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Official websites use. Share sensitive information only on official, secure websites. Corresponding Author: Phone: ; Fax: ; cgrov sph. Researchers have established that substance use interferes with anti-retroviral medication adherence among gay and bisexual men GBM living with HIV. We conducted retrospective day timeline follow-back interviews and prospective semi-weekly diary data for 10 weeks with PrEP-using GBM, half of whom engaged in club drug use ketamine, ecstasy, GHB, cocaine, or methamphetamine —generating 9, days of data. Further, missing a dose on one day increased the odds of missing a dose the following day by eight-fold. We did not identify an event-level effect of marijuana use or heavy drinking on PrEP adherence. Our data suggest club drug users could have greater protective effects from daily oral or long-acting injectable PrEP compared to a time-driven PrEP regimen because of the concurrence of club drug use and PrEP non-adherence. Los investigadores han establecido que el uso de sustancias interfiere con la adherencia a los medicamentos antiretrovirales entre los hombres gay y bisexuales HGB viviendo con el VIH. No identificamos un efecto a nivel-evento entre uso de marihuana o alcohol excesivo y la adherencia a PrEP. The trajectory of increasing PrEP uptake could continue to rise as new dosing formulations e. Compared to the general population, club drug use i. Researchers have consistently found a strong correlation between club drug use and condomless anal sex CAS in general, as well as concurrent CAS when having sex under the influence of club drugs. Similar to club drugs, heavy alcohol use results in behavioral disinhibiting effects; 50 hazardous alcohol use has been associated with greater CAS among GBM 51 and lower HIV mediation adherence among samples of persons living with HIV including GBM, 52 , 53 particularly when used in combination with other drugs. Substance use was identified as a barrier to PrEP use among Stimulant users were more likely to have sub-optimal levels of Tenofovir drug concentrations compared to non-users in the iPrEx open-label extension study, 62 yet researchers associated with the PATH-PrEP cohort found differences in PrEP adherence among stimulant users by the number of CAS partners reported. In this study, we recruited a sample of PrEP users to investigate the connection between substance use and PrEP adherence. By design, nearly half our participants were club drug users. Those clicking one of our digital ads were routed to a secure online survey that assessed preliminary eligibility criteria. Those deemed preliminary eligible in any screening setting were asked to provide contact information for additional telephone-based screening with a member of our research team. Those eligible were scheduled for a face-to-face assessment at our research office. To be eligible, participants had to 1 be 18 years or older, 2 cisgender male, 3 identify as gay or bisexual, 4 have been taking PrEP for at least 30 days, but not via a study that provided the PrEP medication e. Our goal was to examine the role of club drug use on PrEP adherence, thus half of the sample were required to self-report club drug use in the 30 days prior to screening eligible. All participants provided proof that they were taking PrEP by bringing their PrEP prescription bottle along with their pills , with their name and date printed on it, to their study visit. As part of their baseline visit, participants completed a computer assisted survey as well as a structured day timeline follow-back TLFB 67 , 68 interview which retrospectively captured day-level substance use and PrEP adherence. The TLFB procedure reviews critical life events retrospectively to prompt recall of data, which were recorded into a personalized digital calendar. Interviewers were trained to use familiar language and vernacular of participants regarding drug names e. The TLFB has demonstrated good test-retest reliability, convergent validity, and agreement with collateral reports for drug use 69 and medication adherence. Following their baseline assessment, participants completed prospective semi-weekly diary surveys for 10 weeks. For the prospective diary component, participants received an email at 8pm every Monday and Thursday containing a link to an online survey. Links themselves expired 24 hours after being sent. The online survey asked participants day-by-day about their PrEP adherence and substance use for the previous few days i. On Mondays, participants were asked about the previous Friday, Saturday and Sunday, as well as that day Monday. Participants completed a twice-weekly diary as opposed to a daily diary to avoid pitfalls associated with the diary acting as a reminder to take their PrEP an assessment effect. The TLFB interview and prospective twice weekly diaries assessed for day-by-day use of club drugs ketamine, ecstasy, GHB, cocaine, methamphetamine , marijuana, and heavy drinking 5 or more drinks in one sitting as well as whether a PrEP dose was missed for each of the prior 30 days for the TLFB and prospectively for 10 weeks via the twice weekly diary. To capitalize on the extent of day-level data collected within this study from both the retrospective timeline follow-back interview and prospective diary, we created a combined day-level dataset with identical variables from both sources. To examine the impact of daily substance use on adherence to PrEP, we used a series of generalized linear mixed models conducted within SPSS 24 with days i. Across models, we used a random intercept as well as random slopes for all three of the level 1 substance use effects; we specified a variance components matrix for the random effects i. We modified the SPSS defaults to use Satterwhaite estimation of the degrees of freedom, which is more conservative in estimating the significance of the level 2 effects, and robust estimation of the model standard errors. In total, we ran three models: 1 a concurrent model, where the substance use and PrEP dosing occurred on the same day; 2 a time-lagged model where the PrEP dosing occurred on the next day after the substance use i. Table 1 reports demographic characteristics of the sample. Half Mean age of sample was In total, Overall, men were highly adherent to their PrEP, missing an average of 1. They did not differ by race or ethnicity, or length of time on PrEP. Percentages may not add to due to rounding. We examined the retrospective TLFB data on drug use to further characterize between-person differences in use prior to the baseline— The most common drugs reported in the prior 30 days as captured within the TLFB were cocaine Meanwhile, although not criteria for enrollment, Club drug users were significantly more likely to report marijuana use and heavy drinking see Table 1. All analyses that follow are based on combined day-level data from both the TLFB interview and the subsequent week diary. Across the individuals in the sample, we analyzed 9, days of data for the concurrent models that focused on substance use and missed PrEP doses occurring simultaneously on the same day; due to loss of some data after matching contiguous days, 9, days of data were available for the time-lagged models focused on substance use predicting missed PrEP doses the next day. The first model, in which we were looking at same-day effects of substance use on PrEP adherence, is displayed in Table 2. We found that club drug use was associated with significantly greater odds of missing a PrEP dose on that same day. Additionally, the model revealed that, at level 1, missing a PrEP dose was more likely on a weekend and, at level 2, that those with a college degree had lower odds of missing a PrEP dose on a typical day. The random variance for the intercept was significant, suggesting substantial between-person variability in the odds of missing PrEP on a typical day. We also found that the random variance for the day-level marijuana use slope was significant; in the presence of a non-significant slope, this suggests significant between-person variability in the impacts of marijuana use on PrEP adherence and indicates there are likely level 2 i. The second model, in which we were looking at time-lagged effects of substance use on next-day PrEP adherence, is also displayed in Table 2. The findings from this second model were consistent with the first, showing a nearly identical, significant and positive effect of club drug use on missing a PrEP dose the next day. The main effect of whether the substance use occurred on a weekend was no longer significant when the outcome was no longer paired on the same day as the substance use; those with a college degree continued to have significantly lower odds of missing a PrEP dose on a given day. As with the prior model, there was significant random variability in the intercept and the slope for marijuana use. The third model, in which we were replicating Model 2 while adjusting for whether there was a missed PrEP dose the day before, is not presented in tabular form. Researchers have established that substance use interferes with ART medication adherence among HIV-positive gay and bisexual men, 40 — 46 , 48 , 49 , 73 — 75 yet conflicting reports exist regarding the association between substance use and PrEP adherence among HIV-negative GBM. However, instances of the use of club drugs at the event-level was significantly associated with missing a PrEP dose. In fact, this finding held true whether the impact of club drug use on PrEP adherence was modeled as missing a dose on the same day as the drug use as well as when modeled as missing a dose on the day after the drug use occurred. That is, although likelihood of taking PrEP on any given day was similar between club drug users and non-users, club drug use in-and-of-itself was significantly associated with missing a PrEP dose. These findings suggest that intervention strategies co-targeting club drug use and PrEP adherence may be warranted. Our findings add to a growing body of research investigating substance use and PrEP adherence. In prior research, stimulant use at the aggregate level i. Another group of researchers reported differences in PrEP adherence by stimulant use and number of sexual partners; over time, GBM who reported stimulant use—at the aggregate level—and multiple CAS partners had increasing PrEP adherence over time compared to stimulant users with fewer CAS partners i. That being said, we recognize that adherence was high overall in the study—on average, participants missed fewer than two doses in the prior 30 days. In fact, studies have indicated that as few as four doses out of seven per week might be sufficient to provide protection from HIV. However, our findings do have implications for prescribing PrEP to club drug users. Alternatively, club drug users might benefit from long-acting injectable PrEP—once available—by minimizing the harmful effects of their club drug use on their PrEP dosing because of the less frequent dosing requirements compared to oral PrEP. In our study, heavy drinking was not associated with missing PrEP doses nor was marijuana use, as day-level variables. In models looking at both same-day missed doses as well as next-day missed doses, using marijuana and engaging in an episode of heavy drinking did not significantly impact PrEP use. However, we found that the random variance for the day-level marijuana use slope was significant. This indicates that there was significant between-person variability in the impact of marijuana on PrEP adherence, suggesting that there may be level 2 i. We also note that the overarching study was designed to assess for the role of club drug use on PrEP adherence, but also collected data on marijuana use and heavy drinking—finding null associations with PrEP adherence. Our null findings regarding heavy drinking at the day level conform with a prior report that found no association between heavy drinking and PrEP non-adherence at the aggregate level. We found that missing a PrEP dose on the prior day was associated with more than eight times the odds of missing a dose on the next day. This too remains an area for further investigation with biological sampling, but further reduces our enthusiasm for on-demand PrEP dosing among club drug users. Our findings should be understood in the context of their limitations. First, the relatively modest sample size and recruitment of men only from New York City limits generalizability. Second, additional research is necessary to disentangle the specific substances or combination of substances that have the greatest impact on adherence, as well as why. Third, some of our data included TLFB interviews, which may be subject to recall and social desirability bias. Nevertheless, the TLFB interview procedure has been used in a variety of settings with GBM, particularly with regard to drug and alcohol use, ART adherence, and sexual behavior for recall periods spanning as far back at 6 weeks to 3 months, but it has yet to be validated for collecting data on PrEP adherence. Prospective twice weekly diaries can help to overcome some pitfalls of recall bias, but have the potential of reminding participants about their behavioral patterns e. Other methods of tracking adherence, such as prospective collection of dried blood spot samples or hair, could overcome some of the limitations of self-report. Fourth, we note curious findings with regard to income differences between club drug users and non-users. In our sample, club drug users made greater incomes and this may be associated with the specific club drugs that appeared to be most common in this sample cocaine and ecstasy. More in-depth examination of the role of socioeconomic status on PrEP adherence is warranted. Finally, we must highlight that we lack data on any motivations behind missing PrEP doses. It may be that missed doses were intentional or other factors—aside from club drug use—that predicated a missed dose e. Anecdotally, because the TLFB is a qualitative interview, participants would have had the opportunity to explain why a dose was missed, but these did not evince themselves during data collection. In our study, club drug users were no more likely to miss a dose than non-club drug users on average. However, we found that club drug use at the event level was associated with same-day missed doses as well as next day missed doses. Further, missing a dose on one day increased the odds of missing the dose the following day by eight-fold. Additional research is necessary to disentangle the mechanistic roles that club drugs play in non-adherence as well as to determine exactly which of the club drugs and in what combinations result in the greatest risk for missing a dose. Patterns of PrEP adherence in our data suggest club drug users could have greater protective effects from daily oral or long-acting injectable PrEP compared to a time-driven PrEP regimen because of the concurrence of club drug use and PrEP non-adherence. Finally, although we found that club drug was associated specifically with poorer PrEP adherence, we also highlight the need to investigate the role that substances may play other aspects of the PrEP care continuum, 83 , 84 as for example, they have been shown to impact the HIV treatment care continuum among populations of people living with HIV. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Informed Consent: Informed consent was obtained from all individual participants included in the study. As a library, NLM provides access to scientific literature. AIDS Behav. Show available content in en es. Find articles by Christian Grov. Find articles by H Jonathon Rendina. Find articles by Steven A John. Find articles by Jeffrey T Parsons. PMC Copyright notice. Open in a new tab. Same-day and next-day associations between substance use and missed PrEP dosing. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. More than 1 year Missed any PrEP doses past 90 days. Heavy Alcohol Use past 30 days 1.

Marijuana Regulations

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This first part of the web page provides the status of the City's consideration for amending the marijuana regulations in The Planning Commission has completed its review, including holding a public hearing on September 6, , and formulated its recommendation to the City Council on September 20, The following three Planning Commission PC review packets best describe the background and status of the issue:. The following part of the web page documents the City's efforts during in developing the marijuana regulations in response to I The legislation, effective on June 5, , builds upon the recommendations from both the Planning Commission and Planning staff. Major land use regulatory provisions as set forth in the legislation include:. Please visit the City's updated Marijuana Map to view locations that comply with the zoning requirements. It should be noted the sensitive uses outlined in the map are based off of the best information available. While the City believes the map to be accurate, it is ultimately up to the applicant to confirm that a property is outside of local and State sensitive buffers. The City Council conducted a study session on April 26, , and a public hearing on the same night, on the Marijuana Land Use Code and Nuisance Code Amendments, as recommended by the Planning Commission and as recommended by staff. The Council conducted a follow-up study session on May 3, and conducted the first and final readings of adopting ordinance on May 10 and 24, respectively. The Planning Commission reviewed and deliberated potential amendments to the marijuana regulations during January-April , conducted a public hearing on March 2, and made a recommendation to the City Council on April 6. See relevant documents posted below:. On January 12, , the City Council adopted Substitute Ordinance enacting a temporary moratorium on new marijuana retail uses and establishment of marijuana cooperatives for a period of six months or until earlier terminated if the City's marijuana-related regulations are updated. For further information, please contact the staff identified at the bottom on this page. Ordinance PDF. Posted below are relevant materials compiled prior to, during, and immediately after the public hearing:. Per City Council's request on September 30, the Planning Commission is developing permanent land use regulations for the production, processing, and retailing uses of recreational marijuana, based upon the current interim regulations that are effective through May 16, Posted below are materials reviewed by the Commission:. Tacoma Permits Customer Service. Homelessness Services Learn how we are addressing homelessness Homeowner Assistance Programs Home repair, rehab loans, and homebuyer programs Landlord-Tenant Services Dispute resolution programs, training and referrals Library Services Learn about what's going on at your local Public Library Online Services Access an interactive list of City services Parking Services Get information on parking options around the city. Available Sites and Buildings Access a list of available surplus properties Building Codes and Permits Building permits, inspections and building codes Business Incentives Tax credits, loan options, and other business incentives City Capital Projects View and map current and planned construction projects Complete Streets Complete Streets program and guidelines Film and Movie Location Assistance Apply for a film permit, get assistance on locations. Arts Program Take a public art tour or join the TacomaArt listserv Dining and Nightlife Find dining options, pubs and night spots Farmers Market Plan a trip to purchase fresh, local produce, and goods Golfing Book a tee time, find a game, or schedule lessons Greater Tacoma Convention Center Plan your next meeting, conference, or event Hiking and Biking Trails Explore the beauty of Tacoma on an outdoor adventure. Shopping Discover unique boutiques, specialty shops, and malls Special Events View Tacoma's major events, festivals, and activities Tacoma Dome Get information on upcoming concerts, events, and more Tacoma Rainiers Check out the Rainers team roster, schedule, and stats Tourism Stay, play, and dine during your visit to Tacoma Transportation Transportation options to help you get around town. Compassionate Tacoma 20 is Plenty Campaign. District 1 Community Newsletter Archives. District 2 Community Newsletter Archive. District 3 Community Newsletter Archives. District 4 Community Newsletter Archive. District 5 Community Newsletter Archive. District 7 Community Newsletter Archives. Frequently Asked Questions. Chief Strategy Officer Executive Profile. Tacoma Management Fellows. Current Projects Tacoma Murals Project. Invest Pierce County. Lincoln Streetscape. MBDA Questionnaire. Complete Streets. Business District Program. Street Sweeping. Source Control and Stormwater Monitoring Report. Stormwater Pollution Prevention Campaign. Why Equity? Relocation Landlord Resources Tenant Resources. FAQs for Employees. Archived Bid Results. Archived Board Agendas. Procurement Card Program Electronic Payments. Late Filers Request Waiver of Penalties. Business License Fees Alarms. Fire Suppression After the Fire is Out. Request an Inspection. Engine Visit Station Tour. Funding Opportunities. Links to Surveys and Assessments. Manitou Annexation Area. Walking Tour Calendar. Traffic Unit. Broadway L. Street Use Impact Fees. General Information Courtroom Information. Driving Directions. Community Service Work Crew. Inclement Weather Resources. Visiting the Tacoma Municipal Building. Planning Services. Current Initiatives and Projects. One Tacoma: Comprehensive Plan. Recent and Completed Projects. Marijuana Regulations. Residential Infill Pilot Program. Regulatory Tools and Incentives. Planning Team. Plan and Code Amendments. Print Friendly. Ordinance No. Major land use regulatory provisions as set forth in the legislation include: Cap on Retail Stores: Buffers from Sensitive Uses: 1,ft from schools and playgrounds; ft from transit centers; ft from all other sensitive uses within Downtown Tacoma; and 1,ft from all other sensitive uses outside of Downtown Tacoma. Dispersion between Retail Stores: Not required. Medical Cooperatives: Allow cooperatives, with state buffers, i. The changes are effective March 2, The Council also signaled that the City will track the ongoing discussions at the state level and take appropriate action to address any legislative changes. Ordinance and an updated preliminary recreational marijuana zoning map are available below: Ordinance PDF Interactive Recreational Marijuana Map Council to Review Commission's Recommendations The City Council will conduct a public hearing on February 3, concerning the Planning Commission's recommendations formulated on January 7, on the proposed Recreational Marijuana Permanent Regulations. The City Council extended the interim regulations on September 30, , for six months, from November 17, to May 16, Posted below are the two relevant ordinances adopted by the City Council as well as a link to the webpage of 'Recreational Marijuana Interim Regulations' which contains more background information: Recreational Marijuana Interim Regulations Ordinance No. Social Media. Contact the City City of Tacoma.

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