Introduction and Aims
Since 2011, the Israeli Ministry of Health has been working towards increased regulation of its medical cannabis (MC) program by ensuring that MC licensing procedures adhere to ...the basic principles and practices of the medical profession. The aim of this study is to examine trends in MC licensing in Israel during this period of increasing MC regulation.
Design and Methods
Publicly available data on MC licences, collected by the Ministry of Health, were used to examine trends between 2013 and 2018. The number of MC licences, new MC licence requests and rate of MC licence requests accepted were plotted over time. Gender and age distributions and the medical indicators for which MC licences were approved were also examined.
Results
Absolute numbers of MC licences and MC licence requests increased during the study period while no parallel increase in the rate at which new MC licences were granted was observed. MC licences for post‐traumatic stress disorder increased substantially during the study period. The majority of MC patients in Israel are male, over the age of 40, and used MC for chronic pain.
Conclusions
The observed increase in MC licences is likely driven by an increase in patient demand. This study suggests that social forces (e.g. positive media reporting and public attitudes towards MC), beyond MC regulation, are influencing trends in MC licensing in Israel. Studies that examine the skewed gender distribution of MC licences, and the efficacy of MC for post‐traumatic stress disorder, are urgently needed.
Abstract Background This study aims to gain a more nuanced perspective on the differences between recreationally and medically motivated cannabis use by distinguishing between people who use cannabis ...for recreational purposes, unlicensed and licensed medical users. Methods Data collection was conducted online from a convenience sample of 1479 Israeli cannabis users. Multinomial regression analysis compared unlicensed medical users (38%) with recreational (42%) and licensed medical (5.6%) users in terms of sociodemographics, mode, frequency and problematic cannabis use. Results There were more variables distinguishing unlicensed from licensed users than there were distinguishing features between unlicensed and recreational users. Recreational users were more likely to be male, less likely to eat cannabis, to use cannabis frequently and to use alone and before midday than unlicensed users. Licensed users were older than unlicensed users, they reported less hours feeling stoned, less cannabis use problems and they were more likely to report cannabis use patterns analogous of medication administration for chronic problems (frequent use, vaping, use alone and use before midday). Conclusion This study suggests that a sizable proportion of cannabis users in Israel self-prescribe cannabis and that licensed medical cannabis users differ from unlicensed users. This is, in turn, suggestive of a rigorous medicalized cannabis program that does not function as a backdoor for legal access to recreational use. However, due to methodological limitations this conclusion is only suggestive. The most meaningful differences across recreational, unlicensed and licensed users were mode and patterns of use rather than cannabis use problems. Current screening tools for cannabis use problems may, however, not be well suited to assess such problems in medically motivated users. Indeed, when screening for problematic cannabis use there is a need for a more careful consideration of whether or not cannabis use is medically motivated.
•MC testimonials indirectly increase positive attitudes about recreational cannabis.•Attribution of responsibility for disease moderates the indirect effect.•Cannabis prevention should address the ...role of media in shaping public opinion.
This experimental study tests effects of exposure to video narratives about successful symptom relief with Medical Cannabis (MC) on attitudes, beliefs, and intentions related to recreational cannabis use.
Patient video testimonials were modeled after those found in extant media coverage. Israeli participants (N = 396) recruited through an online survey company were randomly assigned to view a narrative or a non-narrative video containing equivalent information about MC. Video content was further manipulated based on whether the protagonist had a stigmatized disease or not, and whether attribution of responsibility for his disease was internal or external.
Exposure to patient testimonials indirectly increased positive attitudes, beliefs and intentions related to recreational cannabis use through changing attitudes, beliefs and intentions related to MC. Furthermore, exposure to narratives in which the patient was presented as not to blame for contracting his illness (external attribution) was associated with more positive attitudes, beliefs and intentions toward MC, a factor that was significantly associated with more positive attitudes, beliefs and intentions related to recreational cannabis use.
These results suggest that narrative news media coverage of MC may influence public attitudes toward recreational cannabis. Because such media stories continue to be commonplace, it is important to examine potential spillover effects of this coverage on public perceptions of recreational cannabis. Cannabis prevention programs should address the role of media coverage in shaping public opinion and address the distinction between medical and recreational cannabis use.
•Medical and recreational cannabis use is becoming more frequent among older adults.•The detrimental effects of early-life cannabis use may not translate to use in older ages.•Cannabis use in older ...ages may be associated with improved brain health.•Current evidence of long-term effects of cannabis exposure on cognition in old age is only suggestive.
While medical and recreational cannabis use is becoming more frequent among older adults, the neurocognitive consequences of cannabis use in this age group are unclear. The aim of this literature review was to synthesize and evaluate the current knowledge on the association of cannabis use during older-adulthood with cognitive function and brain aging. We reviewed the literature from old animal models and human studies, focusing on the link between use of cannabis in middle- and old-age and cognition. The report highlights the gap in knowledge on cannabis use in late-life and cognitive health, and discusses the limited findings in the context of substantial changes in attitudes and policies. Furthermore, we outline possible theoretical mechanisms and propose recommendations for future research.
The limited evidence on this important topic suggests that use in older ages may not be linked with poorer cognitive performance, thus detrimental effects of early-life cannabis use may not translate to use in older ages. Rather, use in old ages may be associated with improved brain health, in accordance with the known neuroprotective properties of several cannabinoids. Yet, firm conclusions cannot be drawn from the current evidence-base due to lack of research with strong methodological designs.
The legalization of medical and recreational cannabis is a topic of continued debate in countries around the world. It has been suggested that medical cannabis legalization influences cannabis ...legalization for recreational purposes through increased media attention toward the positive health effects of cannabis. However, the nature of media coverage is likely to vary across mass media and online sources (internet and social media). In addition, effects of information engagement on attitudes may vary depending on whether information was actively sought or obtained incidentally during patterns of regular media use (scanned).
This study uses data from an online survey of Israeli adults (N = 554) to test the association between information seeking and scanning about medical cannabis (from mass media and online sources) and attitudes toward medical cannabis. Furthermore, we test indirect effects of media engagement on attitudes toward cannabis legalization through medical cannabis attitudes.
Seeking and scanning for information about medical cannabis from online sources, but not from mass media sources, were associated with positive attitudes toward medical cannabis. Engagement with medical cannabis information from online sources was also indirectly associated with greater support for cannabis legalization, through positive attitudes related to medical cannabis.
The results suggest that one mechanism through which medical cannabis legalization is associated with cannabis legalization for all purposes is public engagement with information about medical cannabis in the media, particularly from the internet and social media channels. As increasingly more jurisdictions are expected to legalize medical cannabis, with resulting increase in media attention, support for recreational cannabis legalization may be expected to grow.
•Non-treatment-seeking college students reported on mood and cannabis use.•More positive affect and less negative affect predicted intention to use cannabis.•Positive affect was relatively high after ...cannabis use.•Negative affect was relatively low after cannabis use.•Cannabis-related problems did not moderate any of these associations.
Reinforcement models identify negative affect (NA) and positive affect (PA) to be important momentary determinants and outcomes of cannabis use. Sensitization and allostatic models further suggest that these mood-cannabis associations are stronger among individuals with more cannabis-related problems. Despite this theoretical background and the fact that cannabis is commonly used for its mood-enhancing effects among college students, surprisingly, little is known about the momentary associations between mood and cannabis use in this population.
To examine the associations between (a) momentary within-person variations in NA (worried, stressed, nervous) and PA (happy, enthusiastic, proud, excited) and intention to use cannabis within the next hour, (b) the within-person variations in time elapsed since last cannabis use, amount used and momentary NA and PA, and (c) to test whether cannabis-related problems moderate the stated associations.
Eighty, more-than-weekly, cannabis using students at the University of Amsterdam reported on cannabis use, NA and PA three times daily for 14 consecutive days. Mixed-effects models were performed to analyze the dataset.
Within-persons, relatively high PA and low NA were associated with a higher likelihood of intending to use cannabis. Within-persons, more recent and greater amounts of cannabis use were associated with relatively high PA. More recent cannabis use was associated with relatively low NA. Cannabis-related problems did not moderate the associations.
While recent cannabis use related to higher PA and lower NA, high PA but low NA preceded use, supporting positive reinforcement rather than negative reinforcement in this college sample of regular cannabis users
•Shorter time elapsed between cannabis use and sleep associated with shorter SOL.•No association found between cannabis use and number of awakenings.•More evidence for cannabis effects on sleep is ...needed.
A substantial proportion of people using cannabis report using it to improve sleep. Yet, little research exists on the associations between the timing of cannabis use and sleep. This study examines the time elapsed between cannabis use and sleep start time and its association with two of the main indicators of sleep continuity: (1) sleep onset latency (SOL) and (2) number of awakenings (NOA) throughout the night.
Each morning, for 7 consecutive days, daily cannabis users (n = 54) reported on the timing of previous night’s cannabis use and sleep indicators on their smartphones. Mixed effects models examined the relations of within- and between-subjects’ time elapsed between previous night cannabis use and sleep start time, with (1) SOL and (2) NOA.
Within subjects, shorter time elapsed between cannabis use and sleep start time was associated with shorter SOL (β = 0.519, p = 0.010), but not NOA (β = -0.030, p = 0.535). Furthermore, between individuals, the time gap between the previous night cannabis use and sleep start time was not associated with SOL or NOA (p > 0.05).
It is possible that cannabis use proximal to bedtime is associated with shorted sleep onset latency but not nighttime awakenings. Cannabis users should be informed about both the potential sleep aid effects of cannabis and its limitations. Pending further evidence of the effects of cannabis on sleep, cannabis users experiencing sleep problems should be provided with evidence-based alternatives to improve sleep, e.g., pharmacological and behavioral treatments.
Debate about medical cannabis legalization are typically informed by three beliefs: (1) cannabis has medical effects, (2) medical cannabis is addictive and (3) medical cannabis legalization leads to ...increased used of cannabis for recreational purposes (spillover effects). We examined how strongly these beliefs are associated with public support for medical cannabis legalization and whether this association differs across divergent medical cannabis policy regimes.
Robust regression analysis was used to analyse data derived from two nationally representative samples of adults participating in comparable cross-sectional online surveys in one country where medical cannabis smoking is illegal (Norway, n = 2175, 51 % male) and in one country where medical cannabis smoking is legal (Israel, n = 648, 49 % male).
The belief that cannabis has medical benefits was more strongly related to support for medical cannabis legalization than were beliefs about addiction and spillover effects. While the support for medical cannabis legalization was stronger in Israel than in Norway (78 vs. 51 %, p < 0.01), the belief variables had, in general, more impact on the policy stand in Norway.
The belief that cannabis has medical benefits is particularly salient for support for medical cannabis legalization. It is possible that the recent surge in evidence supporting the medical benefits of cannabis will increase the belief about medical benefits of cannabis in the general population which may in turn increase public support for medical cannabis legalization. Results also suggest that once medical cannabis is legalized, factors beyond cannabis-specific beliefs will increasingly influence medical cannabis legalization support. These conclusions are, however, only suggestive as the current study is based on cross-sectional data. Hopefully, future research will be able to capitalize on changes in medical cannabis policies and conduct longitudinal studies that enable an examination of the causal relation between public opinion and medical cannabis policy changes.
Despite increasing use of Medical Cannabis (MC) among posttraumatic stress disorder (PTSD) patients, research is lacking on how MC treatment relates to PTSD symptomatology, in particular sleep ...disturbances. This study examines the time gap between MC use and sleep onset and its association with (1) number of awakenings throughout the night, (2) early awakenings, (3) nightmares. Each morning over a two week period, 77 licensed MC patients suffering from PTSD reported on the timing of previous night MC use and sleep disturbances. Within-person analyses found that shorter time gaps between previous night MC use and sleep start time was associated with lower likelihood of experiencing nightmares throughout the night, but it was not associated with nightly awakenings or waking up too early. Between-person analyses showed that individuals who used MC products with higher CBD concentrations reported fewer early awakenings. These preliminary results indicate that future research should test causal relations between MC use and sleep problems in PTSD patients. Future research is warranted in order to explore causal relationships between MC use, nightmares and insomnia in PTSD patients.
•A daily diary study was conducted among licensed medical cannabis patients with PTSD.•Medical cannabis use was associated with lower likelihood of experiencing nightmares throughout the nigh.•Use of MC products with higher CBD concentrations was associated with fewer early awakenings.
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