Nosyk B, Kurz M, Guerra-Alejos BC, Piske M, Dale L, Min JE. Incremental expenditures attributable to daily dispensation and witnessed ingestion for opioid agonist treatment in British Columbia: 2014–20. Addiction. 2023;118(7):1376–1380. https://doi.org/10.1111/add.16160
In the “Acknowledgements” section, the text “This work was funded by a Health Canada Substance Use and Addictions Program grant no. 1819-HQ-000036. We would like to thank Patrick Day (Pharmaceuticals Analytics, Government of British Columbia) for his consultation and contributions to the conceptualization of this article. All inferences, opinions and conclusions drawn in this study are those of the authors and do not reflect the opinions or policies of the Data Steward(s).” was missing a funding source.
This should have read: “This work was funded by a Health Canada Substance Use and Addictions Program (grant no. 1819-HQ-000036) and the National Institutes on Drug Abuse (NIDA grant no. R01DA050629). We would like to thank Patrick Day (Pharmaceuticals Analytics, Government of British Columbia) for his consultation and contributions to the conceptualization of this article. All inferences, opinions and conclusions drawn in this study are those of the authors and do not reflect the opinions or policies of the Data Steward(s).”
We apologize for this error.
Nosyk B, Kurz M, Guerra-Alejos BC, Piske M, Dale L, Min JE.不列颠哥伦比亚省阿片类受体激动剂治疗的每日配药和目击摄入导致的增量支出：2014-20 年。Addiction.2023；118（7）：1376-1380。https://doi.org/10.1111/add.16160In "致谢 "部分的文字 "这项工作由加拿大卫生部物质使用和成瘾项目资助，编号为 1819-HQ-000036。我们要感谢 Patrick Day（不列颠哥伦比亚省政府药物分析部）为本文的构思提供的咨询和贡献。本研究中得出的所有推论、观点和结论均属作者个人观点，并不反映数据管理人的观点或政策"："这项工作得到了加拿大卫生部物质使用与成瘾项目（拨款号：1819-HQ-000036）和美国国家药物滥用研究所（拨款号：R01DA050629）的资助。我们要感谢 Patrick Day（不列颠哥伦比亚省政府制药分析部）为本文的构思提供的咨询和贡献。本研究中的所有推论、观点和结论均属作者个人观点，并不反映数据管理人的观点或政策。
{"title":"Corrigendum to “Incremental expenditures attributable to daily dispensation and witnessed ingestion for opioid agonist treatment in British Columbia: 2014–20”","authors":"","doi":"10.1111/add.16489","DOIUrl":"10.1111/add.16489","url":null,"abstract":"<p>Nosyk B, Kurz M, Guerra-Alejos BC, Piske M, Dale L, Min JE. Incremental expenditures attributable to daily dispensation and witnessed ingestion for opioid agonist treatment in British Columbia: 2014–20. Addiction. 2023;118(7):1376–1380. https://doi.org/10.1111/add.16160</p><p>In the “Acknowledgements” section, the text “This work was funded by a Health Canada Substance Use and Addictions Program grant no. 1819-HQ-000036. We would like to thank Patrick Day (Pharmaceuticals Analytics, Government of British Columbia) for his consultation and contributions to the conceptualization of this article. All inferences, opinions and conclusions drawn in this study are those of the authors and do not reflect the opinions or policies of the Data Steward(s).” was missing a funding source.</p><p>This should have read: “This work was funded by a Health Canada Substance Use and Addictions Program (grant no. 1819-HQ-000036) and the National Institutes on Drug Abuse (NIDA grant no. R01DA050629). We would like to thank Patrick Day (Pharmaceuticals Analytics, Government of British Columbia) for his consultation and contributions to the conceptualization of this article. All inferences, opinions and conclusions drawn in this study are those of the authors and do not reflect the opinions or policies of the Data Steward(s).”</p><p>We apologize for this error.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 6","pages":"1143"},"PeriodicalIF":6.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16489","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140142351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The contribution by Newall and Swanton [<span>1</span>] is an interesting new addition to the discussion on how to reduce gambling harm via player tracking. As the authors note, until recent years player tracking has been mostly used to the advantage of the gambling industry. Gambling companies are able to gather much information, of which the gambler is mostly unaware. Recent access to data of the gambling company Flutter based on the United Kingdom's public information laws showed that there were ~93 data points about one single individual [<span>2</span>].</p><p>The idea of using this data from player tracking for harm reduction is an intriguing idea. However, the mandatory gambling cards issued in Finland and some other countries for this purpose are used also in a problematic manner. The Finnish government monopoly in online gambling will be dismantled by 2026, and the government-owned operator Veikkaus is now trying to get as many consumers as possible to register for its own gambling card to grow its customer base. By doing so, it will gain a competitive advantage over competition from abroad, when the online market opens. This aim of channeling gambling proceeds back to Finland is, therefore, also a political strategy [<span>3</span>].</p><p>Although in Finland gambling is regulated through a state monopoly, with a public health justification, the government has a conflict of interest, because government in practice is the gambling monopoly [<span>4-6</span>]. The effective collection of gambling proceeds is an important goal for governments upholding gambling monopolies [<span>7</span>]. Especially in a situation in which the tax burden is increasingly on individuals in the form of sales and excise taxes, governments are keenly interested in upholding the gambling revenue stream [<span>8-10</span>].</p><p>Because not even the government-owned gambling operators are to be trusted with the task of advancing public health, the question is how much the universal player tracking system would be able to accomplish via privately held operators. Newall and Swanton [<span>1</span>] give examples of the current social responsibility measures of gambling operators, such as contacting consumers who gamble ‘excessively’. Based on available information from Swedish operators, including both monopolistic and privately held companies, it is difficult to say how much is achieved with this practice [<span>11</span>]. The most effective measures to reduce gambling-related harm are the ones that apply to all gamblers, reducing total consumption [<span>12</span>].</p><p>Although universal player tracking may be a step into right direction when not controlled by the gambling industry itself, as Newall and Swanton [<span>1</span>] suggest, additional measures are needed to ensure that player tracking reduces the harm as effectively as possible. A personal gambling license (cf. driver's license, a permit to carry a weapon) could be introduced alongside playe
{"title":"Player tracking in itself may not be enough for efficient reduction of gambling harm, but combined with a personal gambling license could provide new possibilities to tracking gambling-related harm","authors":"Janne Nikkinen","doi":"10.1111/add.16482","DOIUrl":"10.1111/add.16482","url":null,"abstract":"<p>The contribution by Newall and Swanton [<span>1</span>] is an interesting new addition to the discussion on how to reduce gambling harm via player tracking. As the authors note, until recent years player tracking has been mostly used to the advantage of the gambling industry. Gambling companies are able to gather much information, of which the gambler is mostly unaware. Recent access to data of the gambling company Flutter based on the United Kingdom's public information laws showed that there were ~93 data points about one single individual [<span>2</span>].</p><p>The idea of using this data from player tracking for harm reduction is an intriguing idea. However, the mandatory gambling cards issued in Finland and some other countries for this purpose are used also in a problematic manner. The Finnish government monopoly in online gambling will be dismantled by 2026, and the government-owned operator Veikkaus is now trying to get as many consumers as possible to register for its own gambling card to grow its customer base. By doing so, it will gain a competitive advantage over competition from abroad, when the online market opens. This aim of channeling gambling proceeds back to Finland is, therefore, also a political strategy [<span>3</span>].</p><p>Although in Finland gambling is regulated through a state monopoly, with a public health justification, the government has a conflict of interest, because government in practice is the gambling monopoly [<span>4-6</span>]. The effective collection of gambling proceeds is an important goal for governments upholding gambling monopolies [<span>7</span>]. Especially in a situation in which the tax burden is increasingly on individuals in the form of sales and excise taxes, governments are keenly interested in upholding the gambling revenue stream [<span>8-10</span>].</p><p>Because not even the government-owned gambling operators are to be trusted with the task of advancing public health, the question is how much the universal player tracking system would be able to accomplish via privately held operators. Newall and Swanton [<span>1</span>] give examples of the current social responsibility measures of gambling operators, such as contacting consumers who gamble ‘excessively’. Based on available information from Swedish operators, including both monopolistic and privately held companies, it is difficult to say how much is achieved with this practice [<span>11</span>]. The most effective measures to reduce gambling-related harm are the ones that apply to all gamblers, reducing total consumption [<span>12</span>].</p><p>Although universal player tracking may be a step into right direction when not controlled by the gambling industry itself, as Newall and Swanton [<span>1</span>] suggest, additional measures are needed to ensure that player tracking reduces the harm as effectively as possible. A personal gambling license (cf. driver's license, a permit to carry a weapon) could be introduced alongside playe","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 7","pages":"1168-1169"},"PeriodicalIF":6.0,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16482","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140139661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christine Vinci, Cho Y. Lam, Paul E. Etcheverry, Virmarie Correa-Fernandez, Miguel Ángel Cano, Paul M. Cinciripini, David W. Wetter
Aims
Three smoking cessation studies (CARE, Break Free, Por Nuestra Salud [PNS]) were used to measure changes in average alcohol consumption, binge drinking and alcohol-related problems during a smoking cessation attempt and to explore co-action with smoking abstinence.
Design
CARE and PNS were longitudinal cohort cessation studies; Break Free was a two-arm randomized clinical trial.
Setting
Texas, USA.
Participants
Participants were current smokers who were recruited from the community and received smoking cessation interventions. All participants received nicotine replacement therapy and smoking cessation counseling. CARE included 424 smokers (1/3 White, 1/3 African American and 1/3 Latino); Break Free included 399 African American smokers; PNS included 199 Spanish-speaking Mexican-American smokers.
Measurements
Weekly alcohol consumption was collected multiple times pre and post-quit, and binge drinking and alcohol-related problems were collected at baseline and 26 weeks post-quit. Analyses included only those who indicated current alcohol use.
Findings
Average alcohol consumption decreased from baseline to 26 weeks post-quit in CARE (F = 17.09, P < 0.001), Break Free (F = 12.08, P < 0.001) and PNS (F = 10.21, P < 0.001). Binge drinking decreased from baseline to 26 weeks post-quit in CARE (F = 3.94, P = 0.04) and Break Free (F = 10.41, P < 0.001) but not PNS. Alcohol-related problems decreased from baseline to 26 weeks post-quit in CARE (Chi-sq = 6.41, P = 0.010) and Break Free (Chi sq = 14.44, P = 0.001), but not PNS.
Conclusions
Among current drinkers, alcohol use/problems appear to decrease during a smoking cessation attempt and remain low through 26 weeks after the quit attempt. Little evidence was found for co-action, with smoking abstainers and relapsers showing similar change in alcohol use/problems.
{"title":"Co-action and changes in alcohol use during a smoking cessation attempt","authors":"Christine Vinci, Cho Y. Lam, Paul E. Etcheverry, Virmarie Correa-Fernandez, Miguel Ángel Cano, Paul M. Cinciripini, David W. Wetter","doi":"10.1111/add.16472","DOIUrl":"10.1111/add.16472","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Three smoking cessation studies (CARE, Break Free, Por Nuestra Salud [PNS]) were used to measure changes in average alcohol consumption, binge drinking and alcohol-related problems during a smoking cessation attempt and to explore co-action with smoking abstinence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>CARE and PNS were longitudinal cohort cessation studies; Break Free was a two-arm randomized clinical trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Texas, USA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Participants were current smokers who were recruited from the community and received smoking cessation interventions. All participants received nicotine replacement therapy and smoking cessation counseling. CARE included 424 smokers (1/3 White, 1/3 African American and 1/3 Latino); Break Free included 399 African American smokers; PNS included 199 Spanish-speaking Mexican-American smokers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Weekly alcohol consumption was collected multiple times pre and post-quit, and binge drinking and alcohol-related problems were collected at baseline and 26 weeks post-quit. Analyses included only those who indicated current alcohol use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Average alcohol consumption decreased from baseline to 26 weeks post-quit in CARE (<i>F</i> = 17.09, <i>P</i> < 0.001), Break Free (<i>F</i> = 12.08, <i>P <</i> 0.001) and PNS (<i>F</i> = 10.21, <i>P</i> < 0.001). Binge drinking decreased from baseline to 26 weeks post-quit in CARE (<i>F</i> = 3.94, <i>P</i> = 0.04) and Break Free (<i>F</i> = 10.41, <i>P</i> < 0.001) but not PNS. Alcohol-related problems decreased from baseline to 26 weeks post-quit in CARE (<i>Chi-sq</i> = 6.41, <i>P</i> = 0.010) and Break Free (<i>Chi sq</i> = 14.44, <i>P</i> = 0.001), but not PNS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among current drinkers, alcohol use/problems appear to decrease during a smoking cessation attempt and remain low through 26 weeks after the quit attempt. Little evidence was found for co-action, with smoking abstainers and relapsers showing similar change in alcohol use/problems.</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 6","pages":"1059-1070"},"PeriodicalIF":6.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In their article, Newall and Swanton [<span>1</span>] make many important observations about the significance of online tracking for academic research and in the development of safer gambling measures. On the whole, I agree with many of their arguments. Online tracking data provide a valuable source of insights into actual gambling behaviour and associated harms [<span>2</span>]. Such information, whether used retrospectively or in real-time, can be used to inform safer gambling practices [<span>3, 4</span>]. These include the application of play limits; the provision of player information; self-exclusion policies; and the development of harm indicators/risk-detection algorithms [<span>5, 6</span>]. It is observed that, although some single operators have developed technology in these areas, there are fundamental challenges. On the demand side, people can use multiple operators and accounts or set non-binding play limits, whereas on the supply side, there may be difficulties gaining consistency across multiple operators or where some gambling is offered offline [<span>2</span>]. For these reasons, the authors discuss the benefits of a ‘single-customer view’ in which the access point for all gambling might be via an independent organisation that provides monitoring and aggregate safer gambling functionality [<span>1</span>].</p><p>Although such a model is being discussed in some countries (e.g. United Kingdom) [<span>6</span>] and is partially implemented in some Scandinavian countries [<span>7</span>], there are several practical challenges. First, the consolidation of large amounts of data in a single place, presumably in combination with a know-your-customer system, raises concerns around player privacy. Not only could such information be accessed by third parties for other purposes (e.g. credit agencies/loan approvers) with detrimental consequences for customers, it creates a target or ‘honey-pot’ for cyber attackers. A second issue is the ability to apply tracking in countries with State or Province based laws. For example, in Australia, laws relating to online gambling are applied federally, whereas all other forms of land-based gambling are subject to State laws. Each jurisdiction has multiple sectors (casinos, hotels and clubs), and within these, there are separate operators (e.g. chains or hotels or club syndicates). A third practical issue is the danger of leakage effects in the form of an outflow of higher risk customers to unregulated sites elsewhere using either fiat off-ramps (e.g. Paypal) or direct transfers of value using decentralised blockchain-based wallets. Such sites may have few safer gambling provisions.</p><p>Moreover, on the conceptual and design-side, there is the issue of the specifications of aggregated limit-setting and monitoring. How does one determine appropriate levels of expenditure? A commonly suggested solution are ‘affordability checks’ [<span>8</span>], but establishing wealth is a complex process (e.g. cas
{"title":"The benefits and challenges of online player tracking","authors":"Paul Delfabbro","doi":"10.1111/add.16480","DOIUrl":"10.1111/add.16480","url":null,"abstract":"<p>In their article, Newall and Swanton [<span>1</span>] make many important observations about the significance of online tracking for academic research and in the development of safer gambling measures. On the whole, I agree with many of their arguments. Online tracking data provide a valuable source of insights into actual gambling behaviour and associated harms [<span>2</span>]. Such information, whether used retrospectively or in real-time, can be used to inform safer gambling practices [<span>3, 4</span>]. These include the application of play limits; the provision of player information; self-exclusion policies; and the development of harm indicators/risk-detection algorithms [<span>5, 6</span>]. It is observed that, although some single operators have developed technology in these areas, there are fundamental challenges. On the demand side, people can use multiple operators and accounts or set non-binding play limits, whereas on the supply side, there may be difficulties gaining consistency across multiple operators or where some gambling is offered offline [<span>2</span>]. For these reasons, the authors discuss the benefits of a ‘single-customer view’ in which the access point for all gambling might be via an independent organisation that provides monitoring and aggregate safer gambling functionality [<span>1</span>].</p><p>Although such a model is being discussed in some countries (e.g. United Kingdom) [<span>6</span>] and is partially implemented in some Scandinavian countries [<span>7</span>], there are several practical challenges. First, the consolidation of large amounts of data in a single place, presumably in combination with a know-your-customer system, raises concerns around player privacy. Not only could such information be accessed by third parties for other purposes (e.g. credit agencies/loan approvers) with detrimental consequences for customers, it creates a target or ‘honey-pot’ for cyber attackers. A second issue is the ability to apply tracking in countries with State or Province based laws. For example, in Australia, laws relating to online gambling are applied federally, whereas all other forms of land-based gambling are subject to State laws. Each jurisdiction has multiple sectors (casinos, hotels and clubs), and within these, there are separate operators (e.g. chains or hotels or club syndicates). A third practical issue is the danger of leakage effects in the form of an outflow of higher risk customers to unregulated sites elsewhere using either fiat off-ramps (e.g. Paypal) or direct transfers of value using decentralised blockchain-based wallets. Such sites may have few safer gambling provisions.</p><p>Moreover, on the conceptual and design-side, there is the issue of the specifications of aggregated limit-setting and monitoring. How does one determine appropriate levels of expenditure? A commonly suggested solution are ‘affordability checks’ [<span>8</span>], but establishing wealth is a complex process (e.g. cas","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 7","pages":"1166-1167"},"PeriodicalIF":6.0,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16480","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140108472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter Sarich, Shuhan Gao, Yining Zhu, Karen Canfell, Marianne F. Weber
Background and aims
Systematic reviews of the relationship between alcohol consumption and all-cause mortality have reported different relative risk (RR) curves, possibly due to the choice of reference group. Results have varied from ‘J-shaped’ curves, where low-volume consumption is associated with reduced risk, to monotonically increased risk with increasing consumption. We summarised the evidence on alcohol consumption and all-cause mortality exclusively from systematic reviews using lifetime abstainers or low-volume/occasional drinkers as the reference group.
Methods
We conducted a systematic umbrella review of systematic reviews of the relationship between alcohol consumption and all-cause mortality in prospective cohort studies using a reference group of lifetime abstainers or low-volume/occasional drinkers. Several databases (PubMed/Medline/Embase/PsycINFO/Cochrane Library) were searched to March 2022. Reviews were assessed for risk of bias, and those with reference groups containing former drinkers were excluded.
Results
From 2149 articles retrieved, 25 systematic reviews were identified, and five did not include former drinkers in the reference group. Four of the five included reviews had high risk of bias. Three reviews reported a J-shaped relationship between alcohol consumption and all-cause mortality with significant decreased risk for low-volume drinking (RR range 0.84 to 0.95), while two reviews did not. The one review at low risk of bias reported monotonically increased risk with greater consumption (RRs = 1.02, 1.13, 1.33 and 1.52 for low-, medium-, high- and higher-volume drinking, respectively, compared with occasional drinking). All five reviews reported significantly increased risk with higher levels of alcohol consumption (RR range 1.28 to 3.70). Sub-group analyses were reported by sex and age; however, there were evidence gaps for many important factors. Conversely, 17 of 20 excluded systematic reviews reported decreased mortality risk for low-volume drinking.
Conclusions
Over 70% of systematic reviews and meta-analyses published to March 2022 of all-cause mortality risk associated with alcohol consumption did not exclude former drinkers from the reference group and may therefore be biased by the ‘sick-quitter effect’.
{"title":"The association between alcohol consumption and all-cause mortality: An umbrella review of systematic reviews using lifetime abstainers or low-volume drinkers as a reference group","authors":"Peter Sarich, Shuhan Gao, Yining Zhu, Karen Canfell, Marianne F. Weber","doi":"10.1111/add.16446","DOIUrl":"10.1111/add.16446","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>Systematic reviews of the relationship between alcohol consumption and all-cause mortality have reported different relative risk (RR) curves, possibly due to the choice of reference group. Results have varied from ‘J-shaped’ curves, where low-volume consumption is associated with reduced risk, to monotonically increased risk with increasing consumption. We summarised the evidence on alcohol consumption and all-cause mortality exclusively from systematic reviews using lifetime abstainers or low-volume/occasional drinkers as the reference group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic umbrella review of systematic reviews of the relationship between alcohol consumption and all-cause mortality in prospective cohort studies using a reference group of lifetime abstainers or low-volume/occasional drinkers. Several databases (PubMed/Medline/Embase/PsycINFO/Cochrane Library) were searched to March 2022. Reviews were assessed for risk of bias, and those with reference groups containing former drinkers were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 2149 articles retrieved, 25 systematic reviews were identified, and five did not include former drinkers in the reference group. Four of the five included reviews had high risk of bias. Three reviews reported a J-shaped relationship between alcohol consumption and all-cause mortality with significant decreased risk for low-volume drinking (RR range 0.84 to 0.95), while two reviews did not. The one review at low risk of bias reported monotonically increased risk with greater consumption (RRs = 1.02, 1.13, 1.33 and 1.52 for low-, medium-, high- and higher-volume drinking, respectively, compared with occasional drinking). All five reviews reported significantly increased risk with higher levels of alcohol consumption (RR range 1.28 to 3.70). Sub-group analyses were reported by sex and age; however, there were evidence gaps for many important factors. Conversely, 17 of 20 excluded systematic reviews reported decreased mortality risk for low-volume drinking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Over 70% of systematic reviews and meta-analyses published to March 2022 of all-cause mortality risk associated with alcohol consumption did not exclude former drinkers from the reference group and may therefore be biased by the ‘sick-quitter effect’.</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 6","pages":"998-1012"},"PeriodicalIF":6.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Virginia Berridge, Amy Lauren Fairchild, Kylie Morphett, Coral Gartner, Wayne Hall, Ronald Bayer
Background
England, Australia and the United States have approached the regulation of e-cigarettes in very different ways, yet all three countries have appealed to the concept of evidence as underpinning policy responses. We compared these policy responses using a combination of the methodologies of historians and policy scientists in order to elucidate the factors that had influenced policy in each country.
Argument/Analysis
Each country’s evidence and values intersected in different ways, producing very different responses within specific national contexts and histories. Our analysis accordingly emphasized the historical precursors of the policy issues raised by e-cigarettes and placed the policy debate within the context of regulatory bodies and the networks of researchers and advocates who influenced policy. Issues also of importance were the nature of the state; political context; the pre-history of nicotine for smoking cessation; the role of activism and its links with government; the influence of harm reduction ideas from drugs and HIV; and finally, whom policy was perceived to benefit. In the United Kingdom, based on this pre-history of the smoking issue, it was the existing smoker, while in the United States and Australia, protecting children and adolescents has played a central role.
Conclusions
Structural and historical factors appear to underpin differences in e-cigarette policy development in England, Australia and the United States.
{"title":"E-cigarettes: A framework for comparative history and policy","authors":"Virginia Berridge, Amy Lauren Fairchild, Kylie Morphett, Coral Gartner, Wayne Hall, Ronald Bayer","doi":"10.1111/add.16462","DOIUrl":"10.1111/add.16462","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>England, Australia and the United States have approached the regulation of e-cigarettes in very different ways, yet all three countries have appealed to the concept of evidence as underpinning policy responses. We compared these policy responses using a combination of the methodologies of historians and policy scientists in order to elucidate the factors that had influenced policy in each country.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Argument/Analysis</h3>\u0000 \u0000 <p>Each country’s evidence and values intersected in different ways, producing very different responses within specific national contexts and histories. Our analysis accordingly emphasized the historical precursors of the policy issues raised by e-cigarettes and placed the policy debate within the context of regulatory bodies and the networks of researchers and advocates who influenced policy. Issues also of importance were the nature of the state; political context; the pre-history of nicotine for smoking cessation; the role of activism and its links with government; the influence of harm reduction ideas from drugs and HIV; and finally, whom policy was perceived to benefit. In the United Kingdom, based on this pre-history of the smoking issue, it was the existing smoker, while in the United States and Australia, protecting children and adolescents has played a central role.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Structural and historical factors appear to underpin differences in e-cigarette policy development in England, Australia and the United States.</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 11","pages":"1864-1870"},"PeriodicalIF":5.2,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16462","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140100472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In a 2014 Cochrane Review, Siegfried and colleagues [<span>1</span>] concluded there was an absence of robust evidence for or against statutory restrictions on alcohol advertising. Ten years on, Manthey and colleagues [<span>2</span>] find this situation largely unchanged. This is despite the earlier review recommending that future restrictions be implemented alongside robust research programmes to ensure evaluation of all relevant outcomes over time [<span>1</span>]. That two reviews, published a decade apart, reach similar assessments about the state of the evidence comes down to a central and recurrent issue in alcohol marketing literature—we are not capitalising on opportunities to generate robust naturalistic data about the impact of these statutory restrictions.</p><p>This is not intended to devalue the findings of existing research into alcohol marketing restrictions, which has improved markedly in recent years. There is now evidence that Norway's advertising ban reduced recorded alcohol sales [<span>3</span>], that Ireland's Public Health (Alcohol) Act reduced past-month awareness of some advertising activities among adults [<span>4</span>] and that France's Évin law on advertising content reduces positive reactions among young adults [<span>5</span>]. There is also recent evidence about the process of designing and implementing marketing restrictions in multiple European countries [<span>6</span>] and growing evidence of how companies circumvent restrictions using alibi and surrogate marketing [<span>7-9</span>]. These provide key insight into the application and impact of marketing restrictions and highlight the importance of considering outcomes beyond consumption, the focus of the two prior reviews.</p><p>The principal issue, however, is that the overall evidence base remains disparate, with no single jurisdiction providing a comprehensive evaluation of their restrictions. Instead, studies are limited in terms of the outcomes considered, populations sampled and restrictions evaluated. There is also heterogeneity in the methods used, which creates challenges in comparing the relative impact of different degrees of restrictions (e.g. full bans, partial restrictions and content controls).</p><p>Going forward, alcohol marketing restrictions should be accompanied by comprehensive evaluation programmes, making best use of naturalistic experimental designs that are well established as an appropriate way of evaluating the health impacts of policies, programmes and interventions [<span>10</span>]. These programmes should be guided by theories of change and logic models, involving structured identification of the key outcomes anticipated from the restrictions, the indicators needed to examine them (including differences among subpopulations) and the data required to ensure robust evaluation. For example, in addition to consumption, evaluations should consider changes in both marketing exposure and the key antecedents to alcohol use that are
{"title":"Commentary on Manthey et al.: No more missed opportunities—We need to address the absence of robust and comprehensive evaluations about the real-world impact of statutory restrictions on alcohol marketing","authors":"Nathan Critchlow","doi":"10.1111/add.16471","DOIUrl":"10.1111/add.16471","url":null,"abstract":"<p>In a 2014 Cochrane Review, Siegfried and colleagues [<span>1</span>] concluded there was an absence of robust evidence for or against statutory restrictions on alcohol advertising. Ten years on, Manthey and colleagues [<span>2</span>] find this situation largely unchanged. This is despite the earlier review recommending that future restrictions be implemented alongside robust research programmes to ensure evaluation of all relevant outcomes over time [<span>1</span>]. That two reviews, published a decade apart, reach similar assessments about the state of the evidence comes down to a central and recurrent issue in alcohol marketing literature—we are not capitalising on opportunities to generate robust naturalistic data about the impact of these statutory restrictions.</p><p>This is not intended to devalue the findings of existing research into alcohol marketing restrictions, which has improved markedly in recent years. There is now evidence that Norway's advertising ban reduced recorded alcohol sales [<span>3</span>], that Ireland's Public Health (Alcohol) Act reduced past-month awareness of some advertising activities among adults [<span>4</span>] and that France's Évin law on advertising content reduces positive reactions among young adults [<span>5</span>]. There is also recent evidence about the process of designing and implementing marketing restrictions in multiple European countries [<span>6</span>] and growing evidence of how companies circumvent restrictions using alibi and surrogate marketing [<span>7-9</span>]. These provide key insight into the application and impact of marketing restrictions and highlight the importance of considering outcomes beyond consumption, the focus of the two prior reviews.</p><p>The principal issue, however, is that the overall evidence base remains disparate, with no single jurisdiction providing a comprehensive evaluation of their restrictions. Instead, studies are limited in terms of the outcomes considered, populations sampled and restrictions evaluated. There is also heterogeneity in the methods used, which creates challenges in comparing the relative impact of different degrees of restrictions (e.g. full bans, partial restrictions and content controls).</p><p>Going forward, alcohol marketing restrictions should be accompanied by comprehensive evaluation programmes, making best use of naturalistic experimental designs that are well established as an appropriate way of evaluating the health impacts of policies, programmes and interventions [<span>10</span>]. These programmes should be guided by theories of change and logic models, involving structured identification of the key outcomes anticipated from the restrictions, the indicators needed to examine them (including differences among subpopulations) and the data required to ensure robust evaluation. For example, in addition to consumption, evaluations should consider changes in both marketing exposure and the key antecedents to alcohol use that are ","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 5","pages":"812-814"},"PeriodicalIF":6.0,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16471","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140058111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jakob Manthey, Britta Jacobsen, Bernd Schulte, Jürgen Rehm
<p>We appreciate the critical comment made by our colleague Dr Sally Casswell [<span>1</span>]. As pointed out in her critique, the impact of marketing restrictions may not be comparable to the effects of pricing policies and availability restrictions. Casswell acknowledges that ‘ensuring a real change as a result of policy intervention’ is difficult to establish for marketing restrictions, summarizing a key finding of our systematic review [<span>2</span>]. We agree that marketing plays a crucial role for the alcohol industry, we endorse any measures that effectively reduce the exposure of the population to marketing and we advocate for more nuanced approaches to evaluate the effectiveness of marketing bans.</p><p>Although we agree with most of the points raised by Dr Casswell, we disagree with the argument put forward regarding partial marketing bans. As partial marketing bans may not necessarily result in a reduction of marketing exposure in the population, Dr Casswell argues that we should not have included partial bans in our review. Considering partial bans appears to limit her confidence in our conclusion, namely that we found insufficient evidence to support the World Health Organization (WHO) assertion that alcohol marketing restrictions constitute a ‘best buy’.</p><p>We are responding to this criticism with two arguments. First, the latest iteration of this ‘best buy’ adopted by the World Health Assembly in 2023 states ‘Enact and enforce bans or comprehensive restrictions on exposure to alcohol advertising (across multiple types of media)’ [<span>3</span>], whereas the earlier Global Action Plan referred to ‘Restricting or banning alcohol advertising and promotions’ [<span>4</span>]. Therefore, we argue that partial bans can be considered a ‘best buy’ based on official definitions. Second, we have identified five studies that evaluated complete marketing bans [<span>5-9</span>]. However, only one study found a reduction in alcohol consumption following policy implementation [<span>7</span>]. Therefore, our conclusion would not have been different if we had focused exclusively on complete bans.</p><p>Our work does not question the relevance of marketing restrictions for public health. However, we challenge the categorisation of alcohol marketing bans as a ‘best buy’, which gives pricing, availability policies and marketing restrictions equal priority based on cost-effectiveness and ease of implementation [<span>4</span>]. However, a measure cannot be called cost-effective if there is no evidence for effectiveness. Moreover, it may not be easy to implement bans on marketing because the industry often finds ways to circumvent them, and full enforcement will affect the cost-effectiveness further. Finally, the time scale of effect from bans is not clear [<span>10</span>]. In conclusion, labelling marketing restriction as ‘best buy’ can create false expectations for policymakers.</p><p>Currently, it is suggested that alcohol marketing restric
{"title":"Rescheduling alcohol marketing bans within the World Health Organization menu of policy options","authors":"Jakob Manthey, Britta Jacobsen, Bernd Schulte, Jürgen Rehm","doi":"10.1111/add.16476","DOIUrl":"10.1111/add.16476","url":null,"abstract":"<p>We appreciate the critical comment made by our colleague Dr Sally Casswell [<span>1</span>]. As pointed out in her critique, the impact of marketing restrictions may not be comparable to the effects of pricing policies and availability restrictions. Casswell acknowledges that ‘ensuring a real change as a result of policy intervention’ is difficult to establish for marketing restrictions, summarizing a key finding of our systematic review [<span>2</span>]. We agree that marketing plays a crucial role for the alcohol industry, we endorse any measures that effectively reduce the exposure of the population to marketing and we advocate for more nuanced approaches to evaluate the effectiveness of marketing bans.</p><p>Although we agree with most of the points raised by Dr Casswell, we disagree with the argument put forward regarding partial marketing bans. As partial marketing bans may not necessarily result in a reduction of marketing exposure in the population, Dr Casswell argues that we should not have included partial bans in our review. Considering partial bans appears to limit her confidence in our conclusion, namely that we found insufficient evidence to support the World Health Organization (WHO) assertion that alcohol marketing restrictions constitute a ‘best buy’.</p><p>We are responding to this criticism with two arguments. First, the latest iteration of this ‘best buy’ adopted by the World Health Assembly in 2023 states ‘Enact and enforce bans or comprehensive restrictions on exposure to alcohol advertising (across multiple types of media)’ [<span>3</span>], whereas the earlier Global Action Plan referred to ‘Restricting or banning alcohol advertising and promotions’ [<span>4</span>]. Therefore, we argue that partial bans can be considered a ‘best buy’ based on official definitions. Second, we have identified five studies that evaluated complete marketing bans [<span>5-9</span>]. However, only one study found a reduction in alcohol consumption following policy implementation [<span>7</span>]. Therefore, our conclusion would not have been different if we had focused exclusively on complete bans.</p><p>Our work does not question the relevance of marketing restrictions for public health. However, we challenge the categorisation of alcohol marketing bans as a ‘best buy’, which gives pricing, availability policies and marketing restrictions equal priority based on cost-effectiveness and ease of implementation [<span>4</span>]. However, a measure cannot be called cost-effective if there is no evidence for effectiveness. Moreover, it may not be easy to implement bans on marketing because the industry often finds ways to circumvent them, and full enforcement will affect the cost-effectiveness further. Finally, the time scale of effect from bans is not clear [<span>10</span>]. In conclusion, labelling marketing restriction as ‘best buy’ can create false expectations for policymakers.</p><p>Currently, it is suggested that alcohol marketing restric","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 6","pages":"1141-1142"},"PeriodicalIF":6.0,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16476","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140058112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tessa Carr, Carolin Kilian, Laura Llamosas-Falcón, Yachen Zhu, Aurélie M. Lasserre, Klajdi Puka, Charlotte Probst
Background and aims
Increasing levels of alcohol use are associated with a risk of developing an alcohol use disorder (AUD), which, in turn, is associated with considerable burden. Our aim was to estimate the risk relationships between alcohol consumption and AUD incidence and mortality.
Method
A systematic literature search was conducted, using Medline, Embase, PsycINFO and Web of Science for case–control or cohort studies published between 1 January 2000 and 8 July 2022. These were required to report alcohol consumption, AUD incidence and/or AUD mortality (including 100% alcohol-attributable deaths). The protocol was registered with PROSPERO (CRD42022343201). Dose–response and random-effects meta-analyses were used to determine the risk relationships between alcohol consumption and AUD incidence and mortality and mortality rates in AUD patients, respectively.
Results
Of the 5904 reports identified, seven and three studies from high-income countries and Brazil met the inclusion criteria for quantitative and qualitative syntheses, respectively. In addition, two primary US data sources were analyzed. Higher levels of alcohol consumption increased the risk of developing or dying from an AUD exponentially. At an average consumption of four standard drinks (assuming 10 g of pure alcohol/standard drink) per day, the risk of developing an AUD was increased sevenfold [relative risk (RR) = 7.14, 95% confidence interval (CI) = 5.13–9.93] and the risk of dying fourfold (RR = 3.94, 95% CI = 3.53–4.40) compared with current non-drinkers. The mortality rate in AUD patients was 3.13 (95% CI = 1.07–9.13) per 1000 person-years.
Conclusions
There are exponential positive risk relationships between alcohol use and both alcohol use disorder incidence and mortality. Even at an average consumption of 20 g/day (about one large beer), the risk of developing an alcohol use disorder (AUD) is nearly threefold that of current non-drinkers and the risk of dying from an AUD is approximately double that of current non-drinkers.
{"title":"The risk relationships between alcohol consumption, alcohol use disorder and alcohol use disorder mortality: A systematic review and meta-analysis","authors":"Tessa Carr, Carolin Kilian, Laura Llamosas-Falcón, Yachen Zhu, Aurélie M. Lasserre, Klajdi Puka, Charlotte Probst","doi":"10.1111/add.16456","DOIUrl":"10.1111/add.16456","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>Increasing levels of alcohol use are associated with a risk of developing an alcohol use disorder (AUD), which, in turn, is associated with considerable burden. Our aim was to estimate the risk relationships between alcohol consumption and AUD incidence and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A systematic literature search was conducted, using Medline, Embase, PsycINFO and Web of Science for case–control or cohort studies published between 1 January 2000 and 8 July 2022. These were required to report alcohol consumption, AUD incidence and/or AUD mortality (including 100% alcohol-attributable deaths). The protocol was registered with PROSPERO (CRD42022343201). Dose–response and random-effects meta-analyses were used to determine the risk relationships between alcohol consumption and AUD incidence and mortality and mortality rates in AUD patients, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 5904 reports identified, seven and three studies from high-income countries and Brazil met the inclusion criteria for quantitative and qualitative syntheses, respectively. In addition, two primary US data sources were analyzed. Higher levels of alcohol consumption increased the risk of developing or dying from an AUD exponentially. At an average consumption of four standard drinks (assuming 10 g of pure alcohol/standard drink) per day, the risk of developing an AUD was increased sevenfold [relative risk (RR) = 7.14, 95% confidence interval (CI) = 5.13–9.93] and the risk of dying fourfold (RR = 3.94, 95% CI = 3.53–4.40) compared with current non-drinkers. The mortality rate in AUD patients was 3.13 (95% CI = 1.07–9.13) per 1000 person-years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There are exponential positive risk relationships between alcohol use and both alcohol use disorder incidence and mortality. Even at an average consumption of 20 g/day (about one large beer), the risk of developing an alcohol use disorder (AUD) is nearly threefold that of current non-drinkers and the risk of dying from an AUD is approximately double that of current non-drinkers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 7","pages":"1174-1187"},"PeriodicalIF":6.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16456","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140048223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Janna Cousijn, Lauren Kuhns, Francesca Filbey, Tom P. Freeman, Emese Kroon
<p>The past two decades have seen increased legalization of recreational cannabis use across the globe, increased prevalence of use and emerging evidence of increased cannabis-related harms [<span>1</span>]. We argue that precisely how cannabis impacts people who use cannabis, as well as who is likely to use cannabis and why, may vary substantially depending upon variation in legislation, products, promotion, methods of use, social acceptability and norms around use. These factors create unique and regionally specific ‘cannabis contexts’. Although contextual and broader cross-cultural considerations apply to all addictions we believe they are particularly important for cannabis, given the global changes towards more lenient cannabis policies. We aim to increase awareness and stimulate research and debate regarding how cannabis contexts may shape the processes underlying cannabis use disorder (CUD) and associated outcomes.</p><p>The percentage of Δ9-tetrahydrocannabinol (THC) in cannabis products has been increasing internationally [<span>1</span>], but there are substantial differences among regions, markets and type of product [<span>1</span>]. Use of higher-potency cannabis products appears to have risen in the United States and may be more common in states that legalized cannabis [<span>2</span>]. These temporal and regional differences may have health implications [<span>3</span>]. Further increasing regional and individual differences in cannabinoid exposure, new THC products are rising in popularity in the US market, with one in six cannabis users reporting Δ8-THC use [<span>4</span>]. Δ8-THC produces fewer psychoactive effects than Δ9-THC, and may be preferred among those seeking medicinal benefit, indicating a potential difference in attitudes towards use.</p><p>Common routes of administration (ROA) also differ throughout regions and impact the bioavailability of cannabinoids. Cannabis combustion results in faster onset of action and higher blood cannabinoid levels relative to oral ingestion [<span>5</span>]. While smoking is still the most prevalent ROA in the United States and Canada, edible products are rising [<span>6</span>] and smoked cannabis flower combined with tobacco is still most common in European countries [<span>7</span>]. Nicotine and cannabinoids may have compensatory and synergistic neurobiological effects [<span>8</span>], and nicotine–cannabis co-users may have more severe CUD prognoses [<span>9</span>]. These regional variations may result in differential effects of frequent cannabis use on CUD and other physical, cognitive and mental health outcomes.</p><p>Cannabis policies, as well as perceived norms surrounding it, may also influence trajectories of cannabis use, and probably contribute to regional differences in the prevalence of use and CUD. More permissive community attitudes are associated with heightened cannabis use [<span>10</span>]. The interplay of policies and social attitudes may feed into and interact w
{"title":"Cannabis research in context: The case for measuring and embracing regional similarities and differences","authors":"Janna Cousijn, Lauren Kuhns, Francesca Filbey, Tom P. Freeman, Emese Kroon","doi":"10.1111/add.16460","DOIUrl":"10.1111/add.16460","url":null,"abstract":"<p>The past two decades have seen increased legalization of recreational cannabis use across the globe, increased prevalence of use and emerging evidence of increased cannabis-related harms [<span>1</span>]. We argue that precisely how cannabis impacts people who use cannabis, as well as who is likely to use cannabis and why, may vary substantially depending upon variation in legislation, products, promotion, methods of use, social acceptability and norms around use. These factors create unique and regionally specific ‘cannabis contexts’. Although contextual and broader cross-cultural considerations apply to all addictions we believe they are particularly important for cannabis, given the global changes towards more lenient cannabis policies. We aim to increase awareness and stimulate research and debate regarding how cannabis contexts may shape the processes underlying cannabis use disorder (CUD) and associated outcomes.</p><p>The percentage of Δ9-tetrahydrocannabinol (THC) in cannabis products has been increasing internationally [<span>1</span>], but there are substantial differences among regions, markets and type of product [<span>1</span>]. Use of higher-potency cannabis products appears to have risen in the United States and may be more common in states that legalized cannabis [<span>2</span>]. These temporal and regional differences may have health implications [<span>3</span>]. Further increasing regional and individual differences in cannabinoid exposure, new THC products are rising in popularity in the US market, with one in six cannabis users reporting Δ8-THC use [<span>4</span>]. Δ8-THC produces fewer psychoactive effects than Δ9-THC, and may be preferred among those seeking medicinal benefit, indicating a potential difference in attitudes towards use.</p><p>Common routes of administration (ROA) also differ throughout regions and impact the bioavailability of cannabinoids. Cannabis combustion results in faster onset of action and higher blood cannabinoid levels relative to oral ingestion [<span>5</span>]. While smoking is still the most prevalent ROA in the United States and Canada, edible products are rising [<span>6</span>] and smoked cannabis flower combined with tobacco is still most common in European countries [<span>7</span>]. Nicotine and cannabinoids may have compensatory and synergistic neurobiological effects [<span>8</span>], and nicotine–cannabis co-users may have more severe CUD prognoses [<span>9</span>]. These regional variations may result in differential effects of frequent cannabis use on CUD and other physical, cognitive and mental health outcomes.</p><p>Cannabis policies, as well as perceived norms surrounding it, may also influence trajectories of cannabis use, and probably contribute to regional differences in the prevalence of use and CUD. More permissive community attitudes are associated with heightened cannabis use [<span>10</span>]. The interplay of policies and social attitudes may feed into and interact w","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 9","pages":"1502-1504"},"PeriodicalIF":5.2,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16460","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140058110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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