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Mohammad SA, Mousa REA, Gebril SM, Masoud KMM, Radwan RA. Toxic effects of AB-CHMINACA on liver and kidney and detection of its blood level in adult male mice. Forensic Toxicol 2024; 42:7-17. [PMID: 37573525 PMCID: PMC10808145 DOI: 10.1007/s11419-023-00670-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND AB-CHMINACA is a cannabimimetic indazole derivative. In 2013, it was reported in different countries as a substance of abuse. PURPOSE This study evaluated the subacute toxic effects of AB-CHMINACA on the liver and kidneys and measured its blood level in adult male mice. METHODS The histological and biochemical subacute toxic effects on the liver and kidneys were assessed after four weeks of daily intraperitoneal injections of one of the following doses: 0.3 mg/kg, 3 mg/kg, or 10 mg/kg as the highest dose in adult male albino mice. In addition, the blood concentration level of AB-CHMINACA was determined by GC-MS-MS. RESULTS The histological effects showed congestion, hemorrhage, degeneration, and cellular infiltration of the liver and kidney tissues. Considering the control groups as a reference, biochemical results indicated a significant increase in the serum AST only in the highest dose group, while the ALT and creatinine levels did not significantly change. The mean values of AB-CHMINACA blood levels were 3.05 ± 1.16, 15.08 ± 4.30, and 54.43 ± 8.70 ng/mL for the three treated groups, respectively, one hour after the last dose of intraperitoneal injection. The calibration curves were linear in the 2.5-500 ng/mL concentration range. The intra-assay precision and accuracy of the method were less than 7.0% (RSD) and ± 9.2% (Bias). CONCLUSION This research supports the available case reports on AB-CHMINACA toxicity that it has low lethality; still, the chronic administration causes evident liver and kidney histotoxic effects even at low doses with unnoticeable clinical effects in mice.
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Affiliation(s)
- Soheir Ali Mohammad
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Rasha Elhaddad Ali Mousa
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Sohag University, Sohag, Egypt.
| | | | - Khaled Masoud Mohamed Masoud
- Department of Forensic Sciences, College of Criminal Justice, Naif Arab University for Security Sciences, Riyadh, Saudi Arabia
| | - Rania Ahmad Radwan
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Sohag University, Sohag, Egypt
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Kulpa J, Henderson RG, Schwotzer D, Dye W, Trexler KR, McDonald J, Lefever TW, Bonn-Miller MO. Toxicological Evaluation and Pain Assessment of Four Minor Cannabinoids Following 14-Day Oral Administration in Rats. Cannabis Cannabinoid Res 2023; 8:S25-S41. [PMID: 37721989 DOI: 10.1089/can.2023.0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Introduction: Despite growing consumer interest and market availability, the safety of minor cannabinoids, generally present in low concentrations in Cannabis sativa L., is not well understood. Materials and Methods: Cannabichromene (CBC; 3.2, 10, 17, 22, 32, or 100 mg/kg-bw/day), cannabinol (CBN; 1, 3.2, 10, 17, 32, or 100 mg/kg-bw/day), delta-8-tetrahydrocannabinol (D8-THC; 0.32, 1, 3.2, or 10 mg/kg-bw/day), tetrahydrocannabivarin (THCV; 3.2, 10, 17, 22, 32, or 100 mg/kg-bw/day), and vehicle (medium-chain triglyceride oil) preparations were administered via oral gavage once daily for 14 days to Sprague Dawley rats. Changes in behavior, body weight, food consumption, clinical pathology, organ weights, body temperature, and thermal pain sensitivity (tail flick assay) were assessed. Select organ tissues were collected at terminal necropsy and fixed for histopathological examination. Results: No treatment-related deaths were observed throughout the study, and cannabinoids were generally well tolerated. While some significant trends in body weight differences from controls (increases and decreases) were observed, these occurred independently of food consumption. Overall, differences in serum chemistry and hematology parameters between cannabinoid groups and their respective control groups were considered to occur due to biological variation among rats. No treatment-related gross abnormalities were observed in examined organs. Significant changes in absolute and relative organ weights occurred primarily in males and were generally of negligible magnitude. There were no biologically significant histopathological observations. While pain tolerance was significantly improved in animals treated with D8-THC (3.2 and 10 mg/kg-bw/day, day 14), results across minor cannabinoids were inconsistent and warrant further study. Conclusion: Minor cannabinoids were well tolerated across 14 days of daily oral administration at the doses assessed. Modest, dose-dependent trends in relative organ weights and serum chemistry parameters warrant exploration at higher oral doses. These data will assist in dose selection for future studies investigating the long-term safety and effects of CBC, CBN, D8-THC, and THCV.
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Affiliation(s)
| | | | | | - Wendy Dye
- Lovelace Biomedical, Albuquerque, New Mexico, USA
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3
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Filipiuc LE, Ştefănescu R, Solcan C, Ciorpac M, Szilagyi A, Cojocaru D, Stanciu GD, Creangă I, Caratașu CC, Ababei DC, Gavrila RE, Timofte AD, Filipiuc SI, Bild V. Acute Toxicity and Pharmacokinetic Profile of an EU-GMP-Certified Cannabis sativa L. in Rodents. Pharmaceuticals (Basel) 2023; 16:ph16050694. [PMID: 37242477 DOI: 10.3390/ph16050694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/28/2023] Open
Abstract
The conundrum of Cannabis sativa's applications for therapeutical purposes is set apart by the hundreds of known and commercially available strains, the social, cultural and historical context, and the legalization of its use for medical purposes in various jurisdictions around the globe. In an era where targeted therapies are continuously being developed and have become the norm, it is imperative to conduct standardized, controlled studies on strains currently cultivated under Good Manufacturing Practices (GMP) certification, a standard that guarantees the quality requirements for modern medical and therapeutic use. Thus, the aim of our study is to evaluate the acute toxicity of a 15.6% THC: <1% CBD, EU-GMP certified, Cannabis sativa L. in rodents, following the OECD acute oral toxicity guidelines, and to provide an overview of its pharmacokinetic profile. Groups of healthy female Sprague-Dawley rats were treated orally with a stepwise incremental dose, each step using three animals. The absence or presence of plant-induced mortality in rats dosed at one step determined the next step. For the EU GMP-certified Cannabis sativa L. investigated, we determined an oral LD50 value of over 5000 mg/kg in rats and a human equivalent oral dose of ≈806.45 mg/kg. Additionally, no significant clinical signs of toxicity or gross pathological findings were observed. According to our data, the toxicology, safety and pharmacokinetic profile of the tested EU-GMP-certified Cannabis sativa L. support further investigations through efficacy and chronic toxicity studies in preparation for potential future clinical applications and especially for the treatment of chronic pain.
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Affiliation(s)
- Leontina-Elena Filipiuc
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Raluca Ştefănescu
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Carmen Solcan
- Faculty of Veterinary Medicine, Ion Ionescu de la Brad University of Life Sciences, 700490 Iasi, Romania
| | - Mitică Ciorpac
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Andrei Szilagyi
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Dana Cojocaru
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Gabriela Dumitrita Stanciu
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Ioana Creangă
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Cătălin-Cezar Caratașu
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Daniela-Carmen Ababei
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Pharmacodynamics and Clinical Pharmacy Department, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Roxana-Elena Gavrila
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Andrei-Daniel Timofte
- Histology Department, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Silviu-Iulian Filipiuc
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Veronica Bild
- Advanced Research and Development Center for Experimental Medicine (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Pharmacodynamics and Clinical Pharmacy Department, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
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Geci M, Scialdone M, Tishler J. The Dark Side of Cannabidiol: The Unanticipated Social and Clinical Implications of Synthetic Δ 8-THC. Cannabis Cannabinoid Res 2023; 8:270-282. [PMID: 36264171 PMCID: PMC10061328 DOI: 10.1089/can.2022.0126] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The explosive growth of the cannabis industry in the United States over the past decade has spurred a multitude of products derived from phytocannabinoids produced by Cannabis sativa L. Decades of cannabis prohibition coupled with the more recent 2018 Farm Bill have lead to several unanticipated consequences and the widespread availability of synthetic cannabinoids derived from hemp CBD, including Δ8-THC, Δ10-THC and HHC. Methods: Herein, we review the available literature of the complexity of the chemistry of its current manufacture, namely, the acid-catalyzed ring closure of cannabidiol (ACRCC), the myriad of issues involving the unsolved technical problems with quality control of ACRCC-Δ8-THC and the multitude of isomerized byproducts, and the lack of consistent regulation regarding consumer safety and labeling. Results: We provide what we believe is the first comprehensive listing of all the documented ACRCC-Δ8-THC byproducts. Perhaps, most importantly, we highlight the growing concern that, other than Δ8-THC itself, the compounds in ACRCC-Δ8-THC product mixtures have not been subjected to any human toxicological evaluation. This is especially troubling as ACRCC-Δ8-THC products relate to vaping, and their contribution to a growing and lethal epidemic of electronic cigarette, or vaping, product use-associated lung injury (EVALI). Conclusions: Quality control is totally inadequate in the newly emerging Δ8-THC industry. American consumers are ingesting products that are mislabeled with many compounds that have never received any toxicological testing. EVALI cases continue to be reported with a fatality rate approaching 2% (in California).
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Affiliation(s)
- Michael Geci
- Whole Health & Healing Integrative Clinic, Cherry Valley, New York, USA
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Tokarczyk B, Suchan M, Adamowicz P. New Synthetic Cannabinoid ADB-BUTINACA-Related Death of a Police Dog. J Anal Toxicol 2023; 47:e23-e28. [PMID: 36472351 DOI: 10.1093/jat/bkac097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/15/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
The popularity of synthetic cannabinoids puts police sniffer dogs at risk of accidental introduction of such substances into the body. The extreme efficacy and potency of many new synthetic cannabinoids are associated with a high risk of serious poisonings and even deaths. The paper presents the toxicological findings in an intoxication of a police dog, in which a new synthetic cannabinoid ADB-BUTINACA was detected and quantified in postmortem materials. The screening analyses were performed by liquid chromatography with tandem mass spectrometry (LC-MS-MS) and liquid chromatography--quadrupole/time-of-flight mass spectrometry (LC-QTOF-MS). LC-MS-MS was also used for quantitative analyses, while LC-QTOF-MS for metabolite identification. Due to unusual matrices, the standard addition method was used for the quantitative determination of ADB-BUTINACA. The determined concentrations of ADB-BUTINACA in blood, lung, stomach, liver and kidney were 8.1 ng/mL, 6.4 ng/g, 1.5 ng/g, 1.8 ng/g and 0.4 ng/g, respectively. Apart from ADB-BUTINACA, the monohydroxylated metabolites and the dihydrodiol metabolite were detected and identified in all analyzed materials, and moreover the product of N-debutylation was found in blood and liver. The described case presents the identification and quantitation of a new synthetic cannabinoid ADB-BUTINACA in postmortem dog specimens. Although the cause of death was acute gastric dilatation, it cannot be ruled out that this process was the result of synthetic cannabinoid inhalation. Due to dogs' sensitivity to cannabinoids, ADB-BUTINACA poisoning cannot be excluded either. The described case suggests that ADB-BUTINACA elicits serious adverse effects in dogs. The article also indicates the dangers to which police dogs coming into contact with extremely potent drugs may be exposed.
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Affiliation(s)
- Bogdan Tokarczyk
- Institute of Forensic Research, Westerplatte 9, Krakow 31-033, Poland
| | - Marta Suchan
- Institute of Forensic Research, Westerplatte 9, Krakow 31-033, Poland
| | - Piotr Adamowicz
- Institute of Forensic Research, Westerplatte 9, Krakow 31-033, Poland
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Corsato Alvarenga I, Panickar KS, Hess H, McGrath S. Scientific Validation of Cannabidiol for Management of Dog and Cat Diseases. Annu Rev Anim Biosci 2023; 11:227-246. [PMID: 36790884 DOI: 10.1146/annurev-animal-081122-070236] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Cannabidiol (CBD) is a non-psychotropic phytocannabinoid of the plant Cannabis sativa L. CBD is increasingly being explored as an alternative to conventional therapies to treat health disorders in dogs and cats. Mechanisms of action of CBD have been investigated mostly in rodents and in vitro and include modulation of CB1, CB2, 5-HT, GPR, and opioid receptors. In companion animals, CBD appears to have good bioavailability and safety profile with few side effects at physiological doses. Some dog studies have found CBD to improve clinical signs associated with osteoarthritis, pruritus, and epilepsy. However, further studies are needed to conclude a therapeutic action of CBD for each of these conditions, as well as for decreasing anxiety and aggression in dogs and cats. Herein, we summarize the available scientific evidence associated with the mechanisms of action of CBD, including pharmacokinetics, safety, regulation, and efficacy in ameliorating various health conditions in dogs and cats.
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Affiliation(s)
- Isabella Corsato Alvarenga
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA;
| | - Kiran S Panickar
- Science & Technology Center, Hill's Pet Nutrition, Inc., Topeka, Kansas, USA
| | - Hannah Hess
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA;
| | - Stephanie McGrath
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA;
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7
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Simon TA, Simon JH, Heaning EG, Gomez-Caminero A, Marcu JP. Delta-8, a Cannabis-Derived Tetrahydrocannabinol Isomer: Evaluating Case Report Data in the Food and Drug Administration Adverse Event Reporting System (FAERS) Database. Drug Healthc Patient Saf 2023; 15:25-38. [PMID: 36742440 PMCID: PMC9894081 DOI: 10.2147/dhps.s391857] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/16/2023] [Indexed: 01/30/2023] Open
Abstract
Purpose The aim of this study was to characterize the frequency of adverse effects where delta-8 tetrahydrocannabinol (D8-THC) was identified as a possible suspect drug in the FDA Adverse Event Reporting System (FAERS) database. Methods A case-series design was used. Results A total of 183 cases listed D8-THC as a suspect drug in FAERS as of June 30, 2021. The most common events included dyspnea, respiratory disorder, and seizure. The reporting odds ratios were consistently and significantly greater than 2, a 2-fold increase from 2019 to 2021, indicating a potential safety signal. Conclusion The first report of D8-THC, in the FAERS database, as a suspect drug appears to be in 2011. Overall, there are 183 total cases listing D8-THC as a suspect drug in the FAERS database as of June 30, 2021. Of the 183 cases, most were respiratory in nature.
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Affiliation(s)
- Teresa A Simon
- Physicians Research Center, LLC, Toms River, NJ, USA,Correspondence: Teresa A Simon, Physicians Research Center, LLC, Toms River, NJ, 08753, USA, Tel +732 818-7900, Fax +732 557-0217, Email
| | - John H Simon
- Physicians Research Center, LLC, Toms River, NJ, USA
| | | | | | - Jahan P Marcu
- Physicians Research Center, LLC, Toms River, NJ, USA,Marcu Enterprises, Jersey City, NJ, USA
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8
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Vázquez‐Valadez VH, Oliva‐Arellano MV, Martínez‐Soriano PA, Hernández‐Serda MA, Velázquez‐Sánchez AM, Concepción Rodríguez‐Maciel J, Angeles E. In Silico
Predictability of Toxicity Parameters Using the OECD QSAR Toolbox of Some Components of
Cannabis sativa. ChemistrySelect 2023. [DOI: 10.1002/slct.202204079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Víctor Hugo Vázquez‐Valadez
- Laboratorio de Química Medicinal y Teórica FESC – Universidad Nacional Autónoma de México Av. 1 de Mayo S/N Cuautitlán Izcalli Estado de México México ZIP 54750
- QSAR Analytics SA de CV. Tempano 10, Colonia Atlanta, Cuautitlán Izcalli Estado de México México ZIP 54740
| | - María Virginia Oliva‐Arellano
- Laboratorio de Química Medicinal y Teórica FESC – Universidad Nacional Autónoma de México Av. 1 de Mayo S/N Cuautitlán Izcalli Estado de México México ZIP 54750
| | - Pablo Arturo Martínez‐Soriano
- Laboratorio de Química Medicinal y Teórica FESC – Universidad Nacional Autónoma de México Av. 1 de Mayo S/N Cuautitlán Izcalli Estado de México México ZIP 54750
| | - Manuel Alejandro Hernández‐Serda
- Laboratorio de Química Medicinal y Teórica FESC – Universidad Nacional Autónoma de México Av. 1 de Mayo S/N Cuautitlán Izcalli Estado de México México ZIP 54750
| | - Ana María Velázquez‐Sánchez
- Laboratorio de Química Medicinal y Teórica FESC – Universidad Nacional Autónoma de México Av. 1 de Mayo S/N Cuautitlán Izcalli Estado de México México ZIP 54750
| | - José Concepción Rodríguez‐Maciel
- Laboratorio de Fitosanidad – Entomología y Acarología Colegio de Posgraduados Km 36.5 Carretera México-Texcoco, Texcoco Estado de México México ZIP 56230
| | - Enrique Angeles
- Laboratorio de Química Medicinal y Teórica FESC – Universidad Nacional Autónoma de México Av. 1 de Mayo S/N Cuautitlán Izcalli Estado de México México ZIP 54750
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Bailey MM, Emily Mills MC, Haas AE, Bailey K, Kaufmann RC. The effects of subacute exposure to a water-soluble cannabinol compound in male mice. J Cannabis Res 2022; 4:44. [PMID: 35897117 PMCID: PMC9327251 DOI: 10.1186/s42238-022-00153-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/08/2022] [Indexed: 01/05/2023] Open
Abstract
Background Cannabinol (CBN) is one of the many cannabinoids present in Cannabis sativa and has been explored as a potential treatment for sleeplessness. The purpose of this study was to determine the physiological and behavioral effects of subacute exposure to therapeutic and low pharmacological levels of a mechanically formed, stabilized water-soluble cannabinol nano-emulsion (CBNight™). Methods Sixty-two male mice were randomly assigned to one of six treatment groups given CBNight™ at dosages designed to deliver 0mg (control) to 4 mg/kg of CBN daily via oral gavage for 14 days. In-cage behavior was observed at 30 minutes and at 2, 4, 8, and 16 hours after each dose. After 14 days, the mice were sacrificed and necropsied. Organs were weighed and inspected for gross abnormalities, and blood was collected via cardiac puncture for clinical chemistry. Results No dosage-dependent adverse effects on behavior, body mass, or blood chemistry were observed, except that the highest doses of CBNight™ were associated with significantly lower eosinophil counts. Conclusions The commercially available, water-soluble CBN compound employed in this study does not appear to cause adverse effects in mice; rather, it appears to be well tolerated at pharmacological levels. The findings of eosinopenia at higher doses of CBN and lack of hepatotoxicity at any dosage employed in this study have not been reported to date. Supplementary Information The online version contains supplementary material available at 10.1186/s42238-022-00153-w.
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Wagner B, Gerletti P, Fürst P, Keuth O, Bernsmann T, Martin A, Schäfer B, Numata J, Lorenzen MC, Pieper R. Transfer of cannabinoids into the milk of dairy cows fed with industrial hemp could lead to Δ 9-THC exposure that exceeds acute reference dose. NATURE FOOD 2022; 3:921-932. [PMID: 37118216 DOI: 10.1038/s43016-022-00623-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/26/2022] [Indexed: 04/30/2023]
Abstract
The industrial hemp sector is growing and, in recent years, has launched many novel hemp-derived products, including animal feed. It is, however, unclear to what extent individual cannabinoids from industrial hemp transfer from the feed into products of animal origin and whether they pose a risk for the consumer. Here we present the results of a feeding experiment with industrial hemp silage in dairy cows. Hemp feeding included changes in feed intake, milk yield, respiratory and heart rates, and behaviour. We combined liquid chromatography-tandem mass spectrometry-based analyses and toxicokinetic computer modelling to estimate the transfer of several cannabinoids (Δ9-tetrahydrocannabinol (Δ9-THC), Δ8-THC, Δ9-tetrahydrocannabinolic acid, Δ9-tetrahydrocannabivarin, 11-OH-Δ9-THC, 11-nor-9-carboxy-Δ9-THC, cannabidiol, cannabinol and cannabidivarin) from animal feed to milk. For Δ9-THC, which has a feed-to-milk transfer rate of 0.20% ± 0.03%, the acute reference dose for humans was exceeded in several consumer groups in exposure scenarios for milk and dairy product consumption when using industrial hemp to feed dairy cows.
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Affiliation(s)
- Bettina Wagner
- German Federal Institute for Risk Assessment (BfR), Berlin, Germany.
| | - Pietro Gerletti
- German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Peter Fürst
- Chemical and Veterinary Analytical Institute Münsterland-Emscher-Lippe (CVUA-MEL), Münster, Germany
| | - Oliver Keuth
- Chemical and Veterinary Analytical Institute Münsterland-Emscher-Lippe (CVUA-MEL), Münster, Germany
| | - Thorsten Bernsmann
- Chemical and Veterinary Analytical Institute Münsterland-Emscher-Lippe (CVUA-MEL), Münster, Germany
| | - Annett Martin
- German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Bernd Schäfer
- German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Jorge Numata
- German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Marc C Lorenzen
- German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Robert Pieper
- German Federal Institute for Risk Assessment (BfR), Berlin, Germany.
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La Maida N, Di Giorgi A, Pichini S, Busardò FP, Huestis MA. Recent challenges and trends in forensic analysis: Δ9-THC isomers pharmacology, toxicology and analysis. J Pharm Biomed Anal 2022; 220:114987. [PMID: 35985136 DOI: 10.1016/j.jpba.2022.114987] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
Δ9-tetrahydrocannabinol (Δ9-THC) isomers, especially Δ8-tetrahydrocannabinol (Δ8-THC), are increasing in foods, beverages, and e-cigarettes liquids. A major factor is passage of the Agriculture Improvement Act (AIA) that removed hemp containing less than 0.3 % Δ9-THC from the definition of "marijuana" or cannabis. CBD-rich hemp flooded the market resulting in excess product that could be subjected to CBD cyclization to produce Δ8-THC. This process utilizes strong acid and yields toxic byproducts that frequently are not removed prior to sale and are currently inadequately studied. Pharmacological activity is qualitatively similar for Δ8-THC and Δ9-THC, but most preclinical studies in mice, rats, and monkeys documented greater ∆9-THC potency. Both isomers caused graded dose-response effects on euphoria, blurred vision, mental confusion and lethargy, although Δ8-THC was at least 25 % less potent. The most common analytical methodologies providing baseline resolution of ∆8-THC and ∆9-THC in non-biological matrices are liquid-chromatography coupled to diode-array detection (LC-DAD or LC-PDA), while liquid chromatography coupled to mass spectrometry is preferred for biological matrices. Other available analytical methods are gas-chromatography-mass spectrometry (GC-MS) and quantitative nuclear magnetic resonance (QNMR). Current knowledge on the pharmacology of ∆8-THC and other ∆9-THC isomers are reviewed to raise awareness of the activity of these isomers in cannabis products, as well as analytical methods to discriminate ∆9-THC qualitatively, and quantitatively and ∆8-THC in biological and non-biological matrices.
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Affiliation(s)
- Nunzia La Maida
- Unit of Forensic Toxicology, Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Università la Sapienza, V. Le Regina Elena 366, 00161 Rome, Italy
| | - Alessandro Di Giorgi
- Department of Excellence of Biomedical Science and Public Health, University "Politecnica delle Marche" of Ancona, Via Tronto 10/a, 60124, Ancona, Italy
| | - Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, V. Le Regina Elena 299, 00161 Rome, Italy
| | - Francesco Paolo Busardò
- Department of Excellence of Biomedical Science and Public Health, University "Politecnica delle Marche" of Ancona, Via Tronto 10/a, 60124, Ancona, Italy.
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
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Epidemiology of Δ8THC-Related Carcinogenesis in USA: A Panel Regression and Causal Inferential Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137726. [PMID: 35805384 PMCID: PMC9265369 DOI: 10.3390/ijerph19137726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 12/26/2022]
Abstract
The use of Δ8THC is increasing at present across the USA in association with widespread cannabis legalization and the common notion that it is “legal weed”. As genotoxic actions have been described for many cannabinoids, we studied the cancer epidemiology of Δ8THC. Data on 34 cancer types was from the Centers for Disease Control Atlanta Georgia, substance abuse data from the Substance Abuse and Mental Health Services Administration, ethnicity and income data from the U.S. Census Bureau, and cannabinoid concentration data from the Drug Enforcement Agency, were combined and processed in R. Eight cancers (corpus uteri, liver, gastric cardia, breast and post-menopausal breast, anorectum, pancreas, and thyroid) were related to Δ8THC exposure on bivariate testing, and 18 (additionally, stomach, Hodgkins, and Non-Hodgkins lymphomas, ovary, cervix uteri, gall bladder, oropharynx, bladder, lung, esophagus, colorectal cancer, and all cancers (excluding non-melanoma skin cancer)) demonstrated positive average marginal effects on fully adjusted inverse probability weighted interactive panel regression. Many minimum E-Values (mEVs) were infinite. p-values rose from 8.04 × 10−78. Marginal effect calculations revealed that 18 Δ8THC-related cancers are predicted to lead to a further 8.58 cases/100,000 compared to 7.93 for alcoholism and −8.48 for tobacco. Results indicate that between 8 and 20/34 cancer types were associated with Δ8THC exposure, with very high effect sizes (mEVs) and marginal effects after adjustment exceeding tobacco and alcohol, fulfilling the epidemiological criteria of causality and suggesting a cannabinoid class effect. The inclusion of pediatric leukemias and testicular cancer herein demonstrates heritable malignant teratogenesis.
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13
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Prevalence and characteristics of cannabis-induced toxicoses in pets: Results from a survey of veterinarians in North America. PLoS One 2022; 17:e0261909. [PMID: 35442991 PMCID: PMC9020701 DOI: 10.1371/journal.pone.0261909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/27/2022] [Indexed: 11/20/2022] Open
Abstract
Cannabis legalization in North America has coincided with an increase in reports of cannabis-induced toxicosis in pets, but the magnitude of this problem, as well as outcomes of these incidents remain unknown. Therefore, we examined the frequency, diagnostic criteria, clinical signs, and prognoses of cannabis toxicoses in pets in North America. We conducted an online survey between January, 2021 and April, 2021 targeting veterinarians practicing in Canada and the United States (US). Out of the 251 study participants, 191 practiced in Canada. Cannabis toxicosis was most commonly reported in dogs (n = 226 veterinarians), and the number of toxicosis cases increased significantly in Canada (p<0.0001) and the US (p = 0.002) after October, 2018. Frequently reported clinical signs of cannabis toxicosis included: urinary incontinence (n = 195), disorientation (n = 182), ataxia (n = 178), lethargy (n = 150), hyperesthesia (n = 134), and bradycardia (n = 112). Edibles were most commonly suspected to be the cause of toxicosis (n = 116). The most common route of exposure was ingestion (n = 135), while the most cited reason was ingestion while unattended (n = 135). Cannabis toxicosis was mostly diagnosed using supportive clinical signs (n = 229), the most common treatment was outpatient monitoring (n = 182), and pets were most often treated as out-patients (n = 103). The legalization of cannabis use in Canada and the US is likely an important factor associated with the increased cannabis toxicosis cases in pets; however, the legal status may also increase reporting. The medicinal use of cannabis by pet-owners for pets may also contribute to a portion of the reported toxicoses. Most pets that experienced cannabis toxicosis recovered completely, suggesting that most cannabis toxicoses do not result in long-term ill effects. Even though some deaths (n = 16) were reported in association with cannabis toxicosis, the presence of confounders such as toxins, and underlying conditions cannot be ruled out, emphasizing the need for rigorous controlled laboratory studies to investigate this important issue.
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Beitzke B, Pate DW. A broader view on deriving a reference dose for THC the in foods. Crit Rev Toxicol 2022; 51:695-722. [PMID: 35174773 DOI: 10.1080/10408444.2021.2008867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
An Acute Reference Dose (ARfD) of 1 µg of delta-9-tetrahydrocannabinol (THC) per kilogram (kg) of body weight (bw) per day was recommended by the European Food Safety Authority (EFSA) for its assessment of possible acute health risks from the intake of industrial hemp food products. The scientific basis for this opinion, such as their choice of a Point of Departure for identification of the Lowest Observed Adverse Effect Level (LOAEL) for THC on the central nervous system, and the seeming absence of an experimental No Observed Adverse Effect Level (NOAEL), is critically reviewed. Moreover, the risk assessment for an ARfD derivation for THC is then reconsidered. In contrast to the EFSA Scientific Opinion of 2015, a higher LOAEL is presently identified from pharmacokinetic and pharmacodynamic studies, and forensic data, in representative cohorts of healthy humans after oral administrations of low THC doses. A NOAEL for THC is derived through this combination of results, demonstrating a threshold for impairment of psychomotor function only after intake of an oral THC bolus beyond 2.5 mg for the average healthy adult. This 2.5 mg dose produces mean THC blood serum levels of <2 ng/mL, as well as do two doses when taken daily within a time interval of ≥6 h. The forensic threshold of THC that is correlated with the impairment of psychomotor function is known to be between 2 and 5 ng/mL in blood serum for adults. For an appropriately spaced intake of 2 × 2.5 mg THC per day, an adult can therefore be regarded as being at the NOAEL. Applying a default uncertainty factor of 10 for intraspecies variability to a NOAEL of 2 × 2.5 mg (over ≥6 hours) for THC, yields a "daily dose of no concern" or a "tolerable upper intake level" of 0.50 mg, corresponding to 7 µg/kg bw. Starting with a NOAEL of only 2.5 mg, consumed as a single bolus, the lowest possible daily THC Acute Reference Dose would therefore be 0.25 mg, or 3.5 µg/kg bw for healthy adults, as the absolutely most conservative estimate. Other justifiable estimates have ranged up to 14 µg/kg bw per day.
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Affiliation(s)
- Bernhard Beitzke
- EIHA Advisory Committee, European Industrial Hemp Association, Brussels, Belgium
| | - David W Pate
- NICM Health Research Institute, Western Sydney University, Westmead, Australia
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15
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Datta S, Ramamurthy PC, Anand U, Singh S, Singh A, Dhanjal DS, Dhaka V, Kumar S, Kapoor D, Nandy S, Kumar M, Koshy EP, Dey A, Proćków J, Singh J. Wonder or evil?: Multifaceted health hazards and health benefits of Cannabis sativa and its phytochemicals. Saudi J Biol Sci 2021; 28:7290-7313. [PMID: 34867033 PMCID: PMC8626265 DOI: 10.1016/j.sjbs.2021.08.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022] Open
Abstract
Cannabis sativa, widely known as 'Marijuana' poses a dilemma for being a blend of both good and bad medicinal effects. The historical use of Cannabis for both medicinal and recreational purposes suggests it to be a friendly plant. However, whether the misuse of Cannabis and the cannabinoids derived from it can hamper normal body physiology is a focus of ongoing research. On the one hand, there is enough evidence to suggest that misuse of marijuana can cause deleterious effects on various organs like the lungs, immune system, cardiovascular system, etc. and also influence fertility and cause teratogenic effects. However, on the other hand, marijuana has been found to offer a magical cure for anorexia, chronic pain, muscle spasticity, nausea, and disturbed sleep. Indeed, most recently, the United Nations has given its verdict in favour of Cannabis declaring it as a non-dangerous narcotic. This review provides insights into the various health effects of Cannabis and its specialized metabolites and indicates how wise steps can be taken to promote good use and prevent misuse of the metabolites derived from this plant.
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Affiliation(s)
- Shivika Datta
- Department of Zoology, Doaba College, Jalandhar, Punjab 144001, India
| | - Praveen C. Ramamurthy
- Interdisciplinary Centre for Water Research (ICWaR), Indian Institute of Sciences, Bangalore 560012, Karnataka, India
| | - Uttpal Anand
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, Uttar Pradesh, India
| | - Simranjeet Singh
- Interdisciplinary Centre for Water Research (ICWaR), Indian Institute of Sciences, Bangalore 560012, Karnataka, India
| | - Amritpal Singh
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Government Dental College and Hospital, Amphala, Jammu 180012, India
| | - Daljeet Singh Dhanjal
- Department of Biotechnology, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Vaishali Dhaka
- Department of Biotechnology, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Sanjay Kumar
- Institute of Multidisciplinary Research for Advanced Materials, Tohoku University, Sendai, Miyagi 980-8577, Japan
| | - Dhriti Kapoor
- Department of Botany, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Samapika Nandy
- Department of Life Sciences, Presidency University, Kolkata 700073, West Bengal, India
| | - Manoj Kumar
- Department of Life Sciences, School of Natural Science, Central University of Jharkhand, Brambe, Ratu-Lohardaga Road Ranchi, Jharkhand 835205, India
| | - Eapen P. Koshy
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, Uttar Pradesh, India
| | - Abhijit Dey
- Department of Life Sciences, Presidency University, Kolkata 700073, West Bengal, India
| | - Jarosław Proćków
- Department of Plant Biology, Institute of Environmental Biology, Wrocław University of Environmental and Life Sciences, Kożuchowska 5b, 51-631 Wrocław, Poland
| | - Joginder Singh
- Department of Biotechnology, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, Punjab 144411, India
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Mahmud MS, Hossain MS, Ahmed ATMF, Islam MZ, Sarker ME, Islam MR. Antimicrobial and Antiviral (SARS-CoV-2) Potential of Cannabinoids and Cannabis sativa: A Comprehensive Review. Molecules 2021; 26:7216. [PMID: 34885798 PMCID: PMC8658882 DOI: 10.3390/molecules26237216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 12/26/2022] Open
Abstract
Antimicrobial resistance has emerged as a global health crisis and, therefore, new drug discovery is a paramount need. Cannabis sativa contains hundreds of chemical constituents produced by secondary metabolism, exerting outstanding antimicrobial, antiviral, and therapeutic properties. This paper comprehensively reviews the antimicrobial and antiviral (particularly against SARS-CoV-2) properties of C. sativa with the potential for new antibiotic drug and/or natural antimicrobial agents for industrial or agricultural use, and their therapeutic potential against the newly emerged coronavirus disease (COVID-19). Cannabis compounds have good potential as drug candidates for new antibiotics, even for some of the WHO's current priority list of resistant pathogens. Recent studies revealed that cannabinoids seem to have stable conformations with the binding pocket of the Mpro enzyme of SARS-CoV-2, which has a pivotal role in viral replication and transcription. They are found to be suppressive of viral entry and viral activation by downregulating the ACE2 receptor and TMPRSS2 enzymes in the host cellular system. The therapeutic potential of cannabinoids as anti-inflammatory compounds is hypothesized for the treatment of COVID-19. However, more systemic investigations are warranted to establish the best efficacy and their toxic effects, followed by preclinical trials on a large number of participants.
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Affiliation(s)
- Md Sultan Mahmud
- Faculty of Textile Engineering, Bangladesh University of Textiles, Dhaka 1208, Bangladesh; (M.S.M.); (A.T.M.F.A.); (M.Z.I.)
| | - Mohammad Sorowar Hossain
- Biomedical Research Foundation, Dhaka 1230, Bangladesh;
- School of Environment and Life Sciences, Independent University, Dhaka 1229, Bangladesh
| | - A. T. M. Faiz Ahmed
- Faculty of Textile Engineering, Bangladesh University of Textiles, Dhaka 1208, Bangladesh; (M.S.M.); (A.T.M.F.A.); (M.Z.I.)
| | - Md Zahidul Islam
- Faculty of Textile Engineering, Bangladesh University of Textiles, Dhaka 1208, Bangladesh; (M.S.M.); (A.T.M.F.A.); (M.Z.I.)
| | - Md Emdad Sarker
- Faculty of Textile Engineering, Bangladesh University of Textiles, Dhaka 1208, Bangladesh; (M.S.M.); (A.T.M.F.A.); (M.Z.I.)
| | - Md Reajul Islam
- Faculty of Textile Engineering, Bangladesh University of Textiles, Dhaka 1208, Bangladesh; (M.S.M.); (A.T.M.F.A.); (M.Z.I.)
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17
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Lauinger CA, Peacock R. Marijuana toxicosis in dogs in Melbourne, Australia, following suspected ingestion of human faeces: 15 cases (2011-2020). Aust Vet J 2021; 100:90-97. [PMID: 34786688 DOI: 10.1111/avj.13134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/11/2021] [Accepted: 10/17/2021] [Indexed: 11/28/2022]
Abstract
This retrospective case series describes a novel and unexpected source for marijuana toxicosis in dogs; suspected ingestion of human faeces containing Δ9 -tetrahydrocannabinol (THC). Medical records from four, 24-h veterinary emergency hospitals in Melbourne, Australia, were reviewed and 15 dogs met the criteria for inclusion in this case series. Clinical signs of marijuana toxicosis included ataxia (n = 13), mydriasis (n = 6), hyperaesthesia (n = 5), urinary incontinence (n = 4) and stupor (n = 3). A urine drug screening test was performed for eight dogs and all were positive for THC. Confirmation of ingestion of human faeces was based on owner-witnessed ingestion (n = 7) or the presence of faecal material within vomit (n = 8). Sites of human faecal exposure were recorded to be a local park (n = 10), beach (n = 1), camp site (n = 1) and walking trail (n = 1). Time from exposure to development of clinical signs ranged between 3 and 6 h (n = 4). All dogs survived to discharge. Ingestion of human faeces containing THC may lead to marijuana toxicosis in dogs. Veterinary staff and owners should be attentive in regard to using appropriate hygiene measures when managing these dogs.
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Affiliation(s)
- C A Lauinger
- Animal Emergency Centre, Mount Waverley, Victoria, 3149, Australia
| | - R Peacock
- Animal Emergency Centre, Mount Waverley, Victoria, 3149, Australia
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18
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R C Coelho MP, de O P Leme F, A Moreira F, E M T Branco S, M Melo M, G de Melo E. Current review of hemp-based medicines in dogs. J Vet Pharmacol Ther 2021; 44:870-882. [PMID: 34605042 DOI: 10.1111/jvp.13016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/30/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
Medical use of Cannabis (or hemp) began thousands of years ago. In the 20th century, mechanisms of action were demonstrated with the discovery of its active substances, the phytocannabinoids, and its pharmacological targets, the endocannabinoid system. This system is composed of receptors, endogenous substances, and enzymes, and it participates in the modulation of physiological mechanisms in several species, including dogs. Studies indicate that changes in this system may contribute to the genesis of some diseases. Therefore, the use of substances that act on its components may help in the treatment of these diseases. The main phytocannabinoids described are Δ9- tetrahydrocannabinol (THC) and cannabidiol (CBD). In humans, the benefits of using CBD in several diseases have been demonstrated. The popularization of this type of treatment has also reached veterinary medicine, which on one hand was related to an increase in adverse event records, but on the other also allowed reports of anecdotal evidences of its effectiveness and safety in animals. Clinical studies published so far indicate that the use of CBD in dogs can be safe at given doses and can contribute to osteoarthritis and idiopathic epilepsy treatments. Clinical and pre-clinical studies and case reports were reviewed in this report to identify the main characteristics of hemp-based therapies in dogs, including its pharmacokinetics, pharmacodynamics, safety, and efficacy in the treatment of diseases.
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Affiliation(s)
- Maria Paula R C Coelho
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fabiola de O P Leme
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fabricio A Moreira
- Departamento de Farmacologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Stephanie E M T Branco
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marilia M Melo
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Eliane G de Melo
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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19
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Sihota A, Smith BK, Ahmed S, Bell A, Blain A, Clarke H, Cooper ZD, Cyr C, Daeninck P, Deshpande A, Ethans K, Flusk D, Le Foll B, Milloy M, Moulin DE, Naidoo V, Ong M, Perez J, Rod K, Sealey R, Sulak D, Walsh Z, O’Connell C. Consensus-based recommendations for titrating cannabinoids and tapering opioids for chronic pain control. Int J Clin Pract 2021; 75:e13871. [PMID: 33249713 PMCID: PMC8365704 DOI: 10.1111/ijcp.13871] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/24/2020] [Accepted: 11/20/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS Opioid misuse and overuse have contributed to a widespread overdose crisis and many patients and physicians are considering medical cannabis to support opioid tapering and chronic pain control. Using a five-step modified Delphi process, we aimed to develop consensus-based recommendations on: 1) when and how to safely initiate and titrate cannabinoids in the presence of opioids, 2) when and how to safely taper opioids in the presence of cannabinoids and 3) how to monitor patients and evaluate outcomes when treating with opioids and cannabinoids. RESULTS In patients with chronic pain taking opioids not reaching treatment goals, there was consensus that cannabinoids may be considered for patients experiencing or displaying opioid-related complications, despite psychological or physical interventions. There was consensus observed to initiate with a cannabidiol (CBD)-predominant oral extract in the daytime and consider adding tetrahydrocannabinol (THC). When adding THC, start with 0.5-3 mg, and increase by 1-2 mg once or twice weekly up to 30-40 mg/day. Initiate opioid tapering when the patient reports a minor/major improvement in function, seeks less as-needed medication to control pain and/or the cannabis dose has been optimised. The opioid tapering schedule may be 5%-10% of the morphine equivalent dose (MED) every 1 to 4 weeks. Clinical success could be defined by an improvement in function/quality of life, a ≥30% reduction in pain intensity, a ≥25% reduction in opioid dose, a reduction in opioid dose to <90 mg MED and/or reduction in opioid-related adverse events. CONCLUSIONS This five-stage modified Delphi process led to the development of consensus-based recommendations surrounding the safe introduction and titration of cannabinoids in concert with tapering opioids.
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Affiliation(s)
- Aaron Sihota
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBCCanada
| | | | - Sana‐Ara Ahmed
- Medical Director, Anesthesiology and Interventional Chronic PainAhmed Institute for Pain and Cannabinoid ResearchCalgaryABCanada
| | - Alan Bell
- Department of Family and Community MedicineUniversity of TorontoTorontoONCanada
| | - Allison Blain
- Department of AnesthesiaMichael G DeGroote Pain ClinicHamilton Health SciencesMcMaster UniversityHamiltonONCanada
| | - Hance Clarke
- Department of Anesthesia and Pain MedicineToronto General HospitalUniversity Health NetworkUniversity of TorontoTorontoONCanada
| | - Ziva D. Cooper
- Department of Psychiatry and Biobehavioral ScienceUCLA Cannabis Research InitiativeJane and Terry Semel Institute for Neuroscience and Human Behavior University of CaliforniaLos AngelesCAUSA
| | - Claude Cyr
- Department of Family MedicineMcGill UniversityMontrealQCCanada
| | - Paul Daeninck
- Max Rady College of MedicineRady Faculty of Health SciencesUniversity of Manitoba, and CancerCare ManitobaWinnipegMBCanada
| | - Amol Deshpande
- Comprehensive Interdisciplinary Pain ProgramDivision of Physical MedicineToronto Rehabilitation InstituteTorontoONCanada
| | - Karen Ethans
- Department of MedicineSection of Physical Medicine and RehabilitationUniversity of ManitobaWinnipegMBCanada
| | - David Flusk
- Faculty of MedicineMemorial University of NewfoundlandSt John’s NLCanada
| | - Bernard Le Foll
- Translational Addiction Research LaboratoryCentre for Addiction and Mental HealthTorontoONCanada
- Alcohol Research and Treatment ClinicAcute Care ProgramCentre for Addiction and Mental HealthTorontoONCanada
- Campbell Family Mental Health Research InstituteCentre for Addiction and Mental HealthTorontoONCanada
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoONCanada
- Department of PsychiatryUniversity of TorontoTorontoONCanada
- Institute of Medical SciencesUniversity of TorontoTorontoONCanada
- British Columbia Centre on Substance UseVancouverBCCanada
| | - M‐J Milloy
- British Columbia Centre on Substance UseVancouverBCCanada
- Department of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Dwight E. Moulin
- Departments of Clinical Neurological Sciences and OncologyEarl Russell Chair in Pain MedicineWestern UniversityLondonONCanada
| | | | - May Ong
- Department of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Jordi Perez
- Department of AnesthesiaMcGill UniversityMontrealQCCanada
| | - Kevin Rod
- FCFP Director Toronto Poly ClinicLecturer DFCM University of TorontoTorontoONCanada
| | | | | | - Zachary Walsh
- Department of PsychologyUniversity of British ColumbiaVancouverBCCanada
| | - Colleen O’Connell
- Department of Physical Medicine and RehabilitationStan Cassidy Centre for RehabilitationFrederictonNBCanada
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20
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Bhaskar A, Bell A, Boivin M, Briques W, Brown M, Clarke H, Cyr C, Eisenberg E, de Oliveira Silva RF, Frohlich E, Georgius P, Hogg M, Horsted TI, MacCallum CA, Müller-Vahl KR, O'Connell C, Sealey R, Seibolt M, Sihota A, Smith BK, Sulak D, Vigano A, Moulin DE. Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process. J Cannabis Res 2021; 3:22. [PMID: 34215346 PMCID: PMC8252988 DOI: 10.1186/s42238-021-00073-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Globally, medical cannabis legalization has increased in recent years and medical cannabis is commonly used to treat chronic pain. However, there are few randomized control trials studying medical cannabis indicating expert guidance on how to dose and administer medical cannabis safely and effectively is needed. METHODS Using a multistage modified Delphi process, twenty global experts across nine countries developed consensus-based recommendations on how to dose and administer medical cannabis in patients with chronic pain. RESULTS There was consensus that medical cannabis may be considered for patients experiencing neuropathic, inflammatory, nociplastic, and mixed pain. Three treatment protocols were developed. A routine protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg CBD twice daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 2.5 mg and titrate by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg/day of THC. A conservative protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg once daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 1 mg/day and titrate by 1 mg every 7 days until a maximum daily dose of 40 mg/day of THC. A rapid protocol where the clinician initiates the patient on a balanced THC:CBD variety at 2.5-5 mg of each cannabinoid once or twice daily and titrates by 2.5-5 mg of each cannabinoid every 2 to 3 days until the patient reaches his/her goals or to a maximum THC dose of 40 mg/day. CONCLUSIONS In summary, using a modified Delphi process, expert consensus-based recommendations were developed on how to dose and administer medical cannabis for the treatment of patients with chronic pain.
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Affiliation(s)
- Arun Bhaskar
- Pain Management Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Alan Bell
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Matthew Brown
- Department of Pain Medicine, The Royal Marsden Hospital, London, UK
- The Institute of Cancer Research, London, UK
| | - Hance Clarke
- Department of Anesthesia and Pain Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Claude Cyr
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Elon Eisenberg
- Institute of Pain Medicine, Rambam Health Care Campus, The Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Eva Frohlich
- Department of Anaesthesiology and Pain Management, Helen Joseph Hospital, Johannesburg, South Africa
| | | | - Malcolm Hogg
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | | | | | - Kirsten R Müller-Vahl
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Colleen O'Connell
- Department of Physical Medicine and Rehabilitation, Stan Cassidy Centre for Rehabilitation, Fredericton, NB, Canada
| | - Robert Sealey
- Cannabinoid Medicine Specialist, Victoria, BC, Canada
| | - Marc Seibolt
- Algesiologikum- Centers for Pain Medicine, Day Clinic for Pain Medicine, Munich, Germany
| | - Aaron Sihota
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Brennan K Smith
- CTC Communications, Medical Division, Mississauga, ON, Canada
| | | | - Antonio Vigano
- Department of Oncology, McGill University, Montreal, QC, Canada
| | - Dwight E Moulin
- Departments of Clinical Neurological Sciences and Oncology, Earl Russell Chair of Pain Medicine, Western University, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
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21
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Gutierrez A, Creehan KM, Turner ML, Tran RN, Kerr TM, Nguyen JD, Taffe MA. Vapor exposure to Δ9-tetrahydrocannabinol (THC) slows locomotion of the Maine lobster (Homarus americanus). Pharmacol Biochem Behav 2021; 207:173222. [PMID: 34197845 DOI: 10.1016/j.pbb.2021.173222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/01/2022]
Abstract
RATIONALE Despite a long history of use in synaptic physiology, the lobster has been a neglected model for behavioral pharmacology. A restaurateur proposed that exposing lobster to cannabis smoke reduces anxiety and pain during the cooking process. It is unknown if lobster gill respiration in air would result in significant Δ9-tetrahydrocannabinol (THC) uptake and whether this would have any detectable behavioral effects. OBJECTIVE The primary goal was to determine tissue THC levels in the lobster after exposure to THC vapor. Secondary goals were to determine if THC vapor altered locomotor behavior or nociception. METHODS Tissue samples were collected (including muscle, brain and hemolymph) from Homarus americanus (N = 3 per group) following 30 or 60 min of exposure to vapor generated by an e-cigarette device using THC (100 mg/mL in a propylene glycol vehicle). Separate experiments assessed locomotor behavior and hot water nociceptive responses following THC vapor exposure. RESULTS THC vapor produced duration-related THC levels in all tissues examined. Locomotor activity was decreased (distance, speed, time-mobile) by 30 min inhalation of THC. Lobsters exhibit a temperature-dependent withdrawal response to immersion of tail, antennae or claws in warm water; this is novel evidence of thermal nociception for this species. THC exposure for 60 min had only marginal effect on nociception under the conditions assessed. CONCLUSIONS Vapor exposure of lobsters, using an e-cigarette based model, produces dose-dependent THC levels in all tissues and reduces locomotor activity. Hot water nociception was temperature dependent, but only minimal anti-nociceptive effect of THC exposure was confirmed.
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Affiliation(s)
- Arnold Gutierrez
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Department of Neuroscience, The Scripps Research Institute; La Jolla, CA, USA
| | - Kevin M Creehan
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Department of Neuroscience, The Scripps Research Institute; La Jolla, CA, USA
| | - Mitchell L Turner
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Colorado College, Colorado Springs, CO, USA
| | - Rachelle N Tran
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; University of Washington, Seattle, WA, USA
| | - Tony M Kerr
- Department of Neuroscience, The Scripps Research Institute; La Jolla, CA, USA
| | - Jacques D Nguyen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Department of Neuroscience, The Scripps Research Institute; La Jolla, CA, USA
| | - Michael A Taffe
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Department of Neuroscience, The Scripps Research Institute; La Jolla, CA, USA.
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Toxicological properties of Δ9-tetrahydrocannabinol and cannabidiol. Arh Hig Rada Toksikol 2021; 71:1-11. [PMID: 32597140 PMCID: PMC7837244 DOI: 10.2478/aiht-2020-71-3301] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 03/01/2020] [Indexed: 11/20/2022] Open
Abstract
Cannabis sativa L. contains more than 100 phytocannabinoids that can interact with cannabinoid receptors CB1 and CB2. None of the cannabinoid receptor ligands is entirely CB1- or CB2-specific. The effects of cannabinoids therefore differ not just because of different potency at cannabinoid receptors but also because they can interact with other non-CB1 and non-CB2 targets, such as TRPV1, GPR55, and GPR119. The most studied phytocannabinoid is Δ9-tetrahydrocannabinol (THC). THC is a partial agonist at both cannabinoid receptors, but its psychotomimetic effect is produced primarily via activation of the CB1 receptor, which is strongly expressed in the central nervous system, with the noteworthy exception of the brain stem. Although acute cognitive and other effects of THC are well known, the risk of irreversible neuropsychological effects of THC needs further research to elucidate the association. Unlike THC, phytocannabinoid cannabidiol (CBD) does not appear to have psychotomimetic effects but may interact with some of the effects of THC if taken concomitantly. CBD administered orally has recently undergone well-controlled clinical trials to assess its safety in the treatment of paediatric epilepsy syndromes. Their findings point to increased transaminase levels as a safety issue that calls for postmarketing surveillance for liver toxicity. The aim of this review is to summarise what is known about acute and chronic toxicological effects of both compounds and address the gaps in knowledge about the safety of exogenous cannabinoids that are still open.
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The impact of state cannabis legislation, county-level socioeconomic and dog-level characteristics on reported cannabis poisonings of companion dogs in the USA (2009-2014). PLoS One 2021; 16:e0250323. [PMID: 33861797 PMCID: PMC8051783 DOI: 10.1371/journal.pone.0250323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/05/2021] [Indexed: 11/19/2022] Open
Abstract
With current trends in cannabis legalization, large efforts are being made to understand the effects of less restricted legislation on human consumption, health, and abuse of these products. Little is known about the effects of cannabis legalization and increased cannabis use on vulnerable populations, such as dogs. The objective of this study was to examine the effects of different state-level cannabis legislation, county-level socioeconomic factors, and dog-level characteristics on dog cannabis poisoning reports to an animal poison control center (APCC). Data were obtained concerning reports of dog poisoning events, county characteristics, and state cannabis legislation from the American Society for the Prevention of Cruelty to Animals’ (ASPCA) APCC, the US Census Bureau, and various public policy-oriented and government websites, respectively. A multilevel logistic regression model with random intercepts for county and state was fitted to investigate the associations between the odds of a call to the APCC being related to a dog being poisoned by a cannabis product and the following types of variables: dog characteristics, county-level socioeconomic characteristics, and the type of state-level cannabis legislation. There were significantly higher odds of a call being related to cannabis in states with lower penalties for cannabis use and possession. The odds of these calls were higher in counties with higher income variability, higher percentage of urban population, and among smaller, male, and intact dogs. These calls increased throughout the study period (2009–2014). Reporting of cannabis poisonings were more likely to come from veterinarians than dog owners. Reported dog poisonings due to cannabis appear to be influenced by dog-level and community-level factors. This study may increase awareness to the public, public health, and veterinary communities of the effects of recreational drug use on dog populations. This study highlights the need to educate dog owners about safeguarding cannabis products from vulnerable populations.
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24
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Schofs L, Sparo MD, Sánchez Bruni SF. The antimicrobial effect behind Cannabis sativa. Pharmacol Res Perspect 2021; 9:e00761. [PMID: 33822478 PMCID: PMC8023331 DOI: 10.1002/prp2.761] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/01/2021] [Indexed: 12/11/2022] Open
Abstract
The development of multidrug-resistant bacteria has revealed the need for new antimicrobial compounds. Cannabis sativa preparations have a long history of medical applications, including the treatment of infectious diseases. This review collects the information about the activity of C. sativa extracts and its main components (cannabinoids and terpenes) against pathogenic bacteria and fungus, to assess its potential using as antimicrobial agents.
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Affiliation(s)
- Laureano Schofs
- Laboratory of Pharmacology, Faculty of Veterinary Medicine, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina.,Tandil Veterinary Research Center (CIVETAN), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Comisión de investigaciones científicas de la Provincia de Buenos Aires (CICPBA), Tandil, Argentina
| | - Mónica D Sparo
- Tandil Veterinary Research Center (CIVETAN), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Comisión de investigaciones científicas de la Provincia de Buenos Aires (CICPBA), Tandil, Argentina.,Clinical Department, Faculty of Health Sciences, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
| | - Sergio F Sánchez Bruni
- Laboratory of Pharmacology, Faculty of Veterinary Medicine, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina.,Tandil Veterinary Research Center (CIVETAN), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Comisión de investigaciones científicas de la Provincia de Buenos Aires (CICPBA), Tandil, Argentina
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25
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Peng H, Shahidi F. Cannabis and Cannabis Edibles: A Review. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2021; 69:1751-1774. [PMID: 33555188 DOI: 10.1021/acs.jafc.0c07472] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cannabis is an excellent natural source of fiber and various bioactive cannabinoids. So far, at least 120 cannabinoids have been identified, and more novel cannabinoids are gradually being unveiled by detailed cannabis studies. However, cannabinoids in both natural and isolated forms are especially vulnerable to oxygen, heat, and light. Therefore, a diversity of cannabinoids is associated with their chemical instability to a large extent. The research status of structural conversion of cannabinoids is introduced. On the other hand, the use of drug-type cannabis and the phytocannabinoids thereof has been rapidly popularized and plays an indispensable role in both medical therapy and daily recreation. The recent legalization of edible cannabis further extends its application into the food industry. The varieties of legal edible cannabis products in the current commercial market are relatively monotonous due to rigorous restrictions under the framework of Cannabis Regulations and infancy of novel developments. Meanwhile, patents/studies related to the safety and quality assurance systems of cannabis edibles are still rare and need to be developed. Furthermore, along with cannabinoids, many phytochemicals such as flavonoids, lignans, terpenoids, and polysaccharides exist in the cannabis matrix, and these may exhibit prebiotic/probiotic properties and improve the composition of the gut microbiome. During metabolism and excretion, the bioactive phytochemicals of cannabis, mostly the cannabinoids, may be structurally modified during enterohepatic detoxification and gut fermentation. However, the potential adverse effects of both acute and chronic exposure to cannabinoids and their vulnerable groups have been clearly recognized. Therefore, a comprehensive understanding of the chemistry, metabolism, toxicity, commercialization, and regulations regarding cannabinoid edibles is reviewed and updated in this contribution.
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Affiliation(s)
- Han Peng
- Department of Biochemistry Memorial University of Newfoundland, St. John's, Newfoundland, Canada A1B 3X9
| | - Fereidoon Shahidi
- Department of Biochemistry Memorial University of Newfoundland, St. John's, Newfoundland, Canada A1B 3X9
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26
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Stewart C, Fong Y. Perioperative Cannabis as a Potential Solution for Reducing Opioid and Benzodiazepine Dependence. JAMA Surg 2021; 156:181-190. [DOI: 10.1001/jamasurg.2020.5545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Camille Stewart
- Department of Surgery, University of Colorado School of Medicine, Aurora
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, California
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Bahramsoltani R, Rahimi R. Hot and Cold Theory: Evidence in Pharmacology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1343:109-117. [DOI: 10.1007/978-3-030-80983-6_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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28
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Breivogel CS, Wells JR, Jonas A, Mistry AH, Gravley ML, Patel RM, Whithorn BE, Brenseke BM. Comparison of the Neurotoxic and Seizure-Inducing Effects of Synthetic and Endogenous Cannabinoids with Δ 9-Tetrahydrocannabinol. Cannabis Cannabinoid Res 2020; 5:32-41. [PMID: 32322674 PMCID: PMC7173680 DOI: 10.1089/can.2019.0003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Introduction: Synthetic cannabinoids (SCs) are commonly found in preparations used as recreational drugs. Although severe adverse health effects are not generally associated with cannabis use, a rising number of studies document seizures and even death after SC use. In this study, a mouse model is used to investigate the hypothesis that SCs are more toxic than Δ9-tetrahydrocannabinol (THC), the principal psychoactive constituent of cannabis. Materials and Methods: Beginning with the SCs, JWH-073 and AM-2201, dose–response curves were generated to find the dose of each drug that was similarly efficacious to 50 mg/kg THC. Mice were given daily intraperitoneal (IP) injections of vehicle, 50 mg/kg THC, 30 mg/kg JWH-073, or 1 mg/kg AM-2201 until tolerance to the antinociceptive and hypothermic effects was complete, and then were assessed for spontaneous and antagonist-precipitated withdrawal and potential organ damage. No differences in tolerance were noted, but AM-2201 showed more rearing in the spontaneous and antagonist-precipitated withdrawal phases than either vehicle or the other two drug treatments. Histopathological examination of these mice revealed no drug-induced lesions. In a subsequent set of experiments, various doses of THC, methanandamide (mAEA), and of a variety of SCs (HU-210, CP55940, JWH-073, AM-2201, and PB-22) were given IP, and convulsions and change in body temperature were quantified. Discussion: The treatments yielded varying numbers of convulsions and a range of changes in body temperature. JWH-073 and AM-2201 produced significantly more convulsions than THC, HU-210, mAEA, or cannabidiol (CBD) (the latter two producing none). HU-210, CP55940, JWH-073, and mAEA produced greater hypothermia than THC or CBD. Convulsions and hypothermia induced by several agonists were prevented by pretreatment with a CB1 antagonist, but not a CB2 antagonist. Conclusions: In agreement with human studies and case reports, this study found that SCs generally produced more seizures than THC. Of particular significance was the finding that mAEA produced far greater hypothermia than THC (similar to most SCs), but unlike the SCs and THC, produced no seizures.
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Affiliation(s)
- Chris S Breivogel
- Department of Pharmaceutical Sciences, Campbell University College of Pharmacy & Health Sciences, Buies Creek, North Carolina
| | - Jacob R Wells
- Department of Pharmaceutical Sciences, Campbell University College of Pharmacy & Health Sciences, Buies Creek, North Carolina
| | - Amreen Jonas
- Department of Pharmaceutical Sciences, Campbell University College of Pharmacy & Health Sciences, Buies Creek, North Carolina
| | - Artik H Mistry
- Department of Pharmaceutical Sciences, Campbell University College of Pharmacy & Health Sciences, Buies Creek, North Carolina
| | - Morgan L Gravley
- Department of Pharmaceutical Sciences, Campbell University College of Pharmacy & Health Sciences, Buies Creek, North Carolina
| | - Rajul M Patel
- School of Osteopathic Medicine, Campbell University, Buies Creek, North Carolina
| | - Brianna E Whithorn
- School of Osteopathic Medicine, Campbell University, Buies Creek, North Carolina
| | - Bonnie M Brenseke
- School of Osteopathic Medicine, Campbell University, Buies Creek, North Carolina
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Banister SD, Arnold JC, Connor M, Glass M, McGregor IS. Dark Classics in Chemical Neuroscience: Δ 9-Tetrahydrocannabinol. ACS Chem Neurosci 2019; 10:2160-2175. [PMID: 30689342 DOI: 10.1021/acschemneuro.8b00651] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cannabis ( Cannabis sativa) is the most widely used illicit drug in the world, with an estimated 192 million users globally. The main psychoactive component of cannabis is (-)- trans-Δ9-tetrahydrocannabinol (Δ9-THC), a compound with a diverse range of pharmacological actions. The unique and distinctive intoxication caused by Δ9-THC primarily reflects partial agonist action at central cannabinoid type 1 (CB1) receptors. Δ9-THC is an approved therapeutic treatment for a range of conditions, including chronic pain, chemotherapy-induced nausea and vomiting, and multiple sclerosis, and is being investigated in indications such as anorexia nervosa, agitation in dementia, and Tourette's syndrome. It is available as a regulated pharmaceutical in products such as Marinol, Sativex, and Namisol as well as in an ever-increasing range of unregistered medicinal and recreational cannabis products. While cannabis is an ancient medicament, contemporary use is embroiled in legal, scientific, and social controversy, much of which relates to the potential hazards and benefits of Δ9-THC itself. Robust contemporary debate surrounds the therapeutic value of Δ9-THC in different diseases, its capacity to produce psychosis and cognitive impairment, and the addictive and "gateway" potential of the drug. This review will provide a profile of the chemistry, pharmacology, and therapeutic uses of Δ9-THC as well as the historical and societal import of this unique, distinctive, and ubiquitous psychoactive substance.
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Affiliation(s)
- Samuel D. Banister
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- Faculty of Science and School of Chemistry, The University of Sydney, Sydney, NSW 2006, Australia
| | - Jonathon C. Arnold
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Medical Science and Discipline of Pharmacology, The University of Sydney, Sydney, NSW 2006, Australia
| | - Mark Connor
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Michelle Glass
- Department of Pharmacology and Toxicology, University of Otago, Dunedin 9016, New Zealand
| | - Iain S. McGregor
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- Faculty of Science and School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia
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30
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Kopjar N, Fuchs N, Žunec S, Mikolić A, Micek V, Kozina G, Lucić Vrdoljak A, Brčić Karačonji I. DNA Damaging Effects, Oxidative Stress Responses and Cholinesterase Activity in Blood and Brain of Wistar Rats Exposed to Δ 9-Tetrahydrocannabinol. Molecules 2019; 24:E1560. [PMID: 31010235 PMCID: PMC6515386 DOI: 10.3390/molecules24081560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 01/24/2023] Open
Abstract
Currently we are faced with an ever-growing use of Δ9-tetrahydrocannabinol (THC) preparations, often used as supportive therapies for various malignancies and neurological disorders. As some of illegally distributed forms of such preparations, like cannabis oils and butane hash oil, might contain over 80% of THC, their consumers can become intoxicated or experience various detrimental effects. This fact motivated us for the assessments of THC toxicity in vivo on a Wistar rat model, at a daily oral dose of 7 mg/kg which is comparable to those found in illicit preparations. The main objective of the present study was to establish the magnitude and dynamics of DNA breakage associated with THC exposure in white blood and brain cells of treated rats using the alkaline comet assay. The extent of oxidative stress after acute 24 h exposure to THC was also determined as well as changes in activities of plasma and brain cholinesterases (ChE) in THC-treated and control rats. The DNA of brain cells was more prone to breakage after THC treatment compared to DNA in white blood cells. Even though DNA damage quantified by the alkaline comet assay is subject to repair, its elevated level detected in the brain cells of THC-treated rats was reason for concern. Since neurons do not proliferate, increased levels of DNA damage present threats to these cells in terms of both viability and genome stability, while inefficient DNA repair might lead to their progressive loss. The present study contributes to existing knowledge with evidence that acute exposure to a high THC dose led to low-level DNA damage in white blood cells and brain cells of rats and induced oxidative stress in brain, but did not disturb ChE activities.
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Affiliation(s)
- Nevenka Kopjar
- Institute for Medical Research and Occupational Health, Zagreb HR-10001, Croatia.
| | - Nino Fuchs
- University Hospital Centre Zagreb, Zagreb HR-10000 Croatia.
| | - Suzana Žunec
- Institute for Medical Research and Occupational Health, Zagreb HR-10001, Croatia.
| | - Anja Mikolić
- Institute for Medical Research and Occupational Health, Zagreb HR-10001, Croatia.
| | - Vedran Micek
- Institute for Medical Research and Occupational Health, Zagreb HR-10001, Croatia.
| | - Goran Kozina
- University Centre Varaždin, University North, Varaždin HR-42000, Croatia.
| | - Ana Lucić Vrdoljak
- Institute for Medical Research and Occupational Health, Zagreb HR-10001, Croatia.
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Breitbarth AK, Morgan J, Jones AL. E-cigarettes-An unintended illicit drug delivery system. Drug Alcohol Depend 2018; 192:98-111. [PMID: 30245461 DOI: 10.1016/j.drugalcdep.2018.07.031] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/12/2018] [Accepted: 07/04/2018] [Indexed: 12/15/2022]
Abstract
Since the introduction of electronic cigarettes (e-cigarettes) in 2003, the technology has advanced allowing for greater user modifications, with users now able to control voltage, battery power, and constituents of the e-cigarette liquid. E-cigarettes have been the subject of a growing body of research with most research justifiably focused on the chemical makeup and risk analysis of chemicals, metals, and particulates found in e-cigarette liquids and vapor. Little research to date has focused on assessing the risks associated with the drug delivery unit itself and its potential for use as an illicit drug delivery system. In light of this, a range of illicit drugs was researched focusing on pharmacodynamics, usual method of administration, the dosage required for toxicity, toxic effects, and evidence of existing use in e-cigarettes in both literature and online illicit drug forums. A systematic literature search found evidence of current use of e-cigarettes to vape almost all illicit drug types analyzed. This presents both a potential population health risk and a management issue for clinicians. It also raises the issue of policing illicit drugs due to potential altered characteristic smells and storage within e-cigarette fluids. E-cigarettes are a viable illicit drug delivery system with evidence both inside and outside of the formal medical literature detailing their potential use for drug delivery of a wide range of illicit and legal drugs.
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Affiliation(s)
| | - Jody Morgan
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Alison L Jones
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
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Janeczek A, Zawadzki M, Szpot P, Niedzwiedz A. Marijuana intoxication in a cat. Acta Vet Scand 2018; 60:44. [PMID: 29996908 PMCID: PMC6042427 DOI: 10.1186/s13028-018-0398-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/02/2018] [Indexed: 11/19/2022] Open
Abstract
Background Cannabis from hemp (Cannabis sativa and C. indica) is one of the most common illegal drugs used by drug abusers. Indian cannabis contains around 70 alkaloids, and delta-9-tetrahydrocannabinol (delta-9-THC) is the most psychoactive substance. Animal intoxications occur rarely and are mostly accidental. According to the US Animal Poison Control Center, cannabis intoxication mostly affects dogs (96%). The most common cause of such intoxication is unintentional ingestion of a cannabis product, but it may also occur after the exposure to marijuana smoke. Case presentation A 6-year-old Persian cat was brought to the veterinary clinic due to strong psychomotor agitation turning into aggression. During hospitalisation for 14 days, the cat behaved normally and had no further attacks of unwanted behaviour. It was returned to its home but shortly after it developed neurological signs again and was re-hospitalised. On presentation, the patient showed no neurological abnormalities except for symmetric mydriasis and scleral congestion. During the examination, the behaviour of the cat changed dramatically. It developed alternate states of agitation and apathy, each lasting several minutes. On interview it turned out that the cat had been exposed to marijuana smoke. Blood toxicology tests by gas chromatography tandem mass spectrometry revealed the presence of delta-9-tetrahydrocannabinol (THC) at 5.5 ng/mL, 11-hydroxy-delta-9-THC at 1.2 ng/mL, and 11-carboxy-delta-9-THC at 13.8 ng/mL. The cat was given an isotonic solution of NaCl 2.5 and 2.5% glucose at a dose of 40 mL/kg/day parenterally and was hospitalised. After complete recovery, the cat was returned to it’s owner and future isolation of the animal from marijuana smoke was advised. Conclusions This is the first case of a delta-9-tetrahydrocannabinol intoxication in a cat with both description of the clinical findings and the blood concentration of delta-9-THC and its main metabolites.
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Greb A, Puschner B. Cannabinoid treats as adjunctive therapy for pets: gaps in our knowledge. TOXICOLOGY COMMUNICATIONS 2018. [DOI: 10.1080/24734306.2018.1434470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Alexandra Greb
- University Honors Program, University of California, Davis, CA, USA
| | - Birgit Puschner
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA, USA
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Richards JR, Schandera V, Elder JW. Treatment of acute cannabinoid overdose with naloxone infusion. TOXICOLOGY COMMUNICATIONS 2017. [DOI: 10.1080/24734306.2017.1392715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- John R. Richards
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA
| | - Verena Schandera
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA
| | - Joshua W. Elder
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA
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Burns TL, Ineck JR. Cannabinoid Analgesia as a Potential New Therapeutic Option in the Treatment of Chronic Pain. Ann Pharmacother 2016; 40:251-60. [PMID: 16449552 DOI: 10.1345/aph.1g217] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To review the literature concerning the physiology of the endocannabinoid system, current drug development of cannabinoid agonists, and current clinical research on the use of cannabinoid agonists for analgesia. Data Sources: Articles were identified through a search of MEDLINE (1966–August 2005) using the key words cannabis, cannabinoid, cannabi*, cannabidiol, nabilone, THC, pain, and analgesia. No search limits were included. Additional references were located through review of the bibliographies of the articles identified. Study Selection and Data Extraction: Studies of cannabinoid agonists for treatment of pain were selected and were not limited by pain type or etiology. Studies or reviews using animal models of pain were also included. Articles that related to the physiology and pharmacology of the endocannabinoid system were evaluated. Data Synthesis: The discovery of cannabinoid receptors and endogenous ligands for these receptors has led to increased drug development of cannabinoid agonists. New cannabimimetic agents have been associated with fewer systemic adverse effects than delta-9-tetrahydrocannabinol, including recent development of cannabis medicinal extracts for sublingual use (approved in Canada), and have had promising results for analgesia in initial human trials. Several synthetic cannabinoids have also been studied in humans, including 2 cannabinoid agonists available on the international market. Conclusions: Cannabinoids provide a potential approach to pain management with a novel therapeutic target and mechanism. Chronic pain often requires a polypharmaceutical approach to management, and cannabinoids are a potential addition to the arsenal of treatment options.
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Affiliation(s)
- Tammy L Burns
- Creighton University Medical Center, Omaha, NE 68178-4879, USA
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Williams K, Wells RJ, McLean MK. Suspected synthetic cannabinoid toxicosis in a dog. J Vet Emerg Crit Care (San Antonio) 2015; 25:739-44. [DOI: 10.1111/vec.12378] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 03/27/2014] [Accepted: 05/06/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | - Raegan J. Wells
- Emergency Animal Clinic, 86 West Juniper Avenue; Gilbert AZ 85233 (Wells)
| | - Mary Kay McLean
- ASPCA National Animal Poison Control Center; Urbana IL. 61802
- Department of Clinical Sciences; Colorado State University; Fort Collins CO 80523
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Scientific Opinion on the risks for human health related to the presence of tetrahydrocannabinol (THC) in milk and other food of animal origin. EFSA J 2015. [DOI: 10.2903/j.efsa.2015.4141] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Taffe MA. Δ9-Tetrahydrocannabinol attenuates MDMA-induced hyperthermia in rhesus monkeys. Neuroscience 2011; 201:125-33. [PMID: 22138434 DOI: 10.1016/j.neuroscience.2011.11.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 11/01/2011] [Accepted: 11/16/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Cannabis is commonly consumed by Ecstasy (3,4-methylenedioxymethamphetamine; MDMA) users, including as an intentional strategy to manipulate the drug experience. The most active psychoactive constituent in cannabis, Δ(9)-tetrahydrocannabinol (THC), and other drugs with partial or full agonist activity at the CB(1) receptor, produces a reduction of body temperature in rodents. Reports show that administration of THC can attenuate temperature increases caused by MDMA in mice or rats; however, a recent study in humans shows that THC potentiates MDMA-induced temperature elevations. Relatively little scientific evidence on the thermoregulatory effects of THC in monkeys is available. METHODS The body temperature of male rhesus macaques was recorded after challenge with THC (0.1-0.3 mg/kg, i.m.) or combined challenge of THC with the CB(1) receptor antagonist SR141716 (Rimonabant; 0.3 mg/kg, i.m.) or combined challenge of THC (0.1, 0.3 mg/kg, i.m.) with MDMA (1.78 mg/kg p.o.) using minimally-invasive, implanted radiotelemetry techniques. RESULTS THC reduced the body temperature of monkeys in a dose-dependent manner with the nadir observed 3-5 h post-injection; however, an attenuation of normal circadian cooling was also produced overnight following dosing. Hypothermia induced by THC (0.3 mg/kg, i.m.) was prevented by Rimonabant (0.3 mg/kg, i.m.). Finally, 0.3 mg/kg THC (i.m.) attenuated the elevation of body temperature produced by MDMA for about 4 h after oral dosing. CONCLUSIONS As with rodents THC produces a robust and lasting decrement in the body temperature of rhesus monkeys; this effect is mediated by the CB(1) receptor. THC also protects against the immediate hyperthermic effects of MDMA in monkeys in a dose-dependent manner. Nevertheless, a paradoxical attenuation of circadian cooling overnight after the THC/MDMA combination cautions that longer-term effects may be critical in assessing risks for the recreational user of cannabis in combination with MDMA.
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Affiliation(s)
- M A Taffe
- Committee on the Neurobiology of Addictive Disorders, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA.
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Abstract
This report describes clinical signs and plasma biochemical changes associated with significant cannabis consumption in three Green iguanas (Iguana iguana) which resulted in seizures, cardiovascular and digestive tract aberrations, elevated hepatic enzymes and bile acid concentrations for a number of weeks post recovery. One case required extensive antiseizuring therapy to recover. All Green iguanas eventually made a full recovery.
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Affiliation(s)
- S J Girling
- Animal Department, Royal Zoological Society of Scotland, Edinburgh Zoo, 134 Corstorphine Road, Edinburgh
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Giroud C, Bollmann M, Thomas A, Mangin P, Favrat B. Consommation de cannabis: quels sont les risques ? ACTA ACUST UNITED AC 2009. [DOI: 10.1051/ata/2009021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
The acute side effects caused by cannabis use are mainly related to psyche and cognition, and to circulation. Euphoria, anxiety, changes in sensory perception, impairment of memory and psychomotor performance are common effects after a dose is taken that exceeds an individually variable threshold. Cannabis consumption may increase heart rate and change blood pressure, which may have serious consequences in people with heart disease. Effects of chronic use may be induction of psychosis and development of dependency to the drug. Effects on cognitive abilities seem to be reversible after abstinence, except possibly in very heavy users. Cannabis exposure in utero may have negative consequences on brain development with subtle impairment of cognitive abilities in later life. Consequences of cannabis smoking may be similar to those of tobacco smoking and should be avoided. Use by young people has more detrimental effects than use by adults. There appear to be promising therapeutic uses of cannabis for a range of indications. Use of moderate doses in a therapeutic context is usually not associated with severe side effects. Current prohibition on cannabis use may also have harmful side effects for the individual and the society, while having little influence on prevalence of use. Harm is greatest for seriously ill people who may benefit from a treatment with cannabis. This makes it difficult to justify criminal penalties against patients.
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Pagotto U, Marsicano G, Cota D, Lutz B, Pasquali R. The emerging role of the endocannabinoid system in endocrine regulation and energy balance. Endocr Rev 2006; 27:73-100. [PMID: 16306385 DOI: 10.1210/er.2005-0009] [Citation(s) in RCA: 578] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
During the last few years, the endocannabinoid system has emerged as a highly relevant topic in the scientific community. Many different regulatory actions have been attributed to endocannabinoids, and their involvement in several pathophysiological conditions is under intense scrutiny. Cannabinoid receptors, named CB1 receptor and CB2 receptor, first discovered as the molecular targets of the psychotropic component of the plant Cannabis sativa, participate in the physiological modulation of many central and peripheral functions. CB2 receptor is mainly expressed in immune cells, whereas CB1 receptor is the most abundant G protein-coupled receptor expressed in the brain. CB1 receptor is expressed in the hypothalamus and the pituitary gland, and its activation is known to modulate all the endocrine hypothalamic-peripheral endocrine axes. An increasing amount of data highlights the role of the system in the stress response by influencing the hypothalamic-pituitary-adrenal axis and in the control of reproduction by modifying gonadotropin release, fertility, and sexual behavior. The ability of the endocannabinoid system to control appetite, food intake, and energy balance has recently received great attention, particularly in the light of the different modes of action underlying these functions. The endocannabinoid system modulates rewarding properties of food by acting at specific mesolimbic areas in the brain. In the hypothalamus, CB1 receptor and endocannabinoids are integrated components of the networks controlling appetite and food intake. Interestingly, the endocannabinoid system was recently shown to control metabolic functions by acting on peripheral tissues, such as adipocytes, hepatocytes, the gastrointestinal tract, and, possibly, skeletal muscle. The relevance of the system is further strenghtened by the notion that drugs interfering with the activity of the endocannabinoid system are considered as promising candidates for the treatment of various diseases, including obesity.
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Affiliation(s)
- Uberto Pagotto
- Endocrinology Unit, Department of Internal Medicine and Gastroenterology, Sant' Orsola-Malpighi Hospital, Bologna, Italy, and Department of Physiological Chemistry, Johannes Gutenberg-University Mainz, Germany.
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Abstract
Currently, the treatment of Tourette's syndrome (TS) is unsatisfactory. Therefore, there is expanding interest in new therapeutical strategies. Anecdotal reports suggested that the use of cannabis might improve not only tics, but also behavioural problems in patients with TS. A single-dose, cross-over study in 12 patients, as well as a 6-week, randomised trial in 24 patients, demonstrated that Delta9-tetrahydrocannabinol (THC), the most psychoactive ingredient of cannabis, reduces tics in TS patients. No serious adverse effects occurred and no impairment on neuropsychological performance was observed. If well-established drugs either fail to improve tics or cause significant adverse effects, in adult patients, therapy with Delta9-THC should be tried. At present, it remains unclear whether herbal cannabis, different natural or synthetic cannabinoid CB1-receptor agonists or agents that interfere with the inactivation of endocannabinoids, may have the best adverse effect profile in TS.
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Affiliation(s)
- Kirsten R Müller-Vahl
- Department of Clinical Psychiatry and Psychotherapy, Medical School Hannover, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
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Abstract
Delta(9)-Tetrahydrocannabinol (THC) is the main source of the pharmacological effects caused by the consumption of cannabis, both the marijuana-like action and the medicinal benefits of the plant. However, its acid metabolite THC-COOH, the non-psychotropic cannabidiol (CBD), several cannabinoid analogues and newly discovered modulators of the endogenous cannabinoid system are also promising candidates for clinical research and therapeutic uses. Cannabinoids exert many effects through activation of G-protein-coupled cannabinoid receptors in the brain and peripheral tissues. Additionally, there is evidence for non-receptor-dependent mechanisms. Natural cannabis products and single cannabinoids are usually inhaled or taken orally; the rectal route, sublingual administration, transdermal delivery, eye drops and aerosols have only been used in a few studies and are of little relevance in practice today. The pharmacokinetics of THC vary as a function of its route of administration. Pulmonary assimilation of inhaled THC causes a maximum plasma concentration within minutes, psychotropic effects start within seconds to a few minutes, reach a maximum after 15-30 minutes, and taper off within 2-3 hours. Following oral ingestion, psychotropic effects set in with a delay of 30-90 minutes, reach their maximum after 2-3 hours and last for about 4-12 hours, depending on dose and specific effect. At doses exceeding the psychotropic threshold, ingestion of cannabis usually causes enhanced well-being and relaxation with an intensification of ordinary sensory experiences. The most important acute adverse effects caused by overdosing are anxiety and panic attacks, and with regard to somatic effects increased heart rate and changes in blood pressure. Regular use of cannabis may lead to dependency and to a mild withdrawal syndrome. The existence and the intensity of possible long-term adverse effects on psyche and cognition, immune system, fertility and pregnancy remain controversial. They are reported to be low in humans and do not preclude legitimate therapeutic use of cannabis-based drugs. Properties of cannabis that might be of therapeutic use include analgesia, muscle relaxation, immunosuppression, sedation, improvement of mood, stimulation of appetite, antiemesis, lowering of intraocular pressure, bronchodilation, neuroprotection and induction of apoptosis in cancer cells.
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Mechoulam R, Hanus L, Fride E. Towards cannabinoid drugs--revisited. PROGRESS IN MEDICINAL CHEMISTRY 2000; 35:199-243. [PMID: 10795402 DOI: 10.1016/s0079-6468(08)70037-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- R Mechoulam
- Brettler Medical Research Center, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, Israel
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Abstract
A series of experiments investigated the behavioral and hedonic effects of the synthetic cannabinoid CP 55,940 in male Wistar rats. CP 55,940 had a biphasic effect on locomotor activity, with a 10 micrograms/kg dose causing locomotor stimulation and a 100 micrograms/kg dose causing profound hypoactivity. CP 55,940 (100 micrograms/kg) also caused a marked hypothermia for at least 3 h following administration, while lower doses (2.5 and 10 micrograms/kg) had no effect. CP 55,940 (100 micrograms/kg) had anorexic and hyperdipsic effects for up to 24 h following administration and caused significant reductions in body weight. CP 55,940 (100 micrograms/kg) also caused significant avoidance to a flavoured fluid (saccharin) with which it was paired. In the conditioned place preference paradigm both the 10 micrograms/kg and 100 micrograms/kg doses of CP 55,940 produced significant place avoidance. It is concluded that CP 55,940 is aversive to rats. The possible mechanisms underlying this aversion are discussed.
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Affiliation(s)
- I S McGregor
- Department of Psychology, University of Sydney, NSW, Australia.
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Abstract
Delta-8-tetrahydrocannabinol (delta-8-THC), a cannabinoid with lower psychotropic potency than the main Cannabis constituent, delta-9-tetrahydrocannabinol (delta-9-THC), was administered (18 mg/m2 in edible oil, p.o.) to eight children, aged 3-13 years with various hematologic cancers, treated with different antineoplastic drugs for up to 8 months. The total number of treatments with delta-8-THC so far is 480. The THC treatment started two hours before each antineoplastic treatment and was continued every 6 hrs for 24 hours. Vomiting was completely prevented. The side effects observed were negligible.
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Affiliation(s)
- A Abrahamov
- Department of Pediatrics, Shaare Zedek Hospital, Jerusalem, Israel
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