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Steel RT. Painful Subjects, Desiring Relief: Experiencing and Governing Pain in a Medical Cannabis Program. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241240467. [PMID: 39086269 DOI: 10.1177/00221465241240467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Cannabis can provide patients benefits for pain and symptom management, improve their functionality, and enhance their well-being. Yet restrictive medical cannabis programs can limit these potential benefits. This article draws on four years of research into Minnesota's medical cannabis program-one of the most restrictive in the United States-including in-depth interviews with patients and a survey of health care professionals. Drawing on the new materialist concepts of Deleuze and Guattari, this article analyzes (a) the benefits patients in Minnesota's medical cannabis program derive from cannabis, (b) how program restrictions mediate access to cannabis and its derived benefits, and (c) some key ways in which medical and criminal justice institutional authorities are reconfigured around medical cannabis. I show how the imperative to authoritatively govern "dangerous drugs" persists in consequential ways as the War on Drugs shifts toward a medicalized, criminalized, and commercial-legalized mixed regime.
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Kim ES, Park SH, Kinney CA, Olejar KJ, Corredor-Perilla IC. Comparison of decarboxylation rates of acidic cannabinoids between secretory cavity contents and air-dried inflorescence extracts in Cannabis sativa cv. 'Cherry Wine'. Sci Rep 2024; 14:16411. [PMID: 39013926 PMCID: PMC11252385 DOI: 10.1038/s41598-024-66420-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024] Open
Abstract
Studies with secretory cavity contents and air-dried inflorescence extracts of the CBD-rich hemp strain, Cannabis sativa cv. 'Cherry Wine', were conducted to compare the decarboxylation rates of acidic cannabinoids between two groups. The secretory cavity contents acquired from the capitate-stalked glandular trichomes by glass microcapillaries, and inflorescence samples air-dried for 15 days of storage in darkness at room temperature were analysed by high-pressure liquid chromatography. The ratio of acidic cannabinoids to the total cannabinoids was ranging from 0.5% to 2.4% lower in the air-dried inflorescence samples compared to the secretory cavity samples as follows. In the secretory cavity content, the percentage of acidic cannabinoids to the total cannabinoids was measured as 86.4% cannabidiolic acid (CBDA), 6.5% tetrahydrocannabinolic acid (THCA), 4.3% cannabichromenic acid (CBCA), 1.4% cannabigerolic acid (CBGA), and 0.6% cannabidivarinic acid (CBDVA), respectively. In the air-dried inflorescence, however, the acidic cannabinoids were detected with 84% CBDA, 4.8% THCA, 3.3% CBCA, 0.8% CBGA, and 0.3% Δ9-tetrahydrocannabivarinic acid (Δ9-THCVA), respectively. The ratio of cannabidiol (CBD) to cannabidiolic acid (CBDA) was close to 1:99 (w/w) in secretory cavity contents, however, it was roughly 1:20 (w/w) in the air-dried inflorescence. In addition, Δ9-tetrahydrocannabivarin (Δ9-THCV) and Δ9-tetrahydrocannabivarinic acid (Δ9-THCVA) were only detected in the air-dried inflorescence sample, and the ratio of Δ9-THCV to Δ9-THCVA was about 1:20 (w/w). Besides, cannabidivarinic acid (CBDVA) was only observed in the secretory cavity content.
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Affiliation(s)
- Eun-Soo Kim
- Institute of Cannabis Research, Colorado State University-Pueblo, Pueblo, CO, 81001, USA.
| | - Sang-Hyuck Park
- Institute of Cannabis Research, Colorado State University-Pueblo, Pueblo, CO, 81001, USA
| | - Chad A Kinney
- Institute of Cannabis Research, Colorado State University-Pueblo, Pueblo, CO, 81001, USA
- Department of Chemistry, Colorado State University-Pueblo, Pueblo, CO, 81001, USA
| | - Kenneth J Olejar
- Department of Chemistry, Colorado State University-Pueblo, Pueblo, CO, 81001, USA
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Elliott J, Fonseca LD, Dereci L, Ochoa P, Taylor M, Kumar G. Sociodemographic profile and clinical presentation of young children unintentionally exposed to marijuana: A single site retrospective cohort. Am J Addict 2024. [PMID: 38745358 DOI: 10.1111/ajad.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/19/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Legalization of medical marijuana has increased unintentional exposure to marijuana in young children. We aim to explore the sociodemographic disadvantage profile, prevalence, and clinical presentation of children diagnosed with unintentional exposure to marijuana. METHODS We conducted a retrospective chart abstraction of 121 children (aged 0-6) seen at the Emergency Department (ED) at a single tertiary hospital center in Dayton, Ohio between January 01, 2010 and January 09, 2022. RESULTS Majority were female (62.8%), white (50.4%), and with Medicaid as their primary insurance (84.3%). The median age at exposure was 1.8 years. There was a 14-fold increase in unintentional marijuana cases pre-2017 (7 cases) versus post-2017 (114 cases), the year of legalization of medical marijuana in the state of Ohio. Majority of the patients were using public assistance (66.4%). 26.7% of the cases had a prior social work consultation and 38.1% had a prior children services consultation. 51.3% of the children had a social disadvantage index score of 3 or greater (range 0-5) with higher scores indicating greater disadvantage. DISCUSSION AND CONCLUSIONS The number of patients presenting to the ED at the hospital has increased 14-fold since the legalization of medical marijuana in Ohio. Half of the children displayed a higher sociodemographic disadvantage index score. SCIENTIFIC SIGNIFICANCE Our study is the first study investigating the sociodemographic profile of children exposed to marijuana. The findings of this study may be utilized to inform policy for safely dispensing recreational and medicinal marijuana products and focus the efforts on families with sociodemographic disadvantage.
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Affiliation(s)
- Jonathan Elliott
- Department of Pediatric Emergency Medicine, Dayton Children's Hospital, Ohio, Dayton, USA
| | - Laura D Fonseca
- Department of Neurology, Dayton Children's Hospital, Ohio, Dayton, USA
| | - Leyla Dereci
- Department of Neurology, Dayton Children's Hospital, Ohio, Dayton, USA
| | - Patricio Ochoa
- Department of Neurology, Dayton Children's Hospital, Ohio, Dayton, USA
| | - Morgan Taylor
- Department of Neurology, Dayton Children's Hospital, Ohio, Dayton, USA
| | - Gogi Kumar
- Department of Neurology, Dayton Children's Hospital, Ohio, Dayton, USA
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Ohio, Dayton, USA
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Nowbath N, Abdelatif N, Lippi G. Comparing the medication costs of treating patients with schizophrenia who use cannabis with those who do not. S Afr J Psychiatr 2024; 30:2211. [PMID: 38726333 PMCID: PMC11079364 DOI: 10.4102/sajpsychiatry.v30i0.2211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/19/2024] [Indexed: 05/12/2024] Open
Abstract
Background Cannabis use is more prevalent among people with schizophrenia than in the general population. This usage detrimentally impacts disease prognosis, contributing to escalated admissions, heightened severity of psychotic symptoms, and reduced medication response. The recent decriminalisation of cannabis in South Africa may lead to an upsurge in usage, consequently intensifying the strain on mental healthcare services. Aim This study aimed to compare the medication costs of patients with schizophrenia depending on cannabis use. Setting Weskoppies Hospital, Pretoria, South Africa, 2018-2019. Methods Data pertaining to medication expenses during the 2018-2019 period were acquired from the hospital pharmacy. Data were collected from 114 patient records to form two equal cohorts: one exposed to cannabis and the other non-exposed, as indicated by urine drug screens or admission of cannabis use. Medications prescribed from admission to time of being ready for discharge were recorded and corresponding costs were calculated. Results Patients who were exposed to cannabis had higher medication costs (R 516.47) than patients who were non-exposed (R 328.69) (p = 0.0519), over the whole admission period. Conclusion Cannabis exposure escalates the financial burden of treating schizophrenia at Weskoppies Hospital. This might be attributed to failure of cost-effective, first-line medications prompting the prescription of costlier, second-line alternatives or higher prescribed dosages. Contribution This study contributes to findings that it is more expensive to treat patients with schizophrenia who have relapsed, if they are using cannabis. This finding has future cost implications when budgeting for pharmacotherapeutic treatment.
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Affiliation(s)
- Nikhil Nowbath
- Department of Psychiatry, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nada Abdelatif
- Department of Biostatistics Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Gian Lippi
- Department of Psychiatry, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Raifman S, Biggs MA, Rocca C, Roberts SCM. Is legal recreational cannabis associated with cannabis use during pregnancy, beliefs about safety, and perceived community stigma? Drug Alcohol Depend 2024; 255:111079. [PMID: 38183831 DOI: 10.1016/j.drugalcdep.2023.111079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Among pregnant and recently pregnant people we investigated whether legal recreational cannabis is associated with pregnancy-related cannabis use, safety beliefs, and perceived community stigma. METHODS In 2022, we surveyed 3571 currently and recently pregnant English- or Spanish-speaking adults in 37 states. Primary outcomes included cannabis use during pregnancy and two continuous scale measures of beliefs about safety and perceived community stigma. Using generalized linear models and mixed effects ordinal logistic regression with random effects for state, we assessed associations between legal recreational cannabis and outcomes of interest, controlling for state-level and individual-level covariates and specifying appropriate functional form. RESULTS Those who reported cannabis use during pregnancy were more likely to believe it is safe and to perceive community stigma compared to those who did not report use during pregnancy. Legal recreational cannabis was not associated with cannabis use during pregnancy, continuation or increase in use, frequency of use, or safety beliefs. Legal recreational cannabis was associated with lower perceived community stigma (coefficient: -0.07, 95% CI: -0.13, -0.01), including among those who reported use during (coefficient = -0.22, 95% CI: -0.40, -0.04) and prior to but not during (coefficient = -0.19, 95% CI: -0.37, -0.01) pregnancy. CONCLUSION Findings do not support concerns that legal recreational cannabis is associated with cannabis use during pregnancy or beliefs about safety. Legal recreational cannabis may be associated with lower community stigma around cannabis use during pregnancy, which could have implications for pregnant people's disclosure of use and care-seeking behavior.
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Affiliation(s)
- Sarah Raifman
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Oakland, CA 94612, USA.
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Oakland, CA 94612, USA
| | - Corinne Rocca
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Oakland, CA 94612, USA
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Oakland, CA 94612, USA
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Cretu B, Zamfir A, Bucurica S, Scheau AE, Savulescu Fiedler I, Caruntu C, Caruntu A, Scheau C. Role of Cannabinoids in Oral Cancer. Int J Mol Sci 2024; 25:969. [PMID: 38256042 PMCID: PMC10815457 DOI: 10.3390/ijms25020969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Cannabinoids have incited scientific interest in different conditions, including malignancy, due to increased exposure to cannabis. Furthermore, cannabinoids are increasingly used to alleviate cancer-related symptoms. This review paper aims to clarify the recent findings on the relationship between cannabinoids and oral cancer, focusing on the molecular mechanisms that could link cannabinoids with oral cancer pathogenesis. In addition, we provide an overview of the current and future perspectives on the management of oral cancer patients using cannabinoid compounds. Epidemiological data on cannabis use and oral cancer development are conflicting. However, in vitro studies assessing the effects of cannabinoids on oral cancer cells have unveiled promising anti-cancer features, including apoptosis and inhibition of cell proliferation. Downregulation of various signaling pathways with anti-cancer effects has been identified in experimental models of oral cancer cells exposed to cannabinoids. Furthermore, in some countries, several synthetic or phytocannabinoids have been approved as medical adjuvants for the management of cancer patients undergoing chemoradiotherapy. Cannabinoids may improve overall well-being by relieving anxiety, depression, pain, and nausea. In conclusion, the link between cannabinoid compounds and oral cancer is complex, and further research is necessary to elucidate the potential risks or their protective impact on oral cancer.
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Affiliation(s)
- Brigitte Cretu
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania; (B.C.); (A.Z.)
| | - Alexandra Zamfir
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania; (B.C.); (A.Z.)
| | - Sandica Bucurica
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Gastroenterology, “Carol Davila” University Central Emergency Military Hospital, 010825 Bucharest, Romania
| | - Andreea Elena Scheau
- Department of Radiology and Medical Imaging, Fundeni Clinical Institute, 022328 Bucharest, Romania;
| | - Ilinca Savulescu Fiedler
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine and Cardiology, Coltea Clinical Hospital, 030167 Bucharest, Romania
| | - Constantin Caruntu
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.)
- Department of Dermatology, “Prof. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
| | - Ana Caruntu
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania; (B.C.); (A.Z.)
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania
| | - Cristian Scheau
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.)
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Syed SA, Singh J, Elkholy H, Palavra IR, Tomicevic M, Eric AP, da Costa MP, Guloksuz S, Radhakrishnan R. International perspective on physician knowledge, attitude and practices related to medical cannabis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.26.23293157. [PMID: 37546945 PMCID: PMC10402227 DOI: 10.1101/2023.07.26.23293157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Background The trends of recreational use of cannabis and use of cannabis for medical indications (i.e. "medical cannabis") have grown in recent years. Despite that, there is still limited scientific evidence to guide clinical decision-making and the strength of evidence for the medical use of cannabis is currently considered to be low. In contrast, there's growing evidence for negative health outcomes related to use of cannabis. In this rapidly shifting landscape, the role of physician's attitudes regarding the therapeutic value of cannabis has become essential. This study aimed to characterize knowledge/experience, attitudes, and potential predictors of clinical practice regarding medical cannabis. Methods We conducted a cross-sectional survey of physicians from 17 countries between 2016-2018. The survey comprised of 28 questions designed to explore physician knowledge, attitude, and practices regarding the use of medical cannabis. Descriptive statistics were used to examine willingness to recommend medical cannabis for medical and psychiatric indications, followed by regression analysis to identify predictors of physician willingness to recommend medical cannabis. Results A total of 323 physicians responded to the survey. Mean age was 35.4± 9.5 years, with 10.04 ±8.6 years of clinical experience. 53 percent of physicians were women. Clinical experience with medical cannabis was overall limited (51.4% noted never having recommended medical cannabis; 33% noted inadequate knowledge regarding medical cannabis). Overall willingness to recommend medical cannabis was highest for chemotherapy-induced nausea, refractory chronic neuropathic pain, and spasticity in amyotropic lateral sclerosis (ALS). Conclusion This international study examining knowledge, attitudes and practices related to medical cannabis among physicians revealed that there are significant gaps in domain-specific knowledge related to medical cannabis. There is wide variability in willingness to recommend medical cannabis that is not consistent with the current strength of evidence. This study thus highlights the need for greater education related to domain-specific knowledge about medical cannabis.
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Affiliation(s)
| | - Jatinder Singh
- Department of Psychiatry, Penn State Milton S. Hershey Medical Center, PA, USA
| | - Hussien Elkholy
- Neurology and Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Marko Tomicevic
- University Hospital Dubrava, Department of Psychiatry Av, Zagreb, Croatia
| | - Anamarija Petek Eric
- Department of Psychiatry, Clinical Hospital Centre Osijek, Croatia
- Faculty of Medicine Osijek, J.J. Strossmayer University Osijek, Croatia
| | - Mariana Pinto da Costa
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Sinan Guloksuz
- Department of Psychiatry, Yale School of Medicine, CT, USA
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
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Ang SP, Sidharthan S, Lai W, Hussain N, Patel KV, Gulati A, Henry O, Kaye AD, Orhurhu V. Cannabinoids as a Potential Alternative to Opioids in the Management of Various Pain Subtypes: Benefits, Limitations, and Risks. Pain Ther 2023; 12:355-375. [PMID: 36639601 PMCID: PMC10036719 DOI: 10.1007/s40122-022-00465-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/22/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Pain is a global phenomenon encompassing many subtypes that include neuropathic, musculoskeletal, acute postoperative, cancer, and geriatric pain. Traditionally, opioids have been a mainstay pharmacological agent for managing many types of pain. However, opioids have been a subject of controversy with increased addiction, fatality rates, and cost burden on the US healthcare system. Cannabinoids have emerged as a potentially favorable alternative or adjunctive treatment for various types of acute and chronic pain. This narrative review seeks to describe the efficacy, risks, and benefits of cannabinoids as an adjunct or even potential replacement for opioids in the treatment of various subtypes of pain. METHODS In June of 2022, we performed a comprehensive search across multiple databases for English-language studies related to the use of cannabinoids in the treatment of various types pain: neuropathic pain, musculoskeletal pain, acute postoperative pain, cancer pain, and geriatric pain. Data from meta-analyses, systematic reviews, and randomized control trials (RCTs) were prioritized for reporting. We sought to focus our reported analysis on more recent literature as well as include older relevant studies with particularly notable findings. RESULTS There is conflicting evidence for the use of cannabinoids in the management of pain. While cannabinoids have shown efficacy in treating specific chronic pain subtypes such as neuropathic pain, fibromyalgia pain, and geriatric pain, they do not show as clear benefit in acute postoperative and the majority of musculoskeletal pain syndromes. Data trends towards cannabinoids having a positive effect in treating cancer pain, but results are not as conclusive. To date, there is a paucity of data comparing cannabinoids directly to opioids for pain relief. Overall, the side effects of cannabinoids appear to be relatively mild. However, there is still potential for addiction, altered brain development, psychiatric comorbidities, and drug-drug interactions. CONCLUSION Cannabinoids may be effective in specific subtypes of pain, but current evidence and guidelines do not yet support its use as the first-line treatment for any type of acute or chronic pain. Rather, it may be considered a good adjunct or alternative for patients who have failed more typical or conservative measures. Additional studies are needed with standardized forms of cannabinoids, route of delivery, and dosing for greater-powered analysis. Providers must weigh the individualized patient risks, benefits, and concurrent medication list in order to determine whether cannabinoids are appropriate for a patient's pain treatment plan.
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Affiliation(s)
- Samuel P Ang
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Shawn Sidharthan
- Department of Neurology, Northwell Health-Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, USA
| | - Wilson Lai
- Department of Anesthesiology and Pain Medicine, Northwell Health-Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, USA
| | - Nasir Hussain
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kiran V Patel
- Department of Anesthesiology, New York University Langone Medical Center, New York, NY, USA
- Department of Anesthesiology and Pain Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Onyeaka Henry
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alan D Kaye
- Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU School of Medicine, Shreveport, LA, USA
- Anesthesiology and Pharmacology, LSU School of Medicine, New Orleans, LA, USA
- Anesthesiology and Pharmacology, Tulane School of Medicine, New Orleans, LA, USA
| | - Vwaire Orhurhu
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA.
- MVM Health, East Stroudsburg, PA, USA.
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Davis MP, Case AA, Cyr C. Do We Have Structure, Process and Outcomes to Support Cannabis as Supportive Therapy in Cancer? Am J Hosp Palliat Care 2023; 40:341-350. [PMID: 35532011 DOI: 10.1177/10499091221101561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cannabis is becoming more popular and more available in the United States. It has been approved for use by multiple states for various conditions and several states now allow recreational cannabis. We explore the structure of cannabis distribution, the process of acquisition, outcomes, and the safety of cannabis in the United States.
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Affiliation(s)
- Mellar P Davis
- 2780Geisinger Commonwealth School of Medicine, Danville, PA, USA
| | - Amy A Case
- Department of Medicine, Department of Supportive and Palliative Care, 2074Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Claude Cyr
- Supportive and Palliative Care Division, 12367McGill University Health Center, Montreal, QC, Canada
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Shao H, Du H, Gan Q, Ye D, Chen Z, Zhu Y, Zhu S, Qu L, Lu J, Li Y, Duan J, Gu Y, Chen M. Trends of the Global Burden of Disease Attributable to Cannabis Use Disorder in 204 Countries and Territories, 1990-2019: Results from the Disease Burden Study 2019. Int J Ment Health Addict 2023:1-23. [PMID: 36817983 PMCID: PMC9913032 DOI: 10.1007/s11469-022-00999-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 02/12/2023] Open
Abstract
Cannabis is the fourth psychoactive substance to be legalized which are of far-reaching significance to the world. We analyzed data from the 2019 Global Burden of Disease Study (GBD) to estimate the incidence and prevalence of cannabis use disorder (CUD) and calculated the disease burden of CUD in 204 countries and territories and 21 regions over the past three decades. We reported disease burden due to CUD in terms of disability-adjusted life years (DALYs), age-standardized rate (ASR), estimated annual percentage change (EAPC), and analyzed associations between the burden of CUD and sociodemographic index (SDI) quintiles. Globally, the number of incidence cases of CUD was estimated to be increasing by 32.3% from 1990 to 2019 and males are nearly double higher than that of female. DALYs increase 38.6% from 1990. Young people aged 20-24 years old with cannabis use disorder have the highest DALYs in 2019, followed by those younger than 20 years old. India, Canada, USA, Qatar, Kenya, and high SDI quintile areas showed a high burden of disease. Nearly 200 million individuals are cannabis users worldwide, and CUD is a notable condition of GBD. The global cultivation of cannabis, rooted in different cultures, diversified access to cannabis, legalization in controversy, the promotion of medical cannabis, and many other factors promote the global cannabis industry is constantly updated and upgraded. It deserves more discussion in the future in terms of pathophysiological mechanisms, socioeconomics, law, and policy improvement. Supplementary Information The online version contains supplementary material available at 10.1007/s11469-022-00999-4.
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Affiliation(s)
- Heng Shao
- Department of Geriatrics, The First People’s Hospital of Yunnan Province, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan China
| | - Heyue Du
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Quan Gan
- Faculté de Médecine, Université Paris Saclay, Paris, France
| | - Dequan Ye
- Department of Ultrasound in Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhuangfei Chen
- Medical Faculty, Kunming University of Science and Technology, Kunming, Yunnan China
| | - Yanqing Zhu
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan China
- Department of Clinical Psychology, The First People’s Hospital of Yunnan Province, Yunnan, China
| | - Shasha Zhu
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan China
- Department of Clinical Psychology, The First People’s Hospital of Yunnan Province, Yunnan, China
| | - Lang Qu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Junyan Lu
- Institute of Medical Biology Chinese Academy of Medical Sciences, Kunming, China
| | - Yutong Li
- Department of Psychology, Mount Holyoke College, South Hadley, MA USA
| | - Jing Duan
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Yingqi Gu
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Meiling Chen
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan China
- Department of Clinical Psychology, The First People’s Hospital of Yunnan Province, Yunnan, China
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Gangwani P, Lillian D, Dobbins J, Feng C, Vorrasi J, Kolokythas A. Is Recreational Marijuana Use Associated With Changes in the Vital Signs or Anesthetic Requirements During Intravenous Sedation? J Oral Maxillofac Surg 2023; 81:527-535. [PMID: 36746375 DOI: 10.1016/j.joms.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE The prevalence of tetrahydrocannabinol (THC) use is increasing in the general population due to its increased availability, legality, and cultural acceptability. The purpose of the current study was to measure the association of THC use on the vital signs and anesthetic requirements during intravenous (IV) sedation procedures in recreational marijuana users. METHODS A retrospective cohort study was performed. A study sample was chosen from July 2018 to May 2022 based on the following inclusion criteria: patients who underwent toxicology screening due to their history of recent drug use and received IV sedation. The predictor variable of the present study is THC status grouped into THC+ and THC-. THC status was established using urine toxicology. Patients who screened positive for THC were coded THC+. Patients who screened negative for THC were coded THC-. Primary outcome variable was changes in vital signs, including mean arterial pressure (MAP), heart rate (HR), and respiratory rate (RR) during IV sedation procedures in THC+ and THC- groups. Secondary outcome variable was difference in medication (midazolam, fentanyl, propofol, and ketamine) requirements in THC+ and THC- groups. Covariates included age, gender, race, weight, duration of surgery, smoking history, and alcohol use, data on psychiatric diagnosis and psychiatric medications. Descriptive statistics and 2-sample t test were calculated. Statistical significance was set at P < .05. RESULTS In total, 53 patients met the inclusion criteria and were included in the study, with 27 patients in the THC+ group and 26 patients in the THC- group. There were no significant statistical differences in the MAP%, HR%, and RR% at T5, T10, T20, and T30 between the THC+ and THC- groups. When comparing THC+ and THC- groups, in bivariate analyses, the THC+ group required, on average, higher doses of fentanyl [83.82 mcg compared to 65 mcg (P = .02)] and propofol [70 mg compared to 45.26 mg (P = .03)] during IV sedation. However, after adjusting the effect of age, gender, and weight, THC had no significant effect on midazolam (P-value = .28), fentanyl (P-value = .12), propofol (P-value = .06) and ketamine (P-value = .86) requirements. CONCLUSIONS These findings suggest there are no differences in vital signs or anesthetic requirements between the THC+ and THC- groups.
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Affiliation(s)
- Pooja Gangwani
- Associate Professor, Department of Oral and Maxillofacial Pathology, Medicine, Surgery, Temple University Kornberg School of Dentistry, Philadelphia, PA.
| | - David Lillian
- Private Practice, Grand Junction Oral Surgery, Colorado
| | - Joshua Dobbins
- Resident, Department of Oral and Maxillofacial Surgery, University of Rochester/EIOH, Rochester, NY
| | - Changyong Feng
- Professor, Department of Biostatistics and Computational Biology, University of Rochester/EIOH, Rochester, NY
| | - John Vorrasi
- Associate Professor, Chair and Program Director, Department of Oral and Maxillofacial Surgery, University of Rochester/EIOH, Rochester, NY
| | - Antonia Kolokythas
- Professor, Chair and Program Director, Department of Oral and Maxillofacial Surgery, The Dental College of Georgia, Professor of Surgery, Augusta, GA
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Huffstetler CM, Cochran B, May CA, Maykut N, Silver CR, Cedeno C, Franck E, Cox A, Fadool DA. Single cannabidiol administration affects anxiety-, obsessive compulsive-, object memory-, and attention-like behaviors in mice in a sex and concentration dependent manner. Pharmacol Biochem Behav 2023; 222:173498. [PMID: 36455670 DOI: 10.1016/j.pbb.2022.173498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022]
Abstract
RATIONALE The behavioral effects of cannabidiol (CBD) are understudied, but are important, given its therapeutic potential and widespread use as a natural supplement. OBJECTIVE The objective of this study was to test whether a single injection of CBD affected anxiety-like or attention-like behavior, or memory in wildtype mice or mice with reported trait anxiety due to a targeted gene-deletion in a voltage-dependent potassium channel, Kv1.3. METHODS Wildtype C57BL/6 J and Kv1.3-/- mice of both sexes were reared to adulthood and then administered an intraperitoneal injection of 10 or 20 mg/kg CBD. Mice were behaviorally-phenotyped using the marble-burying test, the light-dark box (LDB), short (1 h) and long-term (24 h) object memory test, the elevated-plus maze (EPM), and the object-based attention task in order to assess obsessive compulsive-, anxiety-, and attention-like behaviors, and memory. RESULTS We discovered that acute CBD treatment reduced marble burying in male, but not female mice. CBD was effective in lessening anxiety-like behaviors determined by the LDB test in both male and female wildtype mice, whereby the effective dose required to observe the effect in females was less. In Kv1.3-/- mice, CBD increased anxiety-like behaviors in the LDB in both sexes at the higher concentration of CBD and it similarly increased anxiety-like behavior in females in the EPM at the lower concentration of CBD. Long-term object memory was reduced in male wildtype mice at the lower concentration of CBD. Finally, ADHD- or attention-like behaviors were not altered by CBD in wildtype mice, but in Kv1.3-/- mice, females were observed to have a loss in attention while males demonstrated improved attention. CONCLUSIONS We conclude that administration of a single dose of CBD has immediate effects on mouse behavior that is dose, sex, and anxiety-state dependent - and that these behavioral outcomes are important to examine in parallel human trials.
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Affiliation(s)
| | - Brigitte Cochran
- Department of Biological Science, Florida State University, Tallahassee, FL 32306, USA.
| | - Camilla Ann May
- Department of Biological Science, Florida State University, Tallahassee, FL 32306, USA.
| | - Nicholas Maykut
- Department of Biological Science, Florida State University, Tallahassee, FL 32306, USA.
| | - Claudia Rose Silver
- Department of Biological Science, Florida State University, Tallahassee, FL 32306, USA.
| | - Claudia Cedeno
- Department of Biological Science, Florida State University, Tallahassee, FL 32306, USA.
| | - Ezabelle Franck
- Department of Biological Science, Florida State University, Tallahassee, FL 32306, USA; Program in Neuroscience, Florida State University, Tallahassee, FL 32306, USA.
| | - Alexis Cox
- Department of Biological Science, Florida State University, Tallahassee, FL 32306, USA.
| | - Debra Ann Fadool
- Department of Biological Science, Florida State University, Tallahassee, FL 32306, USA; Program in Neuroscience, Florida State University, Tallahassee, FL 32306, USA; Institute of Molecular Biophysics, Florida State University, Tallahassee, FL 32306, USA.
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13
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Marchese M, Zhu C, Charbonneau LF, Peragine C, De Angelis C. Description and Disposition of Patients With Cancer Accessing a Novel, Pharmacist-Led Cannabis Consultation Service. JCO Oncol Pract 2022; 18:e1777-e1786. [PMID: 35609230 DOI: 10.1200/op.21.00748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE The Cannabis Consultation Service (CCS) is an innovative pharmacist-led resource at the Sunnybrook Odette Cancer Centre. Its mandate is to provide education and guide patients through access and appropriate use of high-quality plant-derived cannabinoids (PDCs). Our objective was to describe the CCS, explain its processes, and characterize patient disposition with respect to use of PDCs. METHODS We retrospectively reviewed the charts of patients referred to the CCS from July 13, 2020, to March 05, 2021. We used descriptive statistics to report on the patient population and service metrics. RESULTS During the 34-week period, 96 patients accessed the CCS (median age, 61 years). The top reasons for CCS consultation were management of cancer pain, insomnia, and general interest. Medical cannabis was supported as an option in 44/96 patients. Reasons for not supporting PDC use included lack of indication, potential drug interaction/contraindication, or requiring treatment with first-line therapy. Of the 40 patients requiring a medical document, 22 initiated therapy. The most common product used was a 2:50 THC:CBD (Tetrahydrocannabinol:Cannabidiol) cannabis oil. At the date of last contact, few patients remained on therapy because of lack of benefit, patient choice, and/or hesitancy. CONCLUSION Despite patients with cancer having interest in seeking PDCs for symptom management, only a few initiated and continued therapy. Pharmacists have an opportunity to advise patients and the oncology team on the risks and benefits of PDCs. These results can be used to support the development of medical cannabis programs by oncology centers and focus future research priorities.
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Affiliation(s)
- Maria Marchese
- Department of Pharmacy, Sunnybrook Odette Cancer Centre, Toronto, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Catherine Zhu
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - L Flay Charbonneau
- Department of Pharmacy, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Christine Peragine
- Department of Pharmacy, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Carlo De Angelis
- Department of Pharmacy, Sunnybrook Odette Cancer Centre, Toronto, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
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14
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Steel RT. Medicalising the menace? The symbiotic convergence of medicine and law enforcement in the medicalisation of marijuana in Minnesota. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:1324-1343. [PMID: 35939569 PMCID: PMC9540305 DOI: 10.1111/1467-9566.13513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
The medicalisation of marijuana has occurred rapidly, albeit nonuniformly, across the US and around the world over the past 3 decades. This paper centres on the medicalisation of marijuana in Minnesota-which has one of the most restrictive programs in the country-as a case for evaluating the negotiation of institutional boundaries with the shift from criminalisation to medicalisation after nearly a century of criminal prohibition. Drawing upon Foucauldian discourse analyses of the medical and law enforcement associations' position statements and legislative hearings that shaped medical marijuana policy in Minnesota, this paper demonstrates a symbiotic convergence between medicine and law enforcement through the deployment of shared discursive strategies in their opposition to medical marijuana that reinforce marijuana's criminalised status by solidifying the boundaries between proper medicine and dangerous drugs. Criminal justice and medical institutions draw upon one another's definitions, logics, and practices in a mutually constitutive manner, while still maintaining distinct user subjects and institutional interventions for each based on the user's access to state-approved forms of marijuana. The consequences for the governing of marijuana in Minnesota are explored, as well as the broader implications for the sociological study of medicalisation and criminalisation with respect to the governance of drugs and health.
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Affiliation(s)
- Ryan T. Steel
- Department of Sociology and AnthropologyUniversity of RichmondRichmondVirginiaUSA
- Department of SociologyUniversity of Minnesota (Twin Cities)MinneapolisMinnesotaUSA
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15
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Kluger BM, Huang AP, Miyasaki JM. Cannabinoids in movement disorders. Parkinsonism Relat Disord 2022; 102:124-130. [PMID: 36038457 DOI: 10.1016/j.parkreldis.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION On the basis of both scientific progress and popular lore, there is growing optimism in the therapeutic potential of cannabis (marijuana) and cannabinoid-based chemicals for movement disorders. There is also notable skepticism regarding the scientific basis for this therapeutic optimism and significant concerns regarding the safety and regulation of cannabinoid products, particularly those available without prescription. METHODS In recognition of the high interest and controversial nature of this subject, the meeting committee of the International Parkinson and Movement Disorders Society arranged for a talk on cannabis at the 2019 annual meeting's Controversies in Movement Disorders plenary session. This paper summarizes the highlights of this session. RESULTS The endocannabinoid system is strongly tied to motor function and dysfunction, with basic research suggesting several promising therapeutic targets related to cannabinoids for movement disorders. Clinical research on cannabinoids for motor and nonmotor symptoms in Parkinson's disease, Huntington's disease, Tourette's syndrome, dystonia, and other movement disorders to date are promising at best and inconclusive or negative at worst. Research in other populations suggest efficacy for common symptoms like pain. While social campaigns against recreational cannabinoid use focus on cognitive changes in adolescents, the long-term sequelae of regulated medical use in older adults with movement disorders is unknown. The overall risks of cannabinoids may be similar to other commonly used medications and include falls and apathy. CONCLUSION Further research is greatly needed to better understand the actual clinical benefits and long-term side effects of medical cannabis products for movement disorders indications and populations.
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Affiliation(s)
- Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Andrew P Huang
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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16
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Ransing R, de la Rosa PA, Pereira-Sanchez V, Handuleh JIM, Jerotic S, Gupta AK, Karaliuniene R, de Filippis R, Peyron E, Sönmez Güngör E, Boujraf S, Yee A, Vahdani B, Shoib S, Stowe MJ, Jaguga F, Dannatt L, da Silva AK, Grandinetti P, Jatchavala C. Current state of cannabis use, policies, and research across sixteen countries: cross-country comparisons and international perspectives. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2022. [PMID: 34735077 DOI: 10.4762/2237-6089-2021-0263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Varying public views on cannabis use across countries may explain the variation in the prevalence of use, policies, and research in individual countries, and global regulation of cannabis. This paper aims to describe the current state of cannabis use, policies, and research across sixteen countries. METHODS PubMed and Google Scholar were searched for studies published from 2010 to 2020. Searches were conducted using the relevant country of interest as a search term (e.g., "Iran"), as well as relevant predefined keywords such as "cannabis," "marijuana," "hashish," "bhang "dual diagnosis," "use," "addiction," "prevalence," "co-morbidity," "substance use disorder," "legalization" or "policy" (in English and non-English languages). These keywords were used in multiple combinations to create the search string for studies' titles and abstracts. Official websites of respective governments and international organizations were also searched in English and non-English languages (using countries national languages) to identify the current state of cannabis use, policies, and research in each of those countries. RESULTS The main findings were inconsistent and heterogeneous reporting of cannabis use, variation in policies (e.g., legalization), and variation in intervention strategies across the countries reviewed. European countries dominate the cannabis research output indexed on PubMed, in contrast to Asian countries (Thailand, Malaysia, India, Iran, and Nepal). CONCLUSIONS Although global cannabis regulation is ongoing, the existing heterogeneities across countries in terms of policies and epidemiology can increase the burden of cannabis use disorders disproportionately and unpredictably. There is an urgent need to develop global strategies to address these cross-country barriers to improve early detection, prevention, and interventions for cannabis use and related disorders.
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Affiliation(s)
- Ramdas Ransing
- Department of Psychiatry, BKL Walawalkar Rural Medical College, Maharashtra, India
| | - Pedro A de la Rosa
- Educación de la Afectividad y Sexualidad Humana, Instituto Cultura y Sociedad, Universidad de Navarra, Pamplona, Spain. Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Victor Pereira-Sanchez
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Stefan Jerotic
- Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Ruta Karaliuniene
- Elblandklinikum Radebeul Clinic for Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
| | | | - Ekin Sönmez Güngör
- Department of Psychiatry, University of Health Sciences, Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Said Boujraf
- Clinical Neurosciences Laboratory, Sidi Mohamed ben Abdellah University, Fez, Morocco
| | - Anne Yee
- Department of Psychological Medicine, University Malaya Centre of Addiction Sciences, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bita Vahdani
- Qazvin University of Medical Sciences Qazvin, Iran. Department of Psychology, University of Tehran, Tehran, Iran
| | - Sheikh Shoib
- Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Rainawari, Kashmir, India
| | - M J Stowe
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Lisa Dannatt
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Paolo Grandinetti
- Addictions Service, Department of Territorial Services, ASL Teramo, Teramo, Italy
| | - Chonnakarn Jatchavala
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
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17
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O'Keefe EL, Dhore A, Lavie CJ. Early Onset Cardiovascular Disease from Cocaine, Amphetamines, Alcohol, and Marijuana. Can J Cardiol 2022; 38:1342-1351. [PMID: 35840019 DOI: 10.1016/j.cjca.2022.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 01/16/2023] Open
Abstract
Cardiovascular disease (CVD), a disease typically associated with aging and the definitive leading cause of death worldwide, now threatens the young and middle-aged populations. Recreational abuse of alcohol, marijuana, cocaine and amphetamine-type stimulants has been an escalating public health problem for decades, but now use of these substances has become a significant contributor to early onset CVD. While this remains a global phenomenon, the epicenter of substance abuse is rooted in North America where it has been exacerbated by the COVID-19 pandemic. For the first time in history, the United States (US) crossed 100,000 overdose-related deaths in a calendar year. Sadly, Canada's recreational drug abuse problem closely mirrors that of the US. This is indicative of the larger public health crisis unfolding, as we now know that these substances are cardiotoxic and are contributing to the rising levels of premature chronic CVD, including hypertension, arrhythmias, heart failure, stroke, myocardial infarction, arterial dissection, sudden cardiac death and early mortality.
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Affiliation(s)
| | | | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA.
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18
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Vila Silván C, Vaney C, Dykukha I. Systematic reviews of randomized controlled trials of cannabinoid products in chronic pain conditions and for symptoms associated with multiple sclerosis: what do they tell us? Expert Rev Clin Pharmacol 2022; 15:415-431. [PMID: 35679523 DOI: 10.1080/17512433.2022.2088501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : To investigate whether published systematic reviews of randomized controlled trials provide sufficient clarity to inform prescribing of cannabinoid products aimed for medicinal use, we examined their features and findings in two well-researched areas: chronic cancer/noncancer pain and multiple sclerosis (MS)-related symptoms. AREAS COVERED : Structured searches from January 2011 to 2 February 2021 identified 31 systematic reviews (with/without meta-analyses) that met the inclusion criteria. Support for the efficacy of cannabinoids was minimal in cancer pain, and somewhat stronger in noncancer (especially neuropathic) pain and MS spasticity. All systematic reviews and most meta-analyses grouped cannabinoid products together without appropriate consideration of their differential attributes (active constituent(s), concentration/strength, dosage forms, administration route), dosing regimens or treatment durations. Patient populations and efficacy outcome measures were inhomogeneous, particularly for studies in noncancer pain and MS. Separate results for specific cannabinoid formulations were rarely provided. EXPERT OPINION : The therapeutic effect of cannabinoids, as already demonstrated for some products, is not reflected clearly in the current range of systematic reviews and meta-analyses in chronic pain and MS. To truly inform evidence-based practice, future publications should aim to present results by individual product from well-conducted clinical trials using appropriate and homogeneous outcome measures in well-defined patient populations.
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Affiliation(s)
| | - Claude Vaney
- Médecin-Adjoint, Clinique de Réhabilitation, HFR Meyriez-Murten, Meyriez, Switzerland
| | - Igor Dykukha
- Medical Affairs, Almirall Hermal GmbH, Scholtzstrasse 3, Reinbek, Germany
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19
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van der Eijk Y, Chen JIP. Case for raising the minimum legal age of tobacco sale to 25. Tob Control 2022; 31:487-492. [PMID: 33414266 DOI: 10.1136/tobaccocontrol-2020-055964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/15/2020] [Accepted: 11/17/2020] [Indexed: 11/03/2022]
Abstract
Restricting youth access to tobacco is an essential component of a comprehensive tobacco control policy. While there has been a growing movement to raise the minimum legal age (MLA) of purchasing tobacco from 18 to 21, more restrictive measures, such as raising the MLA to 25 (MLA25), have been criticised as being overly restrictive on adult's free choice. We argue that, even within a policy approach that prioritises freedom of choice, there is a strong case for MLA25 in view of neurobiological evidence which shows that, before age 25, people are neurobiologically vulnerable to developing an addiction. We discuss further considerations for an MLA25 policy, in particular its potential impact on the free choice of young adults to start or quit smoking, potential public health impact and potential effectiveness considering that most underage youth source cigarettes from older peers.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jacinta I-Pei Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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20
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Focus on Rural Adolescent Cannabis Use and Abuse: Ignored Epidemiologic Trends, Unique Risks, Long-Term Concerns, and Hope. CNS Spectr 2022; 28:277-280. [PMID: 35387706 DOI: 10.1017/s1092852922000736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractCannabis-related issues for adolescents and young adults are emerging from the shadow of rural opioid addiction and deaths. The rural pediatric population has multiple risk factors putting them at increased risk for adverse consequences with the expansion of cannabis legalization across the United States. Research in this area is rich but scattered across professional disciplines. Differences in demographics and cultures between rural and urban youth are gaining attention. Epidemiological factors relevant to rurality as a risk for cannabis and other substance use are considered for formulating clinical care, public policymakers, and future research. Race, culture, community stability, basic demographics of age, gender, educational status, and demands for more and better, accessible services for rural, nonmetropolitan areas comprise factors for consideration and are detailed. Research findings provide direction for policymakers and clinicians for prevention and intervention efforts to improve care for rural populations, validating and expanding upon insights gained to date.
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21
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Grotsch K, Fokin VV. Between Science and Big Business: Tapping Mary Jane's Uncharted Potential. ACS CENTRAL SCIENCE 2022; 8:156-168. [PMID: 35233448 PMCID: PMC8875429 DOI: 10.1021/acscentsci.1c01100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Indexed: 06/14/2023]
Abstract
At the intersection of science and medicine, government policy, and pop culture, cannabis has prompted society since the beginning of recorded history. And yet, there is comparatively little replicable data on the plant, its constituents, and their capacity to modify human physiology. Over the past decades, several findings have pointed toward the importance of the endogenous cannabinoid system in maintaining homeostasis, making it an important target for various diseases. Here, we summarize the current state of knowledge on endogenous- and plant-based cannabinoids, address the issues related to cannabinoid-based drug discovery, and incite efforts to utilize their polypharmacological profile toward tackling diseases with a complex underlying pathophysiology. By fusing modern science and technology with the empirical data that has been gathered over centuries, we propose an outlook that could help us overcome the dearth of innovation for new drugs and synchronously redefine the future of drug discovery. Simultaneously, we call attention to the startling disconnect between the scientific, regulatory, and corporate entities that is becoming increasingly evident in this booming industry.
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Affiliation(s)
- Katharina Grotsch
- Bridge Institute and Loker
Hydrocarbon Research Institute, University
of Southern California, 1002 Childs Way, Los Angeles, California 90089-3502, United States
| | - Valery V. Fokin
- Bridge Institute and Loker
Hydrocarbon Research Institute, University
of Southern California, 1002 Childs Way, Los Angeles, California 90089-3502, United States
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22
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Wynne J, Kozuch P. Medical marijuana for inflammatory bowel disease: the highs and lows. Scand J Gastroenterol 2022; 57:197-205. [PMID: 34919496 DOI: 10.1080/00365521.2021.1998604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Increased interest in cannabis as a potential treatment and/or adjuvant therapy for inflammatory bowel disease (IBD) has been driven by patients with refractory disease seeking relief as well those who desire alternatives to conventional therapies. Available data have shown a potential role of cannabis as a supportive medication, particularly in pain reduction; however, it remains unknown whether cannabis has any impact on the underlying inflammatory process of IBD. The purpose of this review article is to summarize the available literature concerning the use of cannabis for the treatment of IBD and highlight potential areas for future study.
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Affiliation(s)
- Joshua Wynne
- Internal Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Patricia Kozuch
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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23
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Adler L, Zacay G, Schonmann Y, Azuri J, Yehoshua I, Vinker S, Shani M, Heymann AD, Hoffman R. Primary care physicians' attitudes and knowledge regarding medical cannabis and willingness to prescribe it: the Israeli experience. Fam Pract 2022; 39:59-64. [PMID: 34476478 DOI: 10.1093/fampra/cmab108] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Use of medical cannabis (MC) in Israel has increased since its regulatory approval in 2016. Currently, more than 1% of Israeli adults are treated with MC; this requires primary care physicians (PCPs) to be familiar with this treatment option. OBJECTIVES We assessed the attitudes and knowledge of Israeli PCPs toward MC and evaluated their willingness to prescribe it for different medical conditions. METHODS A cross-sectional survey which was distributed to PCPs in Israel. Physicians were asked about their opinions, knowledge, and willingness to prescribe MC. RESULTS Two hundred and one PCPs answered the questionnaire. Their average age was 47 years (±11.2), 71% were specialists. 51% of the respondents thought that MC is an effective treatment. 63% replied that they had little knowledge and 75% indicated that they would like to deepen it. 61% of the respondents were willing to initiate an MC treatment for a dying patient, while less than 50% were willing to initiate MC treatment for various other conditions. Most respondents indicated that they were willing to renew a prescription for any approved medical condition. Willingness to prescribe MC increased for physicians who agreed that MC was effective (odds ratio [OR] 21.9, 95% confidence interval [CI] 2.40-200.85), for physicians who strongly agreed with the statement that they had sufficient knowledge (OR 5.0, 95% CI 1.58-15.83) and for residents compared with specialists (OR 4.0, 95% CI 1.52-10.73). CONCLUSIONS Our survey revealed PCPs' differing opinions and insufficient knowledge regarding treatment with MC. These findings suggest that continuing medical education regarding MC is needed.
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Affiliation(s)
- Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Galia Zacay
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
| | - Yochai Schonmann
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel
| | - Joseph Azuri
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Ilan Yehoshua
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Leumit Health Services, Headquarters, Medical Division, Tel Aviv, Israel
| | - Michal Shani
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine Central District, Clalit Health Services, Rehovot, Israel
| | - Anthony D Heymann
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
| | - Robert Hoffman
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
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24
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Lewis M, Flood J. The transition of cannabis into the mainstream of Australian healthcare: framings in professional medical publications. J Cannabis Res 2021; 3:48. [PMID: 34802449 PMCID: PMC8606098 DOI: 10.1186/s42238-021-00105-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medicinal cannabis has been legalised for use for a range of specified medical conditions in Australia since 2016. However, the nature of the government regulations and the subsequent complexity of prescribing, as well as doctors' safety uncertainties and the stigma of the plant, remain contributing barriers to patient access. Media representations can offer insights into the nature of the discourse about new medical products and therapies and how ideas and understandings about social phenomena become constructed. Focusing on professional medical publications, this study sought to investigate how medicinal cannabis is being represented in professional medical publications. METHODS Using a content analysis approach, we investigated articles about medicinal cannabis from 2000 to the end of 2019 in the Medical Journal of Australia, Australian Doctor, Medical Observer, Australian Journal of General Practice, Australian Family Physician, and Australian Medicine. Articles were coded according to article type, framings of cannabis, headline and article tone, and key sources used in the article. We also used manifest textual analysis to search for word frequencies, and specific conditions referred to in the articles retrieved. RESULTS A total of 117 articles were retrieved for analysis, the majority of which were news stories for a physician audience. Across the longitudinal period, we found that most reports carried a positive tone towards medicinal cannabis. Cannabis is most frequently framed as a legitimate therapeutic option that is complex to prescribe and access, does not have a strong evidence base to support its use, and also carries safety concerns. At the same time, the outlook on cannabis research data is largely positive. Primary sources most frequently used in these reports are peer-reviewed journals or government reports, voices from medical associations or foundations, as well as government and university researchers. Chronic pain or pain were the conditions most frequently mentioned in articles about cannabis, followed by epilepsy, cancer or cancer pain, and nausea and chemotherapy. CONCLUSIONS This analysis offers evidence that medicinal cannabis is being framed as a valid medicine advocated by the community, with potential for addressing a range of conditions despite the lack of evidence, and a medicine that is not free of risk.
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Affiliation(s)
| | - John Flood
- Griffith University, Queensland, Australia
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25
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Caputo MP, Rodriguez CS, Padhya TA, Mifsud MJ. Medical Cannabis as Adjunctive Therapy for Head and Neck Cancer Patients. Cureus 2021; 13:e18396. [PMID: 34729274 PMCID: PMC8555939 DOI: 10.7759/cureus.18396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/29/2021] [Indexed: 12/15/2022] Open
Abstract
The goal of this systematic review was to define a consensus within the current literature regarding the impact/effect of cannabis or cannabinoids on the treatment of patients with head and neck cancer. We conducted a review of PubMed, Embase, and Web of Science databases, using a comprehensive search strategy, focusing on articles relating to head & neck cancer and cannabis/cannabinoids without a time limit for publication. Two, independent reviewers screened articles based on title/abstract and included the ones selected by both. We then conducted a full-text review and excluded all articles which did not meet inclusion criteria. A single reviewer then assessed studies for methodological quality and extracted relevant data using a premade data collection tool. We identified five studies that met inclusion criteria. Studies were of varying quality and the majority investigated recreational cannabis use with only one study reporting dosing across participants. Lack of standardized cannabis exposure presents a wide array of potential confounding variables across the remaining studies. Meta-analysis was not attempted due to variability in reported outcomes. It is impossible to draw any conclusions regarding the benefit or adverse effects of current medical cannabis products in this patient population. The literature regarding the effect of cannabis/cannabinoids on head & neck cancer patients is limited. However, the current lack of evidence does not definitively disprove the efficacy of cannabis. High-quality studies are necessary for physicians to provide advice to patients who are either using or interested in cannabis as an adjunctive treatment.
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Affiliation(s)
- Mathew P Caputo
- Otolaryngology - Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | | | - Tapan A Padhya
- Otolaryngology - Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Matthew J Mifsud
- Otolaryngology - Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
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26
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Perlman AI, McLeod HM, Ventresca EC, Salinas MG, Post PJ, Schuh MJ, Abu Dabrh AM. Medical Cannabis State and Federal Regulations: Implications for United States Health Care Entities. Mayo Clin Proc 2021; 96:2671-2681. [PMID: 34607636 DOI: 10.1016/j.mayocp.2021.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/16/2021] [Accepted: 05/11/2021] [Indexed: 10/20/2022]
Abstract
Thirty-six states and four territories in the United States have legalized cannabis for medical and/or recreational use. Marijuana, however, continues to be classified as a schedule I substance under the Federal Controlled Substance Act and remains illegal under US federal law. The incongruity between state and federal legislation creates various challenges for stakeholders: patients, medical trainees, providers, and health care institutions. This communication provides an overview of the major policies impacting Cannabis sativa use within the United States, various state and federal regulations, and highlights potential implications for health care institutions moving forward. Existing literature, regulations, and policies on medical marijuana (MMJ) use in health care settings were searched, reviewed, analyzed, and distilled. As a consequence of legislative inconsistencies, there is insufficient clarity and resultant challenges regarding MMJ usage, prescription, possession, education, and research-related policies for health care stakeholders across the United States. Coupled with limited scientific evidence on the clinical efficacy of MMJ, the needs of the patient and the quality of health care delivery may be affected as hospitals balance the competing risks of being legislatively compliant while protecting the rights of patients and health care employees. There is a recognized need to better define acceptable MMJ policies and regulations in health care settings that are evidence-based, legally compliant, and adequately address the needs of both patients and providers. Given the complexity of the legal and policy landscape, there are potential opportunities for improvement, including in medical education and training, research, and usage oversight of MMJ for stakeholders in the United States.
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Affiliation(s)
- Adam I Perlman
- Department of Integrative Health, Mayo Clinic, Jacksonville, FL.
| | - Heidi M McLeod
- Department of Integrative Health, Mayo Clinic, Jacksonville, FL
| | | | | | - Peter J Post
- Department of Pharmacy, Mayo Clinic, Rochester, NY
| | - Michael J Schuh
- Department of Family Medicine and Palliative Medicine and Pharmacy, Mayo Clinic, Jacksonville, FL
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27
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Mungmunpuntipantip R, Wiwanitkit V. Marijauna (Cannabis sativa L.) and roles against monkeypox. Ayu 2021; 42:175. [PMID: 37347085 PMCID: PMC10281249 DOI: 10.4103/ayu.ayu_35_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
| | - Viroj Wiwanitkit
- Department of Biological Science, Joseph Ayobabalola University, Ikeji-Arakeji, Osun, Nigeria, India
- Research Center, Chandigarh University, Punjab, India
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28
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Bostwick JM. Medical Marijuana Regulations: You Can't Make Sense of Nonsense. Mayo Clin Proc 2021; 96:2514-2516. [PMID: 34531064 DOI: 10.1016/j.mayocp.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
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29
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Affiliation(s)
- Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec, CIUSSSS CN Hôpital St-Sacrement, Québec, QC G1S 4L8, Canada
| | - Clermont E Dionne
- Department of social and preventive medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Québec, QC G1V 0A6, Canada
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30
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Zolotov Y, Gruber SA. Cannabis and aging: research remains in its infancy. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:523-526. [PMID: 34376078 DOI: 10.1080/00952990.2021.1949334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Yuval Zolotov
- Regional Alcohol and Drug Abuse Research Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Staci A Gruber
- Cognitive and Clinical Neuroimaging Core, McLean Hospital Imaging Center, Belmont, MA, USA.,Marijuana Investigations for Neuroscientific Discovery (MIND) Program, McLean Hospital Imaging Center, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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31
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Boeri M, Pereira E, Minkova A, Marcato K, Martinez E, Woodall D. Green Hope: Perspectives on Cannabis from People who Use Opioids. SOCIOLOGICAL INQUIRY 2021; 91:668-695. [PMID: 34538961 PMCID: PMC8446945 DOI: 10.1111/soin.12359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
While states are implementing policies to legalize cannabis for medical or recreational purposes, it remains a Schedule 1 controlled substance with no medical uses according to US federal law. The perception of cannabis depends on social and cultural norms that impact political institutions involved in implementing policy. Because of negative social constructions, such as the "gateway hypothesis," legalization of cannabis has been slow and contentious. Recent studies suggest that cannabis can help combat the opioid epidemic. This paper fills a gap in our understanding of how cannabis is viewed by people who are actively misusing opioids and not in treatment. Using ethnographic methods to recruit participants living in a state that legalized cannabis and a state where cannabis was illegal, survey and interview data were analyzed informed by a social constructionist lens. Findings from their "insider perspective" suggest that for some people struggling with problematic opioid use, cannabis can be beneficial.
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32
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Talley-Bruns RC, Shatkin MS, Dhar Y, Zelicof SB. The Physiological Effects, Including Risks and Potential Benefits, of Cannabis for Patients Undergoing Elective Orthopedic Procedures. Orthopedics 2021; 44:e314-e319. [PMID: 33561869 DOI: 10.3928/01477447-20210201-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Given the evolving regulations regarding and availability of cannabis in the United States, physicians should understand the risks and benefits associated with its use. Patients are interested in learning about the use of cannabis for the management of orthopedic pain and any potential risks associated with it when undergoing elective surgery. Edible and topical cannabis products appear to have fewer side effects than inhaled cannabis products. A review of the literature was performed regarding different modes of administration and their related risks and potential benefits specifically regarding perioperative concerns for elective orthopedic procedures. Larger studies are necessary to further determine the efficacy, safety, and side effect profile of cannabis. [Orthopedics. 2021;44(3):e314-e319.].
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33
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An Exploration of Self-Reported Medicinal Cannabis Use Among a Sample of Eastern Canadian Postsecondary Students. J Behav Health Serv Res 2021; 49:487-499. [PMID: 34240307 DOI: 10.1007/s11414-021-09763-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 01/29/2023]
Abstract
In October 2018, prior to the legalization of cannabis in Canada, a survey was completed by 1050 Memorial University of Newfoundland students. Both descriptive quantitative and thematic qualitative data analyzes were used. Approximately 16% of the sample reported ever using cannabis for medicinal purposes (n=175), with only 16.6% of medicinal users reporting authorization by a healthcare provider (HCP). The majority (80.2%) were aware of possible side effects of cannabis. Prior personal experience (65.3%) and peer influence (59.5%) informed participants' medicinal use. Approximately 40% reported having replaced/reduced prescribed medication. Roughly 60% of medicinal users had not disclosed their use to their HCP. Consistent with previous studies, medicinal cannabis use among postsecondary students appears to be largely motivated for mental health related conditions and is grounded in personal experience versus evidence-based guidelines. There is a need for increased communication between HCPs and patients to promote lower-risk use among medicinal cannabis users.
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34
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Bonnici J, Clark M. Maltese health and social wellbeing student knowledge, attitudes and beliefs about medical cannabis. Complement Ther Med 2021; 60:102753. [PMID: 34139340 DOI: 10.1016/j.ctim.2021.102753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 01/08/2023] Open
Abstract
Given the recent emergence of medical cannabis legalization in Malta, the objective of this study was to assess knowledge, attitudes, and beliefs about medical cannabis among a sample of Maltese students. The sample comprised 327 students enrolled in the University of Malta's Faculties of Health Sciences, Medicine and Surgery, and Social Wellbeing. The vast majority of respondents expressed a desire for formal education and training about medical cannabis. While 52 % of the study cohort felt prepared to answer patient or client questions about medical cannabis, 83 % reported no formal education about medical cannabis. Findings evidence the need for medical cannabis curriculum, education, training and field practice for University of Malta students who will soon be professionals promoting health care.
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Affiliation(s)
- Jamie Bonnici
- Faculty for Social Wellbeing, University of Malta, Malta.
| | - Marilyn Clark
- Faculty for Social Wellbeing, University of Malta, Malta
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35
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Shepard RD, Nugent FS. Targeting Endocannabinoid Signaling in the Lateral Habenula as an Intervention to Prevent Mental Illnesses Following Early Life Stress: A Perspective. Front Synaptic Neurosci 2021; 13:689518. [PMID: 34122037 PMCID: PMC8194269 DOI: 10.3389/fnsyn.2021.689518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/29/2021] [Indexed: 12/21/2022] Open
Abstract
Adverse events and childhood trauma increase the susceptibility towards developing psychiatric disorders (substance use disorder, anxiety, depression, etc.) in adulthood. Although there are treatment strategies that have utility in combating these psychiatric disorders, little attention is placed on how to therapeutically intervene in children exposed to early life stress (ELS) to prevent the development of later psychopathology. The lateral habenula (LHb) has been a topic of extensive investigation in mental health disorders due to its prominent role in emotion and mood regulation through modulation of brain reward and motivational neural circuits. Importantly, rodent models of ELS have been shown to promote LHb dysfunction. Moreover, one of the potential mechanisms contributing to LHb neuronal and synaptic dysfunction involves endocannabinoid (eCB) signaling, which has been observed to critically regulate emotion/mood and motivation. Many pre-clinical studies targeting eCB signaling suggest that this neuromodulatory system could be exploited as an intervention therapy to halt maladaptive processes that promote dysfunction in reward and motivational neural circuits involving the LHb. In this perspective article, we report what is currently known about the role of eCB signaling in LHb function and discuss our opinions on new research directions to determine whether the eCB system is a potentially attractive therapeutic intervention for the prevention and/or treatment of ELS-associated psychiatric illnesses.
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Affiliation(s)
- Ryan D Shepard
- Department of Pharmacology, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Fereshteh S Nugent
- Department of Pharmacology, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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36
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Chin G, Etiz BAF, Nelson AM, Lim PK, Scolaro JA. Knowledge and Opinion on Cannabinoids Among Orthopaedic Traumatologists. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202104000-00006. [PMID: 33872227 PMCID: PMC8057750 DOI: 10.5435/jaaosglobal-d-21-00047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/22/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Cannabinoids are an increasingly popular therapy among orthopaedic patients for musculoskeletal conditions. A paucity of evidence to support their use in orthopaedics exists, likely because of the incongruence of federal and state legalization and the stigma surrounding cannabis. The purpose of this study is to elucidate sentiments and knowledge base of the orthopaedic trauma community with regard to cannabinoid-containing compounds. METHODS A 21-question online survey was distributed to the members of the Orthopaedic Trauma Association with a response window of 3 months. RESULTS We evaluated 251 responses. Most (88%) of the respondents did not believe that they were knowledgeable about the mechanism of action of cannabis/cannabidiol (CBD) but did feel that cannabis or CBD products play a role in managing postoperative pain (73%). Most respondents did not believe that they would be stigmatized if they suggested CBD (83%) or cannabis (67%) to patients. Despite this, fewer respondents have suggested CBD (38%) or cannabis (29%) to their patients. CONCLUSIONS Sentiment toward cannabinoids among orthopaedic traumatologists is remarkably favorable; however, in-depth understanding is admittedly poor and routine use is uncommon. More clinical research for cannabinoids is needed to help orthopaedic traumatologists provide guidance for patients seeking advice for this recently popular therapeutic.
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Affiliation(s)
- Garwin Chin
- From the Department of Orthopaedic Surgery, University of California, Irvine, CA (Dr. Chin, Dr. Lim, and Dr. Scolaro), Orange, CA; the University of California, Irvine School of Medicine, Irvine, CA (Mr. Etiz); and the Department of Anesthesiology and Perioperative Care, Division of Pain Medicine, University of California (Dr. Nelson), Irvine, Orange, CA
| | - Brent A. F. Etiz
- From the Department of Orthopaedic Surgery, University of California, Irvine, CA (Dr. Chin, Dr. Lim, and Dr. Scolaro), Orange, CA; the University of California, Irvine School of Medicine, Irvine, CA (Mr. Etiz); and the Department of Anesthesiology and Perioperative Care, Division of Pain Medicine, University of California (Dr. Nelson), Irvine, Orange, CA
| | - Ariana M. Nelson
- From the Department of Orthopaedic Surgery, University of California, Irvine, CA (Dr. Chin, Dr. Lim, and Dr. Scolaro), Orange, CA; the University of California, Irvine School of Medicine, Irvine, CA (Mr. Etiz); and the Department of Anesthesiology and Perioperative Care, Division of Pain Medicine, University of California (Dr. Nelson), Irvine, Orange, CA
| | - Philip K. Lim
- From the Department of Orthopaedic Surgery, University of California, Irvine, CA (Dr. Chin, Dr. Lim, and Dr. Scolaro), Orange, CA; the University of California, Irvine School of Medicine, Irvine, CA (Mr. Etiz); and the Department of Anesthesiology and Perioperative Care, Division of Pain Medicine, University of California (Dr. Nelson), Irvine, Orange, CA
| | - John A. Scolaro
- From the Department of Orthopaedic Surgery, University of California, Irvine, CA (Dr. Chin, Dr. Lim, and Dr. Scolaro), Orange, CA; the University of California, Irvine School of Medicine, Irvine, CA (Mr. Etiz); and the Department of Anesthesiology and Perioperative Care, Division of Pain Medicine, University of California (Dr. Nelson), Irvine, Orange, CA
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37
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Zolotov Y, Grinstein Cohen O, Findley PA, Reznik A, Isralowitz R, Willard S. Attitudes and knowledge about medical cannabis among Israeli and American nursing students. NURSE EDUCATION TODAY 2021; 99:104789. [PMID: 33571928 DOI: 10.1016/j.nedt.2021.104789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 12/06/2020] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although medical cannabis regulations are emerging in many places around the world, a contentious conundrum remains within the medical establishment regarding the appropriate part that cannabis may have in the provision of health care. Nurses have an indispensable role in the care management of patients, and given the consideration of cannabis as a possible treatment, they are warranted to be aware of its medical properties, as well as to be able to adequately answer patient queries. Nevertheless, very little is currently known about nurses' perceptions related to medical cannabis. OBJECTIVE To assess attitudes, beliefs and knowledge about medical cannabis among nursing students. METHODS Cross-sectional study in two universities: Rutgers University (RU) in New Jersey and Ben Gurion University of the Negev (BGU) in Israel. In addition to demographic data, the survey instrument included questions about attitudes, beliefs, knowledge, and training. RESULTS Overall, 387 students participated, mainly females (87.8%). The vast majority from both sub-groups stated they would recommend cannabis to their patients if allowed to do so (91.2%), and were in agreement that medical cannabis is associated with significant benefits for physical (93.5%) and mental (87.8%) health. Compared to the BGU sub-group, more students from RU stated that they feel prepared to answer patient questions about medical cannabis (19.5% vs. 33.5%, respectively; χ2 = 9.74, p < 0.01). While the majority of respondents stated they have not received any formal education related to medical cannabis, they expressed endorsement for such training and education. CONCLUSIONS In light of the expanding number of patients who use medical cannabis, this study highlights the importance of incorporating medical cannabis education for nurses in academic and clinical curricula.
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Affiliation(s)
- Yuval Zolotov
- Regional Alcohol and Drug Abuse Research Center, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Orli Grinstein Cohen
- Department of Nursing, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Patricia A Findley
- Graduate School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Alexander Reznik
- Regional Alcohol and Drug Abuse Research Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Richard Isralowitz
- Regional Alcohol and Drug Abuse Research Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Suzanne Willard
- School of Nursing, Rutgers University, New Brunswick, NJ, USA
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Isralowitz R, Reznik A, Zolotov Y, Grinstein-Cohen O, Wacht O, Pruginin I, Yehudai M, Edelstein O. Toward medical cannabis education in Israel. Complement Ther Med 2021; 58:102709. [PMID: 33716092 DOI: 10.1016/j.ctim.2021.102709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/08/2021] [Accepted: 03/06/2021] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES To assess knowledge, attitudes and beliefs regarding medical cannabis among Israeli medical, nursing, social work and other health related students as well as to outline the formation of an instrument for standardized data collection on these topics. METHODS An invitation to participate with a link for the online survey was sent to all students pursuing a degree in medicine, nursing, social work, and other health disciplines in the Ben Gurion University of the Negev, Israel. The instrument included 32 items that measured knowledge, attitudes and beliefs regarding medical cannabis. In addition, demographic data were collected and participants were asked about the frequency of medical or recreational cannabis use. RESULTS Among the 763 participants, 596 were females (78 %), and the mean age was 25.8 years. While the reported personal use of medical cannabis was minimal (1.9 %), cannabis use for recreational purposes was relatively common (54.0 %). The vast majority believed that medical cannabis holds significant health benefits but expressed concerns regarding potential risks of cannabis use. Additionally, the vast majority of students felt unprepared to answer patients' questions about medical cannabis and expressed a desire to receive more training. Several significant differences between the different academic disciplines were observed. CONCLUSIONS In light of current regulatory and scientific developments, it is apparent that students of health professions will need a greater level of understanding of medical cannabis than previous generations of students. This study emphasizes the ample need for more knowledge and formal education to students of health and related professions.
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Affiliation(s)
- Richard Isralowitz
- Regional Alcohol and Drug Abuse Research (RADAR) Center, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Alexander Reznik
- Regional Alcohol and Drug Abuse Research (RADAR) Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Yuval Zolotov
- Regional Alcohol and Drug Abuse Research (RADAR) Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Orli Grinstein-Cohen
- Department of Nursing, Toby Mower Curriculum for the Prevention and Treatment of Addiction, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Oren Wacht
- Department of Emergency Medical Services, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Itay Pruginin
- Regional Alcohol and Drug Abuse Research (RADAR) Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Mor Yehudai
- Regional Alcohol and Drug Abuse Research (RADAR) Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Offer Edelstein
- The Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Loiselle MM, Gulin S, Rose T, Burker E, Bolger L, Smith P. The relationship between marijuana use and psychosocial variables in living kidney donor candidates. Clin Transplant 2021; 35:e14248. [PMID: 33555627 DOI: 10.1111/ctr.14248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/26/2021] [Accepted: 02/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND We investigate whether marijuana use in living kidney donor candidates is associated with psychosocial risk factors that place donors at higher risk for adverse outcomes and the unique associations between marijuana use and donor candidacy. METHODS Medical records of 757 living kidney donor candidates were reviewed. Patients were grouped into marijuana users/abstainers; demographic, psychiatric, and substance use variables were compared. Multivariate logistic regression assessed the independent association of marijuana use on committee approval for donation. RESULTS Marijuana use was associated with lack of health insurance, legal history, lower education level, active and history of substance use disorder, active psychiatric disorder, history of multiple psychiatric diagnoses, and history of suicidality. Marijuana users were also more likely to be young, male, unmarried, and less likely to be approved for donation by the multidisciplinary selection committee. This latter association persisted in multivariate models. CONCLUSIONS This is the first study to show that marijuana use is associated with psychosocial factors that could impact behavioral adherence following kidney donation, while reducing chances of committee approval for kidney donation. Special attention to potential overlay between psychosocial risk factors and marijuana use should be considered when evaluating kidney donors, particularly in context of increasingly legal use.
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Affiliation(s)
- Marci M Loiselle
- Department of Psychiatry and Behavioral Sciences, Division of Behavioral Medicine, Duke University Medical Center, Durham, NC, USA
| | - Shaina Gulin
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Terra Rose
- Department of Allied Health Sciences and Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Eileen Burker
- Department of Allied Health Sciences and Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Lauren Bolger
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Patrick Smith
- Department of Psychiatry and Behavioral Sciences, Division of Behavioral Medicine, Duke University Medical Center, Durham, NC, USA
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Ryan JE, McCabe SE, Boyd CJ. Medicinal Cannabis: Policy, Patients, and Providers. Policy Polit Nurs Pract 2021; 22:126-133. [PMID: 33567970 DOI: 10.1177/1527154421989609] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Medicinal cannabis is legal in some form in 47 states, 3 United States territories, and the District of Columbia. An estimated three million Americans use cannabis for relief of a variety of illnesses, and this figure is expected to grow based on policy changes. However, cannabis remains illegal at the federal level as a Schedule I drug under the 1970 Controlled Substances Act. Schedule I classification of cannabis has impeded the advancement of research, leaving providers with little evidence-based information to educate their patients. Furthermore, the disparities in individual state laws create significant social and health inequities in gaining access to medicinal cannabis. Conflicting state and federal policies regarding medicinal cannabis create logistical and ethical dilemmas, and all U.S. stakeholders-patients, providers, and health delivery systems-may be impacted by conflicting federal and state policies. This brief addresses the impact of conflicting cannabis policies.
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Affiliation(s)
- Jennie E Ryan
- College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, United States
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, United States
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Breijyeh Z, Jubeh B, Bufo SA, Karaman R, Scrano L. Cannabis: A Toxin-Producing Plant with Potential Therapeutic Uses. Toxins (Basel) 2021; 13:117. [PMID: 33562446 PMCID: PMC7915118 DOI: 10.3390/toxins13020117] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
For thousands of years, Cannabis sativa has been utilized as a medicine and for recreational and spiritual purposes. Phytocannabinoids are a family of compounds that are found in the cannabis plant, which is known for its psychotogenic and euphoric effects; the main psychotropic constituent of cannabis is Δ9-tetrahydrocannabinol (Δ9-THC). The pharmacological effects of cannabinoids are a result of interactions between those compounds and cannabinoid receptors, CB1 and CB2, located in many parts of the human body. Cannabis is used as a therapeutic agent for treating pain and emesis. Some cannabinoids are clinically applied for treating chronic pain, particularly cancer and multiple sclerosis-associated pain, for appetite stimulation and anti-emesis in HIV/AIDS and cancer patients, and for spasticity treatment in multiple sclerosis and epilepsy patients. Medical cannabis varies from recreational cannabis in the chemical content of THC and cannabidiol (CBD), modes of administration, and safety. Despite the therapeutic effects of cannabis, exposure to high concentrations of THC, the main compound that is responsible for most of the intoxicating effects experienced by users, could lead to psychological events and adverse effects that affect almost all body systems, such as neurological (dizziness, drowsiness, seizures, coma, and others), ophthalmological (mydriasis and conjunctival hyperemia), cardiovascular (tachycardia and arterial hypertension), and gastrointestinal (nausea, vomiting, and thirst), mainly associated with recreational use. Cannabis toxicity in children is more concerning and can cause serious adverse effects such as acute neurological symptoms (stupor), lethargy, seizures, and even coma. More countries are legalizing the commercial production and sale of cannabis for medicinal use, and some for recreational use as well. Liberalization of cannabis laws has led to increased incidence of toxicity, hyperemesis syndrome, lung disease cardiovascular disease, reduced fertility, tolerance, and dependence with chronic prolonged use. This review focuses on the potential therapeutic effects of cannabis and cannabinoids, as well as the acute and chronic toxic effects of cannabis use on various body systems.
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Affiliation(s)
- Zeinab Breijyeh
- Pharmaceutical Sciences Department, Faculty of Pharmacy, Al-Quds University, Jerusalem Abu Dis P144, Palestine; (Z.B.); (B.J.)
| | - Buthaina Jubeh
- Pharmaceutical Sciences Department, Faculty of Pharmacy, Al-Quds University, Jerusalem Abu Dis P144, Palestine; (Z.B.); (B.J.)
| | - Sabino A. Bufo
- Department of Sciences, University of Basilicata, 85100 Potenza, Italy
- Department of Geography, Environmental Management & Energy Studies, University of Johannesburg, Johannesburg 2092, South Africa
| | - Rafik Karaman
- Pharmaceutical Sciences Department, Faculty of Pharmacy, Al-Quds University, Jerusalem Abu Dis P144, Palestine; (Z.B.); (B.J.)
- Department of Sciences, University of Basilicata, 85100 Potenza, Italy
| | - Laura Scrano
- Department of European Cultures (DICEM), University of Basilicata, 75100 Matera, Italy;
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Medical cannabis education among healthcare trainees: A scoping review. Complement Ther Med 2021; 58:102675. [PMID: 33539943 DOI: 10.1016/j.ctim.2021.102675] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/24/2021] [Accepted: 01/24/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES It has been previously demonstrated that healthcare professionals would like additional education on medical cannabis. However, there has not yet been a review of the status of medical cannabis curriculum for medical and allied healthcare trainees worldwide, even though future healthcare workers will be placed on the forefront of patient care and must be prepared to counsel patients. This study was designed to address this gap in knowledge. DESIGN A search syntax was generated and databases PubMed, ERIC, CINAHL, and Web of Science were searched for relevant articles. A grey literature search of Google Scholar, MedEd, Medline, and the Proquest Dissertations and Theses section was also performed. All titles and abstracts were screened. Selected articles were subsequently screened using predetermined inclusion and exclusion criteria. RESULTS Allied healthcare trainees lacked sufficient knowledge about medical cannabis and did not feel prepared to counsel patients on this subject. Additionally, they expressed a growing interest in medical cannabis and would like more standardized education on the topic. Finally, faculty and deans in various institutions agreed on the need to educate students on the subject, and aimed to implement courses on medical cannabis or expand their existing curricula. CONCLUSIONS While the medical cannabis landscape is developing, medical and allied health students are not properly educated and knowledgeable on this emerging field of clinical care. The findings suggest that the implementation of competencies-based curricula on medical cannabis is essential for medical and allied healthcare trainees to have the appropriate level of knowledge to counsel and educate their patients.
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Ceasar RC, Kral AH, Simpson K, Wenger L, Goldshear JL, Bluthenthal RN. Factors associated with health-related cannabis use intentions among a community sample of people who inject drugs in Los Angeles and San Francisco, CA 2016 to 2018. Drug Alcohol Depend 2021; 219:108421. [PMID: 33301996 PMCID: PMC7856255 DOI: 10.1016/j.drugalcdep.2020.108421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Cannabis motivations have been studied extensively among patients of medicinal cannabis dispensaries, but less is known about motivations in community samples of opioid-using people who inject drugs. Our objective is to describe cannabis use motivations associated with self-treatment of physical pain, emotional issues, and as an opioid substitute. METHODS Data come from 6-month follow-up interviews with people who inject drugs who participated in a study on the efficacy of an injection initiation prevention intervention in Los Angeles and San Francisco, California from 2016-18. The analytic sample consists of 387 people who inject drugs who reported past-month cannabis use. We developed multivariable logistic regression models by reported cannabis use motivations: physical pain relief, emotional problems, and opioid substitute. RESULTS The most common cannabis use motivations reported by people who inject drugs was to "get high," relieve physical pain and emotional problems, and reduce opioid use. In separate multivariate models, using cannabis for physical pain relief was associated with higher odds of using cannabis as a substitute for opioids; cannabis for emotional problems was associated with being diagnosed with depression; and cannabis as a substitute for opioids was associated with non-prescribed, non-injection methadone use. CONCLUSION People who inject drugs reported using cannabis for health-related motivations. This motivation aligns with health needs and suggests the acceptability of cannabis use for health reasons in this population. Studies to determine the medical effectiveness of cannabis products for these common health and mental health needs among people who inject drugs are needed.
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Affiliation(s)
- Rachel Carmen Ceasar
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA.
| | - Alex H Kral
- Behavioral Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA
| | - Kelsey Simpson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | - Lynn Wenger
- Behavioral Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA
| | - Jesse L Goldshear
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | - Ricky N Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
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Braun IM, Nayak MM, Revette A, Wright AA, Chai PR, Yusufov M, Pirl WF, Tulsky JA. Cancer patients' experiences with medicinal cannabis-related care. Cancer 2021; 127:67-73. [PMID: 32986266 PMCID: PMC7736188 DOI: 10.1002/cncr.33202] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/21/2020] [Accepted: 05/06/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Little is known about medical cannabis (MC)-related care for patients with cancer using MC. METHODS Semistructured telephone interviews were conducted in a convenience sample of individuals (n = 24) with physician-confirmed oncologic diagnoses and state/district authorization to use MC (Arizona, California, Florida, Illinois, Massachusetts, Oregon, New York, and Washington, DC) from April 2017 to March 2019. Standard qualitative techniques were used to assess the degree of MC-related health care oversight, MC practices, and key information sources. RESULTS Among 24 participants (median age, 57 years; range, 30-71 years; 16 women [67%]), MC certifications were typically issued by a professional new to a patient's care after a brief, perfunctory consultation. Patients disclosed MCuse to their established medical teams but received little medical advice about whether and how to use MC. Patients with cancer used MC products as multipurpose symptom management and as cancer-directed therapy, sometimes in lieu of standard-of-care treatments. Personal experimentation, including methodical self-monitoring, was an important source of MC know-how. Absent formal advice from medical professionals, patients relied on nonmedical sources for MC information. CONCLUSIONS Patients with cancer used MC with minimal medical oversight. Most received MC certifications through brief meetings with unfamiliar professionals. Participants desired but were often unable to access high-quality clinical information about MC from their established medical teams. Because many patients are committed to using MC, a product sustained by a growing industry, medical providers should familiarize themselves with the existing data for MM and its limitations to address a poorly met clinical need.
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Affiliation(s)
- Ilana M. Braun
- Harvard Medical SchoolBostonMassachusetts,Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusetts,Department of PsychiatryBrigham and Women's HospitalBostonMassachusetts
| | - Manan M. Nayak
- Harvard Medical SchoolBostonMassachusetts,Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusetts,Phyllis F. Cantor Center for Research in Nursing and Patient Care ServicesDana‐Farber Cancer InstituteBostonMassachusetts
| | - Anna Revette
- Harvard Medical SchoolBostonMassachusetts,Survey and Data Management CoreDana‐Farber Cancer InstituteBostonMassachusetts
| | - Alexi A. Wright
- Harvard Medical SchoolBostonMassachusetts,Department of Medical OncologyDivision of Population SciencesDana‐Farber Cancer InstituteBostonMassachusetts
| | - Peter R. Chai
- Harvard Medical SchoolBostonMassachusetts,Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusetts,Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusetts,Fenway InstituteBostonMassachusetts
| | - Miryam Yusufov
- Harvard Medical SchoolBostonMassachusetts,Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusetts,Department of PsychiatryBrigham and Women's HospitalBostonMassachusetts
| | - William F. Pirl
- Harvard Medical SchoolBostonMassachusetts,Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusetts,Department of PsychiatryBrigham and Women's HospitalBostonMassachusetts
| | - James A. Tulsky
- Harvard Medical SchoolBostonMassachusetts,Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusetts,Division of Palliative MedicineBrigham and Women's HospitalBostonMassachusetts
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A qualitative review of cannabis stigmas at the twilight of prohibition. J Cannabis Res 2020; 2:46. [PMID: 33526147 PMCID: PMC7819345 DOI: 10.1186/s42238-020-00056-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND As laws change and cannabis use increases, it is worthwhile to take a rich account of cannabis stigmas in society, and this review identifies a disjunction between quantitative investigations on cannabis users and qualitative investigations on the same population. This is also the first attempt to explicate cannabis stigmas as they manifest on multiple analytical levels. Following brief explanations of the normalization hypothesis and the concept of stigma, this review is organized between structural (macro) stigmas, social (meso) stigmas, and personal (micro) stigmas. Furthermore, since cannabis stigmas are similar to the stigmas faced by sexual minorities in that each is physically concealable, the two groups are compared here because the literature base is more extensive with the latter. METHODS This qualitative review synthesizes the body of empirical studies on both medical and nonmedical cannabis use with attention to stigma, stereotypes, and other social consequences. Studies considered for the review mostly come from the social sciences, particularly sociology. The information presented here is primarily drawn from peer-reviewed articles on cannabis users in the USA, though research from similar national contexts is cited as well. RESULTS This review suggests claims of normalization may be premature. While stigmas surrounding cannabis appear to have diminished, there is little evidence that such stigmas have entirely disappeared. It is possible that sweeping claims of cannabis normalization may be symptomatic of unchecked social privileges or social distance from cannabis users. Such claims may also be the product of valuing quantitative data over the nuanced accounts uncovered through qualitative investigations. CONCLUSION This substantial coverage of the literature indicates the lived experience of a post-prohibition society is not the same as a one where cannabis is normalized. Individuals working with those who use cannabis should not assume stigmas have disappeared, especially since cannabis stigmas often intersect with other sources of social inequality. While a comprehensive discussion of ways to combat lingering social stigmas is beyond the scope of this review, it concludes by highlighting some of the strategies identified through research which help users resist or mitigate these oppressive forces. Future research would be wise to prioritize the experiences of people of color, women, and adult populations if the hope is to identify ways to further normalize the plant in American society.
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Buck JS, Bloomer AK, Wally MK, Seymour RB, Hsu JR. The Current Evidence for Marijuana as Medical Treatment. J Bone Joint Surg Am 2020; 102:2096-2105. [PMID: 33264218 DOI: 10.2106/jbjs.20.00269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- J Stewart Buck
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
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Nachnani R, Raup-Konsavage WM, Vrana KE. The Pharmacological Case for Cannabigerol. J Pharmacol Exp Ther 2020; 376:204-212. [PMID: 33168643 DOI: 10.1124/jpet.120.000340] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/04/2020] [Indexed: 12/13/2022] Open
Abstract
Medical cannabis and individual cannabinoids, such as Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD), are receiving growing attention in both the media and the scientific literature. The Cannabis plant, however, produces over 100 different cannabinoids, and cannabigerol (CBG) serves as the precursor molecule for the most abundant phytocannabinoids. CBG exhibits affinity and activity characteristics between Δ9-THC and CBD at the cannabinoid receptors but appears to be unique in its interactions with α-2 adrenoceptors and 5-hydroxytryptamine (5-HT1A). Studies indicate that CBG may have therapeutic potential in treating neurologic disorders (e.g., Huntington disease, Parkinson disease, and multiple sclerosis) and inflammatory bowel disease, as well as having antibacterial activity. There is growing interest in the commercial use of this unregulated phytocannabinoid. This review focuses on the unique pharmacology of CBG, our current knowledge of its possible therapeutic utility, and its potential toxicological hazards. SIGNIFICANCE STATEMENT: Cannabigerol is currently being marketed as a dietary supplement and, as with cannabidiol (CBD) before, many claims are being made about its benefits. Unlike CBD, however, little research has been performed on this unregulated molecule, and much of what is known warrants further investigation to identify potential areas of therapeutic uses and hazards.
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Affiliation(s)
- Rahul Nachnani
- Department of Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Kent E Vrana
- Department of Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania
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Harwick RM, Carlini BH, Garrett SB. A Taxonomy of Consumers’ Perspectives on the Function of Cannabis in Their Lives: A Qualitative Study in WA State, USA. J Psychoactive Drugs 2020; 52:393-400. [DOI: 10.1080/02791072.2020.1763522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Robin M. Harwick
- Alcohol and Drug Abuse Institute- ADAI, University of Washington, Seattle, WA, USA
| | - Beatriz H. Carlini
- Alcohol and Drug Abuse Institute- ADAI, University of Washington, Seattle, WA, USA
| | - Sharon B. Garrett
- Alcohol and Drug Abuse Institute- ADAI, University of Washington, Seattle, WA, USA
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Loo JSE, Yong AYY, Yong YN. The effect of multiple simulation parameters on MM/PBSA performance for binding affinity prediction of CB1 cannabinoid receptor agonists and antagonists. Chem Biol Drug Des 2020; 96:1244-1254. [PMID: 32462752 DOI: 10.1111/cbdd.13733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/22/2020] [Accepted: 05/16/2020] [Indexed: 12/29/2022]
Abstract
Both the inactive- and active-state CB1 receptor crystal structures have now been solved, allowing their application in various structure-based drug design methods. One potential method utilizing these crystal structures is the Molecular Mechanics/Poisson-Boltzmann Surface Area (MM/PBSA) method of predicting relative binding free.
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Affiliation(s)
- Jason S E Loo
- Center for Drug Discovery and Molecular Pharmacology, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia.,School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Amelia Y Y Yong
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Yen Nee Yong
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
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Mirzaei H, O'Brien A, Tasnim N, Ravishankara A, Tahmooressi H, Hoorfar M. Topical review on monitoring tetrahydrocannabinol in breath. J Breath Res 2020; 14:034002. [PMID: 31842004 DOI: 10.1088/1752-7163/ab6229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Legalization of cannabis for recreational use has compelled governments to seek new tools to accurately monitor Δ9-tetrahydrocannabinol (Δ9-THC) and understand its effect on impairment. Various methods have been employed to measure Δ9-THC, and its respective metabolites, in different biological matrices. Recently, breath analysis has gained interest as a non-invasive method for the detection of chemicals that are either produced as part of biological processes or are absorbed from the environment. Existing breath analyzers function by analyzing previously collected samples or by direct real-time analysis. Portable hand-held devices are of particular interest for law enforcement and personal use. This paper reviews and compares both commercially available and prototype devices that proclaim Δ9-THC detection in exhaled breath using methods such as Field Asymmetric Ion Mobility Spectrometry, Semiconductor-Enriched Single-Walled Carbon Nanotube chemiresistors, Liquid Chromatography Tandem-mass Spectrometry, microfluidic-based artificial olfaction, and optical-based gas sensing.
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