The Impact of Legalization of Access to Recreational Cannabis on Canadian Medical Users with Cancer.

Abstract Background Canada legalized cannabis use for medical purposes in 1999. Legalization of cannabis for recreational purposes in October 2018 offered the opportunity to assess the impact of recreational legalization on cancer patients’ patterns of use to identify learning points that could be helpful to other countries considering similar legislation.Method Two identical anonymous cross-sectional surveys were administered to cancer patients in British Columbia (2 months before and 3 months following legalization), with the same eligibility criteria. The prevalence of medical cannabis use, the distribution of symptoms leading to use, the most common types of cannabis products and sources, reasons for stopping using cannabis, and barriers to access were assessed.Results The overall response rate was 27%. Both cohorts were similar regarding age (median= 66yrs), gender (53% female), and education (approximately 85% of participants had an education level of high school graduation and higher). Respondents had multiple motives for taking cannabis, including to manage multiple symptoms, to treat cancer, and for recreational reasons. The majority of patients in both surveys did not use the legal medical access system. Comparison of the two cohorts showed that after legalization the prevalence of current cannabis use increased by 26% (23·1% to 29·1%, p-value 0·01), including an increased disclosure of recreational motive for use, from 32% to 40%. However, in the post-legalization cohort more Current Users reported problems getting cannabis (18%) than the pre-legalization cohort (8%), (p-value <0·01). The most common barrier cited was lack of available preferred products, including edibles, as these were only available from illegal dispensaries. Conclusions Results showed that legalization of cannabis for recreational purposes may have an impact on those who use medical cannabis. Impacts include an increase in prevalence of use; problems accessing preferred products legally; higher cost, and difficulties using a legal access system. The desired goal of regulation in reducing harms from use of illegal cannabis products are unlikely to be achieved if the legal process is less attractive to patients than use of illegal sources.

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The Impact of Legalization of Access to Recreational Cannabis on Canadian Medical Users with Cancer.

10.21203/rs.3.rs-15703/v2 ◽

2020 ◽

Author(s):

Philippa Helen Hawley ◽

Monica Gobbo ◽

Narsis Afghari

Keyword(s):

Cancer Patients ◽

Cannabis Use ◽

P Value ◽

Medical Cannabis ◽

Eligibility Criteria ◽

Cross Sectional ◽

Access System ◽

Patterns Of Use ◽

Barriers To Access ◽

The Impact

Abstract Background Canada legalized cannabis use for medical purposes in 1999. Legalization of cannabis for recreational purposes in October 2018 offered the opportunity to assess the impact of recreational legalization on cancer patients’ patterns of use to identify learning points that could be of use to other countries considering similar legislation.Method Two identical anonymous cross-sectional surveys were administered to cancer patients in British Columbia(2 months before and 3 months following legalization), with the same eligibility criteria. The prevalence of medical cannabis use, the distribution of symptoms leading to use, the most common types of cannabis products and sources, reasons for stopping using cannabis, and barriers to access were assessed.Results The overall response rate was 27%. Both cohorts were similar regarding age (median= 66yrs), gender (53% of participants were female), and education (one-third of participants had an education level of high school or less). Respondents had multiple motives for taking cannabis, including to manage multiple symptoms, to treat cancer, and for recreational reasons. The majority of patients in both surveys did not use the legal medical access system, but sought products that have a low potential for euphoria, such as edibles. Comparison of the two cohorts showed that after legalization the prevalence of current cannabis use increased by 26% (23·1% to 29·1%, p-value 0·01), including an increased disclosure of recreational motive for use, from 32% to 40%. However, in the post-legalization cohort more Current Users reported problems getting cannabis (18%) than the pre-legalization cohort (8%), (p-value <0·01). The most common barrier cited was lack of available preferred products, including edibles, as these were only available from illegal dispensaries.Conclusions Results showed that legalization of cannabis for recreational purposes may have an impact on those who use medical cannabis. Impacts include an increase in prevalence of use; problems accessing preferred products legally; higher cost, and difficulties using a legal access system. The desired goal of regulation in reducing harms from use of illegal cannabis products are unlikely to be achieved if the legal process is less attractive to patients than use of illegal sources.

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The Impact of Legalization of Access to Recreational Cannabis on Canadian Medical Users with Cancer.

10.21203/rs.3.rs-15703/v3 ◽

2020 ◽

Author(s):

Philippa Helen Hawley ◽

Monica Gobbo ◽

Narsis Afghari

Keyword(s):

Cancer Patients ◽

Cannabis Use ◽

P Value ◽

Medical Cannabis ◽

Eligibility Criteria ◽

Cross Sectional ◽

Access System ◽

Patterns Of Use ◽

Barriers To Access ◽

The Impact

Abstract Background Canada legalized cannabis use for medical purposes in 1999. Legalization of cannabis for recreational purposes in October 2018 offered the opportunity to assess the impact of recreational legalization on cancer patients’ patterns of use to identify learning points that could be helpful to other countries considering similar legislation.Method Two identical anonymous cross-sectional surveys were administered to cancer patients in British Columbia (2 months before and 3 months following legalization), with the same eligibility criteria. The prevalence of medical cannabis use, the distribution of symptoms leading to use, the most common types of cannabis products and sources, reasons for stopping using cannabis, and barriers to access were assessed.Results The overall response rate was 27%. Both cohorts were similar regarding age (median= 66yrs), gender (53% female), and education (approximately 85% of participants had an education level of high school graduation and higher). Respondents had multiple motives for taking cannabis, including to manage multiple symptoms, to treat cancer, and for recreational reasons. The majority of patients in both surveys did not use the legal medical access system. Comparison of the two cohorts showed that after legalization the prevalence of current cannabis use increased by 26% (23·1% to 29·1%, p-value 0·01), including an increased disclosure of recreational motive for use, from 32% to 40%. However, in the post-legalization cohort more Current Users reported problems getting cannabis (18%) than the pre-legalization cohort (8%), (p-value <0·01). The most common barrier cited was lack of available preferred products, including edibles, as these were only available from illegal dispensaries.Conclusions Results showed that legalization of cannabis for recreational purposes may have an impact on those who use medical cannabis. Impacts include an increase in prevalence of use; problems accessing preferred products legally; higher cost, and difficulties using a legal access system. The desired goal of regulation in reducing harms from use of illegal cannabis products are unlikely to be achieved if the legal process is less attractive to patients than use of illegal sources.

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The Impact of Legalization of Access to Recreational Cannabis on Canadian Medical Users with Cancer.

10.21203/rs.3.rs-15703/v1 ◽

2020 ◽

Author(s):

Philippa Helen Hawley ◽

Monica Gobbo ◽

Narsis Afghari

Keyword(s):

Cancer Patients ◽

Negative Impact ◽

Cannabis Use ◽

P Value ◽

Medical Cannabis ◽

Eligibility Criteria ◽

Cross Sectional ◽

Patterns Of Use ◽

Barriers To Access ◽

The Impact

Abstract Background Canada legalized cannabis use for medical purposes in 1999. Legalization of cannabis for recreational purposes in October 2018 offered the opportunity to assess the impact of recreational legalization on cancer patients’ patterns of use to identify learning points that would be of use to other countries considering similar legislation. Method Two identical anonymous cross-sectional surveys were administered to cancer patients in British Columbia, 5 months apart (2 months before and 3 months following legalization), with the same eligibility criteria. The prevalence of medical cannabis use, the distribution of symptoms leading to use, the most common types of cannabis products and sources, reasons for stopping using cannabis, and barriers to access were assessed. Results The overall response rate was 27% with 821 and 852 individuals returning the first and second surveys respectively. Both cohorts were similar regarding participants’ characteristics, including age (median= 66yrs), gender (53% of participants were female), and education (one-third of participants had an education level of high school or less). Comparison of the two cohorts showed that legalization increased the prevalence of current cannabis use by 21% (23·1% to 29·1%, p-value 0·01). However, after legalization, Current Users reported more issues in getting cannabis (18% compared to 8%, p-value: <0·01). The most common barrier cited was lack of available preferred products, from closure of illegal dispensaries. Conclusions Results showed that legalization of access to cannabis for recreational purposes will have an unintended negative impact on those who use cannabis products for medical purposes. These should be anticipated and mitigated in the design and implementation of new legislation. Keywords Cannabis, Cancer, Survey, Symptom Management

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The impact of legalization of access to recreational Cannabis on Canadian medical users with Cancer

BMC Health Services Research ◽

10.1186/s12913-020-05756-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Philippa Hawley ◽

Monica Gobbo ◽

Narsis Afghari

Keyword(s):

Cancer Patients ◽

Cannabis Use ◽

Medical Cannabis ◽

Eligibility Criteria ◽

Cross Sectional ◽

Access System ◽

Patterns Of Use ◽

Barriers To Access ◽

Multiple Symptoms ◽

The Impact

Abstract Background Canada legalized cannabis use for medical purposes in 1999. Legalization of cannabis for recreational purposes in October 2018 offered the opportunity to assess the impact of recreational legalization on cancer patients’ patterns of use to identify learning points that could be helpful to other countries considering similar legislation. Method Two identical anonymous cross-sectional surveys were administered to cancer patients in British Columbia 2 months before and 3 months following legalization, with the same eligibility criteria. The prevalence of medical cannabis use, the distribution of symptoms leading to use, the most common types of cannabis products and sources, reasons for stopping using cannabis, and barriers to access were assessed. Results The overall response rate was 27%. Both cohorts were similar regarding age (median = 66 yrs), gender (53% female), and education (approximately 85% of participants had an education level of high school graduation and higher). Respondents had multiple motives for taking cannabis, including to manage multiple symptoms, to treat cancer, and for recreational reasons. The majority of patients in both surveys did not use the legal medical access system. Comparison of the two cohorts showed that after legalization the prevalence of current cannabis use increased by 26% (23·1% to 29·1%, p-value 0·01), including an increased disclosure of recreational motive for use, from 32 to 40%. However, in the post-legalization cohort more Current Users reported problems getting cannabis (18%) than the pre-legalization cohort (8%), (p-value < 0·01). The most common barrier cited was lack of available preferred products, including edibles, as these were only available from illegal dispensaries. Conclusions Results showed that legalization of cannabis for recreational purposes may have an impact on those who use medical cannabis. Impacts include an increase in prevalence of use; problems accessing preferred products legally; higher cost, and difficulties using a legal access system. The desired goal of regulation in reducing harms from use of illegal cannabis products are unlikely to be achieved if the legal process is less attractive to patients than use of illegal sources.

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A survey of breast cancer patients’ use of cannabis before, during, and after treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19210 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19210-e19210

Author(s):

Marisa C. Weiss ◽

Julianne Hibbs ◽

Terri W. McHugh ◽

Meghan Buckley ◽

Sharon Larson ◽

...

Keyword(s):

Breast Cancer ◽

Informed Consent ◽

Cancer Patients ◽

Therapeutic Agents ◽

Cannabis Use ◽

Efficacy And Safety ◽

Breast Cancer Patients ◽

Medical Cannabis ◽

Eligibility Criteria ◽

Metastatic Sites

e19210 Background: The availability of cannabis is rapidly expanding and cancer is a qualifying condition in all states allowing medical cannabis. However, there are many unknowns with respect to patterns of cannabis use among breast cancer patients. The goal of this study was to better understand how and when cannabis is used among breast cancer patients. Methods: Between 12/16/2019 and 1/19/2020, U.S.-based members of Breastcancer.org and the Healthline communities were invited to participate in a cannabis survey. Subjects confirmed they were age ≥18 and diagnosed with breast cancer within 5 years. After informed consent, data were collected, de-identified and analyzed in aggregate. The study was led by Socanna, conducted by Outcomes Insights, and supported by a grant from Ananda Health/Ecofibre. Results: A total of 3522 persons initiated screening, 832 completed screening, and 725 met eligibility criteria, of whom 612 completed the survey (84%). The results showed that 42% of participants had used medical cannabis products to relieve symptoms, including insomnia (70%), pain (59%), anxiety (57%), stress (51%), and nausea/vomiting (46%). Additionally, cannabis was used prior to treatment in 24%, during treatment in 79%, and after treatment in 54%. Of subjects reporting cannabis use during treatment: 86% used it during chemotherapy, 71% during HER2 therapy, 65% during hormonal therapy, 49% during breast radiation, and 47% during radiation for metastatic sites. Post-surgical use was reported in 51% after mastectomy alone, 40% after lumpectomy, and 38% after mastectomy/reconstruction. An average of 3-4 cannabis products were utilized. Products were sourced from medical dispensaries (54%), family/friends (33%), and recreational sources (27%). Although cannabis using subjects strongly preferred medical sources, 77% had also utilized recreational sources. Conclusions: This survey shows that almost half of breast cancer patients reported using cannabis to help relieve common symptoms from breast cancer or its treatments. Of those, 79% used cannabis during active treatment, which can impact efficacy and safety. To date, studies have not investigated drug interactions between cannabis and these therapeutic agents. Furthermore, there is a concern regarding contaminants. Although most medical cannabis is tested for pathogens and contaminants, this is not the case for cannabis obtained from other sources. The results of this study highlight the need for research regarding cannabis for medical purposes, including safety and interaction studies.

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Medical Cannabis Use in Cancer Patients: Understanding Important Patient Reported Outcomes

10.21203/rs.3.rs-452263/v1 ◽

2021 ◽

Author(s):

Brooke Worster ◽

Ayako Schmida ◽

Gregory Garber ◽

Ilise Posner ◽

Christopher Ahmed ◽

...

Keyword(s):

Quality Of Life ◽

Cancer Patients ◽

Statistical Significance ◽

Symptom Relief ◽

Cannabis Use ◽

Solid Cancer ◽

Medical Cannabis ◽

Patient Reported ◽

The Impact

Abstract The efficacy of cannabis in various symptom management strategies remains mixed. This study assess the impact of medical cannabis on cancer pain, nausea and vomiting, quality of life and cost impact on cancer patients. We enrolled 121 adult patients receiving treatment at an urban NCI-Designated cancer center. Patients completed a one-time telephone survey after certification. Patients with hematologic malignancies used cannabis products longer than solid cancer patients (heme = 10.5 months, solid = 6.2 months, p = 0.016). Positive trends in symptom relief occurred frequently, but did not reach statistical significance while detrimental effects on symptoms or quality of life were rarely noted. Younger patients (< 65) spent more money monthly on cannabis than older patients. The majority of participants reported improvements in cancer-related pain, nausea and quality of life. While much remains unknown about the use of cannabis in cancer patients, this study highlights a successful modality to help patients navigate a complex system to engage in safe, tolerable cannabis use.

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How High? Trends in Cannabis Use Prior to First Admission to Inpatient Psychiatry in Ontario, Canada, between 2007 and 2017: À quelle hauteur? Les tendances de l’usage du cannabis avant la première hospitalisation en psychiatrie en Ontario, Canada entre 2007 et 2017

The Canadian Journal of Psychiatry ◽

10.1177/0706743720984679 ◽

2020 ◽

pp. 070674372098467

Author(s):

Taylor McGuckin ◽

Mark A. Ferro ◽

David Hammond ◽

Shannon Stewart ◽

Bridget Maloney-Hall ◽

...

Keyword(s):

Psychotic Disorders ◽

Area Under The Curve ◽

Cannabis Use ◽

Medical Cannabis ◽

Inpatient Psychiatry ◽

Cross Sectional ◽

And Gender ◽

Using Data ◽

The Impact ◽

First Admission

Objectives: To examine the trends in cannabis use within 30 days of first admission to inpatient psychiatry in Ontario, Canada, between 2007 and 2017, and the characteristics of persons reporting cannabis use. Methods: A retrospective cross-sectional analysis was conducted for first-time admissions to nonforensic inpatient psychiatric beds in Ontario, Canada, between January 1, 2007, and December 31, 2017, using data from the Ontario Mental Health Reporting System ( N = 81,809). Results: Across all years, 20.1% of patients reported cannabis use within 30 days of first admission. Use increased from 16.7% in 2007 to 25.9% in 2017, and the proportion with cannabis use disorders increased from 3.8% to 6.0%. In 2017, 47.9% of patients aged 18 to 24 and 39.2% aged 25 to 34 used cannabis, representing absolute increases of 8.3% and 10.7%, respectively. Increases in cannabis use were found across almost all diagnostic groups, with the largest increases among patients with personality disorders (15% increase), schizophrenia or other psychotic disorders (14% increase), and substance use disorders (14% increase). A number of demographic and clinical factors were significantly associated with cannabis use, including interactions between schizophrenia and gender (area under the curve = 0.88). Conclusions: As medical cannabis policies in Canada have evolved, cannabis use reported prior to first admission to inpatient psychiatry has increased. The findings of this study establish a baseline for evaluating the impact of changes in cannabis-related policies in Ontario on cannabis use prior to admission to inpatient psychiatry.

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Future or Movement? The L2 Acquisition of Aller + V Forms

Languages ◽

10.3390/languages6010016 ◽

2021 ◽

Vol 6 (1) ◽

pp. 16

Author(s):

Pascale Leclercq

Keyword(s):

Native Speakers ◽

Oral Narrative ◽

L2 Acquisition ◽

Cross Sectional ◽

Developmental Patterns ◽

Patterns Of Use ◽

Modal Values ◽

The Impact ◽

Narrative Function ◽

Semantic Values

This study aims to advance the understanding of the impact of the discursive context in the form-function mappings of aller + V forms by native speakers (NSs) and learners of French (NNSs), and to further knowledge about the developmental patterns of use of such forms at three proficiency levels (lower intermediate, upper intermediate, and advanced). While aller + V is often referred to as a periphrastic future form, i.e., a way to express temporal reference, it also takes a range of diverse semantic values (including spatial, aspectual, and modal values), and discursive functions. We therefore set out to examine data from a cross-sectional oral narrative and a longitudinal semi-guided interview task to find out to what extent aller + V forms are used by NSs and NNSs in a study abroad context. Our main results show that at lower intermediate level, spatial values dominate, while temporal and modal values emerge at upper intermediate and advanced levels. As regards the discursive functions of aller + V, learners make context appropriate choices (among others, narrative function in oral narratives, and stance-marking in interviews), but even at advanced level, their range of semantic values and discursive functions is more restricted than native speakers’.

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Factors Associated With Cannabis Use During the Reproductive Cycle: A Retrospective Cross-Sectional Study of Women in States With Recreational and Medical Cannabis Legalization

Maternal and Child Health Journal ◽

10.1007/s10995-021-03197-1 ◽

2021 ◽

Author(s):

Danica Loralyn Taylor ◽

Janice F. Bell ◽

Susan L. Adams ◽

Christiana Drake

Keyword(s):

Substance Use ◽

Prenatal Care ◽

Post Partum ◽

Cannabis Use ◽

Provider Education ◽

Substance Use Prevention ◽

Cross Sectional ◽

Factors Associated ◽

Adequacy Of Prenatal Care ◽

The Impact

Abstract Introduction Passage of cannabis laws may impact cannabis use and the use of other substances. The suggested association is of particular concern in pregnant women where exposure to substances can cause harm to both the pregnant woman and fetus. The present study contributes to the minimal literature on factors associated with cannabis use during the preconception, prenatal, and postpartum periods including state legalization status, concurrent use of tobacco and e-cigarettes and adequacy of prenatal care. Methods We conducted a cross-sectional analysis using combined survey data from the 2016–2018 Pregnancy Risk Assessment Monitoring System (PRAMS) collected from 36,391 women. Logistic regression was used to estimate the impact of state-legalization, adequacy of prenatal care, and other substance use on cannabis use during the preconception, prenatal, and post-partum periods. Results In the preconception model, residence in a recreationally legal state (OR: 2.37; 95% CI, 2.04–2.75) or medically legal state (OR:3.32; 95% CI, 2.90–3.80) compared to a non-legal state was associated with higher odds of cannabis use. In the prenatal model, residence in a recreationally legal state was associated with higher odds of cannabis use (OR: 1.51; 95% CI, 1.29–1.79) whereas there was no association with residence in a medically legal state. Tobacco use including e-cigarettes and moderate prenatal alcohol use were also significantly associated with cannabis use. Conclusion Recreational cannabis legalization is associated with the use of cannabis prior to, during, and after pregnancy. Renewed clinical and policy efforts may be warranted to update prenatal substance use prevention programs, educational campaigns, and provider education as cannabis legalization evolves.

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Cannabis and End-of-Life Care: A Snapshot of Hospice Planning and Experiences Among Illinois Medical Cannabis Patients With A Terminal Diagnosis

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211018655 ◽

2021 ◽

pp. 104990912110186

Author(s):

James Alton Croker ◽

Julie Bobitt ◽

Sara Sanders ◽

Kanika Arora ◽

Keith Mueller ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Fast Track ◽

Hospice Care ◽

Cannabis Use ◽

Care Plan ◽

Medical Cannabis ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Eol Care

Introduction: Between 2013 and 2019, Illinois limited cannabis access to certified patients enrolled in the Illinois Medical Cannabis Program (IMCP). In 2016, the state instituted a fast-track pathway for terminal patients. The benefits of medicinal cannabis (MC) have clear implications for patients near end-of-life (EOL). However, little is known about how terminal patients engage medical cannabis relative to supportive care. Methods: Anonymous cross-sectional survey data were collected from 342 terminal patients who were already enrolled in ( n = 19) or planning to enroll ( n = 323) in hospice for EOL care. Logistic regression models compare patients in the sample on hospice planning vs. hospice enrollment, use of palliative care vs. hospice care, and use standard care vs non-hospice palliative care. Results: In our sample, cancer patients ( OR = 0.21 (0.11), p < .01), and those who used the fast-track application into the IMCP ( OR = 0.11 (0.06), p < .001) were less likely to be enrolled in hospice. Compared to patients in palliative care, hospice patients were less likely to report cancer as their qualifying condition ( OR = 0.16 (0.11), p < .01), or entered the IMCP via the fast-track ( OR = 0.23 (0.15), p < .05). Discussion: Given low hospice enrollment in a fairly large EOL sample, cannabis use may operate as an alternative to supportive forms of care like hospice and palliation. Clinicians should initiate conversations about cannabis use with their patients while also engaging EOL Care planning discussions as an essential part of the general care plan.

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