Clinical Psychopharmacology Unit, Department of Clinical, Educational and Health Psychology, University College London, Faculty of Brain Sciences, University College London, London, UK.
Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK.
Addiction. 2021 Jul;116(7):1622-1630. doi: 10.1111/add.15290. Epub 2020 Nov 20.
Nationally representative data of cannabis-tobacco co-use have shown that these substances are closely entwined and have significant adverse health consequences, although population-level harms of co-use are largely unknown. Current epidemiological research does not assess co-use in a manner that has yielded the necessary data to draw conclusions regarding health effects. This has given rise to a hidden population of co-users who go under-served. Therefore, this paper has two aims: (1) to review new challenges in the collection of co-use data due to rapidly changing regulations of cannabis and nicotine products and (2) to provide recommendations for the terminology and assessment of co-use.
We argue that: (1) the prevalence of co-use is not being assessed accurately at a population level and (2) changes in legalization have created novel challenges, but without proper monitoring the impact on co-use will go undetected. We propose a three-level tiered set of recommendations for co-use assessments, which includes assessments of cannabis, tobacco and co-use metrics ranging from least burdensome (self-report of co-administered products) to most burdensome (assays, event-level data).
We propose that clinical studies begin to incorporate cannabis-tobacco co-use assessments to justify better their inclusion in clinical trials and national surveillance surveys. Integration of co-use assessments will aid in understanding the true impact on co-use of the changing cannabis and tobacco/nicotine regulatory environments. Co-use is prevalent and problematic, and the ability to make conclusions about its health outcomes is hindered by lack of nuance in data collection. If you do not measure it, you cannot manage it.
全国代表性的大麻-烟草共同使用数据表明，这些物质紧密交织在一起，会带来严重的健康后果，尽管人群中共同使用的危害在很大程度上尚未可知。目前的流行病学研究并没有以一种能够得出关于健康影响结论的数据评估共同使用。这导致了一个共同使用者的隐藏群体，他们得不到足够的服务。因此，本文有两个目的：（1）审查由于大麻和尼古丁产品法规的迅速变化而在共同使用数据收集方面出现的新挑战；（2）为共同使用的术语和评估提供建议。
我们认为：（1）人群中共同使用的流行率并没有被准确地评估；（2）合法化的变化带来了新的挑战，但如果没有适当的监测，共同使用的影响将无法被发现。我们提出了一个三级分层的共同使用评估建议，包括对大麻、烟草和共同使用指标的评估，从最低负担（共同使用产品的自我报告）到最高负担（分析、事件级数据）。
我们建议临床研究开始纳入大麻-烟草共同使用评估，以证明其纳入临床试验和国家监测调查的合理性。共同使用评估的整合将有助于理解不断变化的大麻和烟草/尼古丁监管环境对共同使用的真正影响。共同使用是普遍存在且有问题的，如果数据收集缺乏细微差别，就很难对其健康后果做出结论。如果你不测量它，你就无法管理它。
