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Reece AS, Hulse GK. European Epidemiological Patterns of Cannabis- and Substance-Related Congenital Neurological Anomalies: Geospatiotemporal and Causal Inferential Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010441. [PMID: 36612763 PMCID: PMC9819725 DOI: 10.3390/ijerph20010441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 05/16/2023]
Abstract
Introduction. Of the many congenital anomalies (CAs) recently linked with community cannabis exposure, arguably the most concerning are neurological CAs (NCAs). We therefore conducted a detailed study of this in fourteen European nations. Methods. Congenital anomaly data were from Eurocat. Drug exposure data were from European Monitoring Centre for Drugs and Drug Addiction. Income from World bank. Results. The Netherlands, Spain, France and Bulgaria reported increasing rates of many NCAs. The NCA rate (NCAR) was higher in nations with increasing daily cannabis use when compared to those without (p = 0.0204, minimum E-value (mEV) = 1.35). At bivariate analysis, the mEVs of the following NCAs were significantly cannabis related: severe microcephaly 2.14 × 1013, craniosynostosis 5.27 × 1011, nervous system 4.87 × 1011, eye 2.73 × 107, microphthalmos 4.07 × 106, anencephalus 710.37, hydrocephalus 245.64, spina bifida 14.86 and neural tube defects 13.15. At inverse probability, weighted panel regression terms including cannabis were significantly related to the following series of anomalies: nervous system, anencephalus, severe microcephalus, microphthalmos, neural tube defect and spina bifida from p = 5.09 × 10−8, <2.2 × 10−16, <2.2 × 10−16, 4.84 × 10−11, <2.2 × 10−16 and 9.69 × 10−7. At geospatial regression, this same series of anomalies had terms including cannabis significant from p = 0.0027, 1.53 × 10−7, 3.65 × 10−6, 2.13 × 10−8, 0.0002 and 9.76 × 10−12. 88.0% of 50 E-value estimates and 72.0% of mEVs > 9. This analysis therefore demonstrates both close association of cannabis exposure with multiple NCAs across space-time and also fulfills the quantitative criteria of causal inferential analysis. Conclusions. Nine NCARs on bivariate and six NCARs on multivariable regression were cannabis related and fulfilled quantitative epidemiological criteria for causality and are consistent with other series. Particular concerns relate to exponential dose−response effects demonstrated in the laboratory and epidemiological studies. Great caution with community cannabinoid penetration is warranted. Data indicate that cannabis is a significant environmental teratogen and thus imply that cannabinoids should be regulated similarly to the manner in which all other important genotoxins are carefully controlled by communities for their self-sustaining longevity and the protection of generations yet to come.
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Affiliation(s)
- Albert Stuart Reece
- Division of Psychiatry, University of Western Australia, Crawley, WA 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
- Correspondence: ; Tel.: +61-7-3844-4000; Fax: +61-7-3844-4015
| | - Gary Kenneth Hulse
- Division of Psychiatry, University of Western Australia, Crawley, WA 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
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Pfeifer P, Auer R, Baggio S, Moggi F. A Nationwide Study of Inpatient Case Rate Incidence of Cannabis-Related Diagnoses in Switzerland. Int J Public Health 2022; 67:1605554. [PMID: 36618434 PMCID: PMC9811405 DOI: 10.3389/ijph.2022.1605554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives: Cannabis is the most commonly used illicit substance and has been associated with mental health issues. In this study, we examined trends in hospitalizations due to cannabis use. Methods: Data were obtained from the Swiss Federal Statistics Office and comprised hospital main diagnoses, gender, age group and region of all psychiatric inpatient cases in Switzerland from 1998 to 2020. We performed trend analyses of annual case rates with cannabinoid-related diagnoses and compared them to trend analyses of alcohol-related and psychotic disorders. Results: Case rates of CRDs significantly increased in the observed time period. From all psychiatric main diagnoses, CRDs were overrepresented in the age groups of 15-24 and 25-44 years. Conclusion: We found a sharp increase in hospitalizations for CRD. Future studies should test whether changes in the upcoming cannabis regulation, which can facilitate the implementation of interventions to address mental health among users, impact future hospitalization rates of CRD.
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Affiliation(s)
- Philippe Pfeifer
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,*Correspondence: Philippe Pfeifer,
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland,Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland,Division of Prison Health, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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MIHALTAN F, NECHITA A, CONSTANTIN A. Cannabis - a Rewritten History and Its Pulmonary Consequences. MAEDICA 2022; 17:911-920. [PMID: 36818264 PMCID: PMC9923077 DOI: 10.26574/maedica.2022.17.4.911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Cannabis presents itself as another challenge of the last decade. Better and better deciphered through in-depth studies, this drug remains a source of scientific debates. Legalized in some states, it competes with tobacco regarding the effects generating respiratory symptoms, chronic bronchitis, bronchial cancer, respiratory infections, etc. In this article we will review the pharmacology, epidemiology, clinical and prevention aspects and try to demonstrate which of these are the most effective means of prevention. This review proves once again that this drug has many hidden dangers.
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Affiliation(s)
- Florin MIHALTAN
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Andrada NECHITA
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Ancuta CONSTANTIN
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Vaičiūnas T, Žemaitaitytė M, Lange S, Štelemėkas M, Oja L, Petkevičienė J, Kowalewska A, Pudule I, Piksööt J, Šmigelskas K. Trends in Adolescent Substance Use: Analysis of HBSC Data for Four Eastern European Countries, 1994-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15457. [PMID: 36497532 PMCID: PMC9737814 DOI: 10.3390/ijerph192315457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
UNLABELLED The aim of the study was to analyze the trends of adolescent substance use in four eastern European countries over the time period from 1994 to 2018. The four countries in focus were selected based on their shared historical backgrounds and major economic and social transformations experienced. METHODS Two decades (1993/1994-2017/2018) of repeated cross-sectional data from the Estonian, Latvian, Lithuanian, and Polish Health Behaviour in School-aged Children survey were used. Data comprised 42,169 school children 15 years of age (9th grade). The following categories of substance use were included: regular alcohol consumption and drunkenness, tobacco smoking, electronic cigarette smoking, and cannabis use. Trends in substance use over time were tested using Jonckheere's trend test. RESULTS Prevalence of substance use among adolescents over time revealed that the Baltic states and Poland have faced relatively different temporal trends. In the Baltic states, there was a general increase during the period of 1994-2002, which was followed by a period of peaking or stability between 2002-2010, and then decreasing trends of these risky behaviors from 2010 onwards. In Poland, the same period had less consistent patterns, with decreasing trends starting much earlier on. The prevalence of cannabis use, which had been measured since 2006, had its own unique pattern with many fluctuations within and between countries. CONCLUSIONS The findings on the prevalence of substance use among adolescents from 1994 to 2018 revealed that the Baltic states and Poland have faced relatively different temporal trends. These countries might be facing new public health challenges in a near future, e.g., use of electronic cigarettes and cannabis use among adolescents.
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Affiliation(s)
- Tomas Vaičiūnas
- Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Monika Žemaitaitytė
- Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Shannon Lange
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON M5S 2S1, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON M5G 2C1, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A4, Canada
| | - Mindaugas Štelemėkas
- Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Leila Oja
- National Institute for Health Development, 11619 Tallinn, Estonia
| | - Janina Petkevičienė
- Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Anna Kowalewska
- Department of Biomedical Aspects of Development and Sexology, Faculty of Education, Warsaw University, 00-927 Warsaw, Poland
| | - Iveta Pudule
- Centre for Disease Prevention and Control, 1005 Riga, Latvia
| | - Jaanika Piksööt
- National Institute for Health Development, 11619 Tallinn, Estonia
| | - Kastytis Šmigelskas
- Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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Muacevic A, Adler JR, Lindsey W, Ramos O, Cheng W, Danisa O. Preoperative Cannabis Use Associated With an Increased Rate of Reoperation and Postoperative Opioid Use Following Anterior Cervical Decompression and Fusion. Cureus 2022; 14:e31285. [PMID: 36514630 PMCID: PMC9733193 DOI: 10.7759/cureus.31285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives The objective of this retrospective cohort study was to evaluate the associations among preoperative cannabis use, postoperative opioid use, and postoperative outcomes following elective anterior cervical decompression and fusion (ACDF). Methods Patients who underwent one- or two-level ACDF were characterized preoperatively as active cannabis users, former users, or nonusers. Patients were also classified based on history of preoperative opioid use as chronic users, acute users, or nonusers. Groups were compared based on outcomes including the rate of emergency department visits six months postoperatively, rate of readmissions one year postoperatively, rate of reoperation two years postoperatively, and daily postoperative opioid use measured in milligram morphine equivalents (MMEs) at 0-6 months and 6-12 months postoperatively. Results Of the 198 patients included in this study, 13 (6.6%) were active cannabis users, 11 (5.6%) were former users, and 174 (87.8%) were nonusers. The rate of reoperation within two years was 23.1% for active cannabis users, 0% for former users, and 4.0% for nonusers (p=0.0075). The average daily opioid use in MMEs 6-12 months postoperatively was 49.4 for active cannabis users, 4.1 for former users, and 13.3 for nonusers (p=0.0014). For chronic opioid users, acute users, and nonusers, the average daily opioid use in MMEs 6-12 months postoperatively was 39.9, 18.4, and 5.7, respectively (p<.0001). Conclusions History of cannabis use is associated with increased postoperative opioid use and increased rate of reoperation following elective ACDF.
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Reece AS, Hulse GK. Epidemiological Patterns of Cannabis- and Substance- Related Congenital Uronephrological Anomalies in Europe: Geospatiotemporal and Causal Inferential Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113769. [PMID: 36360648 PMCID: PMC9657099 DOI: 10.3390/ijerph192113769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Recent reports linking prenatal and community cannabis exposure to elevated uronephrological congenital anomaly (UCA) rates (UCAR's) raise the question of its European epidemiology given recent increases in community cannabinoid penetration there. METHODS UCAR data from Eurocat. Drug use data from European Monitoring Centre for Drugs and Drug Addiction. Income from World bank. RESULTS UCAR increased across Spain, Netherlands, Poland and France. UCAR's and cannabis resin THC increased simultaneously in France, Spain, Netherlands and Bulgaria. At bivariate analysis all UCA's were related to cannabis herb and resin THC concentrations. All UCAR's were bivariately related to cannabis metrics ordered by median minimum E-value (mEV) as hypospadias > multicystic renal disease > bilateral renal agenesis > UCA's > hydronephrosis > posterior urethral valve > bladder exstrophy/epispadias. At inverse probability weighted multivariable analysis terms including cannabis were significant for the following series of anomalies: UCA's, multicystic renal disease, bilateral renal agenesis, hydronephrosis, congenital posterior urethral valves from P = 1.91 × 10-5, 2.61 × 10-8, 4.60 × 10-15, 4.60 × 10-15 and 2.66 × 10-10. At geospatial analysis the same series of UCA's were significantly related to cannabis from P = 7.84 × 10-15, 7.72 × 10-5, 0.0023, 6.95 × 10-5, and 8.82 × 10-5. 45/51 (88.2%) of E-value estimates and 31/51 (60.8%) of mEV's >9. CONCLUSION Analysis confirms a close relationship between cannabis metrics and all seven UCA's and fulfill formal criteria for quantitative causal inference. Given the exponential cannabinoid genotoxicity dose-response relationship results provide a powerful stimulus to constrain community cannabinoid exposure including protection of the food chain to preserve the genome and epigenome of coming generations.
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Affiliation(s)
- Albert Stuart Reece
- Division of Psychiatry, University of Western Australia, Crawley, WA 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
- Correspondence: ; Tel.: +617-3844-4000; Fax: +617-3844-4015
| | - Gary Kenneth Hulse
- Division of Psychiatry, University of Western Australia, Crawley, WA 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
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Mårtensson S, Düring SW, Johansen KS, Tranberg K, Nordentoft M. Time trends in co-occurring substance use and psychiatric illness (dual diagnosis) from 2000 to 2017 - a nationwide study of Danish register data. Nord J Psychiatry 2022; 77:411-419. [PMID: 36271867 DOI: 10.1080/08039488.2022.2134921] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This article aims to describe the time trend in number of dual diagnosis patients treated in the psychiatric system in Denmark from 2000 to 2017. METHOD We calculated the share of patients with dual diagnosis, number of dual diagnosis contacts, number of unique individuals with dual diagnosis as well as number of new patients with dual diagnosis among patients in psychiatric treatment, i.e. among inpatients, outpatients and patients in emergency departments. In order to calculate this, we merged data from the National Patient Register (NPR), the National Registry of Alcohol Treatment, the National treatment registry for substance use, the National Prescription Registry and the Danish National Health Service register in the period from 2000 to 2017. RESULTS We found an overall increase in patients with dual diagnosis in psychiatric treatment in Denmark from 2000 to 2017. We further detected an increase in the age and sex-standardized number of patients with dual diagnosis in treatment over time, however most markedly for outpatients. Further, inclusion of data from other sources of data than the NPR dramatically increased the number of patients that could be identified as dual diagnosis patients. Using these data, almost half of all male inpatients could be identified as dual diagnosis while the share was more than 40% for patients with schizophrenia, schizotypal and delusional disorders (F2) and patients with personality disorders (F6). CONCLUSIONS The increase of individual diagnosis patients necessitates action at different levels. This includes improvement of preventive measures as well as improvement of treatment for this underserved group.
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Affiliation(s)
- Solvej Mårtensson
- Competency Center for Dual Diagnosis, Mental Health Services, Capital Region of Denmark, Roskilde, Denmark
| | - Signe W Düring
- Competency Center for Dual Diagnosis, Mental Health Services, Capital Region of Denmark, Roskilde, Denmark.,Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Katrine S Johansen
- Competency Center for Dual Diagnosis, Mental Health Services, Capital Region of Denmark, Roskilde, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Katrine Tranberg
- Section of General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health - CORE, Copenhagen University Hospital, Copenhagen, Denmark
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Botella-Juan L, Amezcua-Prieto C, Morales-Suarez-Varela MM, Mateos-Campos R, Ayán-Pérez C, Molina AJ, Ortiz-Moncada R, Redondo-Martín S, Alguacil J, Blázquez-Abellán G, Delgado-Rodríguez M, Alonso-Molero J, Fernández-Villa T. Impact of the COVID-19 Pandemic on the Evolution of Prevalence and Patterns of Cannabis Use among First-Year University Students in Spain-UniHcos Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11577. [PMID: 36141846 PMCID: PMC9517240 DOI: 10.3390/ijerph191811577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
Among university students there has been evidence that the COVID-19 pandemic increased their psychological distress, exacerbated by social restrictions. The main objective of this study was to explore the impact of the COVID-19 pandemic on the prevalence and patterns of cannabis use among university students, in contrast to previous trends since 2012. Data from 10,522 first-year university students (73.3% female, Mage 19 (SD = 1.6)) from eleven Spanish universities collected between 2012 and May 2022 was analysed. Prevalences of cannabis use and their differences by sex were studied, as well as changes in patterns of use and its use for coping during the pandemic. It was found that during lockdown, all prevalence rates of cannabis use decreased in both sexes, showing no statistically significant differences and increasing again in the new normal period in both. Among regular cannabis users, 79.7% reported maintaining or increasing their cannabis use during the pandemic, and of these, half reported using cannabis to cope. Moreover, cannabis use in the usual household increased during the lockdown. These results show that although the overall prevalence of cannabis use was reduced during the lockdown, regular users tended to maintain or increase cannabis use. This could imply two different patterns of use among students, one social and occasional versus the other regular, providing new lines of research for prevention and the implementation of social policies.
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Affiliation(s)
- Lorena Botella-Juan
- Department of Biomedical Sciences, Area of Preventive Medicine and Public Health, Faculty of Health Sciences, University of León, 24071 León, Spain
| | - Carmen Amezcua-Prieto
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.Granada), 18014 Granada, Spain
| | - María M. Morales-Suarez-Varela
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, University of Valencia, 46100 Burjassot, Spain
| | - Ramona Mateos-Campos
- Area of Preventive Medicine and Public Health, University of Salamanca, 37007 Salamanca, Spain
| | - Carlos Ayán-Pérez
- Well-Move Research Group, Department of Special Didactics, University of Vigo, 36310 Vigo, Spain
| | - Antonio José Molina
- Department of Biomedical Sciences, Area of Preventive Medicine and Public Health, Faculty of Health Sciences, University of León, 24071 León, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- The Research Group in Gene-Environment and Health Interactions (GIIGAS), Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain
| | - Rocío Ortiz-Moncada
- Area of Preventive Medicine and Public Health, Food and Nutrition Research Group, University of Alicante, 03550 Alicante, Spain
| | - Susana Redondo-Martín
- Department of Pathological Anatomy, Microbiology and Preventive Medicine and Public Health, School of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain
- Comisionado Regional para la Droga, Junta de Castilla y León, 47009 Valladolid, Spain
| | - Juan Alguacil
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Centre for Research on Natural Resources, Health, and Environment (RENSMA), University of Huelva, 21071 Huelva, Spain
| | - Gemma Blázquez-Abellán
- Department of Medical Sciences, Faculty of Pharmacy, University of Castilla-La Mancha, 02008 Albacete, Spain
| | - Miguel Delgado-Rodríguez
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Department of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | - Jessica Alonso-Molero
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Cantabria-IDIVAL, 39008 Santander, Spain
| | - Tania Fernández-Villa
- Department of Biomedical Sciences, Area of Preventive Medicine and Public Health, Faculty of Health Sciences, University of León, 24071 León, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- The Research Group in Gene-Environment and Health Interactions (GIIGAS), Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain
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Prota C, Ravera A, Caleo O, Campanile A. Marijuana-induced toxic myocarditis: a case report and a review of the literature. J Cardiovasc Med (Hagerstown) 2022; 23:814-818. [PMID: 36166341 DOI: 10.2459/jcm.0000000000001374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cannabis consumption has increased over the past decade, together with its application in the medical field.1 Therefore, close monitoring of the potential harm to public health caused by its use is required. Many of the related health implications of cannabis include cardiovascular diseases.2 In young adults with a history of cannabis use, higher frequency of admission for acute myocardial infarction, arrhythmia and stroke were described in a recent study.3 Although rare, cases of marijuana-induced toxic myocarditis have been reported in literature.4-11 This study examines a case of a young male patient with acute myocarditis following marijuana use.
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Affiliation(s)
| | - Amelia Ravera
- Department of Cardiology, Intensive Cardiac Care Unit
| | - Oliviero Caleo
- Department of Radiology, Ruggi D'Aragona Hospital, Salerno, Italy
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Reece AS, Hulse GK. Cannabis- and Substance-Related Epidemiological Patterns of Chromosomal Congenital Anomalies in Europe: Geospatiotemporal and Causal Inferential Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11208. [PMID: 36141481 PMCID: PMC9517644 DOI: 10.3390/ijerph191811208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Laboratory data link cannabinoid exposure to chromosomal mis-segregation errors. Recent epidemiological reports confirm this link and raise concern that elevated chromosomal congenital anomaly rates (CCAR) may be occurring in Europe which is experiencing increased cannabis use, daily intensity of use and cannabinoid potency. METHODS CCAR data from Eurocat. Drug use data from the European Monitoring Centre for Drugs and Drug Addiction. Income from World Bank. Bivariate, multivariate, panel and geotemporospatial regressions analyzed. Inverse probability weighting of panel models and E-values used as major quantitative causal inferential methodologies. RESULTS In countries where daily cannabis use was rising the trend for CCA's was upwards whereas in those where daily use was declining it was usually downwards (p = 0.0002). In inverse probability weighted panel models terms for cannabis metrics were significant for chromosomal disorders, trisomies 21 and 13 and Klinefelters syndrome from p < 2.2 × 10-16. In spatiotemporal models cannabis terms were positive and significant for chromosomal disorders, genetic disorders, trisomies 21, 18 and 13, Turners and Klinefelters syndromes from 4.28 × 10-6, 5.79 × 10-12, 1.26 × 10-11, 1.12 × 10-7, 7.52 × 10-9, 7.19 × 10-7 and 7.27 × 10-7. 83.7% of E-value estimates and 74.4% of minimum E-values (mEV) > 9 including four values each at infinity. Considering E-values: the sensitivity of the individual disorders was trisomy 13 > trisomy 21 > Klinefelters > chromosomal disorders > Turners > genetic syndromes > trisomy 18 with mEV's 1.91 × 1025 to 59.31; and daily cannabis use was the most powerful covariate (median mEV = 1.91 × 1025). CONCLUSIONS Data indicate that, consistent with reports from Hawaii, Canada, Colorado, Australia and USA, CCARs are causally and spatiotemporally related to metrics and intensity of cannabis exposure, directly impact 645 MB (21.5%) of the human genome and may implicate epigenomic-centrosomal mechanisms.
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Affiliation(s)
- Albert Stuart Reece
- Division of Psychiatry, University of Western Australia, Crawley, WA 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Gary Kenneth Hulse
- Division of Psychiatry, University of Western Australia, Crawley, WA 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
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Singaram M, Muraleedhran VR, Sivaprakasam M. Cross fertilisation of Public Health and Translational Research. J Indian Inst Sci 2022; 102:763-782. [PMID: 35968232 PMCID: PMC9364283 DOI: 10.1007/s41745-022-00317-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/21/2022] [Indexed: 01/05/2023]
Abstract
Public health is defined as the science of protecting the safety and improving the health of communities through education, policy-making and research for the prevention of disease (Gatseva and Argirova in J Public Health 19(3):205-6, 2011, 10.1007/s10389-011-0412-8; Winslow in Mod Med 2(1306):183-91, 1920. 10.1126/science.51.1306.23; What is public health. Centers for Disease Control Foundation. Centers for Disease Control, Atlanta, https://www.cdcfoundation.org/what-public-health; What is the WHO definition of health? from the Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, On 7 April 1948. The definition has not been amended since. 22 July 1946; signed by the representatives of 61 States (Official Records of WHO, no. 2, p. 100) and entered into force, 19 June;1948. https://web.archive.org/web/20190307113324/https:/www.who.int/about/who-we-are/frequently-asked-questions). Translational research in healthcare is not only useful and satisfying for the researchers to bring their work to market but it would also support public health by bringing affordable, attainable and scalable solutions to the community at large. This is of high significance because instead of increasing the GDP spent in public health, we should focus on the increasing the translational research spending, as this would lead to improved solutions. Hence, the public health offering would reach a larger community at an improved cost. The COVID-19 pandemic and the huge number of lives it claimed exposes challenges in the public health. The pandemic has caused economic and social disruption to millions of people around the world, with many falling into extreme poverty. In early 2021, it was estimated nearly 690 million people are undernourished and by end of 2021 to increase further by 132 million (Joint statement by ILO, FAO, IFAD and WHO. Impact of COVID-19 on people's livelihoods, their health and our food systems https://www.who.int/news/item/13-10-2020-impact-of-covid-19-on-people's-livelihoods-their-health-and-our-food-systems). The spending for public health has increased many folds during the pandemic and this is where translational research in healthcare can play a transformative role to reduce the burden on government healthcare budget (Covid-19 and its impact on Indian society. https://timesofindia.indiatimes.com/readersblog/covid-19-and-its-impact-on-india/covid-19-and-its-impact-on-indian-society-27565/). Over the past decade, public health research has started playing a major role in Indian academic settings. COVID-19 pandemic has further highlighted the role of public health. However, the potential of using technological advancement has not been fully utilised. This is where translational research and public health can play a role to tap the full potential of technology. This review paper explores the public health practices to understand the different practices to examine how both public health and translational research can cross-fertilise. It concludes with a short discussion on implications on policymakers.
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Affiliation(s)
- Muthu Singaram
- Healthcare Technology Innovation Centre (HTIC), Indian Institute of Technology Madras (IITM), Chennai, India
| | - V. R. Muraleedhran
- HSS Department and Centre for Technology and Policy, Indian Institute of Technology Madras (IITM), Chennai, India
| | - Mohanasankar Sivaprakasam
- Department of Electrical Engineering and Healthcare Technology Innovation Centre (HTIC), Indian Institute of Technology Madras (IITM), Chennai, India
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Rauschert C, Möckl J, Seitz NN, Wilms N, Olderbak S, Kraus L. The Use of Psychoactive Substances in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:527-534. [PMID: 35791270 PMCID: PMC9677535 DOI: 10.3238/arztebl.m2022.0244] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/01/2022] [Accepted: 06/01/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Monitoring the use of psychoactive substances and substance-related problems in the population allows for the assessment of prevalence and associated health and social consequences. METHODS The data are derived from the Epidemiological Survey of Substance Abuse (ESA) 2021 (n = 9046, 18-64 years). We estimated prevalence rates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications, as well as the prevalence rates of their problematic use (indicating dependence) using screening instruments, and extrapolated the results to the resident population (N = 51 139 451). RESULTS Alcohol was the most frequently used substance, with a 30-day prevalence of 70.5% (36.1 million people), followed by non-opioid analgesic drugs (47.4%; 24.2 million) and conventional tobacco products (22.7%; 11.6 million). E-cigarettes were used by 4.3% (2.2 million) and heat-not-burn products by 1.3% (665 000). Among illegal drugs (12-month prevalence), cannabis was the most frequently used (8.8%; 4.5 million), followed by cocaine/crack (1.6%; 818 000) and amphetamine (1.4%; 716 000). Rates of problematic use among the study participants were 17.6% for alcohol (9.0 million), 7.8% for tobacco (4.0 million), 5.7% for psychoactive medications (2.9 million), and 2.5% for cannabis (1.3 million). CONCLUSION The consumption of psychoactive substances continues to be widespread in Germany. In view of the imminent legal changes, the high prevalence of cannabis use and its problematic use need to be taken into consideration.
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Affiliation(s)
- Christian Rauschert
- IFT Institut für Therapieforschung, Munich,*IFT Institut für Therapieforschung Leopoldstraße 175 80804 München, Germany
| | | | | | | | - Sally Olderbak
- IFT Institut für Therapieforschung, Munich,Psychology Department, University of Arizona, Tucson, USA
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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Reece AS, Hulse GK. European Epidemiological Patterns of Cannabis- and Substance-Related Body Wall Congenital Anomalies: Geospatiotemporal and Causal Inferential Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9027. [PMID: 35897396 PMCID: PMC9330494 DOI: 10.3390/ijerph19159027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 12/24/2022]
Abstract
As body wall congenital anomalies (BWCAs) have a long history of being associated with prenatal or community cannabis exposure (CCE), it was of interest to investigate these epidemiological relationships in Europe given the recent increases in cannabis use prevalence, daily intensity, and Δ9-tetrahydrocannabinol (THC) potency. Methods: This study makes use of BWCA data from Eurocat, drug exposure data from the European Monitoring Centre for Drugs and Drug Addiction, and income from the World Bank. Results: The mapping analysis showed that BWCARs increased in France, Spain, and the Netherlands. The bivariate mapping analysis showed that the BWCA rates (BWCAR) and the cannabis resin THC concentration rose simultaneously in France, the Netherlands, Bulgaria, Sweden, and Norway. The bivariate ranking of the BWCARs by median minimum E-value (mEV) was omphalocele > diaphragmatic hernia > abdominal wall defects > gastroschisis. With inverse probability weighted multivariable panel regression, the series of BWCAs, including gastroschisis, omphalocele, and diaphragmatic hernia, was positively related to various metrics of cannabis use from p = 2.45 × 10−14, 4.77 × 10−7 and <2.2 × 10−16. With geospatial regression, the same series of BWCAs was related to cannabis metrics from p = 0.0016, 5.28 × 10−6 and 4.88 × 10−9. Seventeen out of twenty-eight (60.7%) of the E-value estimates were >9 (high range), as were 14/28 (50.0%) of the mEVs. Conclusion: The data confirm the close relationship of the BWCARs with the metrics of CCE, fulfill the quantitative criteria of causal inference, and underscore the salience of the public health impacts of cannabinoid teratogenicity. Of major concern is the rising CCE impacting exponential cannabinoid genotoxic dose-response relationships. CCE should be carefully restricted to protect the food chain, the genome, and the epigenome of coming generations.
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Affiliation(s)
- Albert Stuart Reece
- Division of Psychiatry, University of Western Australia, Crawley, WA 6009, Australia;
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Gary Kenneth Hulse
- Division of Psychiatry, University of Western Australia, Crawley, WA 6009, Australia;
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
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64
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Baumeister SE, Alayash Z, Baurecht H, Reckelkamm SL, Kocher T, Holtfreter B, Ehmke B, Nolde M. Cannabis use and the risk of periodontitis: A two-sample Mendelian randomization study. J Clin Periodontol 2022; 49:654-661. [PMID: 35451161 DOI: 10.1111/jcpe.13632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/18/2022] [Accepted: 04/15/2022] [Indexed: 12/28/2022]
Abstract
AIM This study aimed to leverage human genetic data to investigate whether cannabis use causally affects periodontitis. MATERIALS AND METHODS Data were obtained from summary statistics of genome-wide association studies of lifetime cannabis use (N = 184,765), cannabis use disorder (17,068 cases; 357,219 controls), and periodontitis (17,353 cases; 28,210 controls). We performed two-sample Mendelian randomization (MR) analysis using 6 genetic variants as instrumental variables for lifetime cannabis use and 11 variants as instruments for cannabis use disorder to estimate associations with periodontitis. RESULTS There was no evidence for an association between genetic liability for lifetime cannabis use or cannabis use disorder with periodontitis. The estimates from the primary analyses were supported in multivariable MR analysis, which considered potential pleiotropic pathways and in weak instrument analyses. CONCLUSIONS This study provides little evidence to support a detrimental effect of genetic liability for cannabis use on periodontal health.
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Affiliation(s)
| | - Zoheir Alayash
- Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany
| | - Hansjörg Baurecht
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Stefan Lars Reckelkamm
- Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Benjamin Ehmke
- Clinic for Periodontology and Conservative Dentistry, University of Münster, Münster, Germany
| | - Michael Nolde
- Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany
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65
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Fei T, Wang T. Comparative extraction of cannabinoids and terpenoids from
Cannabis Sativa L
. using three solvents. J AM OIL CHEM SOC 2022. [DOI: 10.1002/aocs.12583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Tao Fei
- Department of Food Science The University of Tennessee Knoxville Tennessee USA
| | - Tong Wang
- Department of Food Science The University of Tennessee Knoxville Tennessee USA
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66
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Monti MC, Frei P, Weber S, Scheurer E, Mercer-Chalmers-Bender K. Beyond Δ9-tetrahydrocannabinol and cannabidiol: chemical differentiation of cannabis varieties applying targeted and untargeted analysis. Anal Bioanal Chem 2022; 414:3847-3862. [PMID: 35380230 PMCID: PMC9061671 DOI: 10.1007/s00216-022-04026-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 12/18/2022]
Abstract
Cannabis sativa (C. sativa) is commonly chemically classified based on its Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) content ratios. However, the plant contains nearly 150 additional cannabinoids, referred to as minor cannabinoids. Minor cannabinoids are gaining interest for improved plant and product characterization, e.g., for medical use, and bioanalytical questions in the medico-legal field. This study describes the development and validation of an analytical method for the elucidation of minor cannabinoid fingerprints, employing liquid chromatography coupled to high-resolution mass spectrometry. The method was used to characterize inflorescences from 18 different varieties of C. sativa, which were cultivated under the same standardized conditions. Complementing the targeted detection of 15 cannabinoids, untargeted metabolomics employing in silico assisted data analysis was used to detect additional plant ingredients with focus on cannabinoids. Principal component analysis (PCA) was used to evaluate differences between varieties. The overall purpose of this study was to examine the ability of targeted and non-targeted metabolomics using the mentioned techniques to distinguish cannabis varieties from each other by their minor cannabinoid fingerprint. Quantitative determination of targeted cannabinoids already gave valuable information on cannabinoid fingerprints as well as inter- and intra-variety variability of cannabinoid contents. The untargeted workflow led to the detection of 19 additional compounds. PCA of the targeted and untargeted datasets revealed further subgroups extending commonly applied phenotype classification systems of cannabis. This study presents an analytical method for the comprehensive characterization of C. sativa varieties.
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Affiliation(s)
- Manuela Carla Monti
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Pestalozzistrasse 22, 4056, Basel, Switzerland
| | - Priska Frei
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Pestalozzistrasse 22, 4056, Basel, Switzerland
| | - Sophie Weber
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Pestalozzistrasse 22, 4056, Basel, Switzerland
| | - Eva Scheurer
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Pestalozzistrasse 22, 4056, Basel, Switzerland
| | - Katja Mercer-Chalmers-Bender
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Pestalozzistrasse 22, 4056, Basel, Switzerland.
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Faccioli E, Pezzuto F, Dell’Amore A, Lunardi F, Giraudo C, Mammana M, Schiavon M, Cirnelli A, Loy M, Calabrese F, Rea F. Fatal Early-Onset Aspergillosis in a Recipient Receiving Lungs From a Marijuana-Smoking Donor: A Word of Caution. Transpl Int 2022; 35:10070. [PMID: 35237097 PMCID: PMC8883434 DOI: 10.3389/ti.2022.10070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Eleonora Faccioli
- Thoracic Surgery and Lung Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
- *Correspondence: Eleonora Faccioli, ,
| | - Federica Pezzuto
- Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Andrea Dell’Amore
- Thoracic Surgery and Lung Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesca Lunardi
- Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Chiara Giraudo
- Radiology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Marco Mammana
- Thoracic Surgery and Lung Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marco Schiavon
- Thoracic Surgery and Lung Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Monica Loy
- Thoracic Surgery and Lung Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Fiorella Calabrese
- Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Federico Rea
- Thoracic Surgery and Lung Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Reece AS, Hulse GK. European epidemiological patterns of cannabis- and substance-related congenital cardiovascular anomalies: geospatiotemporal and causal inferential study. ENVIRONMENTAL EPIGENETICS 2022; 8:dvac015. [PMID: 35966825 PMCID: PMC9364688 DOI: 10.1093/eep/dvac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/15/2022] [Accepted: 07/01/2022] [Indexed: 05/16/2023]
Abstract
As prenatal and community cannabis exposures have recently been linked with congenital heart disease (CHD), it was of interest to explore these associations in Europe in a causal framework and space-time context. Congenital anomaly data from Eurocat, drug-use data from the European Monitoring Centre for Drugs and Drug Addiction, and income from the World Bank. Countries with rising daily cannabis use had in general higher congenital anomaly rates over time than those without (time: status interaction: β-Est. = 0.0267, P = 0.0059). At inverse probability-weighted panel regression, cannabis terms were positive and significant for CHD, severe CHD, atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, tetralogy of Fallot, vascular disruptions, double outlet right ventricle, transposition of the great vessels, hypoplastic right heart, and mitral valve anomalies from 1.75 × 10-19, 4.20 × 10-11, <2.2 × 10-16, <2.2 × 10-16, 1.58 × 10-12, 4.30 × 10-9, 4.36 × 10-16, 3.50 × 10-8, 5.35 × 10-12, <2.2 × 10-16, 5.65 × 10-5 and 6.06 × 10-10. At spatial regression, terms including cannabis were positive and significant for this same list of anomalies from 0.0038, 1.05 × 10-10, 0.0215, 8.94 × 10-6, 1.23 × 10-5, 2.05 × 10-5, 1.07 × 10-6, 8.77 × 10-5, 9.11 × 10-6, 0.0001, 3.10 × 10-7 and 2.17 × 10-7. 92.6% and 75.2% of 149 E-value estimates and minimum E-values were in high zone >9; 100.0% and 98.7% >1.25. Data show many congenital cardiac anomalies exhibit strong bivariate relationships with metrics of cannabis exposure. Causal inferential modelling for the twelve anomalies selected demonstrated convincing evidence of robust relationships to cannabis which survived adjustment and fulfilled epidemiological criteria for causal relationships. Space-time regression was similarly confirmatory. Epigenomic pathways constitute viable potential mechanisms. Given exponential genotoxic dose-response effects, careful and astute control of cannabinoid penetration is indicated.
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Affiliation(s)
- Albert Stuart Reece
- *Correspondence address. 39 Gladstone Rd., Highgate Hill, Brisbane, QLD, Australia. Tel: +617 3844-4000; Fax: (617) 3844-4015; E-mail:
| | - Gary Kenneth Hulse
- Department of Psychiatry, University of Western Australia, 35 Stirling Hwy, Crawley, Perth, WA 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
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69
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Reece AS, Hulse GK. Effects of cannabis on congenital limb anomalies in 14 European nations: A geospatiotemporal and causal inferential study. ENVIRONMENTAL EPIGENETICS 2022; 8:dvac016. [PMID: 35966826 PMCID: PMC9364687 DOI: 10.1093/eep/dvac016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 05/16/2023]
Abstract
Cannabinoid exposure is increasing in some European nations. Europe therefore provides an interesting test environment for the recently reported link between cannabis exposure and congenital limb anomaly (CLA) rates (CLARs). Exponential genotoxic dose-response relationships make this investigation both intriguing and imperative. Annual CLAR in 14 nations were from Epidemiological Surveillance of Congenital Anomalies. Drug use rates were from European Monitoring Centre for Drugs and Drug Dependency. Median household income was from the World Bank. E-values provide a quantitative measure of robustness of results to confounding by extraneous covariates. Inverse probability weighting is an important technique for equalizing exposures across countries and removing sources of bias. Rates of CLA, hip dysplasia and the whole group of limb anomalies were higher in countries with increasing daily cannabis use (P = 1.81 × 10-16, 0.0005 and 2.53 × 10-6, respectively). In additive inverse-probability-weighted panel models, the limb reduction-resin Δ9-tetrahydrocannabinol (THC) concentration E-value estimate was 519.93 [95% lower bound (mEV) 49.56], order Resin > Herb ≫ Tobacco > Alcohol. Elevations were noted in 86% E-value estimates and 70.2% of mEVs from 57 E-value pairs from inverse-probability-weighted panel models and from spatial models. As judged by the mEV the degree of association with metrics of cannabis exposure was hip dysplasia > polydactyly > syndactyly > limb anomalies > limb reductions with median E-value estimates from 3.40 × 1065 to 7.06 and median mEVs from 6.14 × 1033 to 3.41. Daily cannabis use interpolated was a more powerful metric of cannabis exposure than herb or resin THC exposure. Data indicate that metrics of cannabis exposure are closely linked with CLAR and satisfy epidemiological criteria for causality. Along with Hawaii and the USA, Europe now forms the third international population in which this causal link has been demonstrated. Cannabis as a predictor of limb anomalies was more potent than tobacco or alcohol. Cannabinoid access should be restricted to protect public health and the community genome/epigenome transgenerationally.
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Affiliation(s)
- Albert Stuart Reece
- *Correspondence address. 39 Gladstone Rd., Highgate Hill, Brisbane, Queensland, Australia. Tel: (+617) 3844-4000; Fax: (+617) 3844-4015; E-mail:
| | - Gary Kenneth Hulse
- Division of Psychiatry, University of Western Australia, Crawley, WA 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
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Reece AS, Hulse GK. Cannabinoid and substance relationships of European congenital anomaly patterns: a space-time panel regression and causal inferential study. ENVIRONMENTAL EPIGENETICS 2022; 8:dvab015. [PMID: 35145760 PMCID: PMC8824558 DOI: 10.1093/eep/dvab015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/27/2022] [Indexed: 05/04/2023]
Abstract
With reports from Australia, Canada, USA, Hawaii and Colorado documenting a link between cannabis and congenital anomalies (CAs), this relationship was investigated in Europe. Data on 90 CAs were accessed from Eurocat. Tobacco and alcohol consumption and median household income data were from the World Bank. Amphetamine, cocaine and last month and daily use of cannabis from the European Monitoring Centre for Drugs and Drug Addiction. Cannabis herb and resin Δ9-tetrahydrocannabinol concentrations were from published reports. Data were processed in R. Twelve thousand three hundred sixty CA rates were sourced across 16 nations of Europe. Nations with a higher or increasing rate of daily cannabis use had a 71.77% higher median CA rates than others [median ± interquartile range 2.13 (0.59, 6.30) v. 1.24 (0.15, 5.14)/10 000 live births (P = 4.74 × 10-17; minimum E-value (mEV) = 1.52]. Eighty-nine out of 90 CAs in bivariate association and 74/90 CAs in additive panel inverse probability weighted space-time regression were cannabis related. In inverse probability weighted interactive panel models lagged to zero, two, four and six years, 76, 31, 50 and 29 CAs had elevated mEVs (< 2.46 × 1039) for cannabis metrics. Cardiovascular, central nervous, gastrointestinal, genital, uronephrology, limb, face and chromosomalgenetic systems along with the multisystem VACTERL syndrome were particularly vulnerable targets. Data reveal that cannabis is related to many CAs and fulfil epidemiological criteria of causality. The triple convergence of rising cannabis use prevalence, intensity of daily use and Δ9-tetrahydrocannabinol concentration in herb and resin is powerfully implicated as a primary driver of European teratogenicity, confirming results from elsewhere.
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Affiliation(s)
- Albert Stuart Reece
- **Correspondence address. Department of Psychiatry, University of Western Australia, Stirling Hwy, Crawley, Western Australia 6009, Australia. Tel: (617) +3844-4000; Fax: (617) +3844-4015; E-mail:
| | - Gary Kenneth Hulse
- Division of Psychiatry, University of Western Australia, Crawley, Western Australia 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia 6027, Australia
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Reece AS, Hulse GK. Congenital anomaly epidemiological correlates of Δ8THC across USA 2003-16: panel regression and causal inferential study. ENVIRONMENTAL EPIGENETICS 2022; 8:dvac012. [PMID: 35782486 PMCID: PMC9245652 DOI: 10.1093/eep/dvac012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 05/16/2023]
Abstract
Δ8-Tetrahydrocannabinol (Δ8THC) is marketed in many US states as 'legal weed'. Concerns exist relating to class-wide genotoxic cannabinoid effects. We conducted an epidemiological investigation of Δ8THC-related genotoxicity expressed as 57 congenital anomaly (CA) rates (CARs) in the USA. CARs were taken from the Centers for Disease Control, Atlanta, Georgia. Drug exposure data were taken from the National Survey of Drug Use and Health, with a response rate of 74.1%. Ethnicity and income data were taken from the US Census Bureau. National cannabinoid exposure was taken from Drug Enforcement Agency publications and multiplied by state cannabis use data to derive state-based estimates of Δ8THC exposure. At bivariate continuous analysis, Δ8THC was associated with 23 CAs on raw CA rates, 33 CARs after correction for early termination for anomaly estimates and 41 on a categorical analysis comparing the highest and lowest exposure quintiles. At inverse probability weighted multivariable additive and interactive models lagged to 0, 2 and 4 years, Δ8THC was linked with 39, 8, 4 and 9 CAs. Chromosomal, cardiovascular, gastrointestinal, genitourinary, limb, central nervous system (CNS) and face systems were particularly affected. The minimum E-values ranged to infinity. Both the number of anomalies implicated and the effect sizes demonstrated were much greater for Δ8THC than for tobacco and alcohol combined. Δ8THC appears epidemiologically to be more strongly associated with many CAs than for tobacco and alcohol and is consistent with a cannabinoid class genotoxic/epigenotoxic effect. Quantitative causality criteria were fulfilled, and causal relationships either for Δ8THC or for cannabinoid/s, for which it is a surrogate marker, may be in operation.
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Affiliation(s)
- Albert Stuart Reece
- *Correspondence address. 39 Gladstone Rd., Highgate Hill, Brisbane, QLD, Australia. Tel: (617) +3844-4000; Fax: +(617) 3844-4015; E-mail:
| | - Gary Kenneth Hulse
- Division of Psychiatry, University of Western Australia, Crawley, WA 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
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Jones É, Vlachou S. Cannabidiol Does Not Cause Significant Changes to Working Memory Performance in the N-Back Task. Pharmaceuticals (Basel) 2021; 14:1165. [PMID: 34832947 PMCID: PMC8623009 DOI: 10.3390/ph14111165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/04/2021] [Accepted: 11/10/2021] [Indexed: 11/20/2022] Open
Abstract
Cannabis use can be traced back to several centuries before the Common Era, when it was used for industrial, medicinal and recreational purposes. More recently, over 100 different cannabinoid compounds have been identified, one of which is cannabidiol (CBD), a compound widely used for anti-inflammatory and anxiolytic treatment. The literature surrounding the cognitive effects of CBD is limited, with most studies focusing on the effects of other cannabinoids on cognition. To expand this literature, this study investigated whether CBD causes significant differences to working memory (WM) functioning, as measured by the N-back task. It was hypothesised that CBD does not cause statistically significant differences to WM. In all, 54 participants, 33 females and 21 males, were recruited, with a mean age of 32.63 years. Of these 54 participants, 26 reported using CBD and no other cannabinoids, while 28 reported not using any cannabinoid. The participants were instructed to answer a short online survey to gather basic demographic data and to complete an online N-back task to measure WM. For the computerised N-back task, the participants completed a practice and three test blocks, where they were instructed to respond to whether a series of letter stimuli were presented one trial back (1-back), two trials back (2-back) or three trials back (3-back). Multivariate analysis of covariance yielded no statistically significant difference on either response time or response accuracy data between groups after controlling for how long the participants use CBD and for what reason they use CBD. These results support our hypothesis that CBD does not cause significant changes to WM functioning. Further research is greatly needed to investigate the long-term effects of CBD use on WM and on general cognitive functioning.
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Affiliation(s)
| | - Styliani Vlachou
- Neuropsychopharmacology Division, Behavioural Neuroscience Laboratory, School of Psychology, Faculty of Science and Health, Dublin City University, Glasnevin, Dublin 9, D09 Y074 Dublin, Ireland;
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Reece AS, Hulse GK. Quadruple convergence - rising cannabis prevalence, intensity, concentration and use disorder treatment. THE LANCET REGIONAL HEALTH. EUROPE 2021; 10:100245. [PMID: 34806073 PMCID: PMC8589707 DOI: 10.1016/j.lanepe.2021.100245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Albert Stuart Reece
- Division of Psychiatry, University of Western Australia, Crawley, Western Australia 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, 6027, Australia
| | - Gary Kenneth Hulse
- Division of Psychiatry, University of Western Australia, Crawley, Western Australia 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, 6027, Australia
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