BACKGROUND: Cannabis is the most consumed illicit substance in Europe. Although its sale and use remain generally prohibited, European public policies have evolved in recent years by legalizing cannabis for medical use and considering its legalization for recreational use. However, in the literature there are arguments in favor of a particular relationship between cannabis consumption and the development of psychotic symptoms. Thus, since cannabis consumption tends to increase with legalization, the aim of this review was to investigate the impact of the legalization of cannabis for recreational use on the risk of psychosis in regions of the world already concerned.
METHODS: A systematic review of the literature was carried out in April 2024 in the PubMed-Medline database according to PRISMA criteria. The sequence of keywords used was as follows: (\"Cannabis\" [Mesh] or cannabis) AND ((\"Psychotic Disorders\" [Mesh] or Psychotic Disorders) or (\"Schizophrenia Spectrum and Other Psychotic Disorders\" [Mesh]) or (\"Schizophrenia\" [Mesh] or Schizophrenia)) AND legal use. The inclusion criteria applied for the selection of articles in this systematic review were: (1) any article investigating the potential impact of the legalization of cannabis for recreational use on the risk of psychosis (any type of psychosis diagnosed according to ICD-9, ICD-10, DSM-4 or DSM-5) by the intermediary of epidemiological (incidence or prevalence) and/or clinical (ambulatory consultations, emergency visits or hospitalizations) criteria, (2) any type of study (cross-sectional, longitudinal, prospective, retrospective, interventional and experimental) with a methodology including a temporal and/or geographic comparison of the risk of psychosis associated with the legalization of cannabis for recreational use with the exception of literature reviews and clinical cases descriptions, (3) absence of limitation for the age of the populations studied and for the date of publication, and (4) articles written in English or French. After evaluation by the two authors of the 160 articles identified, seven studies investigating the impact of the legalization of cannabis for recreational use on the risk of psychosis were included in this systematic literature review.
RESULTS: Four of the studies showed no increase in the use of health services for psychosis following the legalization of cannabis for recreational use whereas three other studies highlighted a negative impact of the legalization of cannabis for recreational use on the risk of psychosis. All of these studies were carried out in North America and were characterized by a low level of scientific evidence.
CONCLUSIONS: Given the complexity of assessing the impact of the legalization of cannabis for recreational use on the risk of psychosis, additional investigations through studies of better scientific quality are essential. However, based on the data already available, there is some evidence that there is a potential negative impact on mental health due to the legalization of cannabis for recreational use. In this context, in the event of legalization of cannabis for recreational use it seems essential to recommend lower risk use of cannabis (limit the frequency of use, delay the age of first consumption, control the THC content of products and promote prevention/education). Finally, in order to enable dynamic evolution of public health strategies the establishment of continued monitoring is essential as cannabis legalization evolves.

UNASSIGNED: Despite the legalization of cannabis use for medical purposes in Thailand in February 2019, illicit providers are still widespread and accessible. This study aimed to understand why people still chose to receive medical cannabis treatment or products from unlicensed or illegal providers. The practices of unlicensed or illegal providers in provision of medical cannabis products or treatment services were also examined.
UNASSIGNED: Qualitative in-depth interviews were conducted among medical cannabis providers and users, including 36 unlicensed and 7 licensed providers and 25 users in 2019-2021. Snowball sampling was used to recruit participants until saturation of data was achieved. Interviews included open-ended questions about the providers\' practices and attitudes towards medical cannabis. Interviews were recorded and transcribed, and thematic analysis was performed.
UNASSIGNED: Overall, six reasons were identified to answer why unlicensed/illicit providers were still popular, including: 1) easy accessibility; 2) familiarity with the unlicensed providers before the legal scheme became available; 3) favorable characters (kind, supportive, non-judgmental) of unlicensed providers; 4) affordable treatment fees; 5) trust in the quality of the medicines; and 6) lack of knowledge and negative attitudes towards cannabis from healthcare professionals. Most providers started their career as medical cannabis providers by using it themselves or with their relatives and being satisfied with the results. They used cannabis products to treat all diseases, including skin, eyes, HIV/AIDS, non-communicable diseases and all kinds of cancers. Additionally, they believed that it was effective, with no or minimal adverse effects.
UNASSIGNED: This study suggests that some patients will continue receiving medical cannabis treatment and products from unlicensed or illegal providers. More attention should be paid on increasing the capacity of medical cannabis service systems within public health hospitals, and the certification of unlicensed providers, so as to integrate them into a regulated system.

Background and Objective: Research has linked marijuana use with lower body mass index (BMI). The current study explores the correlation between marijuana use on BMI in the general U.S. population. It reports the prevalence of marijuana in adults in relation to BMI, overall and across the levels of important variables. Materials and Methods: This study used a probability sample of U.S. adults 18 years of age and older from the 2016 through 2022 Behavioral Risk Factor Surveillance System, a telephone-administered survey. The survey collects data from a representative sample regarding health-related risk behaviors, chronic health conditions, and use of preventive services. The primary outcome variables are current (at least once in the last 30 days) and daily (at least 20 of the last 30 days) marijuana use. Results: The study sample consists of 735,921 participants in the surveys that completed the optional module on marijuana use. Prevalence of marijuana use in adults doubled during the study period (7.48% to 14.91%). The increase directly corresponds with a shift toward legalization of medical and recreational marijuana. On average, the prevalence of use is 9% higher when medical marijuana is legal and 81% higher when recreational marijuana is legal (vs. not legal). For obese individuals, prevalence of current marijuana use is 35% lower than for nonobese individuals on average. Lower prevalence of marijuana use in obese individuals is consistently observed across the levels of certain demographic variables, employment status, tobacco smoking history, marijuana legalization status, and certain medical conditions (asthma, arthritis, and depression). In 2022, the adjusted odds of current or daily marijuana use are significantly lower and similar among obese (vs. non-obese) (0.68, 0.69, respectively), such that reduced obesity does not require daily use. Similarly, the adjusted odds of current marijuana use decrease in similar fashion to daily marijuana use with higher BMI weight classification. Conclusion: Marijuana use is correlated with lower BMI. As legalization and prevalence of the drug in the U.S. increases, the prevalence of obesity may decline. However, clinicians should view this outcome along with the known health risks associated with marijuana use.

BACKGROUND: Legalization has increased cannabis availability in Canada. Research shows complex relationships between cannabis use and mental health, and a need for health care providers to engage with patients about cannabis use. Providers have noted gaps in knowledge and research on the medical effects of cannabis as barriers to service delivery. It is unclear how providers and patients in mental health care settings have been impacted by legalization.
METHODS: From June 1 to July 2, 2021, we conducted a qualitative study involving semi-structured interviews with 20 health care providers in a range of roles (e.g., physicians, pharmacists, nurses) within a psychiatric hospital setting. Participants responded to open-ended questions with follow-up probes on various topics related to cannabis legalization. Topics included impacts on patient mental and physical health, clinical impacts, education and training, legal cannabis retail system and the medical cannabis access system.
RESULTS: Thematic analysis identified several themes in the data. Participants reported that legalization has had some positive impacts relating to clinical care and cannabis safety. They also expressed concerns with increased rates of cannabis use, risks to mental health and ongoing challenges engaging with patients about cannabis. Participants made recommendations for medical educators and regulators (e.g., updated curriculums, clinical guidelines), the mental health care sector (e.g., implementation of standardized screening), government (e.g., public health campaigns, safe use guidelines), the medical cannabis access system (e.g., increased regulation, research), and the legal cannabis system (e.g., zoning changes, point-of-sale information).
CONCLUSIONS: This study begins to address the paucity of data on impacts of legalization from mental health service delivery settings. Findings show that although legalization has had some positive impacts, there are ongoing patient concerns and unmet provider needs. More research is needed to understand the experiences of providers delivering care to populations experiencing mental health and/or substance use concerns who use cannabis in the post-legalization era.

暂无摘要。

The purpose of this study was to evaluate Chaldean American perspectives towards legalization and moral acceptability of recreational and medicinal marijuana in the state of Michigan. An online survey was created and distributed through various social media groups, churches, and Chaldean organizations which resulted in a total of 637 respondents following the removal of respondents who did not meet criteria. The survey was open from March 20th, 2022 to April 20th, 2022. The independent variable was level of religiosity. The dependent variables were moral acceptability, opinion towards legalization of recreational and medicinal marijuana, and risk of cannabis use disorder. Logistic regression was used to estimate the strength of the association between the independent and dependent variables. Approximately 64% of the sample was female and 54.6% were between the ages of 21 to 29. Almost 80% of respondents reported high religiosity and 83.4% strongly or somewhat supported the legalization of medicinal marijuana. In addition, 85.8% felt medicinal marijuana was morally acceptable and 58.9% believed recreational marijuana was morally wrong. In the fully adjusted models, individuals who reported high religiosity (compared to low/moderate) were more likely to oppose legalization of recreational marijuana (OR = 2.80; 95% CI = 1.46, 5.39) and believed that marijuana was morally wrong (OR = 2.36; 95% CI = 1.16, 4.78). This trend was not observed with medicinal marijuana. These findings have important implications in better understanding a traditionally conservative ethnic minority group in their attitudes towards marijuana and how religion influences their perspectives. Additional studies are needed to examine any changes in opinion overtime as this is the first study of its kind.

Cannabis use and cannabis use disorders have taken on a new social significance as a result of partial legalization. In 2021 a total of 4.5 million adults (8.8%) in Germany used the drug. The number of users as well as problematic use have risen in the last decade. Cannabis products with a high delta-9-tetrahydrocannabinol (THC) content and their regular use lead to changes in cannabinoid receptor distribution in the brain and to modifications in the structure and functionality of relevant neuronal networks. The consequences of cannabinoid use are particularly in the psychological functioning and can include intoxication, harmful use, dependence with withdrawal symptoms and cannabis-induced mental disorders. Changes in the diagnostics between ICD-10 and ICD-11 are presented. Interdisciplinary S3 guidelines on cannabis-related disorders are currently being developed and will be finalized shortly.
UNASSIGNED: Cannabiskonsum und Cannabiskonsumstörungen haben durch die Teillegalisierung eine neue gesellschaftliche Brisanz erreicht. Im Jahr 2021 nutzten 4,5 Mio. Erwachsene (8,8 %) in Deutschland die Droge. Die Zahl der Konsumenten und Konsumentinnen wie auch des problematischen Konsums ist angestiegen. Cannabisprodukte mit hohem δ‑9-Tetrahydrocannabinol(THC)-Gehalt sowie deren regelmäßiger Konsum führen zu Änderungen der Cannabinoidrezeptorverteilung im Gehirn und zu Modifikationen der Struktur und Funktionsfähigkeit relevanter neuronaler Netzwerke. Folgen des Konsums von Cannabinoiden liegen vor allem im psychischen Bereich und können Intoxikationen, schädlicher Gebrauch, Abhängigkeit mit Entzugssymptomen und cannabisinduzierte psychische Störungen sein. Änderungen der Diagnostik zwischen International Statistical Classification of Diseases and Related Health Problems 10 (ICD-10) und ICD-11 werden dargestellt. Eine interdisziplinäre S3-Leitinie „Cannabisbezogene Störungen“ wird aktuell entwickelt und in Kürze fertiggestellt.

BACKGROUND: In December 2018 the Michigan Regulation and Taxation of Marihuana Act legalized the recreational use of cannabis in Michigan. There are now high potency forms of cannabis readily available in the state, which could result in increased emergency department (ED) visit rates due to intoxication in adults and children. Although cannabis related visits account for a small percentage of all adult and pediatric ED visits, they impose a significant burden on the health care system\'s resources. This study aimed to assess the impact of the legalization of recreational marijuana on the rate of ED visits for acute cannabis intoxication.
METHODS: We utilized the legalization of marijuana in the state of Michigan to conduct a natural experiment utilizing a retrospective observational cohort design of ED visits for acute intoxication before and after legalization. The study was conducted at a health system composed of eight hospitals in southeast Michigan, including both academic and community hospitals serving a diverse patient population. We estimated monthly cannabis-related ED visits based on cannabis-related ICD-10 discharge codes and total ED visits using electronic health record data from 2016 to 2022. A negative-binomial (NB) regression model was used to estimate the immediate and cumulative changes in cannabis-related ED visit rate after legalization.
RESULTS: There were a total of 2177 ED visits from 2066 patients for cannabis intoxication in our study cohort. Of the 2177 visits, 671 were before and 1506 were after legalization. In the univariate analysis, recreational cannabis legalization was associated with an increase in the average cannabis-related ED visit rate (Rate Ratio [RR]:1.70, 95% CI: (1.49, 1.94), p-value <0.001). In the multivariate analysis adjusting for age, results remain significant (RR 1.47, 95% CI (1.29, 1.70), p-value <0.001). The increased visit rate occurred in the first month after legalization; however, the slope of the increasing rate of ED visits were similar before and after cannabis legalization (RR, 1.28, 95% CI (1.07, 1.54), p-value <0.001).
CONCLUSIONS: The legalization of recreational cannabis in Michigan was associated with an immediate increase in ED visit rates for acute cannabis intoxications across all ages, especially among middle-aged adults, in the context of an stably increasing ED visit rate.

Cannabis control policies are increasingly being liberalized, including the legalization of non-medical cannabis use and supply in multiple settings, for example in Canada, with main policy objectives focusing on improved public health. An important while contested matter has been the appropriate design of legal cannabis supply structures and sources. These, in most Americas-based legalization settings, have included provisions for (limited) \'home cultivation\'. Recent data suggest that about 8% of active consumers engage in cannabis home cultivation for their own supply, while approximately 14% are exposed to it in/around their home. Home cultivation commonly exceeds legal limits and/or occurs where not allowed, and is disproportionately associated with high-frequency and/or other risk patterns of cannabis use. In addition, home cultivation may facilitate exposure or diversion of cannabis to minors, as well as pose possible environmental exposure risks especially when occurring indoors. Given its placement in private spaces, related regulations are largely shielded from enforcement. Home cultivation, therefore, bears substantive potential to circumvent or work counter to public health‒oriented legalization policy objectives. Recent assessments of health outcomes from cannabis legalization show mixed-including multiple adverse-results, implying the need for regulatory revisions towards protecting public health outcomes. Especially in settings where extensive (e.g. commercial) retail systems were established to provide regulated, legal cannabis products to consumers, it is questionable whether home cultivation overall serves primary public health‒oriented objectives; relevant data should be expanded and used to review related provisions.
RéSUMé: Les politiques de contrôle du cannabis sont de plus en plus libéralisées, y compris la légalisation de la consommation et de l’accès au cannabis à des fins non médicales dans de nombreux contextes, par exemple au Canada, dont les principaux objectifs politiques sont axés sur l’amélioration de la santé publique. Une question importante, bien que controversée, a été la conception appropriée des structures et sources d’approvisionnement légal en cannabis. Celles-ci, dans la plupart des contextes de légalisation basés en Amériques, ont inclus des dispositions pour la ‘culture à domicile’ (limitée). Des données récentes suggèrent qu’environ 8 % des consommateurs actifs pratiquent la culture à domicile de cannabis pour leur propre approvisionnement, tandis qu’environ 14 % y sont exposés dans/autour de leur maison. La culture à domicile dépasse généralement les limites légales et/ou a lieu là où elle n’est pas autorisée, et est associée de manière disproportionnée à une consommation de cannabis à fréquence élevée et/ou à d’autres risques. En outre, la culture à domicile peut faciliter l’exposition ou le détournement du cannabis pour les mineurs, ainsi que présenter des risques d’exposition environnementale, en particulier lorsqu’elle se produit à l’intérieur. Étant donné qu’elles touchent à des espaces privés, les réglementations connexes sont largement à l’abri de toute application. La culture à domicile présente donc un potentiel important de contournement ou d’obstacles aux objectifs politiques axés sur la santé publique. Des évaluations récentes des conséquences sur la santé de la légalisation du cannabis montrent des résultats mitigés, y compris de multiples effets négatifs, ce qui implique la nécessité de révisions réglementaires en vue d’améliorer les résultats en matière de santé publique. En particulier dans les contextes où de vastes systèmes de vente au détail (par exemple commerciaux) ont été établis pour fournir aux consommateurs des produits à base de cannabis légaux et réglementés, on peut se demander si la culture à domicile sert globalement les principaux objectifs de santé publique; les données pertinentes devraient être élargies et utilisées pour réexaminer les dispositions y étant reliées.

BACKGROUND: Co-use of tobacco and cannabis has long been an issue for prevention and intervention efforts targeting these substances. Blunt use-cannabis inside a cigar wrapper-has been a consistent mode of cannabis consumption since the 1990s. Since then, both tobacco control and cannabis policies have changed considerably. This paper examines the influence of tobacco taxes and smoke-free policies as well as medical and recreational cannabis policies on blunt use among young people.
METHODS: Combining state-level tobacco control and cannabis policy data with the restricted-access youth cohort of the Population Assessment of Tobacco and Health (PATH) study, we use multilevel logistic regression models to examine the impact of these policies on past-year blunt use.
RESULTS: While we found a main effect whereby both legal medical and recreational cannabis policies are associated with higher odds of blunt use among youth, interaction effects demonstrate that this association only emerges in states lacking a comprehensive tobacco smoke-free policy. In states with smoke-free policies, we found no significant associations between cannabis policy and odds of blunt use.
CONCLUSIONS: Denormalization through smoke-free policies may mitigate the effects of recreational and medical cannabis policies on blunt use. Smoke-free policies represent a possible cost-effective mechanism to curb the co-use of tobacco and cannabis in the form of blunts. States with medical and recreational cannabis policies may benefit from greater prevention efforts for young people specifically focused on blunt use, especially in states that do not have strong tobacco control.