Made available in DSpace on 2015-12-06T23:45:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2012 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / As evidencias obtidas em estudos pre-clinicos demonstram que as substancias contidas na planta Cannabis sativa L., os fitocanabinoides, e outras drogas que atuam sobre o sistema endocanabinoide apresentam efeitos em modelos animais preditivos de atividade antidepressiva. Entretanto, os efeitos da interacao entre os principais fitocanabinoides farmacologicamente ativos, o (u)-trans-Δ9-tetrahidrocanabinol (Δ9-THC) e o canabidiol (CBD), sao desconhecidos nestes modelos. Neste sentido, este estudo buscou avaliar os efeitos da interacao entre o Δ9-THC e o CBD nos testes da natacao forcada (TNF), suspensao pela cauda (TSC) e inibicao da hipotermia induzida por apomorfina (IHA) em camundongos. Camundongos suicos machos adultos receberam uma administracao aguda intraperitoneal (i.p.) de Δ9-THC (1, 1,25, 2,5 e 5 mg/kg), CBD (1, 5 e 10 mg/kg), a associacao entre Δ9-THC e CBD (proporcoes de 1:1 e 1:8), imipramina (5, 15 e 30 mg/kg) ou veiculo e foram submetidos aos testes trinta minutos apos a administracao das drogas. Os efeitos do Δ9-THC (0,625, 1,25, 2,5, 5 e 10 mg/kg, i.p.) sobre a atividade locomotora dos camundongos tambem foram avaliados utilizando caixas de atividade locomotora. Os resultados mostraram que o Δ9-THC (5 mg/kg) induziu efeitos sugestivos de atividade antidepressiva no TNF e efeitos sugestivos de atividade depressiva no TSC. O CBD administrado isoladamente nao alterou os parametros avaliados nas doses testadas. Contudo, o CBD (5 mg/kg) atenuou os efeitos do Δ9-THC (5 mg/kg) sobre a imobilidade no TNF e no TSC quando estes compostos foram administrados simultaneamente. Nao houve efeito de ambos os compostos estudados sobre a hipotermia induzida por apomorfina (10 mg/kg). Estes resultados demonstram que o CBD interfere nos efeitos do Δ9-THC sobre a imobilidade em camundongos, evidenciando uma interacao farmacologica entre estes fitocanabinoides sobre o desamparo comportamental / BV UNIFESP: Teses e dissertações

Submitted by Morgana Andrade (morgana.andrade@ufes.br) on 2016-04-06T20:58:17Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação Fernando.pdf: 3408650 bytes, checksum: 8e6f48a8678d513330c4dbecc0a5c9bb (MD5) / Approved for entry into archive by Patricia Barros (patricia.barros@ufes.br) on 2016-05-17T16:10:00Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação Fernando.pdf: 3408650 bytes, checksum: 8e6f48a8678d513330c4dbecc0a5c9bb (MD5) / Made available in DSpace on 2016-05-17T16:10:00Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação Fernando.pdf: 3408650 bytes, checksum: 8e6f48a8678d513330c4dbecc0a5c9bb (MD5) / FAPES / Popularmente conhecida como maconha, a Cannabis sativa é a mais usada de todas as drogas ilícitas e seu comércio, em conjunto com outras drogas, é uma das atividades criminosas que mais consomem recursos públicos e está intimamente associado aos homicídios. No Estado do Espírito Santo (ES), 70% dos homicídios tem relação com o tráfico de entorpecentes, apresentando atualmente o segundo maior índice dos país. A despeito da atuação policial, não existem estudos detalhados sobre plantio, distribuição e consumo de Cannabis no Brasil, de uma forma geral, sabe-se apenas que a maior parte da droga é produzida no Paraguai ou cultivada dentro do próprio país e acredita-se que o Paraguai seja responsável pelo abastecimento das regiões sul, sudeste e centro-oeste do Brasil. A identificação genética de Cannabis apreendidas pela Polícia Civil pode auxiliar na determinação geográfica de plantios e possíveis rotas do tráfico, informação essencial para a ação da polícia no combate ao tráfico de drogas. Com objetivo de caracterizar as amostras de Cannabis apreendidas pela Polícia Civil do ES e verificar correlações que pudessem indicar origens comuns, foram analisados 18 loci STR de 165 amostras oriundas de 71 dos 78 municípios do Estado. Foram encontrados 89 alelos, variando de 2 (loci A501 e 9269) a 12 alelos (locus A301). Os loci H06 e A305 apresentaram 3 alelos cada e o locus B05 apresentou 4 alelos, similar ao encontrado em amostras do Paraguai. Os dados alélicos dos loci A305, B05 e H06 sugerem que a região sudeste do Brasil pode estar sendo abastecida por Cannabis de origem Paraguaia. Também foi verificado que 4 alelos apareceram apenas nas amostras 176 e 230. A amostra 230 era proveniente de uma apreensão realizada na cidade de Aracruz, onde a Polícia verificou a ligação do proprietário com o tráfico internacional de entorpecentes, e demonstrou ser geneticamente mais próxima de amostras da Alemanha, sugerindo que sua matriz tem origem no exterior podendo, dentre outras possibilidades, ter chegado ao ES através do tráfico pela internet. Os resultados obtidos fornecem mais informações a respeito da maconha comercializada no Brasil, podendo ser utilizados em estudos futuros para elaboração de um banco de dados baseado em STR para aplicação forense. / Popularly known as marijuana, Cannabis sativa is the most used of all illicit drugs and, with other drugs, its trade is one of the criminal activities that most consume public resources and is closely related to homicides. In the Espírito Santo State (ES), 70% of homicides is related to drug trafficking, currently presenting the second highest rate in the country. Despite the police action, there is no detailed studies of planting, distribution and Cannabis consumption in Brazil, in general, we only know that most drug is produced in Paraguay or grown within the country and it is believed that Paraguay is responsible for supplying the Brazil’s south, southeast and centerwest region. Genetic analysis of Cannabis seized by the police can assist in determining, geographically, plantations and possible routes of trafficking, essential information for police’s action in drug trafficking combat. In order to characterize the Cannabis samples seized by the police at ES and verify correlations that could indicate common origins, we analyzed 18 STR loci in 165 samples from 71 of 78 municipalities in the State. We have found 89 alleles ranging from 2 (A501 loci and 9269) to 12 alleles (A301 locus). The loci H06 and A305 presented each, 3 alleles and the locus B05, 4 alleles, similar to that found in Paraguayan samples. The allelic data of loci A305, B05 and H06 suggest that Brazil 's southeast region can be being supplied by Paraguayan Cannabis. We also found four alleles that appeared only in samples 176 and 230. Sample 230 was seized in Aracruz city, where the police found owner's connection with international trafficking, and demonstrated to be genetically nearest to German samples, suggesting a foreign origin what could be explained by internet trafficking. The obtained results provide more information about marijuana’s market in Brazil and could be used in future studies to develop a STR database for forensic application.

Nowadays young people and other members of the society often find themselves in many malpractices such as rape, suicide, murder dropping out of school and other harmful activities due to the use of cannabis sativa (dagga) which is on the rise. This study concentrated on the use of cannabis sativa (dagga) in Mzintlava, Ngquza Hill Local Municipality in the Eastern Cape Province of South Africa. Young people are actually the victims of the consequences of the use of dagga. Indications are that parents often ignore their children to use cannabis sativa until they can no longer stop them. Earlier researches on substance use in South Africa have always been descriptive. This resulted in sketchy understanding of factors that predisposed young children to the use and even abuse of dagga and the reasons why parents and the community underestimated the practice until the stage of addiction. Without this understanding, it will be difficult to introduce effective ways of abolishing dagga use among young children and other members of the community. Finding effective measures to prevent substance use has been difficult. Research is therefore needed in order to understand the basis of the problem. This study attempts to examine factors that make parents and the communities to leave children to taking substances until the stage where they can longer stop them. It will also lead to establishing factors that put young children or teenagers particularly at risk to the use of dagga.

This dissertation is divided into three parts. The first part aimed to investigate the cannabidiol anxiolytic effect in treatment-naïve individuals with social anxiety disorder through simulation of public speaking. Twenty-four never-treated social anxiety disorder subjects were allocated to receive 0 or 600 mg cannabidiol (CBD; n=12) in a double-blind randomized design. The same number of controls performed the simulation of a public speaking test without receiving any medication. Pretreatment with CBD significantly reduced anxiety, cognitive impairment, and discomfort in speech performance and significantly decreased alertness in their anticipatory speech. The placebo group displayed higher anxiety, cognitive impairment, discomfort, and alertness when compared with controls as assessed with the Visual Analogue Mood Scale (VAMS). The SSPS-N scores showed significant increases during testing of the placebo group that was almost abolished in the cannabidiol group. No significant differences were observed between the cannabidiol and control groups in SSPS-N scores or in cognitive impairment, discomfort, and alertness factors of the VAMS. The second part evaluated healthy subjects\' x y during a public speaking test following a high rimonabant oral dose, to understand better the possible pharmacological approaches for anxiety disorder treatment. Twenty four participants were randomly allocated to receive 0 or 90 mg rimonabant (n=12) in a double-blind design. No significant adverse effects were reported in either group. Participants who received rimonabant showed increased anxiety levels compared to placebo during anticipatory speech and performance measurements. Rimonabant treatment did not affect sedation, cognitive impairment, discomfort, blood pressure, heart rate, self-statements during public speaking, or bodily symptoms scales. Increased anxiety may reflect lower endocannabinoid activity in CB1 receptors and CB1 p \' possible role in modulation of anxiety and anxiety disorders. The third part aimed to monitor cannabinoid blood concentrations during sustained abstinence from chronic daily cannabis smoking. Thirty male chronic daily cannabis smokers resided on a secure clinical research unit for up to 33 days, with blood collected once daily. ?9-tetrahydrocannabinol (THC), 11-hydroxy-THC (11-OH-THC), and 11-nor-9-carboxy-THC (THCCOOH) whole blood concentrations were quantified by two-dimensional gas chromatography-mass spectrometry. Twenty-seven of 30 participants were THC-positive on admission, with a median (range) concentration 1.4 ng/mL (0.3-6.3). THC decreased gradually with only 1 of 11 participants negative at 26 days; 2 of 5 participants remained THC-positive (0.3 ng/mL) for 30 days. 5.0% f p p h TH >=1 0 g/ L f 12 y M 11-OH-THC w 1 1 g/ L w h >=1 0 g/ L 24h THCCOOH detection rates were 96.7 on admission, decreasing slowly to 95.7 and 85.7% on days 8 and 22, respectively; four of 5 participants remained THCCOOH positive (0.6-2.7 ng/mL) after 30 days and one remained positive on discharge at 33 days. THC was quantified in some participants for 30 days, albeit in low concentrations, due to the large cannabinoid body burden from extended exposure / Esta tese é dividida em três partes. A primeira parte consiste em investigar o efeito ansiolítico do canabidiol na ansiedade social através do teste de simulação de falar em público. Vinte e quatro sujeitos com ansiedade social, nunca tratados, receberam placebo ou canabidiol (CBD) 600 mg (n=12) em um estudo randomizado e duplo-cego. O mesmo número de indivíduos saudáveis realizaram o teste de simulação de falar em público sem receber medicação. A administração do CBD reduziu significativamente a ansiedade, sedação física e outros sentimentos e atitudes durante a fase de estresse, e diminui o nível de alerta na fase pré-estresse. O grupo placebo apresentou níveis elevado de ansiedade, sedação física, outros sentimentos e atitudes, e alerta comparado com o grupo controle. A pontuação do SSPS-N evidenciou aumento significativo durante o teste no grupo placebo, enquanto que o CBD reduziu estes níveis. Não houve diferenças significativas entre os grupos CBD e controle na SSPS-N e nos fatores sedação física, outros sentimentos e atitudes e alerta, da Visual Analogue Mood Scale (VAMS). A segunda parte do estudo avaliou a ansiedade em indivíduos saudáveis que receberam alta dose oral de rimonabanto e submetidos ao teste de simulação de falar em público, para melhor entendimento do possível mecanismo farmacológico para tratamento de transtornos de ansiedade. Vinte e quatro sujeitos saudáveis receberam placebo ou rimonabanto 90 mg (n=12) em um randomizado e duplo-cego. Não foi observado efeitos adversos significativo em ambos grupos. O grupo rimonabanto apresentou maiores níveis de ansiedade na fase pré-estresse e durante o estresse. Não houve diferença significativa quanto aos demais fatores avaliados entre os grupos. O aumento na ansiedade após administração do rimonabanto pode-se ao fato de haver diminuição no sistema endocanabinóide nos receptores CB1 e a possível modulação na ansiedade clínica e patológica. A terceira parte objetivou quantificar canabinóides no sangue total em usuários crônicos de cannabis durante abstinência supervisionada. Trinta usuários crônicos de cannabis, do sexo masculino, permaneceram no centro de pesquisa por até 33 dias, com coleta de sangue uma vez ao dia. ?9-tetrahidrocanabinol (THC), 11-hidróxi-THC (11-OH-THC) e 11-nor-9-carbóxi-THC (THCCOOH) foram quantificados no sangue por meio da cromatografia gasosa-espectrometria de massa bidimensional. Vinte e sete de 30 usuários foram positivos para THC no ingresso do estudo, com concentração mediana (variação) de 1.4 ng/mL (0.3-6.3). Níveis de THC diminuíram gradativamente com somente 1 de 11 participantes negativo no dia 26; 2 de 5 indivíduos permaneceram positivos para THC (0.3 g/ L p 30 5 0% j TH >=1 0 g/ L p 12 ç mediana de 11-OH-TH f 1 1 g/ L g >=1 0 g/ L pó 24h. A taxa de detecção de THCCOOH foi 96.7% no ingresso, diminuindo gradativamente para 95.7 e 85.7% nos dias 8 e 22, respectivamente; 4 de 5 sujeitos permaneceram positivo para THCCOOH (0.6-2.7 ng/mL) após 30 dias e um permaneceu positivo no 33º dia. Foi detectado THC em alguns indivíduos por 30 dias, porém em baixas concentrações, devido a extensa eliminação do canabinóide em decorrência da exposição crônica

During the 1800’s cannabis use was described as a treatment for a variety of metabolic disorders but its recreational use in the twentieth century resulted in laws which made the usage of cannabis illegal despite its medicinal properties. Cannabis usage has been reported to be useful in the treatment of Type 2 diabetes but unfortunately conflicting results are often published and its mechanism of action is still unknown. The aim of this project was to investigate the effect of phytocannabinoid treatment on adipogenesis and lipolysis in 3T3-L1 cells, to unravel their mechanism of action and also to test for potential anti-diabetic properties. The studies showed that phytocannabinoid treatment promoted higher glucose uptake and significantly less fat accumulation when compared to Rosiglitazone. Rosiglitazone is an anti-diabetic drug that has recently been withdrawn from the market since its usage has been associated with severe side effects. It was also found that during the 1800’s cannabis use was described as a treatment for a variety of metabolic disorders but its recreational use in the twentieth century resulted in laws which made the usage of cannabis illegal despite its medicinal properties. Cannabis usage has been reported to be useful in the treatment of Type 2 diabetes but unfortunately conflicting results are often published and its mechanism of action is still unknown. The aim of this project was to investigate the effect of phytocannabinoid treatment on adipogenesis and lipolysis in 3T3-L1 cells, to unravel their mechanism of action and also to test for potential anti-diabetic properties. The studies showed that phytocannabinoid treatment promoted higher glucose uptake and significantly less fat accumulation when compared to Rosiglitazone. Rosiglitazone is an anti-diabetic drug that has recently been withdrawn from the market since its usage has been associated with severe side effects. It was also found that phytocannabinoid treatment was able to reverse the insulin-resistant state of 3T3-L1 cells. The study indicates that the mechanism of action occurs at the mitochondrial level where enzymes such as succinate dehydrogenase and glycerol-3-phosphate dehydrogenase are modulated thereby affecting oxidative phosphorylation involved in the respiratory chain. In addition the effect observed with phytocannabinoid treatment is time dependent and affects the cells differently at different developmental stages. Therefore it can be concluded that phytocannabinoid treatment not only helps to maintain the balance between adipogenesis and lipolysis in 3T3-L1 cells but its use may also be helpful in the treatment of Type 2 diabetes and/or obesity-related insulin resistance.phytocannabinoid treatment was able to reverse the insulin-resistant state of 3T3-L1 cells. The study indicates that the mechanism of action occurs at the mitochondrial level where enzymes such as succinate dehydrogenase and glycerol-3-phosphate dehydrogenase are modulated thereby affecting oxidative phosphorylation involved in the respiratory chain. In addition the effect observed with phytocannabinoid treatment is time dependent and affects the cells differently at different developmental stages. Therefore it can be concluded that phytocannabinoid treatment not only helps to maintain the balance between adipogenesis and lipolysis in 3T3-L1 cells but its use may also be helpful in the treatment of Type 2 diabetes and/or obesity-related insulin resistance.

Des réformes sans précédent ont eu lieu dans les dernières années en ce qui concerne le cannabis. Cette substance est à l’avant-plan de la mouvance remettant en question la prohibition des drogues illicites. Au Canada, le gouvernement Libéral annonçait récemment son intention de présenter un cadre de légalisation pour le printemps 2017, mais une communauté d’activistes et d’organisations diverses s’exprime depuis des décennies sur la nécessité d’une telle réforme. L’objectif de cette thèse de maîtrise est d’étudier différentes perspectives militantes pour voir comment des groupes anti-prohibition issus de la société civile conçoivent et envisagent la légalisation du cannabis au Canada. Ces acteurs sont relativement peu traités dans la littérature constructiviste à propos des politiques sur le cannabis, qui se concentre davantage sur la couverture médiatique ou les discours gouvernementaux. Or, les organisations pro-légalisation présentent un argumentaire riche et détaillé abordant beaucoup d’éléments névralgiques de ce débat. Étudier leurs différents points de vue permet de mieux saisir les tensions et les nuances de la conversation sociale sur le cannabis. Après avoir composé un échantillon diversifié de douze organisations canadiennes militant en faveur de la légalisation, nous avons d’abord assemblé une archive de documents rendus disponibles par ces organisations. Puis, entre octobre 2015 et mars 2016, nous avons mené des entretiens avec un représentant ou une représentante de chaque groupe, afin d’obtenir une illustration à jour et plus détaillée du discours de l’organisation. Pour traiter ces données, nous avons eu recours à l’analyse de cadres, raffinée à l’aide d’outils de l’analyse du discours. Nous avons identifié quatre perspectives diagnostiques utilisées pour définir le problème avec le système actuel de gestion du cannabis au Canada : un cadre basé sur l’inefficacité, un cadre critique, un cadre d’injustice et un cadre politique. Ces diagnostics amènent à proposer des solutions distinctes, qui peuvent être situées par rapport à trois pôles généraux : la santé et la sécurité, les droits et libertés ou le marché libre et ouvert. Cela dit, malgré des perspectives variées, les acteurs étudiés s’entendent sur plusieurs points concrets lorsqu’il s’agit de définir la légalisation dans la pratique. De façon générale, cette thèse offre une grille de lecture permettant de mieux comprendre la complexité du débat entourant la légalisation du cannabis.

Background A growing body of research suggests the therapeutic use of cannabis may affect the use of other substances, including reducing the use of alcohol, tobacco and prescription drugs such as opioid analgesics. However, most of the evidence stems from small, cross-sectional surveys or population-level studies, both of which have significant limitations, including the inability to conclusively determine causality for behavioural changes. Furthermore, very little detail has been gathered on the factors that potentially impact substitution, including patient characteristics and patterns of cannabis use (e.g., X, Y, Z). Additionally, despite consistent calls by physicians, academics, patients and policy-makers around the globe citing the need for high quality studies to identify the risks and benefits of cannabis in both medical and non-medical applications, there are many pre-existing and ongoing challenges to conducting such research. These include shifting regulatory policies that may be impacting access to cannabis for both medical and non-medical use, and that could ultimately be affecting patient retention in prospective medical cannabis studies. In the interest of learning more about how the use of cannabis effects the use of alcohol, tobacco and other substances, and to better understand factors that may be impacting retention in prospective cannabis research, I designed and conducted two studies: 1. The Canadian Cannabis Patient Survey 2019 (CCPS 2019) was a national cross-sectional survey of 2102 Canadian medical cannabis patients that examined demographics, patient patterns of cannabis use, and self-reported changes in the use of alcohol, tobacco, prescription drugs and illicit substances following medical cannabis initiation. 2. The Tilray Observational Patient Survey (TOPS) was a prospective, multi-site, observational study examining the impact of medical cannabis products on quality of life and the use of prescription drugs of 1145 patients over a 6 month period, which provided an opportunity to conduct a survival analysis and other analyses to assess variables potentially impacting retention in longitudinal cannabis studies. Methods This dissertation includes three analyses of the data resulting from these studies in the form of one published and two submitted manuscripts. The first paper provides an overview of research to date examining the impact of cannabis and cannabinoids on alcohol use, followed by an analysis of the 973 CCPS 2019 participants who either previously or currently use alcohol. The questionnaire gathered a detailed inventory of alcohol use prior and post medical cannabis initiation using two separate but related measures: drinking days per month, and standard drinks per week. The analyses used descriptive statistics as well as univariate and multivariate regression analyses to explore patient characteristics and other variables potentially associated with changes in alcohol use post medical cannabis, including assessing the impact of “intent” to use medical cannabis to reduce alcohol use, as well as participation in other substance use treatment modalities. Findings suggest that medical cannabis initiation is associated with significant reductions in alcohol use, and that younger age (<55 years of age), specific intent to use medical cannabis to reduce alcohol use, and greater patterns of alcohol use prior to medical cannabis initiation were associated with greater odds of reducing alcohol. The second paper follows a similar methodology and format as the first paper, but with a focus on tobacco/nicotine (T/N) use. In this case, 650 survey participants reported past or current T/N use, and the analysis focused on assessing patient characteristics and other variables associated with changes in T/N uses per day, with the primary outcome of interest being no use in the 30 days prior to the survey, which was considered to be complete cessation of T/N use. The findings suggest that odds of T/N cessation were greater amongst those who were age 55 or older or that reported >25 T/N uses per day prior to initiating medical cannabis use, and that specific intent to use medical cannabis in T/N reduction/cessation efforts resulted in significantly greater odds of reducing T/N use, while involvement with traditional T/N cessation treatments (pharmacological or psychobehavioral) was negatively associated with T/N cessation. The third paper addresses the challenge of retaining patients in prospective observational medical cannabis studies at a time when there are major policy changes disrupting the legal supply while also increasing access options for adults who use cannabis. The Tilray Observational Patient Study (TOPS) was one of the largest national prospective medical cannabis studies ever conducted, taking place at 21 medical clinics in five provinces. The study was designed to assess the impact of medical cannabis on quality of life and prescription drug use over a six month period. However, initial data analysis on 1145 patients enrolled at/before Oct 15, 2018 that had completed at least one post baseline visit highlighted a significant rate of patients that were lost to follow up (LTFU). This high drop out rate, coupled with a compensation scheme that provided credits to help cover the cost of medical cannabis led to concerns of potential retention bias limited the conclusions that could be drawn from this data. However, the study and resulting data provided a unique opportunity to examine baseline patient characteristics that may have been protective of LTFU, so a survival analysis was conducted on this cohort. Additionally, since the study took place during the official launch of the legalization of adult non-medical use of cannabis in Canada on Oct. 17th, 2018, the potential impact of this significant increase in legal access options on the odds of study retention was the subject of additional analyses. The survival analysis found that baseline use of antidepressants or antiseizure medications, citing no preference for either THC or CBD, and inhalation as a primary method of use were associated with increased probability of survival/retention in the study at six months. Additionally, while the legalization of non-medical adult cannabis use in October 2018 resulted in more than three times the odds of participants being LTFU at six months, being under 55 years old, having a preference for THC, or citing inhalation as a primary method of use was partially protective of LTFU following legalization. Discussion The studies in this dissertation presented an opportunity to gather subjective and objective data on naturalistic patterns of medical cannabis use from large, heterogeneous cohorts of patients, and to explore associated impacts on the use of alcohol, tobacco and other substances. The results of these studies provide a more comprehensive understanding of the public health risks and benefits associated with the medical use of cannabis, and could subsequently inform policy decisions affecting access to cannabis vis-à-vis other drugs, private and public payer considerations related to cost-coverage for medical cannabis, and potentially lead to the development of novel alcohol and tobacco cessation strategies. Additionally, the survival analysis conducted on TOPS participants highlights some of the challenges of conducting medical cannabis research at a time when patients have a multitude of cannabis access options, including legal adult dispensaries and a still robust illicit market. Future longitudinal medical cannabis studies should consider the potential impact of policy changes effecting cannabis access on study retention/survival, and may want to focus on patient populations with characteristics associated with lower odds of LTFU. / Graduate / 2022-03-09

Background: While recreational cannabis use is common, medical cannabis programs have proliferated across North America, including a federal program in Canada. Few comparisons of medical and recreational cannabis users (RCUs) exist; this study compared these groups on key characteristics. Methods: Data came from a community-recruited sample of formally approved medical cannabis users (MCUs; n = 53), and a sub-sample of recreational cannabis users (RCUs; n = 169) from a representative adult survey in Ontario (Canada). Samples were telephone-surveyed on identical measures, including select socio-demographic, substance and medication use, and health and disability measures. Based on initial bivariate comparisons, multivariate logistical regression with a progressive adjustment approach was performed to assess independent predictors of group status. Results: In bivariate analyses, older age, lower household income, lower alcohol use, higher cocaine, prescription opioid, depression and anxiety medication use, and lower health and disability status were significantly associated with medical cannabis use. In the multivariate analysis, final model, household income, alcohol use, and disability levels were associated with medical cannabis use. Conclusions/Scientific Significance: Compared to RCUs, medical users appear to be mainly characterized by factors negatively influencing their overall health status. Future studies should investigate the actual impact and net benefits of medical cannabis use on these health problems.

This thesis examined Bill C-46 as a case study of the constructed nature of public policy as inspired by Foucault’s (1982) argument that this construction, over time, can become “truth.” Our main research question was if the Canadian governments' construction of the problem of cannabis-impaired driving, which was used to justify the necessity and the content of new offences in Bill C-46, was contested in whole or in part during the parliamentary debates that resulted in the adoption of this law or, was the construction of cannabis-impaired driving accepted without contest by most of the parliamentarians and witnesses? This thesis used Bacchi and Goodwin’s (2016) What’s the Problem Represented to be (WPR) framework to answer this question. Our two main findings of this thesis were first, that the construction of the problem was not substantially contested by parliamentarians or witnesses during the debate and second, that inequality is embedded in the content of Bill C-46. Our analysis presented the constructed division between “good citizens” who are not punishable by criminal sanctions for impaired driving or problematic driving behaviours such as driving while fatigued, or distracted driving. On the other hand, the “bad citizens”, including drivers who had consumed cannabis, were perceived as deserving of criminal punishment despite not necessarily being impaired. The Liberal Party was concerned more with political viability of cannabis legalization resulting in a problem construction that generates ineffective solutions to the objective of promoting road safety.

No description available.