BACKGROUND AND AIMS:Alcohol-free and low alcohol [no/lo; ≤1.2% alcohol by volume (ABV)] drinks are increasingly popular in some high-income countries and offer potential public health benefits if used as substitutes for regular-strength drinks; however, perceived high prices may deter people from buying these products. This paper explored whether no/lo drinks are more expensive than regular-strength drinks. We compared for no/lo and regular-strength drinks: (i) average prices and price distributions; (ii) prices of products matched on brand and pack size; and (iii) average prices across different multipack sizes, container sizes and container types (e.g. bottle vs. can). DESIGN:Cross-sectional analysis of population-level, off-trade (i.e. shops) sales data. SETTING:Great Britain, 2024. CASES:N = 21 147 no/lo and regular-strength stock-keeping units (SKUs, e.g. 6x300ml Heineken 0.0). MEASUREMENTS:We analysed data from the market research company Circana. Analyses were stratified by beverage categories: beer, cider, wine, spirits and ready-to-drinks (RTDs). Our primary measures were median prices of all products available and median purchase prices (i.e. weighted by sales volume). Prices were per standard serving size for each beverage type. We used quantile regression to test differences in median prices. FINDINGS:In 2024, the median price of no/lo drinks available was lower than for regular-strength drinks (ranging from beer -19% to wine -44%; P < 0.001), except for RTDs (11% higher; P = 0.390). In contrast, the purchase price of no/lo drinks was 7% higher for beer (P < 0.001), similar for cider (0.4% difference; P < 0.001) and lower for wine (-47%; P < 0.001), spirits (-10%; P < 0.001) and RTDs (-31%; P < 0.001). Top-selling no/lo products were cheaper than matched regular-strength products of the same brand and pack size. For example, 15 of the 17 top-selling no/lo beers were between 6% and 42% cheaper than their regular-strength equivalents; however, the top-selling no/lo products were primarily premium brands, and no/lo beers and ciders were typically sold in smaller, less cost-efficient pack and container sizes. CONCLUSIONS:In Great Britain, the alcohol-free and low alcohol (no/lo) products available to buy in the off-trade (i.e. in shops) are cheaper on average than regular-strength drinks, but people still tend to pay more for no/lo beer than regular-strength beer and pay a similar price for no/lo cider as regular-strength cider. This discrepancy is partially because no/lo beers and ciders are often sold in smaller, less cost-efficient pack and container sizes. The premium branding of top-selling no/lo products may also contribute to higher prices.
BACKGROUND AND AIMS:Excessive alcohol use is a leading preventable chronic disease risk factor. Alcohol minimum unit pricing (MUP) policies are not used in the United States despite evidence of associations with reduced drinking and alcohol-related harms. To inform potential population-level chronic disease prevention strategies, we estimated effects of various hypothetical MUPs on alcohol sales. METHOD:Simulation based on observational time-series data. We used weekly off-premises product-specific alcohol retail sales and prices in 28 states of the United States for November 2022-November 2023 from NielsenIQ to estimate the own-price elasticity of spirits and cross-price elasticities of wine, beer and ready-to-drinks with respect to spirits. Using estimated elasticities, we simulated changes in total alcohol sales associated with hypothetical spirits MUPs ranging from $0.10 to $1.10 per standard drink (0.6 fluid ounces of alcohol). RESULTS:A hypothetical MUP of $0.80 per standard drink on spirits yielded the largest estimated decrease in alcohol sales (-1.7%) and would affect 5374 of 26 249 spirits products. To reach the $0.80 MUP, the sales-weighted average price increase among affected products was $0.24 per drink. CONCLUSIONS:Minimum unit pricing policies on distilled spirits in the United States could shift purchasing behavior and help reduce alcohol-related harms.
BACKGROUND AND AIMS:Problematic pornography use (PPU) has received growing scholarly attention; however, much of the existing research has been conducted in Western, educated, industrialized, rich and democratic (WEIRD) sociocultural contexts and may not fully capture how sociocultural factors can shape experiences of PPU in contexts characterized by stronger moral regulation surrounding sexuality. This study explored the lived experiences of individuals with PPU in China and examined how multi-layered stigma processes might have shaped PPU-related experience. DESIGN:A qualitative study using reflexive thematic analysis of semi-structured interview data. SETTING:Online recruitment and data collection conducted in mainland China. PARTICIPANTS:Thirty-one adults who self-identified as experiencing PPU participated in online semi-structured interviews (26 males and 5 females; mean age = 31.32 ± 7.77 years). MEASUREMENTS:In-depth interviews explored pornography use experiences, motivations, perceived consequences, stigma and coping strategies. FINDINGS:Five themes were identified: multi-layered stigma processes; motivations for pornography use; manifestations of PPU; negative consequences of PPU; and personal coping strategies. Participants' motivations broadly aligned with motivations reported in prior PPU research conducted in WEIRD contexts, but also reflected sociocultural factors emphasized within participants' local context, including limited opportunities for open sexual communication, perceived gaps in sex education and concerns related to social and interpersonal risks. Participants described impaired control, psychological distress, shame, secrecy and self-blame, experiences that have also been documented in WEIRD contexts. However, participants described these experiences within a context of legal, familial and sociocultural regulation surrounding sexuality. Coping strategies were predominantly individualized and short-term, frequently accompanied by distress, intrusive sexual thoughts and recurring difficulties regulating use. CONCLUSIONS:Although many experiences associated with problematic pornography use may be shared across cultures, sociocultural environments may shape how pornography use is morally interpreted, socially regulated and experienced as problematic, as well as how individuals cope with related distress and stigma.
BACKGROUND AND AIMS:Cannabis use is highly prevalent among young adults with first-episode psychosis (FEP) and is associated with poorer clinical and functional outcomes. Mobile health interventions may help address structural barriers to delivering cannabis-focused psychosocial interventions within early intervention services (EIS), yet little is known about how such tools are experienced and integrated into routine care. This study explored young adults with FEP and clinician experiences of two cannabis-focused mobile interventions, iCanChange (iCC) and Cannabis Harm-reducing App to Manage Practices Safely (CHAMPS), with a particular focus on implementation within EIS. DESIGN:Qualitative exploratory study using semi-structured individual interviews. Data were analysed using a reflexive thematic approach informed by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. SETTING:Six EIS programs in Canada (five in Quebec and one in Nova Scotia). PARTICIPANTS:Twenty-eight young adults aged 18-35 years with FEP who participated in the intervention arms of the iCC or CHAMPS pilot randomized controlled trials, and 17 EIS clinicians from multiple professional backgrounds. MEASUREMENTS:Semi-structured interviews explored experiences of app use, perceived benefits and challenges, contextual influences, clinician involvement and factors affecting engagement and integration within EIS. Themes were mapped to the i-PARIHS domains of innovation, recipients, context and facilitation. FINDINGS:Participants generally perceived both mobile interventions as acceptable, relevant and well aligned with the daily realities of young adults with FEP. The apps' accessibility, flexibility and non-judgmental approach supported self-reflection, autonomy and increased awareness of cannabis use. However, engagement was shaped by individual motivation, psychosis-related symptoms, competing life and treatment priorities and, for some, app-related challenges, including content-related concerns and technical issues that interfered with use. Clinician involvement was widely viewed as beneficial for sustaining engagement and supporting reflection, yet was inconsistently implemented due to time constraints, limited familiarity with app content and uncertainty regarding clinicians' roles. CONCLUSIONS:Cannabis-focused mobile interventions appear to be acceptable and relevant complements to standard early intervention service care for psychosis. Their successful implementation depends not only on usability, but also on active facilitation, clear clinician role definitions and adaptive integration strategies that align with real-world constraints within early intervention services.
BACKGROUND AND AIMS:Recovery capital and genetic liability may be related to substance use disorder (SUD) remission through psychosocial and biologic pathways, but their joint association with remission course remains poorly understood. This question is clinically important because people entering remission differ in recovery resources and inherited liability. We examined associations of baseline recovery capital index (RCI) and a multitrait polygenic risk score (PRS) with 12-month electronic health record (EHR) observed remission and described the treatment-related pathway component captured by EHR recorded service contact. DESIGN:National cohort study using All of Us electronic health record, survey and genomic data. Weighted relapse hazards were estimated with inverse probability of treatment and censoring weights, followed by bootstrap g-computation to estimate 12-month remission summaries. SETTING:United States health care systems participating in All of Us. PARTICIPANTS:Adults with non-nicotine SUD evidence and baseline RCI and PRS data. Among 7257 eligible participants, 2413 contributed 5124 constructed remission episodes and 7287-episode month observations before final restrictions; bridge models used 7068 observations from 5123 episodes. MEASUREMENTS:Exposures were baseline RCI, a 0 to 1 mean across 21 retained survey items and an addiction PRS standardized, residualized on 10 ancestry principal components and normalized to a 0 to 1 scale. Outcomes were EHR observed relapse and 12-month remission summaries from remission qualifiers, active use diagnoses and toxicology. FINDINGS:Comparing the 90th with the 10th percentile of RCI was associated with higher 12-month remission probability by 7.9 percentage points [95% confidence interval (CI) = 1.5-14.8] at low PRS and 10.6 points (95% CI = 3.9-17.8) at median PRS. At high PRS, the contrast was 6.4 points (95% CI = -2.6 to 16.1). The pattern was non-monotonic, with less favorable remission at lower to mid RCI combined with mid to higher PRS and more favorable remission at high RCI with low PRS. PRS added modest information beyond RCI; severity adjusted point estimates preserved positive RCI contrasts. CONCLUSIONS:Recovery capital and genetic liability appear to be jointly associated with 12-month electronic health record observed substance use disorder remission projections in a nonlinear pattern. Higher recovery capital appears to be associated with more favorable projections across most polygenic risk score levels. Contrasts are modest and sensitive to censoring assumptions.
BACKGROUND AND AIMS:Between 2000 and 2022, annual opioid overdose fatalities in the United States rose from 10 000 per year to over 80 000 per year. It is generally agreed that a major contributing factor to the US opioid crisis was the increased and widespread availability of the prescription opioid oxycodone during the 1990s and early 2000s. While the opioid crisis and oxycodone's contribution to it have been well documented, it remains underappreciated just how early after its introduction this drug's tendency towards diversion, misuse, dependence and addiction became apparent. This paper reviews the scientific and public health literature that accumulated during the 20th century indicating oxycodone's addiction liability to be of equivalent concern to that of morphine. METHODS:A narrative review drawing from original scientific, clinical and public health literature obtained from digital archives relevant to the period of interest. FINDINGS AND CONCLUSIONS:Attention was first drawn to oxycodone's addiction liability by concerned clinicians as early as two years after the drug became commercially available in Germany in 1917, with additional evidence accumulating both in that country and abroad over the subsequent decades. This, combined with research conducted under the supervision of the Committee on Drug Addiction and Narcotics (CDAN) within the Medical Sciences Division of the US National Research Council, led to global recognition of the fact that oxycodone should not be considered any less an addiction liability than morphine. Concerns raised by clinicians about oxycodone throughout that period, and speculation on the causal factors underlying the rapid increase in oxycodone's misuse frequency, are reminiscent of those accepted as contributory to the current global opioid crisis, including lax prescription practices, misleading marketing strategies and inconsistent government oversight. Attempts to draw on this early body of evidence to influence drug policy regarding oxycodone were undermined by a tendency to assess the addiction potential of drug formulations independently of their active ingredients.
BACKGROUND AND AIMS:In British Columbia, Canada, an initiative was implemented in 2020 to reduce overdose mortality by prescribing pharmaceutical opioids (primarily hydromorphone) as a substitute for the toxic unregulated drug supply. This study estimated changes in the level and trend of unregulated opioid use and non-prescribed hydromorphone use before and after the implementation of prescribed pharmaceutical alternatives (PPA) among a cohort of young people who use drugs. DESIGN:Longitudinal observational study. Data were drawn from a community-recruited prospective cohort study. We used interrupted time series (ITS) analyses to assess level and trend of self-reported quarterly unregulated opioid and non-prescribed hydromorphone use before, upon and after the implementation of PPA. We used generalized estimating equations (GEE) models to adjust for factors known to influence substance use. SETTING:Vancouver, British Columbia, Canada, between December 2015 and May 2024. PARTICIPANTS:644 street-involved young people who use drugs (median age at baseline: 23.4 years; 32.6% women). MEASUREMENTS:The main outcomes were self-reported any unregulated opioid use and any non-prescribed hydromorphone use in the past six months, obtained through interviewer-administered questionnaires. The primary explanatory variables for the GEE analyses were: time in quarters, interview date after PPA implementation and an interaction term between time and PPA implementation. FINDINGS:436 (67.7%) participants reported unregulated opioid use, and 124 (19.3%) reported non-prescribed hydromorphone use during the study. In the ITS analysis, unregulated opioid use showed a statistically significant immediate drop following PPA implementation [per-quarter coefficient (PQC): -5.30; 95% confidence interval (CI) = -10.51 to -0.09], with no statistically significant trend observed in the post-PPA period (PQC: 0.06; 95% CI = -0.35 to 0.47). For non-prescribed hydromorphone use, a downward trend was observed in the pre-PPA period (PQC: -0.46; 95% CI = -0.80 to -0.12). Following PPA implementation, no level change was observed (PQC: 2.61; 95% CI = -2.60 to 7.82), and the pre-existing downward trend was halted (PQC: 0.31; 95% CI = -0.10 to 0.72). The GEE analysis confirmed these opposing trends. CONCLUSIONS:British Columbia, Canada's 2020 implementation of prescribed pharmaceutical alternatives to reduce opioid overdose mortality was associated with a statistically significant decline in unregulated opioid use and a halt to the pre-existing downward trend in non-prescribed hydromorphone use among a cohort of young people.
BACKGROUND AND AIMS:United States (US) sales of oral nicotine pouches (ONPs) more than tripled from 2021 to 2024, with Zyn brand consistently the market leader. To understand the relative price of ONPs and cigarettes, this study answers three questions about differences in price for the leading brand of ONPs (Zyn) and cigarettes (Marlboro): What is the difference in price per milligram (mg) of nicotine content? What is the difference in price per mg of nicotine yield (i.e., how much nicotine the product delivers)? Do these differences vary by store type? METHODS:Using data from a representative sample of California tobacco retailers, this study calculated price per mg of nicotine content and nicotine yield for a canister of Zyn Chill 6 mg ONPs and a pack of Marlboro Red cigarettes among stores that sold both products (n = 716). Weighted, paired-sample t-tests assessed the within-store difference between Zyn and Marlboro price per mg of nicotine content and yield. Two weighted, linear mixed models estimated the within-store difference in price per mg of nicotine content and nicotine yield for Zyn and Marlboro, controlling for store type. RESULTS:On average, price per mg of nicotine content in a 15-pouch canister of Zyn Chill 6 mg ONPs was $0.09 (standard deviation [SD] = 0.02) and in a 20-stick pack of Marlboro Red cigarettes was $0.05 (SD = 0.004) (mean difference = $0.04, SD = 0.02, p < 0.001); however, the price per mg of nicotine yield for Zyn was $0.15 (SD = 0.03) and for Marlboro was $0.30 (SD = 0.02) (mean difference = -$0.16, SD = 0.03, p < 0.001). Difference in price per mg of nicotine content was greater in liquor stores (p < 0.001), small markets (p = 0.004), and tobacco specialty shops (p < 0.001) compared with convenience stores; however, the difference in price per mg of nicotine yield was smaller in liquor stores (p < 0.001) and tobacco specialty shops (p < 0.001) compared with convenience stores. CONCLUSIONS:In stores in California, United States, Zyn brand oral nicotine pouches (ONPs) were priced higher per mg of nicotine content than Marlboro cigarettes, although the average difference was small; however, Zyn ONPs were priced substantially lower than Marlboro cigarettes per mg of nicotine yield. Differences in price also varied by store type.
BACKGROUND AND AIMS:Comprehensive community initiatives (CCI) are prioritised in global drug strategies to address alcohol related harms. However, their impact is unclear and moderators of impact are rarely considered. We explored CCIs that address alcohol use or related harms including approaches, effectiveness and factors that strengthen impact. METHOD:A systematic review and meta-analysis (PROSPERO ID CRD420251044005). Embase, Medline, CINAHL, PsycINFO and the Cochrane Database of Systematic Reviews were searched. Reference lists for English-language articles were hand-searched without date restriction. A meta-analysis and qualitative synthesis were completed on any measure of alcohol use or related harms including potential moderators of impact (including community type, level of engagement, initiative combinations, duration, recency, evaluation quality and length of follow-up). RESULTS:The systematic review included 44 studies (from 15 419 articles), with 35 assessing alcohol use and 21 assessing alcohol-related harms. Meta analysis included 15 outcome estimates from nine studies across three alcohol use outcomes: any recent (past month) alcohol use [six studies, n = 32 397, relative risk (RR) = 0.96, 95% confidence interval (CI) = 0.87-1.06, heterogeneity (I2) = 85.6%], any lifetime alcohol use (three studies, n = 13 025, RR = 0.82, 95% CI = 0.63-1.08, I2 = 96.8%) and any recent risky drinking (six studies, n = 82 383, RR = 1.02, 95% CI = 0.95-1.10, I2 = 72.9%). Data were insufficient for meta-analysis of additional alcohol use (e.g. frequency) or related harms outcomes. Subgroup analyses were underpowered and did not identify clear moderators of impact. Pooled estimates were imprecise, with substantial-to-considerable heterogeneity across outcomes (I2 = 72.9%-96.8%; τ2 = 0.0049-0.0544) and findings varied across studies. CCIs showed possible small preventive effects on any alcohol use, but not on recent risky drinking. Qualitative analysis indicated that CCIs incorporating school-based or parenting components showed more consistent signals of benefit compared with other initiative combinations. CONCLUSIONS:Conclusions on the impact of comprehensive community initiatives on alcohol use and harms remain tentative because estimates from existing studies are imprecise and findings vary across studies.
BACKGROUND AND AIMS:This study qualitatively explored psychological change processes as described by participants and therapists within a phase 2a clinical trial evaluating the safety, tolerability, and preliminary efficacy of a single dose of intranasal 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT; BPL-003) administered alongside psychological support and manualised cognitive behavioural therapy (CBT) for relapse prevention in alcohol use disorder (AUD). DESIGN:Embedded qualitative sub-study within an open-label, phase 2a, single-dose (Day 0) clinical trial with 12-week follow-up (Day 84 endpoint). Semi-structured interviews were conducted remotely with participants at Day 1 post-dose and end-of-study (Day 84). Therapists were interviewed once to triangulate participant accounts and explore perceived change processes in the context of psychological support and CBT. SETTING:One drug and alcohol service and one research facility in London, UK (29 March 2023-2 July 2024). PARTICIPANTS:Ten participants (8 men, 2 women) with moderate to severe AUD and six therapists who worked on the study. MEASUREMENTS:Interviews with participants followed a topic guide covering alcohol use history and motivations; expectations, intentions and preparation; acute dosing-day experiences; perceived psychological and behavioural changes; and the perceived role of support and relapse-prevention CBT. Therapists were interviewed to provide a complementary professional viewpoint on the changes and role of support. All interviews were audio-recorded, transcribed verbatim, and analysed using an interpretative phenomenological perspective supported by iterative categorisation. FINDINGS:Immediately after dosing, participants commonly described the experience using metaphors of a "reset", "cleansing", or "rebirth", often accompanied by emotional catharsis and rapid shifts in self-perception. They reported increased clarity regarding their relationship with alcohol, enhanced emotional openness, and improved self-compassion and interpersonal connectedness. At the 12-week follow-up, participants who maintained abstinence (n = 5) described the psychedelic experience as a pivotal turning point, facilitating sustained reappraisals of identity, values, and patterns of alcohol use. They also reported greater mindfulness, cognitive flexibility, and emotional acceptance, coupled with enhanced relationship quality, better sleep, increased energy, and overall well-being. Participants who resumed moderated drinking (n = 2) reported similarly increased self-awareness, reduced compulsivity, and greater emotional regulation. Therapist accounts closely corroborated these participant narratives, highlighting observed shifts in psychological flexibility, emotional openness, and adaptive behavioural responses. Therapists also noted that the psychedelic experience enabled rapid relaxation and revision of maladaptive core beliefs and promoted resilience and acceptance, even in participants with initially challenging experiences. CONCLUSIONS:Participant and therapist accounts indicate that a single dose of 5-methoxy-N,N-dimethyltryptamine, when embedded in a relapse-prevention cognitive behavioural therapy programme, can support meaningful shifts in self-appraisal, emotional regulation, and behavioural patterns associated with alcohol consumption.
BACKGROUND AND AIMS:Alcohol consumption at high levels is common among people experiencing homelessness and contributes to inequalities. In relative terms these individuals are underrepresented in substance use services. This study captured common trajectories and identified barriers and facilitators to accessing treatment among a group of people currently experiencing homelessness and who have used or have been eligible for alcohol treatment. METHODS:Qualitative study in which we conducted 32 semi-structured 'journey-mapping' interviews with individuals currently experiencing homelessness and currently or previously using alcohol harmfully. Interviews were conducted in London homeless centres (UK), audio-recorded and transcribed verbatim. We used a life course-informed, journey-mapping thematic analysis (with elements of reflexive thematic analysis) to capture how participants made sense of their trajectories of alcohol use and recovery. RESULTS:Overall, we generated six themes describing participants' journeys: 'Early access & exposure to alcohol', 'Drivers and vulnerabilities for heavy alcohol use', 'Sustained heavy alcohol use: coping mechanisms, consequences and compounding challenges', 'Systemic, interpersonal and environmental barrier to recovery', 'Internal path towards recovery: growth, relationships and motivation' and 'Recovery through external support systems and structures'. Participants often situated the onset of heavy drinking in childhood trauma and adverse family environments, describing alcohol as a coping mechanism for emotional pain. Homelessness was narrated as both a consequence and driver of drinking, with environmental factors such as sleeping rough and shared identities around heavy drinking reinforcing consumption. Recovery was portrayed as a deeply personal process requiring internal motivation, autonomy and supportive relationships. Barriers of accessing care included long waiting times, administrative hurdles and negative service experiences, while facilitating factors comprised stable housing, personalised care and peer support. Transformative shifts in perspective and the development of self-compassion were described as pivotal turning points. CONCLUSIONS:Among people experiencing homelessness, heavy drinking appears to be commonly rooted in childhood trauma and adverse family environments, with homelessness described as both a consequence and a reinforcing driver of alcohol use. Recovery is portrayed as a highly personal process supported by stable housing, personalised care and meaningful relationships, including peer support.
BACKGROUND AND AIMS:The introduction of prescribed medical cannabis in many parts of the world raises issues regarding how we conceptualise Cannabis Use Disorders (CUD). The Diagnostic Statistical Manual Version 5 (DSM5) provides a framework for 'Prescription Cannabis Use Disorder' (Pr-CUD) when a person is using medical cannabis only-as-prescribed, by excluding tolerance and withdrawal items from the diagnosis - with 9 instead of 11 diagnostic criteria. In this study, we compared the 12-month prevalence rates of CUD in a sample of people prescribed medical cannabis in Australia by a medical or nurse practitioner, according to whether we use conventional DSM5 11-items for 'CUD' versus 9-items for 'Pr-CUD'. DESIGN:Secondary analysis of data from CAMS22 Survey - an online anonymous cross-sectional survey of people self-reporting use of medical cannabis within the past 12 months. SETTING AND PARTICIPANTS:2054 adults using prescribed medical cannabis in the preceding 12 months in Australia for a health condition. MEASUREMENTS:Consumer characteristics, indications and patterns of medical and non-medical cannabis use, self-reported DSM5 criteria for CUD. FINDINGS:2054 participants reported using prescribed medical cannabis in the past 12 months, of which 986 (48%) reported using cannabis only as prescribed, and 1068 (52%) reported using cannabis not as prescribed. By applying 9-item DSM5 CUD criteria for participants using cannabis as prescribed and 11-item criteria for participants using cannabis not as prescribed, 640/2054 (31.2%) met Any P-CUD (>2 criteria) and 241/2054 (11.7%) met Moderate-Severe P-CUD (>4 criteria) thresholds. This is in contrast to 748/2054 (36.4%) met Any CUD and 273/2054 (13.3%) Moderate-Severe CUD when using 11 DSM5 criteria for all participants. Amongst the 986 participants using cannabis as prescribed, Pr-CUD (9-item) prevalence was statistically significantly lower than under the 11-item framework, both for Any CUD (9% [Pr-CUD] vs 20% [11-item]; % difference = 11.8 [95% confidence interval (CI): 8.3, 15.8]; odds ratio (OR) = 1.3 [CI: 1.1, 1.4]) and Moderate-Severe CUD (2% [Pr-CUD] vs 5% [11-item]; % difference = 2.9 [CI: 1.4, 5.0]; OR = 2.6 [CI: 1.6, 4.4]). CONCLUSIONS:Diagnostic Statistical Manual Version 5 cannabis use disorder (CUD) diagnostic criteria developed for illicit cannabis use may not be appropriate for people using medical cannabis under prescribed conditions. CUD rates are statistically significantly reduced when the 'Prescription Cannabis Use Disorder' framework is applied to people only using cannabis products in accordance with the conditions identified on their prescription (including dose, route of administration and indication). This has considerable clinical and policy implications in settings where medical cannabis is legally available under a prescription model.
AIMS:This study assessed the feasibility and acceptability of a new theory- and evidence-based intervention designed to prevent return to pre-admission smoking behaviours after discharge from a smokefree mental health in-patient setting in the United Kingdom (UK). DESIGN:A multi-centre individually randomised controlled feasibility trial with follow-up at 3 and 4-6 months. SETTING:Acute adult mental health wards of six National Health Service Mental Health Trusts in England. PARTICIPANTS:Thirty-eight (17 intervention, 21 usual care) adults who smoked on or after admission to an acute adult mental health in-patient ward and wished to continue reducing or quitting smoking after discharge, enrolled between February and November 2024. INTERVENTION:The intervention comprised usual care and a 12-week, theory- and evidence-informed support programme including a bespoke resource kit, personalised behavioural support including phone calls and text messages, and access to a digital smoking cessation app with 24/7 live support. It was delivered by trained mental health workers. The comparator group received usual care as per UK national guidance, typically involving brief behavioural support, offers of nicotine replacement therapy and sometimes electronic cigarettes. MEASUREMENT:Primary outcomes included recruitment and retention, intervention acceptability and feasibility of collecting smoking, mental health and economic data. Success criteria for progression to trial were set a priori at a minimum of 60% of the n = 64 target for both recruitment and retention, i.e. at n = 38. Secondary outcomes included measures of smoking, quitting, reduction of cigarette consumption. Acceptability data were collected through exploratory interviews with participants, mental health staff and interventionists. FINDINGS:We recruited n = 38 (60%) participants and retained n = 20 (52.6%) at 3 months, and n = 13 (34.2%) at second follow-up. As such, criteria agreed to determine progression to full trial were marginally met for recruitment and not met for retention. Two intervention participants reported maintaining abstinence. Motivation to quit remained higher in the intervention than the usual care group over time, and use of e-cigarettes was overall common (76.9% n = 10 across groups at 4-6 month follow up). Intervention group participants reported valuing the tailored and personalised behavioural support options but engaged little with tailored digital tools. Health economic data collection was feasible, though refinement is needed for future research. CONCLUSIONS:A new intervention delivering smoking cessation support to individuals discharged from smoke-free mental health settings was discontinued because key feasibility criteria were not met, highlighting the need for focused reconsideration of recruitment and retention strategies, intervention design and delivery in mental health in-patient populations. Design implications are discussed, taking into account individual patient-level and systemic challenges.
