Benedikt Fischer1, Tessa Robinson2, Chris Bullen3, Valerie Curran4, Didier Jutras-Aswad5, Maria Elena Medina-Mora6, Rosalie Liccardo Pacula7, Jürgen Rehm8, Robin Room9, Wim van den Brink10, Wayne Hall11. 1. Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil. Electronic address: bfischer@sfu.ca. 2. Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. 3. Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Health Innovation (NIHI), The University of Auckland, Auckland, New Zealand. 4. Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom. 5. Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada. 6. Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico; Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico. 7. Schaeffer Center for Health Policy and Economics, Sol Price School of Public Policy, University of Southern California, Los Angeles, United States. 8. Institute for Mental Health Policy Research, Centre for Addiction & Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. 9. Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden. 10. Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. 11. National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD 4072, Australia; National Addiction Centre, Institute of Psychiatry, Kings College London, United Kingdom.
Abstract
BACKGROUND: Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based 'Lower Risk Cannabis Use Guidelines' (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis. METHODS: Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process. RESULTS: A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible. CONCLUSIONS: Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.
BACKGROUND: Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based 'Lower Risk Cannabis Use Guidelines' (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis. METHODS: Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process. RESULTS: A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible. CONCLUSIONS: Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.
Authors: George Sam Wang; Christine Buttorff; Asa Wilks; Daniel Schwam; Gregory Tung; Rosalie Liccardo Pacula Journal: Int J Drug Policy Date: 2022-04-22
Authors: Maria Resah B Villanueva; Narges Joshaghani; Nicole Villa; Omar Badla; Raman Goit; Samia E Saddik; Sarah N Dawood; Ahmad M Rabih; Ahmad Niaj; Aishwarya Raman; Manish Uprety; Maria Calero; Safeera Khan Journal: Cureus Date: 2022-07-16
Authors: Brittney A Hultgren; Katarina Guttmannova; Christine M Lee; Daniela Acuna; Rachel L Cooper; Jason R Kilmer; Jennifer M Cadigan; Brian H Calhoun; Mary E Larimer Journal: PLoS One Date: 2022-09-27 Impact factor: 3.752