1
|
Yan X, Bedillion MF, Claus ED, Huang-Pollock C, Ansell EB. Sex differences in the prospective association of excessively long reaction times and hazardous cannabis use at six months. Addict Behav Rep 2024; 20:100558. [PMID: 39027408 PMCID: PMC11252613 DOI: 10.1016/j.abrep.2024.100558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/02/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
Objective The neurocognitive risk mechanisms predicting divergent outcomes likely differ between men and women who use cannabis recreationally. Increasingly, the use of descriptive distributions including the ex-Gaussian has been applied to draw stronger inferences about neurocognitive health in clinical populations. The current project examines whether the long tail of reaction times (RTs) in a distribution, as characterized by the ex-Gaussian parameter tau which may represent difficulty with the regulation of arousal, predicts problematic cannabis use 6 months later in those who use cannabis recreationally, and whether sex moderates these prospective associations. Method Young adults (ages 18-30, mean age 20.5 years, N =159, 57.2% women, 69.2% Caucasian) who recreationally used cannabis either occasionally (at least once per month) or frequently (three times or more per week) completed the Stroop Color-Word Task at baseline. Ex-Gaussian parameter tau was estimated for each participant. Self-report of hazardous cannabis use (CUDIT-R) and dysregulation of negative (DERS) and positive emotions (DERS-Positive) were obtained at baseline and 6-month follow-up. Results For those with larger tau at baseline, being a man (but not a woman) was associated with increased difficulty regulating positive emotions concurrently (b = -0.01, F (1,159) = 5.48, p = 0.02), and with hazardous cannabis use six months later (b = -0.007, F (1,159) = 4.42, p = 0.037) after controlling for baseline hazardous cannabis use. Conclusions Excessively long RTs during cognitive performance may help characterize men at risk for increased hazardous use, which contributes to understanding between-sex heterogeneity in pathways towards cannabis use disorders.
Collapse
Affiliation(s)
- Xu Yan
- Department of Psychology, The Pennsylvania State University, United States
| | - Margaret F. Bedillion
- Department of Biobehavioral Health, The Pennsylvania State University, United States
| | - Eric D. Claus
- Department of Biobehavioral Health, The Pennsylvania State University, United States
| | | | - Emily B. Ansell
- Department of Biobehavioral Health, The Pennsylvania State University, United States
| |
Collapse
|
2
|
Do EK, Yoon SN, McKay T, Schillo BA, Hair EC. Cannabis and vaping nicotine: An exploration of risk factors using a nationally representative sample of youth and young adults. Addict Behav 2024; 157:108094. [PMID: 38936264 DOI: 10.1016/j.addbeh.2024.108094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Given that cannabis and e-cigarettes are among the most commonly used substances among young people, there is a need to identify risk factors for concurrent cannabis consumption and nicotine vaping among youth and young adults. METHODS Data were obtained from the Truth Longitudinal Cohort, collected from September 2020 to March 2021, among a cohort aged 15-24 years (N = 6379). Chi-square tests were conducted to detect differences in sample characteristics by dual use status (never e-cigarette and never cannabis users, never cannabis and former/noncurrent e-cigarette users, never e-cigarette and former/noncurrent cannabis users, former/noncurrent e-cigarette and cannabis users, current e-cigarette only users, current cannabis only users, and concurrent cannabis and e-cigarette dual users). Multinomial logistic regression was used to determine key demographic variables predicting dual use status. RESULTS Household tobacco use (Relative Risk Ratio, RRR = 4.93), higher sensation seeking (RRR = 3.98), and mental health score (RRR = 2.58) were associated with higher risk of dual use. Being 15-17 years (RRR = 0.22), being female (RRR = 0.59) and having parents with an education level of some college or more (RRR = 0.64) were associated with lower risk of dual use. CONCLUSION Findings suggest the need to carefully monitor cannabis and vaping nicotine among young people. The identification of risk factors provides additional guidance for prevention and treatment efforts, suggesting the need to address use of both substances and target those most at risk.
Collapse
Affiliation(s)
- Elizabeth K Do
- Schroeder Institute, Truth Initiative, Washington, DC, USA; Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
| | | | - Tatum McKay
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | | | - Elizabeth C Hair
- Schroeder Institute, Truth Initiative, Washington, DC, USA; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; School of Global Public Health, New York University, New York, NY, USA
| |
Collapse
|
3
|
Hofheimer JA, McGowan EC, Smith LM, Meltzer-Brody S, Carter BS, Dansereau LM, Pastyrnak S, Helderman JB, Neal CR, DellaGrotta SA, O'Shea TMD, Lester BM. Risk Factors for Postpartum Depression and Severe Distress among Mothers of Very Preterm Infants at NICU Discharge. Am J Perinatol 2024; 41:1396-1408. [PMID: 37072014 PMCID: PMC11223892 DOI: 10.1055/s-0043-1768132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/03/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To identify psychological, medical, and socioenvironmental risk factors for maternal postpartum depression (PPD) and severe psychological distress (SPD) at intensive care nursery discharge among mothers of very preterm infants. STUDY DESIGN We studied 562 self-identified mothers of 641 infants born <30 weeks who were enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study (NOVI) conducted in nine university-affiliated intensive care nurseries. Enrollment interviews collected socioenvironmental data, depression, and anxiety diagnoses prior to and during the study pregnancy. Standardized medical record reviews ascertained prenatal substance use, maternal and neonatal medical complications. The Edinburgh Postnatal Depression Scale and Brief Symptom Inventory were administered at nursery discharge to screen for PPD and SPD symptoms, respectively. RESULTS Unadjusted analyses indicated mothers with positive screens for depression (n = 76, 13.5%) or severe distress (n = 102, 18.1%) had more prevalent prepregnancy/prenatal depression/anxiety, and their infants were born at younger gestational ages, with more prevalent bronchopulmonary dysplasia, and discharge after 40 weeks postmenstrual age. In multivariable analyses, prior depression or anxiety was associated with positive screens for PPD (risk ratio [RR]: 1.6, 95% confidence interval [CI]: 1.1-2.2) and severe distress (RR: 1.6, 95% CI: 1.1-2.2). Mothers of male infants had more prevalent depression risk (RR: 1.7, 95% CI: 1.1-2.4), and prenatal marijuana use was associated with severe distress risk (RR: 1.9, 95% CI: 1.1-2.9). Socioenvironmental and obstetric adversities were not significant after accounting for prior depression/anxiety, marijuana use, and infant medical complications. CONCLUSION Among mothers of very preterm newborns, these multicenter findings extend others' previous work by identifying additional indicators of risk for PPD and SPD associated with a history of depression, anxiety, prenatal marijuana use, and severe neonatal illness. Findings could inform designs for continuous screening and targeted interventions for PPD and distress risk indicators from the preconception period onward. KEY POINTS · Preconceptional and prenatal screening for postpartum depression and severe distress may inform care.. · Prior depression, anxiety, and neonatal complications predicted severe distress and depression symptoms at NICU discharge.. · Readily identifiable risk factors warrant continuous NICU screening and targeted interventions to improve outcomes..
Collapse
Affiliation(s)
- Julie A. Hofheimer
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elisabeth C. McGowan
- Department of Pediatrics, Women and Infant's Hospital/Brown University, Providence, Rhode Island
| | - Lynne M. Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles, California
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian S. Carter
- Department of Pediatrics, Department of Medical Humanities and Bioethics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri
| | - Lynne M. Dansereau
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Steven Pastyrnak
- Department of Pediatrics, Spectrum Health Helen DeVos Children's Hospital/Michigan State University, Grand Rapids, Michigan
| | - Jennifer B. Helderman
- Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Charles R. Neal
- Division of Neonatology, Department of Pediatrics, Kapi'olani Medical Center for Women and Children and Hawaii Pacific Medical Group, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii
| | - Sheri A. DellaGrotta
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Thomas Michael D. O'Shea
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Barry M. Lester
- Departments of Pediatrics, Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| |
Collapse
|
4
|
Meyers S, Gant K, Burmeister M. Assessment of education in a community hospital on healthcare providers' knowledge of and attitudes toward medical marijuana. CURRENTS IN PHARMACY TEACHING & LEARNING 2024; 16:396-403. [PMID: 38538449 DOI: 10.1016/j.cptl.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/02/2024] [Accepted: 03/15/2024] [Indexed: 05/15/2024]
Abstract
INTRODUCTION Although medical marijuana usage continues to become more socially acceptable and is increasingly regarded as a legitimate treatment alternative for certain medical conditions such as cancer and epilepsy, stigma remains. METHODS This study examined whether offering an educational session addressing several key aspects of medical marijuana (e.g., pharmacology, legality) to healthcare providers in a community hospital setting improved knowledge about and/or altered attitudes toward marijuana use. This information was collected through administration of pre- and post-education session surveys. Multiple choice questions were utilized to assess knowledge of marijuana pharmacotherapy, pharmacodynamic interactions, and regulations, whereas descriptive analyses via Likert-scale questions determined attitudes toward medical marijuana. A secondary outcome entailed analysis of drug interactions with marijuana users via retrospective chart review. RESULTS A total of 43 healthcare providers participated in the study. There were statistically significant increases in healthcare provider knowledge post-education session across multiple occupations (physician, P < .01; nurse, P < .001; pharmacist, P < .01; and nurse technician, P < .05). A total of 72 patients (83%) who self-reported marijuana use for medical or recreational purposes had a potential drug-drug interaction with marijuana. CONCLUSIONS As both medical and recreational marijuana continue to become legalized across the United States, formal education surrounding marijuana use and laws becomes increasingly important for healthcare providers and can be highly effective in preventing misinformation.
Collapse
Affiliation(s)
- Sierra Meyers
- Xavier University of Louisiana College of Pharmacy, 1 Drexel Drive, New Orleans, LA 70125, United States of America.
| | - Kisha Gant
- Slidell Memorial Hospital, 1001 Gause Boulevard, Slidell, LA 70458, United States of America.
| | - Melissa Burmeister
- William Carey School of Pharmacy, 19640 Highway 67, Biloxi, MS 39532, United States of America.
| |
Collapse
|
5
|
Thetsane RM. Envisaging challenges for the emerging medicinal Cannabis sector in Lesotho. J Cannabis Res 2024; 6:23. [PMID: 38755701 PMCID: PMC11097424 DOI: 10.1186/s42238-024-00229-9] [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: 06/30/2023] [Accepted: 03/25/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Cultivation of Cannabis and its use for medical purposes has existed for millennia on the African continent. The plant has also been widely consumed in the African continent since time immemorial. In particular, Lesotho has been largely growing Cannabis since approximately the 1550s and was illegally grown and unlawfully used for both medicinal and recreational purposes. It was only in 2017 when Lesotho started licensing Cannabis companies and regulating cultivation of Cannabis for medicinal purposes. However, the Lesotho Cannabis industry seems to have excluded the Small, Medium and Micro Enterprises (SMMEs) in the legalisation of Cannabis, the sector has the potential for small Cannabis enterprises in Lesotho. OBJECTIVE This study attempts to examine challenges facing the evolving Cannabis sector in Lesotho as envisaged by Cannabis company managers with the aim of being proactive while addressing such challenges. METHODS The qualitative descriptive method was employed using both primary and secondary data. For the selection of the three Cannabis managers exponential non-discriminative snowball sampling was adopted and interviews with the managers were recorded and transcribed verbatim. Thematic analysis was used to analyse the descriptive explanations of the Cannabis managers to determine the themes that were further consolidated into categories. RESULTS The implementation and compliance with the laws in the Lesotho medicinal Cannabis sector has proved very challenging, with long timeframes for finalising regulatory frameworks and not being applied objectively. The industry does not provide opportunities for Small, Medium and Micro Enterprises (SMMEs) to venture into the Cannabis business. CONCLUSION In Lesotho, the Cannabis sector appears to be faced with many challenges emanating from the implementation and enforcement of Cannabis laws. The Lesotho Government should review its Cannabis laws and regulations with a view to benefiting SMMEs and legalising Cannabis production so as to serve both the domestic and international markets.
Collapse
Affiliation(s)
- Regina M Thetsane
- Department of Business Administration, National University of Lesotho, BTM - Building. Office Number BTM 201 P.0. Roma. 180, Maseru, Lesotho.
| |
Collapse
|
6
|
Monyela S, Kayoka PN, Ngezimana W, Nemadodzi LE. Evaluating the Metabolomic Profile and Anti-Pathogenic Properties of Cannabis Species. Metabolites 2024; 14:253. [PMID: 38786730 PMCID: PMC11122914 DOI: 10.3390/metabo14050253] [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: 03/31/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
The Cannabis species is one of the potent ancient medicinal plants acclaimed for its medicinal properties and recreational purposes. The plant parts are used and exploited all over the world for several agricultural and industrial applications. For many years Cannabis spp. has proven to present a highly diverse metabolomic profile with a pool of bioactive metabolites used for numerous pharmacological purposes ranging from anti-inflammatory to antimicrobial. Cannabis sativa has since been an extensive subject of investigation, monopolizing the research. Hence, there are fewer studies with a comprehensive understanding of the composition of bioactive metabolites grown in different environmental conditions, especially C. indica and a few other Cannabis strains. These pharmacological properties are mostly attributed to a few phytocannabinoids and some phytochemicals such as terpenoids or essential oils which have been tested for antimicrobial properties. Many other discovered compounds are yet to be tested for antimicrobial properties. These phytochemicals have a series of useful properties including anti-insecticidal, anti-acaricidal, anti-nematicidal, anti-bacterial, anti-fungal, and anti-viral properties. Research studies have reported excellent antibacterial activity against Gram-positive and Gram-negative multidrug-resistant bacteria as well as methicillin-resistant Staphylococcus aureus (MRSA). Although there has been an extensive investigation on the antimicrobial properties of Cannabis, the antimicrobial properties of Cannabis on phytopathogens and aquatic animal pathogens, mostly those affecting fish, remain under-researched. Therefore, the current review intends to investigate the existing body of research on metabolomic profile and anti-microbial properties whilst trying to expand the scope of the properties of the Cannabis plant to benefit the health of other animal species and plant crops, particularly in agriculture.
Collapse
Affiliation(s)
- Shadrack Monyela
- Department of Agriculture and Animal Health, University of South Africa, Science Campus, Florida, Johannesburg 1710, South Africa
| | - Prudence Ngalula Kayoka
- Department of Agriculture and Animal Health, University of South Africa, Science Campus, Florida, Johannesburg 1710, South Africa
| | - Wonder Ngezimana
- Department of Horticulture, Faculty of Plant and Animal Sciences and Technology, Marondera University of Agricultural Sciences and Technology, Marondera P.O. Box 35, Zimbabwe
| | - Lufuno Ethel Nemadodzi
- Department of Agriculture and Animal Health, University of South Africa, Science Campus, Florida, Johannesburg 1710, South Africa
| |
Collapse
|
7
|
Fingesi TS, Kimaru LJ, Okusanya BO, Ehiri JE, Rosales C. Nicotine and Alcohol Use as Predictors of Recreational Cannabis Use in Adolescence: A Systematic Review and Narrative Synthesis. Subst Use Misuse 2024; 59:1367-1382. [PMID: 38658323 DOI: 10.1080/10826084.2024.2342008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background: The prevalence of recreational cannabis use among adolescents is a growing public health concern due to its link to short- and long-term adverse effects on adolescents' wellbeing, physical health, mental health, and interpersonal behaviors. Method: Five databases were searched from inception to March 17, 2023, for exposure (nicotine product, alcohol) and outcome (recreational cannabis) in adolescents (persons aged 10-19 years). The studies were screened independently by two reviewers, and the quality of the studies was assessed with Newcastle Ottawa and AXIS tool. PRISMA guidelines were employed in this review. Result: Twenty-one (21) studies involving 2,778,406 adolescents were included in the appraisal and heterogeneity was found among these studies. Ascertainment bias was commonly detected in thirteen (13) of the included studies. Among the substances examined as potential exposures, nicotine-product use emerged as a significant factor associated with future cannabis use among adolescents, particularly in mid-adolescence and in places where recreational cannabis use has been legalized. Conclusion: Current evidence suggests an association between nicotine-product use and subsequent recreational cannabis use among adolescents. However, further research is needed to establish causality between exposure to nicotine substances and the use of recreational cannabis within this age demographic. Additionally, there is a need for the development of prevention programs and targeted policies that continuously inform and update this vulnerable sub-population about the risks associated with cannabis use for leisure.
Collapse
Affiliation(s)
- T S Fingesi
- Community Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Phoenix, Arizona, USA
| | - L J Kimaru
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - B O Okusanya
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - J E Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - C Rosales
- Division of Public Health Practice and Translational Research, Mel and Enid Zuckerman College of Public Health, University of Arizona, Phoenix, Arizona, USA
| |
Collapse
|
8
|
Leavitt TC, Chihuri S, Li G. State cannabis laws and cannabis positivity among fatally injured drivers. Inj Epidemiol 2024; 11:14. [PMID: 38605393 PMCID: PMC11010426 DOI: 10.1186/s40621-024-00498-1] [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: 02/05/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND As of November 8, 2023, 24 states and the District of Columbia have legalized cannabis for both recreational and medical use (RMCL-states), 14 states have legalized cannabis for medical use only (MCL-states) and 12 states have no comprehensive cannabis legislation (NoCL-states). As more states legalize cannabis for recreational use, it is critical to understand the impact of such policies on driving safety. METHODS Using the 2019 and 2020 Fatality Analysis Reporting System data, we performed multivariable logistic regression modeling to explore the association between state level legalization status and cannabis positivity using toxicological testing data for 14,079 fatally injured drivers. We performed a sensitivity analysis by including multiply imputed toxicological testing data for the 14,876 eligible drivers with missing toxicological testing data. RESULTS Overall, 4702 (33.4%) of the 14,079 fatally injured drivers tested positive for cannabis use. The prevalence of cannabis positivity was 30.7% in NoCL-states, 32.8% in MCL-states, and 38.2% in RMCL-states (p < 0.001). Compared to drivers fatally injured in NoCL-states, the adjusted odds ratios of testing positive for cannabis were 1.09 (95% confidence interval: 0.99, 1.19) for those fatally injured in MCL-states and 1.54 (95% confidence interval: 1.34, 1.77) for those fatally injured in RMCL-states. Sensitivity analysis yielded similar results. CONCLUSIONS Over one-third of fatally injured drivers tested positive for cannabis use. Drivers fatally injured in states with laws permitting recreational use of cannabis were significantly more likely to test positive for cannabis use than those in states without such laws. State medical cannabis laws had little impact on the odds of cannabis positivity among fatally injured drivers.
Collapse
Affiliation(s)
- Thea Clare Leavitt
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, USA
| | - Stanford Chihuri
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th St, New York, NY, USA
| | - Guohua Li
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, USA.
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th St, New York, NY, USA.
| |
Collapse
|
9
|
Kim HJ, Satre DD, Leyden W, Leibowitz AS, Campbell CI, Silverberg MJ. Self-reported pain severity and use of cannabis and opioids in persons with HIV in an urban primary care setting in Northern California: A cross-sectional study. Medicine (Baltimore) 2024; 103:e37581. [PMID: 38552034 PMCID: PMC10977539 DOI: 10.1097/md.0000000000037581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 02/21/2024] [Indexed: 04/02/2024] Open
Abstract
Persons with HIV (PWH) experience high levels of pain. We examined the relationship of pain severity with use of cannabis and prescription opioids among PWH. This cross-sectional study evaluated associations between self-reported pain (moderate/severe vs mild/none) and cannabis and prescription opioid use in a primary care sample of PWH enrolled in an alcohol use treatment study at Kaiser Permanente, San Francisco. Prevalence ratios (PR) for moderate/severe pain associated with cannabis, opioid use, or both in the prior 30 days were obtained from Poisson regression models. Adjusted models included race/ethnicity, education, employment, HIV ribonucleic acid levels, depression, and anxiety. Overall, 614 PWH completed baseline questionnaires from May 2013 to May 2015, among whom 182/614 (29.6%) reported moderate/severe pain. The prevalence of moderate/severe pain varied by substances: 19.1% moderate/severe pain among study participants who reported neither cannabis or opioids, 30.2% for cannabis alone, 41.2% for opioids alone, and 60.9% for those reporting both substances. In adjusted models, compared with PWH who reported neither substance (reference), prevalence of moderate/severe pain was higher for those using cannabis alone (PR 1.54; 95% CI 1.13-2.09), opioids alone (PR 1.96; 95% CI 1.31-2.94), and those reporting both (PR 2.66; 95% CI 1.91-3.70). PWH who reported opioid and/or cannabis use were more likely to report moderate/severe pain compared with PWH who did not report use of these substances. To improve patient care, it is vital to assess patients' approaches to pain management including substance use and target appropriate interventions to reduce pain in PWH.
Collapse
Affiliation(s)
- Hannah J. Kim
- Kaiser Permanente National Patient Care Services, Oakland, CA
- Community Health Systems, University of California, San Francisco, San Francisco, CA
- Kaiser Permanente Northern California Division of Research, Oakland, CA
| | - Derek D. Satre
- Kaiser Permanente Northern California Division of Research, Oakland, CA
- Weill Institute for Neurosciences, Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Wendy Leyden
- Kaiser Permanente Northern California Division of Research, Oakland, CA
| | - Amy S. Leibowitz
- Kaiser Permanente Northern California Division of Research, Oakland, CA
| | - Cynthia I. Campbell
- Kaiser Permanente Northern California Division of Research, Oakland, CA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA
| | | |
Collapse
|
10
|
Kock L, Melbostad HS, Heil SH. Prevalence of psychosocial issues among pregnant women who do and do not use illicit substances. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2024; 38:205-210. [PMID: 37616097 PMCID: PMC10891299 DOI: 10.1037/adb0000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
OBJECTIVE The American College of Obstetricians and Gynecologists (ACOG) recommends providers screen their prenatal patients for 11 psychosocial issues because they affect patient mental and physical well-being. The prevalence and co-occurrence of these issues have rarely been compared among pregnant women who do and do not report recent illicit substance use. METHOD Seven psychosocial issues identified by ACOG were operationalized using National Survey on Drug Use and Health variables. We report weighted prevalence and adjusted risk ratios (ARR) for these issues in pregnant women who did versus did not report past-month illicit substance use. RESULTS Pregnant women (n = 3,657) who reported past-month illicit substance use (6.3%; 95% CI [5.4-7.3]) had significantly higher prevalence of almost all psychosocial issues examined, including past-month cigarette smoking (44.9% versus 9.5%; ARR = 2.84, 95% CI [2.21-3.65]); past-month alcohol use, 36.1% versus 7.9%; ARR = 4.71 (3.59-6.18); serious past-month distress, 23.0% versus 5.0%; ARR = 3.51 (2.39-5.15); no health insurance, 11.7% versus 6.2%; ARR = 1.71 (1.07-2.74); and receipt of food stamps, 45.0% versus 24.0%; ARR = 1.40 (1.18-1.67). Moving 3 + times in the past year followed a similar pattern, but results were compatible with there being no difference, 10.6% versus 5.5%; ARR = 1.39 (0.86-2.25). The majority of pregnant women reporting illicit substance use endorsed experiencing ≥ 2 psychosocial issues while the majority of those who did not report illicit substance use did not endorse any. CONCLUSIONS Pregnant women who use illicit substances experience higher prevalence and greater co-occurrence of psychosocial issues compared to those who do not, reinforcing recommendations for multidisciplinary approaches to care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
- Loren Kock
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 S Prospect Street, Burlington, 05401, USA
| | - Heidi S. Melbostad
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 S Prospect Street, Burlington, 05401, USA
- Howard Center Chittenden Clinic, 75 San Remo Dr, S Burlington 05403, USA
| | - Sarah H. Heil
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 S Prospect Street, Burlington, 05401, USA
| |
Collapse
|
11
|
Bezalwar A, Patil PS, Pajai S, Girdhar A. Journey of Marijuana From "Folk Tales" to "Doors of Justice": A Comprehensive Review. Cureus 2024; 16:e57190. [PMID: 38681315 PMCID: PMC11056232 DOI: 10.7759/cureus.57190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
This comprehensive review delves into the intricate journey of marijuana in India, tracing its historical and cultural significance from ancient times to the present day. Despite its deep-rooted presence in religious rituals, traditional medicine, and cultural festivities, marijuana faces stringent prohibition under the Narcotic Drugs and Psychotropic Substances Act 1985. This review critically examines the current legal framework, highlighting its societal impacts and limitations. Through an evidence-based analysis, it advocates for a reevaluation of marijuana laws to align with contemporary realities, promoting public health, social equity, and economic development. By envisioning a future of evidence-based regulation and innovation, India can unlock the full potential of marijuana as a "miracle crop" for the betterment of its people and society.
Collapse
Affiliation(s)
- Apurva Bezalwar
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pradeep S Patil
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shobha Pajai
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Anshita Girdhar
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
12
|
Goyal A, Quazi MA, Syed R, Ikram HA, Sheikh FA, Farooq A, Sultan S, Sheikh AB. Investigating the Impact of Cannabis Consumption on Hospital Outcomes in Patients With Primary Spontaneous Pneumothorax: A Nationwide Analysis. Cureus 2024; 16:e55601. [PMID: 38586642 PMCID: PMC10995417 DOI: 10.7759/cureus.55601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Existing data suggest an association between primary spontaneous pneumothorax (PSP) and cannabis consumption, although evidence remains controversial. Methods This study used the 2016-2019 National Inpatient Sample Database to examine inpatients with PSP, categorizing them as cannabis users and non-users. Multivariate regression analyzed continuous variables, chi-square assessed categorical variables, and logistic regression models were built. Propensity score matching (PSM) mitigated the confounding bias. Results A total of 399,495 patients with PSP were admitted during the study period (13,415 cannabis users and 386,080 non-cannabis users). Cannabis users were more likely to be younger (p<0.001) and male (p<0.001) with a lower risk of baseline comorbidities than non-users. Cannabis users had a lower risk of sudden cardiac arrest, vasopressor use, the development of acute kidney injury, venous thromboembolism, the requirement for invasive and non-invasive mechanical ventilation, hemodialysis, ventilator-associated pneumonia, and the need for a tracheostomy. Cannabis use was associated with a 3.4 days shorter hospital stay (p<0.001), as confirmed by PSM analysis (2.3 days shorter, p<0.001). Additionally, cannabis users showed a lower risk of in-hospital mortality (p<0.001), a trend maintained in the PSM analysis (p<0.001). Conclusions Our study revealed correlations suggesting that cannabis users with PSP might experience lower in-hospital mortality and fewer complications than non-cannabis users.
Collapse
Affiliation(s)
- Aman Goyal
- Department of Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Mohammed A Quazi
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, USA
| | - Rayika Syed
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, USA
| | - Hafiz Abdullah Ikram
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Farooq A Sheikh
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Asif Farooq
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Sulaiman Sultan
- Department of Nephrology, University of New Mexico School of Medicine, Albuquerque, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| |
Collapse
|
13
|
Naimi TS, Lira MC, Pessar SC, Smart R, Blanchette J, Pacula RL. Relationships Between Alcohol and Cannabis Policies in U.S. States, 1999-2019. J Stud Alcohol Drugs 2024; 85:254-260. [PMID: 38147075 PMCID: PMC10941819 DOI: 10.15288/jsad.23-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 12/02/2023] [Indexed: 12/27/2023] Open
Abstract
OBJECTIVE A crucial question regarding the public health impacts of cannabis legalization is its impact on alcohol consumption and alcohol-related harm. However, little is known about whether these changing cannabis policies are occurring in liberal or in restrictive alcohol policy environments, either of which likely affect public health outcomes. We constructed comprehensive state-level alcohol and cannabis policy indices and explored relationships between them. METHOD We assessed relationships between the Alcohol Policy Scale (APS) and the Cannabis Policy Scale (CPS) from 1999 to 2019. The APS and CPS were based on 29 and 17 state-level policies, respectively, and each policy was weighted for its relative efficacy and degree of state-year implementation. RESULTS From 1999 to 2019, average state APS scores increased modestly (became more restrictive) by 4.11 points (2019 M = 43.23, range: 24.44-66.31) and average CPS scores decreased (became less restrictive) by 15.33 points (2019 M = 76.40, range: 29.40-95.74) on a 100-point scale. In 2019, average APS scores were similar among states that prohibited (criminalized) possession of cannabis (42.00), decriminalized possession (41.33), legalized medical cannabis (44.36), and legalized recreational cannabis (43.32). Across states, there was no correlation between the restrictiveness of state-level alcohol and cannabis policies (r = .03, p = .37) in unadjusted models, although there was some variation by time, geographic region, and political party, with a weak negative correlation in state fixed-effects models. CONCLUSIONS Although cannabis policies liberalized rapidly from 1999 to 2019, alcohol policies stayed relatively stable and did not differ by degree of cannabis policy liberalization. In general, there were weak associations between cannabis and alcohol policies among states; however, there was some temporal, regional, and political variation.
Collapse
Affiliation(s)
- Timothy S. Naimi
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Marlene C. Lira
- Clinical Addiction Research and Education (CARE) Unit, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Seema Choksy Pessar
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
| | | | - Jason Blanchette
- Department of Health Policy, Law, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Rosalie Liccardo Pacula
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
- Department of Health Policy and Management, Sol Price School of Public Policy, University of Southern California, Los Angeles, California
| |
Collapse
|
14
|
Kritikos AF, Johnson JK, Hodgkin D. Simultaneous Cannabis and Alcohol Use among Medical Cannabis Patients. Subst Use Misuse 2024; 59:847-857. [PMID: 38343069 DOI: 10.1080/10826084.2024.2305795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Background: During the past two decades of cannabis legalization, the prevalence of medical cannabis (MC) use has increased and there has also been an upward trend in alcohol consumption. As less restricted cannabis laws generate more adult cannabis users, there is concern that more individuals may be simultaneously using medical cannabis with alcohol. A few studies have examined simultaneous use of medical cannabis with alcohol, but none of those studies also assessed patients' current or previous non-medical cannabis use. This paper explores simultaneous alcohol and medical cannabis use among medical cannabis patients with a specific focus on previous history of cannabis use and current non-medical cannabis use. Methods: A retrospective cohort study of MC patients (N = 319) from four dispensaries located in New York. Bivariate chi-square tests and multivariable logistic regression are used to estimate the extent to which sociodemographic and other factors were associated with simultaneous use. Results: Approximately 29% of the sample engaged in simultaneous use and a large share of these users report previous (44%) or current (66%) use of cannabis for non-medical purposes. MC patients who either previously or currently use cannabis non-medicinally, men, and patients using MC to treat a pain-related condition, were significantly more likely to report simultaneous alcohol/MC use. Conclusions: Findings indicate that there may be differential risks related to alcohol/MC use, which should be considered by cannabis regulatory policies and prevention/treatment programs. If patients are using cannabis and/or alcohol to manage pain, clinicians should screen for both alcohol and cannabis use risk factors.
Collapse
Affiliation(s)
| | - Julie K Johnson
- Cannabis Control Commission, Commonweath of Massachusetts, Worcester, MA, USA
| | - Dominic Hodgkin
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| |
Collapse
|
15
|
Amin S, Chae SW, Kawamoto CT, Phillips KT, Pokhrel P. Cannabis use among cancer patients and survivors in the United States: a systematic review. JNCI Cancer Spectr 2024; 8:pkae004. [PMID: 38291891 PMCID: PMC10868394 DOI: 10.1093/jncics/pkae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND How cannabis products are being used by cancer patients and survivors in the United States is poorly understood. This study reviewed observational data to understand the modes, patterns, reasons, discontinuation, and adverse experiences of cannabis use. METHODS PubMed and PsycINFO database searches were conducted between May 2022 and November 2022. Of the 1162 studies identified, 27 studies met the inclusion criteria. The intercoder agreement was strong (0.81). RESULTS The majority (74%) of the studies were cross-sectional in design. Study samples were approximately equal proportions of men and women and majority White participants. The prevalence of cannabis use based on national samples ranged between 4.8% and 22%. The most common modes of cannabis intake were topical application (80%), smoking (73%), vaping (12%), and ingestion of edible products (10%). Younger age, male gender, being a current or former smoker, and higher socioeconomic status were associated with greater likelihood of cannabis use. The main motive for cannabis use was management of symptoms due to cancer or cancer treatment such as pain, nausea, lack of sleep, and anxiety. A majority of the participants across studies reported that cannabis helped reduce these symptoms. Lack of symptom improvement, side effects such as fatigue and paranoia, cost, and social stigma were identified as some of the reasons for discontinuing cannabis use. CONCLUSIONS It appears that cannabis may help cancer patients and survivors manage symptoms. However, more longitudinal studies are needed to determine whether positive experiences of cannabis use outweigh adverse experiences over time in this vulnerable population.
Collapse
Affiliation(s)
- Samia Amin
- Population Sciences Program, University of Hawaiʻi Cancer Center, University of Hawaiʻi at Manoa, Honolulu, HI, USA
| | - Si Woo Chae
- Population Sciences Program, University of Hawaiʻi Cancer Center, University of Hawaiʻi at Manoa, Honolulu, HI, USA
| | - Crissy T Kawamoto
- Population Sciences Program, University of Hawaiʻi Cancer Center, University of Hawaiʻi at Manoa, Honolulu, HI, USA
| | - Kristina T Phillips
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Pallav Pokhrel
- Population Sciences Program, University of Hawaiʻi Cancer Center, University of Hawaiʻi at Manoa, Honolulu, HI, USA
| |
Collapse
|
16
|
Borja-Montes OF, Hanif H, Quazi MA, Sohail AH, Roth MA, Millhuff AC, Sheikh AB. Venous thromboembolism and cannabis consumption, outcomes among hospitalized patients in the United States: A nationwide analysis. Curr Probl Cardiol 2024; 49:102184. [PMID: 37907189 DOI: 10.1016/j.cpcardiol.2023.102184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 10/28/2023] [Indexed: 11/02/2023]
Abstract
Venous Thromboembolism (VTE) carries significant clinical implications, and with the rise in cannabis consumption, its potential influence on VTE outcomes warrants investigation. Using the National Inpatient Sample (NIS) database (2016-2019), we analyzed 2,217,184 hospitalized VTE patients. Among these, 1.8 % (38,810) reported cannabis use. We compared demographics, comorbidities, in-hospital outcomes, and quality metrics between cannabis users and non-users with VTE. Cannabis users were chiefly younger males (average age 45 in cannabis users vs. 62 in non-cannabis users) from lower-income brackets. Notably, 5.4 % discharged against medical advice. Although in-hospital mortality was initially lower for cannabis users (2.8 % vs. 5.1 %, OR 0.6, 95 % CI 0.69-0.94, p = 0.008), this difference became non-significant post-propensity-score matching (aOR 0.9, 95% CI 0.72-1.10, p = 0.3). Non-users faced higher in-hospital complications, a trend that persisted post-PSM. Among cannabis users, key mortality predictors were peripheral vascular disease, acute kidney injury, vasopressor use, cardiogenic shock, myocardial infarction, invasive ventilation, and surgical embolectomy. Cannabis users also had a shorter hospital stay (4.2 vs. 5.4 days) and slightly reduced costs ($27,472.95 vs. $31,660.75). The significantly younger age of VTE patients who use cannabis, coupled with the considerable proportion discharging against medical advice, underscores the urgency for tailored care interventions. Additional research is vital to comprehensively understand the interplay between cannabis consumption and VTE outcomes.
Collapse
Affiliation(s)
- Oscar F Borja-Montes
- Department of Internal Medicine, University of New Mexico School of Medicine, MSC10-5550, Albuquerque, NM 87131, USA
| | - Hamza Hanif
- Department of General Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Mohammed A Quazi
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM, USA
| | - Amir H Sohail
- Division of Surgical Oncology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Margaret A Roth
- Department of Internal Medicine, University of New Mexico School of Medicine, MSC10-5550, Albuquerque, NM 87131, USA
| | - Alexandra C Millhuff
- Department of Internal Medicine, University of New Mexico School of Medicine, MSC10-5550, Albuquerque, NM 87131, USA.
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico School of Medicine, MSC10-5550, Albuquerque, NM 87131, USA
| |
Collapse
|
17
|
Gu J, Guo X, Liu X, Yuan Y, Zhu Y, Chen M, Zhou TY, Fu Q. Gone with the weed: incidents of adolescent marijuana use in the United States, 1976-2021. Ann Epidemiol 2023; 88:23-29. [PMID: 37839727 DOI: 10.1016/j.annepidem.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE This study sought to examine grouped and right-censored (GRC) counts of adolescent marijuana use and estimate its temporal trajectories and sociodemographic disparities over almost half a century. METHODS After compiling 46 waves of nationally representative data from the Monitoring the Future (MTF) study from 1976 to 2021 (sample size = 491,348), we utilized an innovative modified Poisson (mixture) approach to analyze past-year marijuana use quantified by GRC counts. RESULTS The overall reduction in incidence rates of marijuana use was attributable to an almost 40% reduction in the risk of marijuana use (with the proportion of at-risk adolescents at 51.36% in 1979 and 31.53% in 2021). Despite substantial changes over the study period, the recent incidence rates for at-risk individuals were similar to those in the early 1980s. Living in an intact family was a protective factor against adolescent marijuana use over time. CONCLUSIONS The incidence rates of marijuana use among at-risk students, especially those from disadvantaged families, remained high over the study period. The modified Poisson (mixture) approach serves as the preferred tool for modeling GRC responses. It is essential to distinguish among risk, at-risk incidence, and overall incidence when assessing substance use and other risky behaviors.
Collapse
Affiliation(s)
- Jiaxin Gu
- Department of Sociology, The University of British Columbia, Vancouver, Canada
| | - Xin Guo
- School of Mathematics and Physics, The University of Queensland, Brisbane, Australia
| | - Xiaoxi Liu
- School of Public Administration, Nanjing Normal University, Nanjing, China
| | - Yue Yuan
- Research Institute of Social Development, Southwestern University of Finance and Economics, Chengdu, Sichuan, China
| | - Yushu Zhu
- Urban Studies Program and School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
| | - Minheng Chen
- Department of Sociology, The University of British Columbia, Vancouver, Canada
| | - Tian-Yi Zhou
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Qiang Fu
- Department of Sociology, The University of British Columbia, Vancouver, Canada.
| |
Collapse
|
18
|
Sevigny EL, Greathouse J, Medhin DN. Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1362. [PMID: 37915420 PMCID: PMC10616541 DOI: 10.1002/cl2.1362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Background Globally, cannabis laws and regulations are rapidly changing. Countries are increasingly permitting access to cannabis under various decriminalization, medicalization, and legalization laws. With strong economic, public health, and social justice incentives driving these domestic cannabis policy reforms, liberalization trends are bound to continue. However, despite a large and growing body of interdisciplinary research addressing the policy-relevant health, safety, and socioeconomic consequences of cannabis liberalization, there is a lack of robust primary and systematic research that comprehensively investigates the consequences of these reforms. Objectives This evidence and gap map (EGM) summarizes the empirical evidence on cannabis liberalization policies. Primary objectives were to develop a conceptual framework linking cannabis liberalization policies to relevant outcomes, descriptively summarize the empirical evidence, and identify areas of evidence concentration and gaps. Search Methods We comprehensively searched for eligible English-language empirical studies published across 23 academic databases and 11 gray literature sources through August 2020. Additions to the pool of potentially eligible studies from supplemental sources were made through November 2020. Selection Criteria The conceptual framework for this EGM draws upon a legal epidemiological perspective highlighting the causal effects of law and policy on population-level outcomes. Eligible interventions include policies that create or expand access to a legal or decriminalized supply of cannabis: comprehensive medical cannabis laws (MCLs), limited medical cannabidiol laws (CBDLs), recreational cannabis laws (RCLs), industrial hemp laws (IHLs), and decriminalization of cultivations laws (DCLs). Eligible outcomes include intermediate responses (i.e., attitudes/behaviors and markets/environments) and longer-term consequences (health, safety, and socioeconomic outcomes) of these laws. Data Collection and Analysis Both dual screening and dual data extraction were performed with third person deconfliction. Primary studies were appraised using the Maryland Scientific Methods Scale and systematic reviews were assessed using AMSTAR 2. Main Results The EGM includes 447 studies, comprising 438 primary studies and nine systematic reviews. Most research derives from the United States, with little research from other countries. By far, most cannabis liberalization research focuses on the effects of MCLs and RCLs. Studies targeting other laws-including CBDLs, IHLs, and DCLs-are relatively rare. Of the 113 distinct outcomes we documented, cannabis use was the single most frequently investigated. More than half these outcomes were addressed by three or fewer studies, highlighting substantial evidence gaps in the literature. The systematic evidence base is relatively small, comprising just seven completed reviews on cannabis use (3), opioid-related harms (3), and alcohol-related outcomes (1). Moreover, we have limited confidence in the reviews, as five were appraised as minimal quality and two as low quality. Authors’ Conclusions More primary and systematic research is needed to better understand the effects of cannabis liberalization laws on longer-term-and arguably more salient-health, safety, and socioeconomic outcomes. Since most research concerns MCLs and RCLs, there is a critical need for research on the societal impacts of industrial hemp production, medical CBD products, and decriminalized cannabis cultivation. Future research should also prioritize understanding the heterogeneous effects of these laws given differences in specific provisions and implementation across jurisdictions.
Collapse
Affiliation(s)
- Eric L. Sevigny
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
| | - Jared Greathouse
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
| | - Danye N. Medhin
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
| |
Collapse
|
19
|
Graham M, Chiu V, Stjepanović D, Hall W. A provisional evaluation of Australia's medical cannabis program. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104210. [PMID: 37813082 DOI: 10.1016/j.drugpo.2023.104210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/03/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023]
Abstract
In 2016, the Australian Government legislated to allow cannabis to be prescribed to patients as an unapproved medicine under the special access provisions of the Therapeutic Goods Act. This paper compares the Australian regulatory approach with other national approaches, outlines the main provisions of the Special Access Scheme for medical cannabis, describes how the program has evolved since 2017, includes an analysis of adverse events reported to the Therapeutic Goods Administration, and discusses the barriers that remain for patients who wish to access medical cannabis. It assesses how well the Australian program has addressed the challenges of providing patients with easier access to medical cannabis while ensuring that high-quality products are used safely and effectively under medical guidance.
Collapse
Affiliation(s)
- Myfanwy Graham
- Centre for Drug Repurposing & Medicines Research, School of Medicine and Public Health, The University of Newcastle, Australia; Schaeffer Center for Health Policy & Economics, The University of Southern California, United States.
| | - Vivian Chiu
- National Centre for Youth Substance Use Research, The University of Queensland, Australia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use Research, The University of Queensland, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Australia
| |
Collapse
|
20
|
Dyar C, Morgan E, Kaysen D. Trends in Cannabis and Alcohol Use by Sexual Identity in the 2015-2019 National Survey on Drug Use and Health. J Stud Alcohol Drugs 2023; 84:874-883. [PMID: 37449947 PMCID: PMC10765981 DOI: 10.15288/jsad.22-00410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE Sexual minority individuals are at substantially elevated risk for both cannabis use disorder (CUD) and alcohol use disorder (AUD). Although recent increases in the legalization of cannabis have been linked to increases in cannabis use among the general population, few studies have examined if changes in cannabis use and CUD vary by sexual identity. The purpose of the current study was to examine sexual identity differences in trends for CUD and compare them to trends for AUD. METHOD We used data from 2015-2019 National Survey on Drug Use and Health to examine annual prevalence and year-specific disparities in cannabis use, CUD, heavy episodic drinking, and AUD. We also examined sex-specific sexual identity differences in linear trends for these substance use outcomes over this 5-year period. RESULTS All groups except lesbian females experienced significant increases in cannabis use rates from 2015 to 2019. Heterosexual males, heterosexual females, and bisexual females also experienced significant increases in CUD rates. In contrast, no group exhibited significant increases in heavy episodic drinking or AUD rates. Bisexual women exhibited some of the largest year-specific disparities in cannabis use and CUD as well as the largest growth in disparities across time. CONCLUSIONS The few changes in heavy episodic drinking and AUD alongside numerous changes in cannabis use and CUD suggest that changes in cannabis use may be attributable to legalization of cannabis use in many states during this period. Given profound disparities and increasing rates of CUD affecting bisexual females, further research is needed to identify factors that may explain their disproportionate burden.
Collapse
Affiliation(s)
- Christina Dyar
- College of Nursing, Ohio State University, Columbus, Ohio
| | - Ethan Morgan
- College of Nursing, Ohio State University, Columbus, Ohio
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
21
|
Sharma P, Rao V, Chand PK, Murthy P. Quantification of Δ9-tetrahydrocannabinol in urine as a marker of cannabis abuse. Indian J Med Res 2023; 158:535-541. [PMID: 37929356 PMCID: PMC10878489 DOI: 10.4103/ijmr.ijmr_3899_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND OBJECTIVES Cannabis use has long been associated with celebration and hospitality, although abuse must be confirmed through testing. It has always been difficult to develop an accurate and reliable confirmatory method for the quantification of tetrahydrocannabinol carboxylic acid (THC-COOH) that meets local requirements. The goal was to develop a rapid, cost-effective analytical technique that can handle large batches. METHODS Because of the wide metabolite detection window and ease of collection, urine was preferable sample. The extraction of a pre-screened urine sample (adulteration and multidrug screening) was done on Bond Elut cartridges using a positive pressure vacuum manifold, followed by quantification using a gas chromatograph and mass spectrometer. RESULTS The assay was linear between 15 and 300 ng/ml ( r2 of 0.99). The intra-day precision was 8.69 per cent and the inter-day precision was 10.78 per cent, respectively with a 97.5 per cent recovery rate for the lowest concentration. A total of 939 urine samples were examined, with 213 detecting cannabis. Sixty per cent of the total individuals tested positive for simply cannabinoids, 33 per cent for cannabinoids and sedatives, five per cent for cannabinoids and morphine and one for cannabis, morphine and cocaine. INTERPRETATION CONCLUSIONS Assay characteristics included modest sample preparation, rapid chromatography, high specificity and small sample volume with a processing time of 12 h. The assay described here can be applied for diagnostic laboratories and in forensic settings as well.
Collapse
Affiliation(s)
- Priyamvada Sharma
- Department of Clinical Psychopharmacology & Neurotoxicology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Vijayashree Rao
- Department of Centre for Addicition Medicine, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Prabhat Kumar Chand
- Department of Centre for Addicition Medicine, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Pratima Murthy
- Department of Clinical Psychopharmacology & Neurotoxicology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| |
Collapse
|
22
|
Liu T, Liu J, Chen H, Zhou X, Fu W, Cao Y, Yang J. Cannabinoid receptor 2 signal promotes type 2 immunity in the lung. CELL INSIGHT 2023; 2:100124. [PMID: 37868095 PMCID: PMC10585230 DOI: 10.1016/j.cellin.2023.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023]
Abstract
Type 2 immunity in the lung protects against pathogenic infection and facilitates tissue repair, but its dysregulation may lead to severe human diseases. Notably, cannabis usage for medical or recreational purposes has increased globally. However, the potential impact of the cannabinoid signal on lung immunity is incompletely understood. Here, we report that cannabinoid receptor 2 (CB2) is highly expressed in group 2 innate lymphoid cells (ILC2s) of mouse and human lung tissues. Of importance, the CB2 signal enhances the IL-33-elicited immune response of ILC2s. In addition, the chemogenetic manipulation of inhibitory G proteins (Gi) downstream of CB2 produces a similarly promotive effect. Conversely, the genetic deletion of CB2 mitigates the IL-33-elicited type 2 immunity in the lung. Also, such ablation of the CB2 signal ameliorates papain-induced tissue inflammation. Together, these results have elucidated a critical aspect of the CB2 signal in lung immunity, implicating its potential involvement in pulmonary diseases.
Collapse
Affiliation(s)
- Tingting Liu
- Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Jiaqi Liu
- State Key Laboratory of Membrane Biology, School of Life Sciences, Peking University, Beijing, 100871, China
| | - Hongjie Chen
- Peking University-Tsinghua University-National Institute of Biological Sciences Joint Graduate Program, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Xin Zhou
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
- Peking University Third Hospital Cancer Center, Beijing, 100191, China
| | - Wei Fu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
- Peking University Third Hospital Cancer Center, Beijing, 100191, China
| | - Ying Cao
- Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Jing Yang
- Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
- State Key Laboratory of Membrane Biology, School of Life Sciences, Peking University, Beijing, 100871, China
- Peking University-Tsinghua University-National Institute of Biological Sciences Joint Graduate Program, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
- IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100871, China
- Peking University Third Hospital Cancer Center, Beijing, 100191, China
- Institute of Molecular Physiology, Shenzhen Bay Laboratory, Shenzhen, 518055, China
| |
Collapse
|
23
|
Di X, Xiang L, Wang M, Wei X. Association between marijuana use and kidney stone: a cross-sectional study of NHANES 2009 to 2018. Front Pharmacol 2023; 14:1214647. [PMID: 37745067 PMCID: PMC10513173 DOI: 10.3389/fphar.2023.1214647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Objective: The purpose of this investigation is to determine whether regular marijuana use is related to history of kidney stones in the US population. Methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2018. Kidney stone and marijuana use data were collected from self-report questionnaires. Multivariate logistic regression and multiple sensitivity analyses were applied to examine the relationship between marijuana usage and kidney stones. Results: There are approximately 26.04% of the US population have admitted to using marijuana in their lifetime. Compared with none regular users, those with a higher frequency of marijuana use were more males, more non-Hispanic races, lower than high school education, overweight, no recreational activity, without diabetes mellitus, and more coronary heart disease. After adjusting for potential confounders, multivariate regression analysis demonstrated that marijuana use was inversely correlated to kidney stones in males (Odds ratio [OR] = 0.72, 95% Confidence interval [CI] = 0.54-0.97). One to seven times/week regular consumption of marijuana was associated with kidney stones in males (OR = 0.62, 95% CI = 0.43-0.89). Sensitivity analyses validated the robustness of our outcomes. Conclusion: Our findings revealed that regular marijuana male users were inversely associated with kidney stones. Marijuana use one to six times/week was inversely related to the risk of kidney stones in males. Further studies are required to explore the dose and type associations of marijuana with kidney stones.
Collapse
Affiliation(s)
- Xingpeng Di
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liyuan Xiang
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Menghua Wang
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Wei
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
24
|
Fataar F, Driezen P, Owusu-Bempah A, Hammond D. Patterns of problematic cannabis use in Canada pre- and post-legalisation: Differences by neighbourhood deprivation, individual socioeconomic factors and race/ethnicity. Drug Alcohol Rev 2023; 42:1534-1546. [PMID: 37137866 DOI: 10.1111/dar.13677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION The legalisation of cannabis in Canada in 2018, and subsequent increase in prevalence of use, has generated interest in understanding potential changes in problematic patterns of use, including by socio-demographic factors such as race/ethnicity and neighbourhood deprivation level. METHODS This study used repeat cross-sectional data from three waves of the International Cannabis Policy Study web-based survey. Data were collected from respondents aged 16-65 prior to cannabis legalisation in 2018 (n = 8704), and post-legalisation in 2019 (n = 12,236) and 2020 (n = 12,815). Respondents' postal codes were linked to the INSPQ neighbourhood deprivation index. Multinomial regression models examined differences in problematic use by socio-demographic and socio-economic factors and over time. RESULTS No evidence of a change in the proportion of those aged 16-65 in Canada whose cannabis use would be classified as 'high risk' was noted from before cannabis legalisation (2018 = 1.5%) to 12 or 24 months after legalisation (2019 = 1.5%, 2020 = 1.6%; F = 0.17, p = 0.96). Problematic use differed by socio-demographic factors. For example, consumers from the most materially deprived neighbourhoods were more likely to experience 'moderate' vs 'low risk' compared to those living outside deprived neighbourhoods (p < 0.01 for all). Results were mixed for race/ethnicity and comparisons for high risk were limited by small sample sizes for some groups. Differences across subgroups were consistent from 2018 to 2020. DISCUSSION AND CONCLUSIONS The risk of problematic cannabis use does not appear to have increased in the 2 years following cannabis legalisation in Canada. Disparities in problematic use persisted, with some racial minority and marginalised groups experiencing higher risk.
Collapse
Affiliation(s)
- Fathima Fataar
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Pete Driezen
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | | | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| |
Collapse
|
25
|
Kim K, Pacula RL, Dick AW, Stein BD, Druss BG, Agbese E, Cohrs AC, Leslie DL. Medical marijuana access and prolonged opioid use among adolescents and young adults. Am J Addict 2023; 32:479-487. [PMID: 37291067 PMCID: PMC10686234 DOI: 10.1111/ajad.13440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/19/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Laws liberalizing access to medical marijuana are associated with reduced opioid analgesic use among adults, but little is known about the impact of such policies on adolescents and young adults. METHODS This retrospective cohort study used 2005 to 2014 claims from MarketScan® Commercial database, which covers all 50 states and Washington D.C. The sample included 195,204 adolescent and young adult patients (aged 12-25) who underwent one of 13 surgical procedures. RESULTS Of the 195,204 patients, 4.8% had prolonged opioid use. Several factors were associated with a higher likelihood of prolonged opioid use, including being female (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], 1.21-1.33), longer hospital stay (aOR, 1.04; 95% CI, 1.02-1.06), greater days of index opioid supply (8-14 days: aOR, 1.39, 95% CI, 1.33-1.45; greater than 14 days: aOR, 2.42, 95% CI, 2.26-2.59), rural residence (aOR, 1.07; 95% CI, 1.01-1.14), and cholecystectomy (aOR, 1.16; 95% CI, 1.08-1.25). There was not a significant association of medical marijuana dispensary laws on prolonged opioid use (aOR, 0.98; 95% CI, 0.81-1.18). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Medical marijuana has been suggested as a substitute for opioids, but our results focusing on adolescents and young adults provide new evidence that this particularly vulnerable population does not exhibit reductions in prolonged use of opioids after surgery when they have legal access to medical marijuana. These findings are the first to demonstrate potentially important age differences in sustained use of opioids, and point to the need for prescriber oversight and management with this vulnerable population.
Collapse
Affiliation(s)
- Kyungha Kim
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Rosalie L. Pacula
- Sol Price School of Public Policy, Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
| | | | | | - Benjamin G. Druss
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Edeanya Agbese
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Austin C. Cohrs
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Douglas L. Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| |
Collapse
|
26
|
Sirangelo TM, Ludlow RA, Spadafora ND. Molecular Mechanisms Underlying Potential Pathogen Resistance in Cannabis sativa. PLANTS (BASEL, SWITZERLAND) 2023; 12:2764. [PMID: 37570918 PMCID: PMC10420965 DOI: 10.3390/plants12152764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Abstract
Cannabis (Cannabis sativa L.) is one of the earliest cultivated crops, valued for producing a broad spectrum of compounds used in medicinal products and being a source of food and fibre. Despite the availability of its genome sequences, few studies explore the molecular mechanisms involved in pathogen defense, and the underlying biological pathways are poorly defined in places. Here, we provide an overview of Cannabis defence responses against common pathogens, such as Golovinomyces spp., Fusarium spp., Botrytis cinerea and Pythium spp. For each of these pathogens, after a summary of their characteristics and symptoms, we explore studies identifying genes involved in Cannabis resistance mechanisms. Many studies focus on the potential involvement of disease-resistance genes, while others refer to other plants however whose results may be of use for Cannabis research. Omics investigations allowing the identification of candidate defence genes are highlighted, and genome editing approaches to generate resistant Cannabis species based on CRISPR/Cas9 technology are discussed. According to the emerging results, a potential defence model including both immune and defence mechanisms in Cannabis plant-pathogen interactions is finally proposed. To our knowledge, this is the first review of the molecular mechanisms underlying pathogen resistance in Cannabis.
Collapse
Affiliation(s)
- Tiziana M. Sirangelo
- ENEA-Italian National Agency for New Technologies, Energy and Sustainable Economic Development-Division Biotechnologies and Agroindustry, 00123 Rome, Italy
| | - Richard A. Ludlow
- School of Biosciences, Cardiff University, Sir Martin Evans Building, Museum Avenue, Cardiff CF10 3AX, UK;
| | - Natasha D. Spadafora
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, 44121 Ferrara, Italy
| |
Collapse
|
27
|
Castillo-Carniglia A, Rivera-Aguirre A, Santaella-Tenorio J, Fink DS, Crystal S, Ponicki W, Gruenewald P, Martins SS, Keyes KM, Cerdá M. Changes in Opioid and Benzodiazepine Poisoning Deaths After Cannabis Legalization in the US: A County-level Analysis, 2002-2020. Epidemiology 2023; 34:467-475. [PMID: 36943813 PMCID: PMC10712490 DOI: 10.1097/ede.0000000000001609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Cannabis legalization for medical and recreational purposes has been suggested as an effective strategy to reduce opioid and benzodiazepine use and deaths. We examined the county-level association between medical and recreational cannabis laws and poisoning deaths involving opioids and benzodiazepines in the US from 2002 to 2020. METHODS Our ecologic county-level, spatiotemporal study comprised 49 states. Exposures were state-level implementation of medical and recreational cannabis laws and state-level initiation of cannabis dispensary sales. Our main outcomes were poisoning deaths involving any opioid, any benzodiazepine, and opioids with benzodiazepines. Secondary analyses included overdoses involving natural and semi-synthetic opioids, synthetic opioids, and heroin. RESULTS Implementation of medical cannabis laws was associated with increased deaths involving opioids (rate ratio [RR] = 1.14; 95% credible interval [CrI] = 1.11, 1.18), benzodiazepines (RR = 1.19; 95% CrI = 1.12, 1.26), and opioids+benzodiazepines (RR = 1.22; 95% CrI = 1.15, 1.30). Medical cannabis legalizations allowing dispensaries was associated with fewer deaths involving opioids (RR = 0.88; 95% CrI = 0.85, 0.91) but not benzodiazepine deaths; results for recreational cannabis implementation and opioid deaths were similar (RR = 0.81; 95% CrI = 0.75, 0.88). Recreational cannabis laws allowing dispensary sales was associated with consistent reductions in opioid- (RR = 0.83; 95% CrI = 0.76, 0.91), benzodiazepine- (RR = 0.79; 95% CrI = 0.68, 0.92), and opioid+benzodiazepine-related poisonings (RR = 0.83; 95% CrI = 0.70, 0.98). CONCLUSIONS Implementation of medical cannabis laws was associated with higher rates of opioid- and benzodiazepine-related deaths, whereas laws permitting broader cannabis access, including implementation of recreational cannabis laws and medical and recreational dispensaries, were associated with lower rates. The estimated effects of the expanded availability of cannabis seem dependent on the type of law implemented and its provisions.
Collapse
Affiliation(s)
- Alvaro Castillo-Carniglia
- Society and Health Research Center and School of Public Health, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Chile
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile
- Millennium Nucleus on Sociomedicine (Sociomed), Chile
- Department of Population Health, New York University Grossman School of Medicine, NY
| | - Ariadne Rivera-Aguirre
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile
- Department of Population Health, New York University Grossman School of Medicine, NY
| | | | | | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, New Brunswick, NJ
| | - William Ponicki
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA
| | - Paul Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA
| | | | | | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, NY
| |
Collapse
|
28
|
Momenzadeh K, Yeritsyan D, Kheir N, Nazarian RM, Nazarian A. Propylene glycol and Kolliphor as solvents for systemic delivery of cannabinoids via intraperitoneal and subcutaneous routes in preclinical studies: a comparative technical note. J Cannabis Res 2023; 5:24. [PMID: 37340498 DOI: 10.1186/s42238-023-00194-9] [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: 01/12/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Substance administration to laboratory animals necessitates careful consideration and planning in order to enhance agent distribution while reducing any harmful effects from the technique. There are numerous methods for administering cannabinoids; however, several parameters must be considered, including delivery frequency, volume of administration, vehicle, and the level of competence required for staff to use these routes properly. There is a scarcity of information about the appropriate delivery method for cannabinoids in animal research, particularly those that need the least amount of animal manipulation during the course of the investigation. This study aims to assess the feasibility and potential side effects of intraperitoneal and subcutaneous injection of CBD and THC using propylene glycol or Kolliphor in animal models. By evaluating the ease of use and histopathological side effects of these solvents, this study intends to help researchers better understand an accessible long-term delivery route of administration in animal experiments while minimizing the potential confounding effects of the delivery method on the animal. METHODS Intraperitoneal and subcutaneous methods of systemic cannabis administration were tested in rat models. Subcutaneous delivery via needle injection and continuous osmotic pump release were evaluated using propylene glycol or Kolliphor solvents. In addition, the use of a needle injection and a propylene glycol solvent for intraperitoneal (IP) administration was investigated. Skin histopathological changes were evaluated following a trial of subcutaneous injections of cannabinoids utilizing propylene glycol solvent. DISCUSSION Although IP delivery of cannabinoids with propylene glycol as solvent is a viable method and is preferable to oral treatment in order to reduce gastrointestinal tract degradation, it has substantial feasibility limitations. We conclude that subcutaneous delivery utilizing osmotic pumps with Kolliphor as a solvent provides viable and consistent route of administration for long-term systemic cannabinoid delivery in the preclinical context.
Collapse
Affiliation(s)
- Kaveh Momenzadeh
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA
| | - Rosalyn M Nazarian
- Pathology Service, Dermatopathology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA.
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia.
| |
Collapse
|
29
|
Colby AM, Dilley JA, Pensky HM, Johnson JK. Medical Cannabis Program Sustainability in the Era of Recreational Cannabis. Clin Ther 2023; 45:578-588. [PMID: 37414508 PMCID: PMC11221586 DOI: 10.1016/j.clinthera.2023.01.017] [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: 11/15/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Since October 2022, a total of 21 states have enacted both medical-use and adult-use cannabis legalization, each with their own unique set of laws, regulations, implementation, structures, and enforcement ("policies"). Unlike adult-use programs, medical-use programs often represent a safer and affordable option for patients with diverse needs; however, current evidence suggests that medical-use program activity decreases after implementation of adult-use retail. The current study compares medical patient registration data and medical- and adult-use retail data from 3 distinct medical- and adult-use states (Colorado, Massachusetts, and Oregon) in the time after adult-use retail implementation in each state. METHODS To investigate changes in medical cannabis programs with simultaneous adult-use legalization, correlation and linear regression analyses were used to assess outcome measures: (1) medical-use retail sales; (2) adult-use retail sales; and (3) number of registered medical patients in all fiscal quarters after adult-use retail sales were implemented in each state to September 2022. FINDINGS Adult-use cannabis sales increased significantly over time in all 3 states. However, both medical-use sales and number of medical patients registered in the states increased only in Massachusetts. IMPLICATIONS Results indicate that states' preexisting medical-use programs may undergo critical changes after adult-use cannabis legalization is enacted and implemented. Key policy and program differences, such as regulatory differences in the implementation of adult-use retail sales, may have differential impacts on medical-use programs. For continued patient access, it is critical that future research assess the differences within and between states' medical-use and adult-use programs that permit sustainability of medical-use programs alongside adult-use legalization and implementation.
Collapse
Affiliation(s)
- Alexander M Colby
- Massachusetts Cannabis Control Commission, Worcester, Massachusetts, USA.
| | - Julia A Dilley
- Program Design and Evaluation Services, Multnomah County/Oregon Public Health Division, Portland, Oregon, USA
| | - Hailey M Pensky
- Massachusetts Cannabis Control Commission, Worcester, Massachusetts, USA
| | - Julie K Johnson
- Massachusetts Cannabis Control Commission, Worcester, Massachusetts, USA
| |
Collapse
|
30
|
Johnson JK, Colby A. History of Cannabis Regulation and Medicinal Therapeutics: It's Complicated. Clin Ther 2023; 45:521-526. [PMID: 37414502 DOI: 10.1016/j.clinthera.2023.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 07/08/2023]
Abstract
The genus Cannabis has a complex history, with great variations in the genus itself, as well as in its current uses worldwide. Today, it is the most commonly used psychoactive substance, with 209 million users in 2020. The legalization of cannabis for medicinal or adult use is complex. From its origins as a therapeutic agent in 2800 bc China, to the current knowledge on cannabinoids and the cannabinoid system, to the complex status of cannabis regulation across continents-knowledge gained from the history of cannabis use can inform research on cannabis-based treatments for patients with medical conditions that remain challenging in 21st century medicine, warranting research and evidence-based policy options. Changes in cannabis-related policymaking, scientific advances, and perceptions may result in increasing patient inquiries about its medicinal usage, regardless of personal opinions, thus meriting education and training of clinicians. This commentary outlines the long history of cannabis use, its current therapeutic potential from a regulatory research perspective, and the continued challenges in research and regulation in the ever-changing era of modern cannabis use. It is crucial to understand the history and complexity of cannabis use as medicine to better understand its potential for clinical therapeutics and the effects of modern-day legalization on other health- and society-related issues.
Collapse
Affiliation(s)
- Julie K Johnson
- Massachusetts Cannabis Control Commission, Worcester, Massachusetts.
| | - Alexander Colby
- Massachusetts Cannabis Control Commission, Worcester, Massachusetts
| |
Collapse
|
31
|
Sharma P, Wilfahrt RP, Lackore K, Hammond CJ. Differences in Cannabidiol-Related Attitudes and Practice Behaviors Between U.S. Primary Care Physicians Practicing in a Single Health Care System Across States With and Without Marijuana Legalization. Cannabis Cannabinoid Res 2023. [PMID: 37220016 DOI: 10.1089/can.2023.0011] [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: 05/25/2023] Open
Abstract
Introduction: Dramatic shifts in marijuana laws, along with federal deregulation of hemp with the 2018 Farm Bill, have resulted in increased availability and use of cannabidiol (CBD) supplements throughout the United States (US). Given the rapid increase in CBD use in the U.S. general population, in this study, we aim to characterize primary care physician (PCP) attitudes and practice behaviors and to assess whether differences in provider attitudes and behaviors vary as a function of marijuana legalization (ML) status in the state of practice. Materials and Methods: Data are from an online provider survey on CBD supplement-related attitudes, beliefs, and behaviors administered to 508 PCPs as part of a larger mixed methods study. Participating PCPs were recruited from the Mayo Clinic Healthcare Network and provided medical care in primary care settings across four U.S. states (Minnesota, Wisconsin, Florida, and Arizona). Results: The survey response rate was 45.4% (n=236/508). According to providers, CBD was frequently brought up in PCP settings, typically by patients. PCPs were generally hesitant to screen for or discuss CBD with their patients and identified multiple barriers to open patient-provider dialogue about CBD. PCPs practicing in states that had passed ML were more receptive to patients using CBD supplements, whereas PCPs practicing in states that had not passed ML were more concerned about CBD-related side effects. Regardless of state ML status, most PCPs did not feel that they should be recommending CBD supplements to their patients. Most PCPs reported believing that CBD was unhelpful for most conditions for which it is marketed, with chronic non-cancer pain and anxiety/stress being exceptions. PCP respondents generally felt that they had insufficient knowledge/training around CBD. Conclusions: Results from this mixed methods study show that PCPs practicing in the U.S. rarely screen for or discuss CBD use with their patients and report several barriers to engage in proactive CBD-focused practice behaviors. Furthermore, survey results show that some PCP attitudes, practice behaviors, and barriers vary as a function of state ML status. These findings may guide medical education efforts and inform primary care practice modifications aimed at enhancing screening and monitoring of patient CBD use by PCPs.
Collapse
Affiliation(s)
- Pravesh Sharma
- Department of Psychiatry and Psychology, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Robert P Wilfahrt
- Department of Famiily Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kandace Lackore
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher J Hammond
- Department of Psychiatry and Behavioral Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
32
|
Kock LS, Melbostad HS, Heil SH. Prevalence of Psychosocial Issues Among Pregnant Women Who Do and Do Not Use Illicit Substances. RESEARCH SQUARE 2023:rs.3.rs-2845911. [PMID: 37163000 PMCID: PMC10168477 DOI: 10.21203/rs.3.rs-2845911/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Objective It is often believed that pregnant women who use illicit substances are more likely to experience psychosocial issues like smoking, depression, and inadequate health care compared to pregnant women who do not. However, the prevalence of these psychosocial issues has rarely been calculated and compared using nationally representative data. Methods Important psychosocial issues identified by the American College of Obstetricians and Gynecologists were operationalized using variables in the National Survey on Drug Use and Health. We report weighted prevalence and age-adjusted odds ratios for these issues in pregnant women who did vs. did not report past-month illicit substance use. Results Pregnant women (n = 3,657) who reported past-month illicit substance use (6.3%; 95% CI 5.4-7.0) had significantly higher rates of almost all psychosocial issues examined, including past-month cigarette smoking (44.9% vs. 6.5%; age-adjusted odds ratio (AOR) = 7.14 (95% CI 4.98-10.20)); past-month alcohol use (36.1% vs. 7.8%; AOR = 6.80 (4.69, 9.86)); serious past-month distress (23.0% vs. 5.0%; AOR = 4.99 (3.07-8.11)); no health insurance (11.7% vs. 6.2%; AOR = 1.79 (1.07-2.99)); and receipt of food stamps (45.0% vs. 24.0%; AOR = 2.26 (1.55-3.29)). Moving 3 + times in the past year followed a similar pattern, but results were compatible with there being no difference between groups (10.6% vs. 5.5%; AOR = 1.59 (0.95-2.66)). In contrast to other issues examined, English language proficiency was higher among those who reported illicit substance use (4.7% vs. 0.4%; AOR = 0.08 (0.01-0.63)). Conclusions Pregnant women who use illicit substances experience higher rates of most psychosocial issues compared to those who do not, reinforcing recommendations for multidisciplinary approaches to care.
Collapse
|
33
|
Sherman SG, Tomko C, Rouhani S. De Facto Decriminalization for Drug Possession and Sex Work in Baltimore, Maryland. Am J Prev Med 2023; 64:567-568. [PMID: 36690542 DOI: 10.1016/j.amepre.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/23/2022] [Accepted: 10/25/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW Cannabis has been used since ancient times for medical and recreational research. This review article will document the validity of how medical cannabis can be utilized for chronic nonmalignant pain management. RECENT FINDINGS Current cannabis research has shown that medical cannabis is indicated for symptom management for many conditions not limited to cancer, chronic pain, headaches, migraines, and psychological disorders (anxiety and post-traumatic stress disorder). Δ9-Tetrahydrocannabinol (THC) and cannabidiol (CBD) are active ingredients in cannabis that modulate a patient's symptoms. These compounds work to decrease nociception and symptom frequency via the endocannabinoid system. Research regarding pain management is limited within the USA as the Drug Enforcement Agency (DEA) classifies it as a schedule one drug. Few studies have found a limited relationship between chronic pain and medical cannabis use. A total of 77 articles were selected after a thorough screening process using PubMed and Google Scholar. This paper demonstrates that medical cannabis use provides adequate pain management. Patients suffering from chronic nonmalignant pain may benefit from medical cannabis due to its convenience and efficacy.
Collapse
|
35
|
Cooke ME, Potter KW, Jashinski J, Pascale M, Schuster RM, Tervo-Clemmens B, Hoeppner BB, Pachas GN, Evins AE, Gilman JM. Development of cannabis use disorder in medical cannabis users: A 9-month follow-up of a randomized clinical trial testing effects of medical cannabis card ownership. Front Psychiatry 2023; 14:1083334. [PMID: 36960460 PMCID: PMC10027723 DOI: 10.3389/fpsyt.2023.1083334] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
Background Evidence for long-term effectiveness of commercial cannabis products used to treat medical symptoms is inconsistent, despite increasingly widespread use. Objective To prospectively evaluate the effects of using cannabis on self-reported symptoms of pain, insomnia, anxiety, depression, and cannabis use disorder (CUD) after 12 months of use. Methods This observational cohort study describes outcomes over 9 months following a 12-week randomized, waitlist-controlled trial (RCT: NCT03224468) in which adults (N = 163) who wished to use cannabis to alleviate insomnia, pain, depression, or anxiety symptoms were randomly assigned to obtain a medical marijuana card immediately (immediate card acquisition group) or to delay obtaining a card for 12 weeks delay (delayed card acquisition group). During the 9-month post-randomization period, all participants could use cannabis as they wished and choose their cannabis products, doses, and frequency of use. Insomnia, pain, depression, anxiety, and CUD symptoms were assessed over the 9-month post-randomization period. Results After 12 months of using cannabis for medical symptoms, 11.7% of all participants (n = 19), and 17.1% of those using cannabis daily or near-daily (n = 6) developed CUD. Frequency of cannabis use was positively correlated with pain severity and number of CUD symptoms, but not significantly associated with severity of self-reported insomnia, depression, or anxiety symptoms. Depression scores improved throughout the 9 months in all participants, regardless of cannabis use frequency. Conclusions Frequency of cannabis use was not associated with improved pain, anxiety, or depression symptoms but was associated with new-onset cannabis use disorder in a significant minority of participants. Daily or near-daily cannabis use appears to have little benefit for these symptoms after 12 months of use.
Collapse
Affiliation(s)
- Megan E. Cooke
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
| | - Kevin W. Potter
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Julia Jashinski
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
| | - Michael Pascale
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
| | - Randi M. Schuster
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Brenden Tervo-Clemmens
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
| | - Bettina B. Hoeppner
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Gladys N. Pachas
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - A. Eden Evins
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jodi M. Gilman
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
| |
Collapse
|
36
|
The protective effect of cannabinoids against colorectal cancer cachexia through modulation of inflammation and immune responses. Biomed Pharmacother 2023; 161:114467. [PMID: 36871538 DOI: 10.1016/j.biopha.2023.114467] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Cancer cachexia is a multifactorial disorder characterized by weight loss and muscle wasting, and there are currently no FDA-approved medications. In the present study, upregulation of six cytokines was observed in serum samples from patients with colorectal cancer (CRC) and in mouse models. A negative correlation between the levels of the six cytokines and body mass index in CRC patients was seen. Gene Ontology analysis revealed that these cytokines were involved in regulating T cell proliferation. The infiltration of CD8+ T cells was found to be associated with muscle atrophy in mice with CRC. Adoptive transfer of CD8+ T cells isolated from CRC mice resulted in muscle wasting in recipients. The Genotype-Tissue Expression database showed that negative correlations between the expression of cachexia markers and cannabinoid receptor 2 (CB2) in human skeletal muscle tissues. Pharmacological treatment with Δ9-tetrahydrocannabinol (Δ9-THC), a selective CB2 agonist or overexpression of CB2 attenuated CRC-associated muscle atrophy. In contrast, knockout of CB2 with a CRISPR/Cas9-based strategy or depletion of CD8+ T cells in CRC mice abolished the Δ9-THC-mediated effects. This study demonstrates that cannabinoids ameliorate CD8+ T cell infiltration in CRC-associated skeletal muscle atrophy via a CB2-mediated pathway. Serum levels of the six-cytokine signature might serve as a potential biomarker to detect the therapeutic effects of cannabinoids in CRC-associated cachexia.
Collapse
|
37
|
Mathur NK, Ruhm CJ. Marijuana legalization and opioid deaths. JOURNAL OF HEALTH ECONOMICS 2023; 88:102728. [PMID: 36808015 DOI: 10.1016/j.jhealeco.2023.102728] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 06/18/2023]
Abstract
Many states have legalized marijuana over the last two decades, initially for medical purposes and more recently for recreational consumption. Despite prior research, it remains unclear how these policies are related to rates of opioid-involved overdose deaths, which have trended rapidly upwards over time. We examine this question in two ways. First, we replicate and extend previous investigations to show that the prior empirical results are frequently fragile to the choice of specifications and time periods, and probably provide an overly optimistic assessment of the effects of marijuana legalization on opioid deaths. Second, we present new estimates suggesting that legal medical marijuana, particularly when available through retail dispensaries, is associated with higher opioid mortality. The results for recreational marijuana, while less reliable, also indicate that retail sales may be correlated with greater death rates relative to the counterfactual of no legal cannabis. A likely mechanism for these effects is the emergence of illicit fentanyl, which has increased the riskiness of even small positive effects of cannabis legalization on the consumption of opioids.
Collapse
Affiliation(s)
- Neil K Mathur
- Department of Economics, University of Virginia, United States
| | - Christopher J Ruhm
- Frank Batten School of Leadership & Public Policy, University of Virginia and National Bureau of Economic Research, 235 McCormick Road, Charlottesville, VA 22903-4893, United States.
| |
Collapse
|
38
|
Abbasi R, Alavi NM, Farzandipour M, Gong Y, Nabovati E. Using pharmacy surveillance information systems to Monitor the dispensing practice of under-controlled drugs: A qualitative study on necessities, requirements, and implementation challenges. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
|
39
|
Barbalat G, Liu S. Long-Term Impact of Medical Marijuana Laws on the Burden of Cannabis Use Disorders in US Male and Female Adolescents and Young Adults. Community Ment Health J 2023; 59:391-399. [PMID: 36036345 DOI: 10.1007/s10597-022-01018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/06/2022] [Indexed: 01/25/2023]
Abstract
Deregulation of cannabis use has raised concerns regarding its potential effects on health, particularly in adolescents and young adults. Here, we extracted data from the Global Burden of Disease database to estimate the long-term effect (> 5 years) of medical marijuana laws (MML) on 2019 cannabis use disorders Disability Adjusted Life Years (2019 CUD DALYs) in US male and female adolescents (15-19 years old) and young adults (20-24 years old). Socio-cultural, demographic and economic characteristics were used as baseline covariates. To improve the robustness of estimation, we took advantage of machine learning techniques. We found no significant effect of MML on 2019 CUD DALYS in each of our four age/sex groups. Estimates from a marginal structural model taking into account age and sex strata in the same model were also non-significant. Our findings suggest that MML may have a negligible effect (if any) on cannabis use disorders in this population group.
Collapse
Affiliation(s)
- Guillaume Barbalat
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Hôpital Le Vinatier, Pôle Centre rive gauche, Université de Lyon, CNRS & Université Lyon, UMR, 5229, France.
- Department of Population Health Sciences, Weill Cornell Medicine, 1300 York Ave, 10065, New York, NY, USA.
| | - Sze Liu
- Department of Population Health Sciences, Weill Cornell Medicine, 1300 York Ave, 10065, New York, NY, USA
| |
Collapse
|
40
|
Cannabis Legalization and the Decline of Cannabis Use Disorder (CUD) Treatment Utilization in the US. CURRENT ADDICTION REPORTS 2023. [DOI: 10.1007/s40429-022-00461-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
41
|
Lin AL, Nah G, Tang JJ, Vittinghoff E, Dewland TA, Marcus GM. Cannabis, cocaine, methamphetamine, and opiates increase the risk of incident atrial fibrillation. Eur Heart J 2022; 43:4933-4942. [PMID: 36257330 DOI: 10.1093/eurheartj/ehac558] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Atrial fibrillation (AF) is now regarded as a preventable disease, requiring a search for modifiable risk factors. With legalization of cannabis and more lenient laws regarding the use of other illicit substances, investigation into the potential effects of methamphetamine, cocaine, opiate, and cannabis exposure on incident AF is needed. METHODS AND RESULTS Using Office of Statewide Health Planning and Development databases, a longitudinal analysis was performed of adult Californians ≥18 years of age who received care in an emergency department, outpatient surgery facility, or hospital from 1 January 2005 to 31 December 2015. Associations between healthcare coding for the use of each substance and a new AF diagnosis were assessed. Among 23,561,884 patients, 98 271 used methamphetamine, 48 701 used cocaine, 10 032 used opiates, and 132 834 used cannabis. Of the total population, 998 747 patients (4.2%) developed incident AF during the study period. After adjusting for potential confounders and mediators, use of methamphetamines, cocaine, opiates, and cannabis was each associated with increased incidence of AF: hazard ratios 1.86 [95% confidence interval (CI) 1.81-1.92], 1.61 (95% CI 1.55-1.68), 1.74 (95% CI 1.62-1.87), and 1.35 (95% CI 1.30-1.40), respectively. Negative control analyses in the same cohort failed to reveal similarly consistent positive relationships. CONCLUSION Methamphetamine, cocaine, opiate, and cannabis uses were each associated with increased risk of developing incident AF. Efforts to mitigate the use of these substances may represent a novel approach to AF prevention.
Collapse
Affiliation(s)
- Anthony L Lin
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Gregory Nah
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Janet J Tang
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Thomas A Dewland
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| |
Collapse
|
42
|
Acute Ischemic Stroke Among Cannabis Users in the United States and Possible Risk Factors for Mortality. Neurologist 2022:00127893-990000000-00048. [DOI: 10.1097/nrl.0000000000000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
43
|
Blanchette JG, Pacula RL, Smart R, Lira MC, Pessar SC, Naimi TS. The Cannabis Policy Scale: A New Research and Surveillance Tool for U.S. States. J Stud Alcohol Drugs 2022; 83:829-838. [PMID: 36484580 PMCID: PMC9756403 DOI: 10.15288/jsad.21-00462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/03/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Rapid shifts toward cannabis liberalization in the United States have created immense policy variability that is challenging to measure. We developed composite measures to characterize the restrictiveness of U.S. state cannabis policy environments. METHOD Nine panelists, consisting of four research team members and five expert policy consultants, nominated distinct cannabis policies pertaining to cannabis prohibition, medicalization, and legalization for recreational use. For each of the 17 nominated policies, panelists developed implementation ratings and rated each policy's relative efficacy for reducing excessive cannabis use by adults, youth use, and impaired driving. Cannabis Policy Scale scores were then calculated for each state-year for all 50 states from 1999 to 2019 by weighting policies by their efficacy and implementation ratings, and then summing over policies. RESULTS Median Cannabis Policy Scale scores remained stable until 2008, when they started declining (representing policy liberalization), with steeper declines after 2012. In 2019, state Cannabis Policy Scale scores targeting excessive use among the general population ranged from 29.6 to 66.7 for recreational cannabis legalization states, and from 72.4 to 93.4 for medical cannabis legalization states. Cannabis Policy Scale scores using youth-specific and driving-specific efficacy ratings showed similar trends. CONCLUSIONS The Cannabis Policy Scale reflects trends toward liberalization of cannabis policy in many U.S. states. Even within crude policy phenotypes (e.g., medical cannabis programs), Cannabis Policy Scale scores varied considerably between states and over time. The Cannabis Policy Scale is a new measure that can add nuance to cannabis policy research and help assess cannabis policy-outcome relationships.
Collapse
Affiliation(s)
| | - Rosalie Liccardo Pacula
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
| | | | | | - Seema Choksy Pessar
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
| | - Timothy S. Naimi
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
44
|
Sordo L, Gual A. [Recreational cannabis and therapeutic cannabinoids, neither shaken nor stirred]. GACETA SANITARIA 2022; 36:500-501. [PMID: 35680484 DOI: 10.1016/j.gaceta.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Luis Sordo
- Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España.
| | - Antoni Gual
- Grup de Recerca en Addiccions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Unitat de Conductes Addictives Hospital Clínic, Barcelona, España
| |
Collapse
|
45
|
Nnam MU, Ordu GEO, Eteng MJ, Ukah JA, Arua CC, Okechukwu GP, Obasi CO. "When I Take Drugs, I Don't Care": Insights into the Operational Dynamics of Male Violent Offenders in a Correctional Centre. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022; 66:1454-1474. [PMID: 34096346 DOI: 10.1177/0306624x211022653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study investigated the operational dynamics of male violent offenders incarcerated in Abakaliki custodial center, Nigeria. A cross-sectional survey research design was adopted and purposive technique used to recruit 260 inmates charged with violent offenses. The data generated from structured questionnaire were analyzed using Predictive Analytic Software (PAS), with ordinary least regression, descriptive statistics and spearman rank order correlation techniques, employed in testing the variables explored. Findings revealed that this population use drugs to enhance criminal performance through being brutal; instilling fear in victims to secure their total compliance and submission; and suppressing regret for their criminal acts. Heroin, followed by, cocaine, cannabis, tramadol, and multiple drug use, were commonly used drugs in the population surveyed, with their offenses ranging from cultism, armed robbery, murder and burglary to kidnapping and assault and battery. Gaining insights into the changing operational knowledge, procedures and dynamics of violent offenders will (re)direct policy approach and action that are capable of increasing public and custodial safety. It will also orient and direct practical prison reforms for successful rehabilitation and reintegration of released inmates into the free world.
Collapse
|
46
|
Guttmannova K, Oesterle S, Skinner ML, Kuklinski MR, Hultgren B, Rhew IC, Parker M, Briney JS, White HR. Substance-Specific Risk Factors among Young Adults: Potential Prevention Targets across Cannabis-Permissive Environments. Subst Use Misuse 2022; 57:1923-1930. [PMID: 36151975 PMCID: PMC9701568 DOI: 10.1080/10826084.2022.2120363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE This study examined levels of substance-specific risk factors such as perception of harm from substance use among young adults in a range of cannabis-permissive environments. The main objective was to inform future preventive interventions aimed at reducing cannabis use in the context of increasingly permissive environments. METHODS Data came from the Community Youth Development Study (CYDS) collected in 2016 when participants were about 23 years old (n = 1,722 participants residing in 46 U.S. states). Young adults self-reported their perceptions about the harms related to cannabis, alcohol, and cigarette use; attitudes about and ease of access to cannabis and other substances; and perceived wrongfulness and social acceptability of cannabis, alcohol, and cigarette use and of selling of cannabis and other illegal drugs. RESULTS Young adults in more permissive cannabis contexts reported higher levels of all cannabis-specific risk factors (e.g., greater access to and more favorable attitudes about cannabis use), except for perception of harm from regular cannabis use. However, permissiveness of the cannabis environment was not associated with heightened levels of risk factors for other substance use (such as alcohol, cigarettes, and opioids). CONCLUSIONS Future preventive interventions for young adults living in more permissive cannabis contexts may need to focus on cannabis-specific risk factors in particular and go beyond considerations of harm from regular use. Future studies should replicate these findings with other samples.
Collapse
Affiliation(s)
- Katarina Guttmannova
- Center for the Study of Health and Risk Behavior, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Sabrina Oesterle
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, Arizona, USA
| | - Martie L Skinner
- Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington, USA
| | - Margaret R Kuklinski
- Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington, USA
| | - Brittney Hultgren
- Center for the Study of Health and Risk Behavior, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Isaac C Rhew
- Center for the Study of Health and Risk Behavior, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Myra Parker
- Center for the Study of Health and Risk Behavior, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - John S Briney
- Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington, USA
| | - Helene R White
- Center of Alcohol and Substance Studies, Rutgers University, Piscataway, New Jersey, USA
| |
Collapse
|
47
|
A Meta-Analysis of fMRI Studies of Youth Cannabis Use: Alterations in Executive Control, Social Cognition/Emotion Processing, and Reward Processing in Cannabis Using Youth. Brain Sci 2022; 12:brainsci12101281. [PMID: 36291215 PMCID: PMC9599849 DOI: 10.3390/brainsci12101281] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Adolescent cannabis use (CU) is associated with adverse health outcomes and may be increasing in response to changing cannabis laws. Recent imaging studies have identified differences in brain activity between adult CU and controls that are more prominent in early onset users. Whether these differences are present in adolescent CU and relate to age/developmental stage, sex, or cannabis exposure is unknown. Methods: A systematic review and subsequent effect-size seed-based d mapping (SDM) meta-analysis were conducted to examine differences in blood-oxygen-level-dependent (BOLD) response during fMRI studies between CU and non-using typically developing (TD) youth. Supplemental analyses investigated differences in BOLD signal in CU and TD youth as a function of sex, psychiatric comorbidity, and the dose and severity of cannabis exposure. Results: From 1371 citations, 45 fMRI studies were identified for inclusion in the SDM meta-analysis. These studies compared BOLD response contrasts in 1216 CU and 1486 non-using TD participants. In primary meta-analyses stratified by cognitive paradigms, CU (compared to TD) youth showed greater activation in the rostral medial prefrontal cortex (rmPFC) and decreased activation in the dorsal mPFC (dmPFC) and dorsal anterior cingulate cortex (dACC) during executive control and social cognition/emotion processing, respectively. In meta-regression analyses and subgroup meta-analyses, sex, cannabis use disorder (CUD) severity, and psychiatric comorbidity were correlated with brain activation differences between CU and TD youth in mPFC and insular cortical regions. Activation differences in the caudate, thalamus, insula, dmPFC/dACC, and precentral and postcentral gyri varied as a function of the length of abstinence. Conclusions: Using an SDM meta-analytic approach, this report identified differences in neuronal response between CU and TD youth during executive control, emotion processing, and reward processing in cortical and subcortical brain regions that varied as a function of sex, CUD severity, psychiatric comorbidity, and length of abstinence. Whether aberrant brain function in CU youth is attributable to common predispositional factors, cannabis-induced neuroadaptive changes, or both warrants further investigation.
Collapse
|
48
|
Arya S, Ghosh A, Kazhungil F. Early career psychiatrist’s attitude toward medicinal and recreational cannabis legalization in India; findings from an online survey. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2120424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Sidharth Arya
- State Drug Dependence Treatment Centre, Institute of Mental Health, Pt BDS University of Health Sciences, Rohtak, India
| | - Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Sciences and Research, Chandigarh, India
| | - Firoz Kazhungil
- Department of Psychiatry, NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE
| |
Collapse
|
49
|
Kalonji P, Revol A, Broers B, Ljuslin M, Pautex S. Patient-Related Barriers to the Prescription of Cannabinoid-Based Medicines in Palliative Care: A Qualitative Approach. Palliat Med Rep 2022; 3:200-205. [PMID: 36203714 PMCID: PMC9531874 DOI: 10.1089/pmr.2022.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pauline Kalonji
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Aurélie Revol
- Palliative Medicine Division and University Hospital Geneva, Geneva, Switzerland
| | - Barbara Broers
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
- Primary Care Division, University Hospital Geneva, Geneva, Switzerland
| | - Michael Ljuslin
- Palliative Medicine Division and University Hospital Geneva, Geneva, Switzerland
| | - Sophie Pautex
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
- Palliative Medicine Division and University Hospital Geneva, Geneva, Switzerland
| |
Collapse
|
50
|
Sirangelo TM, Ludlow RA, Spadafora ND. Multi-Omics Approaches to Study Molecular Mechanisms in Cannabis sativa. PLANTS (BASEL, SWITZERLAND) 2022; 11:2182. [PMID: 36015485 PMCID: PMC9416457 DOI: 10.3390/plants11162182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
Cannabis (Cannabis sativa L.), also known as hemp, is one of the oldest cultivated crops, grown for both its use in textile and cordage production, and its unique chemical properties. However, due to the legislation regulating cannabis cultivation, it is not a well characterized crop, especially regarding molecular and genetic pathways. Only recently have regulations begun to ease enough to allow more widespread cannabis research, which, coupled with the availability of cannabis genome sequences, is fuelling the interest of the scientific community. In this review, we provide a summary of cannabis molecular resources focusing on the most recent and relevant genomics, transcriptomics and metabolomics approaches and investigations. Multi-omics methods are discussed, with this combined approach being a powerful tool to identify correlations between biological processes and metabolic pathways across diverse omics layers, and to better elucidate the relationships between cannabis sub-species. The correlations between genotypes and phenotypes, as well as novel metabolites with therapeutic potential are also explored in the context of cannabis breeding programs. However, further studies are needed to fully elucidate the complex metabolomic matrix of this crop. For this reason, some key points for future research activities are discussed, relying on multi-omics approaches.
Collapse
Affiliation(s)
- Tiziana M. Sirangelo
- CREA—Council for Agricultural Research and Agricultural Economy Analysis, Genomics and Bioinformatics Department, 26836 Montanaso Lombardo, Italy
| | - Richard A. Ludlow
- School of Biosciences, Cardiff University, Sir Martin Evans Building, Museum Avenue, Cardiff CF10 3AX, UK
| | - Natasha D. Spadafora
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, 44121 Ferrara, Italy
| |
Collapse
|