The purpose of this integrative literature review was to understand the effects of medical cannabis for chronic pain management in adults. Anecdotal reports suggest the use of medical marijuana as a pain management therapy could be an alternative to opioids and other medications which have long term consequences. Potential uses span the health care continuum, from prescribed outpatient symptom management, to acute care, extended care, home care, and hospice treatment settings. The methodology included a review and synthesis of relevant research articles from 2012 to 2018, written in the English language. The findings suggest medical cannabis has the potential of effectively managing chronic pain in older adults. Adverse effects, if present, are mild and resolve without intervention. Lower doses of medical cannabis were reported to be more effective in treating chronic pain compared to higher doses. Inconsistencies in the efficacy of THC were noted compared to CBD for managing neuropathic pain. Implication for nursing practice, policy, education, and recommendation for future research were discussed along with study limitations.

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<p>Marijuana use has been shown to increase and peak during young adulthood (i.e., ages 18-35). However, it appears that Black individuals do not decline in use at rates similar to other race groups. Marijuana use among Black adults has been linked to more problems such as increased arrests, greater mental health disorder diagnoses, and substance dependence. The biopsychosocial model of racism and race-based theoretical framework aims to understand how factors such as racial discrimination as a traumatic event could be associated with marijuana behaviors, particularly among Black adults. The present study aims to examine the association between racial discrimination and marijuana use and problem use above and beyond trauma exposure. Further, I aimed to explore whether gender or vocation (college, community, and military) moderated the relationships. 391 Black adults (57.5% female; mean age 24.9) completed measures on marijuana use and problems, trauma exposure, and racial discrimination distress. Hierarchical linear regression and Hayes PROCESS macro were used to evaluate the study aims. Racial discrimination distress was associated with marijuana use above and beyond trauma exposure (DR2=.016, <em>p</em>=.004). However, racial discrimination distress did not add significant variance within the model for problem marijuana use (DR2=.001, <em>p</em>=.419). Additionally, moderation by gender and vocation were not supported in either model. Taken together, the present results support that examining psychological and health outcomes among Black young adults should include an evaluation of racial discrimination distress. Further, future studies should continue to evaluate sociodemographic factors in larger more representative community-based studies to better understand potential variation in risk among Black young adults.</p>

Indiana University-Purdue University Indianapolis (IUPUI) / Marijuana use has been shown to increase and peak during young adulthood (i.e., ages 18-35). However, it appears that Black individuals do not decline in use at rates similar to other race groups. Marijuana use among Black adults has been linked to more problems such as increased arrests, greater mental health disorder diagnoses, and substance dependence. The biopsychosocial model of racism and race-based theoretical framework aims to understand how factors such as racial discrimination as a traumatic event could be associated with marijuana behaviors, particularly among Black adults. The present study aims to examine the association between racial discrimination and marijuana use and problem use above and beyond trauma exposure. Further, I aimed to explore whether gender or vocation (college, community, and military) moderated the relationships. 391 Black adults (57.5% female; mean age 24.9) completed measures on marijuana use and problems, trauma exposure, and racial discrimination distress. Hierarchical linear regression and Hayes PROCESS macro were used to evaluate the study aims. Racial discrimination distress was associated with marijuana use above and beyond trauma exposure (R2=.016, p=.004). However, racial discrimination distress did not add significant variance within the model for problem marijuana use (R2=.001, p=.419). Additionally, moderation by gender and vocation were not supported in either model. Taken together, the present results support that examining psychological and health outcomes among Black young adults should include an evaluation of racial discrimination distress. Further, future studies should continue to evaluate sociodemographic factors in larger more representative community-based studies to better understand potential variation in risk among Black young adults.

Background With the impending legalization of recreational cannabis in Canada, it is important to examine the strength of association between cannabis use and common mental health concerns including depression, anxiety, and suicide and the extent to which these associations have changed over time. It is also important to examine the moderating effects of developmental age and biological sex on these associations. Methods This study uses Statistics Canada data from the 2002 and 2012 Canadian Community Health Survey’s Mental Health Component (CCHS-MH) which represent repeated cross-sectional surveys from nationally representative samples of Canadians 15 years of age and older (2002 n=36,984; 2012 n=25,113). Stepwise multivariate analyses were performed using linear regression for psychological distress and binary logistic regression for Major Depressive Episode (MDE) and suicidal thoughts and attempts. Time was accounted for as a binary indicator (2002 vs. 2012) and an interaction term between cannabis use and time was added to all the models. Additional interaction terms were added to the models to test the moderating effects of cannabis frequency, developmental age, and biological sex. Sensitivity analyses were performed to adjust for other substance use and socioeconomic covariates. Weighting and bootstrapping was utilized to present results reflective of the Canadian population. Results Cannabis use was positively associated with emotional problems, and this association strengthened over time, particularly for depression and suicidal thoughts and attempts. These temporal associations were similar across age groups and for males and females, and remained after controlling for other substance use and socioeconomic status. Conclusions Findings provide a baseline assessment of the Canadian population prior to legalization and direction for health promotion and prevention campaigns. Results highlight the need for awareness and regular monitoring of the cooccurrence of cannabis use and emotional problems and offer guidance for future research. / Thesis / Master of Health Sciences (MSc) / Using Statistics Canada data from the 2002 and 2012 Canadian Community Health Survey’s Mental Health Component, this dissertation determines the strength of association between cannabis use and common mental health concerns including depression, anxiety, and suicide and the extent to which these associations have changed over time. Cannabis use was positively associated with emotional problems, and this association strengthened over time, particularly for depression and suicidal thoughts and attempts. These temporal associations were similar across age groups and for males and females, and remained after controlling for other substance use and socioeconomic status. These results add novel insights to the existing literature about the changing relationship between cannabis use and emotional problems over time and potential mechanisms of this change are discussed. Given the impending legalization of recreational cannabis in Canada, clinical and research implications of results are discussed at length.

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La légalisation du cannabis au Canada en octobre 2018 pose à la fois des défis et des opportunités à saisir, notamment en ce qui concerne la réorientation des fonds publics pour améliorer l'efficacité de la prévention chez les jeunes. Alors que les jeunes âgés entre 15 et 24 ans sont caractérisés par un usage de cannabis supérieur à toutes les autres tranches d'âges, les méfaits associés à la substance sont amplifiés lorsque la consommation est fréquente et précoce. L'objectif de cette recherche consiste alors à déterminer quels sont les différents segments de consommateurs et de non-consommateurs de cannabis que l'on peut retrouver dans une population d'adolescents et jeunes adultes. De fait, les non-consommateurs de cannabis ne sont pas un groupe homogène. La création des profils à l'aide de l'analyse typologique repose sur les variables de segmentation suivantes: les motivations à consommer ou à ne pas consommer du cannabis, les croyances quant aux effets du cannabis, la recherche de sensations et l'attitude envers la substance. Un échantillon de 338 répondants âgés entre 15 et 24 ans comprenant 139 consommateurs et 198 non-consommateurs de cannabis a permis de révéler la présence de six profils distincts. Parmi les consommateurs, quatre profils se distinguent : les expérimentateurs, les usagers réguliers, les épicuriens et les occasionnels. En ce qui concerne les non-consommateurs, on retrouve plutôt deux profils : les résolus et les vulnérables. De tous ces profils, les consommateurs réguliers et les non-consommateurs vulnérables apparaissent plus susceptibles à la consommation de cannabis, et devraient, pour cette raison, retenir l'attention des gestionnaires en marketing sociétal. Enfin, une analyse discriminante a permis de révéler l'importance de la recherche de sensations pour discriminer entre les groupes de consommateurs et entre les groupes de nonconsommateurs, ce qui suppose la pertinence de tenir compte du niveau de recherche de sensations des profils les plus vulnérables afin de mieux orienter les messages de prévention. / The legalization of cannabis in Canada in October 2018 poses both challenges and opportunities, especially when it comes to the redirection of public funds for the purpose of improving the effectiveness of the prevention among young people. As the share of young people aged between 15 and 24 years old is characterized by a greater usage of cannabis than any other age group, the harms associated with the substance use are amplified in the case of an early and frequent use. Hence, the objective of the present study is to determine which segments of consumers and non-consumers of cannabis can be found in a population of adolescents and young adults. Indeed, the non-consumers of cannabis do not form a homogeneous group. The profile creation through cluster analysis is based on the following segmentation variables: the motivations that lead to use or not to use cannabis, the beliefs about the effects of cannabis, the search for sensations and the attitude toward the substance. A sample of 338 respondents aged between 15 and 24 years old, comprising 139 consumers and 198 non-consumers of cannabis, revealed six distinct profiles. Four profiles are found among the consumers: the experimenters, the epicureans, the regular and the occasional users. As regards the non-consumers, two profiles are identified: the determined and the vulnerable. Of all these profiles, the regular consumers and the vulnerable non-consumers seem to be more likely to use cannabis and should therefore justify more attention from societal marketing managers. All in all, a discriminant analysis exposed the relevance of the search for sensations in discriminating the groups of consumers and non-consumers, which implies the relevance to take into account the degree of the search for sensations when it comes to most at-risk profiles, in order to better target the prevention messages.

Le chemin menant à la légalisation du cannabis au Canada en 2018 semble aussi sinueux que celui menant à sa prohibition en 1923. De nombreux acteurs ont contribué à la réforme, mais les données disponibles ne permettent pas toujours de comprendre l’influence que ceux-ci ont pu avoir. Ce mémoire de maitrise se compose de deux études scientifiques complémentaires visant le même objectif principal: contribuer à la compréhension de la légalisation du cannabis, et particulièrement à la compréhension des rôles joués par l’opinion publique et par les médias. D’emblée, une étude de la portée de la littérature (scoping review) rassemble les connaissances scientifiques actuelles à propos de l’opinion publique et des drogues au Canada. Elle présente 161 références sélectionnées parmi 29 260 études, dont la plus ancienne remonte à 1956. Elle montre que l’opinion publique par rapport au cannabis est sous-étudiée au Canada en comparaison avec l’alcool et le tabac. Elle montre aussi la faible présence des auteurs et des théories en sciences sociales. Enfin, elle révèle la complexité de tracer l’évolution de l’opinion publique avec le peu de données disponibles, et donc de comprendre son impact sur la légalisation. Une seconde étude examine ensuite par analyse textuelle automatisée le traitement médiatique du cannabis au Canada et au Québec dans 29 955 articles tirés de six médias de 1985 à 2020. Cette étude offre une double contribution théorique en mesurant d’abord la normalisation du cannabis selon la théorie de Parker et al. (1998), pour ensuite clarifier le rôle des médias dans l’évolution du cadrage du cannabis selon le modèle de l’activation en cascade de Entman (2004). Les résultats montrent un traitement médiatique du cannabis plus neutre, voire plus positif depuis 2015. En 2019, la probabilité est plus élevée qu’un média aborde le cannabis sous un angle économique plutôt que judiciaire. L’étude expose l’apparition de discours alternatifs dans les médias dès les années 1990, faisant compétition au cadrage prohibitionniste défendu par les gouvernements. Ensemble, ces deux études offrent des indicateurs supplémentaires sur les influences de l’opinion publique et des médias, et appellent à davantage de recherches afin de peindre le portrait complet de la route ayant mené à la légalisation du cannabis au Canada en octobre 2018. / The road to the legalization of cannabis in Canada in 2018 seems as winding as the road to its prohibition in 1923. Many actors have contributed to the reform, but the available data do not always allow to understand the influence they may have had. This master’s thesis consists of two complementary studies with the same main objective: to contribute to the understanding of the legalization of cannabis and particularly to the understanding of the roles played by public opinion and the media. First of all, a scoping review brings together current scientific knowledge about public opinion and drugs in Canada. It presents 161 references selected from 29,260 studies, the oldest of which dates back to 1956. It shows that public opinion about cannabis is under-studied in Canada compared to alcohol and tobacco. It also shows the low presence of authors and theories from the social sciences. Finally, it reveals the complexity of tracing the evolution of public opinion with the limited data available, and thus of understanding its impact on legalization. A second study then examines by automated textual analysis the media treatment of cannabis in Canada and Quebec in 29,955 articles drawn from six media from 1985 to 2020. This study makes a double theoretical contribution by first measuring the normalization of cannabis according to the theory of Parker, Aldridge, & Measham (1998), and then clarifying the role of the media in the evolution of the framing of cannabis according to Entman’s (2004) cascade activation model. The results show a more neutral or even positive media treatment of cannabis since 2015. In 2019, there is a higher probability that the media will approach cannabis from an economic rather than a judicial perspective. The study also shows the emergence of alternative discourses in the media as early as the 1990s, competing with the prohibitionist framework put forward by governments. Taken together, these two studies provide additional indicators of public and media influences, and call for more researches to paint a complete picture of the road to cannabis legalization in Canada in October 2018.

L’usage de drogues illicites et la symptomatologie dépressive sont associés, mais la nature de cette association demeure mal comprise. Une clarification des mécanismes en jeu est nécessaire afin de pouvoir intervenir sur la cooccurrence des deux phénomènes, dont les conséquences individuelles et sociales sont lourdes. Ces efforts de clarification débutent à l’adolescence, moment où sont typiquement initiés la consommation de substances et les problèmes affectifs. L’objectif de cette thèse est de contribuer à clarifier la nature des associations entre l’usage de certaines des drogues illicites les plus fréquemment consommées et les symptômes dépressifs chez les adolescents. Les données utilisées proviennent d’une cohorte de l’échantillon longitudinal de la Stratégie d’Intervention Agir Autrement (SIAA) comprenant plus de 3000 jeunes fréquentant des écoles en milieu défavorisé du Québec, qui ont été suivis pendant leur secondaire (2003-2007). Le premier article empirique de la thèse porte sur la relation entre l’usage de cannabis et la symptomatologie dépressive. Cette étude a examiné l’existence d’associations prospectives bidirectionnelles entre les deux phénomènes du début (13-14 ans) à la fin du secondaire (16-17 ans). Les analyses ont considéré des liens directs, mais également des liens indirects via deux facteurs reflétant des appartenances sociales normatives et non normatives : l’attachement à l’école et l’affiliation à des pairs déviants et consommateurs de drogues. Les résultats indiquent que les symptômes dépressifs et l’usage de cannabis peuvent représenter des facteurs de risque mutuels et suggèrent qu’un mécanisme indirect impliquant une érosion des attaches normatives pourrait jouer un rôle dans des cascades développementales reliant les deux manifestations. Le deuxième article empirique visait à déterminer si l’usage de deux drogues de synthèse, le MDMA (ecstasy) et les méth/amphétamines (speed), à 15-16 ans était associé au développement de symptômes dépressifs élevés un an plus tard, en prenant en considération des facteurs confondants potentiels. Tel qu’attendu, les résultats montrent une prédiction de la symptomatologie dépressive par l’usage de MDMA et de méth/amphetamines, particulièrement lorsque cet usage est concomitant. Ces résultats représentent une des premières évidences d’un risque posé par l’usage de drogues de synthèse par rapport au développement de symptômes affectifs chez les jeunes. / Illicit drug use and depressive symptoms are associated, but the nature of this association remains poorly understood. Clarifying the underlying mechanism(s) is necessary in order to design interventions which can potentially reduce the co-occurrence of the two phenomena, which accounts for sizeable individual and social costs. Clarification efforts should start in adolescence, when drug use and affective problems are typically initiated. The aim of this thesis is to help clarify the nature of the association between some of the most frequently used illicit drugs and depressive symptomatology in adolescents. This work was carried out using a cohort from the New Approaches, New Solutions (NANS) longitudinal dataset, which comprises more than 3000 students attending school in disadvantaged areas of Quebec (Canada) who were followed throughout high school (2003-2007). The first article of the thesis focuses on the association between cannabis use and depressive symptoms. This study examined prospective associations in both directions between the two phenomena from the beginning (grade 8) to the end (grade 11) of high school. Direct links were analysed, as well as indirect links involving two factors reflecting normative and non normative social connectedness: school bonding and affiliation with deviant and substance-using peers. Results indicate that depressive symptoms and cannabis use can be mutual risk factors and that a social mechanism involving an erosion of normative social connectedness may play a mediating role in bidirectional developmental cascades linking the two manifestations. The second article tested whether the use of two synthetic drugs, MDMA (ecstasy) and meth/amphetamines (speed), in grade 10 was associated with the development of elevated depressive symptoms the following year, independently from potential confounders. As hypothesized, the use of MDMA and meth/amphetamine was independently predictive of subsequent depressive symptoms. Concurrent use of the two substances was more predictive than singular use. Given the paucity of well-controlled longitudinal studies on the subject, these results provide some of the first compelling evidence that synthetic drug use may pose a risk for the development of affective symptoms in youth.