Skip to main content

Advertisement

SpringerLink
Log in

Knowledge of Cannabinoid Content Among People Living with HIV Who Use Cannabis: a Daily Diary Study

  • Full length manuscript
  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background

Many people living with HIV (PLWH) use cannabis for medicinal reasons. Patients’ knowledge of the tetrahydrocannabinol (THC) and cannabidiol (CBD) concentrations of the cannabis products they use may be important in helping patients achieve symptom relief while guarding against potential risks of cannabis use. However, no studies have examined cannabinoid concentration knowledge among PLWH.

Method

PLWH (N = 29; 76% men, mean age 47 years) reporting cannabis use for both medicinal and nonmedicinal reasons completed daily surveys over 14 days assessing cannabis products used, knowledge of cannabinoid concentrations of cannabis products used, cannabis use motives (medicinal, nonmedicinal, both), and positive and negative cannabis-related consequences. Across the 361 cannabis use days captured on the daily surveys, at least some knowledge of cannabinoid concentrations was reported on an average of 43.1% (for THC) and 26.6% (for CBD) of the days.

Results

Generalized linear mixed models revealed that participants were more likely to report knowing THC and CBD concentrations on days when they used non-flower forms of cannabis relative to days when they used cannabis flower only. Participants who used cannabis for medicinal reasons on a greater proportion of days had greater knowledge of cannabinoid concentration overall across days. Further, greater overall knowledge of cannabinoid concentrations was associated with fewer reported negative cannabis-related consequences.

Conclusions

Findings suggest that among PLWH, knowledge of cannabinoid concentrations may be higher when using non-flower cannabis products and among those reporting primarily medicinal cannabis use. Moreover, knowledge of cannabinoid concentration may protect against negative cannabis-related consequences in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

De-identified study data and study materials are available upon request, subject to any applicable ethics approval.

Notes

  1. Vape cartridges, edibles/beverages, concentrates, oils, capsules/tablets, and other unspecified cannabis products were merged into a single non-flower cannabis product category due to low frequencies in original product categories.

  2. Medicinal and mixed (i.e., both medicinal and nonmedicinal) cannabis use motives were combined due to few exclusively medicinal days (39, 10.80%).

  3. One daily survey in which previous-day cannabis use was reported was excluded as data were missing for all cannabis-related variables.

References

  1. Harris GE, Dupuis L, Mugford GJ, et al. Patterns and correlates of cannabis use among individuals with HIV/AIDS in Maritime Canada. Can J Infect Dis Med Microbiol. 2014;25(1):e1–7.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Pacek LR, Towe SL, Hobkirk AL, Nash D, Goodwin RD. Frequency of cannabis use and medical cannabis use among persons living with HIV in the United States: findings from a nationally representative sample. AIDS Educ Prev. 2018;30(2):169–81. https://doi.org/10.1521/aeap.2018.30.2.169.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Shiau S, Arpadi SM, Yin MT, Martins SS. Patterns of drug use and HIV infection among adults in a nationally representative sample. Addict Behav. 2017;68:39–44. https://doi.org/10.1016/j.addbeh.2017.01.015.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Costiniuk CT, Saneei Z, Salahuddin S, et al. Cannabis consumption in people living with HIV: reasons for use, secondary effects, and opportunities for health education. Cannabis and Cannabinoid Research. 2019;4(3):204–13. https://doi.org/10.1089/can.2018.0068.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Fogarty A, Rawstorne P, Prestage G, Crawford J, Grierson J, Kippax S. Marijuana as therapy for people living with HIV/AIDS: social and health aspects. AIDS Care. 2007;19(2):295–301. https://doi.org/10.1080/09540120600841930.

    Article  CAS  PubMed  Google Scholar 

  6. Furler MD, Einarson TR, Millson M, Walmsley S, Bendayan R. Medicinal and recreational marijuana use by patients infected with HIV. AIDS Patient Care STDS. 2004;18(4):215–28. https://doi.org/10.1089/108729104323038892.

    Article  PubMed  Google Scholar 

  7. Wardell JD, Shuper PA, Hendershot CS. A longitudinal investigation of the association between cannabis use and alcohol use among people living with HIV. Drug Alcohol Depend. 2018;193:7–13. https://doi.org/10.1016/j.drugalcdep.2018.08.026.

    Article  PubMed  Google Scholar 

  8. Adams JW, Bryant KJ, Edelman EJ, et al. Association of cannabis, stimulant, and alcohol use with mortality prognosis among HIV-infected men. AIDS Behav. 2018;22(4):1341–51. https://doi.org/10.1007/s10461-017-1905-4.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lake S, Kerr T, Capler R, Shoveller J, Montaner J, Milloy MJ. High-intensity cannabis use and HIV clinical outcomes among HIV-positive people who use illicit drugs in Vancouver. Canada Int J Drug Policy. 2017;42:63–70. https://doi.org/10.1016/j.drugpo.2017.02.009.

    Article  PubMed  Google Scholar 

  10. Montgomery L, Bagot K, Brown JL, Haeny AM. The Association between marijuana use and HIV continuum of care outcomes: a systematic review. Curr HIV/AIDS Rep. 2019;16(1):17–28. https://doi.org/10.1007/s11904-019-00422-z.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Health Canada. Canadian Cannabis Survey 2021: Summary. Published December 23, 2021. Accessed November 11, 2022. https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2021-summary.html

  12. Freeman TP, Lorenzetti V. “Standard THC units”: a proposal to standardize dose across all cannabis products and methods of administration. Addiction. 2020;115(7):1207–16. https://doi.org/10.1111/add.14842.

    Article  PubMed  Google Scholar 

  13. Hammond D, Goodman S. Knowledge of tetrahydrocannabinol and cannabidiol levels among cannabis consumers in the United States and Canada. Cannabis and Cannabinoid Research. 2022;7(3):345–54. https://doi.org/10.1089/can.2020.0092.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tassone F, Di Ciano P, Liu Y, Rueda S. On offer to Ontario consumers three years after legalization: a profile of cannabis products, cannabinoid content, plant type, and prices. Front Psychiatry. 2023;14:1111330. https://doi.org/10.3389/fpsyc.2023.1111330.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Fischer B, Russell C, Sabioni P, et al. Lower-risk cannabis use guidelines: a comprehensive update of evidence and recommendations. Am J Public Health. 2017;107(8):e1–12. https://doi.org/10.2105/AJPH.2017.303818.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hammond D. Communicating THC levels and ‘dose’ to consumers: implications for product labelling and packaging of cannabis products in regulated markets. Int J Drug Policy. 2021;91:102509. https://doi.org/10.1016/j.drugpo.2019.07.004

  17. Sikorski C, Leos-Toro C, Hammond D. Cannabis consumption, purchasing and sources among young Canadians: the Cannabis Purchase and Consumption Tool (CPCT). Subst Use Misuse. 2021;56(4):449–57. https://doi.org/10.1080/10826084.2021.1879142.

    Article  PubMed  Google Scholar 

  18. Freeman TP, Morgan CJA, Hindocha C, Schafer G, Das RK, Curran HV. Just say ‘know’: how do cannabinoid concentrations influence users’ estimates of cannabis potency and the amount they roll in joints? Addiction. 2014;109(10):1686–94. https://doi.org/10.1111/add.12634.

    Article  PubMed  Google Scholar 

  19. Wheeler M, Merten JW, Gordon BT, Hamadi H. CBD (cannabidiol) product attitudes, knowledge, and use among young adults. Subst Use Misuse. 2020;55(7):1138–45. https://doi.org/10.1080/10826084.2020.1729201.

    Article  PubMed  Google Scholar 

  20. Kruger DJ, Kruger JS, Collins RL. Frequent cannabis users demonstrate low knowledge of cannabinoid content and dosages. Drugs: Educ, Prev Policy. 2021;28(1):97–103. https://doi.org/10.1080/09687637.2020.1752150

  21. Riekert KA, Rand CS. Electronic monitoring of medication adherence: when is high-tech best? J Clin Psychol Med Settings. 2002;9(1):25–34. https://doi.org/10.1023/A:1014131928789.

    Article  Google Scholar 

  22. Simons JS, Dvorak RD, Merrill JE, Read JP. Dimensions and severity of marijuana consequences: development and validation of the Marijuana Consequences Questionnaire (MACQ). Addict Behav. 2012;37(5):613–21. https://doi.org/10.1016/j.addbeh.2012.01.008.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Mannes ZL, Burrell LE, Ferguson EG, et al. The association of therapeutic versus recreational marijuana use and antiretroviral adherence among adults living with HIV in Florida. Patient Prefer Adherence. 2018;12:1363–72. https://doi.org/10.2147/PPA.S167826.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wardell JD, Rueda S, Fox N, et al. Disentangling medicinal and recreational cannabis use among people living with HIV: an ecological momentary assessment study. AIDS Behav. 2023;27(4):1350–63. https://doi.org/10.1007/s10461-022-03871-7.

    Article  PubMed  Google Scholar 

  25. Cuttler C, Spradlin A. Measuring cannabis consumption: psychometric properties of the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU). PLoS One. 2017;12(5):e0178194. https://doi.org/10.1371/journal.pone.0178194

  26. Adamson SJ, Kay-Lambkin FJ, Baker AL, et al. An improved brief measure of cannabis misuse: the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Drug Alcohol Depend. 2010;110(1–2):137–43. https://doi.org/10.1016/j.drugalcdep.2010.02.017.

    Article  PubMed  Google Scholar 

  27. Yaremych HE, Preacher KJ, Hedeker D. Centering categorical predictors in multilevel models: best practices and interpretation. Psychol Methods. Advance online publication. https://doi.org/10.1037/met0000434

  28. Enders CK, Tofighi D. Centering predictor variables in cross-sectional multilevel models: a new look at an old issue. Psychol Methods. 2007;12(2):121. https://doi.org/10.1037/1082-989X.12.2.121.

    Article  PubMed  Google Scholar 

  29. Bates D, Mächler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. J Stat Softw. 2015;67(1):1–48. https://doi.org/10.18637/jss.v067.i01.

    Article  Google Scholar 

  30. Government of Canada. About cannabis. Health Canada. Published 2022. Accessed February 10, 2023. https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/about.html

  31. Spanagel R, Bilbao A. Approved cannabinoids for medical purposes – comparative systematic review and meta-analysis for sleep and appetite. Neuropharmacol. 2021;196:108680. https://doi.org/10.1016/j.neuropharm.2021.108680

  32. Tran T, Kavuluru R. Social media surveillance for perceived therapeutic effects of cannabidiol (CBD) products. Int J Drug Policy. 2020;77:102688. https://doi.org/10.1016/j.drugpo.2020.102688

  33. Hurd YL. Leading the next CBD wave—safety and efficacy. JAMA Psychiat. 2020;77(4):341–2. https://doi.org/10.1001/jamapsychiatry.2019.4157.

    Article  Google Scholar 

  34. Pearson MR. A meta-analytic investigation of the associations between cannabis use and cannabis-related negative consequences. Psychol Addict Behav. 2019;33(3):190. https://doi.org/10.1037/adb0000452.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Nicolle Fox, Dinat Khan, Korina Taguba, Dennis Padilla, and Katalin Halasz for their assistance with data collection for this study.

Funding

This research was supported by grants from the Canadian Institutes of Health Research Canadian HIV Trials Network (CTN PT037; PIs: Jeffrey D. Wardell and Sergio Rueda) and from the Canadian Institutes of Health Research (159754; PIs: Jeffrey D. Wardell and Christian S. Hendershot). The views expressed herein do not necessarily represent the official policy of the Canadian Institutes of Health Research. Sergio Rueda holds an Innovator Award from the Ontario HIV Treatment Network. Cecilia T. Costiniuk holds a FRQ-S Junior 2 Clinician-Researcher Career Award. Mohammad-Ali Jenabian holds the Tier 2 CIHR Canada Research Chair in Immuno-Virology.

Author information

Authors and Affiliations

  1. Department of Psychology, York University, 277 Behavioural Sciences Building, 4700 Keele St., Toronto, ON, Canada

    Sophie G. Coelho & Jeffrey D. Wardell

  2. Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada

    Sergio Rueda, Paul A. Shuper, John A. Cunningham & Jeffrey D. Wardell

  3. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Sergio Rueda, John A. Cunningham & Jeffrey D. Wardell

  4. CIHR Canadian HIV Trials Network, Vancouver, BC, Canada

    Sergio Rueda, Cecilia T. Costiniuk, Mohammad-Ali Jenabian, Shari Margolese, Enrico Mandarino, Joel Singer & Jeffrey D. Wardell

  5. Chronic Viral Illness Service and Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada

    Cecilia T. Costiniuk

  6. Infection and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada

    Cecilia T. Costiniuk

  7. Department of Biological Sciences, Université du Québec á Montréal, Montreal, QC, Canada

    Mohammad-Ali Jenabian

  8. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Paul A. Shuper

  9. Department of Psychiatry, University of North Carolina – Chapel Hill, Chapel Hill, NC, USA

    Christian S. Hendershot

  10. Bowles Centre for Alcohol Studies, University of North Carolina – Chapel Hill, Chapel Hill, NC, USA

    Christian S. Hendershot

  11. Department of Addictions, Kings College London, London, UK

    John A. Cunningham

  12. Unity Health Toronto, St. Michael’s Hospital, Toronto, ON, Canada

    Gordon Arbess

  13. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

    Gordon Arbess

  14. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    Joel Singer

Authors
  1. Sophie G. Coelho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sergio Rueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cecilia T. Costiniuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammad-Ali Jenabian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shari Margolese
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Enrico Mandarino
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paul A. Shuper
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christian S. Hendershot
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. John A. Cunningham
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gordon Arbess
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Joel Singer
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jeffrey D. Wardell
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SGC: conceptualization; data curation; formal analysis; and writing, original draft. SR: conceptualization; methodology; funding acquisition; and writing, review and editing. CC: funding acquisition and writing, review and editing. M-AJ: funding acquisition and writing, review and editing. SM: conceptualization; methodology; funding acquisition; and writing, review and editing. EM: conceptualization; methodology; funding acquisition; and writing, review and editing. PAS: funding acquisition and writing, review and editing. CSH: methodology; funding acquisition; and writing, review and editing. JAC: funding acquisition and writing, review and editing. GA: funding acquisition and writing, review and editing. JS: funding acquisition and writing, review and editing. JDW: conceptualization, methodology, data curation, funding acquisition, project administration, supervision, and writing, review and editing.

Corresponding author

Correspondence to Jeffrey D. Wardell.

Ethics declarations

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research ethics committee and with the relevant tenants of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Coelho, S.G., Rueda, S., Costiniuk, C.T. et al. Knowledge of Cannabinoid Content Among People Living with HIV Who Use Cannabis: a Daily Diary Study. Int.J. Behav. Med. (2023). https://doi.org/10.1007/s12529-023-10221-x

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12529-023-10221-x

Keywords

Search

Navigation