Trends of cannabis use and related harms before and after legalization for recreational purpose in a developing country in Asia.

BACKGROUND: Thailand was the first country in Asia to legalize the use and purchase of cannabis leaves in February 2021 and the whole plant in June 2022 after the 2019 allowance for medical purposes. The study explored trends in cannabis use in Thailand before and after the recreational cannabis allowance was imposed. METHODS: Cannabis and other variables of substance use, cannabis use disorder, and attitude towards cannabis of the Thai population aged 18 to 65 years in 2019 (n = 5,002), 2020 (n = 5,389) and 2021 (n = 5,669) were obtained from annual surveys conducted in the last two months of each year by the Centre for Addiction Studies. The surveys were repeat cross-sectional surveys of the general population of Thailand. Repeated variables from at least two annual surveys were included for analysis using the Chi-square test and the t-test. RESULTS: The prevalence of cannabis use in the past year had increased from 2.2% in 2019 to 2.5% and 4.2% in 2020 and 2021 respectively, while those of methamphetamine, alcohol, and tobacco use had decreased. Trends in past-year drinking/eating cannabis products had increased, especially among the middle age group (40-49 years) from 2.1% (95% confidence interval (CI): 1.3, 3.1) in 2019 and 1.1% (95% CI: 0.6, 1.9) in 2020 to 3.8% (95% CI: 2.8, 5.0) in 2021. The younger population aged 18-19 had an increase in cannabis smoking from 0.9% (95% CI: 0.1, 3.3) in 2019 to 2.0% (95% CI: 0.5, 5.1) and 2.2% (95% CI: 0.7, 5.1) in 2020 and 2021 respectively. Symptoms of cannabis use disorder among cannabis users increased from 2019 to 2020 and then reversed afterwards in 2021. Thais had greater health knowledge about the benefits and harms of cannabis and had attitudes toward more harm of cannabis in 2021; however, 35.6% or a third of the sample in 2021 truly believed that cannabis was a cure for cancer, and 23.2% or one-fourth were uncertain or did not believe that cannabis was addictive. CONCLUSIONS: Although most of the substances had a lower prevalence of use during the COVID-19 pandemic in Thailand, cannabis had a higher use after legalization. Thai youth had a growing trend to smoke cannabis.

Canada?s Cannabis Legalization with Strict Public Health Control

To describe the impact of the legalization of cannabis for recreational use under strict public health control in 2018 on the fol-lowing outcomes: cannabis use and use patterns, attributable harm, economic considerations. Methodology: Narrative review based on govern-ment documents, surveys, and published literature. Results: The 12-month prevalence increased after legalization and has decreased during the COVID-19 pandemic. Little change in prevalence for adolescents. Persons with daily use remained stable. No rigorous studies on changes in attributable health harm, but some indication that harm, as measured in prevalence of cannabis use disorders, treatment rate, and attributable traffic injury remained stable. No data yet available for cancer. Cannabis attributable emergency visits increased, including among children (poisoning). Cannabis-related offences decreased as biggest public health gain. Economic predictions were not realized, and there is some pressure from cannabis industry to loosen public health regulations in order to increase use. Conclusions: Overall, while not achieving its main objectives of more youth protection and decreases in cannabis-attributable health harm, legalization with strict public health control resulted in less cannabis-related offences and up to now did not seem to increase cannabis-attributable disease burden.

Trinidad and Tobago and money laundering control: a country committed to strengthening the link

PurposeIn 2008, the author wrote on the Concept of "Money Laundering Control: The Missing Link in Trinidad and Tobago. Now, approximately two years after that seminal assessment, the author has re-assessed the domestic anti-money laundering (AML) framework, with particular reference to the controls in place to address money laundering (ML) and the confiscation of the proceeds of crime. This paper aims to assess the efficiency and effectiveness of the newly implemented regime and considers whether it meets international standards.Design/methodology/approachThis analysis embraces a pluralist approach. Within this assessment, a case study method is used with contextual qualitative analysis. Empirical data is analyzed and causal connections are linked to the analysis.FindingsThis research highlights catalytic change and creativity in addressing deficiencies within the AML architecture in Trinidad and Tobago. Upon analysis, it is pellucid that a radically altered criminal justice landscape has emerged and a more aggressive and targeted approach to address ML and the confiscation of the proceeds of crime is apparent. The result is a shift in paradigm with tangible outcomes to suggest that the strategies have borne fruit and that the twin island Republic is indeed committed to strengthening the link.Research limitations/implicationsFindings are limited to Trinidad and Tobago and to the period ended April 2020.Originality/valueAs a country with a medium to high ML risk, the possible negative socio-economic effects of ML cannot be underscored. Disruption of ML and the confiscation of the proceeds of crime are, therefore, imperative. This paper considers the progress made in addressing these pertinent issues and assists in assessing the effects of the reformation efforts undertaken by Trinidad and Tobago.

The effects of the 4/20 cannabis holiday and adult-use cannabis legalization on medical cannabis sales and medical cannabis patient registration in Arizona.

BACKGROUND: This study examined whether the 4/20 cannabis holiday was associated with increases in medical cannabis sales from licensed dispensaries in Arizona from 2018-2021, and whether adult-use cannabis legalization (the vote in November 2020 and retail sales in January 2021) was associated with declines in medical cannabis sales and in the number of registered medical patients. METHODS: Data came from the Arizona Medical Marijuana Program monthly reports from January 2018-December 2021. The reports show daily sales from licensed medical cannabis dispensaries (i.e., the number of medical cannabis dispensary transactions and the amount of cannabis sold in pounds), which we averaged by week, and show the number of registered medical cannabis patients each month. Autoregressive integrated moving average models were used to test changes in these outcomes associated with the 4/20 cannabis holiday and with legalization of adult-use cannabis. RESULTS: During the week of the 4/20 cannabis holiday, medical cannabis dispensary transactions abruptly increased by an average of 2,319.4 transactions each day (95% CI: 1636.1, 3002.7), and the amount of medical cannabis sold increased by an average of 120.3 pounds each day (95% CI: 99.3-141.3). During the first week of adult-use cannabis sales in late January 2021, medical cannabis dispensary transactions abruptly decreased by an average of 5,073 transactions each day (95% CI: -5,929.5, -4216.7), and the amount of medical cannabis sold decreased by an average of 119.1 pounds each day (95% CI: -144.2, -94.0). Moreover, medical cannabis sales continued to gradually decline each week after the start of adult-use retail sales, with declines in sales preceding declines in registered patients. By December 2021, slightly over a year after the vote to legalize adult-use cannabis, the actual number of registered medical cannabis patients fell short of the forecasted number, had adult-use not been legalized, by 36.5%. Moreover, the number of medical dispensary transactions and the amount of medical cannabis sold fell short of expectations, had adult-use cannabis not been legalized, by 58% and 53%, respectively. CONCLUSIONS: Findings document the blurred boundary between medical and non-medical cannabis use and are consistent with the possibility that medical cannabis legalization contributes to increases in adult cannabis use and dependence.

Changing cannabis policies and social work: Implications for students, families, and schools

State laws governing recreational and medicinal cannabis use are trending toward legalization, which has implications for school social workers and the students, families, and communities they serve. The patchwork of policies and conflicting public opinion sends mixed messages to youth and families who may lack sufficient information regarding risks of adolescent cannabis use. This article will explore topics relevant to legalization of cannabis including medical versus recreational use, racial overtones in marijuana policy, effects on student cognitive development and mental health, child welfare involvement, disparities in school discipline, criminal record expungement, and school-based cannabis prevention programs. The article will conclude with a summary of recommendations for schools. This article is a product of the research conducted by the Health Education and Leadership Scholars planning team at the University of Illinois for a policy-practice conference that was cancelled due to COVID-19. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Canada's Cannabis Legalization with Strict Public Health Control Lessons for Germany?

Aims: To describe the impact of the legalization of cannabis for recreational use under strict public health control in 2018 on the following outcomes: cannabis use and use patterns, attributable harm, economic considerations. Methodology: Narrative review based on government documents, surveys, and published literature. Result(s): The 12-month prevalence increased after legalization and has decreased during the COVID-19 pandemic. Little change in prevalence for adolescents. Persons with daily use remained stable. No rigorous studies on changes in attributable health harm, but some indication that harm, as measured in prevalence of cannabis use disorders, treatment rate, and attributable traffic injury remained stable. No data yet available for cancer. Cannabis attributable emergency visits increased, including among children (poisoning). Cannabis-related offences decreased as biggest public health gain. Economic predictions were not realized, and there is some pressure from cannabis industry to loosen public health regulations in order to increase use. Conclusion(s): Overall, while not achieving its main objectives of more youth protection and decreases in cannabis-attributable health harm, legalization with strict public health control resulted in less cannabis-related offences and up to now did not seem to increase cannabis-attributable disease burden.Copyright © 2023 Hogrefe Verlag GmbH & Co. KG. All rights reserved.

The effect of recreational cannabis legalization on rates of traffic injury in Canada.

AIMS: To measure the impact of Canada's recreational cannabis legalization (RCL) in October 2018 and the subsequent impact of the coronavirus disease 2019 (COVID-19) lockdowns from March 2020 on rates of emergency department (ED) visits and hospitalizations for traffic injury. DESIGN: An interrupted time series analysis of rates of ED visits and hospitalizations in Canada recorded in population-based databases from January/April 2010 to March 2021. SETTING: ED visits in Ontario and Alberta and hospitalizations in Ontario, Alberta, British Columbia, the Prairies (Manitoba and Saskatchewan) and the Maritimes (Nova Scotia, New Brunswick, Newfoundland and Prince Edward Island). PARTICIPANTS: Monthly counts of presentations to the ED or hospital for motor vehicle injury or pedestrian/cyclist injury, used to calculate monthly rates per 100 000 population. MEASUREMENTS: An occurrence of one or more International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA) code for motor vehicle injury (V20-V29, V40-V79, V30-V39 and V86) and pedestrian/cyclist injury (V01-V09 and V10-V19) within the National Ambulatory Care Reporting System and Discharge Abstract Database. FINDINGS: There were no statistically significant changes in rates of ED visits and hospitalizations for motor vehicle or pedestrian/cyclist injury after RCL after accounting for multiple testing. After COVID-19, there was an immediate decrease in the rate of ED visits for motor vehicle injury that was statistically significant only in Ontario (level change ß = -16.07 in Ontario, 95% CI = -20.55 to -11.60, P = 0.000; ß = -10.34 in Alberta, 95% CI = -17.80 to -2.89, P = 0.008; α of 0.004) and no changes in rates of hospitalizations. CONCLUSIONS: Canada's recreational cannabis legalization did not notably impact motor vehicle and pedestrian/cyclist injury. The rate of emergency department visits for motor vehicle injury decreased immediately after COVID-19 lockdowns, resulting in rates below post-recreational cannabis legalization levels in the year after COVID-19.

Canada's Cannabis Legalization with Strict Public Health Control: Lessons for Germany?

:Aims: To describe the impact of the legalization of cannabis for recreational use under strict public health control in 2018 on the following outcomes: cannabis use and use patterns, attributable harm, economic considerations. Methodology: Narrative review based on government documents, surveys, and published literature. Results: The 12-month prevalence increased after legalization and has decreased during the COVID-19 pandemic. Little change in prevalence for adolescents. Persons with daily use remained stable. No rigorous studies on changes in attributable health harm, but some indication that harm, as measured in prevalence of cannabis use disorders, treatment rate, and attributable traffic injury remained stable. No data yet available for cancer. Cannabis attributable emergency visits increased, including among children (poisoning). Cannabis-related offences decreased as biggest public health gain. Economic predictions were not realized, and there is some pressure from cannabis industry to loosen public health regulations in order to increase use. Conclusions: Overall, while not achieving its main objectives of more youth protection and decreases in cannabis-attributable health harm, legalization with strict public health control resulted in less cannabis-related offences and up to now did not seem to increase cannabis-attributable disease burden. (English) [ FROM AUTHOR]

Inter-Year Comparison of Adverse Reactions Associated with Legal Cannabis Products Reported to Health Canada, 2018-2019 to 2021: An International Journal of Medical Toxicology and Drug Experience

Introduction: Since the legalization of cannabis for non-medical purposes in Canada on October 17, 2018, there have been changes in the landscape including increasing availability of legal cannabis products, ongoing public knowledge and education on cannabis, an outbreak of vaping-associated lung illness and the covid-19 pandemic. These shifting contexts may have influenced cannabis use behaviours, and the number and type of cannabis adverse reactions (ARs) reported since legalization. Health Canada's (HC) Vigilance Framework for Cannabis Products allows for the monitoring, detection, assessment and risk management of ARs to support regulatory decision-making, knowledge translation and public communication of the safety of cannabis products. Objective: The objective of this presentation is to provide an inter- year comparison of ARs associated with legal cannabis products reported to HC during the first year (October 17, 2018-December 31, 2019), second year (January 1, 2020-December 31, 2020) and third year (January 1, 2021-December 31, 2021) of legalization. Methods: A descriptive, comparative analysis of AR cases involving legal cannabis products received by HC from October 17, 2018 to December 31, 2019 (referred to as 2018-2019), January 1, 2020 to December 31, 2020 and January 1, 2021-December 31, 2021 was conducted to characterize ARs across these three reporting periods. Results: The total number of cases received by HC increased across reporting periods (n = 151 in 2018-2019, n = 161 in 2020, n = 174 in 2021), with serious cases increasing 36% overall between 2018-2019 and 2021 despite 2018-2019 having covered a longer reporting per- iod. Cases more frequently involved females than males in all periods, while AR cases in 2020 and 2021 more frequently involved older adults (65+ years), whereas middle age adults (35 to 64 years) accounted for the largest proportion of cases in 2018-2019. Ingestible cannabis extracts (e.g., cannabis oils in liquid or capsules) were the most frequently reported suspect cannabis product in AR cases across three reporting periods despite widening availability of other types of legal cannabis products (cannabis topicals, other extracts such as cannabis vaping products and edibles) as of October 17, 2019. Conclusion: While the total number of cases of ARs associated with legal cannabis products submitted to HC have increased across reporting periods, other variables have remained stable or have decreased. Health Canada will continue to monitor and analyse trends in cannabis ARs and publish these results in future years.

Cultural, Social and Psychological Factors of the Conservative Consumer towards Legal Cannabis Use—A Review since 2013

Cannabis consumption has become the center of much debate globally. The positive public perception of the medicinal benefits of cannabis and the rise of recreational usage of cannabis necessitate dramatic changes in cannabis reform policy. As a consequence, there is an increase in cannabis legalization around the globe, although it is still facing many rejections. It is crucial to understand the factors affecting public acceptance of cannabis use to support the contextualization and success of cannabis legalization. This review aims to address consumer cultural, social and psychological factors regarding the legal use of cannabis. Based on this review, cultures influence the endorsement or rejection of cannabis use depending on political views, religious sentiments and affiliated subcultures (adult, youth and adolescent subcultures). Regarding the social factors, socioeconomic status, measured by income, education level and occupation, is a key determinant of cannabis use. The beliefs opposing cannabis legalization are due to the negative stigma surrounding cannabis use. Nevertheless, growing awareness about the pharmaceutical and therapeutic effects of cannabis has led to an increase in positive attitudes towards cannabis legalization. Thus, dissemination of cannabis use benefits reaffirmed by scientific evidence could be a strategic way to alleviate the public’s negative feedback on cannabis legalization.

Fully legal or only medical and religious purposes? Public support for cannabis policies in the Eastern Caribbean

Purpose>Public support for various policy options for managing cannabis in the Caribbean and the characteristics of those most likely to support specific policy options remains largely unknown. The purpose of this study is to investigate the impact of age, sex and employment status on the public attitudes towards the full legalisation of cannabis, partial legalisation (that is for medical or religious purposes) or its continued prohibition.Design/methodology/approach>Using secondary data collected from nationally representative public opinion polls conducted by Caribbean Research and Development Services from 2016–2018, this paper compares the public attitudes towards cannabis in Barbados, St. Vincent and the Grenadines, St. Lucia, Antigua and Barbuda and Dominica using a multinomial logistic model.Findings>Support for the continued prohibition, legalisation or partial legalisation of cannabis varied significantly by age, employment status and country of residence. Women, people over 51 years of age and the employed were more likely to support full prohibition. Attitudes towards cannabis policy in the Caribbean are by no means homogenous, neither are the policy shifts occurring across the region, with some of these changes occurring slowly and not necessarily reflective of cultural dynamics.Originality/value>This study is unique in its cross-country analysis in the Caribbean and providing valuable insight into the levels public support for cannabis legalisation. Its findings can help shape targeted public education in these countries.

The association between recreational cannabis legalization, commercialization and cannabis-attributable emergency department visits in Ontario, Canada: an interrupted time-series analysis.

BACKGROUND AND AIMS: Recreational cannabis was legalized in Canada in October 2018. Initially, the Government of Ontario (Canada's largest province) placed strict limits on the number of cannabis retail stores before later removing these limits. This study measured changes in cannabis-attributable emergency department (ED) visits over time, corresponding to different regulatory periods. DESIGN: Interrupted time-series design using population-level data. Two policy periods were considered; recreational cannabis legalization with strict store restrictions (RCL, 17 months) and legalization with no store restrictions [recreational cannabis commercialization (RCC), 15 months] which coincided with the COVID-19 pandemic. Segmented Poisson regression models were used to examine immediate and gradual effects in each policy period. SETTING: Ontario, Canada. PARTICIPANTS: All individuals aged 15-105 years (n = 13.8 million) between January 2016 and May 2021. MEASUREMENTS: Monthly counts of cannabis-attributable ED visits per capita and per all-cause ED visits in individuals aged 15+ (adults) and 15-24 (young adults) years. FINDINGS: We observed a significant trend of increasing cannabis-attributable ED visits pre-legalization. RCL was associated with a significant immediate increase of 12% [incident rate ratio (IRR) = 1.12, 95% confidence interval (CI) = 1.02-1.23] in rates of cannabis-attributable ED visits followed by significant attenuation of the pre-legalization slope (monthly slope change IRR = 0.98, 95% CI = 0.97-0.99). RCC and COVID-19 were associated with immediate significant increases of 22% (IRR = 1.22, 95% CI = 1.09-1.37) and 17% (IRR = 1.17, 95% CI = 1.00-1.37) in rates of cannabis-attributable visits and the proportion of all-cause ED visits attributable to cannabis, respectively, with insignificant increases in monthly slopes. Similar patterns were observed in young adults. CONCLUSIONS: In Ontario, Canada, cannabis-attributable emergency department visits stopped increasing over time following recreational cannabis legalization with strict retail controls but then increased during a period coinciding with cannabis commercialization and the COVID-19 pandemic.

Changes in unintentional cannabis exposures in children 6 months to 5 years reported to United States poison centers during the first nine months of the coronavirus-19 pandemic.

INTRODUCTION: Almost half of exposures reported to United States (US) poison centers are exploratory ingestions in children under the age of 5 years. Pediatric cannabis exposures reported to US poison centers have risen over the last twenty years, with greater increases in the last 5 years. In 2020, the Coronavirus disease 2019 (COVID-19) pandemic resulted in widespread stay-at-home orders and subsequent changes in work, education, and daycare. This study describes the changes in pediatric cannabis exposures during the first nine months of the COVID-19 pandemic relative to the three years before the pandemic. METHODS: Cases were identified from the National Poison Data System. Inclusion criteria was unintentional cannabis exposure in children aged 6 months to 5 years between January 1, 2017 and December 31, 2020. Analysis was performed with segmented regression of interrupted time series analysis comparing January 2017-March 2020 (pre-COVID-19) to April 2020-December 2020 (COVID-19 period). Autocorrelation was assessed using Dubin-Watson test. RESULTS: There were 7,679 unintentional pediatric exposures from January 1, 2017 through December 31, 2020. There was a significant increase of 3.1% per month during the pre-COVID-19 period (p < .0001). A statistically significant immediate increase in number of exposures per month occurred in April 2020 (58.4%; p < .0001). The slope in the COVID-19 period was -0.01% (p = .99). No autocorrelation was detected. DISCUSSION AND CONCLUSIONS: Unintentional cannabis exposures in children aged 6 months to 5 years reported to United States poison centers increased significantly after the initial COVID-19 stay-at-home orders. This trend may be associated with COVID-19 quarantines, increased time children are spending at home, increased availability of cannabis products in homes, or other reasons. Future efforts should evaluate specific factors that resulted in the observed increases in pediatric exposures.

United States marijuana legalization and opioid mortality epidemic during 2010-2020 and pandemic implications.

BACKGROUND: The hypothesis that marijuana availability reduces opioid mortality merits more complete testing, especially in a country with the world's highest opioid death rate and 2nd highest cannabis-use-disorder prevalence. METHODS: The United States opioid mortality rate was compared in states and District of Columbia that had implemented marijuana legalization with states that had not, by applying joinpoint methodology to Centers for Disease Control and Prevention data. Variables included race/ethnicity and fentanyl-type opioids (fentanyls). RESULTS: After the same rates during 2010-2012, the opioid mortality rate increased more rapidly in marijuana-legalizing than non-legalizing jurisdictions (2010-2020 annual pairwise comparison p = 0.003 for all opioids and p = 0.0004 for fentanyls). During the past decade, all four major race/ethnicities in the U.S. had evidence for a statistically-significant greater increase in opioid mortality rates in legalizing than non-legalizing jurisdictions. Among legalizing jurisdictions, the greatest mortality rate increase for all opioids was in non-Hispanic blacks (27%/year, p = 0.0001) and for fentanyls in Hispanics (45%/year, p = 0.0000008). The greatest annual opioid mortality increase occurred in 2020, the first year of the COVID-19 pandemic, with non-Hispanic blacks having the greatest increase in legalizing vs. non-legalizing opioid-death-rate difference, from 32% higher in legalizing jurisdictions in 2019 to more than double in 2020. CONCLUSIONS: Instead of supporting the marijuana protection hypothesis, ecologic associations at the national level suggest that marijuana legalization has contributed to the U.S.'s opioid epidemic in all major races/ethnicities, and especially in blacks. If so, the increased use of marijuana during the 2020-2022 pandemic may thereby worsen the country's opioid crisis.

Public Health Implications of Cannabis Legalization: An Exploration of Adolescent Use and Evidence-Based Interventions.

This article examines the relaxation of state marijuana laws, changes in adolescent use of marijuana, and implications for drug education. Under federal law, use of marijuana remains illegal. In spite of this federal legislation, as of 1 June 2021, 36 states, four territories and the District of Columbia have enacted medical marijuana laws. There are 17 states, two territories and the District of Columbia that have also passed recreational marijuana laws. One of the concerns regarding the enactment of legislation that has increased access to marijuana is the possibility of increased adolescent use of marijuana. While there are documented benefits of marijuana use for certain medical conditions, we know that marijuana use by young people can interfere with brain development, so increased marijuana use by adolescents raises legitimate health concerns. A review of results from national survey data, including CDC's YRBS, Monitoring the Future, and the National Household Survey on Drug Use, allows us to document changes in marijuana use over time. Increased legal access to marijuana also has implications for educational programming. A "Reefer Madness" type educational approach no longer works (if it ever did). We explore various strategies, including prevention programs for education about marijuana, and make recommendations for health educators.

Dancers win at work: unionization and Nowak v Chandler Bars Group Ltd

In the United Kingdom, United Sex Workers is organizing as the sex workers' branch of the trade union United Voices of the World (UVW). Sex workers have located dancer unionization and labour rights within a political framework and set of demands relating to socially reproductive labour and decriminalization of all forms of sex work. Their efforts have led to an Employment Tribunal decision that dancers fall within the definition of “worker” found in various UK labour laws. At the same time, the broad perspective and demands of the sex-worker rights movement expose the limits of worker status, and the gains made through unionization have, at least at this time, been eclipsed by COVID-19.

Changes in California cannabis exposures following recreational legalization and the COVID-19 pandemic.

INTRODUCTION: Since 2012, eighteen states and the District of Columbia have legalized recreational cannabis. Past research suggests this policy change is associated with increased cannabis exposures however this has not yet been studied in California, despite its status as the world's largest legal cannabis market. METHODS: This observational, retrospective study analyzed trends in cannabis exposures reported to the California Poison Control System (CPCS) from 2010 to 2020. We assessed shifts in exposures before and after the legalization of recreational cannabis in November 2016, the establishment of recreational retail sales in January 2018, and the institution of a statewide shelter-in-place order due to the COVID-19 pandemic in March 2020 using interrupted time-series analysis and reviewed all records to identify specific products associated with exposures. RESULTS: Between 2010 and 2020 edible exposures increased from near zero to 79% of exposures in 2020. Cannabis exposures significantly increased following recreational legalization in 2016 (by an estimated 2.07 exposures per month [CI: 0.60, 3.55]; p < 0.01) and initiation of retail sales in 2018 (0.85 [CI: 0.12, 1.58]; p < 0.05). There was no significant change in cannabis exposures following the first shelter-in-place order of the COVID-19 pandemic (1.59 [CI: -1.61, 3.68]; p = 0.43). Cannabis exposures for those thirteen and under increased significantly both after recreational legalization (1.04 [CI: 0.38, 1.70]) and after the opening of the retail sales market (0.73 [CI: 0.34, 1.12]), but not following the shelter-in-place order (1.59 [CI: -1.61, 3.68]), nor was there a significant change for those older than thirteen. CONCLUSIONS: Our findings suggest that cannabis legalization is linked to increased exposures, particularly for products such as gummies and candy edibles among children under the age of thirteen. Clinicians should be aware of these risks and communicate them to patients, and policymakers should consider stronger regulations on packaging to reduce these exposures.Key pointsQuestion: How have cannabis exposures changed following legalization of recreational use, the opening of the recreational retail sales market, and the institution of shelter-in-place orders during the COVID-19 pandemic?Findings: In this retrospective review of 10,757 cases reported to the California Poison Control System (CPCS) between 2010 and 2020, exposures increased significantly after the legalization of recreational cannabis use and the opening of the recreational retail sales market, particularly among children, who primarily consumed candies and gummies.Meaning: Stronger regulation of cannabis edibles that mimic other products is warranted to decrease exposures among children.

Looking back from 2020, how cannabis use and related behaviours changed in Canada.

BACKGROUND: The Canadian government legalized non-medical cannabis use by adults in October 2018 to minimize associated harms and redirect profits from criminals. In October 2019, a wider array of products, including edibles, was legalized, with entry into the legal market beginning in December. DATA AND METHODS: Three quarters (the first quarters of 2018 and 2019 and the fourth quarter of 2020) of the National Cannabis Survey were used to examine changes in cannabis use (overall use and daily or almost daily (DAD) use), consumption methods, products and sources. RESULTS: Cannabis use in the past three months was higher in late 2020 (20.0%) than in 2019 (17.5%) and 2018 (14.0%), and this was particularly the case among: females (for whom rates rose to equal male rates for the first time), adults aged 25 and older, and some provinces. Similarly, DAD use, at 7.9% also increased. Higher percentages of Canadians reported getting at least some of their cannabis from legal sources or growing it, and fewer were relying on friends and family or illegal sources in 2020. DISCUSSION: This study spans three years-from before legalization to about two years after. It provides a more complete picture of the law's impact on cannabis use and related behaviours, given the more established legal cannabis industry better equipped to compete with the black market on price, convenience and selection. Findings demonstrate that change is continuing, and, as before, some cautions and assurances remain. The impact of the COVID-19 pandemic on cannabis use continues to be difficult to measure. Monitoring remains important, given the ever-changing provincial retail landscapes; the introduction of new products; and the pressure by the industry to remove or adjust potency limits, and allow widespread delivery, farm-gate sales and cannabis lounges.

International policies and challenges on the legalization of traditional medicine/herbal medicines in the fight against COVID-19.

The coronavirus disease 2019 (COVID-19) has now rapidly spread around the world, causing an outbreak of acute infectious pneumonia. To develop effective and safe therapies for the prevention and treatment of COVID-19 has become the major global public health concern. Traditional medicine (TM)/herbal medicines (HMs) have been used to treat multiple epidemics in human history, which brings hope for the fight against COVID-19 in some areas. For example, in China, India, and South Korea with traditional medication history and theory, the governments issued a series of guidelines to support TM/HMs in the medication of COVID-19. In contrast, other countries e.g. North American and European governments are typically silent on these practices, unless to warn of possible harm and overselling. Such difference is due to the discrepancy in culture, history and philosophical views of health care and medication, as well as unharmonized policies and standards in the regulation and legalization of TM/HMs among different areas. Herein, we reviewed the responses and scientific researches from seven selected countries on the policies and legalization of TM/HMs to treat COVID-19, and also analyzed the major challenges and concerns to utilize the traditional knowledge and resource.

Health and Safety in the Legal Cannabis Industry Before and During COVID-19.

In 2020, medical cannabis is legal in thirty-six states and adult use ("recreational") cannabis is legal in fifteen, despite cannabis remaining illegal at the federal level. Up to 250,000 individuals work as full-time employees in cannabis. During the COVID-19 pandemic, California, Colorado, and other states deemed medical cannabis business as essential, raising occupational challenges and safety issues for cannabis employees. In 2020, interviews were conducted with Ethan, an extraction lab assistant in Las Vegas; Haylee, a trainer with a cannabis company in Sacramento; and Belinda, a Wisconsin-based occupational health and safety trainer, to showcase concerns and experiences in cannabis workplaces and training programs. Findings from interviews reveal pro-worker activities to promote workplace safety and labor unionism while large multistate operators seek to optimize profits and obstruct workers' rights. Knowledge gained through the interviews contributes to discussions to lessen the potential exposure of the cannabis workforce to COVID 19.