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Krüger M, van Eeden T, Beswa D. Cannabis sativa Cannabinoids as Functional Ingredients in Snack Foods-Historical and Developmental Aspects. PLANTS (BASEL, SWITZERLAND) 2022; 11:plants11233330. [PMID: 36501366 PMCID: PMC9739163 DOI: 10.3390/plants11233330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 05/10/2023]
Abstract
The published health benefits of Cannabis sativa has caught the attention of health-conscious consumers and the food industry. Historically, seeds have long been utilized as a food source and currently there is an increasing number of edibles on the market that contain cannabis. Cannabinoids include the psychoactive constituent, delta-9-tetrahydrocannabinol (THC), and the non-psychoactive cannabidiol (CBD) that are both compounds of interest in Cannabis sativa. This paper looks at the distribution of nutrients and phytocannabinoids in low-THC Cannabis sativa, the historical uses of hemp, cannabis edibles, and the possible side-effects and concerns related to cannabis edibles. Several authors have pointed out that even though the use of cannabis edibles is considered safe, it is important to mention their possible side-effects and any concerns related to its consumption that negatively influence consumer acceptance of cannabis edibles. Such risks include unintentional overdose by adults and accidental ingestion by children and adolescents resulting in serious adverse effects. Therefore, cannabis edibles should be specifically packaged and labelled to differentiate them from known similar non-cannabis edibles so that, together with tamperproof packaging, these measures reduce the appeal of these products to children.
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Affiliation(s)
- Marlize Krüger
- Department of Life and Consumer Sciences, School of Agriculture and Life Sciences, University of South Africa, 28 Pioneer Ave, Florida Park, Roodepoort 1709, South Africa
| | - Tertia van Eeden
- Department of Life and Consumer Sciences, School of Agriculture and Life Sciences, University of South Africa, 28 Pioneer Ave, Florida Park, Roodepoort 1709, South Africa
| | - Daniso Beswa
- Department of Life and Consumer Sciences, School of Agriculture and Life Sciences, University of South Africa, 28 Pioneer Ave, Florida Park, Roodepoort 1709, South Africa
- Department of Biotechnology and Food Technology, Faculty of Science, University of Johannesburg, 25 Louisa St, Doornfontein, Johannesburg 2028, South Africa
- Correspondence: ; Tel.: +27-11559-6000
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2
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Hazle MC, Hill KP, Westreich LM. Workplace Cannabis Policies: A Moving Target. Cannabis Cannabinoid Res 2022; 7:16-23. [PMID: 33998870 PMCID: PMC8864412 DOI: 10.1089/can.2020.0095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: This article proposes a workplace cannabis policy paradigm that encompasses rapidly changing laws and regulations, legally defensible drug testing policies, and the needs of particular workplaces. Numerous states have now decriminalized medical or recreational use of cannabis, although U.S. federal law still defines cannabis as a Schedule I substance with no currently accepted medical use and a high potential for abuse. For employers and employees, the confusion generated by this contradiction is exacerbated by the widely varying effects of the available cannabis delivery systems, the primitive and cumbersome drug testing protocols often used in workplace settings, difficulties in measuring cannabis-related workplace impairment, and a rapidly changing cultural ethos regarding cannabis. Although other articles have addressed many of the broad theoretical constructs, there exists little practical guidance on how workplace drug programs should address cannabis use by employees, both on the job and during off-hours. Materials and Methods: Research for this review was performed in the PubMed/National Library of Medicine database. Discussion: Cannabis use is associated with cognitive deficits, motivation problems, and perceptual distortions, so employers have a legitimate interest in preventing on-the-job impairment related to cannabis use. Similarly, employees have a legitimate interest in behaving as they wish outside of the workplace, as long as that behavior does not affect their job performance. Relevant statues and case law on the subject of cannabis in the workplace reflect different legal models across jurisdictions, in addition to legislators and judges' attempts to manage this tension between employer and employees. Conclusion: An effective workplace cannabis policy must fit into a larger workplace drug and alcohol policy. It should be constructed with a collaborative effort of addiction professionals, labor attorneys, and human resource professionals. Only then can the ultimate workplace cannabis policy comply with relevant laws, protect workplace safety and productivity, and support employees while remaining flexible enough to adapt to changes in the legal environment.
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Affiliation(s)
- Mia C. Hazle
- Division of Addiction Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,*Address correspondence to: Mia C. Hazle, MD, Division of Addiction Psychiatry, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA,
| | - Kevin P. Hill
- Division of Addiction Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Laurence M. Westreich
- Division of Alcoholism and Drug Abuse, Department of Psychiatry, New York University School of Medicine, New York, New York, USA
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3
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Saulino PA, Greenwald BD, Gordon DJ. The changing landscape of the use of medical marijuana after traumatic brain injury: a narrative review. Brain Inj 2021; 35:1510-1520. [PMID: 34632896 DOI: 10.1080/02699052.2021.1978548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To summarize the potential therapeutic benefits of medical marijuana for patients with traumatic brain injury (TBI). METHODS A systematic search was conducted using PubMed and Cochran's library for information regard the safety and efficacy of medical marijuana as a therapeutic agent. We investigated, in depth, articles specifically evaluating medical marijuana's use in TBI, as well as articles that summarized the effects of marijuana in general. Articles from the year 2000-2020 were included. RESULTS A total of 37 articles met our inclusion criteria. An additional 3 articles were obtained from reference lists. CONCLUSION Studies have shown that medical marijuana can potentially aid the recovery from TBI by modulating the endocannabinoid system, reducing inflammation and secondary injury. Adverse cognitive and physiological effects have been observed in the acute setting as well as chronically, though more research is necessitated. There is also the concern of significant drug-drug interactions that have not been thoroughly studied. Thus, while there is evidence that medical marijuana can be beneficial in the treatment of TBI, more research is necessitated to fully explore the long-term efficacy and adverse effects.
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Affiliation(s)
- Patrick A Saulino
- Rutgers Robert Wood Johnson Medical School, Ringgold Standard Institution, Piscataway, New Jersey, USA
| | - Brian D Greenwald
- Center for Brain Injuries, JFK Johnson Rehabilitation Institute, Ringgold Standard Institution - Physical Medicine and Rehabilitation, Edison, New Jersey, USA.,Rutgers Robert Wood Johnson Medical School New Brunswick, - Physical Medicine and Rehabilitation, Edison, New Jersey, USA
| | - Dustin J Gordon
- Rehabilitation Specialists, Ringgold Standard Institution, Fairleigh Dickinson University, Fair Lawn, New Jersey, USA.,Fairleigh Dickinson University in Teaneck, New Jersey, USA
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4
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Perlman AI, McLeod HM, Ventresca EC, Salinas MG, Post PJ, Schuh MJ, Abu Dabrh AM. Medical Cannabis State and Federal Regulations: Implications for United States Health Care Entities. Mayo Clin Proc 2021; 96:2671-2681. [PMID: 34607636 DOI: 10.1016/j.mayocp.2021.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/16/2021] [Accepted: 05/11/2021] [Indexed: 10/20/2022]
Abstract
Thirty-six states and four territories in the United States have legalized cannabis for medical and/or recreational use. Marijuana, however, continues to be classified as a schedule I substance under the Federal Controlled Substance Act and remains illegal under US federal law. The incongruity between state and federal legislation creates various challenges for stakeholders: patients, medical trainees, providers, and health care institutions. This communication provides an overview of the major policies impacting Cannabis sativa use within the United States, various state and federal regulations, and highlights potential implications for health care institutions moving forward. Existing literature, regulations, and policies on medical marijuana (MMJ) use in health care settings were searched, reviewed, analyzed, and distilled. As a consequence of legislative inconsistencies, there is insufficient clarity and resultant challenges regarding MMJ usage, prescription, possession, education, and research-related policies for health care stakeholders across the United States. Coupled with limited scientific evidence on the clinical efficacy of MMJ, the needs of the patient and the quality of health care delivery may be affected as hospitals balance the competing risks of being legislatively compliant while protecting the rights of patients and health care employees. There is a recognized need to better define acceptable MMJ policies and regulations in health care settings that are evidence-based, legally compliant, and adequately address the needs of both patients and providers. Given the complexity of the legal and policy landscape, there are potential opportunities for improvement, including in medical education and training, research, and usage oversight of MMJ for stakeholders in the United States.
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Affiliation(s)
- Adam I Perlman
- Department of Integrative Health, Mayo Clinic, Jacksonville, FL.
| | - Heidi M McLeod
- Department of Integrative Health, Mayo Clinic, Jacksonville, FL
| | | | | | - Peter J Post
- Department of Pharmacy, Mayo Clinic, Rochester, NY
| | - Michael J Schuh
- Department of Family Medicine and Palliative Medicine and Pharmacy, Mayo Clinic, Jacksonville, FL
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5
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Kane T, Flood C, Oluwato T, Pan Q, Zilbermint M. Expanding legal treatment options for medical marijuana in the State of Louisiana. J Community Hosp Intern Med Perspect 2021; 11:343-349. [PMID: 34234903 PMCID: PMC8118431 DOI: 10.1080/20009666.2021.1890339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The use of cannabis for ‘medical’ purposes has expanded throughout the USA. Despite the limited peer-reviewed medical research, medical marijuana therapy has been to treat chronic pain, stimulate appetite, treat nausea, and ameliorate muscle spasticity. Challenge: In the state of Louisiana, this potential treatment is strictly controlled. The ability of the individual patient to receive this therapy is limited since any prescribing provider had to be both licensed by the state medical board and registered with the board to prescribe medical marijuana. Medical cannabis could be used only for limited medical disorders. The ‘Medical Marijuana’ HB819 bill authorizes the recommendation of medical marijuana for additional conditions and allows any state-licensed physician to recommend/prescribe medical marijuana. Alternative options: The government may consider working with the state medical board to lessen its regulation allowing a collaborative effort to formalize protocols for safe prescribing of medical marijuana. A more liberal option would be to make it available to the consumer over the counter, while a state tracking mechanism is set in place to limit the amount purchased. Conclusions: Two stakeholders pertaining to this new legislation to focus on are the Louisiana State government and healthcare providers. This law probably has the biggest impact on healthcare providers and their relationship to patients. This legislation may allow providers to have more ‘freedom in medical marijuana treatment plans’. These benefits would be monitored using such criteria as cost, access to care, as well as patient and healthcare provider satisfaction.
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Affiliation(s)
- Theresa Kane
- Health Care Management MBA Program, Johns Hopkins University Carey Business School, Baltimore, MD, USA
| | - Christopher Flood
- Health Care Management MBA Program, Johns Hopkins University Carey Business School, Baltimore, MD, USA.,Department of Quality, Suburban Hospital, Johns Hopkins Medicine, Bethesda, USA
| | - Tobi Oluwato
- Health Care Management MBA Program, Johns Hopkins University Carey Business School, Baltimore, MD, USA.,Department of Quality, Suburban Hospital, Johns Hopkins Medicine, Bethesda, USA.,Department of OB Hospitalists, Sutter East Bay Medical Group, Berkeley, CA, USA
| | - Qinshi Pan
- Health Care Management MBA Program, Johns Hopkins University Carey Business School, Baltimore, MD, USA.,Johns Hopkins Community Physicians at Suburban Hospital, Suburban Hospital, Bethesda, MD, USA
| | - Mihail Zilbermint
- Health Care Management MBA Program, Johns Hopkins University Carey Business School, Baltimore, MD, USA.,Johns Hopkins Community Physicians at Suburban Hospital, Suburban Hospital, Bethesda, MD, USA.,Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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6
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Howard J, Osborne J. Cannabis and work: Need for more research. Am J Ind Med 2020; 63:963-972. [PMID: 32797692 DOI: 10.1002/ajim.23170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/12/2022]
Abstract
Cannabis sativa is one of the oldest and most widely used plants in the world with a variety of industrial, medical, and nonmedical applications. Despite its long history, cannabis-derived products remain a source of controversy across the fields of medicine, law, and occupational safety and health. More favorable public attitudes about cannabis in the US have resulted in greater access to cannabis through legalization by states, leading to more consumption by workers. As more states adopt cannabis access laws, and as more workers choose to consume cannabis products, the implications for existing workplace policies, programs, and practices become more salient. Past workplace practices were grounded in a time when cannabis consumption was always viewed as problematic, considered a moral failing, and was universally illegal. Shifting cultural views and the changing legal status of cannabis indicate a need for research into the implications and challenges relating to cannabis and work. This commentary suggests research needs in the following areas: (a) data about industries and occupations where cannabis consumption among workers is most prevalent; (b) adverse health consequences of cannabis consumption among workers; (c) workplace supported recovery programs; (d) hazards to workers in the emerging cannabis industry; (e) relationship between cannabis consumption and occupational injuries; (f) ways to assess performance deficits and impairment from cannabis consumption; (g) consumption of synthetic cannabinoids to evade detection by drug testing; (h) cannabis consumption and its effect on occupational driving; and (i) ways to craft workplace policies and practices that take into consideration conflicting state and federal laws pertaining to cannabis.
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Affiliation(s)
- John Howard
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention US Department of Health and Human Services Washington DC
| | - Jamie Osborne
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention US Department of Health and Human Services Atlanta Georgia
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7
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Wolfrom B, Ng VK. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:e140-e141. [PMID: 32404465 PMCID: PMC7219799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Brent Wolfrom
- Directeur du programme postdoctoral au Département de médecine familiale de l'Université Queen's à Kingston (Ontario), et observateur des soins de santé des anciens combattants pour le Groupe d'intérêt des membres sur la médecine du travail du Collège des médecins de famille du Canada.
| | - Victor K Ng
- Médecin conseiller auprès de la division Développement professionnel et Soutien à la pratique, et professeur adjoint en médecine familiale et d'urgence à l'Université de Toronto (Ontario) et à l'Université Western à London (Ontario)
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8
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Wolfrom B, Ng VK. Cannabis in the workplace: What physicians need to know. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:317-318. [PMID: 32404448 PMCID: PMC7219804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Brent Wolfrom
- Postgraduate Program Director in the Department of Family Medicine at Queen's University in Kingston, Ont, and Veterans' Health Observer for the Occupational Medicine Community of Practice of the College of Family Physicians of Canada.
| | - Victor K Ng
- Physician advisor in the Professional Development and Practice Support division of the College of Family Physicians of Canada and Assistant Professor in family and emergency medicine at the University of Toronto in Ontario and at Western University in London, Ont
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9
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Ghimire KM, Maclean JC. Medical marijuana and workers' compensation claiming. HEALTH ECONOMICS 2020; 29:419-434. [PMID: 32020740 DOI: 10.1002/hec.3992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
We study the effect of state medical marijuana laws (MMLs) on workers' compensation (WC) claiming among adults. Medical marijuana is plausibly related to WC claiming by allowing improved symptom management, and thus reduced need for the benefit, among injured or ill workers. We use data on claiming drawn from the Annual Social and Economic supplement to the Current Population Survey over the period 1989 to 2012, coupled with a differences-in-differences design to provide the first evidence on this relationship. Our estimates show that, post MML, WC claiming declines, both the propensity to claim and the level of income from WC. These findings suggest that medical marijuana can allow workers to better manage symptoms associated with workplace injuries and illnesses and, in turn, reduce need for WC. However, the reductions in WC claiming post MML are very modest in size.
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Affiliation(s)
- Keshar M Ghimire
- Business and Economics Department, University of Cincinnati Blue Ash College, Blue Ash, Ohio
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10
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Abuse of Licit and Illicit Psychoactive Substances in the Workplace: Medical, Toxicological, and Forensic Aspects. J Clin Med 2020; 9:jcm9030770. [PMID: 32178358 PMCID: PMC7141377 DOI: 10.3390/jcm9030770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/01/2020] [Accepted: 03/10/2020] [Indexed: 01/23/2023] Open
Abstract
About one-third of adult life is spent in the workplace. The use of psychoactive substances is a major preventable cause of morbidity and mortality. The consumption of psychoactive substances during or outside working hours greatly increases the frequency and severity of labor accidents, as well as the workers’ poor general state of health and productivity, implying higher costs for enterprises. It is the responsibility of organizations to ensure the safety and health of their workers. These cannot be limited to traditional routine clinical exams, as other aspects also have an impact on health. Thus, prevention and intervention in the consumption of psychoactive substances (e.g., ethanol, opioids, central nervous system stimulants or depressants, hallucinogens, Cannabis derivatives, dissociative substances, and inhalants) in labor activity should be considered as an investment of organizations and not as a cost, in view of the professional, personal, and family advantages for workers and employers, with a potential impact on productivity, security, health, and quality of life at work. Despite the extensive literature on the subject, each article generally focuses on one or another aspect of a very specific nature, not tackling the problem in a holistic way by confronting clinical, safety, and legal issues. This article presents a reflection on the legal, laboratorial, clinical, ethical, forensic, and safety concerns related to the consumption of psychoactive substances in the workplace, and can be a cross-cutting contribution to occupational medicine, forensic medicine, and insurance medicine, as well as for entrepreneurs, lawyers, judges, workers, and technicians from the public and private sectors that develop projects in this area. This discussion is based on general principles established internationally and highlights the role of the occupational healthcare system and other decision-making actors in the prevention and supervision of workplace psychoactive consumption.
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11
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Sarris J, Sinclair J, Karamacoska D, Davidson M, Firth J. Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review. BMC Psychiatry 2020; 20:24. [PMID: 31948424 PMCID: PMC6966847 DOI: 10.1186/s12888-019-2409-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 12/15/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Medicinal cannabis has received increased research attention over recent years due to loosening global regulatory changes. Medicinal cannabis has been reported to have potential efficacy in reducing pain, muscle spasticity, chemotherapy-induced nausea and vomiting, and intractable childhood epilepsy. Yet its potential application in the field of psychiatry is lesser known. METHODS The first clinically-focused systematic review on the emerging medical application of cannabis across all major psychiatric disorders was conducted. Current evidence regarding whole plant formulations and plant-derived cannabinoid isolates in mood, anxiety, sleep, psychotic disorders and attention deficit/hyperactivity disorder (ADHD) is discussed; while also detailing clinical prescription considerations (including pharmacogenomics), occupational and public health elements, and future research recommendations. The systematic review of the literature was conducted during 2019, assessing the data from all case studies and clinical trials involving medicinal cannabis or plant-derived isolates for all major psychiatric disorders (neurological conditions and pain were omitted). RESULTS The present evidence in the emerging field of cannabinoid therapeutics in psychiatry is nascent, and thereby it is currently premature to recommend cannabinoid-based interventions. Isolated positive studies have, however, revealed tentative support for cannabinoids (namely cannabidiol; CBD) for reducing social anxiety; with mixed (mainly positive) evidence for adjunctive use in schizophrenia. Case studies suggest that medicinal cannabis may be beneficial for improving sleep and post-traumatic stress disorder, however evidence is currently weak. Preliminary research findings indicate no benefit for depression from high delta-9 tetrahydrocannabinol (THC) therapeutics, or for CBD in mania. One isolated study indicates some potential efficacy for an oral cannabinoid/terpene combination in ADHD. Clinical prescriptive consideration involves caution in the use of high-THC formulations (avoidance in youth, and in people with anxiety or psychotic disorders), gradual titration, regular assessment, and caution in cardiovascular and respiratory disorders, pregnancy and breast-feeding. CONCLUSIONS There is currently encouraging, albeit embryonic, evidence for medicinal cannabis in the treatment of a range of psychiatric disorders. Supportive findings are emerging for some key isolates, however, clinicians need to be mindful of a range of prescriptive and occupational safety considerations, especially if initiating higher dose THC formulas.
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Affiliation(s)
- Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, 2145, Australia.
- Department of Psychiatry, The Melbourne Clinic, Professorial Unit, The University of Melbourne, Melbourne, Australia.
| | - Justin Sinclair
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, 2145, Australia
| | - Diana Karamacoska
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, 2145, Australia
| | - Maggie Davidson
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, 2145, Australia
| | - Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, 2145, Australia
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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12
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Mokwena K. Social and public health implications of the legalisation of recreational cannabis: A literature review. Afr J Prim Health Care Fam Med 2019; 11:e1-e6. [PMID: 31793317 PMCID: PMC6890535 DOI: 10.4102/phcfm.v11i1.2136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/23/2019] [Accepted: 08/09/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND After many years of legal struggles for the legalisation of recreational use of cannabis, the Constitutional Court of South Africa ruled in favour of the applicants in September 2018. Although the ruling issued caution regarding the social challenges accompanying this legalisation, it did not address how the country would deal with the societal consequences of this ruling. AIM The aim of this article was to discuss the social and public health implications of the legalisation of recreational cannabis on South Africa. METHODS Literature review on the social, health and legal impacts of legalisation of cannabis, considering experiences of other countries that have legalised cannabis. RESULTS The legalisation brings a range of significant negative consequences, which include an expected increase in the number of users and the subsequent undesirable effects on the physical, mental and social health of communities. CONCLUSION In terms of financial, infrastructural and human resources, South Africa cannot afford the consequences of the legalisation of recreational cannabis. Poor communities, children and the youth will carry the brunt of the scourge of cannabis use.
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Affiliation(s)
- Kebogile Mokwena
- Department of Social and Behavioural Health Sciences, Sefako Makgatho Health Sciences University, Pretoria.
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13
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Bachhuber M, Arnsten JH, Wurm G. Use of Cannabis to Relieve Pain and Promote Sleep by Customers at an Adult Use Dispensary. J Psychoactive Drugs 2019; 51:400-404. [PMID: 31264536 PMCID: PMC6823130 DOI: 10.1080/02791072.2019.1626953] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 04/10/2019] [Accepted: 04/22/2019] [Indexed: 01/04/2023]
Abstract
Medical cannabis patients consistently report using cannabis as a substitute for prescription medications; however, little is known about individuals accessing cannabis through adult-use markets. A survey at two retail stores was conducted in Colorado, United States. Between August 2016 and October 2016, store staff asked customers if they wanted to participate and, if so, provided an electronic survey link. All customers reporting medical certification were excluded. Of 1,000 adult-use only customer respondents, 65% reported taking cannabis to relieve pain and 74% reported taking cannabis to promote sleep. Among respondents taking cannabis for pain, 80% reported that it was very or extremely helpful, and most of those taking over-the-counter pain medications (82%) or opioid analgesics (88%) reported reducing or stopping use of those medications. Among respondents taking cannabis for sleep, 84% found it very or extremely helpful, and most of those taking over-the-counter (87%) or prescription sleep aids (83%) reported reducing or stopping use of those medications. De facto medical use of cannabis for symptom relief was common among adult-use dispensary customers and the majority reported that cannabis decreased their medication use. Adult use cannabis laws may broaden access to cannabis for the purpose of symptom relief.
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Affiliation(s)
- Marcus Bachhuber
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Julia H Arnsten
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Gwen Wurm
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
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DINI G, BRAGAZZI N, MONTECUCCO A, RAHMANI A, DURANDO P. Psychoactive drug consumption among truck-drivers: a systematic review of the literature with meta-analysis and meta-regression. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E124-E139. [PMID: 31312742 PMCID: PMC6614564 DOI: 10.15167/2421-4248/jpmh2019.60.2.1245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/02/2019] [Indexed: 11/16/2022]
Abstract
Few studies have assessed the extent of psychoactive drug consumption in the occupational setting. The trucking sector, in particular, is an important cause for concern, since psychoactive substance use has a relevant impact on the drivers' health and safety, increasing the risk of injuries and traffic accidents, potentially affecting the general public health as well. A systematic review of the literature and meta-analysis was performed in order to provide Occupational Health Professionals and policy-makers with an updated epidemiological perspective regarding this important issue. The results showed a prevalence of overall drug consumption of 27.6% [95%CI 17.8-40.1], particularly high considering illicit CNS-stimulants (amphetamine consumption of 21.3% [95%CI 15.7-28.1], and cocaine consumption of 2.2% [95%CI 1.2-4.1]). It appears that truck-drivers choose stimulant substances as a form of performance enhancing drug, in order to increase productivity. However, chronic and high dose consumption has been shown to decrease driving skills, placing these professional drivers at risk for health and road safety. Further research is required, particularly in Europe, in order to fill the knowledge gap and improve the strength of evidence.
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Affiliation(s)
- G. DINI
- Department of Health Sciences (DISSAL), Occupational Medicine, University of Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
| | - N.L. BRAGAZZI
- Department of Health Sciences (DISSAL), Occupational Medicine, University of Genoa, Italy
- Correspondence: Nicola Luigi Bragazzi, Dipartimento di Scienze della Salute (DISSAL), Università degli Studi di Genova, l.go R. Benzi 10 (Padiglione 3), 16132 Genova, Italy - E-mail:
| | - A. MONTECUCCO
- Department of Health Sciences (DISSAL), Occupational Medicine, University of Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
| | - A. RAHMANI
- Department of Health Sciences (DISSAL), Occupational Medicine, University of Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
| | - P. DURANDO
- Department of Health Sciences (DISSAL), Occupational Medicine, University of Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
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Anderson DM, Rees DI, Tekin E. Medical marijuana laws and workplace fatalities in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 60:33-39. [PMID: 30092547 DOI: 10.1016/j.drugpo.2018.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/13/2018] [Accepted: 07/15/2018] [Indexed: 11/25/2022]
Abstract
AIMS The aim of this research was to determine the association between legalizing medical marijuana and workplace fatalities. DESIGN Repeated cross-sectional data on workplace fatalities at the state-year level were analyzed using a multivariate Poisson regression. SETTING To date, 29 states and the District of Columbia have legalized the use of marijuana for medicinal purposes. Although there is increasing concern that legalizing medical marijuana will make workplaces more dangerous, little is known about the relationship between medical marijuana laws (MMLs) and workplace fatalities. PARTICIPANTS All 50 states and the District of Columbia for the period 1992-2015. MEASUREMENTS Workplace fatalities by state and year were obtained from the Bureau of Labor Statistics. Regression models were adjusted for state demographics, the unemployment rate, state fixed effects, and year fixed effects. FINDINGS Legalizing medical marijuana was associated with a 19.5% reduction in the expected number of workplace fatalities among workers aged 25-44 (incident rate ratio [IRR], 0.805; 95% CI, .662-.979). The association between legalizing medical marijuana and workplace fatalities among workers aged 16-24, although negative, was not statistically significant at conventional levels. The association between legalizing medical marijuana and workplace fatalities among workers aged 25-44 grew stronger over time. Five years after coming into effect, MMLs were associated with a 33.7% reduction in the expected number of workplace fatalities (IRR, 0.663; 95% CI, .482-.912). MMLs that listed pain as a qualifying condition or allowed collective cultivation were associated with larger reductions in fatalities among workers aged 25-44 than those that did not. CONCLUSIONS The results provide evidence that legalizing medical marijuana improved workplace safety for workers aged 25-44. Further investigation is required to determine whether this result is attributable to reductions in the consumption of alcohol and other substances that impair cognitive function, memory, and motor skills.
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Affiliation(s)
- D Mark Anderson
- Department of Agricultural Economics and Economics, Montana State University, P.O. Box 172920, Bozeman, MT, 59717-2920, United States.
| | - Daniel I Rees
- Department of Economics, University of Colorado Denver, United States.
| | - Erdal Tekin
- School of Public Affairs, American University, United States.
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Rineer JR, Duhart Clarke S, Cluff LA, Peiper NC. Comparing medical and recreational cannabis use among employees: associations with health and work-related outcomes. Int Rev Psychiatry 2018; 30:268-276. [PMID: 30179533 DOI: 10.1080/09540261.2018.1465397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Nearly one in five US employees reports having used cannabis in the past year. As policies and laws regarding cannabis use rapidly change, concerns have arisen over employees' use of cannabis, for both medical and recreational purposes. While extant workplace research has not distinguished between types of cannabis users, other studies have found that medical users are clinically and socio-demographically different from non-medical users. This study utilized a sample of employed National Survey on Drug Use and Health (NSDUH) respondents to examine differences in workplace characteristics and health outcomes among employed medical, recreational, and mixed-use cannabis users. While some differences were initially seen when examining health and work-related outcomes between the groups, several changed after controlling for other important health-related factors. One key difference between the user groups is the higher percentages of medical and mixed-use cannabis users in the construction and mining industries. This study discusses future research needs, as well as practical implications for workers and employers.
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Affiliation(s)
- Jennifer R Rineer
- a Public Health Research Division , RTI International , Research Triangle Park , NC , USA
| | - Sarah Duhart Clarke
- a Public Health Research Division , RTI International , Research Triangle Park , NC , USA
| | - Laurie A Cluff
- a Public Health Research Division , RTI International , Research Triangle Park , NC , USA
| | - Nicholas C Peiper
- a Public Health Research Division , RTI International , Research Triangle Park , NC , USA
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Smith R, Hall KE, Etkind P, Van Dyke M. Current Marijuana Use by Industry and Occupation - Colorado, 2014-2015. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:409-413. [PMID: 29649186 PMCID: PMC5898224 DOI: 10.15585/mmwr.mm6714a1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Scholze AR, Martins JT, Galdino MJQ, Ribeiro RP. Ambiente ocupacional e o consumo de substâncias psicoativas entre enfermeiros. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Analisar a relação entre o ambiente de trabalho e o consumo de substâncias psicoativas entre enfermeiros hospitalares. Métodos Estudo transversal e descritivo, realizado com enfermeiros de três instituições hospitalares públicas localizados em um município da Região Sul do Brasil, sendo duas de média complexidade e uma de alta complexidade. A população deste estudo foi composta por 221 enfermeiros. Com base nesse número, calculou-se o tamanho amostral por estratos, considerando-se a proporção de 50%, nível de confiança de 95% e erro máximo de 5%, o que resultou no número mínimo de 175 participantes. Mediante a estratificação proporcional por instituição definiu-se o mínimo de 103 enfermeiros da alta complexidade e 36 de cada instituição de média complexidade. Adotou-se como critérios de inclusão: trabalhar na instituição há pelo menos um ano e não estar afastado por licença. A coleta de dados foi realizada entre outubro de 2015 e abril de 2016. Na coleta de dados utilizaram-se informações sociodemográficas e ocupacionais, o Nursing Work Index - Revised e o Alcohol, Smoking and Substance Involvement Screening Test. Os dados foram analisados no programa Statistical Package for Social Sciences, versão 20.0. Inicialmente, verificou-se a normalidade pelo teste de Kolmogorov-Smirnov. Foram realizadas análises descritivas, por frequências absoluta e relativa para as variáveis categóricas; e medianas e medidas de dispersão para as numéricas. Resultados Álcool, tabaco e sedativos foram as substâncias mais consumidas. Renda mensal apresentou correlação positiva com o consumo de álcool entre enfermeiros dos hospitais de média complexidade (p=0,01). No hospital de alta complexidade, o consumo de álcool relacionou-se negativamente a relação médico-enfermeiro (p=0,03). Autonomia, relação médico-enfermeiro e suporte organizacional estiveram correlacionados negativamente ao uso de sedativos (p<0,01; p<0,01; p=0,02, respectivamente). Conclusão Quanto mais desfavorável o ambiente de trabalho do enfermeiro, sobretudo na relação com médicos, suporte organizacional e autonomia, maior foi o consumo de substâncias psicoativas.
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Peiper NC, Baumgartner PM, Chew RF, Hsieh YP, Bieler GS, Bobashev GV, Siege C, Zarkin GA. Patterns of Twitter Behavior Among Networks of Cannabis Dispensaries in California. J Med Internet Res 2017; 19:e236. [PMID: 28676471 PMCID: PMC5516098 DOI: 10.2196/jmir.7137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/06/2017] [Accepted: 04/07/2017] [Indexed: 12/17/2022] Open
Abstract
Background Twitter represents a social media platform through which medical cannabis dispensaries can rapidly promote and advertise a multitude of retail products. Yet, to date, no studies have systematically evaluated Twitter behavior among dispensaries and how these behaviors influence the formation of social networks. Objectives This study sought to characterize common cyberbehaviors and shared follower networks among dispensaries operating in two large cannabis markets in California. Methods From a targeted sample of 119 dispensaries in the San Francisco Bay Area and Greater Los Angeles, we collected metadata from the dispensary accounts using the Twitter API. For each city, we characterized the network structure of dispensaries based upon shared followers, then empirically derived communities with the Louvain modularity algorithm. Principal components factor analysis was employed to reduce 12 Twitter measures into a more parsimonious set of cyberbehavioral dimensions. Finally, quadratic discriminant analysis was implemented to verify the ability of the extracted dimensions to classify dispensaries into their derived communities. Results The modularity algorithm yielded three communities in each city with distinct network structures. The principal components factor analysis reduced the 12 cyberbehaviors into five dimensions that encompassed account age, posting frequency, referencing, hyperlinks, and user engagement among the dispensary accounts. In the quadratic discriminant analysis, the dimensions correctly classified 75% (46/61) of the communities in the San Francisco Bay Area and 71% (41/58) in Greater Los Angeles. Conclusions The most centralized and strongly connected dispensaries in both cities had newer accounts, higher daily activity, more frequent user engagement, and increased usage of embedded media, keywords, and hyperlinks. Measures derived from both network structure and cyberbehavioral dimensions can serve as key contextual indicators for the online surveillance of cannabis dispensaries and consumer markets over time.
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Affiliation(s)
- Nicholas C Peiper
- RTI International, Behavioral Health and Criminal Justice Research Division, Research Triangle Park, NC, United States
| | - Peter M Baumgartner
- RTI International, Center for Data Science, Research Triangle Park, NC, United States
| | - Robert F Chew
- RTI International, Center for Data Science, Research Triangle Park, NC, United States
| | - Yuli P Hsieh
- RTI International, Survey Research Division, Research Triangle Park, NC, United States
| | - Gayle S Bieler
- RTI International, Center for Data Science, Research Triangle Park, NC, United States
| | - Georgiy V Bobashev
- RTI International, Center for Data Science, Research Triangle Park, NC, United States
| | - Christopher Siege
- RTI International, Research Computing Division, Research Triangle Park, NC, United States
| | - Gary A Zarkin
- RTI International, Behavioral Health and Criminal Justice Research Division, Research Triangle Park, NC, United States
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Medical Marijuana: Just the Beginning of a Long, Strange Trip? Phys Ther 2017; 97:239-248. [PMID: 27660328 DOI: 10.2522/ptj.20160367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/16/2016] [Indexed: 12/12/2022]
Abstract
Medical marijuana continues to gain acceptance and become legalized in many states. Various species of the marijuana plant have been cultivated, and this plant can contain up to 100 active compounds known as cannabinoids. Two cannabinoids seem the most clinically relevant: Δ9-tetrahydrocannabinol (THC), which tends to produce the psychotropic effects commonly associated with marijuana, and cannabidiol (CBD), which may produce therapeutic effects without appreciable psychoactive properties. Smoking marijuana, or ingesting extracts from the whole plant orally (in baked goods, teas, and so forth), introduces variable amounts of THC, CBD, and other minor cannabinoids into the systemic circulation, where they ultimately reach the central and peripheral nervous systems. Alternatively, products containing THC, CBD, or a combination of both compounds, can be ingested as oral tablets or via sprays applied to the oral mucosal membranes. These products may provide a more predictable method for delivering a known amount of specific cannabinoids into the body. Although there is still a need for randomized controlled trials, preliminary studies have suggested that medical marijuana and related cannabinoids may be beneficial in treating people with chronic pain, inflammation, spasticity, and other conditions seen commonly in physical therapist practice. Physical therapists, therefore, should be aware of the options that are available for patients considering medical marijuana and should be ready to provide information for these patients. Clinicians also should be aware that marijuana can produce untoward effects on cognition, coordination, balance, and cardiovascular and pulmonary function and should be vigilant for any problems that may arise if patients are using cannabinoids during physical rehabilitation.
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Bowles NP, Herzig MX, Shea SA. Recent legalization of cannabis use: effects on sleep, health, and workplace safety. Nat Sci Sleep 2017; 9:249-251. [PMID: 29089789 PMCID: PMC5656354 DOI: 10.2147/nss.s152231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Nicole P Bowles
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Maya X Herzig
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Steven A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
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Interpretation of Workplace Tests for Cannabinoids. J Med Toxicol 2016; 13:106-110. [PMID: 27686239 DOI: 10.1007/s13181-016-0587-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/16/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022] Open
Abstract
Workplace urine drug testing for an inactive THC metabolite is common in both federally regulated and non-regulated drug testing. A positive result does not document impairment, or even recent use, when impairment is likely the most important parameter being searched for by the drug testing procedure. Most cannabinoid testing does not detect imported synthetics. Currently, urine is the most widely tested matrix, but blood, plasma, oral fluid, and hair may also be accepted in federally regulated testing in the future. This article will discuss the history, the status quo, and the possible near term future of workplace testing for marijuana in employees.
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