Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain.
Health and Addictions Research Group, IDIBAPS, Barcelona, Spain.
Eur Addict Res. 2024;30(5):288-301. doi: 10.1159/000540541. Epub 2024 Sep 16.
Cannabis ranks as one of the most widely used psychoactive substances worldwide. Its usage has been reported as a risk factor for developing a variety of physical and mental health issues, alongside social and economic problems. According to the World Health Organization (WHO), hazardous (or high-risk) substance use is defined as "a pattern of substance use that increases the risk of harmful consequences for the user." The primary objective of this study was to achieve a consensus on an operational definition of high-risk cannabis use suitable for a European jurisdiction (Spain).
A three round Delphi study was conducted. The Delphi technique entails group decision-making and iterative forecasting by consulting a panel of experts and conducting systematic feedback rounds. An online survey was distributed among a diverse expert panel comprising professionals from Spain working on fields related to cannabis use (research, policy planning, and clinical professionals). One-hundred ninety-nine invitations were sent to experts, of which forty-five (22.6%) accepted to participate. All participants were provided the option to revise a background document with the latest compiled scientific evidence and guidelines related to health and social conditions associated to cannabis usage. This background document also proposed the quantification of dose using a standardized unit established for the population of Spain (the Standard Joint Unit or SJU) based on quantity of cannabis main psychoactive constituent, 9-tetrahydrocannabinol (9-THC) (1 SJU = 1 joint = 0.25 g of cannabis = 7 mg of 9-THC). Three rounds of Likert scale and open-ended questions were administered until consensus, defined as ≥75% agreement, was attained.
Consensus was reached on defining high-risk cannabis use as the usage of more than 4 SJU (>28 mg THC) per week or any use of cannabis with potency >10% THC. Concurrent use of cannabis with other drugs was also considered high risk, while the smoked route was considered the riskiest administration route. It was also agreed that vulnerable groups for high-risk cannabis use (for whom any pattern of cannabis use represents high risk of harm) include individuals under the age of 21, pregnant or breastfeeding women, individuals with psychiatric history, those with medical health issues related to cannabis use, professional drivers and heavy machine operators.
This operational definition of high-risk cannabis use for Spain elucidates usage patterns and individual vulnerability factors predictive of heightened harm. Its adoption holds potential to inform decision-making among individuals, professionals, and policy-makers, facilitating evidence-based interventions aimed at prevention and risk reduction.
大麻是世界上使用最广泛的精神活性物质之一。据世界卫生组织（WHO）称，其使用被报告为多种身心健康问题以及社会和经济问题的风险因素。危险（或高风险）物质使用的定义是“增加使用者产生有害后果风险的物质使用模式”。本研究的主要目的是就适用于欧洲司法管辖区（西班牙）的高风险大麻使用的操作性定义达成共识。
进行了三轮 Delphi 研究。Delphi 技术通过咨询专家小组并进行系统的反馈轮次来进行小组决策和迭代预测。一项在线调查分发给了一个由从事与大麻使用相关领域（研究、政策规划和临床专业）的西班牙专业人士组成的多元化专家小组。向专家发送了 199 份邀请，其中 45 人（22.6%）接受了参与。所有参与者都有机会修订一份背景文件，该文件汇集了与与大麻使用相关的健康和社会条件有关的最新科学证据和指南。该背景文件还根据西班牙人口使用的标准化单位（标准联合单位或 SJU）提出了使用剂量的量化，该单位基于大麻主要精神活性成分 9-四氢大麻酚（9-THC）的数量（1 SJU = 1 个关节= 0.25 克大麻= 7 毫克 9-THC）。进行了三轮李克特量表和开放式问题调查，直到达成共识，即≥75%的同意率。
就将每周使用超过 4 SJU（>28mg THC）或任何使用效力>10% THC 的大麻定义为高风险大麻使用达成了共识。同时使用大麻和其他药物也被认为是高风险的，而吸烟途径被认为是风险最高的给药途径。还一致认为，高风险大麻使用的弱势群体（任何大麻使用模式对他们来说都有很高的伤害风险）包括 21 岁以下的人、孕妇或哺乳期妇女、有精神病史的人、与大麻使用相关的医疗健康问题患者、职业驾驶员和重型机械操作员。
西班牙的这种高风险大麻使用的操作性定义阐明了可预测伤害风险增加的使用模式和个体脆弱性因素。它的采用有可能为个人、专业人员和决策者提供决策信息，促进基于证据的干预措施，以预防和减少风险。
