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Mims MM, Parikh AC, Sandhu Z, DeMoss N, Mhawej R, Queimado L. Surgery-Related Considerations in Treating People Who Use Cannabis: A Review. JAMA Otolaryngol Head Neck Surg 2024; 150:918-924. [PMID: 39172477 DOI: 10.1001/jamaoto.2024.2545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Importance Cannabis use has experienced substantial growth. Many patients treated by otolaryngologists are using cannabis in various forms, often without the knowledge of the treating surgeon. These cannabinoid substances have various systemic effects, and it is critical for otolaryngologists to recognize how cannabis use may contribute to a patient's care. Observations Cannabis use has effects that contribute to every phase of a surgeon's care. Preoperative counseling for tapering use may prevent increased rates of adverse effects. Care with anesthesia must be observed due to increased rates of myocardial ischemia, higher tolerance to standard doses, and prolonged sedation. Although results of studies are mixed, there may be an association with cannabis use and postoperative pain, nausea, and vomiting. Postoperative wound healing may be improved through the use of topical cannabinoids. Significant drug-drug interactions exist with cannabis, most notably with several common anticoagulant medications. Care should be exercised when managing medications for people who use cannabis. While many people who use cannabis consume it infrequently, a substantial population has developed cannabis use disorder, which is associated with increased morbidity and mortality postoperatively. Screening for cannabis use disorder is important and can be done through short screening tools. Conclusions and Relevance Patients who use cannabis may require special attention regarding preoperative counseling and workup, intraoperative anesthesia, postoperative pain management, nausea, wound healing, and drug-drug interactions. As patient use continues to increase, otolaryngologists will find an increasing need to remain up to date on how cannabis use contributes to patient care.
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Affiliation(s)
- Mark M Mims
- Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Aniruddha C Parikh
- Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Zainab Sandhu
- University of Oklahoma Medical School, Oklahoma City
| | - Noah DeMoss
- University of Oklahoma Medical School, Oklahoma City
| | - Rachad Mhawej
- Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Lurdes Queimado
- Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City
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2
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Tomlinson DC, Coughlin LN, Bohnert KM, Ilgen MA. Cannabis expectancies and associations with cannabis use and health functioning among adults with chronic pain. Addict Behav 2024; 160:108166. [PMID: 39317012 DOI: 10.1016/j.addbeh.2024.108166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/29/2024] [Accepted: 09/14/2024] [Indexed: 09/26/2024]
Abstract
INTRODUCTION Cannabis is increasingly available to individuals in the United States, with the majority of states legalizing medical or recreational cannabis use. Cannabis expectancies (e.g., positive expectations from cannabis use) are related to more frequent cannabis use and associated with greater odds of lapse following a cessation attempt. METHODS To evaluate the relationship between expectancies and cannabis- and health-related outcomes, we surveyed adults who used medical cannabis for chronic pain (n = 633; 52.2 % female; 82.1 % white) over a two-year period. Then, we performed a principal components analysis (PCA) on the Cannabis Expectancies Questionnaire to derive components of cannabis expectancies. We performed k-means clustering to identify subgroups with similar expectancies. The relationship between subgroup assignment and cannabis use outcomes (frequency, quantity), and physical and mental health functioning were evaluated. RESULTS The PCA identified a three-component solution and k-means clustering identified four subgroups: low expectancies, negative expectancies, amotivation expectancies, and positive expectancies. Participants' cannabis expectancies were dynamic over time. After adjusting for demographics, expectancy subgroup was able to predict six-month cannabis use frequency (χ2(3) = 11.244; p = 0.010) and mental health functioning (χ2(3) = 24.926; p < 0.001), but not quantity (χ2(3) = 2.741, p = 0.433) or physical health functioning (χ2(3) = 5.110, p = 0.164). CONCLUSION In a large cohort of individuals who use medical cannabis, four subgroups with differing cannabis expectancies emerged: low expectancies, negative expectancies, amotivation expectancies, and positive expectancies. These subgroups predicted subsequent outcomes and may be important for targeted intervention approaches to reduce cannabis use and improve functioning.
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Affiliation(s)
- Devin C Tomlinson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Lara N Coughlin
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Kipling M Bohnert
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Mark A Ilgen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Mattingly DT, Richardson MK, Hart JL. Prevalence of and trends in current cannabis use among US youth and adults, 2013-2022. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 12:100253. [PMID: 39040476 PMCID: PMC11262189 DOI: 10.1016/j.dadr.2024.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 06/13/2024] [Accepted: 06/27/2024] [Indexed: 07/24/2024]
Abstract
Introduction Cannabis use is increasing due to several factors including the adoption of laws legalizing its use across the United States (US). We examined changes in current cannabis use among US youth and adults and by key sociodemographic groups. Methods Using data from the 2013-2022 National Survey on Drug Use and Health (n=543,195), we estimated the prevalence of (2013-2019, 2020, 2021-2022) and trends in (2013-2019, 2021-2022) current (i.e., past 30-day) cannabis use among US youth (aged 12-17) and adults (aged 18+) overall and by age, gender, race and ethnicity, educational attainment, and total annual family income. We also examined sociodemographic factors associated with use from 2013 to 2019, in 2020, and from 2021 to 2022. Results Cannabis use increased from 7.59 % to 11.48 % in 2013-2019, was 11.54 % in 2020, and increased again from 13.13 % to 15.11 % in 2021-2022. Among youth, cannabis use remained constant from 2013 to 2019 and 2021-2022. In 2022, use was highest among aged 18-34, male, non-Hispanic multiracial, and generally lower SES adults. From 2021-2022, cannabis use increased among several groups such as adults who were aged 35-49 (14.25-17.23 %), female (11.21-13.00 %), and Hispanic (10.42-13.50 %). Adults who were aged 18-25, male, non-Hispanic multiracial, some college educated, and of lower annual family income had consistently higher odds of current cannabis use from 2013 to 2019, in 2020, and from 2021 to 2022. Conclusions Cannabis use is increasing overall and among certain sociodemographic groups. Our findings inform prevention and harm reduction efforts aimed at mitigating the prevalence of cannabis use in the US.
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Affiliation(s)
- Delvon T. Mattingly
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
- Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Maggie K. Richardson
- Department of Educational, School, & Counseling Psychology, College of Education, University of Kentucky, Lexington, KY 40506, USA
| | - Joy L. Hart
- Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, KY 40292, USA
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY 40202, USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX 75231, USA
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Hamilton LK, Bradley KA, Matson TE, Lapham GT. Discriminative validity of a substance use symptom checklist for moderate-severe DSM-5 cannabis use disorder (CUD) in primary care settings. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 12:100260. [PMID: 39156656 PMCID: PMC11326943 DOI: 10.1016/j.dadr.2024.100260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/20/2024] [Accepted: 07/12/2024] [Indexed: 08/20/2024]
Abstract
Background The prevalence of cannabis use disorder (CUD) is increasing in the US and primary care providers need tools to identify patients with moderate-severe CUD to facilitate treatment. A single-item screen for cannabis (SIS-C) has outstanding discriminative validity for CUD. However, because the prevalence of moderate-severe CUD is typically low, the probability that an average patient who screens positive for daily cannabis has moderate-severe cannabis use disorder is low, making follow-up assessment important. Methods This study reports the discriminative validity of a DSM-5 Substance Use Symptom Checklist ("Checklist") for moderate-severe CUD among 498 primary care patients who reported daily cannabis use on the SIS-C. We evaluated the performance of the Checklist (score 0-11) completed during routine care, compared to ≥4 DSM-5 CUD symptoms (moderate-severe CUD) on the Composite International Diagnostic Interview Substance Abuse Module from a confidential survey (reference standard). We estimated areas under receiver operating curve (AUROC), sensitivities, specificities, and post-test probabilities. Results Of 498 eligible patients, 17 % met diagnostic criteria for moderate-severe CUD. The Checklist's AUROC for moderate-severe CUD was 0.77 (95 % CI: 0.71-0.83), and Checklist scores of 1-2 balanced sensitivity and specificity. Among patients from a population with average prevalence of CUD before screening (~6 % prevalence) and daily use on the SIS-C, a Checklist score of 3 indicated a post-test probability of 82.1 %. Conclusion Overall performance of the Checklist was good and the high specificity made it useful for identifying patients likely to have moderate-severe CUD among those at average risk.
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Affiliation(s)
| | - Katharine A. Bradley
- Kaiser Permanente Washington Health Research Institute, USA
- Department of Health Systems and Population Health, University of Washington, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, USA
- Department of Medicine, University of Washington, USA
| | - Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute, USA
- Department of Health Systems and Population Health, University of Washington, USA
| | - Gwen T. Lapham
- Kaiser Permanente Washington Health Research Institute, USA
- Department of Health Systems and Population Health, University of Washington, USA
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5
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Thompson ES, Alcorn J, Neary JP. Cannabinoid Therapy in Athletics: A Review of Current Cannabis Research to Evaluate Potential Real-World Cannabinoid Applications in Sport. Sports Med 2024:10.1007/s40279-024-02094-1. [PMID: 39168949 DOI: 10.1007/s40279-024-02094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 08/23/2024]
Abstract
The increasing legalization of Cannabis sativa plant products has sparked growing interest in their therapeutic applications. Prohibition laws established in 1937 hindered formal research on cannabis, a plant with cultural and medicinal roots dating back to 2700 BC in Chinese history. Despite regulatory hurdles, published research on cannabis has emerged; yet elite athletes remain an underrepresented population in these studies. Athletes, known for exploring diverse substances to optimize performance, are drawn to the potential benefits of cannabinoid therapy, with anecdotal reports suggesting positive effects on issues ranging from anxiety to brain injuries. This review aims to evaluate empirical published cannabis research with a specific focus on its potential applications in athletics. The changing legal landscape, especially the removal of cannabis from drug testing programs in leagues such as the National Basketball Association (NBA), and endorsements by Major League Baseball (MLB) for cannabinoid products and the National Football League (NFL) for cannabis research, reflects a shift in the acceptability of such substances in sports. However, stigma, confusion, and a lack of education persist, hindering a cohesive understanding among sports organizations, including business professionals, policymakers, coaches, and medical/training staff, in addition to athletes themselves. Adding to the confusion is the lack of consistency with cannabinoid regulations from sport to sport, within or out of competition, and with cannabis bioactive compounds. The need for this review is underscored by the evolving attitudes toward cannabinoids in professional sports and the potential therapeutic benefits or harms they may offer. By synthesizing current cannabis research, this review aims to provide a comprehensive understanding of the applications and implications of cannabinoid use in the realm of athletics.
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Affiliation(s)
| | - Jane Alcorn
- University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada
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Rubenstein D, Green MJ, Sweitzer MM, Keefe FJ, McClernon FJ. Bidirectional relationships between pain and patterns of cannabis and tobacco use in a US nationally representative sample. Pain 2024:00006396-990000000-00687. [PMID: 39172858 DOI: 10.1097/j.pain.0000000000003381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/10/2024] [Indexed: 08/24/2024]
Abstract
ABSTRACT One-fifth of US adults experience chronic pain, which is associated with increased tobacco and cannabis use. Although bidirectional relationships between tobacco and pain have been demonstrated, pathways between pain, cannabis use, and co-use of cannabis and tobacco are understudied. We aimed to estimate the effects of (1) substance use (exclusive and co-use of cannabis and tobacco) on later pain intensity, and (2) pain intensity on later substance use. Data were from 31,983 adults in biennial surveys (2015-2021) of the US nationally representative longitudinal Population Assessment of Tobacco and Health Study (n = 71,055 pairs of consecutive surveys; T1 and T2). Past-week pain intensity was dichotomized (≤4/10 no/low pain; >4/10 moderate/severe pain). Mutually exclusive substance use categories (past 30 days) were no cannabis/tobacco use; exclusive cannabis/tobacco use; and co-use. Logistic regression assessed whether T1 substance use affected moderate/severe pain at T2. Multinomial models assessed whether pain status at T1 affected substance use at T2. Compared with no cannabis/tobacco use at T1, co-use (OR: 2.29 [95% CI: 2.09-2.51]), exclusive tobacco use (2.00 [1.86-2.14]), and exclusive cannabis use (1.35 [1.13-1.61]) were all associated with moderate/severe pain at T2. Moderate/severe pain at T1 increased odds of co-use (2.43 [2.22-2.66]), exclusive tobacco (2.12 [1.98-2.28]), and exclusive cannabis use (1.46 [1.29-1.65]) compared with no cannabis/tobacco use at T2, and increased odds of co-use at T2 compared with exclusive cannabis/tobacco use. Findings demonstrated bidirectional relationships between pain and the exclusive use and co-use of cannabis and tobacco and indicate potential synergy in the co-use of cannabis and tobacco with respect to pain.
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Affiliation(s)
- Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, United States
| | - Michael J Green
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, United States
| | - Maggie M Sweitzer
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, United States
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7
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Choi NG, Moore J, Choi BY. Cannabis use disorder and substance use treatment among U.S. adults. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 167:209486. [PMID: 39151799 DOI: 10.1016/j.josat.2024.209486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/24/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Recent expansion of cannabis legalization in multiple states calls for reexamination of the prevalence of cannabis use, cannabis use disorder (CUD), and the associations between CUD severity and substance use treatment. We used Andersen's behavioral model of healthcare use as the conceptual/analytic framework for examining treatment use. METHODS We used data from the 2022 National Survey on Drug Use and Health (NSDUH; N = 47,100, age 18+) to describe the prevalence of past-year cannabis use, CUD and CUD severity, other substance use disorders, and substance use treatment. We compared sociodemographic, mental health, healthcare use, and cannabis and other substance use characteristics by CUD severity. Finally, we used logistic regression models to examine the associations between CUD severity and substance use treatment. RESULTS Of the U.S. adult population, 23.0 % used cannabis in the past year; 7.0 % had a CUD (3.9 % mild, 1.9 % moderate, and 1.2 % severe CUD); and 4.7 % received substance use treatment. Of past-year cannabis users, 30.3 % had CUD (16.9 % mild, 8.4 % moderate, and 5.0 % severe CUD), and 9.6 % received substance use treatment. Cannabis users had 3-4 times higher rates of other substance use disorders than nonusers. Of those with CUD, 38.4 % had moderate/severe mental illness, 52.4 % had other substance use disorders, and 16.5 % received substance use treatment. Among all cannabis users, moderate (aOR [adjusted odds ratios] = 1.48, 95 % CI = 1.03-2.13) and severe (aOR = 2.57, 95 % CI = 1.60-4.11) CUDs were associated with greater odds of substance use treatment. Among cannabis users without nicotine dependence and alcohol, opioid, tranquilizer/sedative, and stimulant use disorders, only severe CUD (aOR = 6.03, 95 % CI = 3.37-10.78) was associated with greater odds of substance use treatment. CONCLUSIONS This study shows increased prevalence of cannabis use and CUD among U.S. adults, and with or without other substance use disorders, CUD was associated with greater odds of substance use treatment. However, the overall low rate of treatment use among those with CUD is concerning. Healthcare providers need to provide education for both medical and recreational users on the development of tolerance and dependence. Harm reduction strategies to minimize the negative consequences of CUD are also needed.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA.
| | - John Moore
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, USA
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8
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Crowley R, Cline K, Hilden D, Beachy M. Regulatory Framework for Cannabis: A Position Paper From the American College of Physicians. Ann Intern Med 2024; 177:1104-1105. [PMID: 39038289 DOI: 10.7326/m24-0638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
Cannabis, also known as marijuana, is the dried flowers, stems, seeds, and leaves of the Cannabis sativa plant. It contains more than 100 compounds, including tetrahydrocannabinol, which has psychoactive effects. Federal law prohibits the possession, distribution, and use of cannabis outside limited research activities, but most states have legalized cannabis for medical or recreational use. However, research into the potential therapeutic and adverse health effects of cannabis has been limited, in part because of the drug's federal legal status. In this position paper, the American College of Physicians (ACP) calls for the decriminalization of possession of small amounts of cannabis for personal use and outlines a public health approach to controlling cannabis in jurisdictions where it is legal. ACP recommends the rigorous evaluation of the health effects and potential therapeutic uses of cannabis and cannabinoids as well as research into the effects of legalization on cannabis use. It also calls for evidence-based medical education related to cannabis and increased resources for treatment of cannabis use disorder.
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Affiliation(s)
- Ryan Crowley
- American College of Physicians, Washington, DC (R.C., K.C.)
| | - Katelan Cline
- American College of Physicians, Washington, DC (R.C., K.C.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
| | - Micah Beachy
- University of Nebraska Medical Center, Omaha, Nebraska (M.B.)
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9
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Russell L, Condo K, DeFlorville T. Nutrition, endocannabinoids, and the use of cannabis: An overview for the nutrition clinician. Nutr Clin Pract 2024; 39:815-823. [PMID: 38555505 DOI: 10.1002/ncp.11148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/21/2024] [Accepted: 03/02/2024] [Indexed: 04/02/2024] Open
Abstract
The endocannabinoid system (ECs) is composed of multiple signaling compounds and receptors within the central and peripheral nervous system along with various organs, including the gut, liver, and skeletal muscle. The ECs has been implicated in metabolism, gut motility, and eating behaviors. The ECs is altered in disease states such as obesity. Recent studies have clarified the role of the gut microbiome and nutrition on the ECs. Exogenous cannabinoid (CB) use, either organic or synthetic, stimulates the ECs through CB1 and CB2 receptors. However, the role of CBs is unclear in regard to nutrition optimization or to treat disease states. This review briefly summarizes the effect of the ECs and exogenous CBs on metabolism and nutrition. With the increased legalization of cannabis, there is a corresponding increased use in the United States. Therefore, nutrition clinicians need to be aware of both the benefits and harm of cannabis use on overall nutrition status, as well as the gaps in knowledge for future research and guideline development.
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Affiliation(s)
- Lindsey Russell
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kayla Condo
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tiffany DeFlorville
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Carpenter KM, Walker DD, Mullis K, Berlin HM, Short E, Javitz HS, Carlini BH. Testing a Brief Quitline Intervention for Tobacco Cannabis Co-Users: A Randomized Controlled Pilot Study. Tob Use Insights 2024; 17:1179173X241261302. [PMID: 38873657 PMCID: PMC11171437 DOI: 10.1177/1179173x241261302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/25/2024] [Indexed: 06/15/2024] Open
Abstract
Background: Tobacco cannabis co-use is common and becoming more prevalent. Frequent and heavy users of cannabis may struggle to quit smoking. Quitlines offer free cessation treatment in the United States and 25% of quitline callers may also be cannabis users. The present paper describes a randomized pilot study of a tailored intervention for cannabis and cigarette co-users. The intervention combines the quitline smoking cessation treatment with a motivational enhancement therapy-based cannabis intervention. Methods: The randomized pilot study was conducted within four state-funded quitlines with quitline coaches as interventionists. 102 quitline callers who were cannabis and cigarette co-users were randomized to receive treatment as usual (TAU) or the new Quitline Check-Up (QLCU) intervention. Outcomes were collected 90 days post-randomization. Primary outcomes included feasibility and acceptability of delivering the QLCU in the quitline setting. Secondary outcomes included 7-day point prevalence tobacco abstinence, past 30-day cannabis use, and Cannabis Use Disorder Identification Test scores. Results: Study participants were heavy cannabis users, averaging 25 days of use in the past 30; nearly 70% used at a level considered hazardous. Fidelity ratings indicated coaches were successful at delivering the intervention. Treatment engagement was high for both groups (TAU m = 3.4 calls; QLCU m = 3.6 calls) as was treatment satisfaction. Intent-to-treat quit rates (with survey non-responders classified as smokers) were 28.6% for the TAU control group and 24.5% for the QLCU group (P = .45). Discussion: Hazardous cannabis use rates were high in this sample of tobacco cannabis co-users calling quitlines to quit smoking. The intervention for co-users was acceptable and feasible to deliver. No improvements in tobacco cessation outcomes were observed. Pragmatic intervention development within a real-world clinical setting can streamline the intervention development process. More research is needed on tobacco cannabis co-users and who can benefit from a tailored intervention. Registered: ClinicalTrials.gov NCT04737772, February 4, 2021.
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Heal DJ, Gosden J, Smith SL. A critical assessment of the abuse, dependence and associated safety risks of naturally occurring and synthetic cannabinoids. Front Psychiatry 2024; 15:1322434. [PMID: 38915848 PMCID: PMC11194422 DOI: 10.3389/fpsyt.2024.1322434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 05/27/2024] [Indexed: 06/26/2024] Open
Abstract
Various countries and US States have legalized cannabis, and the use of the psychoactive1 and non-psychoactive cannabinoids is steadily increasing. In this review, we have collated evidence from published non-clinical and clinical sources to evaluate the abuse, dependence and associated safety risks of the individual cannabinoids present in cannabis. As context, we also evaluated various synthetic cannabinoids. The evidence shows that delta-9 tetrahydrocannabinol (Δ9-THC) and other psychoactive cannabinoids in cannabis have moderate reinforcing effects. Although they rapidly induce pharmacological tolerance, the withdrawal syndrome produced by the psychoactive cannabinoids in cannabis is of moderate severity and lasts from 2 to 6 days. The evidence overwhelmingly shows that non-psychoactive cannabinoids do not produce intoxicating, cognitive or rewarding properties in humans. There has been much speculation whether cannabidiol (CBD) influences the psychoactive and potentially harmful effects of Δ9-THC. Although most non-clinical and clinical investigations have shown that CBD does not attenuate the CNS effects of Δ9-THC or synthetic psychoactive cannabinoids, there is sufficient uncertainty to warrant further research. Based on the analysis, our assessment is cannabis has moderate levels of abuse and dependence risk. While the risks and harms are substantially lower than those posed by many illegal and legal substances of abuse, including tobacco and alcohol, they are far from negligible. In contrast, potent synthetic cannabinoid (CB1/CB2) receptor agonists are more reinforcing and highly intoxicating and pose a substantial risk for abuse and harm. 1 "Psychoactive" is defined as a substance that when taken or administered affects mental processes, e.g., perception, consciousness, cognition or mood and emotions.
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Affiliation(s)
- David J. Heal
- DevelRx Limited, Nottingham, United Kingdom
- Department of Life Sciences, University of Bath, Bath, United Kingdom
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12
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Gelberg L, Beck D, Koerber J, Akabike WN, Dardick L, Lin C, Shoptaw S, Javanbakht M. Cannabis Use Reported by Patients Receiving Primary Care in a Large Health System. JAMA Netw Open 2024; 7:e2414809. [PMID: 38837159 PMCID: PMC11154156 DOI: 10.1001/jamanetworkopen.2024.14809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/02/2024] [Indexed: 06/06/2024] Open
Abstract
Importance Despite the changing legal status of cannabis and the potential impact on health, few health systems routinely screen for cannabis use, and data on the epidemiology of cannabis use, and especially medical cannabis use among primary care patients, are limited. Objective To describe the prevalence of, factors associated with, and reasons for past-3 month cannabis use reported by primary care patients. Design, Setting, and Participants This cross-sectional study used electronic health record data from patients aged 18 years and older who had an annual wellness visit between January 2021 and May 2023 from a primary care clinic within a university-based health system in Los Angeles, California. Exposures Factors of interest included age, race and ethnicity, sex, employment status, and neighborhood Area Deprivation Index (ADI). Main Outcomes and Measures Cannabis use was assessed using the Alcohol Substance Involvement Screening Test (ASSIST). Patients were also asked about reasons for use, symptoms for which they used cannabis, and mode of use. Results Among the 175 734 patients screened, the median (range) age was 47 (18-102) years; 101 657 (58.0%) were female; 25 278 (15.7%) were Asian, 21 971 (13.7%) were Hispanic, and 51 063 (31.7%) were White. Cannabis use was reported by 29 898 (17.0%), with 10 360 (34.7%) having ASSIST scores indicative of moderate to high risk for cannabis use disorder (CUD). Prevalence of cannabis use was higher among male patients than female patients (14 939 [20.0%] vs 14 916 [14.7%]) and younger patients (18-29 years, 7592 [31.0%]; ≥60 years, 4200 [8.5%]), and lower among those who lived in the most disadvantaged neighborhoods (ADI decile 9-10, 189 [13.8%]; ADI decile 1-2, 12 431 [17.4%]). The most common modes of use included edibles (18 201 [61.6%]), smoking (15 256 [51.7%]), and vaporizing (8555 [29.0%]). While 4375 patients who reported using cannabis (15.6%) did so for medical reasons only, 21 986 patients (75.7%) reported using cannabis to manage symptoms including pain (9196 [31.7%]), stress (14 542 [50.2%]), and sleep (16 221 [56.0%]). The median (IQR) number of symptoms managed was 2 (1-4), which was higher among patients who were at moderate to high risk for CUD (4 [2-6] symptoms). Conclusions and Relevance In this study, cannabis use and risk of CUD were common, and more than three-quarters of patients who reported any cannabis use reported doing so to manage a health-related symptom. These findings suggest that integration of information regarding cannabis use for symptom management could help provide a crucial point-of-care opportunity for clinicians to understand their patients' risk for CUD.
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Affiliation(s)
- Lillian Gelberg
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Dana Beck
- UCLA School of Nursing, Los Angeles, California
| | - Julia Koerber
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California
| | - Whitney N. Akabike
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Lawrence Dardick
- Department of Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Clara Lin
- Department of Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Steve Shoptaw
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California
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Baral A, Liu J, Garcia-Davis S, Diggs BNA, Ayala L, Aka A, Agrawal YS, Messiah SE, Vidot DC. Prevalence of Metabolic Syndrome Among Emerging Adult Cannabis Users by Race/Ethnicity: Analysis of the 2009-2018 National Health and Nutrition Examination Surveys. AMERICAN JOURNAL OF MEDICINE OPEN 2024; 11:100069. [PMID: 39034940 PMCID: PMC11256325 DOI: 10.1016/j.ajmo.2024.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 03/02/2024] [Accepted: 03/24/2024] [Indexed: 07/23/2024]
Abstract
Background Association between cannabis use and metabolic syndrome (MetS) has been documented; yet variation by race/ethnicity is understudied. We examined cannabis use and MetS by race/ethnicity among emerging adults (18-25 years old), the age group with the highest prevalence of cannabis use. Methods Data from 18- to 25-year-olds who completed the National Health and Nutrition Examination Survey (2009-2018) were analyzed. Current cannabis use was defined as ≥1 day of use in the last 30 days. MetS was defined using standardized guidelines as ≥3 of the following: elevated fasting glucose, triglycerides, systolic (SBP) and/or diastolic blood pressure (DPB), waist circumference, and/or low high-density lipoprotein (HDL) cholesterol. Logistic regression was used to examine the association between current cannabis use (CCU) and MetS, adjusting for covariates. Results Of 3974 respondents, 48.8% were female, mean age 21.1 years (SD = 2.4), 56.7% non-Hispanic white, 20.4% Hispanic, and 14.0% non-Hispanic black (NHB). Hispanics had the highest MetS prevalence (7.9%) and lowest CCU prevalence (23.5%). NHB had highest CCU prevalence (33.4%, P < .0001) and lowest MetS prevalence (4.8%, P = .2543). CCUs had a higher mean SBP (P = .020) and Hispanics (P = .002) than never users. Conversely, NHB CCUs exhibited lower mean SBP than NHB never users (P = .008). CCUs had 42% reduced odds of MetS than never users (AOR: 0.58, 95% CI: 0.35-0.95). Among NHB, CCUs had 78% lower likelihood of having MetS than never users (AOR: 0.22, 95% CI: 0.06-0.81). Conclusions Cannabis use impacts MetS and blood pressure differently by race/ethnicity. Current cannabis use was associated with lower odds of MetS overall and among NHB. Further research is warranted to investigate how administration routes, dosages, and usage duration affect MetS.
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Affiliation(s)
- Amrit Baral
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL
- University of Miami School of Nursing and Health Studies, Miami, FL
| | - Jingxin Liu
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL
| | - Sandra Garcia-Davis
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL
| | - Bria-Necole A. Diggs
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL
- University of Miami School of Nursing and Health Studies, Miami, FL
| | - Lizelh Ayala
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL
| | - Anurag Aka
- University of Miami School of Nursing and Health Studies, Miami, FL
| | - Yash S. Agrawal
- University of Miami School of Nursing and Health Studies, Miami, FL
| | - Sarah E. Messiah
- University of Texas Health Science Center at Houston, School of Public Health, Houston, TX
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston School of Public Health, Houston, TX
| | - Denise C. Vidot
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL
- University of Miami School of Nursing and Health Studies, Miami, FL
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; New York State Psychiatric Institute, New York
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Tareen K, Winder GS. Tobacco, cannabis, and the liver. Clin Liver Dis (Hoboken) 2024; 23:e0210. [PMID: 38872776 PMCID: PMC11168856 DOI: 10.1097/cld.0000000000000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/15/2024] [Indexed: 06/15/2024] Open
Affiliation(s)
- Kinza Tareen
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Gerald Scott Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
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Affiliation(s)
- Tom P Freeman
- Addiction and Mental Health Group, Department of Psychology, University of Bath, Bath, UK
| | - Wayne Hall
- National Centre for Youth Substance Use Research, University of Queensland, St Lucia, QLD, Australia
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