An investigation of cannabis use for insomnia in depression and anxiety in a naturalistic sample

BACKGROUND

Little is known about cannabis use for insomnia in individuals with depression, anxiety, and comorbid depression and anxiety. To develop a better understanding of distinct profiles of cannabis use for insomnia management, a retrospective cohort study was conducted on a large naturalistic sample.

METHODS

Data were collected using the medicinal cannabis tracking app, Strainprint®, which allows users to monitor and track cannabis use for therapeutic purposes. The current study examined users managing insomnia symptoms in depression (n = 100), anxiety (n = 463), and comorbid depression and anxiety (n = 114), for a total of 8476 recorded sessions. Inferential analyses used linear mixed effects modeling to examine self-perceived improvement across demographic variables and cannabis product variables.

RESULTS

Overall, cannabis was perceived to be efficacious across all groups, regardless of age and gender. Dried flower and oral oil were reported as the most used and most efficacious product forms. In the depression group, all strains were perceived to be efficacious and comparisons between strains revealed indica-dominant (M_diff = 1.81, 95% CI 1.26-2.36, P_adj < .001), indica hybrid (M_diff = 1.34, 95% CI 0.46-2.22, P_adj = .045), and sativa-dominant (M_diff = 1.83, 95% CI 0.68-2.99, P_adj = .028) strains were significantly more efficacious than CBD-dominant strains. In anxiety and comorbid conditions, all strain categories were perceived to be efficacious with no significant differences between strains.

CONCLUSIONS

In terms of perceptions, individuals with depression, anxiety, and both conditions who use cannabis for insomnia report significant improvements in symptom severity after cannabis use. The current study highlights the need for placebo-controlled trials investigating symptom improvement and the safety of cannabinoids for sleep in individuals with mood and anxiety disorders.

Predictors of Medical Students’ Perceptions About Medical Cannabis

Background: There has been a recent uptick in interest regarding the therapeutic properties of cannabis. Evidence exists to support the role of medical cannabis (MC) in chronic illness management for conditions such as posttraumatic stress, pain, and cancer. The majority of physicians in the United States report not knowing how to prescribe or answer questions about MC and receive minimal education about it during training. As MC becomes more socially acceptable with federal legalization in process, new physicians will encounter patients looking for information on the utility and safety of MC. The goal of this research was thus to assess the perceived knowledge, beliefs, and perceptions of medical students towards MC, and to obtain a better understanding of factors that may influence their attitudes.

Methods: A descriptive, cross-sectional study design was used to investigate the medical students’ knowledge, attitudes, and perceptions regarding MC. Quantitative data were collected from 526 medical students (years one to four) via an anonymous, online, 32-item questionnaire to determine if perceived knowledge, concerns about the potential negative effects of cannabis, and certain beliefs would significantly contribute to their attitudes toward MC. Hypothesis testing was conducted using Spearman-rank order correlation and multivariate linear regression analyses.

Results: A statistically significant regression equation was found: (F(4, 428)=114.826, p<.001 with an R²=0.518 [adjusted R² =0.513]) indicating greater perception of knowledge about MC, lower concern for possible negative effects of MC use, greater belief in federal legalization of MC, and greater belief in the federal legalization of recreational cannabis significantly contributed to a higher score on positive attitudes and perceptions toward MC. Moreover, while many participants reported physicians should be able to prescribe MC, they reported that little if any MC education had been provided.

Conclusions: This study identified the knowledge, concerns, and perceptions of medical students regarding MC as well as several factors contributing to their attitudes about it. Favorable attitudes toward MC among patients exist and as its popularity and acceptance among patients continue, more may be asking their physicians about symptomatic and curative treatment with cannabis-based products. Results from this research have the potential to assist medical educators in understanding students’ perceptions about MC to help guide innovative and contemporary curricular advances as a public health imperative.

Microbiota and Transcriptomic Effects of an Essential Oil Blend and Its Delivery Route Compared to an Antibiotic Growth Promoter in Broiler Chickens

This study evaluated the effect of the delivery of a commercial essential oil blend containing the phytonutrients star anise, cinnamon, rosemary, and thyme oil (via different routes) on broiler chickens’ ileal and ceca microbiota and liver transcriptome compared to an antibiotic growth promoter. Eggs were incubated and allocated into three groups: non-injected, in ovo saline, and in ovo essential oil. On day 18 of incubation, 0.2 mL of essential oil in saline (dilution ratio of 2:1) or saline alone was injected into the amnion. At hatch, chicks were assigned to post-hatch treatment combinations: (A) a negative control (corn-wheat-soybean diet), (B) in-feed antibiotics, (C) in-water essential oil (250 mL/1000 L of drinking water), (D) in ovo saline, (E) in ovo essential oil, and (F) in ovo essential oil plus in-water essential oil in eight replicate cages (six birds/cage) and raised for 28 days. On days 21 and 28, one and two birds per cage were slaughtered, respectively, to collect gut content and liver tissues for further analysis. Alpha and beta diversity differed significantly between ileal and ceca samples but not between treatment groups. In-feed antibiotic treatment significantly increased the proportion of specific bacteria in the family Lachnospiraceae while reducing the proportion of bacteria in the genus Christensenellaceae in the ceca, compared to other treatments. Sex-controlled differential expression of genes related to cell signaling and tight junctions were recorded. This study provides data that could guide the use of these feed additives and a foundation for further research.

Vapor Pressure, Vaping, and Corrections to Misconceptions Related to Medical Cannabis' Active Pharmaceutical Ingredients' Physical Properties and Compositions

Medical cannabis products contain dozens of active pharmaceutical ingredients (APIs) derived from the cannabis plant. However, their actual compositions and relative doses significantly change according to the production methods. Product compositions are strongly dependent on processing step conditions and on components' evaporation during those steps. Review of the documentation presented to caregivers and to patients show erroneous data or misinterpretation of data related to the evaporation, for example, cannabinoids' boiling points, as well as confusions between terms, such as boiling, vaporization, and evaporation. Clarifying these aspects is essential for caregivers, for researchers, and for developers of manufacturing processes. Original and literature data were analyzed, comparing composition changes during various processing steps and correlating the extent of change to components' vapor pressures at the corresponding temperature. Evaporation-related composition changes start at temperatures as low as those of drying and curing and become extensive during decarboxylation. The relative rate of components' evaporation is determined by their relative vapor pressure and monoterpenes are lost first. On vaping, terpenes are inhaled before cannabinoids do. Commercial medical cannabis products are deficient in terpenes, mainly monoterpenes, compared with the cannabis plants used to produce them. Terms, such as "whole plant" and "full spectrum," are misleading since no product actually reflects the original cannabis plant composition. There are important implications for medical cannabis manufacturing and for the ability to make the most out of the terpene API contribution. Medical cannabis products' composition and product delivery are controlled by the relative vapor pressure of the various APIs. Quantitative data provided in this study can be used for improvement to reach better accuracy, reproducibility, and preferred medical cannabis compositions.

Cannabis use among patients with cutaneous lymphoma: A cross-sectional survey

OBJECTIVE

To evaluate patterns of cannabis use in patients with cutaneous lymphoma (CL), as well as the association between cannabis use and itch specifically.

DESIGN

Cross-sectional survey created in partnership with the Cutaneous Lymphoma Foundation (CLF).

SETTING

The online survey was distributed electronically via email to the CLF listserv and links posted to social media over a 2-week period. Main Outcome Measures Respondents were classified as current cannabis users, prior users, and never users. A visual analog scale (VAS) was used to assess itching severity, improvement of itch, and interest in learning about cannabis.

RESULTS

A total of 119 patient responses (61% female, mean age 59y) were included in analysis. The majority had mycosis fungoides or Sézary syndrome (74%; 88/119) and early stage (IA-IIA) disease (56%; 48/86). Mean VAS itch score was 3.2 + 2.8 for the cohort. Over half (55%; 60/110) reported ever having used cannabis, with 22% (24/110) endorsing current cannabis use. Common methods of cannabis use were smoking (54%) and vaporizing (46%). 25% (6/24) of current users reported using cannabis specifically to treat itch; these respondents noted that cannabis resulted in moderate improvement of itching (mean 6.6/10). There was strong interest in learning more about cannabis and cancer, and most desired this information from their CL doctor/nurse.

CONCLUSIONS

Cannabis use is common among patients with CL, and patients report improvement of itching as a result of using cannabis. Further studies are needed to elucidate the risks and benefits of cannabis use in this patient population.

Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis

OBJECTIVE

To review interventions to reduce long term opioid treatment in people with chronic non-cancer pain, considering efficacy on dose reduction and discontinuation, pain, function, quality of life, withdrawal symptoms, substance use, and adverse events.

DESIGN

Systematic review and meta-analysis of randomised controlled trials and non-randomised studies of interventions.

DATA SOURCES

Medline, Embase, PsycINFO, CINAHL, and the Cochrane Library searched from inception to July 2021. Reference lists and previous reviews were also searched and experts were contacted.

ELIGIBILITY CRITERIA FOR STUDY SELECTION

Original research in English. Case reports and cross sectional studies were excluded.

DATA EXTRACTION AND SYNTHESIS

Two authors independently selected studies, extracted data, and used the Cochrane risk-of-bias tools for randomised and non-randomised studies (RoB 2 and ROBINS-I). Authors grouped interventions into five categories (pain self-management, complementary and alternative medicine, pharmacological and biomedical devices and interventions, opioid replacement treatment, and deprescription methods), estimated pooled effects using random effects meta-analytical models, and appraised the certainty of evidence using GRADE (grading of recommendations, assessment, development, and evaluation).

RESULTS

Of 166 studies meeting inclusion criteria, 130 (78%) were considered at critical risk of bias and were excluded from the evidence synthesis. Of the 36 included studies, few had comparable treatment arms and sample sizes were generally small. Consequently, the certainty of the evidence was low or very low for more than 90% (41/44) of GRADE outcomes, including for all non-opioid patient outcomes. Despite these limitations, evidence of moderate certainty indicated that interventions to support prescribers' adherence to guidelines increased the likelihood of patients discontinuing opioid treatment (adjusted odds ratio 1.5, 95% confidence interval 1.0 to 2.1), and that these prescriber interventions as well as pain self-management programmes reduced opioid dose more than controls (intervention v control, mean difference -6.8 mg (standard error 1.6) daily oral morphine equivalent, P<0.001; pain programme v control, -14.31 mg daily oral morphine equivalent, 95% confidence interval -21.57 to -7.05).

CONCLUSIONS

Evidence on the reduction of long term opioid treatment for chronic pain continues to be constrained by poor study methodology. Of particular concern is the lack of evidence relating to possible harms. Agreed standards for designing and reporting studies on the reduction of opioid treatment are urgently needed.

REVIEW REGISTRATION

PROSPERO CRD42020140943.

Exposure to negative news stories about vaping, and harm perceptions of vaping, among youth in England, Canada, and the US before and after the outbreak of E-cigarette or Vaping-Associated Lung Injury (EVALI)

Introduction

Little is known about the international impact of E-cigarette or Vaping-Associated Lung Injury (‘EVALI’) on youth perceptions of vaping harms.

Methods

Repeat cross-sectional online surveys of youth aged 16–19 years in England, Canada, and the United States before (2017, 2018), during (2019 August/September), and after (2020 February/March, 2020 August) the ‘EVALI’ outbreak (N = 63380). Logistic regressions assessed trends, country differences, and associations between exposure to negative news stories about vaping and vaping harm perceptions.

Results

Exposure to negative news stories increased between 2017 and February–March 2020 in England (12.6% to 34.2%), Canada (16.7% to 56.9%), and the United States (18.0% to 64.6%), accelerating during (2019) and immediately after (February–March 2020) the outbreak (p < .001) before returning to 2019 levels by August 2020. Similarly, the accurate perception that vaping is less harmful than smoking declined between 2017 and February–March 2020 in England (77.3% to 62.2%), Canada (66.3% to 43.3%), and the United States (61.3% to 34.0%), again accelerating during and immediately after the outbreak (p < .001). The perception that vaping takes less than a year to harm users’ health and worry that vaping will damage health also doubled over this period (p ≤ .001). Time trends were most pronounced in the United States. Exposure to negative news stories predicted the perception that vaping takes less than a year to harm health (Adjusted Odds Ratio = 1.55, 1.48-1.61) and worry that vaping will damage health (Adjusted Odds Ratio = 1.32, 1.18-1.48).

Conclusions

Between 2017 and February–March 2020, youth exposure to negative news stories, and perceptions of vaping harms, increased, and increases were exacerbated during and immediately after ‘EVALI’. Effects were seen in all countries but were most pronounced in the United States.

Implications

This is the first study examining changes in exposure to news stories about vaping, and perceptions of vaping harms, among youth in England, Canada, and the United States before, during, and after ‘EVALI’. Between 2017 and February–March 2020, youth exposure to negative news stories, and perceptions of vaping harms, increased, and increases were exacerbated during and immediately after ‘EVALI’. By August 2020, exposure to negative news stories returned to 2019 levels, while perceptions of harm were sustained. Exposure to negative news stories also predicted two of the three harm perception measures. Overall, findings suggest that ‘EVALI’ may have exacerbated youth’s perceptions of vaping harms internationally.

A critical review of cannabis in medicine and dentistry: A look back and the path forward

Introduction

In the last two decades, our understanding of the therapeutic utility and medicinal properties of cannabis has greatly changed. This change has been accompanied by widespread cannabis use in various communities and different age groups, especially within the United States. With this increase, we should consider the potential effects of cannabis–hemp on general public health and how they could alter therapeutic outcomes.

Material and Methods

The present investigation examined cannabis use for recreational and therapeutic use and a review of pertinent indexed literature was performed. The focused question evaluates “how cannabis or hemp products impact health parameters and do they provide potential therapeutic value in dentistry, and how do they interact with conventional medicines (drugs).” Indexed databases (PubMed/Medline, EMBASE) were searched without any time restrictions but language was restricted to English.

Results

The review highlights dental concerns of cannabis usage, the need to understand the endocannabinoid system (ECS), cannabinoid receptor system, its endogenous ligands, pharmacology, metabolism, current oral health, and medical dilemma to ascertain the detrimental or beneficial effects of using cannabis–hemp products. The pharmacological effects of pure cannabidiol (CBD) have been studied extensively while cannabis extracts can vary significantly and lack empirical studies. Several metabolic pathways are affected by cannabis use and could pose a potential drug interaction. The chronic use of cannabis is associated with health issues, but the therapeutic potential is multifold since there is a regulatory role of ECS in many pathologies.

Conclusion

Current shortcomings in understanding the benefits of cannabis or hemp products are limited due to pharmacological and clinical effects not being predictable, while marketed products vary greatly in phytocompounds warrant further empirical investigation. Given the healthcare challenges to manage acute and chronic pain, this review highlights both cannabis and CBD‐hemp extracts to help identify the therapeutic application for patient populations suffering from anxiety, inflammation, and dental pain.

Prosocial Effects of Nonpsychotropic Cannabis sativa in Mice

Introduction:Cannabis sativa L. (C. sativa) is used since ancient times to produce fabrics, baskets, and cords. Later, different ethnic groups used to burn the leaves and flowers of psychotropic cultivars with high Δ9-tetrahydrocannabinol (D9-THC) levels, during the religious or propitiatory rites to alter the state of consciousness. To date, it is not known whether also nonpsychotropic cultivars of C. sativa were used during these rites, and whether these varieties could have an effect on human behavior. This study aimed to evaluate the behavioral effects of an extract of nonpsychotropic C. sativa (NP-CS) in mice. Materials and Methods: An extract of a nonpsychotropic cultivar of C. sativa dissolved in medium-chain triglyceride oil was used and the different phytochemical components were evaluated. The relative composition in terms of phytocannabinoid content was assessed by reverse phase high-performance liquid chromatography coupled to UV detection (RP-HPLC-UV), and the volatile components were analyzed by gas chromatography-mass spectrometry (GC-MS). In addition, the behavioral effect of NP-CS was assessed on a wild-type mouse model. The animals were treated for 14 days (oral gavage) and motility, anxiety, and social effects were assessed. Results: RP-HPLC-UV analysis demonstrated that D9-THC was present in lower concentration with respect to other cannabinoids, like cannabidiol. Furthermore, the GC-MS analysis revealed the presence of several terpenoids. Concerning in vivo studies, chronic treatment with NP-CS did not alter body weight, motility, and anxiety and increased social interaction. Conclusions: This study highlighted the prosocial effects of NP-CS.

Self-Reported Effects of Cannabis on ADHD Symptoms, ADHD Medication Side Effects, and ADHD-Related Executive Dysfunction

OBJECTIVE

People with ADHD are more likely to use cannabis but little is known about the effects of cannabis on ADHD symptoms, ADHD medication side effects, or ADHD-related executive dysfunction.

METHOD

Students (n = 1,738) completed an online survey containing measures of ADHD symptoms, cannabis use, perceived effects of cannabis on ADHD symptoms and medication side effects, as well as executive dysfunction.

RESULTS

Participants with ADHD who have used cannabis reported that cannabis has acute beneficial effects on many symptoms of ADHD (e.g., hyperactivity, impulsivity). Further, they perceived cannabis to improve most of their medication side effects (e.g., irritability, anxiety). Finally, cannabis use frequency was a significant moderator of the associations between symptom severity and executive dysfunction.

CONCLUSION

Results suggest people with ADHD may be using cannabis to self-medicate for many of their symptoms and medication side effects and that more frequent use may mitigate ADHD-related executive dysfunction.

Cannabis sativa as a Treatment for Obesity: From Anti-Inflammatory Indirect Support to a Promising Metabolic Re-Establishment Target

Introduction: Obesity is defined as an excess of accumulation of fat that can be harmful to health. Storage of excess fat in the adipose tissue triggers an inflammatory process, which makes obesity a low-grade chronic inflammatory disease. Obesity is considered a complex and multifactorial disease; hence, no intervention strategy appears to be an ideal treatment for all individuals. Therefore, new therapeutic alternatives are often studied for the treatment of this disease. Currently, herbal medicines are gaining ground in the treatment of obesity and its comorbidities. In this context, much attention is being paid to Cannabis sativa derivatives, and their therapeutic functions are being widely studied, including in treating obesity. Objective: Highlight the pharmacological properties of Δ9-tetrahydrocannabivarin (THCV), Δ9-tetrahydrocannabidinol (THC), and cannabidiol (CBD), the predominant isolated components of Cannabis sativa, as well as its therapeutic potential in the treatment of obesity. Methods: This is a narrative review that shows the existing scientific evidence on the clinical application of Cannabis sativa as a possible treatment for obesity. Data collection was performed in the PubMed electronic database. The following word combinations were used: Cannabis and obesity, Cannabis sativa and obesity, THCV and obesity, THC and obesity, CBD and obesity, and Cannabis sativa and inflammation. Results: Evidence shows that Cannabis sativa derivatives have therapeutic potential due to their anti-inflammatory properties. In addition, people who use cannabis have a lower body mass index than those who do not, making the plant an option to reduce and reverse inflammation and comorbidities in obesity. Conclusion: It is concluded that phytocannabinoids derived from Cannabis sativa have therapeutic potential due to its anti-inflammatory, antioxidant, and neuroprotective properties, making the plant a study option to reduce and reverse inflammation and comorbidities associated with obesity.

Sociodemographic differences in patterns of nicotine and cannabis vaping among US adults

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About half (54.2%) of adults who used electronic vapor products (EVPs) vaped nicotine only.

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Only 7.4% of adults who used EVPs vaped cannabis only, while one-fourth (23.8%) vaped nicotine and cannabis.

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Patterns of nicotine and cannabis vaping differed by age, race/ethnicity, education, and sexual orientation.

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Vaping nicotine and cannabis and cannabis only was more common among young adults.

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Vaping cannabis only was more common among Hispanic and non-Hispanic Black adults.

Nicotine and cannabis vaping has increased over the past several years. While patterns of cigarette and cannabis co-use are well-documented, less is known about the intersection between nicotine and cannabis vaping, especially among adults. Thus, we categorized nicotine and cannabis vaping among adults (18+) who currently (past 30-day) used electronic vapor products (EVPs) from Wave 4 of the Population Assessment of Tobacco and Health Study (n = 3795) as: 1) nicotine only, 2) cannabis only, 3) nicotine and cannabis, and 4) non-nicotine/non-cannabis e-liquid. We calculated vaping pattern proportions overall and by sociodemographic characteristics. Adjusted multinomial logistic regression models assessed associations between sociodemographic characteristics and vaping categories relative to nicotine-only vaping. Approximately half (54.2%) of adults who currently used EVPs vaped nicotine only, 7.4% vaped cannabis only, 23.8% vaped nicotine and cannabis, and 14.6% vaped non-nicotine/non-cannabis e-liquid. Young adults (aged 18–24) (vs. adults aged 35+) had at least three-fold greater odds of vaping cannabis only, nicotine and cannabis, and non-nicotine/non-cannabis e-liquid, compared to nicotine only. Hispanic and non-Hispanic Black (vs. non-Hispanic White) adults had 2.5–3 times greater odds of vaping cannabis only and non-nicotine/non-cannabis e-liquid, compared to nicotine only. Sexual minority adults (vs. heterosexual adults) had 1.5 times greater odds of vaping nicotine and cannabis, compared to nicotine only. Nearly half of adults who vaped EVPs consumed something other than nicotine only, and nicotine/cannabis vaping patterns differed by sociodemographic groups. Vaping and nicotine reduction efforts must recognize that adults who currently vape may be vaping cannabis, or neither nicotine nor cannabis.

A Systems Thinking Approach Investigating the Estimated Environmental and Economic Benefits and Limitations of Industrial Hemp Cultivation in Ireland from 2017–2021

There may be unrecognised environmental and economic benefits in cultivating industrial hemp for CO2 sequestration in Ireland. By using a Systems Thinking approach, this study aims to answer how industrial hemp, which can sequester between 10 to 22 million Mt CO2 per hectare, has been helpful towards carbon sequestration efforts. A mixed-methods design combining qualitative and quantitative secondary material is used to inform Behaviour over Time Graphs (BoTGs) to illustrate the data from 2017 to 2021. In 2019 the total CO2 emissions from agriculture was 21,151.24 million Mt, and the total land cultivated with hemp was 547 hectares which represented 0.0079% of total land use and 0.0123% of agricultural land use. Based on a sequestration rate of between 10 and 22 million Mt of CO2, industrial hemp had the potential to sequester between 5470 Mt and 24,068 million Mt of CO2, this represents nearly quarter to potentially all the CO2 from agriculture and equates to a carbon tax equivalent of between €109,400 and €481,360 for that year. The total amount of CO2 sequestrated between 2017 and 2021 was between 14,660 million Mt and 64,504 million Mt of CO2. This represents an estimated contribution in carbon tax equivalent of between €348,805 and €1,534,742, respectively.

Standardized Cannabis Smoke Extract Induces Inflammation in Human Lung Fibroblasts

Cannabis (marijuana) is the most commonly used illicit product in the world and is the second most smoked plant after tobacco. There has been a rapid increase in the number of countries legalizing cannabis for both recreational and medicinal purposes. Smoking cannabis in the form of a joint is the most common mode of cannabis consumption. Combustion of cannabis smoke generates many of the same chemicals as tobacco smoke. Although the impact of tobacco smoke on respiratory health is well-known, the consequence of cannabis smoke on the respiratory system and, in particular, the inflammatory response is unclear. Besides the combustion products present in cannabis smoke, cannabis also contains cannabinoids including Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD). These compounds are hydrophobic and not present in aqueous solutions. In order to understand the impact of cannabis smoke on pathological mechanisms associated with adverse respiratory outcomes, the development of in vitro surrogates of cannabis smoke exposure is needed. Therefore, we developed a standardized protocol for the generation of cannabis smoke extract (CaSE) to investigate its effect on cellular mechanisms in vitro. First, we determined the concentration of Δ9-THC, one of the major cannabinoids, by ELISA and found that addition of methanol to the cell culture media during generation of the aqueous smoke extract significantly increased the amount of Δ9-THC. We also observed by LC-MS/MS that CaSE preparation with methanol contains CBD. Using a functional assay in cells for CB1 receptors, the major target of cannabinoids, we found that this CaSE contains Δ9-THC which activates CB1 receptors. Finally, this standardized preparation of CaSE induces an inflammatory response in human lung fibroblasts. This study provides an optimized protocol for aqueous CaSE preparation containing biologically active cannabinoids that can be used for in vitro experimentation of cannabis smoke and its potential impact on various indices of pulmonary health.

Poly(vinyl alcohol)/Plant Extracts Films: Preparation, Surface Characterization and Antibacterial Studies against Gram Positive and Gram Negative Bacteria

In this study, we aim to obtain biomaterials with antibacterial properties by combining poly(vinyl alcohol) with the extracts obtained from various selected plants from Romania. Natural herbal extracts of freshly picked flowers of the lavender plant (Lavandula angustifolia) and leaves of the peppermint plant (Mentha piperita), hemp plant (Cannabis sativa L.), verbena plant (Verbena officinalis) and sage plant (Salvia officinalis folium) were selected after an intensive analyzing of diverse medicinal plants often used as antibacterial and healing agents from the country flora. The plant extracts were characterized by different methods such as totals of phenols and flavonoids content and UV-is spectroscopy. The highest amounts of the total phenolic and flavonoid contents, respectively, were recorded for Salvia officinalis. Moreover, the obtained films of poly(vinyl alcohol) (PVA) loaded with plant extracts were studied concerning the surface properties and their antibacterial or cytotoxicity activity. The Attenuated Total Reflection Fourier Transform Infrared analysis described the successfully incorporation of each plant extract in the poly(vinyl alcohol) matrix, while the profilometry demonstrated the enhanced surface properties. The results showed that the plant extracts conferred significant antibacterial effects to films toward Staphylococcus aureus and Escherichia coli and are not toxic against fibroblastic cells from the rabbit.

Neurogenic Interventions for Fear Memory via Modulation of the Hippocampal Function and Neural Circuits

Fear memory helps animals and humans avoid harm from certain stimuli and coordinate adaptive behavior. However, excessive consolidation of fear memory, caused by the dysfunction of cellular mechanisms and neural circuits in the brain, is responsible for post-traumatic stress disorder and anxiety-related disorders. Dysregulation of specific brain regions and neural circuits, particularly the hippocampus, amygdala, and medial prefrontal cortex, have been demonstrated in patients with these disorders. These regions are involved in learning, memory, consolidation, and extinction. These are also the brain regions where new neurons are generated and are crucial for memory formation and integration. Therefore, these three brain regions and neural circuits have contributed greatly to studies on neural plasticity and structural remodeling in patients with psychiatric disorders. In this review, we provide an understanding of fear memory and its underlying cellular mechanisms and describe how neural circuits are involved in fear memory. Additionally, we discuss therapeutic interventions for these disorders based on their proneurogenic efficacy and the neural circuits involved in fear memory.

Sex-Dependent Prescription Patterns and Clinical Outcomes Associated With the Use of Two Oral Cannabis Formulations in the Multimodal Management of Chronic Pain Patients in Colombia

To date, the therapeutic use of cannabinoids in chronic pain management remains controversial owing to the limited clinical evidence found in randomized clinical trials (RCTs), the heterogeneous nature of the clinical indication, and the broad range of cannabis-based medicinal products (CBMPs) used in both experimental and observational clinical studies. Here we evaluate patient-reported clinical outcomes (PROMS) in a cohort of adult patients, diagnosed with chronic pain of diverse etiology, who received adjuvant treatment with oral, cannabis-based, magistral formulations between May and September 2021 at the Latin American Institute of Neurology and Nervous System (ILANS-Zerenia) in Bogotá, Colombia. During this period, 2,112 patients completed a PROMS questionnaire aimed at capturing the degree of clinical improvement of their primary symptom and any potential side effects. Most participants were female (76.1%) with an average age of 58.7 years old, and 92.5% (1,955 patients) reported some improvement in their primary symptom (p < 0.001). Two monovarietal, full-spectrum, cannabis formulations containing either cannabidiol (CBD 30 mg/mL; THC <2 mg/mL) or a balanced composition (THC 12 mg/mL; CBD 14 mg/mL) accounted for more than 99% of all prescriptions (59.5 and 39.8%, respectively). The degree of improvement was similar between both formulations, although males reported less effectiveness in the first 4 weeks of treatment. Sex-specific differences were also found in prescription patterns, with male patients increasing the intake of the balanced chemotype overtime. For many patients (71.7%) there were no adverse side effects associated to the treatment and those most reported were mild, such as somnolence (13.0%), dizziness (8.1%) and dry mouth (4.2%), which also appeared to fade over time. Our results constitute the first real-world evidence on the clinical use of medicinal cannabis in Colombia and suggest that cannabis-based oral magistral formulations represent a safe and efficacious adjuvant therapeutic option in the management of chronic pain.

Does Cannabidiol Have a Benefit as a Supportive Care Drug in Cancer?

OPINION STATEMENT

Cannabinoids have been purported as having a wide range of therapeutic uses although currently, there is minimal evidence to support these claims. Patients with advanced cancer experience many distressing symptoms, with some turning to medicinal cannabis to help alleviate these. Focus has fallen on cannabidiol (CBD) as a potential treatment for a variety of symptoms in advanced cancer due to the lack of psychoactive side effects and the potential molecular mechanisms of action associated with this cannabinoid. Many cannabinoid products are easily available in the community, and more countries are legalizing or allowing over the counter products. Studies show that CBD is generally well tolerated, but there are many potential drug interactions that have not been well studied. Few studies have specifically looked at the role of CBD in treating cancer symptoms, with most focusing on combination cannabinoid products. There are currently many unknowns associated with CBD, including which symptoms it might be best for, appropriate dosing, and route of administration. This is especially important in advanced cancer where patients often have significant organ dysfunction and frailty that could impact on the pharmacology of CBD. A small pilot study has shown promise for a role of CBD in the psychological symptoms associated with advanced cancer. Further research is currently underway to further clarify the role of CBD in this setting and to understand how best it might help our patients. Currently we advocate that CBD be used in supervised clinical trials, so that efficacy and adverse effects can be closely monitored.

Cannabidiol and periodontal inflammatory disease: A critical assessment

Cannabidiol (CBD), a non-psychotropic cannabinoid produced by the genus Cannabis, is a phytoceutical that activates the endocannabinoid system (ECS) through binding to CB1 and CB2 receptors. The ECS is involved in cellular homeostasis and regulates metabolic processes in virtually all mammalian tissues. Published studies on CBD focus, inter alia, on its use in prophylaxis and as an anti-inflammatory agent. Here the authors present a critical assessment of the effects of CBD on inflammatory periodontal diseases caused by bacterial virulence factors, and evaluate critically the possible benefits and drawbacks of CBD use in dentistry. Particular attention is paid to the interaction of CBD with microbially colonized oral tissues, the inflammatory response in relation to the immune response, and the destruction/regeneration of hard and soft tissues of the periodontium.

Integrated Medical Cannabis Consultations in a Palliative Care Program: Policies, Procedures, and Progress after Six Years of Practice

Introduction: Our academic ambulatory palliative care program has counseled, monitored, and certified patients for cannabis as part of routine palliative care practice for six years. Objective: We describe the population certified for cannabis and policies, procedures, and medicolegal challenges in our palliative care clinic. Methods: We performed a retrospective review of patients, qualifying diagnoses for cannabis certification, reasons for referral, and number of annual certifications. Results: Between 2015 and 2021, we certified 1711 patients for cannabis. The most common indications were cancer (64%), pain (24%), and neuropathy (9%). Other three months in 2021, 28% of new referrals to our practice were certified for cannabis and 15% of patients were referred explicitly for cannabis certification. Conclusion: Despite legal and practical challenges to implementing a medical cannabis program, our palliative care program has fully integrated cannabis as part of our standard outpatient clinical practice.

Cannabidiol on the Path from the Lab to the Cancer Patient: Opportunities and Challenges

Cannabidiol (CBD), a major non-psychotropic component of cannabis, is receiving growing attention as a potential anticancer agent. CBD suppresses the development of cancer in both in vitro (cancer cell culture) and in vivo (xenografts in immunodeficient mice) models. For critical evaluation of the advances of CBD on its path from laboratory research to practical application, in this review, we wish to call the attention of scientists and clinicians to the following issues: (a) the biological effects of CBD in cancer and healthy cells; (b) the anticancer effects of CBD in animal models and clinical case reports; (c) CBD's interaction with conventional anticancer drugs; (d) CBD's potential in palliative care for cancer patients; (e) CBD's tolerability and reported side effects; (f) CBD delivery for anticancer treatment.

Anti-Microbial Activity of Phytocannabinoids and Endocannabinoids in the Light of Their Physiological and Pathophysiological Roles

Antibiotic resistance has become an increasing challenge in the treatment of various infectious diseases, especially those associated with biofilm formation on biotic and abiotic materials. There is an urgent need for new treatment protocols that can also target biofilm-embedded bacteria. Many secondary metabolites of plants possess anti-bacterial activities, and especially the phytocannabinoids of the Cannabis sativa L. varieties have reached a renaissance and attracted much attention for their anti-microbial and anti-biofilm activities at concentrations below the cytotoxic threshold on normal mammalian cells. Accordingly, many synthetic cannabinoids have been designed with the intention to increase the specificity and selectivity of the compounds. The structurally unrelated endocannabinoids have also been found to have anti-microbial and anti-biofilm activities. Recent data suggest for a mutual communication between the endocannabinoid system and the gut microbiota. The present review focuses on the anti-microbial activities of phytocannabinoids and endocannabinoids integrated with some selected issues of their many physiological and pharmacological activities.

Effects of Δ9-Tetrahydrocannibinol (THC) on Obesity at Different Stages of Life: A Literature Review

The Cannabis sativa plant has historically been used for both recreational and medical purposes. With the recent surge in recreational use of cannabis among adolescents and adults in particular, there is an increased obligation to determine the short- and long-term effects that consuming this plant may have on several aspects of the human psyche and body. The goal of this article was to examine the negative effects of obesity, and how the use of Δ9-tetrahydrocannibinol (THC) or cannabidiol (CBD) can impact rates of this global pandemic at different timepoints of life. Conflicting studies have been reported between adult and adolescents, as there are reports of THC use leading to increased weight due to elevated appetite and consumption of food, while others observed a decrease in overall body weight due to the regulation of omega-6/omega-3 endocannabinoid precursors and a decrease in energy expenditure. Studies supported a positive correlation between prenatal cannabis use and obesity rates in the children as they matured. The data did not indicate a direct connection between prenatal THC levels in cannabis and obesity rates, but that this development may occur due to prenatal THC consumption leading to low birthweight, and subsequent obesity. There are few studies using animal models that directly measure the effects that prenatal THC administration on obesity risks among offspring. Thus, this is a critical area for future studies using a developmental framework to examine potential changes in risk across development.

Storage Stability of Nutritional Qualities, Enzyme Activities, and Volatile Compounds of "Hangjiao No. 2" Chili Pepper Treated With Different Concentrations of 1-Methyl Cyclopropene

This study aimed to determine the effects of different concentrations of 1-methyl cyclopropene (1-MCP) on the nutritional quality, antioxidant enzyme activities, and volatile compounds of "Hangjiao No.2" chili pepper during 12 days of storage at ambient temperature. The chili fruit were randomly selected and divided into four groups corresponding to the four treatments, thus, 0.5, 1.0, and 1.5 μl L^-1 1-MCP and a control. The analysis of the nutritional value, enzyme activities, and volatile compounds were determined at 3 days interval. The results showed that the malondialdehyde (MDA) content was lower in the fruit treated with 1-MCP compared to the control. The treatment with 1.5 μl L^-1 and the control showed the lowest superoxide dismutase (SOD) activity compared to the other treatments. Peroxidase (POD) and Catalase (CAT) were highest in the fruit treated with 0.5 μl L^-1 compared to the control and treatment with 1.0 μl L^-1. The 1.5 μl L^-1 treatment delayed the decline in vitamin C and protein content compared to the control. Nitrate levels increased 1.34-fold at 0.5 μl L^-1 and 2.01-fold in the control. Chlorophyll content degradation was delayed at 1.0 μl L^-1 compared to the control. A total of 88 volatile compounds, including terpenes, aldehydes, alkanes, esters, alcohols, acids, phenolic derivatives, ketones, and other aromatic compounds, were detected in "Hangjiao No.2" pepper during the 12-day storage period and treatment concentrations. The production of volatile terpenes was higher in the control than in the 1-MCP treatments, while the 0.5 μl L^-1 1-MCP treatment generally suppressed the production of volatile compounds during storage. Overall, the production of volatile compounds after treatment was higher in the "Hangjiao No.2" chili fruit treated with 1.0 μl L^-1 1-MCP than in the other treatments throughout the storage period. The results indicate that 1-MCP treatment was more effective in maintaining fruit quality, enhancing the activities of SOD, POD, and CAT, retarding the accumulation of MDA and restoring volatile aromas, with 1.0 μl L^-1 having the best preservative effect on "Hangjiao No.2" chili fruit during storage, which could be useful for future marketing and processing.

Post-Harvest Operations to Generate High-Quality Medicinal Cannabis Products: A Systemic Review

The traditional Cannabis plant as a medicinal crop has been explored for many thousands of years. The Cannabis industry is rapidly growing; therefore, optimising drying methods and producing high-quality medical products have been a hot topic in recent years. We systemically analysed the current literature and drew a critical summary of the drying methods implemented thus far to preserve the quality of bioactive compounds from medicinal Cannabis. Different drying techniques have been one of the focal points during the post-harvesting operations, as drying preserves these Cannabis products with increased shelf life. We followed or even highlighted the most popular methods used. Drying methods have advanced from traditional hot air and oven drying methods to microwave-assisted hot air drying or freeze-drying. In this review, traditional and modern drying technologies are reviewed. Each technology will have different pros and cons of its own. Moreover, this review outlines the quality of the Cannabis plant component harvested plays a major role in drying efficiency and preserving the chemical constituents. The emergence of medical Cannabis, and cannabinoid research requires optimal post-harvesting processes for different Cannabis strains. We proposed the most suitable method for drying medicinal Cannabis to produce consistent, reliable and potent medicinal Cannabis. In addition, drying temperature, rate of drying, mode and storage conditions after drying influenced the Cannabis component retention and quality.

CRISPR-Cas gene editing technology and its application prospect in medicinal plants

The clustered regularly interspaced short palindromic repeats (CRISPR)-Cas gene editing technology has opened a new era of genome interrogation and genome engineering because of its ease operation and high efficiency. An increasing number of plant species have been subjected to site-directed gene editing through this technology. However, the application of CRISPR-Cas technology to medicinal plants is still in the early stages. Here, we review the research history, structural characteristics, working mechanism and the latest derivatives of CRISPR-Cas technology, and discussed their application in medicinal plants for the first time. Furthermore, we creatively put forward the development direction of CRISPR technology applied to medicinal plant gene editing. The aim is to provide a reference for the application of this technology to genome functional studies, synthetic biology, genetic improvement, and germplasm innovation of medicinal plants. CRISPR-Cas is expected to revolutionize medicinal plant biotechnology in the near future.

Cannabidiol and Other Phytocannabinoids as Cancer Therapeutics

Preclinical models provided ample evidence that cannabinoids are cytotoxic against cancer cells. Among the best studied phytocannabinoids, cannabidiol (CBD) is most promising for the treatment of cancer as it lacks the psychotomimetic properties of delta-9-tetrahydrocannabinol (THC). In vitro studies and animal experiments point to a concentration- (dose-)dependent anticancer effect. The effectiveness of pure compounds versus extracts is the subject of an ongoing debate. Actual results demonstrate that CBD-rich hemp extracts must be distinguished from THC-rich cannabis preparations. Whereas pure CBD was superior to CBD-rich extracts in most in vitro experiments, the opposite was observed for pure THC and THC-rich extracts, although exceptions were noted. The cytotoxic effects of CBD, THC and extracts seem to depend not only on the nature of cannabinoids and the presence of other phytochemicals but also largely on the nature of cell lines and test conditions. Neither CBD nor THC are universally efficacious in reducing cancer cell viability. The combination of pure cannabinoids may have advantages over single agents, although the optimal ratio seems to depend on the nature of cancer cells; the existence of a 'one size fits all' ratio is very unlikely. As cannabinoids interfere with the endocannabinoid system (ECS), a better understanding of the circadian rhythmicity of the ECS, particularly endocannabinoids and receptors, as well as of the rhythmicity of biological processes related to the growth of cancer cells, could enhance the efficacy of a therapy with cannabinoids by optimization of the timing of the administration, as has already been reported for some of the canonical chemotherapeutics. Theoretically, a CBD dose administered at noon could increase the peak of anandamide and therefore the effects triggered by this agent. Despite the abundance of preclinical articles published over the last 2 decades, well-designed controlled clinical trials on CBD in cancer are still missing. The number of observations in cancer patients, paired with the anticancer activity repeatedly reported in preclinical in vitro and in vivo studies warrants serious scientific exploration moving forward.

Cannabis Cultivation Facilities: A Review of Their Air Quality Impacts from the Occupational to Community Scale

This review addresses knowledge gaps in cannabis cultivation facility (CCF) air emissions by synthesizing the peer-reviewed and gray literature. Focus areas include compounds emitted, air quality indoors and outdoors, odor assessment, and the potential health effects of emitted compounds. Studies suggest that β-myrcene is a tracer candidate for CCF biogenic volatile organic compounds (BVOCs). Furthermore, β-myrcene, d-limonene, terpinolene, and α-pinene are often reported in air samples collected in and around CCF facilities. The BVOC emission strength per dry weight of plant is higher than most conventional agriculture crops. Nevertheless, reported total CCF BVOC emissions are lower compared with VOCs from other industries. Common descriptors of odors coming from CCFs include "skunky", "herbal", and "pungent". However, there are few peer-reviewed studies addressing the odor impacts of CCFs outdoors. Atmospheric modeling has been limited to back trajectory models of tracers and ozone impact assessment. Health effects of CCFs are mostly related to odor annoyance or occupational hazards. We identify 16 opportunities for future studies, including an emissions database by strain and stage of life (growing cycle) and odor-related setback guidelines. Exploration and implementation of key suggestions presented in this work may help regulators and the industry reduce the environmental footprint of CCF facilities.

Trends and characteristics of cannabis-associated emergency department visits in the United States, 2006-2018

BACKGROUND

Cannabis policies are rapidly changing in the United States, yet little is known about how this has affected cannabis-associated emergency department (ED) visits.

METHODS

We studied trends in cannabis-associated ED visits and identified differences by visit characteristics. Cannabis-associated ED visits from 2006 to 2018 were identified from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project's (HCUP) Nationwide Emergency Department Sample (NEDS). JoinPoint analysis was used to identify trends from 2006 to 2014, prior to medical coding changes in 2015, and Z-tests were used to compare annual rate changes from 2016 to 2018. Changes in rates from 2017 to 2018 were examined by visit characteristics.

RESULTS

From 2006-2014, the rate of cannabis-associated ED visits increased, on average, 12.1% annually (p < 0.05), from 12.3 to 34.7 visits per 100,000 population. The rate increased 17.3% from 2016 to 2017 (p < 0.05) and 11.1% from 2017 to 2018 (p < 0.05). From 2017-2018, rates of visits increased for both males (8.7%; p < 0.05) and females (15.9%; p < 0.05). Patients 0-14 years and 25 years and older had significant rate increases from 2017 to 2018 as did the Midwest region (36.8%; p < 0.05), the Northeast (9.2%; p < 0.05), and the South (4.5%; p < 0.05).

CONCLUSIONS

Cannabis-associated ED visits are on the rise and subgroups are at increased risk. Some potential explanations for increases in cannabis-associated ED visits include increased availability of cannabis products, increased use, and diversity of products available in marketplaces. Strategies are needed to prevent youth initiation, limit potentially harmful use among adults, and ensure safe storage where cannabis use is legal.

Longitudinal associations of emerging adults' drinking trajectories with their behavior, health, education and work outcomes 1, 4, and 9 years later

BACKGROUND

To characterize emerging adults' drinking trajectories and their prospective association with later behavior, health, education, and work outcomes in later young adulthood.

METHODS

This study used a selected cohort (N = 1622) from rounds 3-10 (aged 18-25), 11 (aged 26), 14 (aged 29), and 17 (aged 34) of the US National Longitudinal Survey of Youth 1997. Latent class growth modeling was used to identify trajectories of drinking (days ≥1 drink in the last 30 days) during emerging adulthood (aged 18-25) using data from rounds 3-10. Multinomial and linear regressions compared identified trajectory classes to outcomes measured 1, 4, and 9 years later. Covariates included sex, race, and urbanicity.

RESULTS

Six drinking trajectories were identified: Abstainers (28.42%), Moderate Increasers (24.78%), Light Experimenters (11.96%), Heavy Experimenters (9.86%), Escalators (17.26%), and Heavy Users (7.71%). Compared to abstainers, emerging adults in other classes had significantly (p < .05 to.001) higher odds of binge drinking, smoking, and marijuana use at later rounds. Compared to abstainers, escalators had significantly higher education and income later. No significant difference in physical or mental health was found.

CONCLUSION

Drinking behaviors formed during emerging adulthood continue into later lifetime periods in adulthood. The experimenters shifted their drinking behaviors to greater smoking and marijuana use, while heavy users supplemented their drinking behavior. Interventions in emerging adulthood (particularly ages 19-21), the period when individuals are becoming more independent but malleable, may mitigate adverse effects of alcohol overuse and improve later life behaviors and career outcomes.

Biocontrol Activity of Bacillus spp. and Pseudomonas spp. Against Botrytis cinerea and Other Cannabis Fungal Pathogens

Gray mold caused by Botrytis cinerea is one of the most widespread and damaging diseases in cannabis crops worldwide. With challenging restrictions on pesticide use and few effective control measures, biocontrol agents are needed to manage this disease. The aim of this study was to identify bacterial biocontrol agents with wide-spectrum activity against B. cinerea and other cannabis fungal pathogens. Twelve Bacillus and Pseudomonas strains were first screened with in vitro confrontational assays against 10 culturable cannabis pathogens, namely B. cinerea, Sclerotinia sclerotiorum, Fusarium culmorum, F. sporotrichoides, F. oxysporum, Nigrospora sphaerica, N. oryzae, Alternaria alternata, Phoma sp., and Cercospora sp. Six strains displaying the highest inhibitory activity, namely Bacillus velezensis LBUM279, FZB42, LBUM1082, Bacillus subtilis LBUM979, P. synxantha LBUM223, and P. protegens Pf-5, were further assessed in planta where all, except LBUM223, significantly controlled gray mold development on cannabis leaves. Notably, LBUM279 and FZB42 reduced disease severity by at least half compared with water-treated plants and prevented lesion development and/or sporulation up to 9 days after pathogen inoculation. Genomes of LBUM279, LBUM1082, and LBUM979 were sequenced de novo and taxonomic affiliations were determined to ensure nonrelatedness with pathogenic strains. Moreover, the genomes were exempt of detrimental genes encoding major toxins and virulence factors that could otherwise pose a biosafety risk when used on crops. Eighteen gene clusters of potential biocontrol interest were also identified. To our knowledge, this is the first reported attempt to control cannabis fungal diseases in planta by direct antagonism with beneficial bacteria.

Adherence, Safety, and Effectiveness of Medical Cannabis and Epidemiological Characteristics of the Patient Population: A Prospective Study

Background

Despite the absence of rigorous prospective studies, there has been an increase in the use of cannabis-based medicinal products. During the study period, the use of medical cannabis in Israel was tightly regulated by national policy. Through a prospective study of approximately 10,000 patients, we aimed to characterize the medical cannabis patient population as well as to identify treatment adherence, safety, and effectiveness.

Methods and Findings

In this study of prescribed medical cannabis patients, adherence, safety, and effectiveness were assessed at 6 months. Treatment adherence was assessed by the proportion of patients purchasing the medication out of the total number of patients (excluding deceased cases and patients transferred to another cannabis clinic). Safety was assessed by the frequency of the side-effects, while effectiveness was defined as at least moderate improvement in the patient condition without treatment cessation or serious side-effects. The most frequent primary indications requiring therapy were cancer (49.1%), followed by non-specific pain (29.3%). The average age was 54.6 ± 20.9 years, 51.1% males; 30.2% of the patients reported prior experience with cannabis. During the study follow-up, 1,938 patients died (19.4%) and 1,735 stopped treatment (17.3%). Common side-effects, reported by 1,675 patients (34.2%), were: dizziness (8.2%), dry mouth (6.7%), increased appetite (4.7%), sleepiness (4.4%), and psychoactive effect (4.3%). Overall, 70.6% patients had treatment success at 6 months. Multivariable logistic regression analysis revealed that the following factors were associated with treatment success: cigarette smoking, prior experience with cannabis, active driving, working, and a young age. The main limitation of this study was the lack of data on safety and effectiveness of the treatment for patients who refused to undergo medical assessment even at baseline or died within the first 6 months.

Conclusions

We observed that supervised medical-cannabis treatment is associated with high adherence, improvement in quality of life, and a decrease in pain level with a low incidence of serious adverse events.

Classification of Various Marijuana Varieties by Raman Microscopy and Chemometrics

The Raman analysis of marijuana is challenging because of the sample's easy photo-degradation caused by the laser intensity. In this study, optimization of collection parameters and laser focusing on marijuana trichome heads allowed collecting Raman spectra without damaging the samples. The Raman spectra of Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabinol (CBN) standard cannabinoids were compared with Raman spectra of five different types of marijuana: four Sativa varieties (Amnesia Haze, Amnesia Hy-Pro, Original Amnesia, and Y Griega) and one Indica variety (Black Domina). The results verified the presence of several common spectral bands that are useful for marijuana characterization. Results were corroborated by the quantum chemical simulated Raman spectra of their acid-form (tetrahydrocannabinol acid (THCA), cannabidiol acid (CBDA)) and decarboxylated cannabinoids (THC, CBD, and CBN). A chemometrics-assisted method based on Raman microscopy and OPLS-DA offered good classification among the different marijuana varieties allowing identification of the most significant spectral bands.

Specific Way of Controlling Composition of Cannabinoids and Essential Oil from Cannabis sativa var. Finola

Recently, a series of papers reported preparation and physicochemical properties of various kinds of water treated in contact with various gases with low-temperature, low-pressure glow plasma of low frequency (LPGP). Consecutive papers presented results of watering numerous herbal plants with those kinds of water in planting of numerous herbal plants. Always, the watering influenced the yield and quality of the crops and considerably changed the composition of the essential oils extracted from the watered plants. This paper provides the effects of watering of Cannabis sativum var. Finola with water LPGP-treated either in the air (LPGPA), under molecular nitrogen (LPGPN) or carbon dioxide (LPGPC). Cannabis sativa, particularly its botanic class called hemp, attracts great attention for its numerous applications. They include rope, textiles, clothing, shoes, food, paper, bioplastics, insulation, biofuel and industrial fibre. The watering was maintained for 12 weeks. Regardless of the kind of the used plasma-treated water, a considerable increase in the plant crop yield was noted for first 7 weeks. Further cultivation resulted in a minute increase in the yield. The watering with LPGPC offered the highest crop yield, followed by nontreated water, LPGPN and LPGPA. The yield of essential oil per 1 g of plant was independent of the used kind of plasma-treated water. Watering Finola with LPGPA resulted in a decrease in the level of cannabidivarin (CBD V) and considerable increase in the deal of Δ 9-tetrahydrocannabinol (Δ9-THC). The levels of the remaining components of the essential oil slightly decreased with respect to that in the control sample. Almost identical trends in the influence of watering upon the composition of essential oil were observed in the case of LPGPN. However, an unusually strong decrease in the level of CBD V accompanied by a very high increase in the level of Δ9-THC could be noted. The performed study provided strong evidence that watering seeds and plants of Finola with various kinds of the LPGP-treated water could modulate and even tailor the crop yield, functional properties of the plant and essential oils extracted from it. The composition of the essential oil isolated from the plant watered with LPGPN suggests its application as a substitute of medical marijuana (medical cannabis).

Cannabis, cannabidiol and tetrahydrocannabinol in sport: An overview

The World Antidoping Agency now allows cannabidiol (CBD) to be taken in elite sport but has retained all other cannabinoids on its banned list. This, together with liberalisation of cannabis laws have led to an increasing interest in its use in sport. This includes commercial sponsorship of sporting events and highlights the need for accurate information to be readily available to athletes and their advisers. This narrative review confirms that CBD and tetrahydrocannabinol (THC) do not enhance performance. CBD possesses anti-inflammatory and analgesic properties which have not been adequately evaluated in the area of sport. Some formulations of CBD contain THC or other cannabinoids that may result in a positive drug test. This article is protected by copyright. All rights reserved.

Hallucinogenic drugs and their potential for treating fear-related disorders: Through the lens of fear extinction

Fear-related disorders, mainly phobias and post-traumatic stress disorder, are highly prevalent, debilitating disorders that pose a significant public health problem. They are characterized by aberrant processing of aversive experiences and dysregulated fear extinction, leading to excessive expression of fear and diminished quality of life. The gold standard for treating fear-related disorders is extinction-based exposure therapy (ET), shown to be ineffective for up to 35% of subjects. Moreover, ET combined with traditional pharmacological treatments for fear-related disorders, such as selective serotonin reuptake inhibitors, offers no further advantage to patients. This prompted the search for ways to improve ET outcomes, with current research focused on pharmacological agents that can augment ET by strengthening fear extinction learning. Hallucinogenic drugs promote reprocessing of fear-imbued memories and induce positive mood and openness, relieving anxiety and enabling the necessary emotional engagement during psychotherapeutic interventions. Mechanistically, hallucinogens induce dynamic structural and functional neuroplastic changes across the fear extinction circuitry and temper amygdala's hyperreactivity to threat-related stimuli, effectively mitigating one of the hallmarks of fear-related disorders. This paper provides the first comprehensive review of hallucinogens' potential to alleviate symptoms of fear-related disorders by focusing on their effects on fear extinction and the underlying molecular mechanisms. We overview both preclinical and clinical studies and emphasize the advantages of hallucinogenic drugs over current first-line treatments. We highlight 3,4-methylenedioxymethamphetamine and ketamine as the most effective therapeutics for fear-related disorders and discuss the potential molecular mechanisms responsible for their potency with implications for improving hallucinogen-assisted psychotherapy.

Cannabis-Based Products for the Treatment of Skin Inflammatory Diseases: A Timely Review

The use of natural products in dermatology is increasingly being pursued due to sustainability and ecological issues, and as a possible way to improve the therapeutic outcome of chronic skin diseases, relieving the burden for both patients and healthcare systems. The legalization of cannabis by a growing number of countries has opened the way for researching the use of cannabinoids in therapeutic topical formulations. Cannabinoids are a diverse class of pharmacologically active compounds produced by Cannabis sativa (phytocannabinoids) and similar molecules (endocannabinoids, synthetic cannabinoids). Humans possess an endocannabinoid system involved in the regulation of several physiological processes, which includes naturally-produced endocannabinoids, and proteins involved in their transport, synthesis and degradation. The modulation of the endocannabinoid system is a promising therapeutic target for multiple diseases, including vascular, mental and neurodegenerative disorders. However, due to the complex nature of this system and its crosstalk with other biological systems, the development of novel target drugs is an ongoing challenging task. The discovery of a skin endocannabinoid system and its role in maintaining skin homeostasis, alongside the anti-inflammatory actions of cannabinoids, has raised interest in their use for the treatment of skin inflammatory diseases, which is the focus of this review. Oral treatments are only effective at high doses, having considerable adverse effects; thus, research into plant-based or synthetic cannabinoids that can be incorporated into high-quality, safe topical products for the treatment of inflammatory skin conditions is timely. Previous studies revealed that such products are usually well tolerated and showed promising results for example in the treatment of atopic dermatitis, psoriasis, and contact dermatitis. However, further controlled human clinical trials are needed to fully unravel the potential of these compounds, and the possible side effects associated with their topical use.

Hemp Genome Editing-Challenges and Opportunities

Hemp (Cannabis sativa L.) is a multipurpose crop with many important uses including medicine, fibre, food and biocomposites. This plant is currently gaining prominence and acceptance for its valuable applications. Hemp is grown as a cash crop for its novel cannabinoids which are estimated to be a multibillion-dollar downstream market. Hemp cultivation can play a major role in carbon sequestration with good CO2 to biomass conversion in low input systems and can also improve soil health and promote phytoremediation. The recent advent of genome editing tools to produce non-transgenic genome-edited crops with no trace of foreign genetic material has the potential to overcome regulatory hurdles faced by genetically modified crops. The use of Artificial Intelligence - mediated trait discovery platforms are revolutionizing the agricultural industry to produce desirable crops with unprecedented accuracy and speed. However, genome editing tools to improve the beneficial properties of hemp have not yet been deployed. Recent availability of high-quality Cannabis genome sequences from several strains (cannabidiol and tetrahydrocannabinol balanced and CBD/THC rich strains) have paved the way for improving the production of valuable bioactive molecules for the welfare of humankind and the environment. In this context, the article focuses on exploiting advanced genome editing tools to produce non-transgenic hemp to improve the most industrially desirable traits. The challenges, opportunities and interdisciplinary approaches that can be adopted from existing technologies in other plant species are highlighted.

Immigrants, refugees and cannabis use

Immigration typically occurs from low- to high-income countries and regions. Unfortunately, these wealthier areas also have higher rates of cannabis use (e.g. European Union and the US). This systematic review aimed to summarize available studies on cannabis use among immigrants, refugees, and asylum seekers. In addition, evidence on the association between immigration and cannabis use was reviewed. The rates of cannabis use were lower among immigrants than natives. The risk and protective factors to cannabis use were quite similar to those of the native populations. The population at greatest risk for cannabis use were refugees, males, singles, non-religious, those with lower educational level, living in urban areas, with friends that use cannabis and/or other drugs. Cannabis use tend to increase over generations, and acculturation seems to play a pivotal role. First generation migrants report equal or lower consumption of cannabis when compared with the majority population with a subsequent increase in following generations, with a clear association with acculturation factors. A higher cannabis use was found among migrants with lower cultural congruity as well as a higher level of culture assimilation. This use seems to be unrelated to alcohol or illicit drugs consumption, but possibly associated with tobacco smoking.

Perspectives and Pitfalls in Potency Testing of Cannabinoids by High Performance Liquid Chromatography (HPLC)

Cannabis products have been recently legalized in many countries for recreational or medicinal use. Therefore, rigorous analytical methods to test the potency of samples is required prior to commercialization. In addition, growing interest in the properties of minor cannabinoids has increased the demand for high-throughput methods that can separate the largest number of compounds in the shortest amount of time. High performance liquid chromatography (HPLC) is emerging as the preferred analytical method for potency testing of cannabinoids, but more fundamental work is needed to solve critical issues and contribute to advancing knowledge.

Increasing Access to Safe Medical Cannabis: Establishment of a Medical Cannabis Program in a Safety-Net Academic Medical Center

Despite numerous challenges, Montefiore Medical Center in New York City implemented a program aimed at providing comprehensive, evidence-based medical cannabis certifications to patients, including those who have been historically disenfranchised, and shares insights from five years of operation.

A scoping review of the use of cannabidiol in psychiatric disorders

Cannabidiol (CBD) has become a fast-growing avenue for research in psychiatry, and clinicians are challenged with understanding the implications of CBD for treating mental health disorders. The goal of this review is to serve as a guide for mental health professionals by providing an overview of CBD and a synthesis the current evidence within major psychiatric disorders. PubMed and PsycINFO were searched for articles containing the terms "cannabidiol" in addition to major psychiatric disorders and symptoms, yielding 2952 articles. Only randomized controlled trials or within-subject studies investigating CBD as a treatment option for psychiatric disorders (N = 16) were included in the review. Studies were reviewed for psychotic disorders (n = 6), anxiety disorders (n = 3), substance use disorders (tobacco n = 3, cannabis n = 2, opioid n = 1), and insomnia (n = 1). There were no published studies that met inclusion criteria for alcohol or stimulant use disorder, PTSD, ADHD, autism spectrum disorder, or mood disorders. Synthesis of the CBD literature indicates it is generally safe and well tolerated. The most promising preliminary findings are related to the use of CBD in psychotic symptoms and anxiety. There is currently not enough high-quality evidence to suggest the clinical use of CBD for any psychiatric disorder.

Potential Mechanisms Underlying Marijuana-Associated Periodontal Tissue Destruction

While definitive evidence awaits, cannabis is emerging as a likely risk factor for periodontal tissue destruction. The mechanisms that underlie potential cannabis-induced or cannabis-enhanced periodontal diseases, however, remain to be elucidated. Herein, we 1) examine insights obtained from the endocannabinoid system, 2) summarize animal models of exposure to cannabinoid receptor agonists and antagonists, 3) review the evidence suggesting that cannabis and cannabis-derived molecules exert a profound influence on components of the oral microbiome, and 4) assess studies indicating that marijuana and phytocannabinoids compromise the immune response to plaque. Furthermore, we address how knowledge of cannabinoid influences in the oral cavity may be exploited to provide potential novel periodontal therapeutics, while recognizing that such medicinal approaches may be most appropriate for nonhabitual marijuana users. The suspected increase in susceptibility to periodontitis in marijuana users is multifaceted, and it is clear that we are only beginning to understand the complex toxicological, cellular, and microbial interactions involved. With marijuana consumption increasing across all societal demographics, periodontal complications of use may represent a significant, growing oral health concern. In preparation, an enhanced research response would seem appropriate.

Penile self-amputation due to cannabis-induced psychosis: a case report

Background

In recent decades, cannabis has been widely used around the world for medical and recreational purposes, both legally and illegally. Aside from its therapeutic benefits, cannabis exhibits many adverse effects. Psychosis is one of the potentially harmful effects of cannabis.

Case presentation

A 23-year-old Thai man, who reported cannabis use for 2 years and discontinued for 3 months, restarted smoking two bongs (2 g equivalence) of cannabis. Two hours later, he had a penile erection, felt a severe persistent sharp pain in his penis, and reported that his glans looked distorted. Intending to eradicate the pain, he decided to trim the penile skin several times and completely amputated his penis himself using scissors. Cannabis-induced psychosis was diagnosed because symptoms began after cannabis use, without evidence of other substance abuse. To confirm the cannabis exposure, his urine immunoassay was positive for delta-9-tetrahydrocannabinol (Δ9-THC). The distal penis was deemed too dirty and fragile for reconstruction. Bleeding was controlled, penile stump irrigated and debrided, and scrotal urethrostomy was performed by a urologist. After admission and cannabis discontinuation, his delusion and hallucination subsided.

Conclusions

Cannabis-induced psychosis is an adverse effect of cannabis, which may lead to impaired judgement unexpected self-harm. A multidisciplinary team approach, including a primary care physician, an emergency physician, a urologist, and a psychiatrist, is essential when dealing with a patient with cannabis-induced psychosis and a urogenital injury.

Therapeutic Potential of Cannabis, Cannabidiol, and Cannabinoid-Based Pharmaceuticals

<b><i>Background:</i></b> There is a growing interest in the use of cannabis (and its extracts), as well as CBD oil (hemp extracts containing cannabidiol), for therapeutic purposes. While there is reason to believe that cannabinoids may be efficacious for a number of different diseases and syndromes, there exist limited objective data supporting the use of crude materials (CBD oil, cannabis extracts, and/or cannabis itself). <b><i>Summary:</i></b> In the present review, we examined data for pure cannabinoid compounds (dronabinol, nabilone, and CBD), as well as partially purified medicinal cannabis extracts (nabiximols), to provide guidance on the potential therapeutic uses of high-THC cannabis and CBD oil. In general, data support a role for cannabis/cannabinoids in pain, seizure disorders, appetite stimulation, muscle spasticity, and treatment of nausea/vomiting. Given the biological activities of the cannabinoids, there may be utility in treatment of central nervous system disorders (such as neurodegenerative diseases, PTSD, and addiction) or for the treatment of cancer. However, those data are much less compelling. <b><i>Key Message:</i></b> On balance, there are reasons to support the potential use of medical cannabis and cannabis extract (Δ⁹-THC-dominant or CBD-dominant), but much more careful research is required.

Industry-Based Misconceptions Regarding Cross-Pollination of Cannabis spp

Cross-pollination of commercial crops has been an ongoing issue in many species. Cannabis spp. encompasses the classifications of marijuana [high in Δ9-tetrahydrocannabinol (THC)] and hemp (below 0.3% THC). As such, cannabis is the most recent crop facing the dilemma of cross-pollination and is leading to litigation. These litigations are driven by the large misunderstanding of the impacts of cross-pollination within the cannabis industry. The misconception is that if hemp is cross-pollinated by high THC cannabis, the hemp will become "hot" (high in THC) thereby rendering the crop illegal under the 2018 Farm Bill. However, there are many factors that contribute to the amount of THC a plant may produce. This article examines and refutes the misconception of cross-pollination increasing THC levels by highlighting several methods of how THC may become high in a given hemp crop.

Ethical perspectives of certified public accountants and the cannabis industry

Background

Certified public accountants must follow very high standards of ethical conduct as set forth by the AICPA Code of Professional Conduct and individual state licensing requirements. A 2019 grounded theory qualitative study posed that CPAs remain largely hesitant to serve the cannabis industry primarily because they fear federal prosecution as long as cannabis remains on the DEA’s Schedule I Drug List. The purpose of this research was to determine the perceptions of CPAs regarding providing accounting services to the cannabis industry in states that have legalized cannabis usage. This study investigated whether CPAs would serve the industry, why they might decline to serve the industry, what risks they believe serving the industry posed, and whether they believe serving the cannabis industry would create a moral or ethical issue.

Methods

This follow-up quantitative study investigated a small convenience sample of approximately one hundred CPAs in Colorado and Washington to learn more about their perceptions of serving the cannabis industry. Data was analyzed using chi-square and Mann-Whitney U tests to determine if there were any differences in perceptions between groups such as states, gender, and age categories.

Results

Of the participants, 77% responded that neither they nor their firm provided services to a cannabis-related business client compared to 23% that did serve cannabis clients. More Colorado CPAs were willing to turn down CRB work than were expected and fewer Colorado CPAs would be willing to take on CRB clients than were expected. While in Washington, fewer CPAs would turn down RB clients than expected, and more are willing to accept CRB clients than were expected. The risk due to potential liability coverage issues due to serving the cannabis industry was rated the highest while the risk of losing the CPA license was rated lowest. Data indicated that there was not a statistically significant difference between Colorado and Washington participants related to whether they were morally or religiously opposed to working in the industry or if they viewed serving the industry as an ethical violation.

Conclusion

CPAs remain largely unwilling to serve the cannabis industry primarily because CPAs fear federal prosecution as long as cannabis remains on the DEA’s Schedule I Drug Listing. The results of this study indicate that while most CPAs are not morally or religiously opposed to serving the industry, about half still believe doing so may constitute an ethical violation for a CPA.