Zach Walsh

Cannabis for therapeutic purposes: Patient characteristics, access, and reasons for use

BACKGROUND The authorized and unauthorized use of cannabis for therapeutic purposes (CTP) has increased dramatically in recent years, and physicians have called for further research to better clarify the parameters of effective and appropriate use. We report findings from a large cross-sectional study of the use of CTP in Canada and compare use across medical conditions and across authorized and unauthorized users. METHODS We examined cannabis use history, medical conditions and symptoms, patterns of current use of CTP, modes of access and perceived effectiveness among 628 self-selected Canadians consumers of CTP. Participants were recruited from medical cannabis dispensaries and from organizations that assist users of CTP. RESULTS Patients reported using cannabis to treat multiple symptoms, with sleep, pain, and anxiety being the most common. Cannabis was perceived to provide effective symptoms relief across medical conditions. Patterns of use were also consistent across medical conditions. Notable differences were observed with regard to modes of access. CONCLUSION Across medical conditions respondents reported using cannabis to effectively address diverse symptoms. Results indicate a substantial disconnect between the therapeutic use of cannabis and research on the risks and benefits of such use; particularly with regard to the anxiolytic and sedative use of cannabis. Authorized and unauthorized users exhibited few meaningful differences with regard to medical conditions and patterns of use, but faced substantial differences regarding access.

Subtypes of partner violence perpetrators among male and female psychiatric patients.

The goal of this naturalistic study was to examine heterogeneity among female and male civil psychiatric patients with a history of intimate partner violence (IPV) perpetration. Participants were 567 patients drawn from the MacArthur Violence Risk Assessment Study (J. Monahan et al., 2001). The authors examined subtype composition among 138 women and 93 men with positive histories of IPV and compared these groups with 111 women and 225 men with no histories of IPV. Findings for men and women were consistent with reports from studies of male perpetrators in forensic and community settings in that generally violent/antisocial, borderline/dysphoric, and family only/low-psychopathology subtypes of perpetrators were identified in both men and women. This study provides preliminary evidence for the generalizability of typologies derived from nonpsychiatric partner violence perpetrators to psychiatric populations and suggests that typologies derived from studies of male IPV perpetrators may provide useful guidance for the investigation of female IPV perpetration.

Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors.

INTRODUCTION AND AIMS Recent years have witnessed increased attention to how cannabis use impacts the use of other psychoactive substances. The present study examines the use of cannabis as a substitute for alcohol, illicit substances and prescription drugs among 473 adults who use cannabis for therapeutic purposes. DESIGN AND METHODS The Cannabis Access for Medical Purposes Survey is a 414-question cross-sectional survey that was available to Canadian medical cannabis patients online and by hard copy in 2011 and 2012 to gather information on patient demographics, medical conditions and symptoms, patterns of medical cannabis use, cannabis substitution and barriers to access to medical cannabis. RESULTS Substituting cannabis for one or more of alcohol, illicit drugs or prescription drugs was reported by 87% (n = 410) of respondents, with 80.3% reporting substitution for prescription drugs, 51.7% for alcohol, and 32.6% for illicit substances. Respondents who reported substituting cannabis for prescription drugs were more likely to report difficulty affording sufficient quantities of cannabis, and patients under 40 years of age were more likely to substitute cannabis for all three classes of substance than older patients. DISCUSSION AND CONCLUSIONS The finding that cannabis was substituted for all three classes of substances suggests that the medical use of cannabis may play a harm reduction role in the context of use of these substances, and may have implications for abstinence-based substance use treatment approaches. Further research should seek to differentiate between biomedical substitution for prescription pharmaceuticals and psychoactive drug substitution, and to elucidate the mechanisms behind both. [Lucas P, Walsh Z, Crosby K, Callaway R, Belle-Isle L, Kay B, Capler R, Holtzman S. Substituting cannabis for prescription drugs, alcohol, and other substances among medical cannabis patients: The impact of contextual factors. Drug Alcohol Rev 2016;35:326-333].

Psychopathy and axis I psychiatric disorders among criminal offenders: relationships to impulsive and proactive aggression.

Both psychopathology and aggression are heterogeneous constructs. Determining which forms of psychopathology relate to risk for different classes of aggressive behavior has implications for risk recognition and management. This study examined the relationships of impulsive aggression (IA) and proactive aggression (PA) to psychopathy and symptoms of several Diagnostic and Statistical Manual Axis I disorders in a sample of criminal offenders. Results replicated prior findings from community samples of a broad relationship between psychopathology and IA. PA was related only to psychopathy. An interaction was found whereby IA was associated with impulsive-antisocial traits of psychopathy only for individuals with moderate to high levels of generalized anxiety. Results indicate that assessing and treating several Axis I disorders in offenders may decrease risk for IA. Moreover, current findings raise the possibility that generalized anxiety is a key, modifiable component of the relationship between IA and impulsive-antisocial traits.

Psychopathy and Risk Taking Among Jailed Inmates

Several clinical descriptions of psychopathy suggest a link to risk taking, but the empirical basis for this association is not well established. Moreover, it is not clear whether any association between psychopathy and risk taking is specific to psychopathy or reflects shared variance with other externalizing disorders, such as antisocial personality disorder, alcohol use disorders, and drug use disorders. The present study aimed to clarify relationships between psychopathy and risky behavior among male county jail inmates using both self-reports of real-world risky behaviors and performance on the Balloon Analogue Risk Task (BART), a behavioral measure of risk taking. Findings suggest that associations between externalizing disorders and self-reported risk taking largely reflect shared mechanisms. However, psychopathy appears to account for unique variance in self-reported irresponsible and criminal risk taking beyond that associated with other externalizing disorders. By contrast, none of the disorders was associated with risk-taking behavior on the BART, potentially indicating limited clinical utility for the BART in differentiating members of adult offender populations.

Barriers to access for Canadians who use cannabis for therapeutic purposes

BACKGROUND There is increased interest in the therapeutic potential of cannabis in recent decades. Canada, the Netherlands, Israel and some states in the United States have developed programs to allow access to cannabis for therapeutic purposes (CTP). In Canada, enrollment in the federal CTP program represents fewer than 5% of the estimated users of CTP. The discrepancy between the number of Canadians who report using CTP and the rate of utilization of the federal CTP program suggests the existence of barriers to access to this program. METHODS In the present study we employ a health services analytical framework to examine barriers to access to CTP among 628 current CTP users. We define barriers to access as areas of poor fit between clients and services. We use five dimensions of accommodation, accessibility, availability, affordability, and acceptability to examine access to CTP. RESULTS Our findings reveal that it is difficult for Canadians to find a physician to support their application to access CTP. Accessing CTP from unauthorized sources was common; only 7% of respondents accessed CTP exclusively from authorized sources. Access to CTP was positively associated with the presence of medical cannabis dispensaries, which were not included in the regulatory regime. Access to CTP varied by medical condition and general quality of health. Affordability of CTP was a substantial barrier to access. CONCLUSIONS Strategies need to be developed to encourage scientific inquiry into CTP and address the barriers to access to CTP and the stigma and controversy that surround CTP and strain patient-physician relationships.

Medical cannabis and mental health: A guided systematic review

This review considers the potential influences of the use of cannabis for therapeutic purposes (CTP) on areas of interest to mental health professionals, with foci on adult psychopathology and assessment. We identified 31 articles relating to the use of CTP and mental health, and 29 review articles on cannabis use and mental health that did not focus on use for therapeutic purposes. Results reflect the prominence of mental health conditions among the reasons for CTP use, and the relative dearth of high-quality evidence related to CTP in this context, thereby highlighting the need for further research into the harms and benefits of medical cannabis relative to other therapeutic options. Preliminary evidence suggests that CTP may have potential for the treatment of PTSD, and as a substitute for problematic use of other substances. Extrapolation from reviews of non-therapeutic cannabis use suggests that the use of CTP may be problematic among individuals with psychotic disorders. The clinical implications of CTP use among individuals with mood disorders are unclear. With regard to assessment, evidence suggests that CTP use does not increase risk of harm to self or others. Acute cannabis intoxication and recent CTP use may result in reversible deficits with the potential to influence cognitive assessment, particularly on tests of short-term memory.

Experiences of Kratom Users: A Qualitative Analysis

Abstract Kratom (Mitragyna speciosa) is a psychoactive plant that has been used since at least 1836 in folk medicine in Southeast Asian countries. More recently, kratom has become widely available in the West and is used for both recreational and medicinal purposes. There has, however, been little scientific research into the short- and long-term effects of kratom in humans, and much of the information available is anecdotal. To supplement the increasing scientific understanding of kratom’s pharmacology and research into its effects in animals, we report the results of a qualitative analysis of first-hand descriptions of human kratom use that were submitted to, and published by, a psychoactive substance information website (Erowid.org). Themes that emerged from these experience reports indicate that kratom may be useful for analgesia, mood elevation, anxiety reduction, and may aid opioid withdrawal management. Negative response themes also emerged, indicating potential problems and unfavorable “side” effects, especially stomach upset and vomiting. Based on our analyses, we present preliminary hypotheses for future examination in controlled, quantitative studies of kratom.

Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients

BACKGROUND In 2014 Health Canada replaced the Marihuana for Medical Access Regulations (MMAR) with the Marihuana for Medical Purposes Regulations (MMPR). One of the primary changes in the new program has been to move from a single Licensed Producer (LP) of cannabis to multiple Licensed Producers. This is the first comprehensive survey of patients enrolled in the MMPR. METHODS Patients registered to purchase cannabis from Tilray, a federally authorized Licenced Producer (LP) within the MMPR, were invited to complete an online survey consisting of 107 questions on demographics, patterns of use, and cannabis substitution effect. The survey was completed by 271 respondents. RESULTS Cannabis is perceived to be an effective treatment for diverse conditions, with pain and mental health the most prominent. Findings include high self-reported use of cannabis as a substitute for prescription drugs (63%), particularly pharmaceutical opioids (30%), benzodiazepines (16%), and antidepressants (12%). Patients also reported substituting cannabis for alcohol (25%), cigarettes/tobacco (12%), and illicit drugs (3%). A significant percentage of patients (42%) reported accessing cannabis from illegal/unregulated sources in addition to access via LPs, and over half (55%) were charged to receive a medical recommendation to use cannabis, with nearly 25% paying

Predicting self- and other-directed violence among discharged psychiatric patients: The roles of anger and psychopathic traits

300 or more. CONCLUSION The finding that patients report its use as a substitute for prescription drugs supports prior research on medical cannabis users; however, this study is the first to specify the classes of prescription drugs for which cannabis it is used as a substitute, and to match this substitution to specific diagnostic categories. The findings that some authorized patients purchase cannabis from unregulated sources and that a significant percentage of patients were charged for medical cannabis recommendations highlight ongoing policy challenges for this federal program.