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For public health protection, informed decision-making relies on having a robust foundation of evidence concerning risks and their prevention. Application of an evidence-based framework depends on the availability of pertinent, scientifically sound data generated by well-directed and valid research endeavors. In this essay, we address the current state of research in humans and the evidential base concerning high-concentration delta-9-tetrahydrocannabinol (delta-9-THC) products, which are readily available in the United States. Furthermore, we explore the intricate challenges faced in carrying out research on these products, which reflect the full range of study design issues: measurement of exposure and outcomes, confounding, selection bias, and the generalizability of findings. We offer recommendations to guide future research toward providing more informative evidence. By following these recommendations, researchers and funders on this emerging topic could move toward generating the valid and comprehensive evidence needed to effectively inform public health initiatives and guide policy decisions regarding high-concentration delta-9-THC products and their use. The urgency of generating such evidence cannot be overstated, given the widespread legalization and increasing availability and use of these products. ( Am J Public Health. 2024;114(S8):S639–S644. https://doi.org/10.2105/AJPH.2024.307724 )

As cannabis products become increasingly accessible and novel modes of administration like dabbing and vaping gain popularity, understanding how these modes impact use experiences and abuse liability is crucial. Existing studies primarily utilized laboratory settings with lower-potency research-grade cannabis, failing to capture common modes among individuals who use higher-potency legal market products. This study investigated how modes of administration impact plasma tetrahydrocannabinol (THC) concentrations and subjective effects using naturalistic administration of legal market products. We conducted a secondary analysis of two quasi-experimental studies involving 252 participants (46.4% female). Participants completed a baseline assessment where they reported demographics, substance use, and medical history and an experimental assessment where they administered their products via their preferred modes. These modes were categorized into four general modes of use: dabbing, vaping, bong-like, and joint-like. Primary outcomes included plasma THC concentrations and subjective drug effects, both of which varied significantly across modes. Compared with modes typically associated with flower products (i.e., bong-, joint-like modes), dabbing was associated with higher plasma THC concentrations and subjective effects, indicating greater THC exposure when using this mode and its associated products. Interestingly, dabbing and vaping exhibited more rapid reductions in levels of subjective intoxication over time, suggesting that higher levels of intoxication may not be sustained for these modes. This study underscores the significant impact of modes of administration on THC exposure and subjective drug effects among individuals who regularly use legal market cannabis. Results demonstrate the need for future research to better characterize and account for modes of administration and their associated products.

Objective Marijuana policies in the United States have become more permissive, motivating research on demographic and policy-based differences in behaviors and attitudes towards driving after marijuana use. The Traffic Safety Culture Index is an annual survey with national scope and multiple measures relevant to driving after marijuana use. We tabulated responses to questions about driving after marijuana use from the Traffic Safety Culture Index based on demographic factors, recreational and medical marijuana policies, and per-se marijuana laws. Results Male, younger, lower-income, and lower-education respondents self-reported driving after marijuana use more than their demographic counterparts, more often reported such behavior to be personally acceptable, and exhibited lower support per-se laws. Drivers in states that legalized medical marijuana self-reported driving after marijuana use slightly more than drivers in states where both medical and recreational were illegal. Support for per-se laws was higher among those in states that legalized recreational marijuana and in states with per-se laws. Demographic differences in our outcomes were consistent and cohesive. On the other hand, we found no predominant pattern suggesting that those in states with liberal marijuana policies were more tolerant of driving after marijuana use.

Background Syringe services programs provide sterile injection supplies and a range of health services (e.g., HIV and HEP-C testing, overdose prevention education, provision of naloxone) to a hard-to-reach population, including people who use drugs, aiming to prevent the transmission of infectious diseases. Methods We performed a qualitative needs assessment of existing syringe services programs in the state of Colorado in 2018–2019 to describe—their activities, needs, and barriers. Using a phenomenological approach, we performed semi-structured interviews with key program staff of syringe services programs ( n  = 11). All interviews were digitally recorded, transcribed, and validated. A data-driven iterative approach was used by researchers to develop a coding scheme to organize the data into major themes found across interviews. Memos were written to synthesize main themes. Results Nearly all the syringe program staff discussed their relationships with law enforcement at length. All syringe program staff viewed having a positive relationship with law enforcement as critical to the success of their program. Main factors that influence the quality of relationships between syringe services programs and law enforcement included: (1) alignment in agency culture, (2) support from law enforcement leadership, (3) police officers’ participation and compliance with the Law Enforcement Assisted Diversion (LEAD) program, which provides intensive case management for low-level drug offenders, and (4) implementation of the “Needle-Stick Prevention Law” and Drug Paraphernalia Law Exemption. All syringe program staff expressed a strong desire to have positive relationships with law enforcement and described how a collaborative working relationship was critical to the success of their programs. Conclusions Our findings reveal effective strategies to foster relationships between syringe services programs and law enforcement as well as key barriers to address. The need exists for both syringe services programs and law enforcement to devote time and resources to build a strong, positive partnership. Having such positive relationships with law enforcement has positive implications for syringe services program clients, including law enforcement being less likely to ticket persons for having used syringes, and encourage people who use drugs to seek services from syringe services programs, which can then lead them to other resources, such as housing, wound care, and substance use treatment programs.

Background Acute cannabis use has been demonstrated to slow reaction time and affect decision-making and short-term memory. These effects may have utility in identifying impairment associated with recent use. However, these effects have not been widely investigated among individuals with a pattern of daily use, who may have acquired tolerance. The purpose of this study was to examine the impact of tolerance to cannabis on the acute effects as measured by reaction time, decision-making (gap acceptance), and short-term memory. Methods Participants (ages 25–45) completed a tablet-based (iPad) test battery before and approximately 60 min after smoking cannabis flower. The change in performance from before to after cannabis use was compared across three groups of cannabis users: (1) occasional use ( n  = 23); (2) daily use ( n  = 31); or (3) no current use ( n  = 32). Participants in the occasional and daily use group self-administered ad libitum , by smoking or vaping, self-supplied cannabis flower with a high concentration of total THC (15–30%). Results The occasional use group exhibited decrements in reaction time (slowed) and short-term memory (replicated fewer shapes) from before to after cannabis use, as compared to the no-use group. In the gap acceptance task, daily use participants took more time to complete the task post-smoking cannabis as compared to those with no use or occasional use; however, the level of accuracy did not significantly change. Conclusions The findings are consistent with acquired tolerance to certain acute psychomotor effects with daily cannabis use. The finding from the gap acceptance task which showed a decline in speed but not accuracy may indicate a prioritization of accuracy over response time. Cognitive and psychomotor assessments may have utility for identifying impairment associated with recent cannabis use.

Abstract Introduction: Given the traffic safety and occupational injury prevention implications associated with cannabis impairment, there is a need for objective and validated measures of recent cannabis use. Pupillary light response may offer an approach for detection. Method: Eighty-four participants (mean age: 32, 42% female) with daily, occasional, and no-use cannabis use histories participated in pupillary light response tests before and after smoking cannabis ad libitum or relaxing for 15 min (no use). The impact of recent cannabis consumption on trajectories of the pupillary light response was modeled using functional data analysis tools. Logistic regression models for detecting recent cannabis use were compared, and average pupil trajectories across cannabis use groups and times since light test administration were estimated. Results: Models revealed small, significant differences in pupil response to light after cannabis use comparing the occasional use group to the no-use control group, and similar statistically significant differences in pupil response patterns comparing the daily use group to the no-use comparison group. Trajectories of pupillary light response estimated using functional data analysis found that acute cannabis smoking was associated with less initial and sustained pupil constriction compared to no cannabis smoking. Conclusion: These analyses show the promise of pairing pupillary light response and functional data analysis methods to assess recent cannabis use.

Hospital-based violence intervention programs (HVIPs) address intervention and prevention of community-based interpersonal violence. HVIPs employ Violence Prevention Professionals (VPPs) as first responders to the hospital bedside for patients who present with injuries resulting from community-based interpersonal violence, including firearm injury, stab wounds, and assault. Despite the growing presence of HVIPs in the U.S., the model lacks process and outcome measures to gauge program fidelity and effectiveness. This study utilized a research team of predominantly VPP researchers to conduct key informant interviews with 3 key groups of participants engaged with a regional HVIP, including clients (n = 7), VPPs (n = 9), and healthcare collaborators (n = 8). Analysis of interview data produced 6 overarching themes, including 3 process-based themes: (1) establish the relationship with the hospital site(s) and clients; (2) foundational client engagement; (3) The Work, and 3 outcome-based themes: (1) transition from relationship to partnership; (2) ongoing commitment; (3) The Change that span hospital- to community-based care. Further, the team identified 4 foundational programmatic goals of the HVIP: (1) inspire positive personal change, (2) reduce engagement in violence and other high-risk activity, 3) reduce risk of reinjury and justice system involvement, and (4) reignite young people as beacons of hope. The 6 process-and outcome-related themes and the 4 foundational programmatic goals produced a conceptual framework for the HVIP and a logic model that maps with the conceptual framework. These elements can guide evaluation of HVIP fidelity and effectiveness. Future work can explore the application of these measures at other sites to build the evidence base of the HVIP models in violence intervention and prevention of community-based interpersonal violence, as well as further define the role HVIPs play within the CVI ecosystem.

Aims Progressive legalization of medical and recreational cannabis markets at the state-level has led to rapid growth of medical and recreational cannabis markets and to product diversification with emerging products having high concentrations of delta-9-tetrahydrocannabinol. Research on these products is still limited and the evidence available for policy formulation is diminished by methodological limitations. Methods As a step towards addressing these limitations, the Colorado School of Public Health convened a multidisciplinary workshop that addressed four areas of cannabis research: epidemiological, clinical, surveillance, and policy. Workshop participants provided recommendations in each area to advance research on cannabis to make it more informative for decision-making on key policy topics. Emphasis was placed on assessment of use of cannabis products by study participants. Results Recommendations for research methods and their implementation were made in the four areas. Those for epidemiology include using a core set of exposure assessment measures across three domains; developing this core set through a national and/or international scientific consensus process; ensuring the core set of measures are validated and readily available; and updating the core set periodically to account for ongoing changes in the cannabis landscape. Recommendations in the clinical research area include standard dosing and dosing terminology; standardized data collection instruments; identifying biomarkers for detecting cannabis exposure; and biological matrices. Policy research recommendations were offered for state regulators, evaluators/researchers, and policy makers. Surveillance recommendations include developing and implementing a novel and nimble surveillance system to monitor use of high-concentration forms of cannabis; adding questions to existing surveillance systems with the objective of monitoring high-concentration cannabis and adverse outcomes; and elevating the coordination, synthesis, and dissemination of findings in existing data sources that could signal adverse outcomes from high-concentration cannabis. Conclusions Given the changing marketplace, it is urgent to improve the informativeness of cannabis research through enhanced research methods.

BackgroundEasy firearm access increases injury risk among adolescents. We evaluated the acceptability and feasibility of improving knowledge of a 3 min safe firearm storage education video in the paediatric emergency department.MethodsWe conducted a single-centre block trial in a large paediatric emergency department (August 2020–2022). Participants were caregivers of adolescents (10–17 years) in firearm-owning households. First block participants (control) completed a baseline survey about child safety behaviours (including firearms). Second block participants (intervention) completed a baseline survey, watched the safe firearm storage video and evaluated acceptability. Participants completed a 3-month follow-up survey about firearm safety behaviours and knowledge recall. Demographic and clinical variables were compared between the intervention and control groups using Fisher’s exact and χ2 tests. McNemar’s test was used to compare firearm storage behaviours at the initial and 3-month visit within each group.ResultsResearch staff approached 1264 caregivers; 371 consented to participate (29.4%) and 144 (38.8%) endorsed firearm ownership. There were 95 participants in the control group and 62 in the intervention group. Follow-up was lower in the intervention group (53.7% vs 37.1%, p=0.04). Among participants viewing the video, 80.3% liked the video and 50.0% felt they learnt something new from the video.ConclusionsVideo-based firearm education in a paediatric emergency department is acceptable among a population of caregivers of adolescents with household firearms. This is a higher-risk group that may uniquely benefit from consistent education in the paediatric emergency department. Further study with larger populations is needed to evaluate intervention effectiveness.Trial registrationThe study was registered with ClinicalTrials.gov (NCT05168878).

In Colorado, regulations for recreational and medical cannabis sales require tetrahydrocannabinol (THC) concentration is printed on all products. Labeled THC concentrations can vary by +/-15% of what is in the product. Studies show THC concentrations recorded on product labels are not always reflective of the THC concentration in the cannabis product and there is evidence consumers make purchasing decisions based on label claims. Explore the accuracy of cannabis product labels and differences between THC label accuracy and product type. Data for this analysis come from a larger observational study of cannabis impairment. N = 74 flower, concentrate, and edible product samples from licensed Colorado dispensaries were collected and independently tested for THC concentration. This study was conducted in Colorado, in the Denver Metro Area. Participants in the study voluntarily enrolled and provided one-gram samples of the cannabis they consumed during the study to be independently tested. The cannabis tested for this analysis was donated on a voluntary basis, not all participants chose to donate. The main outcomes of interest for this analysis are accuracy of cannabis product labels compared to observed THC content, accuracy in the context of legally allowable variation, and difference between accuracy by product. Overall, label values were higher than observed values in flower and edible products (p < 0.001) but was not significant for concentrates (p = 0.85). Flower products were observed to be significantly lower on labels versus the 15% legally allowable range (p = 0.04). Concentrate and edible products were not significantly different (p = 0.9 and p = 0.5, respectively). There is tension between legally allowable THC concentration claims on cannabis product labels and how consumers purchase cannabis. As cannabis policy evolves, standards and regulations that ensure accurate THC concentrations are reported on product labels are urgently needed.