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Chronic Pain Management and Marijuana Use: Science-Based Education in Times of Legalization.

Principal Investigator:
Beatriz H. Carlini, PhD, MPH
Senior Research Scientist
Alcohol and Drug Abuse Institute
bia@u.washington.edu
http://bit.ly/adaistaff_carlini

Date: October 1, 2013 to March 31, 2015
Sponsor: Washington State Office of the Attorney General (A85413)
Categories: Marijuana | Training / Information

Other Investigators: Sharon Garrett; Dennis M. Donovan; Jennifer Velotta; Roger Roffman; Gregory Carter; Nancy Sutherland; Meg Brunner


Description: This project addresses gaps in science-based training and education in the area of chronic pain management and cannabis use. The ultimate goal is to increase awareness of treatment options to treat pain and other medical conditions, and decrease unnecessary suffering among people living with chronic pain in the state of Washington. The project will also provide information and education about medical conditions and populations for whom cannabis is not recommended, as well as side-effects and risks. This project proposes development and provision of training and education resources on chronic pain and medical cannabis for the following target groups: a) staff and volunteers of community organizations that provide information and referral for a range of situations involving substance use and people struggling with chronic and acute conditions (Poison Center, Crisis Clinic and Washington Recovery Helpline); b) health care providers and c) the general public. [Photo from the Office of Attorney General Bob Ferguson.]

 

Related Web Sites:
Project website

Comparative Examination of Cannabis Use Disorder as a Risk Factor in HIV Care

Principal Investigator:
Bryan Hartzler, PhD
Senior Research Scientist
Alcohol and Drug Abuse Institute

Date: March 1, 2017 to June 30, 2017
Sponsor: Dedicated Marijuana Fund
Categories: Marijuana | HIV/AIDS


Description: A Center for AIDS Research Network of Integrated Clinical Systems cohort (N=9,153) of HIV+ patients linked to care at seven U.S. settings, including Seattle, was examined. Patient-report surveys were used to delineate the cohort as follows: cannabis abstainers, cannabis users without Cannabis Use Disorder (CUD), and cannabis users with CUD. Generalized estimating equations examined two-year care continuity, comparing these cannabis groups and testing effect modification by established CUD predictors (i.e., age-group, sex, care setting, assessment timing). Supplemental analyses explored group rates of concurrent risky use of other substances. Findings include: 1) a group effect, with 68% care continuity among cannabis users with CUD vs. 73% among cannabis abstainers; 2) effect modification by age-group and assessment timing, with lower care continuity rate among 18-29 year-old cannabis users with CUD than same-age counterparts (56% vs. 67-69%) and greater historical reliability in assessment of their poor care continuity; and 3) cannabis use as a correlate of risky tobacco use, and CUD as a correlate of risky tobacco and alcohol use. Taken together, findings distinguish CUD—and not cannabis use per se—as a risk to care continuity, and underscore a need for diagnostic assessment and polysubstance screening in surveillance efforts.

Results: Hartzler B, Carlini BH, Williams JR, Crane HM, Eron JJ, Elvin H. Geng EH, Mathews WC, Mayer KH, Moore RD, Mugavero MJ, Napravnik S, Rodriguez B, & Donovan DM. Cannabis as a Risk Factor to HIV Care Continuity in the United States. Manuscript submitted to AIDS Care.

Consumers’ Perspectives on the Function of Marijuana in Their Lives

Principal Investigator:
Robin Harwick, PhD
Research Scientist
Alcohol and Drug Abuse Institute
harwick@uw.edu

Date: July 1, 2016 to June 30, 2017
Sponsor: Alcohol and Drug Abuse Institute
Categories: Marijuana

Other Investigators: N. Tatiana Masters, PhD, Research Scientist, ADAI; Beatriz Carlini, PhD, Research Scientist, ADAI


Description: The dichotomy between medicinal and recreational marijuana present in Washington state law reflects the way US science and policy have approached marijuana use for many decades. However, recent research suggests that boundaries between these two types of marijuana use - firmly delineated in public policies - seem quite blurred to consumers. In both clinical and community samples, medical and non-medical marijuana consumption often overlap, and consumers may transition over time from medical to non-medical use or vice-versa. Lines between these types of cannabis consumption may soon blur further as Washington law requires medical marijuana dispensaries to close and the medical system is merged into non-medical retail. This proposal aims to understand cannabis consumption from the perspective of adult regular users, without preconceived ideas that their use is defined by current categories of medicinal or recreational (non-medical). Using grounded theory and qualitative methods of data collection, its purpose is to understand marijuana consumption styles from the ground up. Participants who define themselves as regular marijuana consumers will be recruited for focus groups. Groups (6 total of 6-10 people each) will be recorded and transcribed for analysis. In them, participants will share their perspectives on marijuana's functional utility to them along with their different motivations, settings, and contexts for consumption. Qualitative data analyses informed by grounded theory will be used to produce a taxonomy of how these adults perceive marijuana's function(s) in their lives. Results will delineate cannabis consumption styles and functions described in consumers' accounts, relationships among these styles within participants, and the proportion of each consumption style across participants. Knowledge acquired can be used in shaping research, policies, and treatment related to marijuana consumption. Findings will also inform future grant applications on the development of marijuana consumption survey questions and measures that are valid, reliable, and standardized.

The overall objective of this study is to generate a taxonomy of how adults who regularly consume marijuana perceive its function in their lives. In particular, this study will use grounded theory to understand the phenomenon of marijuana consumption from the consumer's perspective, potentially broadening the framework beyond the binary categories of medical vs non-medical cannabis.

Drug Helplines and Adult Marijuana Users: Assessment in Washington, Colorado, Oregon, and Alaska

Principal Investigator:
Beatriz H. Carlini, PhD, MPH
Senior Research Scientist
Alcohol and Drug Abuse Institute

Date: February 1, 2016 to June 30, 2016
Sponsor: Dedicated Marijuana Fund
Categories: Marijuana

Other Investigators: Sharon Garrett, MPH


Description: Drug helplines are well-known and widely utilized resources for those seeking help with managing their substance use. Using “secret shoppers,” a preliminary assessment of the drug helplines in 4 states was performed. Calls were placed to the helpline staff, where the secret shopper posed as an adult user of marijuana interested in decreasing their marijuana use, and asked questions about cannabinoids and methods of marijuana consumption. In 100% of the calls placed, helpline staff had no knowledge about the effects and interactions of marijuana's 2 main components (tetrahydrocannabinol [THC] and cannabidiol [CBD]), nor could they explain the risk differential of smoking, eating, or vaporizing marijuana. In all but one of the calls placed, helpline responders were respectful and empathic. The assessment suggests that drug helplines are equipped with a respectful, empathetic, and nonjudgmental staff who lack important knowledge to best serve those seeking help for marijuana use.

Results: Carlini BH, Garrett SB. Drug helplines and adult marijuana users: an assessment in Washington, Colorado, Oregon, and Alaska. Substance Abuse 2017 (in press). doi: 10.1080/08897077.2017.1355872

Online Training: Marijuana Training for Help Line Staff: http://adai.uw.edu/helpline/

A Hybrid Effectiveness-Implementation Trial of a School-Based Teen Marijuana Checkup

Principal Investigator:
Denise D. Walker, PhD
Rearch Associate Professor
Social Work
ddwalker@uw.edu

Date: May 15, 2016 to February 28, 2020
Sponsor: National Institute on Drug Abuse (1R01DA040650-01)
Categories: Marijuana | Implementation Research

Other Investigators: Multiple PI: Bryan Hartzler, PhD, ADAI Senior Research Scientist


Description: Marijuana is the most widely used illicit substance with approximately 25 million people in the U.S. having used marijuana in the past year. An estimated 10% of persons who have ever used marijuana will become daily users, with lifetime marijuana dependence rates estimated at 4% of the general population, the highest of any illicit drug. Given that the great majority of adults with one or more marijuana use disorder symptoms report they began smoking before age 18, early intervention efforts with adolescents, particularly those who are using heavily, becomes an important public health objective in order to prevent later problems.

The objectives of the proposed study are to advance Type 2 translational science through an effectiveness-implementation "type 2" hybrid design to evaluate the clinical and cost-effectiveness of an efficacious intervention (Teen Marijuana Check-Up, TMCU) and compare the feasibility, acceptability, impact and cost-effectiveness of two integrity monitoring support systems. Marijuana continues to be the most frequently used drug in the U.S. and adolescent use is associated with negative effects such as academic failure, dropout, and emotional problems. Although marijuana is the most common presenting substance for 12-17 year olds seeking substance abuse treatment, few voluntarily seek indicated services. The TMCU is a brief, school-based motivational enhancement therapy approach that has been systematically evaluated in three randomized controlled trials with reliable beneficial effects in prompting voluntary participation in the intervention and decreasing adolescent marijuana use.

With TMCU now well-positioned for broad dissemination, its public health impact may be enhanced by further research addressing: 1) to what extent its documented efficacy under controlled conditions translates to real-world effectiveness, and 2) what support systems are most useful in promoting sustained integrity in its delivery by the available school-based personnel. The proposed type 2 effectiveness/implementation hybrid trial will include randomization at multiple levels. Students will be randomly-assigned in a 1:2 ratio to `services-as-usual' and TMCU intervention conditions, and school-based personnel identified to deliver TMCU will be randomly-assigned to do so under governance of a `gold-standard' training/oversight support system (i.e., rapid, continual performance-based feedback and weekly coaching about integrity of TMCU delivery) or a less resource-intensive support system similarly including performance-based feedback but with process benchmarking (defined by prior performance of research interventionists in TMCU efficacy trials) prompting points at which these school-based personnel receive purveyor coaching. Expected trial participation of ten schools will enable recruitment of 30 TMCU interventionists, and access to a pool of 250 marijuana-using students during a two-year implementation period. This nested design (e.g., students in schools/intervention conditions; interventionists in schools/training/oversight support systems) will utilize multilevel models in study analyses to account for possible school-level clustering. A cost analysis will also be conducted. Longitudinal outcome and process data will be collected from school based staff (6, 12, 18, & 24 month follow-ups) and students (3 and 6 month follow- ups). The trial will occur in Washington state at an opportune time when legislative, fiscal, and socio-cultural factors converge to heighten potential adolescent exposure to marijuana-related harms-represents an effort by this investigative team to respond to such local challenges in a manner that will advance understanding of best practices for dissemination and implementation of this and other efficacious, school-based interventions.

Related Web Sites:
NIH RePORTER Record

Impacts of Cannabis & Cannabis Legalization on Impaired Driving in WA State

Principal Investigator:
Caleb Banta-Green, PhD, MPH, MSW
Research Scientist
Alcohol and Drug Abuse Institute
calebbg@u.washington.edu
http://bit.ly/adaistaff_bantagreen

Date: July, 2014 to September, 2015
Sponsor: AAA Foundation
Categories: Marijuana | Epidemiology and Drug Abuse Trends

Other Investigators: Ali Rowhani-Rahbar, MD, MPH, PhD (Co-Principal Investigator), Assistant Professor of Epidemiology, UW School of Public Health; Beth E. Ebel, MD, MSc, MPH (Co-Investigator), Adjunct Associate Professor, Epidemiology & Health Services, UW School of Public Health, and Associate Professor, Pediatrics

External collaborators: Fiona Couper, PhD, State Toxicologist, Forensic Laboratory Services Bureau, Washington State Patrol; Staci Hoff, PhD Research Manager, Washington Traffic Safety Commission


Description: In conjunction with the Harborview Injury Prevention & Research Center, we will examine the relationship between changes in Washington State cannabis laws and policies and the incidence of cannabis-impaired driving, using linked toxicological, criminal justice, and crash databases. Secondarily we will examine the relationship between the presence and level of cannabis metabolites in driver blood samples and the severity of driving offense, rates, and police-reported crash severity.

In 2012, Washington passed Initiative 502 that licenses and regulates marijuana production, distribution, and possession for adults (age 21 and over); removes state-law criminal and civil penalties for specified activities; taxes and regulates marijuana sales; and earmarks marijuana-related revenues. The Initiative set a level of 5 ng/mL of tetrahydrocannabinol (THC) in whole blood as a per se level for driving under the influence (DUI).

This change in state law presents a unique opportunity to examine the potential impact of legislation on marijuana-impaired driving and crash risk. Our study team is uniquely positioned to conduct these analyses given our combined scientific expertise and our experience with the data sets, research methods, state agencies, and stakeholders.

Results: Cannabis Use among Drivers Suspected of Driving Under the Influence or Involved in Collisions: Analysis of Washington State Patrol Data. C Banta-Green, A Rowhani-Rahbar, B Ebel, LM Andris, and Q Qui. Report for the AAA Foundation, 6/2016. Report & related resources

Marijuana Use among High-Risk Mothers in Washington State

Principal Investigator:
Therese M. Grant, PhD
Professor
Psychiatry and Behavioral Sciences

Date: March 1, 2016 to June 30, 2016
Sponsor: Dedicated Marijuana Fund
Categories: Marijuana | Pregnancy and Alcohol / Drugs

Other Investigators: Chris Graham, Bia Carlini, Cara Ernst, Natalie Novick Brown


Description: This study examined how legalization affected alcohol and drug use in a sample of pregnant and parenting women with substance use disorders. Data source: Exit interviews from a three-year case management intervention program (Parents and Child Assistance Program - PCAP) from nine counties in Washington State. The sample (N = 1,359) was divided into two cohorts based on whether participants had completed the program before or after legalization. Results: Most study participants reported complete abstinence from alcohol and non-prescription drugs at program exit. Among those who were still using substances, women who completed the intervention after marijuana legalization were significantly more likely to report marijuana use at program exit compared to women who completed before legalization. Across both cohorts (pre- and post-legalization), we found a positive association of exit marijuana use with alcohol, illegal methadone, other opioids, amphetamines, and cocaine use; after controlling for historical period, marijuana use at PCAP exit increased significantly after marijuana legalization in the state. Women who were not abstinent from marijuana at program exit were likely to report use of other substances as well. Our study design demonstrates an association but does not allow us to conclude that marijuana use leads to other substance use among this sample of women with a history of poly-substance use. Results add to the preliminary body of literature on how legalization of marijuana affects substance use in specific populations.

Results: Grant TM, Graham JC; Carlini BH; Ernst CC; Brown NN. Use of marijuana and other substances among pregnant and parenting women with substance use Disorders: Changes in Washington State after marijuana legalization. Journal of Studies on Alcohol and Drugs 2018;79(1):88-95. doi: 10.15288/jsad.2018.79.88.

Medical Cannabis in HIV-positive Substance Users

Principal Investigator:
Howard Newville, PhD
Research Consultant
Alcohol and Drug Abuse Institute
Center for AIDS Research)

Date: March 1, 2016 to June 30, 2016
Sponsor: Dedicated Marijuana Fund
Categories: Marijuana | HIV/AIDS


Description: Recreational cannabis use has been associated with other substance use and decreased antiretroviral therapy (ART) adherence among people living with HIV (PLWH), but the effect of medical cannabis is unknown. We examined substance use and ART adherence in PLWH, comparing medical, recreational, and non-cannabis users. Out of 294 participants, 84 (63%) reported medical cannabis use, while 50 (37%) acknowledged recreational use. Recreational cannabis users were more likely to use a variety of substances than medical and non-cannabis users. They had greater alcohol and drug use severity than non-cannabis users, while medical cannabis users did not differ from non-cannabis users. Recreational cannabis users also had lower rates of ART adherence than non-cannabis users and medical cannabis users, who did not differ from each other. Controlling for substance use severity and age, ART nonadherence was associated with recreational cannabis use, while medical cannabis users did not differ from non-cannabis users. PLWH who use medical cannabis may have different substance use and ART adherence patterns than recreational cannabis users, indicating they are distinct groups. It is important to learn more about the specific reasons for cannabis use and their benefits and consequences to more precisely focus HIV treatments.

Results: Newville H & Sorensen JL Substance use and antiretroviral adherence in medical, recreational, and non-users of cannabis. Manuscript in preparation.

Multi-State Examination of Cannabis Use Disorder Rates in HIV Care

Principal Investigator:
Bryan Hartzler, PhD
Senior Research Scientist
Alcohol and Drug Abuse Institute

Date: March 1, 2016 to June 30, 2016
Sponsor: Marijuana Dedicated Fund
Categories: Marijuana | HIV/AIDS


Description: A Center for AIDS Research Network of Integrated Clinical Systems cohort (N=10,652) of HIV-positive adults linked to care at seven United State sites, including Seattle, was examined. Based on a patient-report instrument, the prevalence of recent cannabis use and corresponding conditional probabilities for Cannabis Use Disorder (CUD) were calculated for the aggregate sample and demographic subgroups. Conditional probability of CUD among cannabis-using patients was 49%, with the highest conditional probabilities among demographic subgroups of young adults and those with non-specified sexual orientation (67-69%) and the lowest conditional probability among females and those 50+ years of age (42% apiece). Similarly, youthful age and male gender emerged as robust multivariate model predictors of CUD. In the context of increasingly lenient policies for use of cannabis as a therapeutic agent for chronic conditions like HIV/AIDS, current study findings offer needed direction in terms of specifying targeted patient groups in HIV care on whom resources for enhanced surveillance and intervention efforts will be most impactful.

Results: Hartzler B, Carlini BH, Newville H, Crane HM, Eron JJ, Elvin H. Geng EH, Mathews WC, Mayer KH, Moore RD, Mugavero MJ, Napravnik S, Rodriguez B, Donovan DM. Identifying HIV care enrollees at-risk for cannabis use disorder. AIDS Care 2017;29(7):846-850.


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