Although many more traditional mental health and public health interventions and prevention strategies exist, some of which have repeatedly demonstrated their effectiveness (1,2), the vast majority of these digital tools remain under-utilized by the population that could benefit from them. There are many reasons for this (financial, socio-economic, shortage of clinical staff, stigmatization) (3), and the scientific community has done little to investigate these interventions.

Thus, mobile health interventions are emerging as a modern, accessible alternative whose growing popularity is explained by their accessibility and ease of approach, especially since the COVID-19 pandemic. Indeed, numerous systematic literature reviews and meta-analyses of randomized controlled trials (RCTs) on the subject have been published over the past decade (4,5). Mobile health interventions could be defined as any medical or public health intervention deployed in digital format via a mobile device (text messages, apps), websites, digital monitoring systems, digital personal assistants as well as any other wireless device, complex or otherwise (6).

In the context of cannabis use in Quebec, several mobile applications exist or are under development with varied, evidence-based health content (informational, preventive, therapeutic, etc.). Furthermore, in the literature on recommendations for safer cannabis use, emphasis is placed on incorporating behavioral protection strategies to reduce the risks associated with cannabis use (7). An example of a behavioral strategy would be to opt for products with low THC content, or with a higher proportion of CBD than THC (8).

Finally, mobile health interventions on cannabis use would be even more relevant for reaching young adults who report a preference for virtual approaches (9,10). It is in this precise context that two pilot randomized controlled trials of two mobile applications are emerging: “Cannabis Harm-reducing Application to Manage Practices Safely (CHAMPS)” and “ICanChange” (ICC).

The first application aims to develop methods for reducing the harm associated with cannabis use, while the second application aims to reduce cannabis use. The main aim of both research projects is to measure the feasibility of this type of intervention in a young population aged 18 to 35 who have had a first psychotic episode. Other types of non-interventional but observational mobile health initiatives are also emerging. One of these, called TRICCHOME, is due to start in January 2025. It will paint a realistic and detailed picture of cannabis use among young adults who consume cannabis at least once a week via a mobile application. Therefore, mobile health is constantly evolving and takes many forms. It is also opening several areas of opportunity for cannabis research by dematerializing resources, offering more accessible interventions and capturing key data.

To find out more and follow the progress of the above-mentioned projects, we invite you to visit our website and social networks.

Article by Amani Mahroug

References

1. Singh, V., Kumar, A., & Gupta, S. (2022). Mental health prevention and promotion—A narrative review. Frontiers in psychiatry, 13, 898009.

2. Breedvelt, Josefien JF, et al. “A systematic review of mental health measurement scales for evaluating the effects of mental health prevention interventions.” European Journal of Public Health3 (2020): 510-516

3. Kerridge BT, Mauro PM, Chou SP, Saha TD, Pickering RP, Fan AZ, et al. Predictors of treatment utilization and barriers to treatment utilization among individuals with lifetime cannabis use disorder in the United States. Drug Alcohol Depend.Dec 01, 2017;181:223-228.

4. Perski O, Hébert ET, Naughton F, Hekler EB, Brown J, Businelle MS. Technology‐mediated just‐in‐time adaptive interventions (JITAIs) to reduce harmful substance use: a systematic review. Addiction. 2022 May;117(5):1220-41.

5. Lehtimaki, S., Martic, J., Wahl, B., Foster, K. T., & Schwalbe, N. (2021). Evidence on digital mental health interventions for adolescents and young people: systematic overview. JMIR mental health, 8(4), e25847.

6. WHO 2017 16. World Health Organization. Global Diffusion of eHealth: Making Universal Health Coverage Achievable. (World Health Organization, 2017).

7. Côté, J., Chicoine, G., Vinette, B., Auger, P., Rouleau, G., Fontaine, G., & Jutras-Aswad, D. (2024). Digital Interventions for Recreational Cannabis Use Among Young Adults: Systematic Review, Meta-Analysis, and Behavior Change Technique Analysis of Randomized Controlled Studies. Journal of Medical Internet Research, 26, e55031.

8. Fischer, B., Robinson, T., Bullen, C., Curran, V., Jutras-Aswad, D., Medina-Mora, M. E., … & Hall, W. (2022). Lower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use: A comprehensive evidence and recommendations update. International Journal of Drug Policy, 99, 103381.

9. Coronado-Montoya, S., Abdel-Baki, A., Crockford, D., Côté, J., Dubreucq, S., Dyachenko, A., … & Jutras-Aswad, D. (2024). Preferences of Young Adults With Psychosis for Cannabis-Focused Harm Reduction Interventions: A Cross-Sectional Study: Préférences des jeunes adultes souffrant de psychose pour les interventions de réduction des méfaits axées sur le cannabis: une étude transversale. The Canadian Journal of Psychiatry, 07067437241242395.

10. Tatar, O., Abdel-Baki, A., Dyachenko, A., Bakouni, H., Bahremand, A., Tibbo, P. G., … & Jutras-Aswad, D. (2023). Evaluating preferences for online psychological interventions to decrease cannabis use in young adults with psychosis: An observational study. Psychiatry research, 326, 115276.

Canada’s Standardised THC Unit?

Since recreational cannabis first began being sold legally in Canada in 2018, the range of products on offer has expanded massively. Not only is there more choice than ever in terms of types of products and ways of using them, but also in terms of the levels of the active component, delta-9-tetrahydrocannabinol (THC). The trend both in Canada and internationally is for stronger, more potent cannabis products, which means higher levels of THC.(Hammond et al., 2022) But research has shown that most consumers are not familiar with THC levels, nor with what constitutes a ‘low’ or ‘high’ dose of THC.(Leos-Toro et al., 2020; Lineham et al., 2023) This can lead to people accidentally over-consuming, resulting in unwanted side-effects and negative health consequences.

A recent paper by Shea Wood and colleagues published in the International Journal of Drug Policy presents the idea of adopting a standardised THC unit in Canada.(Wood et al., 2024) The standard Canadian THC unit recommended by the authors is 2.5 mg, which research suggests would be enough to produce a ‘high’.(Kleinloog et al., 2014) This dose also follows suggestions of selecting a standard unit that is low enough to be unlikely to cause serious side effects in new cannabis users, who are likely to have low tolerance to THC and a greater need for guidance.(Chester et al., 2020) The aim of using a standard THC unit would be to better inform consumers and empower them to make evidence-based decisions in their product choice and consumption of cannabis. A similar standard THC unit is already used by cannabis researchers, but there is still a lot to consider before adopting it across the Canadian cannabis market.

Currently, cannabis sold in Canada is labelled with the amounts of THC as either a concentration or amount per dose, as well as the total amount per container.(Government of Canada, 2024) However, there is a lot of inconsistency in labelling between different types of products and between different provinces, which can make it harder for consumers to relate the THC numbers to how strong the product is. The use of a standard unit, Wood and their colleagues argue, would help people to understand the strength of a cannabis product, making it easier for consumers to predict how it will affect them. By adding how much of a product contains a standard unit, for example 1ml of vape fluid or 2 pieces of an edible, consumers could decide on how they use a product beforehand, rather than trying to titrate their use during consumption. It could also make it simpler to monitor market trends and estimate how much THC the population is using over time, and how the potency of cannabis products themselves are changing.

One key issue is how to apply a single THC unit to all types of cannabis products, regardless of how they’re used. For example, THC is usually less well absorbed by the body when it’s eaten compared to when it’s smoked or vaped, meaning less reaches the brain. Wood and colleagues reason that even less of the THC in edible products is absorbed, the effects balance out because more THC is converted to 11-hydroxy-THC, which is equally or more psychoactive than THC. However, the authors note that more research is needed to better understand how the THC in different types of cannabis affects people, especially since there are many other cannabinoids, such as cannabidiol (CBD) and delta-8-THC, that also differ between products.

Choosing and implementing a Canadian THC unit will require us to consider many factors, including how much THC can cause health problems if used frequently over a long period of time, and how the standardised unit would fit into current public health guidelines and policy. There are also other experts who maintain that the current method of measuring THC in milligrams can meet all of the same needs as the proposed standard unit. Should a standard THC unit be adopted in Canada, a long-term public education campaign will be required to teach consumers what a THC unit represents and how it may differ between products. Ultimately, any decision taken must meet the central purpose of the Cannabis Act, “to protect public health and public safety”.(Government of Canada, 2018)

Article by Lucy Chester

References

Chester, L. A., Chesney, E., Oliver, D., Wilson, J., & Englund, A. (2020). How experimental cannabinoid studies will inform the standardized THC unit. Addiction, 115(7), 1217-1218. https://doi.org/10.1111/add.14959

Government of Canada. (2018). Cannabis Act (S. C. 2018, c. 16). Retrieved 20/11/2024 16:50 from https://laws-lois.justice.gc.ca/eng/acts/c-24.5/

Government of Canada. (2024, 30/01/2024). How to read and understand a cannabis product label. Retrieved 20/11/2024 16:05 from https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/personal-use/how-read-understand-cannabis-product-label.html

Hammond, D., Goodman, S., Wadsworth, E., Freeman, T. P., Kilmer, B., Schauer, G., Pacula, R. L., & Hall, W. (2022). Trends in the use of cannabis products in Canada and the USA, 2018 – 2020: Findings from the International Cannabis Policy Study. Int J Drug Policy, 105, 103716. https://doi.org/10.1016/j.drugpo.2022.103716

Kleinloog, D., Roozen, F., De Winter, W., Freijer, J., & Van Gerven, J. (2014). Profiling the subjective effects of Δ 9 -tetrahydrocannabinol using visual analogue scales. In International Journal of Methods in Psychiatric Research (Vol. 23, pp. 245-256).

Leos-Toro, C., Fong, G. T., Meyer, S. B., & Hammond, D. (2020). Cannabis labelling and consumer understanding of THC levels and serving sizes. Drug Alcohol Depend, 208, 107843. https://doi.org/10.1016/j.drugalcdep.2020.107843

Lineham, J., Wadsworth, E., & Hammond, D. (2023). Self-reported THC content and associations with perceptions of feeling high among cannabis consumers. Drug Alcohol Rev, 42(5), 1142-1152. https://doi.org/10.1111/dar.13664

Wood, S., Gabrys, R., Freeman, T., & Hammond, D. (2024). Canada’s THC unit: Applications for the legal cannabis market. International Journal of Drug Policy, 128, 104457. https://doi.org/https://doi.org/10.1016/j.drugpo.2024.104457

The use of non-therapeutic cannabis in the context of epilepsy and its health implications

The use of cannabis among people with epilepsy is a growing concern. Approximately 50% of individuals with epilepsy consume cannabis non-therapeutically and without the supervision of a healthcare professional. The majority of scientific studies suggest that the anti-seizure effects attributed to cannabis are linked to CBD at very high doses, with robust evidence to date primarily involving pediatric populations with very specific epileptic syndromes. While some uncertain data suggest that THC might influence the intensity and frequency of seizures in certain populations, the supporting evidence remains limited, as most studies have been conducted on products containing predominantly CBD and very little THC. Furthermore, some studies mention that the neurocognitive negative impacts of cannabis are primarily due to THC.

Given the significant number of people with epilepsy who have cognitive and mental health issues, or who are predisposed to developing them, it is necessary to evaluate the prevalence and patterns of non-medical cannabis use, as well as its correlational association with cognitive and mental health in the context of epilepsy. The results of this research will have significant implications for the clinical management of patients and public health policies.

In collaboration with the research laboratory of Dr. Dang Khoa Nguyen, a neuro-epileptologist at CHUM, our research team is conducting a study aimed at providing evidence on the effects of non-therapeutic cannabis use on mental and cognitive health in the context of epilepsy. This study uses surveys and neuropsychological assessments. Our preliminary results show that, over the past 12 months, 42% of men and 19% of women have consumed non-medical cannabis. Among them, 72% reported consuming cannabis containing exclusively THC, more THC than CBD, or equal amounts of THC and CBD. Furthermore, respondents felt poorly or not at all informed about the benefits (72%) and risks (71%) to their health, highlighting the need to address the current knowledge gaps surrounding non-medical cannabis use among people with epilepsy.

This study will enable concerned individuals to make informed choices, considering the potential risks and benefits of non-medical cannabis use.

The advancements of our research will be published on our website, in the “News” section.

Article by Daphné Citherlet

What do people with psychosis want in cannabis harm reduction interventions?

Up to 60% of young people with psychosis uses cannabis, which is associated with significantly poorer clinical and psychosocial outcomes. While existing cannabis interventions typically focus on abstinence or reduction, effective interventions remain scarce, often hindered by low engagement or retention rates. There is a growing demand for harm reduction interventions that can benefit individuals with persistent cannabis use, though few exist for this population. Integrating patient preferences into intervention design could enhance intervention engagement and effectiveness, though this remains understudied for cannabis interventions tailored for people with psychosis.

To address this knowledge gap, our research team conducted a sophisticated survey including two discrete choice experiments among 89 young people with psychosis who used cannabis across Canada, published in Canadian Journal of Psychiatry this month (1). Study findings showed a preference for cannabis harm reduction interventions that were brief, technology-based and which included post-intervention boosters (particularly shorter ones). Acceptability and preference for other intervention characteristics (e.g., psychological approach used, preferred intervention aims, preferences for technology-based interventions) were also assessed in this study.

This study is one of the first to document patient preferences for cannabis harm reduction interventions. These results informed the development of CHAMPS, a brief, technology-based, cannabis harm reduction intervention tailored for this population recently developed by our team; CHAMPS is currently undergoing evaluation in a pilot randomized controlled trial (2). These survey findings can similarly guide the design of future harm reduction interventions for this population.

Article by Stephanie Coronado-Montoya

References

1 Coronado-Montoya, S., Abdel-Baki, A., Crockford, D., Côté, J., Dubreucq, S., Dyachenko, A., Fischer, B., Lecomte, T., L’Heureux, S., Ouellet-Plamondon, C., Roy, M.-A., Tibbo, P., Villeneuve, M., & Jutras-Aswad, D. Preferences of Young Adults With Psychosis for Cannabis-Focused Harm Reduction Interventions: A Cross-Sectional Study: Préférences des jeunes adultes souffrant de psychose pour les interventions de réduction des méfaits axées sur le cannabis : une étude transversale. 0(0), 07067437241242395. https://doi.org/10.1177/07067437241242395

2 Coronado-Montoya, S., Abdel-Baki, A., Côté, J., Crockford, D., Dubreucq, S., Fischer, B., Lachance-Touchette, P., Lecomte, T., L’Heureux, S., Ouellet-Plamondon, C., Roy, M.-A., Tatar, O., Tibbo, P., Villeneuve, M., Wittevrongel, A., & Jutras-Aswad, D. (2023). Evaluation of a cannabis harm reduction intervention for people with first-episode psychosis: Protocol for a pilot multi-centric randomized trial JMIR Research Protocols, 12, e53094. https://doi.org/10.2196/53094

Cannabis use can be more problematic for individuals who have experienced an episode of psychosis. Stephanie Coronado-Montoya, a PhD candidate in the Didier Jutras-Aswad laboratory, advocates for harm reduction as a means of helping people manage problematic cannabis use.

Through her review of over 11,400 scientific articles, Stephanie found that few cannabis-focused interventions existed for people with psychosis who wanted to reduce or prevent cannabis-related harms. Her national survey of patient preferences found two significant demands which emerged from the population: that interventions be short and technology-based.

The CHAMPS app responds to these demands (a mobile app containing a brief psychosocial intervention aiming to reduce cannabis-related harms in people with psychosis). To learn more about this initiative, please listen to the full episode and follow Stephanie on Instagram (@the.brain.diaries).

Genetic Basis of Cannabis Use

Cannabis is one of the most widely used psychoactive substance worldwide. The increased risk of developing a cannabis use disorder has recently been associated with specific genetic variants. These findings have led to numerous studies focused on the characterization of the complex relationship between genetic background and cannabis use. In this context, the article entitled “Genetic basis of cannabis use: a systematic review” aims to summarize some of the current knowledge on the genetic determinants underlying cannabis use, identify genetic variants associated with increased risk of cannabis misuse and its related harms, and highlight the importance of further research to better understand the genetic susceptibilities associated with cannabis use.

One of the genes commonly identified among the results of genomic approaches is the CNR1 gene, which codes for the cannabinoid 1 receptor (CB1R). CB1R is highly expressed in the brain and it is the primary target of the euphoric compound found in cannabis, i.e., delta-9-tetrahydrocannabinol (THC). Studies have shown that certain variants of the CNR1 gene are associated with a greater inclination to consume cannabis, as well as increased sensitivity to the effects of THC. The same can be said about the AKT1 gene, which codes for a protein involved in the regulation of cell growth and survival. In addition, other genes that have been associated with cannabis use include the DRD2 gene, which codes for a dopamine receptor involved in reward and motivation, and the FAAH gene, which codes for an enzyme involved in the breakdown of cannabinoids in the body.

It is important to note that the genetic basis of cannabis use is complex, multifactorial and polygenic, and individual genetic variants probably have little effect on an individual’s propensity to consume. Interactions between specific genetic susceptibilities and environmental factors, such as peer pressure, product availability, and social norms, also play an important role in cannabis use and its related consequences. However, the study of genetic factors makes it possible to explain the mechanisms involved in the response to psychoactive substances, which in turn ensures the ability to identify susceptibility factors that could be used to prevent possible harm or optimize certain benefits. It is thus important to consider genetic factors in the response to different cannabis products, an effort that we are promoting in the laboratory by including different genomic approaches to experimental designs involving cannabinoid administration in humans. This approach will be implemented in our next projects that will start in the upcoming months. Stay tuned to our projects to learn more.

References

Hillmer A, Chawar C, Sanger S, D’Elia A, Butt M, Kapoor R, Kapczinski F, Thabane L, Samaan Z. Genetic basis of cannabis use: a systematic review. BMC Med Genomics. 2021 Aug 12;14(1):203. doi: 10.1186/s12920-021-01035-5. PMID: 34384432; PMCID: PMC8359088.

The Decriminalization of Drugs in British Columbia: A Step in the Right Direction for People with Drug Addictions?

In British Columbia, since January 31^st, 2023, it is no longer a criminal offence for adults to possess up to 2,5 grams of cocaine, methamphetamine and opioids. This change in legislation was made possible via an exemption from the Controlled Drugs and Substances Act granted by Health Canada. Drug decriminalization has been described as a critical step in British Columbia’s efforts to combat the harms associated with the misuse of several psychoactive substances, including opioids^1,2. The three-year pilot project developed by the province is part of a movement to reduce the harms associated with drug use, including overdose deaths and the criminalization of people with substance use disorders³ . This would move drug use and possession from being a criminal offence to being treated as a public health issue.

For many people living with substance use disorder, decriminalization represents a significant shift in the way their situation is perceived and treated. Rather than being punished for their drug use, they would be able to access health and social services without fear of criminal charges. It would also have the potential to reduce the risk of overdose deaths by removing the fear of criminal charges for people showing early signs of overdose or for people being eyewitnesses to an overdose⁴.  People who use substances conveying a high-potential of misuse and overdose could access more easily life-saving interventions such as naloxone, seek treatment, support, and harm reduction services without fear of stigma or legal repercussions.

Nevertheless, the decriminalization of drugs in British Columbia, far from being a panacea for all drug-related problems in society, represents a significant step forward in addressing the harms associated with the criminalization of drug use, and is overall a positive development for people with substance use disorder⁵.

References

1. CCSA (Canadian Centre on Substance Use and Addiction). Decriminalization of Controlled Substances: Policy Brief 2018. [Internet]. 2018 [cited 2023 Feb 23]

2. Government of British Columbia. Decriminalization [Internet]. Government of British Columbia; [updated 2022 Nov 7; cited 2023 Feb 23].

3. CBC News. What you need to know about drugs in British Columbia [Internet]. CBC News; 2021 Oct 21 [cited 2023 Feb 23].

4. CBC News. ‘Toxic drug supply’: Why some experts say decriminalization is a key step to fighting the overdose crisis [Internet]. [place unknown]: CBC News; 2022 Feb 23 [cited 2023 Feb 23].

Drug Policy Alliance. Approaches to Decriminalization [Internet]. United Nations Office on Drugs and Crime; 2015 Feb [cited 2023 Feb 23].