This should be understood and respected. The Kings frequently pointed to the fact that their usage was a product of a world dominated by technology, rationality and materialism that will destroy the world. For that reason, I feel it is necessary to accept the spiritual use of drugs to counteract the problems of the world as the Kings put it. Likewise, it is important to recognize the desire of individuals and groups in our own society for spiritual and transcendental experiences that may stem from a need to counteract our ever increasingly irrationally rational world.The channels with diameters of 1.75 mm and larger were cleared out even in the 5 cm long test pieces. For straight channels, it was possible to remove the uncross-linked resin by feeding a thin wire through the channel, but in case of tortuous channels , this technique was difficult to execute successfully, as the wire could not navigate the bends of the tortuous channels. Instead, we implemented the manual injection of IPA with a syringe directly into the channels. This technique was more efficient and superior to the IPA soak method. As can be seen on Figure 3c, the 3 cm long microchannels were still clogged after a 6 h IPA soak, metal greenhouse benches while the IPA injection successfully cleared the microchannels in another sample of the same geometry. IPA injection is capable of clearing channels all the way down to microchannels with 1 mm diameter.
In the US, as of March 2018, medical use of marijuana is legal in 28 states and the District of Columbia and recreational use is legal in 8 states and the District of Columbia. The liberalization of marijuana laws raises public health concerns, particularly about possible effects on adolescents’ marijuana use and problems. Despite potential risks, the 2016 Monitoring the Future survey shows that 36% of 12th graders and 24% of 10th graders reported past year marijuana use and 23% and 14%, respectively, reported past 30 day use. About 81% of 12th graders and 64% of 10th graders reported that marijuana is “fairly easy” or “very easy” to get. Only 31% of 12th graders and 44% of 10th graders perceived “great risk” in regular marijuana use. Commercialization of cannabis, including marijuana, concentrates, and edibles, may affect adolescents’ use directly by increasing availability or indirectly by promoting beliefs that its use is safe and normative. Although legal sales of recreational marijuana are restricted to adults, enforcement compliance checks indicate that between 11%-23% of recreational outlets may sell to minors. In addition, commercialization may increase the availability of marijuana through diversion, increase exposure to aggressive marketing tactics by the emerging cannabis industry, or increase exposure to others who use or illicitly sell marijuana. Co-use of marijuana with other drugs may be exacerbated by legalization. Although some studies have found positive associations between densities of medical marijuana dispensaries and marijuana use among adults, very little is known about the potential influence of adolescents’ exposure to marijuana dispensaries, recreational outlets, and marketing or the mechanisms through which such exposure may affect their marijuana use.
Studies showing associations between adolescents’ exposure to alcohol and tobacco outlets and use of those substances, suggest the importance of investigating exposure to retail access and marketing of marijuana. The article by Shi et al., makes a timely contribution to this field of research by investigating associations of proximity and density of medical marijuana dispensaries, price of medical marijuana products, and variety of products sold in school neighborhoods with adolescents’ marijuana use and susceptibility. Results showed no associations between adolescents’ current use or susceptibility to use marijuana and proximity or density of medical marijuana dispensaries around schools, price, and product variety. Focusing on exposure around school neighborhoods, this study used traditional measures of proximity and density of outlets around schools. Such measures are often used in studies to assess influences of exposure to alcohol and tobacco outlets on use of those substances. However, research shows that the locations in which young people spend their time are varied and geographically dispersed, and not captured by geographical boundaries such as school or home neighborhoods. Activity spaces include all locations and the routes the individuals experience as a result of their daily activities. Recent studies have found that adolescents’ activity spaces provide a more accurate measure of alcohol and tobacco outlet exposures than do traditional measures. Future research should consider marijuana retail availability in the broader environments where adolescents spend their time. Moreover, the cannabis market is evolving in ways that make it different than the tobacco and alcohol markets. In addition to marijuana, myriad cannabis products are available and heavily marketed.
These products can be smoked, eaten, vaped, or used topically. Many of these products are easily transportable and readily concealed or disguised. Many of them can be used covertly , possibly making use by adolescents less risky than is the case for most alcohol or tobacco products. As noted by Shi et al., future research should consider the range of cannabis products to more accurately assess the effects of marijuana commercialization on adolescents’ marijuana beliefs and use. In addition, unlike alcohol and tobacco, there remains a substantial illegal market. Given tax policies and the resulting price differentials, the underground market may remain a preferred source of marijuana for adolescents. The situation is further complicated by provisions allowing individuals to grow marijuana for personal use, possibly providing access for adolescents directly from family members, friends, and acquaintances who grow it or by providing increased opportunities to steal it. Although the legal market may not be a primary source of marijuana for adolescents, it nonetheless may have an influence by increasing open consumption in public and the home, by normalizing marijuana use, and by increasing exposure to marketing. Importantly, some adolescents may be more susceptible to exposure to marijuana outlets in their daily lives, and therefore at greater risk for marijuana use, susceptibility and problems. The lack of associations between the geography of marijuana dispensaries and marijuana use by adolescents, observed by Shi et al., suggests that the mechanisms by which retail marijuana availability may influence adolescents’ use and problems may be complex. As the national landscape regarding marijuana legalization changes in the US, more research is needed to understand adolescents’ exposures to marijuana commercialization and the mechanisms by which exposures to marijuana dispensaries, recreational outlets, and marketing may affect marijuana use and beliefs. Such research is important to guide policies and prevention efforts to reduce the potential negative effects of marijuana commercialization. Changes in past-month cannabis use by year and age group for Colorado and Kansas are shown in Figures 1 and 2. 5 Over this time span cannabis potency has increased. Current commercialized cannabis is near 20% tetrahydrocannabinol , the primary psychoactive constituent of cannabis, while in the 1980s concentration was <2%. This 10-fold increase in potency does not include other formulations such as oils, waxes, and dabs, rolling greenhouse tables which can reach 80-90% THC. This general increase in cannabis use and increase in cannabis potency has led to cannabis-related presentations to emergency departments and hospitalizations across the state. This review will focus on negative health and safety effects Colorado has experienced with inclusion of relevant peer reviewed literature. It will conclude with a short review of the medicinal use of cannabis products.ED visits and hospitalizations with marijuana-related billing codes have increased following legalization. Mental illness represents a concerningly large number of marijuana related visits. A retrospective review by Wang et al. reported Colorado Hospital Association hospitalizations and ED visits with marijuana-related billing codes. Between 2000 and 2015, hospitalization rates increased 116% from 274 to 593 per 100,000 hospitalizations. For primary diagnosis categories, the prevalence of mental illness was five-fold higher for ED visits and nine-fold higher for hospital admissions for patients with marijuana-related billing codes compared to those without. This data compared diagnostic categories between patients with a marijuana-related diagnostic code and those without. Subsequent data by the CDPHE show significant increases in hospitalizations in each phase of marijuana legalization, increasing from 575 per 100,000 hospitalizations in 2000 to 2413 in the 2014–June 2015 period, as displayed in Figure 3.8.
There are differences in incidence between the Wang study and the CDPHE report because the Wang study only included a patient’s healthcare event if a marijuana code was among the first three diagnostic codes, while the CDPHE study included marijuana diagnostic codes within the top 30. ED and urgent care visits with cannabis-associated International Classification of Diseases codes or positive urine drug screens for teenagers and young adults have increased since legalization, and the majority require behavioral health evaluation. A subsequent retrospective review by Wang et al. from 2005-2015 identified 4202 such visits for patients 13 to <21 years old to a tertiary-care children’s hospital system. Behavioral health evaluation was obtained for 2813 and a psychiatric diagnosis was made for the majority of the visits. ED/ UC visits with cannabis-associated ICD codes or positive urine drug screens of all types increased 2.7-fold from 1.8 per 1000 in 2009 to 4.9 per 1000 in 2015 . Behavioral health consultations increased 2.7-fold from 1.2 per 1000 in 2009 to 3.2 per 1000 in 2015 . These data indicate that despite national survey data suggesting the rate of adolescent marijuana use is flat, there has been a significant increase in adolescent ED/UC visits with cannabis-associated ICD codes or positive urine drug screens.Figure 4 displays these visits by year.Previous studies, including large reviews by the World Health Organization and the National Academies of Sciences, Engineering, and Medicine , have found substantial evidence of a statistical association between cannabis use and the development of schizophrenia or other psychoses, with the highest risk among the most frequent users.In a study of 45,570 Swedish men drafted into the military, the authors found that the men who had tried cannabis by age 18 were 2.4 times more likely to be diagnosed with schizophrenia over the next 15 years than those who had not. A follow-up study found a dose-response relationship between frequency of cannabis use at the age of 18 and the risk of schizophrenia. This effect persisted after controlling for confounding factors such as psychiatric diagnosis at enlistment, IQ score, personality variables concerned with interpersonal relationships, place of upbringing, paternal age, cigarette smoking, disturbed behaviors in childhood, history of alcohol misuse, family history of psychiatric illness, financial situation of the family, and father’s occupation. The researchers estimated that 13% of cases of schizophrenia could have been averted if no one in the cohort had used cannabis. These findings have been reproduced repeatedly and across the world. Cannabis use is associated with increased rates of depression, anxiety, and suicide. The NASEM found that there is a moderate statistical association between cannabis use and an increased risk for the development of depressive disorders and this increases with increased frequency of use . There was also moderate evidence of a statistical association between regular cannabis use and increased incidence of social anxiety disorder . The NAESM found that there was moderate evidence of a statistical association between cannabis use and the incidence of suicidal ideation and suicide attempts , and increased incidence of suicide completion . The NASEM reviewed multiple studies to come to the summary conclusions, and the odds ratios represent the most compelling systematic review for the conclusions. However, there were many more studies used to reach the stated conclusions. The data reviewed by the World Health Organization also demonstrate similar results for depression, anxiety, and suicide.6 Both the NASEM and the WHO reviews acknowledge that reverse causation and shared risk factors cannot be ruled out as explanations of these statistical associations and acknowledge that further research is needed. In the most recent data on Colorado adolescent suicides, marijuana was the most common substance present for ages 10-19 in 2016. Of 62 suicides with toxicology data available, marijuana was present in 30.6% compared to 9.7% for alcohol. This trend has been increasing since liberalization of marijuana policy in 2010. This is more concerning as suicide is currently the leading cause of death of adolescents in Colorado. For all age groups in Colorado, in the five-year period from 2004-2009 there were 4822 suicides and 7.1% of those were marijuana positive on toxicology analysis . In the subsequent five-year period of marijuana legalization, 2010-2015, there were 5880 total suicides , and 12.6% had a positive toxicology for marijuana . This represents a statistically significant 77.5% increase in the proportion of suicide victims with toxicology positive for marijuana for which toxicology data were reported .