Balancing risks and benefits of cannabis use: umbrella review of meta-analyses of randomised controlled trials and observational studies

BMJ, Journal Year: 2023, Volume and Issue: unknown, P. e072348 - e072348

Published: Aug. 30, 2023

Objective To systematically assess credibility and certainty of associations between cannabis, cannabinoids, cannabis based medicines human health, from observational studies randomised controlled trials (RCTs). Design Umbrella review. Data sources PubMed, PsychInfo, Embase, up to 9 February 2022. Eligibility criteria for selecting Systematic reviews with meta-analyses RCTs that have reported on the efficacy safety or were included. Credibility was graded according convincing, highly suggestive, weak, not significant (observational evidence), by GRADE (Grading Recommendations, Assessment, Development Evaluations) Quality assessed AMSTAR 2 (A Measurement Tool Assess Reviews 2). Sensitivity analyses conducted. Results 101 included (observational=50, RCTs=51) (AMSTAR high 33, moderate 31, low 32, critically 5). From supported certainty, increased adverse events related central nervous system (equivalent odds ratio 2.84 (95% confidence interval 2.16 3.73)), psychological effects (3.07 (1.79 5.26)), vision (3.00 5.03)) in people mixed conditions (GRADE=high), improved nausea/vomit, pain, spasticity, but psychiatric, gastrointestinal events, somnolence among others (GRADE=moderate). Cannabidiol 50% reduction seizures (0.59 (0.38 0.92)) seizure (0.36 0.96)) pneumonia, For chronic cannabinoids reduced pain 30% (0.37 0.93), GRADE=high), across different (n=7), distress. epilepsy, cannabidiol risk diarrhoea (2.25 (1.33 3.81)), had no effect sleep disruption populations measures global impression (n=2), quality life, In general population, worsened positive psychotic symptoms (5.21 (3.36 8.01)) total psychiatric (7.49 (5.31 10.42)) negative symptoms, cognition (n=11) healthy people, threshold (0.74 0.91)), unpleasantness (0.60 (0.41 0.88)) (GRADE=high). inflammatory bowel disease, life (0.34 (0.22 0.53) multiple sclerosis, dizziness, dry mouth, nausea, cancer, disruption, (n=2) Cannabis medicines, resulted poor tolerability various Evidence convincing (main sensitivity analyses) pregnant women, small gestational age (1.61 (1.41 1.83)), birth weight (1.43 (1.27 1.62)); drivers, car crash (1.21 1.34)); psychosis (1.71 (1.47 2.00)). Harmful noted additional neonatal outcomes, outcomes crash, population including suicide attempt, depression, mania, impaired users (all suggestive suggestive). Conclusions Convincing converging evidence supports avoidance during adolescence early adulthood, prone mental health disorders, pregnancy before while driving. is effective epilepsy. are palliative medicine without events. Study registration PROSPERO CRD42018093045. Funding None.

Language: Английский

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The association between physical availability of cannabis retail outlets and frequent cannabis use and related health harms: a systematic review

The Lancet Regional Health - Americas, Journal Year: 2024, Volume and Issue: 32, P. 100708 - 100708

Published: March 7, 2024

An increasing number of regions have or are considering legalising the sale cannabis for adult use. Experience from tobacco and alcohol regulation has found that greater access to physical retail stores is positively associated with increased substance use harm. Whether this association exists unclear. We completed a systematic review examining between store adverse health outcomes. identified articles up until July 20, 2023 by searching four databases. included studies measures outcomes: frequent problematic use, healthcare encounters due (e.g., cannabis-induced psychosis), potentially related self-harm episodes). Results were compared study design type, measure, subgroups including: children, adolescents, young adults, pregnant individuals. This was registered PROSPERO (CRD42021281788). The search generated 5750 citations which we 32 containing 44 unique primary analyses (unique measure outcome pairs). Studies come 4 countries (United States, Canada, Netherlands Uruguay). Among analyses, there consistent positive associations 1) service poison control calls directly (10/12 analyses; 83%) (2) cannabis-related hospitalization during pregnancy (4/4; 100%) 3) in adults (7/11; 64%). There no adolescents (1/4; 25%), (2/6; 33%) neonatal birth outcomes (2/7; 26.8%). increases In legal cannabis, restrictions may reduce

Language: Английский

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Changes in Incident Schizophrenia Diagnoses Associated With Cannabis Use Disorder After Cannabis Legalization

JAMA Network Open, Journal Year: 2025, Volume and Issue: 8(2), P. e2457868 - e2457868

Published: Feb. 4, 2025

Importance Despite public health concerns that cannabis legalization may increase the number of cases schizophrenia caused by cannabis, there is limited evidence on this topic. Objective To examine changes in population-attributable risk fraction (PARF) for use disorder (CUD) associated with after liberalization medical and nonmedical Canada. Design, Setting, Participants This population-based cohort study was conducted Ontario, Canada, from January 1, 2006, to December 31, 2022, among 13 588 681 people aged 14 65 years without a history schizophrenia. Exposures Diagnosis CUD emergency department or hospital setting ( International Statistical Classification Diseases Related Health Problems, Tenth Revision, Canada [ ICD-10-CA ] codes F12x T40.7). Main Outcome Measures Changes PARF F20x F25x Diagnostic Manual Mental Disorders [Fourth Edition] DSM-IV code 295x) over 3 policy periods: prelegalization (January 2006 November 2015), (December 2015 September 2018), (October 2018 2022). A secondary outcome diagnosis psychosis not otherwise specified (NOS) F29x 298x). Segmented linear regression used 2018. Results The included individuals (mean [SD] age, 39.3 [16.1] years; 6 804 906 males [50.1%]), whom 118 650 (0.9%) had CUD. total 91 106 (0.7%) developed (80 523 470 031 [0.6%] general population vs 10 583 [8.9%] CUD). almost tripled 3.7% (95% CI, 2.7%-4.7%) during period 10.3% 8.9%-11.7%) period. postlegalization ranged 18.9% 16.8%-21.0%) 19 24 1.8% 1.1%-2.6%) females 45 years. annual incidence stable time, while NOS increased 30.0 55.1 per 100 000 (83.7%) relative steadily no accelerations changes, increases accelerated liberalization. Conclusions Relevance In proportion incident substantial policy. Ongoing research indicated understand long-term associations prevalence psychotic disorders.

Language: Английский

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Cannabis Use Disorder Emergency Department Visits and Hospitalizations and 5-Year Mortality

JAMA Network Open, Journal Year: 2025, Volume and Issue: 8(2), P. e2457852 - e2457852

Published: Feb. 6, 2025

Importance Cannabis use disorders (CUD) are associated with adverse health effects, including mental and motor vehicle collision-related injuries. However, little is known about whether CUDs increased mortality risk. Objective To examine individuals receiving incident hospital-based care (an emergency department visit or hospitalization) for a CUD risk of death. Design, Setting, Participants This population-based retrospective cohort study included all aged 15 to 105 years living in Ontario, Canada, between 2006 2021 (n = 11 622 571 individuals). Overall cause-specific were compared age- sex-matched members the general population other substance using hazard models adjusted comorbid health, use, chronic conditions. Statistical analysis was performed from September December 2024. Exposure Incident care. Main Outcomes Measures identified vital statistics. Results The matched 527 972 (mean [SD] age, 29.9 [13.6] years; 330 034 [62.5%] female) median (IQR) follow-up 5 (3-9) 106 994 had CUD. Within care, 3770 (3.5%) died (0.6%) members. After adjusting conditions, at death relative (adjusted ratio [aHR], 2.79 [95% CI, 2.62-2.97]). Individuals investigated types particularly elevated by suicide (aHR, 9.70 6.04-15.57]), trauma 4.55 3.55-5.82]), opioid poisoning 5.03 2.86-8.84]), drug poisonings 4.56 3.11-6.68]), lung cancer 3.81 2.39-6.07]) population. Compared an individual CUD, alcohol 1.30 1.26-1.34]), stimulants 1.69 1.62-1.75]), opioids 2.19 2.10-2.27]) relatively within years. Conclusions Relevance In this residents markedly These findings suggest important clinical policy implications, given global trends toward cannabis legalization market commercialization accompanied increasing CUDs.

Language: Английский

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Access to legal cannabis market in Canada over the four years following non‐medical cannabis legalisation

Drug and Alcohol Review, Journal Year: 2023, Volume and Issue: 42(5), P. 1114 - 1119

Published: March 18, 2023

Abstract Introduction An increasing number of countries are inthe process legalising non‐medical cannabis. We described how the legal market has changed over first 4 years following legalisation in Canada. Methods collected longitudinal data on operating status and location all cannabis stores Canada for legalisation. examined per capita sales, store closures, drive time between each neighbourhood compared measures public private retail systems. Results Four after legalisation, there were 3305 open (10.6 100,000 individuals aged 15+ years). Canadians spent $11.85CAD a month individual years, 59% neighbourhoods within 5‐minute store. Over sales increased year by an average 122.3% 91.7%, respectively, with larger increases versus systems (4.01 times greater 2.46 sales). The annual increase during 3 was 6.0 15.5 greater, than fourth 7% locations permanently closed. Discussion Conclusion expanded enormously considerable variation access jurisdictions. rapid expansion implications evaluation health impacts

Language: Английский

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Changes in Cannabis-Attributable Hospitalizations Following Nonmedical Cannabis Legalization in Canada

JAMA Network Open, Journal Year: 2023, Volume and Issue: 6(10), P. e2336113 - e2336113

Published: Oct. 5, 2023

Importance The impact of adult-use cannabis legalization and subsequent commercialization (ie, increasing store product access) on hospitalizations in Canada is unclear. Objectives To examine changes overall subtypes due to associated factors following compare between provinces. Design, Setting, Participants This repeated cross-sectional analysis included all acute for individuals aged 15 105 years Canada’s 4 most populous provinces (Ontario, Quebec, Alberta British Columbia, population 26.9 million 2018). Data were obtained from routinely collected health administrative databases. Immediate gradual the age- sex-standardized rates compared using an interrupted time series design over 3 periods: prelegalization (January 2015 September 2018), with restrictions (October 2018 February 2020), commercialization, which overlapped COVID-19 pandemic (March 2020 March 2021). Main Outcomes Measures Rates per 100 000 1000 all-cause hospital admissions. Results There 203 7-year study period, 69 192 (65.8%) among male individuals, 34 678 (33%) 24 years. Overall, rate increased 1.62 times January (3.99 individuals) 2021 (6.46 individuals). largest relative increase was cannabis-induced psychosis (rate ratio, 1.40; 95% CI, 1.34 1.47 during period period). Nationally, a monthly decrease −0.06 (95% CI −0.08 −0.03) individuals. Commercialization immediate 0.83 0.30 1.30) provincial variation changes, less mature legal markets experiencing greatest declines immediately legalization. Conclusions Relevance found that not but was. findings suggest may be increases cannabis-related harms, including psychosis.

Language: Английский

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Association between non-medical cannabis legalization and emergency department visits for cannabis-induced psychosis

Molecular Psychiatry, Journal Year: 2023, Volume and Issue: 28(10), P. 4251 - 4260

Published: July 27, 2023

Language: Английский

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Outcomes associated with nonmedical cannabis legalization policy in Canada: taking stock at the 5-year mark

Canadian Medical Association Journal, Journal Year: 2023, Volume and Issue: 195(39), P. E1351 - E1353

Published: Oct. 9, 2023

KEY POINTS In October 2018, Canada was the first G-20 nation to implement legalization of nonmedical cannabis use and supply for adults.[1][1] Cannabis in had primary objectives improving cannabis-related public health safety; reducing youth access cannabis;

Language: Английский

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Understanding youth and young adult cannabis use in Canada post-legalization: a scoping review on a public health issue

Substance Abuse Treatment Prevention and Policy, Journal Year: 2024, Volume and Issue: 19(1)

Published: June 17, 2024

Abstract Background Canada legalized recreational cannabis in 2018, and one of the primary objectives Cannabis Act was to protect youth by reducing their access providing public education. has highest prevalence use worldwide, particularly among young adults under age 25. is linked with many adverse effects for including psychosis, anxiety, depression, respiratory distress, cannabinoid hyperemesis syndrome, impaired cognitive performance. Despite high evolution policies globally, significant knowledge research gaps remain regarding adult use. The aim this scoping review map extent, nature, range evidence available on since its legalization, order strengthen policies, services, treatments, training, education strategies. Methods Using a framework developed Arksey O’Malley, along PRISMA-ScR guidelines, we conducted rigorous search five academic databases: MEDLINE, Embase, APA PsycINFO, CINAHL Web Science Core Collection. We included empirical studies that collected data after legalization (October 2018) focused or < 30. Two reviewers independently screened articles two stages extracted relevant information from meeting inclusion criteria. Results Of 47 our criteria, 92% used quantitative methods, 6% were qualitative, 2% mixed-methods approach. Over two-thirds (68%) secondary data. These categorized into six focus areas: (1) prevalence, patterns, trends, (2) cannabis-related injuries emergency department (ED) visits, (3) rates patterns during pandemic, (4) perceptions use, (5) prevention tools, (6) offenses. Key findings reviewed include an increase 18-24-year-olds post-legalization, mixed results 18. ED visits intentional unintentional have increased children teens. Perception show mix concern normalization Though limited, are promising raising awareness. A decline offenses noted study. highlights several gaps, need more qualitative data, disaggregation demographic intervention research, comprehensive physical mental health impacts adults. Conclusion Maintaining approach critical, This involves implementing strategies minimize harms, enhancing education, minimizing commercialization, cannabis, promoting guidelines lower-risk harm reduction strategies, increasing training healthcare providers.

Language: Английский

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The ‘ban’ for public health that wasn't? Views and impressions on cannabis retail promotion/advertising realities amidst legalization policy in Canada

International Journal of Drug Policy, Journal Year: 2024, Volume and Issue: 131, P. 104294 - 104294

Published: Jan. 24, 2024

Language: Английский

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