cannabis shops offering legal goods are sparsely scattered across the state — there are roughly 2 per 100,000 people, one of the lowest rates in the nation among states that support legal recreational sales.
By comparison, Oregon has 17.9 retail shops for every 100,000 residents. Colorado boasts a similar ratio, and Washington state’s rate is more than triple California’s.
California has just 823 licensed brick-and-mortar cannabis shops, but close to 3,000 retailers and delivery services operate in the state without a permit, a February 2020 market analysis by Marijuana Business Daily found.
The unchecked cannabis ecosystem has caused major economic and environmental damage in California. Many of the state's estimated 50,000 illegal cultivation sites have been found to use banned pesticides that can poison wildlife and water supplies and are believed to account for hundreds of millions of gallons in water stolen from farms and neighboring communities each year.
Law enforcement agencies in the last few months alone have broken up sprawling grow operations in the arid Antelope Valley and urban Alameda County, discovering around 50 tons of processed cannabis goods and more than 100,000 plants, a haul valued well above $1 billion.
California Attorney General Rob Bonta announced earlier this week that the state had seized 165 weapons and more than 33 tons of infrastructure like water lines and toxic chemicals after conducting close to 500 raids this year.
“The victims of illegal marijuana cultivation are many and the toll is severe,” he said during a news conference. “Families whose water supply is polluted by outlawed pesticides, exploited labor exposed to dangerous and illegal working conditions, farmers deprived of clean soil and water.”
Lawmakers and Capitol staffers say this disunity makes legislative fixes nearly impossible to pass and perpetuates the status quo. That’s a scenario the industry can’t afford, given “the overhead costs that the illegal guy doesn’t do,”Spiker warned.
“The divide between legal and illegal is too big a gap to overcome."
Prevalence of Adolescent Cannabis Vaping: A Systematic Review and Meta-analysis of US and Canadian Studies.
JAMA Pediatr. Published online October 25, 2021. doi:10.1001/jamapediatrics.2021.4102
Key Points
Question: What is the prevalence of adolescent cannabis vaping in the US and Canada?
Findings: This systematic review and meta-analysis reviewed 17 unique studies from the US and Canada, with a total of 198 845 adolescents, and found that the lifetime prevalence of cannabis vaping doubled from 2013 to 2020 (6.1% to 13.6%), past 12-month use doubled from 2017 to 2020 (7.2% to 13.2%), and the 30-day prevalence of cannabis vaping increased 7-fold from 2013 to 2020 (1.6% to 8.4%). Preference for cannabis products may be shifting from dried herb to cannabis oil.
Meaning: The findings of this study suggest that more effective prevention and response measures are required to mitigate the increasing prevalence of cannabis vaping among adolescents.
Abstract
Importance: Vaping products were initially designed to deliver nicotine as a tobacco cigarette substitute (eg, electronic cigarettes) but are now frequently used to deliver psychoactive substances, such as cannabis and its derivatives. Large, nationally representative surveys, such as Monitoring the Future, found that approximately 1 in 3 grade-12 students vaped cannabis in 2018 alone.
Objective: To summarize the findings of epidemiological studies that reported the global prevalence of cannabis vaping in adolescents by survey year and school grades.
Main Outcomes and Measures: Prevalence of cannabis vaping.
Results: Seventeen studies met the eligibility criteria (n = 198 845 adolescents). Although no restrictions were imposed on study location, all 17 studies were from the US and Canada. Across all school grades, the pooled prevalence increased for lifetime use (6.1% in 2013-2016 to 13.6% in 2019-2020), use in the past 12 months (7.2% in 2017-2018 to 13.2% in 2019-2020), and use in the past 30 days (1.6% in 2013-2016 to 8.4% in 2019-2020). Heterogeneity across studies was large. The limited evidence from studies using similar survey and study designs suggested that adolescents’ preference for cannabis products other than dried herbs, which usually contain higher Δ9-tetrahydrocannabinol levels, may have shifted over time.
Conclusions and Relevance: The findings of this study suggest that the prevalence of cannabis vaping has increased among adolescents in the US and Canada and that more effective preventive and response measures are required.
(Dalgarno Institute Comment – Again, a ‘harm reduction’ product that not only ‘isn’t’, yet one that is easily hijacked by pro-drug actors to enable and equip illicit drug use, and most tragically, among the now ‘propagandized’ young.)
This study examined high-risk health behaviors in marijuana-users among a diverse college population in Southern California, post legalization of marijuana for recreational use.
Study design: A cross-sectional research design was employed utilizing existing data via the 2018 National College Health Assessment (NCHA) from a large Minority-Serving Institution (MSI) population [n = 1345 (Hispanic/Latino/a, n = 456; White, n = 353; Asian Pacific Islander (API), n = 288; Multiracial/Biracial, n = 195; Other, n = 53)].
Methods: Chi square and t-tests assessed differences in descriptive characteristics (age, gender, race/ethnicity and GPA) and high-risk behaviors (alcohol, tobacco and sexual behaviors) among marijuana users and non-users. Logistic regression analyses examined the relationship between race/ethnicity and high-risk behaviors with marijuana use (dependent variable).
Results: Among marijuana-users, significant (p = 0.004) differences were observed between race/ethnicity with Whites reporting using most (32.7%), followed by Hispanics (27.6%) and then APIs (17.8%). Marijuana-users compared with non-users consistently reported high-risk alcohol behaviors (p < 0.0001), were more likely to smoke tobacco (p < 0.0001) and engaged in more high-risk sexual behaviors (p < 0.0001). Logistic regression showed after adjusting for demographic characteristics and high-risk behaviors, race/ethnicity was borderline significantly associated with marijuana use, specifically for Whites (OR = 1.53; 95% CI: (−0.01, 0.86), p = 0.06) and the Other race/ethnicity category (OR = 2.32; 95% CI: (0.12, 1.56), p = 0.02) compared with APIs.
Conclusion: Our findings clearly demonstrate deleterious high-risk behaviors such as alcohol use, tobacco use, and certain sexual behaviors occur more among marijuana-users compared to non-users, post legalization of marijuana for recreational use. Further, race-ethnic differences were observed. Therefore, continued examination of marijuana use trends and high-risk behaviors is critical in monitoring the implications of marijuana policy changes, specifically in diverse populations
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algarno Institute Comment – Again, a ‘harm reduction’ product that not only ‘isn’t’, yet one that is easily hijacked by pro-drug actors to enable and equip illicit drug use, and most tragically, among the now ‘propagandized’ young.)
