Objective: To identify perceptions of risks and benefits of cannabis use during pregnancy and postpartum from the patient perspective. Methods: Pregnant and postpartum (up to 3 months) women residing in a state that legalized the sale of recreational cannabis in 2012 were interviewed to determine their perceptions of risks and benefits of cannabis use during pregnancy and postpartum. Qualitative description methodology was used to identify common themes in the data. Nineteen (n = 14 pregnant; n = 5 post-partum) women who used cannabis daily while pregnant were interviewed about perceptions of risks and benefits of cannabis use during pregnancy and postpartum. Results: Five themes, describing the participants’ cannabis use while pregnant and postpartum, emerged from the data. These themes include (1) continued use for health management, (2) ongoing evaluative process, (3) mixed messages, (4) wanting more information, and (5) legal considerations. All 5 of these themes contributed to the overarching theme of Taking Care of Mom and Baby , which encompasses the mother's need and struggle to care for her own health and wellness, as well as that of her unborn baby. Conclusions: In a state with legalized recreational cannabis, pregnant and postpartum women reported continuing daily cannabis use during pregnancy to take care of themselves and their baby. It is crucial for healthcare providers to follow national guidelines and explain risks of cannabis use during pregnancy and postpartum, while also managing expectations based on patient history. A harm reduction approach to decrease cannabis use is vital to help pregnant women who are using cannabis for health management to continuously evaluate their use during pregnancy and postpartum.

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This review of contingency management (CM; the behavior-modification method of providing reinforcement in exchange for objective evidence of a desired behavior) for the treatment of substance-use disorders (SUDs) begins by describing the origins of CM and how it has come to be most commonly used during the treatment of SUDs. Our core objective is to review, describe, and discuss three ongoing critical advancements in CM. We review key emerging areas wherein CM will likely have an impact. In total, we qualitatively reviewed 31 studies in a systematic fashion after searching PubMed and Google Scholar. We then describe and highlight CM investigations across three broad themes: adapting CM for underserved populations, CM with experimental technologies, and optimizing CM for personalized interventions. Technological innovations that allow for mobile delivery of reinforcers in exchange for objective evidence of a desired behavior will likely expand the possible applications of CM throughout the SUD-treatment domain and into therapeutically related areas (eg, serious mental illness). When this mobile technology is coupled with new, easy-to-utilize biomarkers, the adaptation for individual goal setting and delivery of CM-based SUD treatment in hard-to-reach places (eg, rural locations) can have a sustained impact on communities most affected by these disorders. In conclusion, there is still much to be done, not only technologically but also in convincing policy makers to adopt this well-established, cost-effective, and evidence-based method of behavior modification.

Objectives: Opioid misuse constitutes a significant public health problem and is associated with a host of negative outcomes. Despite efforts to curb this increasing epidemic, opioids remain the most widely prescribed class of medications. Prescription opioids are often used to treat chronic pain despite the risks associated with use, and chronic pain remains an important factor in understanding this epidemic. Cannabis is another substance that has recently garnered attention in the chronic pain literature, as increasing numbers of individuals use cannabis to manage chronic pain. Importantly, the couse of substances generally is associated with poorer outcomes than single substance use, yet little work has examined the impact of opioid-cannabis co-use. Methods: The current study examined the use of opioids alone, compared to use of opioid and cannabis co-use, among adults (n ¼ 450) with chronic pain on mental health, pain, and substance use outcomes. Results: Results suggest that, compared to opioid use alone, opioid and cannabis co-use was associated with elevated anxiety and depression symptoms, as well as tobacco, alcohol, cocaine, and sedative use problems, but not pain experience. Conclusions: These findings highlight a vulnerable population of polysubstance users with chronic pain, and indicates the need for more comprehensive assessment and treatment of chronic pain.