This large survey of COVID-19 testing experience among cohorts that follow people living with HIV and people who use drugs across North America provides a snapshot of how the COVID-19 pandemic in its first year may have impacted those who live on the margins of society. This sample included those among the most socially vulnerable in North America – over half were unemployed before the pandemic, about one third food insecure, many people of color almost half of whom were living with HIV. Many of these individuals are not in the formal economy that may partially explain why only half of them were tested for COVID-19 – the entry point into COVID-19 prevention . It is also of concern that across surveys those reporting having COVID-19 symptoms did not have higher testing rates than those who didn’t report symptoms, although the recommendation and priority for COVID-19 was testing of those symptomatic early in the pandemic when testing was limited by supply of tests. Testing continues to be a pillar of COVID-19 control; especially before vaccine availability when these surveys were implemented . Our findings show that lack of COVID-19 testing was associated with markers of social marginalization such as unemployment. As many workplaces began offering testing to their employees, this can explain why unemployed had less opportunity for testing. Fewer Black participants reported testing, and this parallels what has been seen in studies of the more general population . This may be related to historical mistrust with the healthcare system and negative experiences of Black individuals with public health interventions that have previously exploited or misled them . Another key finding was that fewer PLWH reported COVID-19 testing than people HIV negative in these cohorts.
That may be because our PLWH were older, more were Black,cannabis indoor greenhouse and more reported frequent substance use representing intersectional marginalization that may have kept them from accessing a COVID-19 test . The finding that fewer PLWH accessed COVID-19 testing suggests that COVID-19 services may have been less available in places they mostly access care such as their HIV treatment clinics because early in the pandemic there was less in-person HIV care. Moreover, it is possible that because PLWH have weakened immune systems they may been aware of their heightened vulnerability so vigilantly practiced masking and social distancing. While the substance use reported in the month before the survey does not seem high among cohorts of people who use drugs, it must be clarified that our study defined substance use by use of highly addictive, i.e. “hard” or street drugs such as methamphetamine, heroin, cocaine, fentanyl and prescription opioids. Use only of alcohol, tobacco and cannabis were not included in this analysis as the focus was on how the pandemic affected those who use highly addictive illicit substances that usually becomes a dominant part of their lives. Moreover, many of those who participated in this survey reported being on treatment including methadone, and given high rates of relapse of substance use among those in treatment this suggests many in our survey were at high risk of substance use. When critical services that helped PWUD survive overdose and keep their use under control such as group therapy and MOUD became only virtual during the pandemic, the use of such services declined . Virtual access to care may be particularly challenging for individuals who are unemployed and older as fewer may own and have access to the technology needed for this than younger and employed people. What should also be noted is that fewest of those reporting intermittent use of substances were tested for COVID-19, with more of the daily users getting tested. This may be because reduced social interaction during the pandemic may have lessened situations in which some people use drugs particularly affecting those who used at bars or parties and thereby had less exposure to COVID-19. Some substances are often use for social enhancement particularly by YMSM, and the less social opportunities the less they may have felt like or had opportunities to use drugs reflected in their COVID testing rates. The reduction in social use of substances may also reflect the high rates of overdose that were noted during the pandemic as more people may have used drugs alone without someone to help them or call for help if they did overdose .
Higher testing by those reporting daily use may be because these individuals may access services such as needle exchange or MOUD and may have been offered testing through these services.5 Medical marijuana legalization has become both a medical and legal issue. Papers range from casual discussion, passionate and involved such as those by Annas1 and Okie2 , to serious logical argument exemplified beautifully in Cohen’s3 work. Annas1 and Okie2 focused on California’s 1996 medical marijuana law and the 2005 Supreme Court trial Gonzales v. Raich respectively. Cohen3 had a larger scope, reviewing marijuana’s history in the United States from the colonial era to present-day. While the former sources made mention of some valuable scientific evidence, they did so amidst a great deal of personal appeal and anecdotes about those affected. Quotes from doctors, talking about their personal recommendations for patients to use marijuana, and, admittedly, evocative statements from politicians or newspapers frame the discussions. For instance, Annas quotes a Boston Globe writer’s question asking that if legalizing medical marijuana would send the terrible message to children that “If you hurry up and get cancer, you, too, can get high?”.Cohen’s argument did not lack pathos, but he presented his opinion in a strong logical argument, clearly referencing medical findings. All three papers argued, presuming that sufficient medical evidence exists to prescribe marijuana. They, instead, focused on the issue marijuana’s legality, rather than on analyzing the validity of the cited data. Drug abuse and dependence are important considerations for both FDA and Congressional policymakers. While marijuana is relatively non-addictive, especially when compared to FDA-approved opium, cocaine, and methamphetamine,cannabis growing equipment it remains the most abused drug in America.The authors of “Medical marijuana laws in 50 states: Investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence” analyzed use, abuse, and dependence statistics across the U.S. to measure variance caused by marijuana’s legal status.They concluded that rates of addiction, abuse, and dependence did not vary with overall use, but did not develop the idea much further. To expand upon the study the authors could have spent more time discussing why use rates varied with legality. The authors also could have discussed the consequences of the observed use, abuse, and dependence rates and how they should concern or placate readers. While ample research has been done on the cannabinoids thought to give marijuana its medical value, not all results have been conclusive or widely accepted.
“Endocannabinoids in nervous system health and disease: the big picture in a nutshell” provides a broad yet detailed overview of the endocannabinoid system, which is the biochemical pathway that delta-9-tetrahydrocannabinoland other cannabinoids act upon.Some of the sections within this article require more than a casual knowledge of biochemical pathways, or at least their terminology, to follow. Though it occasionally delves into deeper discussion of biochemical pathways, the paper is not too difficult to follow and certainly delivers a “big picture in a nutshell.Borgelt, Franson, Nussbaum, and Wang and the Harvard Mental Health Letter article “Medical marijuana and the mind”put an emphasis on the pharmacology of marijuana and discuss both the current drug delivery methods and the side effects. These two articles differ drastically in their tone, however. Borgelt, Franson, Nussbaum, and Wang discuss, in detail, the mechanisms by which marijuana elicits its effects. “Medical marijuana and the mind”lists the effects of marijuana and discusses the drugs that contain THC, but doesn’t delve into the pharmacokinetics. Unlike most papers, emphasis was placed upon findings that indicate marijuana may increase psychotic episodes in those with schizophrenia and bipolar disorder. The debate on these findings continues to this day without a clear consensus. The author refrains from discussing precise biochemical pathways in favor of discussing the consequences of each mode of delivery or side effect. By keeping avoiding technical terms when possible, the author achieves a casual tone capable of reaching out to a broad audience. Both “Medical marijuana and the mind” and “The pharmacological and clinical effects of medical cannabis” agree that smoking constitutes the largest barrier to marijuana’s acceptance within the medical community.Should a viable alternative be developed, marijuana could become legal once again. With the exception of Cohen, these two articles have the most balanced discussion of both the pros and cons of medical marijuana in its current state. Increasing amounts of research have been performed on the effects of marijuana smoke and ways to replicate its efficient drug delivery without its harmful side effects. Owen, Sutter, and Albertson8 look exclusively at the harm of marijuana smoke on the lungs as it compares to tobacco smoke. They found that, like tobacco smoke, marijuana smoke increases the risk of “pulmonary symptoms such as wheeze, cough, and sputum production.”However, it may not lead to chronic obstructive pulmonary disease.Somewhat confusingly, the paper also discusses marijuana’s effect on the immune system and cancer cells, which doesn’t seem to be directly related to the title of the paper. Though they explain how marijuana smoke can harm the lungs quite thoroughly, there are often departures into less closely related subjects such as the immune system. As a result, it sometimes feels as though the paper is about the endocannabinoid system as a whole, rather than how marijuana smoke affects the lungs. Hazekamp, Ruhaak, Zuurman, Van gerven, and Verpoorte9 decided to analyze the dosage delivery of the “Volcano” vaporizer. Vaporizers attempt to circumvent the harm of smoke during marijuana inhalation by boiling the THC and cannabinoids into a vapor without actual combustion, which produces most of the harmful particles in smoke. The study discovered that the vaporizer delivered similar amounts of THC as traditional smoking, but with less variance. They state that they used one of the multiple heat settings on the device because, by their calculations, it was the most efficient. Not all users may be able to tolerate that temperature setting, so it would be worthwhile to see if the delivery method remains passably effective at other settings. The examiners pointed out that they only studied THC delivery and, while this is the most studied and well understood cannabinoid present in marijuana, it may not be wholly responsible for marijuana’s therapeutic effect. Consequently, research comparing the delivery of the other compounds is necessary. Uritsky, McPherson, and Pradel10 ran an online survey of hospice workers to determine attitudes towards medical marijuana in the industry. While they found that a majority of responders support medical marijuana, they highlighted several potential flaws with their own research. They only surveyed workers for one company, which may attract employees with particular viewpoints based on its policies. Because the survey was run through a website, responders could have submitted answers multiple times by using different computers. Additionally, a high proportion of workers are either volunteers or unlicensed, so their support might be simple personal opinion rather than the result of research and knowledge about the issue. The questions in the survey seemed appropriate for what the researches sought to discover. Perhaps the imprecision of survey-taking, in general, caused more problems than anything the researchers did.The legacy of the Great Recession, as well as longer term structural changes to the global economy, have disproportionately affected young people . Disengagement from the labour market in young adulthood is particularly concerning because it may lead to long-term negative economic consequences for the individual as well as social problems such as criminal offending . The effects of youth unemployment also inflict large economic costs on society . Research is needed to help governments minimize youth labour market disengagement . In the United Kingdom and Europe, social research and policy making around youth unemployment has focused on a particular subset of young people: Those who, in the transition out of compulsory schooling, find themselves not in education, employment, or training.