DECRIMINALIZE DRUGS
Availability of recreational cannabis reduced demand for prescription codeine
States that permit recreational use of cannabis see a reduction in demand for prescription codeine, an opioid with a high potential for misuse, according to a new multi-institutional study led by University of Pittsburgh and Cornell University scientists.
Published this week in Health Economics, the study finds a significant reduction in pharmacy-based codeine distribution in states that have legalized recreational cannabis use. The finding is promising from a public health policy perspective because misuse of prescription opioids annually contributes to more than 10,000 overdose deaths.
Twenty-one U.S. states have passed recreational cannabis laws and legislatures in other states are considering similar measures.
“A reduction in the misuse of opioids can save lives,” said lead author Shyam Raman, a doctoral candidate in Cornell’s Jeb E. Brooks School of Public Policy. “Our research indicates that recreational cannabis laws substantially reduce distribution of codeine to pharmacies, an overlooked potential benefit to legalizing recreational cannabis use.”
The study is among the first to separately examine the impact of recreational cannabis laws on shipments of opioids to hospitals, pharmacies and other endpoint distributors. Previous studies have focused on medical cannabis laws or use of opioids by subsets of consumers, such as Medicaid beneficiaries.
The researchers analyzed data from the Drug Enforcement Administration’s Automation of Reports and Consolidation Orders System (ARCOS) which tracks the flow of controlled substances in the U.S. These are their key findings from states that passed recreational cannabis laws:
- A reduction of 26% in pharmacy-based distribution of codeine and as much as a 37% reduction after recreational cannabis laws have been in effect for four years.
- Minimal impact on distribution of other opioids such as oxycodone, hydrocodone and morphine in any setting.
- Minimal impact on codeine distribution by hospitals which are often have less permissive policies than pharmacies.
“This finding is particularly meaningful,” said senior author Coleman Drake, Ph.D., assistant professor of health policy and management at Pitt’s School of Public Health. “Among prescription opioids, codeine misuse is especially high. Our findings suggest recreational cannabis use may be a substitute for codeine misuse.”
While cannabis and opioids can be used to minimize chronic pain symptoms, they aren’t equivalent in their impact on health.
“Increasing legal access to cannabis may shift some consumers away from opioids and towards cannabis,” said Johanna Catherine Maclean, Ph.D., of George Mason University. “While all substances have some risks, cannabis use is arguably less harmful to health than the non-medical use of prescription opioids.”
W. David Bradford, Ph.D., of the University of Georgia, is an additional co-author of this research, which was supported by the National Institute on Drug Abuse of the National Institutes of Health under award K01D1051761. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
JOURNAL
Health Economics
ARTICLE TITLE
Recreational cannabis and opioid distribution
ARTICLE PUBLICATION DATE
18-Jan-2023
Heavy drinking in young adults tied to endocannabinoid pathway
IMAGE: [11C]CURB BINDING, REFLECTING BRAIN LEVELS OF FAAH, RELATES TO SELF-REPORTED ALCOHOL OUTCOMES. THE AUDIT MEASURES RISKY OR HAZARDOUS ALCOHOL USE, WHILE THE ASQ (ALCOHOL SENSITIVITY QUESTIONNAIRE) MEASURES THE EFFECTS OF ALCOHOL, WITH HIGHER SCORES INDICATING LOWER SENSITIVITY TO ALCOHOL’S EFFECTS. view more
CREDIT: BIOLOGICAL PSYCHIATRY
Philadelphia, January 18, 2023 – Although heavy drinking in young adulthood increases the risk for alcohol use disorder (AUD), not all young heavy drinkers go on to develop AUD, globally the most common substance use disorder. Research has shown that individual differences in alcohol sensitivity and cardiovascular responses may predict drinking patterns and progression to AUD. Little is known, however, about the brain-based mechanisms of AUD vulnerability – a better understanding of which could guide preventive interventions against AUD. A new study explores the role of endocannabinoid levels in hazardous alcohol use.
The study appears in Biological Psychiatry, published by Elsevier.
Led by Isabelle Boileau, PhD, at the Centre for Addiction and Mental Health and University of Toronto, the new study explores the relationship between fatty acid amide hydrolase (FAAH) levels in heavy drinking youth and alcohol intake, drinking patterns, differential responses to alcohol, and family history of AUD. The researchers hypothesized that lower brain FAAH levels would correlate to heavier and more hazardous drinking.
FAAH is an enzyme that degrades the endogenous cannabis-like substance anandamide, a neurotransmitter that activates the cannabinoid 1 receptor (CB1) and is involved in the regulation of pain, appetite, and mood. Endocannabinoid activity specifically in the brain’s striatum and prefrontal cortex regions is thought to modulate the rewarding effects of alcohol. Studies in animals and people have suggested that reduced FAAH activity leads to increased alcohol seeking and consumption and decreased negative effects of intoxication.
The researchers used positron emission tomography imaging of [11C]CURB, a highly specific radiotracer for FAAH, to assess FAAH levels in the striatum, prefrontal cortex, and whole brains of 31 participants aged 19 to 25 who reported at least one occurrence of heavy drinking in the previous 30 days. The researchers also measured behavioral and cardiovascular responses while administering controlled intravenous alcohol infusions to participants.
Lower [11C]CURB binding, reflecting lower FAAH activity and presumably higher anandamide levels, was not related to frequency of alcohol use, but it was associated with more severe use, a greater reported craving for alcohol prior to the infusion, a greater reported “liking” of intoxication during the infusion, and reduced sensitivity to the negative effects of alcohol. “In our study, young adults with lower brain levels of FAAH reported greater stimulation and fewer intoxicating and sedating effects from drinking alcohol,” said Dr. Boileau.
Lower FAAH levels were also associated with lower heart-rate variability, a cardiac measure of parasympathetic nervous system activity. A family history of AUD, present in about half the participants, had no relationship to [11C]CURB binding.
“Our findings are important as they suggest that FAAH levels in the brain may contribute to the maintenance of excessive drinking and to susceptibility for developing an AUD and provide a brain-based target for prevention efforts and treatment approaches,” Dr. Boileau added.
John Krystal, MD, editor of Biological Psychiatry, said of the work, “This fascinating study provides evidence linking increased endocannabinoid levels to reduced sensitivity to the negative effects of alcohol, an important risk factor for heavy drinking and AUD.”
This work suggests that FAAH levels may influence a youth’s susceptibility to alcohol misuse. These findings may guide researchers toward preventive measures to avoid AUD during this critical developmental stage, or potentially to interventions for treatment of AUD.
JOURNAL
Biological Psychiatry
METHOD OF RESEARCH
Experimental study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Association Between Fatty Acid Amide Hydrolase and Alcohol Response Phenotypes: A PET Imaging Study with [11C]CURB in Heavy-drinking Youth
COI STATEMENT
The authors’ affiliations and disclosures of financial and conflicts of interests are available in the article. John H. Krystal, MD, is Chairman of the Department of Psychiatry at the Yale University School of Medicine, Chief of Psychiatry at Yale-New Haven Hospital, and a research psychiatrist at the VA Connecticut Healthcare System. His disclosures of financial and conflicts of interests are available at http://www.biologicalpsychiatryjournal.com/content/bps-editorial-disclosures.
Study: U.S. cannabis advertising
policies suffer from a lack of consistency
BUFFALO, N.Y. – There is a stark contrast between the U.S. and Canada in how cannabis is regulated. Most notably, the government of Canada legalized the drug at the federal level several years ago. In the U.S., however, cannabis remains illegal at the federal level, even as 37 states now have legalized it for medical and/or recreational use.
And when it comes to policies regulating cannabis advertising and marketing, the two countries are even further apart, according to the findings of a new University at Buffalo study that compared cannabis marketing policies in Canada and among U.S. states.
In fact, most states do not address many of the cannabis advertising activities that are prohibited in Canada, the study, published in the journal Cannabis and Cannabinoid Research, found. There are 11 illegal advertising tactics — such as glamorization and testimonials — in Canada’s policy that are not specifically addressed in any of the state policies in the U.S.
“The United States has inconsistencies compared to Canada when it comes to cannabis marketing and advertising regulations. While Canada has a federal Cannabis Act that provides structured guidance for those in the cannabis industry to communicate about the product in a way that protects vulnerable populations, many states in the U.S. tend to be vaguer in their policies,” says Natasha C. Allard, the paper’s lead author and a PhD student in the Department of Community Health and Health Behavior in UB’s School of Public Health and Health Professions.
“This lack of guidance makes things confusing for advertisers and also opens up the potential for public health harms, such as youth being targeted with messaging or the spread of misinformation and false claims,” adds Allard, whose research focuses on health communication and young adult cancer prevention.
Allard’s co-authors are Jessica Kruger, PhD, clinical assistant professor, and Daniel Kruger, PhD, research associate professor, both in the Department of Community Health and Health Behavior at UB. Daniel Kruger is also affiliated with the Population Studies Center in the Institute for Social Research at the University of Michigan.
Canada’s cannabis marketing laws certainly aren’t perfect, the researchers point out, but they are significantly better than the policies that exist in various states, where inconsistencies and a lack of guidance on prohibited advertising tactics leave young people and other vulnerable populations open to being exposed to cannabis advertising.
That’s a problem because previous research on alcohol, cigarettes and e-cigarettes has shown that kids who are exposed to marketing messaging about these substances are more likely to take them up or increase their use.
“Responsible cannabis advertising policies should ensure that marketing messages do not reach a younger demographic,” says Jessica Kruger.
To see how the two countries’ policies differ, researchers reviewed Health Canada’s 2018 Cannabis Act and 2019 Cannabis Regulations. Then, they compared those guidelines with the U.S. states where cannabis is legal for medical and/or adult use, which, at the time of the research, was 36.
Because there’s no federal policy, cannabis advertising regulations vary greatly across the U.S., with some states prohibiting advertising altogether and others putting forth minimal documented regulations. Among the 31 states that did allow some form of cannabis advertising, 74% explicitly prohibit targeting or appealing to minors and 68% prohibit making false or misleading claims. Just over half the states have restrictions on where advertisements can be placed, and 42% have restrictions on building signage.
State cannabis regulations should more strongly ban false claims, especially given the increasing frequency with which cannabis is touted as a “wonder drug,” Allard says. The researchers also recommend that states should consider requiring the U.S. Food and Drug Administration to approve any health benefit claims made in cannabis advertising, and advertisements should be monitored and regulated to avert false and misleading claims.
Canada, however, is much stricter in its approach. For example, its policy extensively and comprehensively outlines and prohibits 18 marketing strategies at a national level, including targeting/appealing to minors, offering coupons and giveaways, promoting health or cosmetic benefits, endorsements and testimonials, false claims, and association with alcohol or tobacco products.
When it comes to television and radio commercials, the United States’ 30% rule — whereby an ad can’t be aired on a show if minors account for 30% or more of the audience — doesn’t adequately protect young people because 30% could still mean that millions of children will see the ad if it is on a popular channel or show.
In contrast, in Canada, all forms of communication must be information only and on a channel that is geared only to adults of legal age.
Moreover, the researchers say, the U.S. could benefit from having nationwide consistency for digital ad requirements, such as age-gating websites (which require visitors to check a box indicating they are 21 or older).
Most states also often overlook laws and policies around cannabis advertising, instead implementing such regulations after legalization has occurred.
“Many states could benefit from thinking through cannabis marketing and advertising activities and structuring these in a clear way for those in the cannabis industry as legalization spreads,” Allard says.
JOURNAL
Cannabis and Cannabinoid Research
METHOD OF RESEARCH
Meta-analysis
SUBJECT OF RESEARCH
Not applicable
ARTICLE TITLE
Cannabis Advertising Policies in the United States: State-Level Variation and Comparison with Canada
No comments:
Post a Comment