Quantifying data-driven metrics of meaningful cannabis reduction

项目概要/摘要 美国成年人使用大麻的比例正在增加，人们对大麻危害的认识也在增加 与大麻使用有关的犯罪率继续下降。随着立法转向广泛的法律的大麻 如果能够获得，则有可能看到使用率进一步增加，经常使用的流行率增加， 大麻使用障碍（CUD）。虽然停止使用大麻仍然是一个重要的里程碑 对许多人来说，探索减少大麻使用危害的方法可能有益于公共健康。伤害 减少战略对酒精和阿片类药物有强有力的经验支持，但减少大麻的危害 还处于初期阶段例如，目前尚不清楚如何最好地实施减少危害的方法， 大麻，以及至关重要的是，如何发现和界定大麻使用的减少，以确定是否有好处 与减少有关。鉴于文献中没有关于减少大麻的既定定义，本文 R21提案旨在通过对六种大麻进行二次分析来解决文献中的这一空白 在我们的研究组内进行的治疗试验（5项已完成，1项正在招募;预计N=873 在最早的补助金开始日期; N=820目前入组;年龄13-65; 28%女性; 26%非洲裔美国人; 12% 西班牙裔/拉丁裔）。我们建议使用这些现有的，去识别的数据来表征尿液中的衰变 大麻素与自我报告的大麻使用显著减少相吻合。通过描述平均值 从这个全面的数据集，我们将有数据- 在未来减少危害的过程中，从操作上定义和生物学上验证大麻减少的驱动指标， 治疗研究。具体来说，本提案的目的是：1）确定是否减少50%或更多 在每周自我报告大麻使用与肌酐标准化尿肌酐相应减少相关， 大麻素使用减少五周后;和2）表征每周肌酐的衰减- 正常化的尿大麻素参与者在第五周减少大麻使用至少50%， 治疗对某些人来说，减少大麻使用危害的战略可能是一种有益的戒烟替代方案。 经常使用者，但重要的大麻危害减少问题不能充分和系统地 没有严格的数据驱动的指标来定义和检测使用的减少。由此产生的结果 研究有可能通过促进向替代性、非替代性和非替代性药物的转变， 治疗成功的禁欲结果，并通过提供 数据驱动的缩减指标。大麻的使用及其后果是公共卫生的一个优先领域 有必要探讨减少大麻对经常使用者的有害影响的战略。

PROJECT SUMMARY/ABSTRACT Rates of cannabis use among adults in the United States are increasing and the perception of harm associated with cannabis use continues to decline. As legislation shifts towards widespread legal cannabis access, there is the potential to see an even greater increase in use rates, increased prevalence of regular use, and the development of cannabis use disorder (CUD). While cannabis cessation remains an important milestone for many, there may be public health benefit to exploring harm reduction approaches to cannabis use. Harm reduction strategies have strong empirical support for alcohol and opioids, but harm reduction work for cannabis is still in its infancy. For example, it is currently unknown how best to implement harm reduction approaches for cannabis and, critically, how to detect and define reductions in cannabis use to determine if there are benefits associated with reduction. Given that there is no established definition of cannabis reduction in the literature, this R21 proposal aims to address this gap in the literature by conducting a secondary analysis of six cannabis treatment trials conducted within our research group (five completed, one currently enrolling; N=873 expected at the earliest grant start date; N=820 currently enrolled; ages 13-65; 28% female; 26% African American; 12% Hispanic/Latinx). We propose to use these existing, de-identified data to characterize the decay in urinary cannabinoids coinciding with significant reductions in self-reported cannabis use. By characterizing the average decay and prediction intervals of urinary cannabinoids from this comprehensive data set, we will have data- driven metrics to operationally define and biologically verify cannabis reduction in future harm reduction and treatment studies. Specifically, the aims of this proposal are to: 1) determine whether 50% or greater decreases in weekly self-reported cannabis use correlate with a corresponding decrease in creatinine-normalized urinary cannabinoids following five weeks of use reduction; and 2) characterize the decay in weekly creatinine- normalized urinary cannabinoids in participants who reduce cannabis use by at least 50% by week five of treatment. Harm reduction strategies for cannabis use may be a beneficial alternative to cessation for some regular users, but important cannabis harm reduction questions cannot be adequately and systemically answered without rigorous and data-driven metrics to define and detect reductions in use. Outcomes from this study have the potential to impact future work on CUD treatment by promoting a shift towards alternative, non- abstinence outcomes of treatment success and improving the rigor of cannabis harm reduction work by providing data-driven reduction metrics. Cannabis use and its consequences represent an area of public health priority and there is a need to explore strategies to reduce the harmful impact of cannabis in regular users.