Quantifying data-driven metrics of meaningful cannabis reduction

项目摘要/摘要 美国成年人的大麻使用率正在上升，人们对大麻危害的认识 与大麻有关的使用继续下降。随着立法转向广泛使用合法大麻 有可能看到使用率有更大的增长，经常使用的普及率增加， 和大麻使用障碍(CUD)的发展。虽然停止吸食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会对公共健康有利。危害 减少战略对酒精和阿片类药物有强有力的经验支持，但减少危害对大麻有效 目前仍处于初级阶段。例如，目前尚不清楚如何最好地实施减少危害的方法 关键是如何发现和界定大麻使用量的减少，以确定是否有好处 与还原相关的。鉴于文献中没有关于减少大麻的既定定义，这 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差距 在我们研究组内进行的治疗试验(5项已完成，1项目前正在登记；N=873预期 在最早的资助开始日期；N=820目前注册；年龄13-65岁；28%女性；26%非裔美国人；12% 西班牙裔/拉丁裔)。我们建议使用这些现有的、未识别的数据来表征尿液中的衰变。 大麻类药物的使用与自我报告的大麻使用大幅减少不谋而合。通过描述平均 尿中大麻素的衰变和预测间隔从这个综合的数据集中，我们将有数据- 驱动的衡量标准，以业务定义和生物验证大麻在未来的减少危害和 治疗研究。具体地说，这项提案的目的是：1)确定降幅是否达到50%或更高 在每周自我报告的大麻使用与相应的肌酐标准化尿量的下降相关 减少使用五周后的大麻素；2)表征每周肌酐的衰退- 在第五周前将大麻使用量减少至少50%的参与者的正常化尿大麻样物质 治疗。对于一些人来说，使用大麻的减害策略可能是戒烟的有益替代方案 经常吸食大麻，但重要的减少大麻危害问题不能得到充分和系统的重视 回答时没有严格的数据驱动型指标来定义和检测使用量的减少。由此产生的结果 这项研究有可能通过促进向替代的、非 戒烟治疗成功的结果和提高大麻减害工作的严谨性 数据驱动的减少指标。大麻的使用及其后果是一个公共卫生优先领域 还需要探讨减少大麻对经常吸食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.