Future studies of peer coaching might consider using validated measures more sensitive to a patient coaching intervention such as the Patient Activation Measure. In sum, veteran peer-delivered motivational coaching failed to achieve enhanced MH treatment engagement in rural veterans compared to control, yet veterans in both arms responded to MH assessment, feedback, and personalized referrals for MH treatment with higher rates of engagement in care than previously observed in this population. Among rural veterans with MH problems, peer coaching resulted in modest improved MH symptoms, quality of life indicators, and engagement in self-care activities, which may have mitigated perceived need for clinician-directed MH treatment. Further research is needed to explore this potential expanded therapeutic role for peer coaches, including risks, benefits, and cost effectiveness.When considering all those impacted by the illegal production of cannabis and cocaine, one must take into account the wide expanse of stakeholders. A partial list of these stakeholders is as follows: animal species, plant species, environmentalists, anti-drug advocates, lobbyists, landowners, citizens, law enforcement, drug agencies, governments, and international organizations. Essentially, any person or animate object negatively affected by drug production, trafficking, selling, or use, is suffering because of the plantation, cultivation, hydroponics flood tray and manufacturing processes. These effects occur in both direct, and indirect forms.
Direct effects caused by the production of cocaine and cannabis include: the clear-cutting of forests, the intentional poisoning of plant and animal species, the toxification and depletion of watersheds, and the emission of greenhouse gasses and air pollutants. Indirect effects of marijuana and cocaine production include: biodiversity loss, ecosystem degradation, drug trafficking, theft, violent crime, drug addiction, drug enforcement and treatment costs, and government destabilization. If the initial, and environmentally destructive, production stages of cannabis and cocaine ceased to transpire, there would exist no physical and useable form of these drugs. Without a consumable form, none of the aforementioned indirect issues would occur as a result of the direct effects of cocaine and cannabis cultivation. The first step to revitalizing our approach towards stopping environmental damage, resulting from drug production, is to create intrastate and international networks that combine the abilities of the two types of agencies with the most at stake, law enforcement and environmental. By combining the resources and talents of various organizations, we can increase the funding and efficiency of efforts focused on preventing ecosystem degradation and illicit drug production. Through raising public awareness of the environmental impacts of illicit drug production, we can stem the consumer base for these drugs while concurrently raising legislative support from concerned constituents. If afflicted parties, regardless of their national or organizational identifications, wish to sincerely resolve this enduring issue, cooperation will be required. In the United States, a majority of states have legalized the use of cannabis for some purposes, and California has been a forerunner in cannabis legalization.
California was the first state to legalize medical cannabis use in 1996. To date, 35 states have legalized medical cannabis; 15 of these 35 have also legalized adult recreational cannabis, and another 13 states permit the use of products with lowtetrahydrocannabinol for medical purposes. Modes of cannabis use include smoking, vaping, and as an edible. Cannabis when smoked may be wrapped in paper or placed within a hollowed-out cigar . In 2018, modes of recent cannabis use among young adults in California were reported as 81% smoking ; 47% vaping; 43% blunt use; and 35% eating/drinking; 78% reported more than one method. Potential mental health harms of cannabis use include increased risk of developing schizophrenia and other psychoses, with heavier cannabis use associated with greater risk. Depression, anxiety, and suicidal thoughts also have been linked to cannabis use. Whether the associations are causal is unknown. Smoking cannabis can affect lung health, with regular use associated with chronic bronchitis. Smoking cannabis during pregnancy is associated with low birthweight; studies of adverse effects of prenatal cannabis use on offspring behavior and cognitive development have been equivocal. Studies of brain structural measures and cannabis use in youth and young adults also have produced mixed results. To characterize the evidence on the health benefits of cannabis use, the National Academies of Sciences, Engineering, and Medicine published a comprehensive indepth review of 10,000 studies. The report found strong evidence from randomized control trials to support the conclusions that cannabis or its constituents are effective for treating chronic pain; as antiemetics in the treatment of chemotherapy induced nausea and vomiting; and for improving patient-reported multiple sclerosis spasticity symptoms. With regards to mental health, other research has found an anxiolytic-like effect of cannabidiol in patients with social anxiety disorder .
There also is moderate evidence for cannabinoids, mainly nabiximols, in improving short-term sleep outcomes in those with chronic medical conditions. Few studies have examined cannabis’s effects on well-being, a construct related to quality of life, and findings have been mixed. Since 1990, there has been an increasing trend in favor of legalizing cannabis in the United States. The Pew Research Center reported that 59% of Americans favor legalizing cannabis for medical and recreational use, while another 32% support cannabis use for medical purposes only; only 8% opposed legalizing cannabis. Since 2002, adult use of cannabis has been increasing. In 2019, 31.6 million Americans reported cannabis use in the past 30 days, with prevalence of 23% among adults aged 18- to-25 and 10.2% among adults 26 years and older. Data from the 2018 California Health Interview Survey showed that among adults 18 years and older, 33% reported cannabis use within the past month. In California, on November 8, 2016, voters passed Prop 64, the Adult Use of Marijuana Act, supporting the legalization of recreational cannabis use for adults 21 years or older. Prop 64 proposed to create a system to regulate the cannabis market and impose taxes on the retail sale and cultivation of cannabis; and allowed for use in a private home or at a business licensed for onsite consumption, and prohibited use while driving and in public areas including federal areas such as parks, as it is illegal under federal law. On January 1, 2018, California was authorized to begin issuing licenses to operate recreational cannabis businesses, legalizing sales from licensed retail outlets and the purchasing of cannabis for recreational use. States that legalized recreational cannabis use had a higher prevalence of cannabis use and greater use of products such as cannabis edibles, drinks, and high potency concentrate than in those that had not. Among the first four states that legalized cannabis for recreational purposes , there were increases in frequent cannabis use and cannabis use disorder among adults aged 26 and older following recreational cannabis legalization. A recent California study found no increase in cannabis use after legalization of recreational cannabis; however, the study sample was restricted to young adults aged 18–24 who used tobacco, so the findings may not generalize to the broader population. Beliefs on the health benefits of cannabis was found to be higher in states that had legalized cannabis for recreational use. With expanding legalization and increases in cannabis use, examining patterns of cannabis use and the factors that might drive cannabis use trends over time is needed. With California’s legalization of recreational cannabis use, we sought to characterize, from pre- to post-policy implementation, adults’ use patterns, exposure to others’ cannabis use, and perceptions of the benefits or harms of cannabis use to physical and mental health and well being. We hypothesized an increase in adult cannabis use and exposure to others’ use as well as more positive health perceptions of cannabis use over time.In this prospective observational study on cannabis policy changes in California, legalized recreational cannabis use was associated with greater self-reported past 30-day use one-month post-legalization, and in the univariate model, remained significantly higher at 6-months post legalization.
Compared to California state data, our study sample had a lower frequency of past 30-day cannabis use . Likely related, the sample had more harmful perceptions of cannabis use: 43% of respondents at baseline and 42% at 1-month post-legalization perceived cannabis use to be harmful, whereas United States data from the Substance Abuse and Mental Health Services Administration estimated 12% of young adults 18 to 25 years old and 29% of adults 26 years or older perceived great risk from smoking cannabis monthly. Surprisingly, hydro flood table exposure to others’ use of cannabis did not change from pre- to post-legalization of recreational cannabis use in our study time frame; however, it is possible that exposure to cannabis smoke may have increased earlier among our study population. A California Department of Public Health survey found that the rate of cannabis exposure in 2016 among adults aged 18 to 64 years was 21.5%, and by 2018 had doubled to 40%, which is similar to our findings on cannabis exposure. In late-2016, Prop 64 was voted on and approved by voters of California and could explain the increase of secondhand cannabis exposure from 2016 to 2018. Significant correlates of cannabis use at all time points included depression diagnosis, while having an other mental illness diagnosis was significantly associated with cannabis use only 6-months post-legalization. A recent study found that from 2005 to 2017, the prevalence of cannabis use among people in the United States with depression was increasing and that those with depression experienced a rapid decrease in perception of risk of cannabis use . While not tested in our study, it is possible those with depression or other mental illness experienced decreasing perceptions of risk of cannabis use. Despite the growing evidence of cannabis use as an effective treatment in chronic pain and its use in mitigating side effects of cancer therapies, our study showed that those with pain and those with a history of cancer were not significantly more likely to use cannabis. Among our California study sample of adults between the ages of 23 to 86 with a mean age of 56 years, we found younger age associated with cannabis use preand post-legalization. These findings are consistent with previous national studies on adults in the United States where cannabis use decreased with increasing age. By 6-months post-legalization, perceived health benefits of cannabis use significantly increased, and in the multivariate model, health perceptions were associated with cannabis use over time. Notably, perceptions of health benefits of cannabis use for mental health showed the largest increase. The literature suggests potential anxiolytic effects of CBD, but also points to the association of mental health harms with high-potency cannabis use. Though our sample had an overall positive perception of cannabis use in benefiting physical health and well being, there was no significant association between cannabis use with pain or cancer, common conditions for which cannabis has been used to treat. Mass marketing and health promotions from cannabis dispensaries also may have contributed to the increase in perceived health benefits of cannabis. Since the legalization of recreational cannabis in California, which includes the selling of cannabis, dispensary ads and mass marketing campaigns promoting uses of cannabis have proliferated. Endorsements from social media influencers and celebrities, may also be adding to overall positive perception of cannabis use. As a response to the mass marketing, Los Angeles and San Diego counties have proposed restrictions on where cannabis ads and billboards can be placed. Much is to be learned on whether these restrictions will impact perceptions and use. To ensure health harms are not ignored, public health interventions such as educational programs and health communications are needed to increase awareness. Study limitations include that the data were self reported by a relatively small convenience sample, and thus may not be generalizable to other populations. The sample was more non-Hispanic White than the general population in California; however, a similar percentage of Californians voted in favor for Proposition 64. Rather than remove respondents who did not complete all the surveys and conduct a complete case analysis that could lead to less power and biased results, we used GEE analyses, which is useful in dealing with missing data and does not require imputation . Missingness was not associated with cannabis use, and therefore consistent with the assumption that outcome data were missing completely at random. To account for missing data, we did adjust for employment, which was associated with attrition, in all models. If perceptions of the health benefits of cannabis use increase over time and become more widespread , cannabis use may increase further.