Association Between Marijuana Use and Risk of Cancer: A Systematic Review and Meta-analysis

Disparities in use modalities among adults who currently use cannabis, 2022-2023

PURPOSE

Following the legalization of cannabis in several U.S. states, the cannabis market has expanded, leading to a wider range of products including smoked, edible, and vape products which have variable health effects. This proliferation highlights the need for more research on patterns of current cannabis use among U.S. adults.

METHODS

We used combined data on adults who currently use (i.e., past 30-day use) cannabis (n = 16,999) from the 2022 and 2023 National Survey on Drug Use and Health. We analyzed whether seven cannabis use modalities including smoking, vaping, dabbing, consuming edibles, taking pills, applying topicals, and absorbing sublingually/orally varied by age, sex, race and ethnicity, sexual orientation, education, income, geographic location, and state medical cannabis laws status by generating weighted proportion estimates and conducting multivariable logistic regression. Additionally, in a subanalysis, we examined differences in blunt use among U.S. adults who reported current cannabis use (n = 12,355), employing similar methods to explore associations with demographic and socioeconomic factors.

RESULTS

Among adults who currently use cannabis, smoking was the most common cannabis use method (77.33%), followed by edibles (37.31%), vaping (34.75%), dabbing (15.01%), applying topicals (5.93%), absorbing sublingually/orally (4.53%), and taking pills (2.11%). Edibles were popular among adults aged 35-49 years (29.57%), whereas vaping was most common among young adults aged 18-25 years (29.80%). Females (vs. males) had lower odds of smoking cannabis (OR: 0.65; 95% CI: 0.57-0.75) and higher odds of applying topicals (OR: 2.92; 95% CI: 2.23-3.83). Non-Hispanic Black (vs. non-Hispanic White) respondents had higher odds of smoking cannabis (OR: 2.03; 95% CI: 1.51-2.74) and lower odds of consuming edibles (OR: 0.66; 95% CI: 0.56-0.77). Adults aged 50 + years (vs. 18-25) had greater odds of absorbing sublingually/orally (OR: 2.45; 95% CI: 1.59-3.76). In the subanalysis, we found that Non-Hispanic Black (vs. non-Hispanic White) adults had higher odds of blunt use (OR: 5.31; 95% CI: 4.23-6.65).

CONCLUSIONS

Use modality disparities among adults who currently use cannabis highlight the need for tailored public health education and interventions, given the distinct health risks associated with each method of use.

Outcomes of cannabis smoking in patients with lung cancer: findings from KBP-CPHG-2020

INTRODUCTION

Cannabis smoking is suspected to be a risk factor for lung cancer. The KBP-2020-CPHG study is a prospective study that collected data from all patients with newly diagnosed lung cancer in non-academic hospitals in France in 2020.

METHOD

We conducted comparative and matched cohort analyses using the dataset, in which cannabis smokers (i.e. participants who self-declared a lifetime intake of ≥20 joints) were compared with tobacco-only smokers. After matching on confounders, we compared age at diagnosis and overall survival.

RESULTS

Among 8999 patients, 314 (3.6%) were cannabis smokers and 7372 were tobacco-only smokers (data missing for 183). Cannabis smokers were younger than tobacco-only smokers at lung cancer diagnosis (mean [± standard deviation] 52.9 [±8.84] versus 67.7 [±9.51] years; p<0.0001), and this difference remained in the paired analysis (matched for histology, sex and cigarette pack-years [±5 pack-years]; n = 298 pairs; median age at diagnosis 53.1 vs 64.8 years; hazard ratio 5.61, 95% CI 4.10-7.68; p<0.0001). Histological type was also different between the two groups, with more cases of adenocarcinoma and large cell neuroendocrine carcinoma among cannabis smokers. Finally, a 1:1 matched analysis controlled for age, sex, stage, histology and cigarette pack-years showed that overall survival was not affected by cannabis smoking (HR 0.90, 95% CI 0.68-1.18; p = 0.44).

CONCLUSION

We provide a detailed description of lung cancer characteristics among cannabis smokers compared with tobacco-only smokers. Cannabis smoking appeared to be associated with lung cancer diagnosis at an earlier age and was not a prognostic factor for mortality.

Cannabis smoking is associated with persistent epigenome-wide disruptions despite smoking cessation

BACKGROUND

The use of cannabis has been associated with both therapeutic and harmful effects. As with cigarette smoking, cannabis smoking may affect the epigenetic regulation (e.g., DNA methylation) of gene expression which could result in long term health effects. The study of DNA methylation in cannabis smoking has to date been restricted to young adults and there remains yet no evaluation of whether cannabis smoking cessation can reverse epigenetic disturbances. Here, we aimed to investigate the relationship between genome-wide DNA methylation and cannabis smoking.

METHODS

We used peripheral blood from a subset of older adults within the Canadian Cohort of Obstructive Lung Disease (CanCOLD) cohort (n = 93) to conduct an epigenome-wide DNA methylation analysis that identified differential methylated positions (DMPs) associated with cannabis smoking at a false discovery rate < 0.05. Using these DMPs, we then identified differentially methylated genes (DMGs) that enriched pathways associated with both former and current cannabis smoking status.

RESULTS

We found DMPs corresponding to 12,115 DMGs and 10,806 DMGs that distinguished the current and former cannabis smoking groups, respectively, from the never cannabis smoking group. 5,915 of these DMGs were shared between the current and former cannabis smoking groups. 50 enriched pathways were also shared between the current and former cannabis smoking groups, which were heavily represented by multiple aging- and cancer-related pathways.

CONCLUSIONS

Our findings indicate that in older adults, cannabis smoking is linked with epigenome-wide disruptions, many of which persist despite cannabis smoking cessation. Epigenetic modulation of genes associated with aging and cancer that remains even after quitting cannabis should serve as a caution that there may be long-lasting epigenetic injury with cannabis smoking.

TRIAL REGISTRATION

NCT00920348.

Cannabis or Cannabinoids for the Management of Chronic Noncancer Pain: Best Practice Advice From the American College of Physicians

DESCRIPTION

The American College of Physicians' Population Health and Medical Science Committee (PHMSC) developed this best practice advice to inform clinicians about what is currently known about the benefits and harms of cannabis or cannabinoids in the management of chronic noncancer pain and to provide advice for clinicians counseling patients seeking this therapy.

METHODS

The PHMSC considers areas where evidence is uncertain or emerging or practice does not follow the evidence to provide clinical advice based on a review and assessment of scientific work, including systematic reviews and individual studies. Sources of evidence included a living systematic review on cannabis and cannabinoid treatments for chronic noncancer pain and a series of living systematic reviews and primary studies.

BEST PRACTICE ADVICE 1A

Clinicians should counsel patients about the benefits and harms of cannabis or cannabinoids when patients are considering whether to start or continue to use cannabis or cannabinoids to manage their chronic noncancer pain.

BEST PRACTICE ADVICE 1B

Clinicians should counsel the following subgroups of patients that the harms of cannabis or cannabinoid use for chronic noncancer pain are likely to outweigh the benefits: young adult and adolescent patients, patients with current or past substance use disorder, patients with serious mental illness, and frail patients and those at risk for falling.

BEST PRACTICE ADVICE 2

Clinicians should advise against starting or continuing to use cannabis or cannabinoids to manage chronic noncancer pain in patients who are pregnant or breastfeeding or actively trying to conceive.

BEST PRACTICE ADVICE 3

Clinicians should advise patients against the use of inhaled cannabis to manage chronic noncancer pain.

Decoding the genetic links between substance use disorder and cancer vulnerability

OBJECTIVE

Cancer remains a leading cause of mortality and morbidity worldwide, imposing a significant public health burden. While cannabis and opioids are widely used in cancer pain management, their potential for abuse and addiction has raised concerns regarding their long-term health effects, including possible associations with cancer risk. However, the relationship between substance use disorders (SUDs) and cancer susceptibility remains controversial. This Mendelian randomization (MR) study aimed to investigate the potential causal effects of cannabis use disorder (CUD) and opioids use disorder (OUD) on cancer vulnerability.

METHODS

We conducted a two-sample MR study using summary statistics from genome-wide association studies, including data from FinnGen and UK Biobank. The primary analytical approach was the inverse-variance weighted (IVW), complemented by a range of sensitivity analyses to assess the robustness of the findings.

RESULTS

IVW analysis identified a causal association between OUD and bladder cancer (OR = 1.040, 95% CI 1.004-1.078, P = 0.029, adj. P = 0.125), acute myeloid leukemia (OR = 0.931, 95% CI 0.885-0.978, P = 0.005, adj. P = 0.061) and ovarian cancer (OR = 0.937, 95% CI 0.891-0.984, P = 0.010, adj. P = 0.064). Sensitivity analysis yielded directionally consistent results. Reverse MR analysis provided no statistically significant evidence supporting a causal effect of these cancers on OUD (all P > 0.05). Additionally, no evidence of a significant causal relationship was observed between CUD and any cancer type (P > 0.05).

CONCLUSIONS

This study suggests a potential causal link between OUD and increased susceptibility to bladder cancer, acute myeloid leukemia, and ovarian cancer, warranting further investigation in larger, multi-ethnic population studies. These results contribute to the ongoing discourse on the long-term health impacts of substance use disorders and highlight the need for further research to elucidate their potential oncogenic effects.

Disparities in use modalities among adults who currently use cannabis, 2022-2023

Purpose: Following the legalization of cannabis in several U.S. states, the cannabis market has expanded, leading to a wider range of products including smoked, edible, and vape products which have variable health effects. This proliferation highlights the need for more research on patterns of current cannabis use among U.S. adults. Methods: We used combined data on adults who currently use (i.e., past 30-day use) cannabis (n=16,999) from the 2022 and 2023 National Survey on Drug Use and Health. We analyzed whether seven cannabis use modalities including smoking, vaping, dabbing, consuming edibles, taking pills, applying topicals, and absorbing sublingually/orally varied by age, sex, race and ethnicity, sexual orientation, education, income, geographic location, and state medical cannabis laws status by generating weighted proportion estimates and conducting multivariable logistic regression. Additionally, in a subanalysis, we examined differences in blunt use among U.S. adults who reported current cannabis use (n=12,355), employing similar methods to explore associations with demographic and socioeconomic factors. Results: Among adults who currently use cannabis, smoking was the most common cannabis use method (77.33%), followed by edibles (37.31%), vaping (34.75%), dabbing (15.01%), applying topicals (5.93%), absorbing sublingually/orally (4.53%), and taking pills (2.11%). Edibles were popular among adults aged 35-49 years (29.57%), whereas vaping was most common among young adults aged 18-25 years (29.80%). Females (vs. males) had lower odds of smoking cannabis (OR: 0.65; 95% CI: 0.57-0.75) and higher odds of applying topicals (OR: 2.92; 95% CI: 2.23-3.83). Non-Hispanic Black (vs. non-Hispanic White) respondents had higher odds of smoking cannabis (OR: 2.03; 95% CI: 1.51-2.74) and lower odds of consuming edibles (OR: 0.66; 95% CI: 0.56-0.77). Adults aged 50+ years (vs. 18-25) had greater odds of absorbing sublingually/orally (OR: 2.45; 95% CI: 1.59-3.76). In the subanalysis, we found that Non-Hispanic Black (vs. non-Hispanic White) adults had higher odds of blunt use (OR: 5.31; 95% CI: 4.23-6.65). Conclusions: Use modality disparities among adults who currently use cannabis highlight the need for tailored public health education and interventions, given the distinct health risks associated with each method of use.

Testicular Germ Cell Tumors: A Review

Importance

Testicular cancer is the most common solid malignancy among males aged 15 to 40 years in the US, with approximately 10 000 new cases diagnosed each year. Between 90% and 95% of testicular cancers are germ cell tumors (GCTs).

Observations

The mean age at diagnosis for testicular cancer is 33 years. GCTs are categorized as seminomas and nonseminomatous GCTs (NSGCTs) based on their embryonic origins and path of differentiation. Risk factors include cryptorchidism, family history of testicular cancer, gonadal dysgenesis, infertility, cannabis use, and genetic conditions such as Klinefelter syndrome. The most common presenting symptom of testicular cancer is a painless testicular mass. History, physical examination, scrotal ultrasound, laboratory assessment of GCT-associated serum tumor markers (α-fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase), and prompt referral to a urologist are indicated when testicular cancer is suspected. Early diagnosis and treatment, starting with a radical inguinal orchiectomy, are important to optimize outcomes. At diagnosis, GCT is stage I (localized to the testicle) in 70% to 75% of patients, stage II (metastatic only to the retroperitoneal lymph nodes) in 20%, and stage III (widely metastatic) in 10%. Treatment of GCTs is guided by histology, clinical staging, and risk classification, with 5-year survival rates of 99%, 92%, and 85% for those diagnosed at stages I, II, and III, respectively. Optimal treatment often involves a multidisciplinary team at high-volume, experienced medical centers and may include surveillance (serum tumor markers [α-fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase] and imaging of the chest, abdomen, and pelvis), surgery (retroperitoneal lymph node dissection), chemotherapy, and/or radiation. Treatment decisions should consider long-term survivorship concerns, including body image, fertility, hypogonadism, mental health, financial cost, adherence to follow-up, and late adverse effects of therapy such as cardiovascular disease, secondary malignancies, and potential psychosocial effects such as anxiety, depression, and social isolation.

Conclusions and Relevance

Testicular cancer is the most common solid malignancy in young men in the US, and 90% to 95% are GCTs. Patients with testicular GCT have a 5-year survival rate of 99%, 92%, and 85% for stages I, II, and III, respectively. Prompt diagnosis and treatment are important to optimize outcomes, and treatment decisions should balance oncologic control with survivorship concerns to minimize long-term adverse effects of treatment.

[Lung cancer epidemiology: evolution over the last twenty years]

Lung Cancer is the second most common cancer in the world but the leading cause of cancer death for both sexes in many countries. Nearly 53,000 new cases were expected in France in 2023, representing 12% of all new cases of cancer, and 33,000 deaths were reported in 2018, representing 21% of all cancer deaths. The KBP studies conducted by the College of General Hospital Pulmonologists (CPHG) for 20 years constitute an excellent barometer of the evolution of the Lung Cancer in France. Lung Cancer is becoming more feminine but still remains a male cancer with a narrowing gap between the two sexes: 65,4% of incident cases are men in the overall population in 2020 but only 58,9% among young subjects (<50 years old). The average age at diagnosis is increasing (67.8 years). The most common histological subtype is adenocarcinoma. Smoking remains the main risk factor but the proportion of non-smokers is increasing (12,6%) due to the impact of air pollution, passive smoking and the aging of the population. The impact of COVID-19 on Lung Cancer mortality in 2020 was significant. Despite the diagnosis which remains mostly late in France, there has been a significant improvement in the prognosis over the past twenty years (reduction in early mortality and increase in median survival) due to therapeutic progress.

Cannabis Use Disorder Emergency Department Visits and Hospitalizations and 5-Year Mortality

Importance

Cannabis use disorders (CUD) are associated with adverse health effects, including mental disorders and motor vehicle collision-related injuries. However, little is known about whether CUDs are associated with increased mortality risk.

Objective

To examine whether individuals receiving incident hospital-based care (an emergency department visit or hospitalization) for a CUD is associated with increased risk of death.

Design, Setting, and Participants

This population-based retrospective cohort study included all individuals aged 15 to 105 years living in Ontario, Canada, between 2006 and 2021 (n = 11 622 571 individuals). Overall and cause-specific mortality were compared between individuals with incident hospital-based CUD care and age- and sex-matched members of the general population or individuals with hospital-based care for other substance use disorders using cause-specific hazard models adjusted for comorbid mental health, substance use, and chronic health conditions. Statistical analysis was performed from September to December 2024.

Exposure

Incident hospital-based CUD care.

Main Outcomes and Measures

Overall and cause-specific mortality identified using vital statistics.

Results

The matched analysis included 527 972 individuals (mean [SD] age, 29.9 [13.6] years; 330 034 [62.5%] female) with a median (IQR) follow-up of 5 (3-9) years; 106 994 had incident CUD. Within 5 years of incident hospital-based CUD care, 3770 individuals (3.5%) died compared with 3770 (0.6%) of matched general population members. After adjusting for comorbid conditions, individuals with incident hospital-based CUD care were at increased risk of death relative to the general population (adjusted hazard ratio [aHR], 2.79 [95% CI, 2.62-2.97]). Individuals with hospital-based CUD care were at increased risk of all investigated types of death and particularly elevated risk of death by suicide (aHR, 9.70 [95% CI, 6.04-15.57]), trauma (aHR, 4.55 [95% CI, 3.55-5.82]), opioid poisoning (aHR, 5.03 [95% CI, 2.86-8.84]), other drug poisonings (aHR, 4.56 [95% CI, 3.11-6.68]), and lung cancer (aHR, 3.81 [95% CI, 2.39-6.07]) relative to the general population. Compared with an individual with hospital-based care for CUD, individuals with hospital-based care for alcohol (aHR, 1.30 [95% CI, 1.26-1.34]), stimulants (aHR, 1.69 [95% CI, 1.62-1.75]), and opioids (aHR, 2.19 [95% CI, 2.10-2.27]) were at relatively increased risk of death within 5 years.

Conclusions and Relevance

In this cohort study of all residents of Ontario, Canada, individuals with incident hospital-based CUD care were at markedly increased risk of death compared with the general population. These findings suggest important clinical and policy implications, given global trends toward cannabis legalization and market commercialization accompanied by increasing cannabis use and CUDs.

The adverse public health effects of non-medical cannabis legalisation in Canada and the USA

Cannabis consumption is legally prohibited in most countries in the world. Several countries are legalising cannabis for adult consumption. It is important to monitor the public health effects of these policy changes. In this paper, we summarise the evidence to date on the legalisation of adult non-medical cannabis use in Canada and the USA. We describe regulatory models for cannabis legalisation, changes in cannabis products and pricing, effects on the illicit cannabis market, changes in cannabis use, and changes in cannabis-related physical and mental health harms. We discuss the challenges in assessing the effects of cannabis legalisation on public health outcomes and emphasise the importance of continuous and rigorous monitoring of adverse health effects to inform the design of public health policies and regulations.

Cancer risk and legalisation of access to cannabis in the USA: overview of the evidence

Cannabis in the USA is transitioning from a nationwide illegal status to liberalisation for medicinal or recreational use across different jurisdictions. As the acceptability and accessibility of cannabis continue to grow, updated knowledge on the cancer risk from recreational cannabis use is necessary to inform recommendations by public health organisations, policy makers, and clinical practitioners. We reviewed the evidence to date. Our umbrella review of current global epidemiological evidence reveals that links between cannabis exposure and cancer risk are more suggestive than conclusive. The cancer type most closely linked to cannabis use is non-seminoma testicular cancer. However, evidence is emerging of an increased risk of other types of cancer (eg, lung squamous cell carcinoma, head and neck squamous cell carcinoma, and oral, breast, liver, cervical, laryngeal, pancreatic, thyroid, and childhood cancer), underscoring the potential importance of incorporating prevention and cessation of cannabis use in cancer prevention efforts. Our review also identified the need for replication of previous studies for additional epidemiological investigations that use rigorous study designs, and data collection protocols free from the biases of major confounders, misclassification, and measurement error in assessing cannabis exposure. Research on the long-term health and economic consequences of all cannabis products (both medical and recreational) are also needed. Currently, the insufficient evidence on the health risks of cannabis use reduces the ability of policy makers, health-care professionals, and individuals to make informed decisions about cannabis use and could expose the public to a potentially serious health risk.

Intraperitoneal delivery of cannabidiol (CBD) and Δ9-tetrahydocannabinol (THC) promotes papillomavirus infections in athymic nude mice

We used our mouse papillomavirus (MmuPV1) model to test the hypothesis that two primary psychoactive ingredients of marijuana, Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), promote papillomavirus persistence in the oral mucosa of infected mice. We conducted intraperitoneal (ip) injections of a moderate dose (3 mg/kg) of either CBD and/or THC in both male and female athymic nude mice and followed the mice up to 20 weeks post-infection. These doses are comparable to what is estimated for human conventional cannabis consumption. All mice were infected with MmuPV1 in the oral cavity at week 4 post-ip delivery of CBD, THC, or a combination of THC and CBD (T + C). THC and CBD were detected in the blood of treated mice for up to 72 h after ip injection. Significantly higher levels of viral DNA were detected in males from both CBD and T + C-treated groups compared to those in the control group at 9- 10-and 12-weeks post infection. A marginally increased viral RNA was also detected in the infected tongues of males in all tested groups compared to that in males in the vehicle control group; the opposite was observed in females. We detected significantly higher levels of dermal dendritic cells (CD205+CD11c+), granulocytes (Ly6G+), but macrophages (F4-80+) recruited to the infected tongues of CBD-treated females. Our findings suggest that CBD may play a role in promoting MmuPV1 persistence in the oral cavity.

The current and future global burden of cancer among adolescents and young adults: a population-based study

BACKGROUND

Compared with children and older adults, the burden of cancer in adolescents and young adults (ages 15-39) is understudied. We aimed to quantify the global burden of adolescent and young adult cancer in 2022 and 2050, and explore patterns in incidence, mortality, and case fatality.

METHODS

In this population-based study, we used the GLOBOCAN database to quantify the number of new cases and cancer-related deaths, and corresponding age-standardised incidence and mortality rates (ASRs; per 100 000 people aged 15-39 years), in adolescents and young adults. Estimates were quantified for all cancers combined, excluding non-melanoma skin cancer, and 33 specific cancer types. Case fatality was estimated using mortality-to-incidence ratios. Overall and sex-specific estimates were calculated at the world, regional, human development index (HDI), and income level. We estimated the future cancer burden by applying the GLOBOCAN 2022 rates to sex-specific demographic projections for the year 2050 using the UN World Population Prospects 2019 revision.

FINDINGS

An estimated 1 300 196 cases and 377 621 cancer-related deaths occurred in adolescents and young adults in 2022. Incidence ASRs were 1·9-times higher and mortality ASRs were 1·2-times higher in females than in males (incidence ASR 52·9 vs 28·3; mortality ASR 13·1 vs 10·6). Although the incidence ASR was highest in the high-income countries, the mortality ASR was highest in the low-income countries; as a result, case fatality ranged from 12% in high-income settings to 57% in low-income settings. Of the 33 cancer types included in our analyses, breast or cervical cancer was the most frequently diagnosed cancer and cause of cancer-related death in 163 and 93 countries, respectively; incidence and mortality also varied the most by region for these cancers. Finally, the adolescent and young adult cancer burden globally is projected to increase by about 12% from 2022 to 2050, albeit with declines of 10·7% projected in very high HDI countries. The increase is expected to overwhelmingly impact low HDI settings, where the burden of both cancer cases and deaths is projected to double (a 102·3% increase).

INTERPRETATION

Although the adolescent and young adult cancer burden incidence is highest in the most developed settings, transitioning countries have the poorest outcomes and will face the greatest increases in burden by 2050. These findings act as a reference to the global adolescent and young adult cancer community to inform cancer control priorities and decrease global inequities.

FUNDING

None.

Cannabis Use and Head and Neck Cancer

Importance

Cannabis is the most commonly used illicit substance worldwide. Whether cannabis use is associated with head and neck cancer (HNC) is unclear.

Objective

To assess the clinical association between cannabis use and HNC.

Design, Setting, and Participants

This large multicenter cohort study used clinical records from a database that included 20 years of data (through April 2024) from 64 health care organizations. A database was searched for medical records for US adults with and without cannabis-related disorder who had recorded outpatient hospital clinic visits and no prior history of HNC. Propensity score matching was performed for demographic characteristics, alcohol-related disorders, and tobacco use. Subsequently, relative risks (RRs) were calculated to explore risk of HNC, including HNC subsites. This analysis was repeated among those younger than 60 years and 60 years or older.

Exposure

Cannabis-related disorder.

Main Outcomes and Measures

Diagnosis of HNC and any HNC subsite.

Results

The cannabis-related disorder cohort included 116 076 individuals (51 646 women [44.5%]) with a mean (SD) age of 46.4 (16.8) years. The non-cannabis-related disorder cohort included 3 985 286 individuals (2 173 684 women [54.5%]) with a mean (SD) age of 60.8 (20.6) years. The rate of new HNC diagnosis in all sites was higher in the cannabis-related disorder cohort. After matching (n = 115 865 per group), patients with cannabis-related disorder had a higher risk of any HNC (RR, 3.49; 95% CI, 2.78-4.39) than those without HNC. A site-specific analysis yielded that those with cannabis-related disorder had a higher risk of oral (RR, 2.51; 95% CI, 1.81-3.47), oropharyngeal (RR, 4.90; 95% CI, 2.99-8.02), and laryngeal (RR, 8.39; 95% CI, 4.72-14.90) cancer. Results were consistent when stratifying by older and younger age group.

Conclusions and Relevance

This cohort study highlights an association between cannabis-related disorder and the development of HNC in adult patients. Given the limitations of the database, future research should examine the mechanism of this association and analyze dose response with strong controls to further support evidence of cannabis use as a risk factor for HNCs.

Medical cannabis use in young adults with cancer: a self-reported survey study

OBJECTIVES

Medical cannabis is increasingly used by young patients with cancer. We aimed to describe the patterns and perceptions of medical cannabis use among young adults with cancer.

METHODS

This cross-sectional survey was conducted from March to May 2021 and included patients aged 18-45 from the Department of Oncology at Sheba Medical Center, as well as participants from the Stop-Cancer social platform. Participants completed an anonymous questionnaire assessing demographics, disease status, cannabis permit status, use patterns and perceptions.

RESULTS

Of the 605 participants who completed the survey, 250 held an active cannabis permit. Median age was 38 (IQR 33-43); 69% were female. Permit holders were less frequently employed (48% vs 76%, p<0.0001), more likely to report prior cannabis (36% vs 21%, p<0.0001) or tobacco use (39% vs 25%, p=0.0003) and define their cancer as 'active' (38% vs 12%, p<0.0001). Among the 371 cancer survivors, 118 (31%) held active permits. Nearly 60% of permit-holding survivors completed their cancer treatment ≥12 months before the survey, and 40% were at least 2 years from treatment. Of cancer survivors holding a cannabis permit, 69% reported daily cannabis use and 67% consumed cannabis through a smoking route. Cannabis was used primarily for managing sleep disturbances (69%), pain (62%) or mood disorders (42%). 21% of survivors considered reducing cannabis consumption.

CONCLUSIONS

Medical cannabis use is prevalent among young adults with cancer, with many continuing to use it during survivorship and after completing cancer treatment. Targeted education on non-smokable forms of cannabis, as well as support for reducing or ceasing cannabis use among young cancer survivors, is needed.

Key insights into cannabis-cancer pathobiology and genotoxicity

Whilst mitochondrial inhibition and micronuclear fragmentation are well established features of the cannabis literature mitochondrial stress and dysfunction has recently been shown to be a powerful and direct driver of micronucleus formation and chromosomal breakage by multiple mechanisms. In turn genotoxic damage can be expected to be expressed as increased rates of cancer, congenital anomalies and aging; pathologies which are increasingly observed in modern continent-wide studies. Whilst cannabinoid genotoxicity has long been essentially overlooked it may in fact be all around us through the rapid induction of aging of eggs, sperm, zygotes, foetus and adult organisms with many lines of evidence demonstrating transgenerational impacts. Indeed this multigenerational dimension of cannabinoid genotoxicity reframes the discussion of cannabis legalization within the absolute imperative to protect the genomic and epigenomic integrity of multiple generations to come.

Secondhand cannabis smoke exposure and respiratory symptoms among adults living in a state with legalized medical cannabis with limited smoke-free protections

Background

Little is known about the demographic and health correlates of secondhand cannabis smoke (SHCS) exposure, despite increased availability and use of cannabis across the U.S. This study examined the prevalence and correlates of SHCS exposure in a sample of N=5,410 adults living in Oklahoma and the association of SHCS exposure with self-reported respiratory problems.

Methods

Data were from a repeated cross-sectional online survey of adults ages 18 and older who completed measurements of past 30-day SHCS exposure in the respondent's home, in a vehicle, and/or in an indoor setting; harm perceptions of SHCS exposure; frequency of current respiratory symptoms; past 30-day use of cannabis, alcohol, and cigarettes.

Results

Almost half (42 %) reported past 30-day SHCS exposure. In bivariate tests, those exposed were male, younger, non-Hispanic (NH) black or Hispanic, reported lower educational and financial attainment, had lower harm perceptions of SHCS exposure, endorsed more respiratory symptoms, and reported past 30-day cannabis and cigarette use (all p's < 0.01). In an adjusted regression model, young adulthood (ages 18-24), NH black race (vs NH White), and past 30-day cigarette smoking and cannabis use emerged as the strongest correlates of SHCS exposure. In interaction models, respiratory symptoms were highest among those reporting past 30-day SHCS exposure and past 30-day cannabis use.

Conclusion

SHCS exposure is common and associated with more frequent respiratory symptoms, particularly among cannabis users. Those exposed were more socially and economically vulnerable.

National cross-sectional survey of US adults to assess the reliability of current and lifetime cannabis smoking

OBJECTIVE

The objective is to examine the test-retest reliability and internal reliability of six self-report questions assessing both current (past 30 days) and lifetime cannabis smoking in an internet survey in the adult US population.

DESIGN

Cross-sectional national survey.

PARTICIPANTS

Out of 957 US adults who completed a national 2020 survey administered through Ipsos KnowledgePanel, 557 completed a second survey ('reliability survey') aimed at assessing the test-retest and internal reliability of questions asking about current and lifetime cannabis smoking. The sample size used in the analysis for the six self-report questions varied and was dependent on respondents answering the questions in both the 2020 survey and the reliability survey.

PRIMARY OUTCOME MEASURE

Test-retest and internal reliability of six self-report questions asking about current and lifetime cannabis smoking.

RESULTS

Among respondents who had smoked cannabis in the past 30 days, 33.8% were aged 18-34, 29.7% were 35-49, 27.7% were 50-64 and 8.8% were 65 or older. Current cannabis smokers were primarily men (59.5%) and white (63.0%). Almost half of current cannabis smokers had a high school diploma or less followed by some college and a bachelor's degree or higher (45.7%, 30.6%, 23.8%, respectively). The question assessing number of days participants smoked cannabis in the past 30 days demonstrated good test-retest (r=0.87) and excellent internal reliability (α=0.94). The questions assessing the number of years, the most common form of use and the number of times participants smoked cannabis over their lifetime also demonstrated test-retest (r=0.77 (acceptable), r=0.75 (acceptable) and κ=0.65 (substantial), respectively) and excellent-to-good internal reliability (α=0.91, α=0.87 and α=0.88, respectively).

CONCLUSIONS

We found simple questions assessing current and lifetime cannabis use to demonstrate both test-retest reliability and internal reliability. These questions can serve as a simple framework for clinicians to evaluate the frequency of cannabis smoking in their patients. Future work should examine if these simple frequency measures of smoking cannabis are associated with adverse health outcomes.

The Efficacy of Cannabis in Oncology Patient Care and Its Anti-Tumor Effects

As the legalization of medical cannabis expands across several countries, interest in its potential advantages among cancer patients and caregivers is burgeoning. However, patients seeking to integrate cannabis into their treatment often encounter frustration when their oncologists lack adequate information to offer guidance. This knowledge gap is exacerbated by the scarcity of published literature on the benefits of medical cannabis, leaving oncologists reliant on evidence-based data disheartened. This comprehensive narrative article, tailored for both clinicians and patients, endeavors to bridge these informational voids. It synthesizes cannabis history, pharmacology, and physiology and focuses on addressing various symptoms prevalent in cancer care, including insomnia, nausea and vomiting, appetite issues, pain management, and potential anti-cancer effects. Furthermore, by delving into the potential mechanisms of action and exploring their relevance in cancer treatment, this article aims to shed light on the potential benefits and effects of cannabis in oncology.

Latent Trajectories of Persistence of Cannabis Use Across Four Decades in 329 Men From the San Diego Prospective Study

OBJECTIVE

These analyses use data from a 40-year prospective study to extend information into the sixth and seventh decades of life regarding latent trajectory classes of cannabis use and predictors of those classes.

METHOD

Data from the San Diego Prospective Study were analyzed for 329 men of European and Hispanic ethnicity who had used cannabis at about age 23 at study entry (Time 1) and who were interviewed about every 5 years through about age 60 to 70. Latent classes of cannabis use trajectories were evaluated using latent class growth analyses, baseline predictors of class membership were determined, and significant predictors of each class were established using logistic regression analyses.

RESULTS

Four latent classes were identified ranging from 12.5% with cannabis use at every follow-up to 25.8% with no use after Time 1. Eight of 14 Time 1 predictors differed significantly across the trajectory classes, including five (age, marital status, religious identity, intensity of cannabis use, and sensation seeking) that significantly contributed to regression analyses when all significant predictors were considered together.

DISCUSSION

Forty-two percent of participants continued using cannabis long-term, including one in eight who used it at every follow-up. Predictors of continued use and identification of those most likely to stop required gathering information on a range of demographic, prior substance use, and personality characteristics.

CONCLUSIONS

Considering the potential enhanced dangers of cannabis use in later life, the high rate of continued use over four decades implies that clinicians should ask all older patients about recent cannabis use, especially if they had used it in their 20s.

Heavy Lifetime Cannabis Use and Mortality by Sex

Importance

The association between mortality and cannabis use remains unclear.

Objective

To examine sex-stratified associations of cumulative lifetime cannabis use with all-cause, cardiovascular disease (CVD), and cancer mortality in the UK Biobank population.

Design, Setting, and Participants

This cohort study used data from volunteers in the UK Biobank population. Participant monitoring for mortality in the UK Biobank study commenced from the point of their inclusion between 2006 and 2010 and continued until December 19, 2020. Data regarding the causes of death were sourced from the National Health Service Information Centre. Data were analyzed from inception of study inclusion to December 2020.

Exposure

Cannabis use status was assessed by questionnaire and categorized as heavy, moderate, low, and never.

Main Outcomes and Measures

The main outcomes were all-cause, CVD, and cancer mortality. Sex-stratified associations of cumulative lifetime cannabis use with mortality were estimated using Cox proportional hazards regression with adjustment for demographic and clinical variables.

Results

Among 121 895 participants (54.51% females with mean [SD] age of 55.15 [7.64] years; 45.49% males with mean [SD] age of 56.46 [7.79] years) during an overall median of 11.80 years (IQR, 10.53-13.22 years) of follow-up, 2375 total deaths occurred, including 1411 deaths from CVD and 440 from cancer. In males, after full adjustment, the hazard ratios (HRs) were 1.28 (95% CI, 0.90-1.81) for all-cause mortality, 0.98 (95% CI, 0.43-2.25) for CVD mortality, and 1.09 (95% CI, 0.71-1.67) for cancer mortality among heavy cannabis users compared with never users. In females, after full adjustment, the HRs were 1.49 (95% CI, 0.92-2.40) for all-cause mortality, 2.67 (95% CI, 1.19-4.32) for CVD mortality, and 1.61 (95% CI, 0.91-2.83) for cancer mortality among heavy cannabis users compared with never users. In female current tobacco users, after full adjustment, heavy cannabis use was associated with all-cause mortality (HR, 2.25; 95% CI, 1.12-4.53), CVD mortality (HR, 2.56; 95% CI, 1.43-15.36), and cancer mortality (HR, 3.52; 95% CI, 1.50-8.33) and among never tobacco users was associated with CVD mortality (HR, 2.98; 95% CI, 1.67-6.61). In male current tobacco users, heavy cannabis use was associated with cancer mortality (HR, 2.44; 95% CI, 1.14-5.23).

Conclusions and Relevance

In this study, a positive association between CVD mortality and heavy lifetime cannabis use was observed among females. Longitudinal studies are needed in general populations to investigate the potential effects of cannabis on mortality.

Does cannabis elevate cancer risk? : Evidence from Mendelian randomization

BACKGROUND

Cannabis use is increasing annually but the relationship between cannabis use and cancer incidence is not uniform because of confounding factors. We aimed to assess the effect of cannabis use on cancer risk using a two-sample Mendelian randomization (MR) approach.

METHODS

Secondary data analyses were performed on pooled data based on Genome-Wide Association Study (GWAS), selecting data from the ICC and UK-Biobank and 23andMeInc lifetime cannabis use and cannabis use disorder related to the substance use disorders working group from the Psychiatric Genomics Consortium, then selecting highly correlated SNPs as instrumental variables. The substance use disorders working group, iPSYCH, and deCODE GWAS data, and then highly correlated SNPs were selected as instrumental variables for two-sample Mendelian randomization analyses using inverse variance weighting, MR-Egger regression, and weighted median, respectively, to evaluate the relationship between lifetime cannabis use and nine tumors, and subsequently analyzed these results in the same way using cannabis use disorders.

RESULTS

The risk of all cancers except breast cancer was not associated with lifetime cannabis use. Our inverse variance weighting method found that lifetime marijuana use reduced the breast cancer risk (P = 0.016, odds ratio [OR] = 0.981), and we subsequently conducted analyses of cannabis use disorders and cancer risk, which showed that cannabis use disorders elevated the risk of breast cancer (P = 0.007, OR = 1.007) as well as the risk of lung cancer (P = 0.014, OR = 1.122).

CONCLUSION

Large MR analyses suggest that lifetime cannabis use may reduce breast cancer risk, but cannabis use disorder exacerbates the risk of breast and lung cancer. The mechanisms responsible for this outcome remain to be investigated.

Marijuana Use May Be Associated with Reduced Prevalence of Prostate Cancer: A National Survey on Drug Use and Health Study from United States of America

Preclinical evidence indicates the potential anti-tumor capabilities of cannabinoids in prostate cancer (PC). We undertook a cross-sectional study using National Survey on Drug Use and Health data from 2002 to 2020, involving 2503 participants in the USA. The independent variable was marijuana use status (current, former, never), while the dependent variable was self-reported PC (yes, no). Eleven other demographic variables were assessed as covariates. PC prevalence was lower among current marijuana users (46/145, 31.7%) and former users (323/1021, 31.6%) compared to non-users (534/1337, 39.9%, p < 0.001). PC prevalence was lower among users versus non-users in the elderly (≥65) (36.4% vs. 42.4%, p = 0.016) and non-Hispanic white subgroups (28.9% vs. 38.3%, p < 0.001). There were no significant PC prevalence differences between users and non-users in the younger population (50-64) or other race/ethnicity. In the multivariable analyses, former marijuana use was associated with lower PC compared to never using (odd ratio = 0.74, 95% CI 0.62-0.90, p = 0.001). Current use was also suggestive of reduced prevalence but was not statistically significant (odd ratio = 0.77, 95% CI 0.52-1.14, p = 0.198), possibly due to low sample size. Our findings from a large national survey provide additional data to link marijuana use with lower PC prevalence.

Cannabis and Cannabinoids in Adults With Cancer: ASCO Guideline

PURPOSE

To guide clinicians, adults with cancer, caregivers, researchers, and oncology institutions on the medical use of cannabis and cannabinoids, including synthetic cannabinoids and herbal cannabis derivatives; single, purified cannabinoids; combinations of cannabis ingredients; and full-spectrum cannabis.

METHODS

A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and cohort studies on the efficacy and safety of cannabis and cannabinoids when used by adults with cancer. Outcomes of interest included antineoplastic effects, cancer treatment toxicity, symptoms, and quality of life. PubMed and the Cochrane Library were searched from database inception to January 27, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations.

RESULTS

The evidence base consisted of 13 systematic reviews and five additional primary studies (four RCTs and one cohort study). The certainty of evidence for most outcomes was low or very low.

RECOMMENDATIONS

Cannabis and/or cannabinoid access and use by adults with cancer has outpaced the science supporting their clinical use. This guideline provides strategies for open, nonjudgmental communication between clinicians and adults with cancer about the use of cannabis and/or cannabinoids. Clinicians should recommend against using cannabis or cannabinoids as a cancer-directed treatment unless within the context of a clinical trial. Cannabis and/or cannabinoids may improve refractory, chemotherapy-induced nausea and vomiting when added to guideline-concordant antiemetic regimens. Whether cannabis and/or cannabinoids can improve other supportive care outcomes remains uncertain. This guideline also highlights the critical need for more cannabis and/or cannabinoid research.Additional information is available at www.asco.org/supportive-care-guidelines.

Cardiovascular and Respiratory Effects of Cannabis Use by Route of Administration: A Systematic Review

Aim: Knowledge of the cardiovascular and respiratory effects of cannabis use by route of administration is unclear. This evidence is necessary to increase clinical and public health awareness given the recent trend in cannabis legalization, normalization, and surge in the availability and usage of various forms of cannabis products. Methods: Search was conducted in Web of Science, ProQuest, Psych INFO, Scopus, Embase, and Medline databases, and subsequently in the references of retrieved articles. Peer-reviewed articles published between 2009 and 2023, that reported on cardiovascular and respiratory effects of cannabis use by route of administration were included. Studies with no report of the route of administration and combined use of other illicit substances were excluded. The review was guided by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results: Of the 1873 articles retrieved, 42 met inclusion criteria encompassing six case reports, 21 reviews, and 15 empirical studies. Four administration routes were identified: smoking, vaping, oral ingestion, and dabbing. Smoking was the most common route of administration and was associated with both respiratory effects, such as bronchitis, dyspnea, and chronic obstructive lung disease, and cardiovascular effects including tachycardia, ventricular arrhythmias, and myocardial infarction. Cannabis edibles were associated with minimal respiratory effects. Tachycardia was the most common cardiovascular effect and was associated with all routes of administration. Conclusion: Cannabis use does cause cardiovascular and respiratory effects, but the conclusion remains tentative of the cardiovascular and respiratory effects by route of administration due to methodological limitations of the studies.

Testicular cancer in 2023: Current status and recent progress

Testicular germ cell tumor (GCT) is the most common solid tumor in adolescent and young adult men. Progress in the management of GCT has been made in the last 50 years, with a substantial improvement in cure rates for advanced disease, from 25% in the 1970s to nearly 80%. However, relapsed or platinum-refractory disease occurs in a proportion, 20% of whom will die from disease progression. This article reviews the current evidence-based treatments for extracranial GCT, the acute and chronic toxic effects that may result, and highlights contemporary advances and progress in the field.

Adverse Impact of Cannabis on Human Health

Cannabis, the most commonly used recreational drug, is illicit in many areas of the world. With increasing decriminalization and legalization, cannabis use is increasing in the United States and other countries. The adverse effects of cannabis are unclear because its status as a Schedule 1 drug in the United States restricts research. Despite a paucity of data, cannabis is commonly perceived as a benign or even beneficial drug. However, recent studies show that cannabis has adverse cardiovascular and pulmonary effects and is linked with malignancy. Moreover, case reports have shown an association between cannabis use and neuropsychiatric disorders. With growing availability, cannabis misuse by minors has led to increasing incidences of overdose and toxicity. Though difficult to detect, cannabis intoxication may be linked to impaired driving and motor vehicle accidents. Overall, cannabis use is on the rise, and adverse effects are becoming apparent in clinical data sets.

Role of Cannabinoids in Oral Cancer

Cannabinoids have incited scientific interest in different conditions, including malignancy, due to increased exposure to cannabis. Furthermore, cannabinoids are increasingly used to alleviate cancer-related symptoms. This review paper aims to clarify the recent findings on the relationship between cannabinoids and oral cancer, focusing on the molecular mechanisms that could link cannabinoids with oral cancer pathogenesis. In addition, we provide an overview of the current and future perspectives on the management of oral cancer patients using cannabinoid compounds. Epidemiological data on cannabis use and oral cancer development are conflicting. However, in vitro studies assessing the effects of cannabinoids on oral cancer cells have unveiled promising anti-cancer features, including apoptosis and inhibition of cell proliferation. Downregulation of various signaling pathways with anti-cancer effects has been identified in experimental models of oral cancer cells exposed to cannabinoids. Furthermore, in some countries, several synthetic or phytocannabinoids have been approved as medical adjuvants for the management of cancer patients undergoing chemoradiotherapy. Cannabinoids may improve overall well-being by relieving anxiety, depression, pain, and nausea. In conclusion, the link between cannabinoid compounds and oral cancer is complex, and further research is necessary to elucidate the potential risks or their protective impact on oral cancer.

Assessment of prevalence, predictors, reasons and regulations of substance smoking among children in Ghana

BACKGROUND

In Ghana, it is against the law for children to smoke. Nevertheless, a portion of children in the country do smoke. However, there is a paucity of research on young smokers in Ghana and other sub-Saharan African nations. This study, therefore, investigated the prevalence of smoking, the kinds of substances children smoke, predictors of smoking, reasons for and factors that lead children to smoke, and regulation of smoking among children in Ghana.

METHODS

In total, 5024 children aged 8-17 were studied using a cross-sectional convergent parallel mixed method. Descriptive statistics, Person's Chi-square test, Fisher Exact test, and binary logistic regression were used to analyse the quantitative data. In contrast, thematic analysis was used to analyse the qualitative data.

RESULTS

The results showed that 3.2% of children had ever smoked. Male children smoked more often than female children. The prevalence of cigarette, marijuana, and shisha smoking was 78.3%, 18%, and 3.7%, respectively. While more male children than female children smoked cigarettes and marijuana, more female children than male children used shisha. Children mainly smoked for fun and due to group culture. In addition, children were influenced by friends; parents, family members, and neighbours who smoke; curiosity; and advertisements and videos to initiate smoking. Despite the availability of regulations and laws regulating tobacco products in public places, tobacco advertisement, promotion, and sale to persons under 18, children are still smoking.

CONCLUSIONS

Children who have ever engaged in smoking reported using cigarettes, marijuana, and shisha. Policymakers urgently need to strategise and strengthen their policies, programmes, and interventions to address smoking among children.

Association between cannabis use and risk of diabetes mellitus type 2: A systematic review and meta-analysis

BACKGROUND

Cannabis consumption exerts multiple effects on metabolism via various pathways, including glucose regulation and insulin secretion. Studies concerning the association between cannabis use and diabetes mellitus type 2 are discrepant.

OBJECTIVE

This study was conducted to evaluate the association between cannabis use and type 2 diabetes mellitus (T2DM).

SEARCH METHODS

We searched PubMed, Scopus, Embase, Proquest, Web of Science, and Cochrane Library with no time, language or study types restriction until July 1, 2022, using various forms of "cannabis" and "diabetes mellitus" search terms.

SELECTION CRITERIA

Randomized control trials, cohort, and case-control studies investigating the relationship between cannabis consumption and diabetes mellitus type 2 were included.

DATA COLLECTION AND ANALYSIS

The Newcastle-Ottawa scale was used to assess the quality of studies. We pooled odds ratio (OR) with 95% confidence interval (CI) using the random-effects model, generic inverse variance method, DerSimonian and Laird approach.

MAIN RESULTS

A meta-analysis of seven studies, containing 11 surveys and 4 cohorts, revealed that the odds of developing T2DM in individuals exposed to cannabis was 0.48 times (95% CI: 0.39 to 0.59) lower than in those without cannabis exposure.

CONCLUSIONS

A protective effect of cannabis consumption on the odds of diabetes mellitus type 2 development has been suggested. Yet given the considerable interstudy heterogeneity, the upward trend of cannabis consumption and cannabis legalization is recommended to conduct studies with higher levels of evidence.

The Acute Exposure of Human Adult Testis Tissue to Cannabinoids THC and CBD Does Not Impact Testosterone Production Nor Germ Cell Lineage

PURPOSE

While an increased risk of developing germ cell tumors has been established in regular cannabis consumers, there is conflicting evidence about an association between cannabis use and testosterone levels in those regular consumers. In this context, we aimed to determine whether Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), the two major and best-studied cannabinoids present in cannabis, also the most used for therapeutic applications, can directly impact the steroidogenic function and germ cell lineage of the human adult testis.

MATERIALS AND METHODS

We used our well-characterized organotypic culture of human testis, in which adult testis explants were exposed to CBD, THC, or CBD/THC [ratio 1:1] from 10-9 to 10-5 M for up to either 48 hours or 9 days of culture. The testes were obtained from multi-organ donors (n=13; mean age: 55.15±5.62 y).

RESULTS

The testosterone production and the spatial distribution of Leydig cells did not change upon CBD and/or THC exposure versus controls after 48 hours or 9 days. The overall tissue morphology of the cannabinoids-exposed testis explants was similar to their control upon 24 hours or 9 days of exposure, a finding confirmed by morphometric analyses on short-term cultures. In line, the number of apoptotic cells was not affected by either 48 hours or 9 days of cannabinoids treatment versus mock. Cannabinoids had no impact on the number of proliferating cells nor on mRNA expression of genes encoding proteins involved in germ cell differentiation, meiosis, or Sertoli and Leydig functions after 24 hours exposure.

CONCLUSIONS

Altogether, these findings show an absence of acute direct effects of exposure to cannabis-derived cannabinoids THC and CBD on testicular testosterone production and germ cells ex vivo. Further studies are warranted to explore an indirect impact of cannabinoids on testis functions through the hypothalamic-pituitary-testis axis, as well as the potential effects of long-term exposures.

Cannabis use among recently treated cancer patients: perceptions and experiences

PURPOSE

To characterize cannabis use among cancer patients, we aimed to describe 1) patterns of cannabis use across multiple cancer sites; 2) perceived goals, benefits, harms of cannabis; and 3) communication about cannabis.

METHODS

Patients with 9 different cancers treated at Memorial Sloan Kettering Cancer Center between March and August 2021 completed an online or phone survey eliciting cannabis use, attitudes, and communication about cannabis. Multivariable logistic regression estimated the association of cancer type and cannabis use, adjusting for sociodemographic characteristics and prior cannabis use.

RESULTS

Among 1258 respondents, 31% used cannabis after diagnosis, ranging from 25% for lung cancer to 59% for testicular cancer. Characteristics associated with cannabis use included younger age, lower education level, and cancer type. In multivariable analysis, compared to lung cancer patients, gastrointestinal cancer patients were more likely to use cannabis (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.25-5.43). Cannabis use in the year prior to diagnosis was strongly associated with cannabis use after diagnosis (OR 19.13, 95% CI 11.92-30.72). Among users, reasons for use included difficulty sleeping (48%); stress, anxiety, or depression (46%); and pain (42%). Among respondents who used cannabis to improve symptoms, 70-90% reported improvement; < 5% reported that any symptom worsened. Only 25% discussed cannabis with healthcare providers.

CONCLUSIONS

Almost a third of cancer patients use cannabis, largely for symptom management. Oncologists may not know about their patients' cannabis use. To improve decision making about cannabis use during cancer care, research is needed to determine benefits and harms of cannabis use.

Balancing risks and benefits of cannabis use: umbrella review of meta-analyses of randomised controlled trials and observational studies

OBJECTIVE

To systematically assess credibility and certainty of associations between cannabis, cannabinoids, and cannabis based medicines and human health, from observational studies and randomised controlled trials (RCTs).

DESIGN

Umbrella review.

DATA SOURCES

PubMed, PsychInfo, Embase, up to 9 February 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Systematic reviews with meta-analyses of observational studies and RCTs that have reported on the efficacy and safety of cannabis, cannabinoids, or cannabis based medicines were included. Credibility was graded according to convincing, highly suggestive, suggestive, weak, or not significant (observational evidence), and by GRADE (Grading of Recommendations, Assessment, Development and Evaluations) (RCTs). Quality was assessed with AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews 2). Sensitivity analyses were conducted.

RESULTS

101 meta-analyses were included (observational=50, RCTs=51) (AMSTAR 2 high 33, moderate 31, low 32, or critically low 5). From RCTs supported by high to moderate certainty, cannabis based medicines increased adverse events related to the central nervous system (equivalent odds ratio 2.84 (95% confidence interval 2.16 to 3.73)), psychological effects (3.07 (1.79 to 5.26)), and vision (3.00 (1.79 to 5.03)) in people with mixed conditions (GRADE=high), improved nausea/vomit, pain, spasticity, but increased psychiatric, gastrointestinal adverse events, and somnolence among others (GRADE=moderate). Cannabidiol improved 50% reduction of seizures (0.59 (0.38 to 0.92)) and seizure events (0.59 (0.36 to 0.96)) (GRADE=high), but increased pneumonia, gastrointestinal adverse events, and somnolence (GRADE=moderate). For chronic pain, cannabis based medicines or cannabinoids reduced pain by 30% (0.59 (0.37 to 0.93), GRADE=high), across different conditions (n=7), but increased psychological distress. For epilepsy, cannabidiol increased risk of diarrhoea (2.25 (1.33 to 3.81)), had no effect on sleep disruption (GRADE=high), reduced seizures across different populations and measures (n=7), improved global impression (n=2), quality of life, and increased risk of somnolence (GRADE=moderate). In the general population, cannabis worsened positive psychotic symptoms (5.21 (3.36 to 8.01)) and total psychiatric symptoms (7.49 (5.31 to 10.42)) (GRADE=high), negative psychotic symptoms, and cognition (n=11) (GRADE=moderate). In healthy people, cannabinoids improved pain threshold (0.74 (0.59 to 0.91)), unpleasantness (0.60 (0.41 to 0.88)) (GRADE=high). For inflammatory bowel disease, cannabinoids improved quality of life (0.34 (0.22 to 0.53) (GRADE=high). For multiple sclerosis, cannabinoids improved spasticity, pain, but increased risk of dizziness, dry mouth, nausea, somnolence (GRADE=moderate). For cancer, cannabinoids improved sleep disruption, but had gastrointestinal adverse events (n=2) (GRADE=moderate). Cannabis based medicines, cannabis, and cannabinoids resulted in poor tolerability across various conditions (GRADE=moderate). Evidence was convincing from observational studies (main and sensitivity analyses) in pregnant women, small for gestational age (1.61 (1.41 to 1.83)), low birth weight (1.43 (1.27 to 1.62)); in drivers, car crash (1.27 (1.21 to 1.34)); and in the general population, psychosis (1.71 (1.47 to 2.00)). Harmful effects were noted for additional neonatal outcomes, outcomes related to car crash, outcomes in the general population including psychotic symptoms, suicide attempt, depression, and mania, and impaired cognition in healthy cannabis users (all suggestive to highly suggestive).

CONCLUSIONS

Convincing or converging evidence supports avoidance of cannabis during adolescence and early adulthood, in people prone to or with mental health disorders, in pregnancy and before and while driving. Cannabidiol is effective in people with epilepsy. Cannabis based medicines are effective in people with multiple sclerosis, chronic pain, inflammatory bowel disease, and in palliative medicine but not without adverse events.

STUDY REGISTRATION

PROSPERO CRD42018093045.

FUNDING

None.

Perceptions of Safety of Daily Cannabis vs Tobacco Smoking and Secondhand Smoke Exposure, 2017-2021

Importance

While rates of cigarette use are declining, more US adults are using cannabis. Perceptions of safety are important drivers of substance use and public policy; however, little is known about the comparative views of US adults on tobacco and cannabis safety.

Objective

To compare public perceptions of safety of cannabis vs tobacco smoke and evaluate how perceptions may be changing over time.

Design, Setting, and Participants

This longitudinal survey study was conducted using a web-based survey administered in 2017, 2020, and 2021. US adults participating in Ipsos KnowledgePanel, a nationally representative, population-based survey panel, were included. Data were analyzed from March 2021 through June 2023.

Main Outcomes and Measures

Two questions directly compared the perception of safety of cannabis vs tobacco in terms of daily smoking and secondhand smoke exposure. Additional questions assessed perceptions of safety of secondhand tobacco smoke for adults, children, and pregnant women, with an analogous set of questions for secondhand cannabis smoke.

Results

A total of 5035 participants (mean [SD] age, 53.4 [16.2] years; 2551 males [50.7%]) completed all 3 surveys and provided responses for tobacco and cannabis risk questions. More than one-third of participants felt that daily smoking of cannabis was safer than tobacco, and their views increasingly favored safety of cannabis vs tobacco over time (1742 participants [36.7%] in 2017 vs 2107 participants [44.3%] in 2021; P < .001). The pattern was similar for secondhand cannabis smoke, with 1668 participants (35.1%) responding that cannabis was safer than tobacco in 2017 vs 1908 participants (40.2%) in 2021 (P < .001). Participants who were younger (adjusted odds ratio [aOR] for ages 18-29 years vs ≥60 years, 1.4 [95% CI, 1.1-1.8]; P = .01) or not married (aOR, 1.2 [95% CI, 1.0-1.4]; P = .01) were more likely to move toward safer views of cannabis use over time, while those who were retired (aOR vs working, 0.8 [95% CI, 0.7-0.9]; P = .01) were less likely to move toward a safer view of cannabis. Participants were also more likely to rate secondhand smoke exposure to cannabis vs tobacco as completely or somewhat safe in adults (629 participants [12.6%] vs. 119 participants [2.4%]; P < .001), children (238 participants [4.8%] vs. 90 participants [1.8%]; P < .001), and pregnant women (264 participants [5.3%] vs. 69 participants [1.4%]; P < .001).

Conclusions and Relevance

This study found that US adults increasingly perceived daily smoking and secondhand exposure to cannabis smoke as safer than tobacco smoke from 2017 to 2021. Given that these views do not reflect the existing science on cannabis and tobacco smoke, the findings may have important implications for public health and policy as the legalization and use of cannabis increase.

Cannabis- and Substance-Related Carcinogenesis in Europe: A Lagged Causal Inferential Panel Regression Study

Recent European data facilitate an epidemiological investigation of the controversial cannabis-cancer relationship. Of particular concern were prior findings associating high-dose cannabis use with reproductive problems and potential genetic impacts. Cancer incidence data age-standardised to the world population was obtained from the European Cancer Information System 2000-2020 and many European national cancer registries. Drug use data were obtained from the European Monitoring Centre for Drugs and Drug Addiction. Alcohol and tobacco consumption was sourced from the WHO. Median household income was taken from the World bank. Cancer rates in high-cannabis-use countries were significantly higher than elsewhere (β-estimate = 0.4165, p = 3.54 × 10^-115). Eighteen of forty-one cancers (42,675 individual rates) were significantly associated with cannabis exposure at bivariate analysis. Twenty-five cancers were linked in inverse-probability-weighted multivariate models. Temporal lagging in panel models intensified these effects. In multivariable models, cannabis was a more powerful correlate of cancer incidence than tobacco or alcohol. Reproductive toxicity was evidenced by the involvement of testis, ovary, prostate and breast cancers and because some of the myeloid and lymphoid leukaemias implicated occur in childhood, indicating inherited intergenerational genotoxicity. Cannabis is a more important carcinogen than tobacco and alcohol and fulfills epidemiological qualitative and quantitative criteria for causality for 25/41 cancers. Reproductive and transgenerational effects are prominent. These findings confirm the clinical and epidemiological salience of cannabis as a major multigenerational community carcinogen.

Should oncologists trust cannabinoids?

Cannabis enjoyed a "golden age" as a medicinal product in the late 19th, early 20th century, but the increased risk of overdose and abuse led to its criminalization. However, the 21st century have witnessed a resurgence of interest and a large body of literature regarding the benefits of cannabinoids have emerged. As legalization and decriminalization have spread around the world, cancer patients are increasingly interested in the potential utility of cannabinoids. Although eager to discuss cannabis use with their oncologist, patients often find them to be reluctant, mainly because clinicians are still not convinced by the existing evidence-based data to guide their treatment plans. Physicians should prescribe cannabis only if a careful explanation can be provided and follow up response evaluation ensured, making it mandatory for them to be up to date with the positive and also negative aspects of the cannabis in the case of cancer patients. Consequently, this article aims to bring some clarifications to clinicians regarding the sometimes-confusing various nomenclature under which this plant is mentioned, current legislation and the existing evidence (both preclinical and clinical) for the utility of cannabinoids in cancer patients, for either palliation of the associated symptoms or even the potential antitumor effects that cannabinoids may have.

Effects of Smoking Marijuana on the Respiratory System: A Systematic Review

BACKGROUND

The prevalence of marijuana use and its derivatives has surged over the past century, largely due to increasing legalization globally. Despite arguments advocating its benefits, marijuana smoking exposes the lungs to harmful combustion byproducts, leading to various respiratory issues such as asthma, pneumonia, emphysema, and chronic obstructive pulmonary disease.

METHODS

We embarked on an extensive literature search, utilizing PubMed/Medline, Scopus, Web of Science, and Google Scholar databases, identifying 200 studies. After the elimination of duplicates, and meticulous review of abstracts and full texts, 55 studies were included in our analysis.

RESULTS

Current literature demonstrates that marijuana use negatively impacts lung function, triggering symptoms like chronic cough, sputum production, and wheezing, and diminishing FEV1/FVC ratio in spirometry tests. Moreover, prolonged or chronic marijuana use augments the risk of respiratory function impairment. While the carcinogenic effects of marijuana are still contested, a weak correlation between marijuana use and lung cancer has been observed in some studies. Additionally, instances of other pathologies linked to marijuana use have been reported, including the development of COPD, pulmonary bullae, spontaneous pneumothorax, pleuritic pain, chronic pulmonary aspergillosis, hemoptysis, and pulmonary Langerhans cell histiocytosis.

CONCLUSIONS

The evidence underscores that marijuana use is detrimental to respiratory health. In light of the escalating trend of marijuana use, particularly among the youth, it is imperative to advocate public health messages discouraging its consumption.

Pleiotropic loci for cannabis use disorder severity in multi-ancestry high-risk populations

Cannabis use disorder (CUD) is common and has in part a genetic basis. The risk factors underlying its development likely involve multiple genes that are polygenetic and interact with each other and the environment to ultimately lead to the disorder. Co-morbidity and genetic correlations have been identified between CUD and other disorders and traits in select populations primarily of European descent. If two or more traits, such as CUD and another disorder, are affected by the same genetic locus, they are said to be pleiotropic. The present study aimed to identify specific pleiotropic loci for the severity level of CUD in three high-risk population cohorts: American Indians (AI), Mexican Americans (MA), and European Americans (EA). Using a previously developed computational method based on a machine learning technique, we leveraged the entire GWAS catalog and identified 114, 119, and 165 potentially pleiotropic variants for CUD severity in AI, MA, and EA respectively. Ten pleiotropic loci were shared between the cohorts although the exact variants from each cohort differed. While majority of the pleiotropic genes were distinct in each cohort, they converged on numerous enriched biological pathways. The gene ontology terms associated with the pleiotropic genes were predominately related to synaptic functions and neurodevelopment. Notable pathways included Wnt/β-catenin signaling, lipoprotein assembly, response to UV radiation, and components of the complement system. The pleiotropic genes were the most significantly differentially expressed in frontal cortex and coronary artery, up-regulated in adipose tissue, and down-regulated in testis, prostate, and ovary. They were significantly up-regulated in most brain tissues but were down-regulated in the cerebellum and hypothalamus. Our study is the first to attempt a large-scale pleiotropy detection scan for CUD severity. Our findings suggest that the different population cohorts may have distinct genetic factors for CUD, however they share pleiotropic genes from underlying pathways related to Alzheimer's disease, neuroplasticity, immune response, and reproductive endocrine systems.

Risk and mortality of testicular cancer in patients with neurodevelopmental or other psychiatric disorders

BACKGROUND

Both testicular germ cell tumours (TGCT) and neurodevelopmental disorders are associated with urogenital malformations. Few studies have investigated the association between psychiatric disorders and TGCT. We investigated whether history of any psychiatric or neurodevelopmental disorder is associated with increased risk or mortality of TGCT.

METHOD

This is a nested case-control study including 6166 TGCT patients diagnosed during 1992-2014, individually matched for age and calendar period to 61,660 controls. We calculated odds ratios (ORs) for the association between type of psychiatric diagnoses and TGCT risk. Among the cases, we used a cohort design and calculated hazard ratios (HRs) of the association between psychiatric diagnose and all-cause and TGCT-specific death.

RESULTS

History of a neurodevelopmental disorder (attention deficit hyperactivity disorder, autism spectrum disorder and intellectual disabilities) was associated with an increased risk of seminoma (OR: 1.54; 1.09-2.19). Seminoma patients with neurodevelopmental disorders were younger (34 versus 38 years, p = 0.004) and had more stage IV disease (5.4% versus 1.2%) than those without. Psychiatric history overall was not associated with TGCT. Patient history of any psychiatric disorder was associated with an increased all-cause and TGCT-specific death.

CONCLUSIONS

We report an association between neurodevelopmental disorders and testicular seminoma, and an increased TGCT-specific mortality for TGCT patients with psychiatric disorders.

Impacts of medical and non-medical cannabis on the health of older adults: Findings from a scoping review of the literature

BACKGROUND

Cannabis legalization has enabled increased consumption in older adults. Age-related mental, physical, and physiological changes may lead to differences in effects of cannabis in older adults compared to younger individuals.

OBJECTIVE

To perform a scoping review to map the evidence regarding the health effects of cannabis use for medical and non-medical purposes in older adults.

METHODS

Electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Library) were searched for systematic reviews (SRs), randomized controlled trials (RCTs) and non-randomized/observational studies (NRSs) assessing the health effects and associations of cannabis use (medical or non-medical) in adults ≥ 50 years of age. Included studies met age-related inclusion criteria or involved a priori identified health conditions common among older adults. Records were screened using a liberal accelerated approach and data charting was performed independently by two reviewers. Descriptive summaries, structured tables, effect direction plots and bubble plots were used to synthesize study findings.

FINDINGS

From 31,393 citations, 133 publications describing 134 unique studies (26 SRs, 36 RCTs, 72 NRSs) were included. Medical cannabis had inconsistent therapeutic effects in specific patient conditions (e.g., end-stage cancer, dementia), with a number of studies suggesting possible benefits while others found no benefit. For medical cannabis, harmful associations outnumbered beneficial, and RCTs reported more negative effects than NRSs. Cannabis use was associated with greater frequencies of depression, anxiety, cognitive impairment, substance use and problematic substance use, accidents/injuries, and acute healthcare use. Studies often were small, did not consistently assess harms, and did not adjust for confounding.

DISCUSSION

The effects of medical cannabis are inconsistent within specific patient conditions. For older adults, generally, the available evidence suggests cannabis use may be associated with greater frequencies of mental health issues, substance use, and acute healthcare use, and the benefit-to-risk ratio is unclear. Studies with a balanced assessment of benefits and harms may guide appropriate public health messaging to balance the marketing pressures of cannabis to older adults.

Association between cannabis use with urological cancers: A population-based cohort study and a mendelian randomization study in the UK biobank

BACKGROUND

Legislation of cannabis use has been approved in many European and North American countries. Its impact on urological cancers is unclear. This study was conducted to explore the association between cannabis use and the risk of urological cancers.

METHODS

We identified 151,945 individuals with information on cannabis use in the UK Biobank from 2006 to 2010. Crude and age-standardized incidence ratios of different urological cancers were evaluated in the entire cohort and subgroups. Cox regression was performed for survival analysis.

RESULTS

Previous use of cannabis was a significant protective factor for renal cell carcinoma (HR = 0.61, 95%CI:0.40-0.93, p = 0.021) and prostate cancer (HR = 0.82, 95%CI:0.73-0.93, p = 0.002) in multivariable analysis. The association between previous cannabis use and both renal cell carcinoma and bladder cancer was only observed in females (HRRCC  = 0.42, 95%CI:0.19-0.94, p = 0.034; HRBCa  = 0.43, 95%CI:0.21-0.86, p = 0.018) but not in men. There was no significant association between cannabis use and testicular cancer incidence. Mendelian randomization demonstrated a potential causal effect of cannabis use on a lower incidence of renal cell carcinoma.

CONCLUSIONS

Previous use of cannabis was associated with a lower risk of bladder cancer, renal cell carcinoma, and prostate cancer. The inverse association between cannabis and both renal cell carcinoma and bladder cancer was only found in females but not in males.

Assessment of the Association of Chlamydia e pneumoniae Infection with Lung Cancer in a Moroccan Patients' Cohort

BACKGROUND

Chlamydia pneumoniae (C. pneumoniae) is a respiratory pathogen associated with chronic inflammatory and its detection in human lung cancer suggests its involvement in cancerogenesis. Our study aimed to evaluate the association between C. pneumoniae  infection and Lung Cancer disease in Moroccans patients and control cohorts, through a molecular investigation.

METHODS

The study comprised 42 lung cancer patients and 43 healthy controls. All participants provided demographics, Clinical, and Toxic behaviors datas, and a peripheral blood sample for testing, a Nested Polymerase Chain Reaction (PCR) was performed for C. pneumoniae Deoxyribonucleic acid (DNA) detection. Statistical analysis was performed using IBM®SPSS®software.

RESULTS

Positive Nested PCR results for cases and controls were respectively 33.3% and 4.7%, there by  significant difference between cases and controls   infection was identified (p <0.05). Data analysis also showed that tobacco could act synergically with C. pneumoniae infection as a risk factor of lung cancer. In fact a significant difference between patients and controls was shown for tobacco and alcohol use (p < 0.05).

CONCLUSION

C. pneumoniae infection is potentially associated with primary Lung cancer in the Moroccan population and has combined effects with Tabaco consumption.

Current Cannabidiol Safety: A Review

BACKGROUND

Marijuana, also known as cannabis, is the second most widely used illegal psychoactive substance smoked worldwide after tobacco, mainly due to the psychoactive effects induced by D-9-tetrahydrocannabinol (9-THC). Cannabidiol (CBD) is extracted from cannabis and may be used as an anti-inflammatory agent. Some patents on cannabidiol are discussed in this review. The cannabinoid is a non-psychoactive isomer of the more infamous tetrahydrocannabinol (THC); and is available in several administration modes, most known as CBD oil.

OBJECTIVES

This study aims to provide an enhanced review of cannabidiol properties used in treating inflammation. This review also emphasises the current safety profile of cannabidiol.

METHODS

Cannabis is also called Marijuana. It is the second most commonly used illegal psychoactive substance in the universe after tobacco. D-9-tetrahydrocannabinol (9-THC) present in cannabis produces psychoactive effects. Cannabidiol (CBD) extracted from cannabis is used for antiinflammatory purposes. Cannabis smoking causes various types of cancer, such as lung, tongue, and jaw. The current review took literature from Google Scholar, PubMed, and Google Patents. Many clinical investigations are included in this review.

RESULT

After analysing the literature on cannabis, it has been suggested that although cannabis is banned in some countries, it may be included in the treatment and mitigation of some diseases and symptoms like pain management, epilepsy, cancer, and anxiety disorder. Mild side effects were frequently observed in cannabis medications, which included infertility in females, liver damage, etc. Conclusion: Cannabis contains chemical compounds such as the cannabinoids delta-9- tetrahydrocannabinol (THC), a psychoactive substance, and non-psychoactive cannabidiol (CBD). Cannabidiol has been confirmed as an efficient treatment of epilepsy in several clinical trials, with one pure CBD product named Epidiolex. It is also used in treating anxiety and acne, as a pain reliever, and has anti-inflammatory properties.

Design and implementation of an Internet-Based cancer risk assessment tool: Use over 10 years

BACKGROUND

Prevention and early intervention can improve survival and quality of life across all cancers. Patient understanding of risk factors and associated actionable lifestyle changes and screening programs is not well understood by clinicians METHODS: An Internet-based tool, Reduce My Risk, was created in 2009 and made available on oncolink.org. Users voluntarily completed a survey regarding demographics and cancer risk factors, and received information about their cancer risk RESULTS: Twenty eight thousand and one surveys were completed from 2009 to 2019. Median age was 26 years (18-101); 60% were females, 87% lived in North America, and 37% had at least a bachelor's degree. Users reported on behavioral/ modifiable risk factors: 13% were current smokers, 52% were current consumers of alcohol, and 8% of those had ≥14 drinks/week. Body mass index (BMI) was ≥30 in 19%; 74% of all surveys reported dietary risks and 36% reported infrequent exercise. Excess UV exposure was reported by 19%. Among women, 36% reported performing breast self-examinations monthly, and 50% reported receiving clinician breast examinations at least once every 3 years. Sixty seven percent of men 55-75 years reported screening prostate specific antigen testing, with 50% receiving annual digital rectal examinations. Nonmodifiable risk factors included family cancer history (64%), genetic syndrome (3%), and cancer-predisposing health conditions (26%) CONCLUSIONS: Ninety-seven percent of users reported modifiable risk factors, and 60% reported ≥4 of these risk factors. Understanding detailed characteristics of a large number of respondents has the potential to improve educational interventions to reduce cancer risk through behavioral modification and cancer screening across the general public.

Marijuana and the Lung: Evolving Understandings

Human beings have used marijuana products for centuries. Relatively recent data showing extensive cannabinoid receptors, particularly in the brain, help to explain the impacts of cannabinoids on symptoms/diseases, such as pain and seizures, with major nervous system components. Marijuana can cause bronchitis, but a moderate body of literature suggests that distal airway/parenchymal lung disease does not occur; marijuana does not cause chronic obstructive pulmonary disease and probably does not cause lung cancer, distinctly different from tobacco. Potentials for cognitive impairment and for damage to the developing brain are contextually important as its beneficial uses are explored.

Cannabinoids and Their Role in Chronic Pain Treatment: Current Concepts and a Comprehensive Review

For decades, chronic pain was managed with an almost conventional approach of using a wide range of analgesic spectrum, surgical approaches and complex interventional pain techniques to modulate or even interrupt pain pathways. These different approaches carry many pharmacological hazards together with the lack of efficacy and safety of many interventional and surgical management techniques for chronic pain have mandated searching for other effective therapies including alternative treatments. Cannabinoids are naturally occurring substances that are derived from Cannabis sativa L. The usage of cannabinoids and their related synthetic chemical compounds has emerged as a choice in the management of different chronic pain conditions is being evaluated, however, the efficacy is still not consistently established. In the present investigation, therefore, we discuss the different aspects related to cannabinoids and their implications in the management of chronic pain conditions. This review will also discuss the safety profile of the cannabinoids together with the legal considerations that hinder their use in different countries.

Is psychedelic use associated with cancer?: Interrogating a half-century-old claim using contemporary population-level data

BACKGROUND

In 1967, concerns about the carcinogenic potential of psychedelics arose after a study reported chromosomal damage in human leukocytes following in vitro lysergic acid (LSD) exposure. Worries were further heightened by subsequent reports of leukemia and other cancers in LSD users. Additional investigations of psychedelics' effects on chromosomes were published over the next decade, with the majority suggesting these concerns were unfounded. However, the relationship between psychedelics and cancer has been explored only minimally from an epidemiological perspective.

AIMS

To determine whether associations exist between psychedelic use and either lifetime cancer or hematologic cancer diagnoses.

METHODS

We analyzed data from adult participants in the 2015-2019 administrations of the National Survey on Drug Use and Health for associations between lifetime use of psychedelics and lifetime diagnosis of either any cancer or hematologic cancer.

RESULTS

We identified no associations between lifetime psychedelic use and either lifetime cancer diagnosis or hematologic cancer diagnosis. Sub-analyses of lifetime lysergamide, phenethylamine, and tryptamine use also revealed no associations with lifetime cancer or hematologic cancer diagnosis.

CONCLUSIONS

While laboratory studies and case reports from the 1960s and 1970s generated concerns about psychedelics' carcinogenic potential, this analysis of recent epidemiological data does not support an association between psychedelic use and development of cancer in general or hematologic cancer. Important study limitations to consider include a lack of information about psychedelic dosage, number of lifetime psychedelic exposures, and the temporal relationship between psychedelic use and cancer diagnosis.

[Inhaled marijuana and the lung, a toxic cocktail?]

Unlike the well-documented effects of tobacco smoke on the lung, the effects of cannabis smoke remain controversial, the main bias consisting in co-consumption of tobacco. That said, the composition of joint smoke is close to that of cigarettes, containing many compounds that are carcinogenic and/or alter the respiratory epithelium. Confirmed respiratory effects in chronic cannabis smokers include aggravated chronic bronchitis symptoms, a cumulative effect with tobacco on COPD and emphysema occurrence, an increased risk of bullous emphysema, and pneumothorax with heightened risk of recurrence after pleural symphysis. Recent prospective studies have shown a negative impact on lung function, with not only damage to the airways, but also DLCO alteration and an accelerated drop in FEV1. Finally, cannabis smoking is very common among young patients with lung cancer. Its consumption could lead to a different lung cancer profile, potentially more undifferentiated and less accessible to targeted therapy. Questioning about cannabis consumption must be systematic and targeted medical care should be offered.

Endocannabinoid System and the Otolaryngologist

The endocannabinoid system is located throughout the central and peripheral nervous systems, endocrine system, gastrointestinal system, and within inflammatory cells. The use of medical cannabinoids has been gaining traction as a viable treatment option for varying illnesses in recent years. Research is ongoing looking at the effect of cannabinoids for treatment of common otolaryngologic pathologies. This article identifies common otolaryngologic pathologies where cannabinoids may have benefit, discusses potential drawbacks to cannabinoid use, and suggests future directions for research in the application of medical cannabinoids.