Brown, J

Castillo-Carniglia, Á

Caulkins, JP

Curran, HV

ElSohly, MA

Englund, A

Freeman, TP

Gage, SH

Griffiths, P

Groshkova, T

Gual, A

Hall, W

Hammond, D

Hindocha, C

Lawn, W

Liccardo Pacula, R

Lorenzetti, V

López-Pelayo, H

Manthey, J

Mokrysz, C

Petrilli, K

van Laar, M

Vandrey, R

Wadsworth, E

Winstock, A

English

UCL Discovery

COMMEN TAR YThe iCannToolkit: a tool to embrace measurement of medicinaland non-medicinal cannabis use across licit, illicit andcross-cultural settingsThe iCannToolkit is a first important step to systemati-cally gather evidence regarding the health effects ofcontemporary medical and non-medical cannabis use—over time, among licit and illicit settings, cultures andage groups—in order to inform policy development andto raise awareness concerning cannabis use-relatedrisks and benefits.We welcome the commentaries [1–3] which endorse ourproposal to standardize the assessment of cannabis use and makeimportant considerations for the universal use of the iCannToolkitthroughout research, treatment and public health settings.Volkow & Weiss [1] highlight that the use of the toolkit hasimportant implications for the standardized measurement of exposureto medicinal cannabis, the use of which is increasing internationally.The iCannToolkit is intended to be applicable to measuring non-medical and medical cannabis use in regulated and illicit markets. Theitems from the first layer will need to be validated (and, if necessary,adapted) to reliably cover medical and non-medical use throughoutnations and jurisdictions. The second and third layers enable thecharacterization of different modes of use and biologically confirmedcannabinoid exposure. We believe that the iCannToolkit can be auseful tool for gathering data to profile and compare the risks andbenefits of exposure to medical and non-medical cannabis. This canhelp us to understand how the legalization of medical and non-medical use affects retail products that are developed and consumed,their health impacts on users and impacts upon the criminal justicesystem.Jesseman [2] suggests that the iCannToolkit is a first step to gath-ering systematic evidence to inform a public health approach to can-nabis regulation, and creates a foundation for research collaboration,data-sharing and coordination. As illustrated by the two Canadian epi-demiological surveys, measurements of cannabis are often incompara-ble due to inconsistent items on cannabis exposure. Integrating itemsof the iCannToolkit into current and new surveys can help to mapchanges in the risks and benefits of diverse modes of cannabis use.International collaborations using harmonized tools will enable theevaluation of natural experiments resulting from diverging policyapproaches and help to understand the health consequences of legalcannabis retail and rapid changes in its legal status internationally.Such quality evidence is needed to inform decisions by jurisdictionsabout which policies to adopt if they make changes to the legal statusof cannabis.Kuhns & Kroon [3] outline important regional and cross-culturaldifferences in many features of cannabis use: potency, legislation, cul-tural costumes, mode of use, cannabinoid content, tobacco use anddifferent labels for the same product and inter-individual differencesin bioavailability. These were acknowledged by Volkow & Weiss andin our previous work [4, 5]. We agree that there are important cross-cultural variations in use. We also agree that international validationof enhanced time-line follow-back methods are needed to ensurecomparability of data collected in different world regions in whichcannabis potency, products and use patterns may differ.Cannabis products and use practices have also changedsubstantially over time. This means that evidence from older cohortsmay be less relevant in assessing the health effects of contemporarycannabis use. It also means that there will be a need to periodicallyadapt and update tools such as the iCannToolkit over time, indifferent world regions and to school students and adolescents.Harnessing the iCannToolkit to assess the 5-mg standard Δ9-tetrahydrocannabinol (THC) unit (recommended by Freeman &Lorenzetti [5] and the National Institute on Drug Abuse (NIDA) [6])may enable us to measure the typical quantity of cannabis exposureacross world regions, time and age groups. Research within theiCannToolkit framework can also help to determine whether and howto weight the standard THC unit among types of cannabis productsand/or routes of administration.In conclusion, the iCannToolkit offers an important first steptowards harmonization of data based on expert consensus. In order tomaximize its value, further work will be needed to implement andvalidate this framework in different international contexts and overtime, as new cannabis products emerge and use practices change.Support from funders and other organizations (e.g. scientific societies,Received: 18 February 2022 Accepted: 21 February 2022DOI: 10.1111/add.15855This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in anymedium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.© 2022 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.Addiction. 2022;1–3. wileyonlinelibrary.com/journal/add 1academia) will play a key role in progressing the consensus. TheiCannToolkit could prove particularly useful in tracking rapid changesin cannabis products, policies and/or regulation and markets(e.g. Canada, United States, Germany, Swiss pilot study) and changes inhealth risks and benefits. The ultimate goal should be to help cannabisusers to make informed decisions about their cannabis use, inform pol-icy development and identify patterns of use that pose a risk to users.KEYWORDSAssessment, cannabis, dose, iCannToolkit, international cannabistoolkit, measurement, standardizationACKNOWLEDGEMENTSThis study was supported by the Society for the Study of Addiction,European Monitoring Centre for Drugs and Drug Addiction.H.L.P. works under the CERCA Programme/Generalitat de Catalunyaand receives funding from the Spanish Ministry of Science, Innovationand Universities, Instituto de Salud Carlos III through a ‘Juan Rodes’contract (JR19/00025). V.L. was supported by a Val & Al RosenstraussSenior Research Fellowship and by an Australian Catholic Universitycompetitive Scheme. A.C.C. received funding from ANID—MillenniumScience Initiative Program, no. NCS2021_003 and no. NCS2021_013.DECLARATION OF INTERESTSA.G. received funding from Novartis for work outside this area(a phase III cocaine trial). A.E. has received speaker a honorarium fromGW Pharmaceuticals. A.W. is the founder of the Global Drug Survey.C.H. became a full-time employee of GW Pharmaceuticals after theconsensus meeting. D.H. has served as a paid expert witness onbehalf of public health authorities in Canada in response to legalchallenges from the cannabis industry. H.L. has received honorariaand travel grants from Janssen and Lundbeck. J.B. has receivedunrestricted research funding to study smoking cessation fromcompanies who manufacture smoking cessation medications (Pfizerand J&J). R.V. receives consulting fees for Canopy Health Innovationsand Syqe Medical Ltd, and is on the Scientific Advisory Board forMyMD Pharmaceuticals and Artiam Bio Inc. V.C. has consulted forJanssen. V.L., W.H., T.P.F., E.W., T.G., W.L., A.C.C., J.P.C., R.L.P., M.v.L., K.P., P.G., M.A.E., S.H.G., J M. and C M. have no competing inter-ests to declare.AUTHOR CONTRIBUTIONSValentina Lorenzetti: Conceptualization; first draft, completion offinal draft for submission. Chandni Hindocha: revisions of manu-script. Kat Petrilli: revisions of manuscript. Jamie Brown: revisionsof manuscript. Alvaro Castillo-Carniglia: revisions of manuscript.Jonathan Caulkins: revisions of manuscript. Amir Englund: revisionsof manuscript. Mahamoud El Sohly: revisions of manuscript.Suzanne Gage: revisions of manuscript. Teodora Groshkova: revi-sions of manuscript. Antoni Gual: revisions of manuscript. DavidHammond: revisions of manuscript. Will Lawn: revisions of manu-script. Hugo Lopez-Pelayo: revisions of manuscript. Jakob Manthey:revisions of manuscript. Claire Mokrysz: revisions of manuscript.Rosalie Liccardo Pacula: revisions of manuscript. Margriet van Laar:revisions of manuscript. Ryan Vandrey: revisions of manuscript. ElleWadsworth: revisions of manuscript. Adam Winstock: revisions ofmanuscript. Wayne Hall: revisions of manuscript. H Valerie Curran:revisions of manuscript. Tom Freeman: Conceptualisation; revisionof first and later drafts.Valentina Lorenzetti1Chandni Hindocha2Kat Petrilli3Paul Griffiths4Jamie Brown5Alvaro Castillo-Carniglia6,7Jonathan P. Caulkins8Amir Englund9,10Mahmoud A. ElSohly11,12Suzanne H. Gage13Teodora Groshkova4Antoni Gual14David Hammond15Will Lawn2Hugo Lopez-Pelayo14Jakob Manthey16,17Claire Mokrysz2Rosalie Liccardo Pacula18Margriet van Laar19Ryan Vandrey20Elle Wadsworth15Adam Winstock5,21Wayne Hall22,23H. Valerie Curran2Tom P. Freeman31Neuroscience of Addiction and Mental Health Program, the HealthyBrain and Mind Research Centre, School of Behavioural and HealthSciences, Faculty of Health, Australian Catholic University, Melbourne,Australia2Clinical Psychopharmacology Unit, University College London, London,UK3Addiction and Mental Health Group (AIM), Department of Psychology,University of Bath, Bath, Somerset, UK4European Monitoring Centre for Drugs and Drug Addiction (EMCDDA),Portugal5Department of Behavioural Science and Health, Institute ofEpidemiology & Health Care, University College London, London, UK6Society and Health Research Center, Universidad Mayor, MillenniumNucleus for the Evaluation and Analysis of Drug Policies (nDP), andMillennium Nucleus on Sociomedicine (SocioMed), Chile7Department of Population Health, NYU Grossman School of Medicine,New York, NY, USA8Carnegie Mellon University Heinz College, Pittsburgh, PA, USA9Addictions Department, Institute of Psychiatry, Psychology &Neuroscience, Kings College London, London, UK2 COMMENTARY10Department of Psychosis Studies, Institute of Psychiatry, Psychology &Neuroscience, King’’s College London, London, UK11National Center for Natural Products Research, School of Pharmacy,University of Mississippi, University, Mississippi, USA12Department Pharmaceutics and Drug Delivery, School of Pharmacy,University of Mississippi, University, MS, USA13Department of Psychology, Institute of Population Health, University ofLiverpool, Liverpool, UK14Addictions Research Group. Psychiatry Department, NeurosciencesInstitute. Hospital Clínic. IDIBAPS. RTA. Barcelona, Spain15School of Public Health Sciences, University of Waterloo, Waterloo,Ontario, Canada16Center for Interdisciplinary Addiction Research, Department ofPsychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany17Department of Psychiatry, Medical Faculty, University of Leipzig,Leipzig, Germany18USC Sol Price School of Public Policy, USC Leonard D. Schaeffer Centerfor Health Policy & Economics, California, Los Angeles, USA19Trimbos Institute, Utrecht, The Netherlands20Department of Psychiatry and Behavioral Sciences, Johns HopkinsUniversity School of Medicine, Baltimore, MD, USA21Global Drug Survey, London, UK22Queensland Alliance for Environmental Health Sciences, The Universityof Queensland, Australia23National Centre for Youth Substance Use Research, The University ofQueensland, AustraliaEmail: valentina.lorenzetti@acu.edu.auORCIDValentina Lorenzetti https://orcid.org/0000-0002-5917-7068REFERENCES1. Weiss SR, Volkow ND. Coordinating cannabis data collectionglobally: policy implications. Addiction. 2021;1–2. https://doi.org/10.1111/add.157512. Jesseman R. We need convincing data to support a public healthapproach to cannabis regulation. Addiction. 2021;1–2. https://doi.org/10.1111/add.157523. Kuhns L, Kroon E. The need to calibrate standardized cannabismeasurements across cultures. Addiction. 2021;1–2. https://doi.org/10.1111/add.157444. Freeman TP, Lorenzetti V. Moving forwards with the standard THCunit. Addiction. 2020;115:1222–3.5. Freeman TP, Lorenzetti V. ‘Standard THC units’: a proposal tostandardize dose across all cannabis products and methods of admin-istration. Addiction. 2020;115:1207–16.6. Volkow ND, Weiss SR. Importance of a standard unit dose forcannabis research. Addiction. 2020;115:1219–21.How to cite this article: Lorenzetti V, Hindocha C, Petrilli K,Griffiths P, Brown J, Castillo-Carniglia A, et al. TheiCannToolkit: a tool to embrace measurement of medicinaland non-medicinal cannabis use across licit, illicit and cross-cultural settings. Addiction. 2022;1–3. https://doi.org/10.1111/add.15855COMMENTARY 3

The iCannToolkit: a tool to embrace measurement of medicinal and non-medicinal cannabis use across licit, illicit and cross-cultural settings

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The iCannToolkit: a tool to embrace measurement of medicinal and non-medicinal cannabis use across licit, illicit and cross-cultural settings

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