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Coraci D, Maccarone MC, Ragazzo L, Tognolo L, Restivo DA, Santilli G, Moreira AL, Ferrara PE, Ronconi G, Masiero S. Botulinum toxin in the rehabilitation of painful syndromes: multiperspective literature analysis, lexical analysis and systematic review of randomized controlled trials. Eur J Transl Myol 2024; 34:12509. [PMID: 38767308 PMCID: PMC11264230 DOI: 10.4081/ejtm.2024.12509] [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: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 05/22/2024] Open
Abstract
Pain represents a common symptom of several diseases and is often associated with a reduction in rehabilitation outcomes and recovery. The effectiveness of pain alleviation by botulinum toxin has been recently demonstrated. We searched in PubMed the papers about this topic published in the last ten years, and we selected clinical trials, guidelines, meta-analyses, reviews, and systematic reviews. We used different approaches: multiperspective presentation, lexical evaluation, and systematic review. The systematic review was only performed for the randomized controlled trials. We predominantly found reviews and trials about the rehabilitation of stroke/brain injury and epicondylitis. The most common outcome measures were pain, function, and spasticity. Among the common words, pain was the most frequent and the terms were grouped into different families, especially concerning the outcomes. Rehabilitation showed a relatively low frequency. Finally, the systematic review showed moderate-low levels of bias which confirms the effectiveness of botulinum toxin for pain treatment. The current literature about botulinum toxin is wide and globally diffuse but with some limitations in study strategies and clearness in the formal presentation. The evidence justifies the use of botulinum toxin in treating pain in different diseases.
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Affiliation(s)
- Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua.
| | | | - Lisa Ragazzo
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua.
| | - Lucrezia Tognolo
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua.
| | | | - Gabriele Santilli
- Department of Anatomical, Histological and Legal Medical Sciences and Science of the Locomotor System, Rome.
| | - Ana Lucila Moreira
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo.
| | | | | | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua.
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Schnurr PP, Hamblen JL, Wolf J, Coller R, Collie C, Fuller MA, Holtzheimer PE, Kelly U, Lang AJ, McGraw K, Morganstein JC, Norman SB, Papke K, Petrakis I, Riggs D, Sall JA, Shiner B, Wiechers I, Kelber MS. The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med 2024; 177:363-374. [PMID: 38408360 DOI: 10.7326/m23-2757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
DESCRIPTION The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) worked together to revise the 2017 VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. This article summarizes the 2023 clinical practice guideline (CPG) and its development process, focusing on assessments and treatments for which evidence was sufficient to support a recommendation for or against. METHODS Subject experts from both departments developed 12 key questions and reviewed the published literature after a systematic search using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) method. The evidence was then evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. Recommendations were made after consensus was reached; they were based on quality and strength of evidence and informed by other factors, including feasibility and patient perspectives. Once the draft was peer reviewed by an external group of experts and their inputs were incorporated, the final document was completed. RECOMMENDATIONS The revised CPG includes 34 recommendations in the following 5 topic areas: assessment and diagnosis, prevention, treatment, treatment of nightmares, and treatment of posttraumatic stress disorder (PTSD) with co-occurring conditions. Six recommendations on PTSD treatment were rated as strong. The CPG recommends use of specific manualized psychotherapies over pharmacotherapy; prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy; paroxetine, sertraline, or venlafaxine; and secure video teleconferencing to deliver recommended psychotherapy when that therapy has been validated for use with video teleconferencing or when other options are unavailable. The CPG also recommends against use of benzodiazepines, cannabis, or cannabis-derived products. Providers are encouraged to use this guideline to support evidence-based, patient-centered care and shared decision making to optimize individuals' health outcomes and quality of life.
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Affiliation(s)
- Paula P Schnurr
- National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (P.P.S., J.L.H., P.E.H.)
| | - Jessica L Hamblen
- National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (P.P.S., J.L.H., P.E.H.)
| | - Jonathan Wolf
- Defense Health Agency, Falls Church, Virginia (J.W.)
| | - Rachael Coller
- Naval Medical Center San Diego, San Diego, California (R.C.)
| | - Claire Collie
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC (C.C.)
| | - Matthew A Fuller
- Veterans Health Administration Pharmacy Benefits Management Service and Case Western Reserve University School of Medicine, Cleveland, Ohio (M.A.F.)
| | - Paul E Holtzheimer
- National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (P.P.S., J.L.H., P.E.H.)
| | - Ursula Kelly
- Joseph Maxwell Cleland Atlanta VA Medical Center and Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia (U.K.)
| | - Ariel J Lang
- Center of Excellence for Stress and Mental Health at VA San Diego Healthcare System and University of California, San Diego, San Diego, California (A.J.L.)
| | - Kate McGraw
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia (K.M., M.S.K.)
| | - Joshua C Morganstein
- Uniformed Services University of the Health Sciences, Center for the Study of Traumatic Stress, Bethesda, Maryland (J.C.M.)
| | - Sonya B Norman
- National Center for PTSD, White River Junction, Vermont, and University of California, San Diego, San Diego, California (S.B.N.)
| | - Katie Papke
- National Social Work Program Office, Veterans Health Administration, Washington, DC (K.P.)
| | - Ismene Petrakis
- National Center for PTSD, West Haven, and Yale University School of Medicine, New Haven, Connecticut (I.P.)
| | - David Riggs
- Uniformed Services University of the Health Sciences, Center for Deployment Psychology, Bethesda, Maryland (D.R.)
| | - James A Sall
- Evidence Based Practice, Quality and Patient Safety, Veterans Health Administration, Washington, DC (J.A.S.)
| | - Brian Shiner
- White River Junction VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (B.S.)
| | - Ilse Wiechers
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC; Yale University School of Medicine, New Haven, Connecticut; and University of California, San Francisco, School of Medicine, San Francisco, California (I.W.)
| | - Marija S Kelber
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia (K.M., M.S.K.)
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Mano-Sousa BJ, Ribeiro LAL, Alves BC, Gonçalves ACA, Silva LM, Duarte-Almeida JM. Bibliometric Analysis of Cannabis sativa Research: Trends, Challenges, and Future Directions. Cannabis Cannabinoid Res 2024; 9:21-34. [PMID: 38252501 DOI: 10.1089/can.2023.0200] [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] [Indexed: 01/24/2024] Open
Abstract
Introduction: The use of medical Cannabis remains unregulated in several countries due to the scarcity of clinical studies with high scientific evidence that establish safety and efficacy of Cannabis products. This study aimed to comprehensively analyze how knowledge has been created in this field, as well as perform a bibliographic mapping to identify knowledge gaps, and investigate key authors and journals that have significantly contributed to advancing our understanding of Cannabis. Method: The study protocol was registered in the International Prospective Register of Systematic Review (CRD42020223084). A systematic search was conducted in the Cochrane Central Register of Controlled Trials, Lilacs, Google Scholar, PubMed, SciELO, Scopus, and Web of Science databases. The bibliographic analysis and mapping were registered using the VOSviewer, Sci2tool, CiteSpace, and PoP software. Results: The systematic search identified 27,597 records, with 17,020 duplicates, resulting in a total of 10,577 articles included. The authors who published the most were Marilyn Ann Huestis (n=108) and Sagnik Bhattacharyya (n=71), while Elisaldo A. Carlini and Raphael Mechoulam published 8 and 22 articles, respectively. The journals Drug and Alcohol Dependence (n=297), Psychopharmacology (n=159) and Addictive Behaviors (n=150) were the ones that published the most on Cannabis. The journals suggest that the articles are correlated with the adverse and toxicological effects of recreational Cannabis use; however, most articles focus on medical Cannabis. The peak of publications was in 2021 (n=1,481). The countries that published the most were the United States (n=9,735), while Brazil occupied the 11th position (n=422). Most publications were carried out in "Pharmacology and Pharmacy" (11.31%), followed by "Psychiatry" (7.66%) and "Medicine" (5.80%). The areas of "Neurosciences" (1.59%), "Biochemistry," "Genetics," and "Molecular Biology" (0.79%) were little explored. Conclusion: This study captured the characteristics of publications about Cannabis and clinical studies in the scientific literature, yielding >10,000 articles, representing a large literature review, to date. Therefore, the most productive countries included the United States, the United Kingdom, and Canada, while the most productive authors were Marilyn Ann Huestis and Sagnik Bhattacharyya, with a peak of publications in 2021. Finally, the most chosen journals were Drug and Alcohol Dependence and Psychopharmacology.
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Affiliation(s)
- Brayan Jonas Mano-Sousa
- Campus Centro-Oeste, Universidade Federal de São João del-Rei, Divinópolis, Minas Gerais, Brazil
| | | | - Bruna Cristina Alves
- Campus Centro-Oeste, Universidade Federal de São João del-Rei, Divinópolis, Minas Gerais, Brazil
| | | | - Luiza Martins Silva
- Campus Centro-Oeste, Universidade Federal de São João del-Rei, Divinópolis, Minas Gerais, Brazil
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Aung AT. Theater as a Site of Resistance in Haresh Sharma's Good People: Questioning Authorities and Contesting Truths in the Clinic. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:327-345. [PMID: 37085624 DOI: 10.1007/s10912-023-09793-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 04/23/2023]
Abstract
Good People, by Singaporean playwright Haresh Sharma, unmasks racial and religious tensions between Singapore's increasingly diverse racial groups and the attendant ramifications on the healthcare ecosystem and the doctor-patient relationship. Drawing upon Michel Foucault's notion of heterotopia, this paper argues that, in Good People, Sharma employs theater as a site of resistance by calling into question state and medical authority. First, state authority is challenged through the play's scrutiny of the ideological principle of multiculturalism and its usefulness in fostering meaningful cross-cultural exchanges and acceptance of different cultural and religious beliefs in the clinic. Second, the play destabilizes medical authority by surfacing the complex relationship between the doctor's unconscious biases, racial and religious prejudice, and clinical judgment, thereby casting doubt on medicine's claims of objectivity. In doing so, this paper argues, the play resists simplistic binary categorizations of the behaviors and motivations of the characters into good/bad or right/wrong, instead raising questions about power, knowledge, and contesting truths within the confines of the cultural space of a hospice.
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Affiliation(s)
- April Thant Aung
- Medical Humanities Research Cluster, Department of English, Nanyang Technological University Singapore, Singapore, Singapore.
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Gazarov EA, Zequeira S, Senetra AS, Howard J, Sharma A, McCurdy CR, Lewis J, Bizon JL, Setlow B. Pharmacokinetics of delta-9-tetrahydrocannabinol following acute cannabis smoke exposure in mice; effects of sex, age, and strain. Front Pharmacol 2023; 14:1227220. [PMID: 37701025 PMCID: PMC10493391 DOI: 10.3389/fphar.2023.1227220] [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: 05/22/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023] Open
Abstract
Increased use of cannabis and cannabinoids for recreational and medical purposes has led to a growth in research on their effects in animal models. The majority of this work has employed cannabinoid injections; however, smoking remains the most common route of cannabis consumption. To better model real-world cannabis use, we exposed mice to cannabis smoke to establish the pharmacokinetics of Δ9THC and its metabolites in plasma and brain. To determine the time course of Δ9THC and two major metabolites [11-hydroxy-delta-9-tetrahydrocannabinol (11-OH-THC) and 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (11-COOH-THC)], male and female C57BL/6J mice were exposed to smoke from sequentially burning 5 cannabis cigarettes. Following smoke exposure, trunk blood and brains were collected at 6 time points (10-240 min). Plasma and brain homogenates were analyzed for Δ9THC and metabolites using a validated ultraperformance liquid chromatography-tandem mass spectrometry method. To assess effects of age, sex, and mouse strain, we exposed mice of four strains (C57BL/6J, FVB, Swiss Webster, and 129S6/SvEv, aged 4-24 months) to cannabis using the same smoke regimen. Samples were collected 10 and 40 min following exposure. Lastly, to assess effects of dose, C57BL/6J mice were exposed to smoke from burning 3 or 5 cannabis cigarettes, with samples collected 40 min following exposure. The pharmacokinetic study revealed that maximum plasma Δ9THC concentrations (Cmax) were achieved at 10 and 40 min for males and females, respectively, while Cmax for brain Δ9THC was observed at 20 and 40 min for males and females, respectively. There were no age or strain differences in plasma Δ9THC concentrations at 10 or 40 min; however, 129S6/SvEv mice had significantly higher brain Δ9THC concentrations than FVB mice. Additionally, 3 cigarettes produced significantly lower plasma 11-COOH-THC concentrations compared to 5 cigarettes, although dose differences were not evident in plasma or brain concentrations of Δ9THC or 11-OH-THC. Across all experiments, females had higher levels of 11-COOH-THC in plasma compared to males. The results reveal robust sex differences in Δ9THC pharmacokinetics, and lay the groundwork for future studies using mice to model the pharmacodynamics of smoked cannabis.
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Affiliation(s)
- Emely A. Gazarov
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Sabrina Zequeira
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | | | - John Howard
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Abhisheak Sharma
- Department of Pharmaceutics, University of Florida, Gainesville, FL, United States
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, United States
| | - Christopher R. McCurdy
- Department of Pharmaceutics, University of Florida, Gainesville, FL, United States
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, United States
- Department of Medicinal Chemistry, University of Florida, Gainesville, FL, United States
| | - Jada Lewis
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Jennifer L. Bizon
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, United States
| | - Barry Setlow
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, United States
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Govindarajan RK, Mishra AK, Cho KH, Kim KH, Yoon KM, Baek KH. Biosynthesis of Phytocannabinoids and Structural Insights: A Review. Metabolites 2023; 13:442. [PMID: 36984882 PMCID: PMC10051821 DOI: 10.3390/metabo13030442] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Cannabis belongs to the family Cannabaceae, and phytocannabinoids are produced by the Cannabis sativa L. plant. A long-standing debate regarding the plant is whether it contains one or more species. Phytocannabinoids are bioactive natural products found in flowers, seeds, and fruits. They can be beneficial for treating human diseases (such as multiple sclerosis, neurodegenerative diseases, epilepsy, and pain), the cellular metabolic process, and regulating biological function systems. In addition, several phytocannabinoids are used in various therapeutic and pharmaceutical applications. This study provides an overview of the different sources of phytocannabinoids; further, the biosynthesis of bioactive compounds involving various pathways is elucidated. The structural classification of phytocannabinoids is based on their decorated resorcinol core and the bioactivities of naturally occurring cannabinoids. Furthermore, phytocannabinoids have been studied in terms of their role in animal models and antimicrobial activity against bacteria and fungi; further, they show potential for therapeutic applications and are used in treating various human diseases. Overall, this review can help deepen the current understanding of the role of biotechnological approaches and the importance of phytocannabinoids in different industrial applications.
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Affiliation(s)
| | - Awdhesh Kumar Mishra
- Department of Biotechnology, Yeungnam University, Gyeongsan 38541, Gyeongbuk, Republic of Korea
| | - Kiu-Hyung Cho
- Gyeongbuk Institute for Bioindustry, Andong 36618, Gyeongbuk, Republic of Korea
| | - Ki-Hyun Kim
- Gyeongbuk Institute for Bioindustry, Andong 36618, Gyeongbuk, Republic of Korea
| | - Kyoung Mi Yoon
- Gyeongbuk Institute for Bioindustry, Andong 36618, Gyeongbuk, Republic of Korea
| | - Kwang-Hyun Baek
- Department of Biotechnology, Yeungnam University, Gyeongsan 38541, Gyeongbuk, Republic of Korea
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Kurtzman ET, Greene J, Begley R, Drenkard KN. "We want what's best for patients." nurse leaders' attitudes about medical cannabis: A qualitative study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100065. [PMID: 38745605 PMCID: PMC11080284 DOI: 10.1016/j.ijnsa.2022.100065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/07/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022] Open
Abstract
Background The majority of states have legalized medical cannabis. Nurse leaders must be prepared for an increase in patients' use of the drug across all care settings. Objectives To explore nurse leaders' attitudes towards, knowledge of, and experiences with medical cannabis. Design : Descriptive qualitative study design. Participants 28 nurse leaders-19 in four focus groups of 3-7 participants and another 9 in interviews. Methods Semi-structured, one-on-one interviews and focus groups of nurse leaders about their attitudes towards and experiences with patients' use of medical cannabis. Thematic analysis was used to identify themes and subthemes. Results Four major themes were identified: overwhelming support for legalized medical cannabis; importance of overcoming the stereotype of a gateway drug; problematic mismatch between federal and state cannabis policies; and nursing needs to be move involved. Conclusions There was strong support for legalized medical cannabis to meet patients' needs; yet, respondents reported little discussion about or education regarding medical cannabis among nurses. Inconsistent federal and state cannabis policies were viewed as especially problematic and in need of alignment.
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Affiliation(s)
- Ellen T. Kurtzman
- Associate Professor, School of Nursing, The George Washington University, 1919 Pennsylvania Ave., NW, Ste. 500, Washington, DC 20006, U.S
| | - Jessica Greene
- Professor and Luciano Chair of Health Care Policy, Marxe School of Public and International Affairs, Baruch College, City University of New York, 135 East 22nd Street, New York, NY
| | - Robyn Begley
- Chief Executive Officer, American Organization for Nursing Leadership, 155 N. Wacker Dr., Suite 400, Chicago, IL 60606
| | - Karen Neil Drenkard
- Associate Dean, Clinical Practice and Community Engagement, School of Nursing, The George Washington University, 1919 Pennsylvania Ave., NW, Ste. 500, Washington, DC 20006
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Townsend CB, Liss F, Langman C, Mazur D, Stache SA, Sharma S, Stolzenberg DS, Srinivasan M, Pedowitz D, Namdari S, Wang ML, Greis AC, Ilyas AM. Perspectives of Orthopedic Patients on Medical Cannabis: A Survey of More Than 2500 Patients. Orthopedics 2022; 45:e309-e314. [PMID: 36098574 DOI: 10.3928/01477447-20220907-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Nationwide perspectives on cannabis have changed dramatically over recent decades. Although cannabis remains illegal at the federal level, medical cannabis (MC) is now legal in most states, and research has continued to show its effectiveness in a variety of medical conditions. However, both perception and acceptance of MC by the general public are evolving and remain poorly understood. Treating patients effectively with these novel therapeutics requires an understanding of the complex interplay of social and legal factors that could affect patient use. This cross-sectional survey study of more than 2500 patients sought to assess current patient perspectives on MC and to investigate factors related to its use that may represent barriers to broader patient use. Most respondents would consider using MC for chronic pain or other medical conditions. Most respondents were aware of the legal status of MC in their state, and 9 of 10 respondents believed that MC should be legal throughout the United States. General public knowledge of the utility of MC is an area needing improvement because older patients were significantly less likely to believe that MC is safe to use or that MC is safer than prescription opioids. As has been reported in previous literature, social stigma and cost appear to remain barriers for patient use of MC. Our findings provide further insight into current patient perspectives on MC, aiding both medical providers and researchers as we continue to provide access to and research MC. [Orthopedics. 2022;45(6):e309-e314.].
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Clouse G, Penman S, Hadjiargyrou M, Komatsu DE, Thanos PK. Examining the role of cannabinoids on osteoporosis: a review. Arch Osteoporos 2022; 17:146. [PMID: 36401719 DOI: 10.1007/s11657-022-01190-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/11/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE Prior research studies have shown that the endocannabinoid system, influenced by CBD and THC, plays a role in bone remodeling. As both the research on cannabis and use of cannabis continue to grow, novel medicinal uses of both its constituents as well as the whole plant are being discovered. This review examines the role of cannabinoids on osteoporosis, more specifically, the endocannabinoid system and its role in bone remodeling and the involvement of the cannabinoid receptors 1 and 2 in bone health, as well as the effects of Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD), and synthetic cannabinoids on bone. METHODS A comprehensive literature search of online databases including PUBMED was utilized. RESULTS A total of 29 studies investigating the effects of cannabis and/or its constituents as well as the activation or inactivation of cannabinoid receptors 1 and 2 were included and discussed. CONCLUSION While many of the mechanisms are still not yet fully understood, both preclinical and clinical studies show that the effects of cannabis mediated through the endocannabinoid system may prove to be an effective treatment option for individuals with osteoporosis.
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Affiliation(s)
- Grace Clouse
- Behavioral Neuropharmacology and Neuroimaging Laboratory On Addictions (BNNLA), Research Institute On Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA
| | - Samantha Penman
- Behavioral Neuropharmacology and Neuroimaging Laboratory On Addictions (BNNLA), Research Institute On Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA
| | - Michael Hadjiargyrou
- Department of Biological and Chemical Sciences, New York Institute of Technology, Old Westbury, NY, USA
| | - David E Komatsu
- Department of Orthopedics, Stony Brook University, Stony Brook, NY, USA
| | - Panayotis K Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory On Addictions (BNNLA), Research Institute On Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA. .,Department of Psychology, University at Buffalo, Buffalo, NY, 14203, USA.
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10
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Lee C, Round JM, Hanlon JG, Hyshka E, Dyck JR, Eurich DT. Generalized Anxiety Disorder 7-Item (GAD-7) Scores in Medically Authorized Cannabis Patients-Ontario and Alberta, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:470-480. [PMID: 34520280 PMCID: PMC9149533 DOI: 10.1177/07067437211043393] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Despite increasing rates of legalization of medical cannabis worldwide, the current evidence available on its effect on mental health outcomes including anxiety is of mixed results. This study assesses the effect of medical cannabis on generalized anxiety disorder 7-item (GAD-7) scores in adult patients between 2014 and 2019 in Ontario and Alberta, Canada. METHODS An observational cohort study of adults authorized to use medical cannabis. The GAD-7 was administered at the time of the first visit to the clinic and subsequently over the follow-up time period of up to 3.2 years. Overall changes in GAD-7 scores were computed (mean change) and categorized as: no change (<1 point); improvement; or worsening-over time. RESULTS A total of 37,303 patients had initial GAD-7 scores recorded and 5,075 (13.6%) patients had subsequent GAD-7 follow-up scores. The average age was 54.2 years (SD 15.7 years), 46.0% were male, and 45.6% noted anxiety symptoms at the baseline. Average GAD-7 scores were 9.11 (SD 6.6) at the baseline and after an average of 282 days of follow-up (SD 264) the average final GAD-7 score recorded was 9.04 (SD 6.6): mean change -0.23 (95% CI, -0.28 to -0.17, t[5,074]: -8.19, p-value <0.001). A total of 4,607 patients (90.8%) had no change in GAD-7 score from their initial to final follow-up, 188 (3.7%) had a clinically significant decrease, and 64 (1.3%) noted a clinically significant increase in their GAD-7 scores. CONCLUSIONS Overall, there was a statistically significant decrease in GAD-7 scores over time (in particular, in the 6-12-month period). However, this change did not meet the threshold to be considered clinically significant. Thus, we did not detect clinical improvements or detriment in GAD-7 scores in medically authorized cannabis patients. However, future well-controlled clinical trials are needed to fully examine risks or benefits associated with using medical cannabis to treat anxiety conditions.
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Affiliation(s)
- Cerina Lee
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jessica M. Round
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - John G. Hanlon
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jason R.B. Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T. Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Ng JY, Chang N. A bibliometric analysis of the cannabis and cannabinoid research literature. J Cannabis Res 2022; 4:25. [PMID: 35610633 PMCID: PMC9131698 DOI: 10.1186/s42238-022-00133-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/12/2022] [Indexed: 11/12/2022] Open
Abstract
Background Cannabis refers to a plant in the family Cannabaceae, which has been used medically, recreationally, and industrially. The last two decades, in particular, have seen a large increase in the volume of literature on this topic. The present bibliometric analysis aims to capture the characteristics of scholarly journal publications on the topic of cannabis and cannabinoid research. Methods Searches were run on the Scopus database on April 02, 2021, as follows “(TITLE (cannabi* OR hashish OR marijuana OR marihuana)) AND ( LIMIT-TO ( DOCTYPE,"ar" ) OR LIMIT-TO ( DOCTYPE,"re" ) )”. Results were exported on the same day to prevent discrepancies between daily database updates. Only “article” and “review” publication types were included; no further search limits were applied. The “article” publication type includes publications featuring original research, whereas “review” includes reviews and conference papers. The following data were collected: number of publications (in total and per year), authors, and journals; open access status; publications per journal; journals publishing the highest volume of literature and their impact factors, language of publication; document type; publication country; author affiliations; funding sponsors; most highly cited publications; and most highly published authors. Trends in this subset of publications were identified and presented. Bibliometric networks were constructed using the software tool VOSviewer. Results A total of 29 802 publications (10 214 open access), published by 65 109 authors, were published in 5474 journals from 1829 to 2021. The greatest number of publications was published over the last 20 years. The journal that published the largest number of publications was Drug and Alcohol Dependence (n = 705). The most productive countries included the USA (n = 12 420), the UK (n = 2236), and Canada (n = 2062); many of the most common institutional affiliations and funding sponsors originated from these countries. Conclusions The number of publications published on the topic of cannabis follows an upward trend. Over the past 20 years, the volume of cannabis research has grown steeply, which can be attributed to a large amount of funding dedicated to researching this topic. Future research should continue to investigate changes in the publication characteristics of emerging research, as the volume of publications on this topic is expected to rapidly grow. Supplementary Information The online version contains supplementary material available at 10.1186/s42238-022-00133-0.
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Affiliation(s)
- Jeremy Y Ng
- Michael G. DeGroote Centre for Learning and Discovery, Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Room 2112, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
| | - Nathan Chang
- Michael G. DeGroote Centre for Learning and Discovery, Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Room 2112, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
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12
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Tomsič K, Rakinić K, Seliškar A. Slovenian Pet Owners' Experience, Attitudes, and Predictors Regarding Cannabinoid Use in Dogs and Cats. Front Vet Sci 2022; 8:796673. [PMID: 35071387 PMCID: PMC8767012 DOI: 10.3389/fvets.2021.796673] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/09/2021] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to assess the personal experience and attitudes of Slovenian pet owners regarding cannabinoid (CBD) use and to identify the predictors of the first use and reuse of CBDs in dogs and cats. We hypothesized that positive attitudes toward CBDs, postmodern health values, and personal experience would be significant predictors of CBD use in animals. An open online survey targeted randomly selected Slovenian dog and cat owners, regardless of their experience with cannabis products. The questionnaire consisted of six sections related to demographic data and personal experience with CBD use, information about the participant's animal, experience with CBD use in the participant's animal, reasons for not using CBDs in their animal, attitudes toward CBD use in dogs and cats, and postmodern health values. Descriptive statistics were performed to analyze demographics, personal experience with CBD use, and experience with CBD use in dogs and cats. Hierarchical multiple regression using the enter method was performed to analyze the important predictors of CBD use. A total of 408 completed questionnaires were included in the statistical analysis. A substantial proportion (38.5%) of owners had already used CBDs to treat their animal. Positive attitudes and previous personal experience were significant (p < 0.05) predictors of first use and reuse of CBDs in pets, while postmodern health values were not. In conclusion, the decision to use CBDs for medicinal purposes is based on acquired information and personal experience. Veterinarians should be informed and familiar with CBDs as a treatment option. However, further research is essential to establish the use of CBDs in veterinary medicine. Improved laws and regulations are also needed to ensure that only high-quality medications are prescribed to dogs and cats.
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Affiliation(s)
- Katerina Tomsič
- Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Kristina Rakinić
- Faculty of Social Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Alenka Seliškar
- Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
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13
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Boeri M, Pereira E, Minkova A, Marcato K, Martinez E, Woodall D. Green Hope: Perspectives on Cannabis from People who Use Opioids. SOCIOLOGICAL INQUIRY 2021; 91:668-695. [PMID: 34538961 PMCID: PMC8446945 DOI: 10.1111/soin.12359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
While states are implementing policies to legalize cannabis for medical or recreational purposes, it remains a Schedule 1 controlled substance with no medical uses according to US federal law. The perception of cannabis depends on social and cultural norms that impact political institutions involved in implementing policy. Because of negative social constructions, such as the "gateway hypothesis," legalization of cannabis has been slow and contentious. Recent studies suggest that cannabis can help combat the opioid epidemic. This paper fills a gap in our understanding of how cannabis is viewed by people who are actively misusing opioids and not in treatment. Using ethnographic methods to recruit participants living in a state that legalized cannabis and a state where cannabis was illegal, survey and interview data were analyzed informed by a social constructionist lens. Findings from their "insider perspective" suggest that for some people struggling with problematic opioid use, cannabis can be beneficial.
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14
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Ahmed I, Rehman SU, Shahmohamadnejad S, Zia MA, Ahmad M, Saeed MM, Akram Z, Iqbal HMN, Liu Q. Therapeutic Attributes of Endocannabinoid System against Neuro-Inflammatory Autoimmune Disorders. Molecules 2021; 26:3389. [PMID: 34205169 PMCID: PMC8199938 DOI: 10.3390/molecules26113389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/11/2021] [Accepted: 05/29/2021] [Indexed: 02/05/2023] Open
Abstract
In humans, various sites like cannabinoid receptors (CBR) having a binding affinity with cannabinoids are distributed on the surface of different cell types, where endocannabinoids (ECs) and derivatives of fatty acid can bind. The binding of these substance(s) triggers the activation of specific receptors required for various physiological functions, including pain sensation, memory, and appetite. The ECs and CBR perform multiple functions via the cannabinoid receptor 1 (CB1); cannabinoid receptor 2 (CB2), having a key effect in restraining neurotransmitters and the arrangement of cytokines. The role of cannabinoids in the immune system is illustrated because of their immunosuppressive characteristics. These characteristics include inhibition of leucocyte proliferation, T cells apoptosis, and induction of macrophages along with reduced pro-inflammatory cytokines secretion. The review seeks to discuss the functional relationship between the endocannabinoid system (ECS) and anti-tumor characteristics of cannabinoids in various cancers. The therapeutic potential of cannabinoids for cancer-both in vivo and in vitro clinical trials-has also been highlighted and reported to be effective in mice models in arthritis for the inflammation reduction, neuropathic pain, positive effect in multiple sclerosis and type-1 diabetes mellitus, and found beneficial for treating in various cancers. In human models, such studies are limited; thereby, further research is indispensable in this field to get a conclusive outcome. Therefore, in autoimmune disorders, therapeutic cannabinoids can serve as promising immunosuppressive and anti-fibrotic agents.
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Affiliation(s)
- Ishtiaq Ahmed
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530005, China;
- School of Medical Science, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia;
| | - Saif Ur Rehman
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530005, China;
| | - Shiva Shahmohamadnejad
- Department of Clinical Biochemistry, School of medicine, Tehran University of Medical Sciences, Tehran 14176-13151, Iran;
| | - Muhammad Anjum Zia
- Enzyme Biotechnology Laboratory, Department of Biochemistry, University of Agriculture, Faisalabad 38040, Pakistan; (M.A.Z.); (M.M.S.)
| | - Muhammad Ahmad
- Faculty of Veterinary Sciences, Shaheed Benazir Bhutto University of Veterinary and Animal Sciences (SBBUVAS), Sakrand 67210, Pakistan;
| | - Muhammad Muzammal Saeed
- Enzyme Biotechnology Laboratory, Department of Biochemistry, University of Agriculture, Faisalabad 38040, Pakistan; (M.A.Z.); (M.M.S.)
| | - Zain Akram
- School of Medical Science, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia;
| | - Hafiz M. N. Iqbal
- Tecnologico de Monterrey, School of Engineering and Sciences, 64849 Monterrey, Mexico;
| | - Qingyou Liu
- State Key Laboratory for Conservation and Utilization of Subtropical Agro-Bioresources, Guangxi University, Nanning 530005, China;
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15
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Winiger EA, Ellingson JM, Morrison CL, Corley RP, Pasman JA, Wall TL, Hopfer CJ, Hewitt JK. Sleep deficits and cannabis use behaviors: an analysis of shared genetics using linkage disequilibrium score regression and polygenic risk prediction. Sleep 2021; 44:zsaa188. [PMID: 32935850 PMCID: PMC7953210 DOI: 10.1093/sleep/zsaa188] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/27/2020] [Indexed: 12/17/2022] Open
Abstract
STUDY OBJECTIVES Estimate the genetic relationship of cannabis use with sleep deficits and an eveningness chronotype. METHODS We used linkage disequilibrium score regression (LDSC) to analyze genetic correlations between sleep deficits and cannabis use behaviors. Secondly, we generated sleep deficit polygenic risk score (PRS) and estimated their ability to predict cannabis use behaviors using linear and logistic regression. Summary statistics came from existing genome-wide association studies of European ancestry that were focused on sleep duration, insomnia, chronotype, lifetime cannabis use, and cannabis use disorder (CUD). A target sample for PRS prediction consisted of high-risk participants and participants from twin/family community-based studies (European ancestry; n = 760, male = 64%; mean age = 26.78 years). Target data consisted of self-reported sleep (sleep duration, feeling tired, and taking naps) and cannabis use behaviors (lifetime ever use, number of lifetime uses, past 180-day use, age of first use, and lifetime CUD symptoms). RESULTS Significant genetic correlation between lifetime cannabis use and an eveningness chronotype (rG = 0.24, p < 0.001), as well as between CUD and both short sleep duration (<7 h; rG = 0.23, p = 0.017) and insomnia (rG = 0.20, p = 0.020). Insomnia PRS predicted earlier age of first cannabis use (OR = 0.92, p = 0.036) and increased lifetime CUD symptom count (OR = 1.09, p = 0.012). CONCLUSION Cannabis use is genetically associated with both sleep deficits and an eveningness chronotype, suggesting that there are genes that predispose individuals to both cannabis use and sleep deficits.
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Affiliation(s)
- Evan A Winiger
- Institute for Behavioral Genetics, University of Colorado Boulder, CO
- Department of Psychology and Neuroscience, University of Colorado Boulder, CO
| | - Jarrod M Ellingson
- Institute for Behavioral Genetics, University of Colorado Boulder, CO
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
| | - Claire L Morrison
- Institute for Behavioral Genetics, University of Colorado Boulder, CO
- Department of Psychology and Neuroscience, University of Colorado Boulder, CO
| | - Robin P Corley
- Institute for Behavioral Genetics, University of Colorado Boulder, CO
| | - Joëlle A Pasman
- Behavioural Science Institute, Radboud University Nijmegen, Amsterdam, The Netherlands
| | - Tamara L Wall
- Department of Psychiatry, University of California, San Diego, CA
| | - Christian J Hopfer
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
| | - John K Hewitt
- Institute for Behavioral Genetics, University of Colorado Boulder, CO
- Department of Psychology and Neuroscience, University of Colorado Boulder, CO
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16
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Stasiłowicz A, Tomala A, Podolak I, Cielecka-Piontek J. Cannabis sativa L. as a Natural Drug Meeting the Criteria of a Multitarget Approach to Treatment. Int J Mol Sci 2021; 22:E778. [PMID: 33466734 PMCID: PMC7830475 DOI: 10.3390/ijms22020778] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/30/2020] [Accepted: 01/11/2021] [Indexed: 12/15/2022] Open
Abstract
Cannabis sativa L. turned out to be a valuable source of chemical compounds of various structures, showing pharmacological activity. The most important groups of compounds include phytocannabinoids and terpenes. The pharmacological activity of Cannabis (in epilepsy, sclerosis multiplex (SM), vomiting and nausea, pain, appetite loss, inflammatory bowel diseases (IBDs), Parkinson's disease, Tourette's syndrome, schizophrenia, glaucoma, and coronavirus disease 2019 (COVID-19)), which has been proven so far, results from the affinity of these compounds predominantly for the receptors of the endocannabinoid system (the cannabinoid receptor type 1 (CB1), type two (CB2), and the G protein-coupled receptor 55 (GPR55)) but, also, for peroxisome proliferator-activated receptor (PPAR), glycine receptors, serotonin receptors (5-HT), transient receptor potential channels (TRP), and GPR, opioid receptors. The synergism of action of phytochemicals present in Cannabis sp. raw material is also expressed in their increased bioavailability and penetration through the blood-brain barrier. This review provides an overview of phytochemistry and pharmacology of compounds present in Cannabis extracts in the context of the current knowledge about their synergistic actions and the implications of clinical use in the treatment of selected diseases.
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Affiliation(s)
- Anna Stasiłowicz
- Department of Pharmacognosy, Poznan University of Medical Sciences, Swiecickiego 4, 61-781 Poznan, Poland;
| | - Anna Tomala
- Department of Pharmacognosy, Medical College, Jagiellonian University, Medyczna 9, 30-688 Cracow, Poland; (A.T.); (I.P.)
| | - Irma Podolak
- Department of Pharmacognosy, Medical College, Jagiellonian University, Medyczna 9, 30-688 Cracow, Poland; (A.T.); (I.P.)
| | - Judyta Cielecka-Piontek
- Department of Pharmacognosy, Poznan University of Medical Sciences, Swiecickiego 4, 61-781 Poznan, Poland;
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17
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Winiger EA, Hitchcock LN, Bryan AD, Cinnamon Bidwell L. Cannabis use and sleep: Expectations, outcomes, and the role of age. Addict Behav 2021; 112:106642. [PMID: 32949837 PMCID: PMC7572650 DOI: 10.1016/j.addbeh.2020.106642] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVES Determine relationship between cannabis use with 1) expectations of cannabis being a sleep aid, 2) subjective sleep outcomes, and 3) the influence of age on these relationships. METHODS In 152 moderate cannabis users with a wide age range (67% female, mean age = 31.45, SD = 12.96, age range = 21-70; mean days of cannabis use in prior two weeks = 5.54, SD = 5.25) we examined the influence of cannabis use history and behaviors on expectations of cannabis being a sleep aid and sleep outcomes via the Pittsburgh Sleep Quality Index (PSQI). Moderation analysis examined the role of age in the relationship between cannabis use and sleep outcomes. RESULTS Endorsing current cannabis use and more days of cannabis use were associated with increased expectations that cannabis use improves sleep (all β > 0.03, p < 0.04). Frequency of recent use and reported average THC or CBD concentration were largely not associated with sleep outcomes. However, endorsing current cannabis use was associated with worse subjective sleep quality (β = 1.34, p = 0.02) and increased frequency of consuming edibles was associated with worse subjective sleep efficiency (β = 0.03, p = 0.04), lower sleep duration (β = 0.03, p = 0.01), and higher global PSQI scores (worse overall sleep) (β = 0.10, p = 0.01). Additionally, age had a moderating influence on the relationship between increased self-reported concentration of CBD and both better sleep duration and sleep quality (both p < 0.03). While the main effects of cannabis use on sleep outcomes did not survive multiple comparisons correction test (all p adj > 0.34), the adjusted p values for the main effects of cannabis behaviors/history on expectations of cannabis as a sleep aid (p adj = 0.07-0.09) and the main effects of CBD concentration on sleep duration (p adj = 0.08), as well as the interaction terms of CBD and age for that model (p adj = 0.07), were trending. CONCLUSION Cannabis users have increased expectations of cannabis being a sleep aid, but few associations existed between cannabis use and sleep outcomes. The two exceptions were endorsing any cannabis use and frequency of edible use. Additionally, age may be an important moderator of the potential positive influence CBD concentration can have on sleep.
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Affiliation(s)
- Evan A Winiger
- Institute for Behavioral Genetics, University of Colorado, Boulder. East Campus, 1480 30(th) Street, Boulder, CO 80309, United States; Department of Psychology and Neuroscience, University of Colorado, Boulder, Muenzinger Psychology Building, 1905 Colorado Ave, Boulder, CO 80309, United States.
| | - Leah N Hitchcock
- Institute of Cognitive Science, University of Colorado, Boulder.Center for Innovation and Creativity, 1777 E Exposition Drive, Boulder, CO 80301, United States
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Muenzinger Psychology Building, 1905 Colorado Ave, Boulder, CO 80309, United States; Institute of Cognitive Science, University of Colorado, Boulder.Center for Innovation and Creativity, 1777 E Exposition Drive, Boulder, CO 80301, United States
| | - L Cinnamon Bidwell
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Muenzinger Psychology Building, 1905 Colorado Ave, Boulder, CO 80309, United States; Institute of Cognitive Science, University of Colorado, Boulder.Center for Innovation and Creativity, 1777 E Exposition Drive, Boulder, CO 80301, United States
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18
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Pérez-Acevedo AP, Pacifici R, Mannocchi G, Gottardi M, Poyatos L, Papaseit E, Pérez-Mañá C, Martin S, Busardò FP, Pichini S, Farré M. Disposition of cannabinoids and their metabolites in serum, oral fluid, sweat patch and urine from healthy individuals treated with pharmaceutical preparations of medical cannabis. Phytother Res 2020; 35:1646-1657. [PMID: 33155722 DOI: 10.1002/ptr.6931] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/07/2022]
Abstract
Recently, several countries authorized the use of cannabis flowering tops (dried inflorescences) with a standardized amount of Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD) and their acidic precursors [Δ-9-tetrahydrocannabinolic acid A (THCA-A) and cannabidiolic acid (CBDA)] to treat neurogenic pain. We studied the acute pharmacological effects and disposition of cannabinoids and their metabolites in serum, oral fluid, sweat patch and urine of 13 healthy individuals treated with medical cannabis decoction and oil. Cannabinoids and their metabolites were quantified by ultrahigh performance tandem mass spectrometry. Even if the oil contained a significantly higher amount of THC, the absorption of THC and its metabolites were similar in both herbal preparations. Conversely, whereas oil contained a significantly higher amount of CBD and a lower amount of CBDA, absorption was significantly higher after decoction intake. Only cannabinoids present in both herbal preparations (THC, CBD, THCA-A and CBDA) were found in oral fluid, due to the higher acidity compared with that of serum. THC metabolites urinary excretion was always higher after decoction administration. Decoction induced greater feeling of hunger and drowsiness than oil preparation. Pharmacokinetics of cannabinoids, their precursors and their metabolites in biological fluids of individuals treated with cannabis decoction and oil showed a high interindividual variability. The aqueous preparation was generally better absorbed than the oil, even if it contained a minor amount of THC, THCA-A and CBD.
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Affiliation(s)
- Ana P Pérez-Acevedo
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roberta Pacifici
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Lourdes Poyatos
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esther Papaseit
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Clara Pérez-Mañá
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Soraya Martin
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesco P Busardò
- Department of Excellence - Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Magí Farré
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
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19
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Round JM, Lee C, Hanlon JG, Hyshka E, Dyck JRB, Eurich DT. Changes in patient health questionnaire (PHQ-9) scores in adults with medical authorization for cannabis. BMC Public Health 2020; 20:987. [PMID: 32576158 PMCID: PMC7310462 DOI: 10.1186/s12889-020-09089-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
Background Legal access to medical cannabis is increasing world-wide. Despite this, there is a lack of evidence surrounding its efficacy on mental health outcomes, particularly, on depression. This study assesses the effect of medical cannabis on Patient Health Questionnaire (PHQ-9) scores in adult patients between 2014 and 2019 in Ontario and Alberta, Canada. Methods An observational cohort study of medically authorized cannabis patients in Ontario and Alberta. Overall change in PHQ-9 scores from baseline to follow-up were evaluated (mean change) over a time period of up to 3.2 years. Results 37,338 patients from the cohort had an initial PHQ-9 score recorded with 5103 (13.7%) patients having follow-up PHQ-9 scores. The average age was 54 yrs. (SD 15.7), 46% male, 50% noted depression at baseline. The average PHQ-9 score at baseline was 10.5 (SD 6.9), following a median follow-up time of 196 days (IQR: 77–451) the average final PHQ-9 score was 10.3 (SD 6.8) with a mean change of − 0.20 (95% CI: − 0.26, − 0.14, p-value < 0.0001). Overall, 4855 (95.1%) had no clinically significant change in their PHQ-9 score following medical cannabis use while 172 (3.4%) reported improvement and 76 (1.5%) reported worsening of their depression symptoms. Conclusions Although the majority showed no clinically important changes in PHQ-9 scores, a number of patients showed improvement or deteriorations in PHQ-9 scores. Future studies should focus on the parallel use of screening questionnaires to control for PHQ-9 sensitivity and to explore potential factors that may have attributed to the improvement in scores pre- and post- 3-6 month time period.
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Affiliation(s)
- Jessica M Round
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Cerina Lee
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - John G Hanlon
- St. Michael's Hospital Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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20
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Inglet S, Winter B, Yost SE, Entringer S, Lian A, Biksacky M, Pitt RD, Mortensen W. Clinical Data for the Use of Cannabis-Based Treatments: A Comprehensive Review of the Literature. Ann Pharmacother 2020; 54:1109-1143. [DOI: 10.1177/1060028020930189] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: To compile and synthesize the available literature describing medical cannabis use across various disease states. Data Sources: PubMed, EBSCO, and Google Scholar searches were conducted using MeSH and/or keywords. Study Selection and Data Extraction: Studies were included if they described the use of cannabis-based products and medications in the treatment of a predefined list of disease states in humans and were published in English. The extraction period had no historical limit and spanned through April 2019. Data Synthesis: Evidence was compiled and summarized for the following medical conditions: Alzheimer disease, amyotrophic lateral sclerosis, autism, cancer and cancer-associated adverse effects, seizure disorders, human immunodeficiency virus, inflammatory bowel disease, multiple sclerosis (MS), nausea, pain, posttraumatic stress disorder, and hospice care. Relevance to Patient Care and Clinical Practice: Based on identified data, the most robust evidence suggests that medical cannabis may be effective in the treatment of chemotherapy-induced nausea and vomiting, seizure disorders, MS-related spasticity, and pain (excluding diabetic neuropathy). Overall, the evidence is inconsistent and generally limited by poor quality. The large variation in cannabis-based products evaluated in studies limits the ability to make direct comparisons. Regardless of the product, a gradual dose titration was utilized in most studies. Cannabis-based therapies were typically well tolerated, with the most common adverse effects being dizziness, somnolence, dry mouth, nausea, and euphoria. Conclusions: As more states authorize medical cannabis use, there is an increasing need for high-quality clinical evidence describing its efficacy and safety. This review is intended to serve as a reference for clinicians, so that the risks and realistic benefits of medical cannabis are better understood.
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Affiliation(s)
| | | | | | | | - Anh Lian
- Intermountain Healthcare, Taylorsville, UT, USA
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21
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Dalal RS, Palchaudhuri S, Snider CK, Lewis JD, Mehta SJ, Lichtenstein GR. Preadmission Cannabis Use Is Positively Correlated With Inpatient Opioid Dose Exposure in Hospitalized Patients With Inflammatory Bowel Diseases. Inflamm Bowel Dis 2020; 27:500-506. [PMID: 32440693 PMCID: PMC7957224 DOI: 10.1093/ibd/izaa104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Opioid use is associated with excess mortality in patients with inflammatory bowel disease (IBD). Recent data have highlighted that inpatient opioid exposure is associated with postdischarge opioid use in this population. It is unknown if preadmission use of cannabis, which is commonly used for symptom relief among patients with IBD, increases the risk for inpatient opioid exposure when patients lack access to cannabis for symptom management. We sought to determine the association between preadmission cannabis use and inpatient opioid exposure while adjusting for relevant confounders. METHODS We performed a retrospective cohort study of adult patients hospitalized for IBD within a large academic health system from March 1, 2017, to April 10, 2018. Opioid exposure was calculated by converting the sum of administered opioid doses to intravenous morphine milligram equivalents and dividing by length of stay. We used multivariable linear regression to assess the association between cannabis use and inpatient opioid exposure while adjusting for confounders including IBD severity and preadmission opioid use. RESULTS Our study included 423 IBD patients. Linear regression analysis showed a significant positive correlation between inpatient opioid exposure (intravenous morphine milligram equivalents divided by length of stay) and preadmission cannabis use (coefficient = 12.1; 95% confidence interval [CI], 2.6-21.5). Other significantly associated variables were first patient-reported pain score (coefficient = 1.3; 95% CI, 0.6-2.0) and preadmission opioid use (coefficient = 22.3; 95% CI, 17.0-27.6). CONCLUSIONS Cannabis use is positively correlated with inpatient opioid exposure after controlling for confounders. A personalized pain management approach should be considered to limit inpatient and possibly future opioid exposure among hospitalized patients with IBD who use cannabis.
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Affiliation(s)
- Rahul S Dalal
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sonali Palchaudhuri
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Christopher K Snider
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James D Lewis
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shivan J Mehta
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gary R Lichtenstein
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Address correspondence to: Gary R. Lichtenstein, Perelman Center for Advanced Medicine, 7 Floor South Pavilion Room 753, 3400 Civic Center Boulevard, Philadelphia, PA 19104 ()
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22
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Devsi A, Kiyota B, Ouellette T, Hegle AP, Rivera-Acevedo RE, Wong J, Dong Y, Pugsley MK, Fung T. A pharmacological characterization of Cannabis sativa chemovar extracts. J Cannabis Res 2020; 2:17. [PMID: 33526117 PMCID: PMC7819338 DOI: 10.1186/s42238-020-00026-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/22/2020] [Indexed: 01/05/2023] Open
Abstract
Background Cannabis contains Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) as the primary constituents responsible for pharmacological activity. However, there are numerous additional chemically-related structures to Δ9–THC and CBD that are pharmacologically active and may influence the pharmacological properties of Δ9-THC and CBD. This study chemically characterized the cannabinoid constituents in a series of cannabis chemovar extracts and investigated the potential cannabinoid entourage effect in two behavioral assays. Methods Six chemovar extracts were compared to pure Δ9-THC, CBD and morphine for effects on the following behavioral assays in mice: hot plate and tail suspension. The battery of behavioral tests was conducted post intravenous administration of cannabis chemovar extract. Cannabinoid profiles of extracts were analyzed using high performance liquid chromatography. Cannabis extracts were administered at equal doses of Δ9-THC to investigate the role of their cannabinoid profiles in modulating the effects of Δ9-THC. Dose response curves were fit using a log[inhibitor] vs response three parameter model and differences between group means were determined using a one-way ANOVA followed by a post hoc test. Results Cannabis chemovars tested in this study exhibited substantially different cannabinoid profiles. All chemovars produced dose-dependent immobility in the tail suspension assay and dose-dependent antinociception in the hot plate assay. The maximum antinociceptive effect and ED50 was comparable between cannabis chemovars and Δ9-THC. Two cannabis chemovars produced significantly greater immobility in the tail suspension test, with no significant differences in ED50. Conclusions Commercially available cannabis chemovars vary widely in cannabinoid content, but when equalized for Δ9-THC content, they produce similar behavioral effects with two exceptions. These findings provide only limited support for the entourage hypothesis. Further studies are necessary to characterize the nature of these pharmacological differences between cannabis chemovars and pure Δ9-THC.
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Affiliation(s)
- Alykhan Devsi
- Department of Pharmacology & Toxicology, Cannevert Therapeutics Ltd., 2176 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Brett Kiyota
- Department of Pharmacology & Toxicology, Cannevert Therapeutics Ltd., 2176 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Theophile Ouellette
- Department of Pharmacology & Toxicology, Cannevert Therapeutics Ltd., 2176 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Andrew P Hegle
- Department of Pharmacology & Toxicology, Cannevert Therapeutics Ltd., 2176 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ricardo E Rivera-Acevedo
- Department of Pharmacology & Toxicology, Cannevert Therapeutics Ltd., 2176 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jasper Wong
- Department of Pharmacology & Toxicology, Cannevert Therapeutics Ltd., 2176 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ying Dong
- Department of Pharmacology & Toxicology, Cannevert Therapeutics Ltd., 2176 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Michael K Pugsley
- Department of Pharmacology & Toxicology, Cannevert Therapeutics Ltd., 2176 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Timothy Fung
- Department of Pharmacology & Toxicology, Cannevert Therapeutics Ltd., 2176 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
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23
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Wu Q, Slesnick N. Substance Abusing Mothers with a History of Childhood Abuse and Their Children's Depressive Symptoms: The Efficacy of Family Therapy. JOURNAL OF MARITAL AND FAMILY THERAPY 2020; 46:81-94. [PMID: 30368852 PMCID: PMC6487235 DOI: 10.1111/jmft.12364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study examined the associations among maternal history of childhood abuse, substance use, and depressive symptoms and the change in children's depressive symptoms in therapy. Mothers (N = 183) were randomly assigned into either a family or an individual treatment condition. Mothers were assessed for their childhood abuse retrospectively, baseline depressive symptoms, and substance use, whereas their children's depressive symptoms were measured five times during 1.5 years. Maternal childhood abuse was associated with a slower decline in child depressive symptoms through elevated maternal depressive symptoms, only in individual treatment. Maternal substance use further moderated this mediation pathway. This study supports the efficacy of family therapy in protecting children of mothers with a substance use disorder and a history of childhood abuse.
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Affiliation(s)
- Qiong Wu
- Department of Family and Child Sciences, College of Human Sciences, Florida State University. Address: 322 Sandels Building, 120 Convocation Way, Tallahassee, FL 32306
- Department of Human Sciences, The Ohio State University. Address: Campbell Hall Room 135, 1787 Neil Ave., Columbus, OH 43210
| | - Natasha Slesnick
- Department of Human Sciences, The Ohio State University. Address: Campbell Hall Room 135, 1787 Neil Ave., Columbus, OH 43210
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24
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Brunelle E, Thibodeau B, Shoemaker A, Halámek J. Step toward Roadside Sensing: Noninvasive Detection of a THC Metabolite from the Sweat Content of Fingerprints. ACS Sens 2019; 4:3318-3324. [PMID: 31793770 DOI: 10.1021/acssensors.9b02020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The sudden increase in states legalizing marijuana has forced law enforcement into a situation where the use and consumption are legal, but there are no limitations for what is acceptable for driving or operating machinery. Using ultraviolet-visible (UV-vis) spectroscopy, fingerprints from volunteers who had used marijuana were analyzed via a competitive immunoassay for the detection of Δ9-tetrahydrocannabinol (Δ9-THC), the main psychoactive component of marijuana, and 11-nor-9-carboxy-THC (THC-COOH), one of the main metabolites produced in the body following the use/consumption of THC-related products. In this research, the THC-COOH metabolite and the enzyme-labeled conjugate compete against each other as the antigens for the system. The antibody used in this assay has a greater affinity for the metabolite; so, as its concentration increases, the absorbance of the system decreases due to less binding of the enzyme-labeled conjugate.
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Affiliation(s)
- Erica Brunelle
- Dept. of Chemistry, University at Albany State University of New York, 1400 Washington Ave., Albany, New York 12222, United States
| | - Brenna Thibodeau
- Dept. of Chemistry, University at Albany State University of New York, 1400 Washington Ave., Albany, New York 12222, United States
| | - Alyssa Shoemaker
- Dept. of Chemistry, University at Albany State University of New York, 1400 Washington Ave., Albany, New York 12222, United States
| | - Jan Halámek
- Dept. of Chemistry, University at Albany State University of New York, 1400 Washington Ave., Albany, New York 12222, United States
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25
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Cecconi S, Rapino C, Di Nisio V, Rossi G, Maccarrone M. The (endo)cannabinoid signaling in female reproduction: What are the latest advances? Prog Lipid Res 2019; 77:101019. [PMID: 31862482 DOI: 10.1016/j.plipres.2019.101019] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/11/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023]
Abstract
Cannabis extracts like marijuana have the highest consumption rate worldwide. Yet, their societal acceptance as recreational and therapeutic drugs could represent a serious hazard to female human reproduction, because cannabis ingredients [termed (phyto)cannabinoids] can perturb an endogenous system of lipid signals known as endocannabinoids. Accumulated evidence on animal models and humans has demonstrated a crucial role of these endogenous signals on different aspects of female reproduction, where they act through an ensamble of proteins that synthesize, transport, degrade and traffic them. Several reports have recently evidenced the potential role of endocannabinoids as biomarkers of female infertility for disease treatment and prevention, as well as their possible epigenetic effects on pregnancy. The purpose of this review is to provide an update of data collected in the last decade on the effects of cannabinoids and endocannabinoids on female reproductive events, from development and maturation of follicles and oocytes, to fertilization, oviductal transport, implantation and labor. In this context, a particular attention has been devoted to the ovary and the production of fertilizable oocytes, because recent studies have addressed this hot topic with conflicting results among species.
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Affiliation(s)
- Sandra Cecconi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Cinzia Rapino
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy.
| | - Valentina Di Nisio
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Gianna Rossi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Mauro Maccarrone
- Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy; European Center for Brain Research (CERC)/Santa Lucia Foundation, Via del Fosso di Fiorano, 64 - 00143 Rome, Italy.
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26
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Belackova V, Shanahan M, Ritter A. Mapping regulatory models for medicinal cannabis: a matrix of options. AUST HEALTH REV 2019; 42:403-411. [PMID: 28553995 DOI: 10.1071/ah16257] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/04/2017] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to develop a framework for assessing regulatory options for medicinal cannabis in Australia. Methods International regulatory regimes for medicinal cannabis were reviewed with a qualitative policy analysis approach and key policy features were synthesised, leading to a conceptual framework that facilitates decision making across multiple dimensions. Results Two central organising dimensions of medicinal cannabis regulation were identified: cannabis supply and patient authorisation (including patient access). A number of the different supply options can be matched with a number of different patient authorisation options, leading to a matrix of possible regulatory regimes. Conclusions The regulatory options, as used internationally, involve different forms of cannabis (synthetic and plant-based pharmaceutical preparations or herbal cannabis) and the varying extent to which patient authorisation policies and procedures are stringently or more loosely defined. The optimal combination of supply and patient authorisation options in any jurisdiction that chooses to make medicinal cannabis accessible will depend on policy goals. What is known about the topic? Internationally, regulation of medicinal cannabis has developed idiosyncratically, depending on formulations that were made available and local context. There has been no attempt to date in the scientific literature to systematically document the variety of regulatory possibilities for medicinal cannabis. What does this paper add? This paper presents a new conceptual schema for considering options for the regulation of medicinal cannabis, across both supply and patient authorisation aspects. What are the implications for practitioners? The design of regulatory systems in Australia, whether for pharmaceutical or herbal products, is a vital issue for policy makers right now as federal and state and territory governments grapple with the complexities of medicinal cannabis regulation. The conceptual schema presented herein provides a tool for more systematic thinking about the options.
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Affiliation(s)
- Vendula Belackova
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW, 22-32 King Street, Randwick, NSW 2052, Australia.
| | - Marian Shanahan
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW, 22-32 King Street, Randwick, NSW 2052, Australia.
| | - Alison Ritter
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW, 22-32 King Street, Randwick, NSW 2052, Australia.
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27
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Treister-Goltzman Y, Freud T, Press Y, Peleg R. Trends in Publications on Medical Cannabis from the Year 2000. Popul Health Manag 2019; 22:362-368. [DOI: 10.1089/pop.2018.0113] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yulia Treister-Goltzman
- Clalit Health Services, Southern District, Israel
- The Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Freud
- The Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yan Press
- Clalit Health Services, Southern District, Israel
- The Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roni Peleg
- Clalit Health Services, Southern District, Israel
- The Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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28
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Chatkin JM, Zani-Silva L, Ferreira I, Zamel N. Cannabis-Associated Asthma and Allergies. Clin Rev Allergy Immunol 2019; 56:196-206. [PMID: 28921405 DOI: 10.1007/s12016-017-8644-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inhalation of cannabis smoke is its most common use and the pulmonary complications of its use may be the single most common form of drug-induced pulmonary disease worldwide. However, the role of cannabis consumption in asthma patients and allergic clinical situations still remains controversial. To review the evidence of asthma and allergic diseases associated with the use of marijuana, we conducted a search of English, Spanish, and Portuguese medical using the search terms asthma, allergy, marijuana, marihuana, and cannabis. Entries made between January 1970 and March 2017 were retrieved. Several papers have shown the relationship between marijuana use and increase in asthma and other allergic diseases symptoms, as well as the increased frequency of medical visits. This narrative review emphasizes the importance to consider cannabis as a precipitating factor for acute asthma and allergic attacks in clinical practice. Although smoking of marijuana may cause respiratory symptoms, there is a need for more studies to elucidate many aspects in allergic asthma patients, especially considering the long-term use of the drug. These patients should avoid using marijuana and be oriented about individual health risks, possible dangers of second-hand smoke exposure, underage use, safe storage, and the over smoking of marijuana.
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Affiliation(s)
- J M Chatkin
- Division of Respiratory Diseases, School of Medicine Pontificia Universidade Catolica do Rio Grande do Sul, Av Ipiranga 6680 Room 501, Porto Alegre, 90610-000, Brazil.
| | - L Zani-Silva
- Division of Respiratory Diseases, School of Medicine Pontificia Universidade Catolica do Rio Grande do Sul, Av Ipiranga 6680 Room 501, Porto Alegre, 90610-000, Brazil
| | - I Ferreira
- Respirology Division, McMaster University, 399 Bathurst St, Toronto, ON, M5T2S8, Canada
| | - N Zamel
- Department of Medicine, Division of Respiratory Diseases, University of Toronto, 399 Bathurst St, Toronto, ON, M5T2S8, Canada
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29
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Ruiz de Azua I, Lutz B. Multiple endocannabinoid-mediated mechanisms in the regulation of energy homeostasis in brain and peripheral tissues. Cell Mol Life Sci 2019; 76:1341-1363. [PMID: 30599065 PMCID: PMC11105297 DOI: 10.1007/s00018-018-2994-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/22/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023]
Abstract
The endocannabinoid (eCB) system is widely expressed in many central and peripheral tissues, and is involved in a plethora of physiological processes. Among these, activity of the eCB system promotes energy intake and storage, which, however, under pathophysiological conditions, can favour the development of obesity and obesity-related disorders. It is proposed that eCB signalling is evolutionary beneficial for survival under periods of scarce food resources. Remarkably, eCB signalling is increased both in hunger and in overnutrition conditions, such as obesity and type-2 diabetes. This apparent paradox suggests a role of the eCB system both at initiation and at clinical endpoint of obesity. This review will focus on recent findings about the role of the eCB system controlling whole-body metabolism in mice that are genetically modified selectively in different cell types. The current data in fact support the notion that eCB signalling is not only engaged in the development but also in the maintenance of obesity, whereby specific cell types in central and peripheral tissues are key sites in regulating the entire body's energy homeostasis.
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MESH Headings
- Adipose Tissue/metabolism
- Animals
- Brain/metabolism
- Endocannabinoids/metabolism
- Energy Metabolism
- Muscle, Skeletal/metabolism
- Obesity/metabolism
- Obesity/pathology
- Receptor, Cannabinoid, CB1/antagonists & inhibitors
- Receptor, Cannabinoid, CB1/genetics
- Receptor, Cannabinoid, CB1/metabolism
- Receptor, Cannabinoid, CB2/antagonists & inhibitors
- Receptor, Cannabinoid, CB2/genetics
- Receptor, Cannabinoid, CB2/metabolism
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Affiliation(s)
- Inigo Ruiz de Azua
- German Resilience Center (DRZ) and Institute of Physiological Chemistry, University Medical Center of the Johannes Gutenberg University Mainz, Duesbergweg 5, 55128, Mainz, Germany.
| | - Beat Lutz
- German Resilience Center (DRZ) and Institute of Physiological Chemistry, University Medical Center of the Johannes Gutenberg University Mainz, Duesbergweg 5, 55128, Mainz, Germany
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30
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Abstract
Cannabis has been cultivated by mankind for a multitude of uses over a period of thousands of years. This review explores how our relationship with the cannabis plant has evolved over this period of time, including the use of cannabis for recreational purposes and for its medicinal properties. The endocannabinoid system plays a complex role in the development of the fetal, infant and adolescent brain. Use of exogenous cannabinoids has the potential to result in supra-physiological stimulation and impact on normal central nervous system development. Cannabis is the most frequently used recreational drug in western societies and its use is common amongst pregnant women. This review summaries much of the evidence about what is known of the long term effects of in utero cannabis exposure. Further, the potential impact of use of medicinal cannabis products during pregnancy is considered and the implications to health professionals caring for pregnant women and their babies are explored.
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Affiliation(s)
- Philip Henschke
- Department of Paediatrics, Mercy Hospital for Women, Heidelberg, Victoria, Australia.
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31
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Exploring cannabis use by patients with multiple sclerosis in a state where cannabis is legal. Mult Scler Relat Disord 2019; 27:383-390. [DOI: 10.1016/j.msard.2018.11.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 02/07/2023]
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32
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Ebbert JO, Scharf EL, Hurt RT. Medical Cannabis. Mayo Clin Proc 2018; 93:1842-1847. [PMID: 30522595 DOI: 10.1016/j.mayocp.2018.09.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022]
Abstract
Medicolegal realities surrounding "medical marijuana" or "medical cannabis" are rapidly evolving in the United States. Clinicians are increasingly being asked by patients to share information about or certify them for medical cannabis. In order to engage in informed discussions with patients or be comfortable certifying them in states with medical cannabis laws, clinicians may benefit from an understanding of the current state of medical knowledge about medical cannabis. Intended for the generalist and subspecialist, this review provides an overview of the legal status, pharmacology, benefits, risks, and abuse liability of medical cannabis along with a general framework for counseling patients.
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Affiliation(s)
- Jon O Ebbert
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN.
| | | | - Ryan T Hurt
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
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Bahorik AL, Sterling SA, Campbell CI, Weisner C, Ramo D, Satre DD. Medical and non-medical marijuana use in depression: Longitudinal associations with suicidal ideation, everyday functioning, and psychiatry service utilization. J Affect Disord 2018; 241:8-14. [PMID: 30086434 PMCID: PMC6455811 DOI: 10.1016/j.jad.2018.05.065] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 05/07/2018] [Accepted: 05/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Marijuana use is clinically problematic in depression, and non-medical and medical use may both contribute to barriers to care in this population. Among outpatients with depression, we examined the differential impact of medical or non-medical marijuana use, relative to no-use, on psychopathology and service use over time. METHOD Participants were 307 psychiatry outpatients participating in a trial of drug/alcohol use treatment for depression. Measures of past 30-day marijuana use, depression/anxiety symptoms, psychiatry visits, and functional data related to health status were collected at baseline, 3, 6, and 12 months. Regressions (baseline and 1 year) and growth models (over time) predicted clinical and psychiatry visit outcomes, from medical or non-medical marijuana use (no-use = reference). RESULTS At baseline, 40.0% of the sample used marijuana and more reported non-medical (71.7%) than medical (28.2%) use. Relative to non-users at baseline, patients using medically had worse mental/physical health functioning (p's < 0.05), and non-medical use was associated with higher suicidal ideation (B = 1.08, p = .002), worse mental health functioning (B = -3.79, p = .015), and fewer psychiatry visits (B = -0.69, p = .009). Patients using non-medically over time improved less in depression symptoms (B = 1.49, p = .026) and suicidal ideation (B = 1.08, p = .003) than non-users. LIMITATIONS Participants were psychiatry outpatients, limiting generalizability. CONCLUSIONS Marijuana use, especially non-medical use, among patients with depression may impede depression symptom improvement while lessening the likelihood of psychiatry visits. Marijuana use and associated barriers to care should receive consideration by depression treatment providers.
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Affiliation(s)
- Amber L. Bahorik
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143,Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3 Floor, Oakland, CA 94612
| | - Stacy A. Sterling
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3 Floor, Oakland, CA 94612
| | - Cynthia I. Campbell
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143,Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3 Floor, Oakland, CA 94612
| | - Constance Weisner
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143,Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3 Floor, Oakland, CA 94612
| | - Danielle Ramo
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143
| | - Derek D. Satre
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143,Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3 Floor, Oakland, CA 94612
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Stetten N, Pomeranz J, Moorhouse M, Yurasek A, Blue AV. The level of evidence of medical marijuana use for treating disabilities: a scoping review. Disabil Rehabil 2018; 42:1190-1201. [PMID: 30456993 DOI: 10.1080/09638288.2018.1523952] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose: Twenty-nine states have bypassed federal regulations by legalizing marijuana (MJ) either medicinally, recreationally or both. The FDA states that there is no empirical evidence that MJ is effective to treat these disorders. With over a billion individuals living with a disability across the globe, it is crucial to fully research the efficaciousness and safety of medical MJ to treat this population. The purpose to present the results of a scoping review of studies focused on the levels of evidence currently available on medical MJ's efficacy in treatment across a large range of disabilities.Methods: Databases were searched for research articles on the current level of evidence to support medical MJ use among people with disabilities.Results: Forty-one peer reviewed articles met the inclusion criteria. Articles focused on attention deficit hyperactivity disorder, post-traumatic stress disorder, depression, schizophrenia, spinal cord injury, multiple sclerosis/movement disorders, fibromyalgia, epilepsy, with some that focused on multiple disabilities.Conclusions: The level of evidence for the use of medical MJ among people with disabilities varies greatly, and has a clear lack of methodologically sound studies. Overall, medical MJ does not improve the level of functioning, but it may improve the overall quality of life for people with disabilities.Implications for RehabilitationEpilepsy can be a disabling chronic disorder which not only impacts physically but can restricts quality of life.Quality of life is diminished even more with treatment resistant epilepsy.Chronic pain is the leading cause of disability and is the most common cause of long-term disability.There is sufficient evidence that medical marijuana is effective in treating epileptic seizures and chronic pain.Medical marijuana may improve the level of functioning and quality of life for individuals with certain disabilities.
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Affiliation(s)
- Nichole Stetten
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Jamie Pomeranz
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Michael Moorhouse
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Ali Yurasek
- College of Health & Human Performance, University of Florida, Gainesville, FL, USA
| | - Amy V Blue
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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Vučković S, Srebro D, Vujović KS, Vučetić Č, Prostran M. Cannabinoids and Pain: New Insights From Old Molecules. Front Pharmacol 2018; 9:1259. [PMID: 30542280 PMCID: PMC6277878 DOI: 10.3389/fphar.2018.01259] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/15/2018] [Indexed: 01/11/2023] Open
Abstract
Cannabis has been used for medicinal purposes for thousands of years. The prohibition of cannabis in the middle of the 20th century has arrested cannabis research. In recent years there is a growing debate about the use of cannabis for medical purposes. The term ‘medical cannabis’ refers to physician-recommended use of the cannabis plant and its components, called cannabinoids, to treat disease or improve symptoms. Chronic pain is the most commonly cited reason for using medical cannabis. Cannabinoids act via cannabinoid receptors, but they also affect the activities of many other receptors, ion channels and enzymes. Preclinical studies in animals using both pharmacological and genetic approaches have increased our understanding of the mechanisms of cannabinoid-induced analgesia and provided therapeutical strategies for treating pain in humans. The mechanisms of the analgesic effect of cannabinoids include inhibition of the release of neurotransmitters and neuropeptides from presynaptic nerve endings, modulation of postsynaptic neuron excitability, activation of descending inhibitory pain pathways, and reduction of neural inflammation. Recent meta-analyses of clinical trials that have examined the use of medical cannabis in chronic pain present a moderate amount of evidence that cannabis/cannabinoids exhibit analgesic activity, especially in neuropathic pain. The main limitations of these studies are short treatment duration, small numbers of patients, heterogeneous patient populations, examination of different cannabinoids, different doses, the use of different efficacy endpoints, as well as modest observable effects. Adverse effects in the short-term medical use of cannabis are generally mild to moderate, well tolerated and transient. However, there are scant data regarding the long-term safety of medical cannabis use. Larger well-designed studies of longer duration are mandatory to determine the long-term efficacy and long-term safety of cannabis/cannabinoids and to provide definitive answers to physicians and patients regarding the risk and benefits of its use in the treatment of pain. In conclusion, the evidence from current research supports the use of medical cannabis in the treatment of chronic pain in adults. Careful follow-up and monitoring of patients using cannabis/cannabinoids are mandatory.
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Affiliation(s)
- Sonja Vučković
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragana Srebro
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Katarina Savić Vujović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Čedomir Vučetić
- Clinic of Orthopaedic Surgery and Traumatology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Prostran
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Sokol NA, Okechukwu CA, Chen JT, Subramanian SV, Rees VW. Maternal Cannabis Use During a Child's Lifetime Associated With Earlier Initiation. Am J Prev Med 2018; 55:592-602. [PMID: 30262151 PMCID: PMC6481668 DOI: 10.1016/j.amepre.2018.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/19/2018] [Accepted: 06/15/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Earlier cannabis initiation is associated with more severe neuropsychiatric and social consequences. The authors investigated whether mothers' cannabis use is associated with earlier cannabis initiation by their children. METHODS Mother and child data were from the National Longitudinal Survey of Youth 1979 (1980-1998 waves) and Child and Young Adults (1988-2014 waves) cohorts, respectively. Cox proportional hazard models assessed the effect of maternal cannabis use prior to a child's adolescence on the child's risk of subsequent cannabis initiation. Models were stratified by race and child's age category (6-16, 17-24, ≥25 years). Adjusted analyses controlled for sociodemographic variables. Analyses were conducted in 2017. RESULTS Median age of cannabis initiation for children of maternal ever users was age 16years compared with age 18years among children of maternal never users. Children of 1-year and multiple-year users were at increased risk of cannabis initiation between ages 6 and 16years (hazard ratio=1.38, p<0.001, and hazard ratio = 1.45, p<0.001, respectively). Effects were slightly stronger among non-Hispanic non-black children. CONCLUSIONS As cannabis legalization expands across the U.S., adult use may become increasingly normative. This study indicates that maternal cannabis use may be a risk factor for early initiation among their offspring. Preventive interventions should consider strategies to delay initiation among children of cannabis users.
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Affiliation(s)
- Natasha A Sokol
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island.
| | - Cassandra A Okechukwu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Sommer JL, Mota N, Edmondson D, El-Gabalawy R. Comorbidity in illness-induced posttraumatic stress disorder versus posttraumatic stress disorder due to external events in a nationally representative study. Gen Hosp Psychiatry 2018; 53:88-94. [PMID: 29776731 DOI: 10.1016/j.genhosppsych.2018.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/03/2018] [Accepted: 02/07/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The current study compared physical and mental health characteristics and quality of life of illness-induced posttraumatic stress disorder (PTSD) versus those with PTSD due to external traumatic events in a population-based sample. METHOD PTSD was assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-5) using DSM-5 criteria in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. Participants with past-year PTSD (n = 1779) were categorized into two groups: illness-induced (6.5%) and other trauma-induced PTSD (92.9%) based on index trauma. Group differences in physical health, mental health, and quality of life were estimated using multiple logistic and linear regressions with adjustment for demographics and medical morbidity. RESULTS Compared to PTSD due to external events, illness-induced PTSD had higher rates of life-threatening illness in the past year. Illness-induced PTSD compared to PTSD due to external events was associated with reduced odds of depressive/bipolar disorders and antisocial personality disorder, but increased odds of cannabis use disorder. The groups did not differ on quality of life after accounting for medical morbidity. CONCLUSION Illness-induced PTSD is common among American adults and has a similar impact on quality of life as PTSD due to external events, but may have distinct mental health correlates.
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Affiliation(s)
- Jordana L Sommer
- Department of Psychology, Faculty of Arts, University of Manitoba, United States; Department of Anesthesia & Perioperative Medicine, Max Rady College of Medicine, University of Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Canada
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, United States
| | - Renée El-Gabalawy
- Department of Psychology, Faculty of Arts, University of Manitoba, United States; Department of Anesthesia & Perioperative Medicine, Max Rady College of Medicine, University of Manitoba, Canada; Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Canada.
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Kerlin AM, Long M, Kappelman M, Martin C, Sandler RS. Profiles of Patients Who Use Marijuana for Inflammatory Bowel Disease. Dig Dis Sci 2018; 63:1600-1604. [PMID: 29594968 DOI: 10.1007/s10620-018-5040-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 03/23/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Marijuana is legal in a number of states for indications that include inflammatory bowel diseases (IBD), and patients are interested in its potential benefits. AIMS We aimed to describe the legal use of marijuana in individuals with IBD in the USA who participate within the CCFA Partners internet-based cohort. METHODS A total of 2357 participants who lived in states where prescription or recreational marijuana was legal, were offered the opportunity to complete a survey on marijuana use and IBD symptoms including perceived benefits of therapy. Bivariate statistics and logistic regression models were used to determine factors associated with marijuana use. RESULTS Surveys were completed by 1666 participants (71%) with only 214 (12.8%) indicating they had asked their medical doctor about its use and 73 actually using prescribed marijuana (4.4%). Within the respondent group (N = 1666), 234 participants lived where both medical and recreational marijuana is legal and 49 (20.9%) reported recreational marijuana use specifically for IBD. Users reported positive benefits (80.7%), but users also reported more depression, anxiety, pain interference, and lower social satisfaction than non-users. Those prescribed marijuana reported more active disease, and more use of steroids, narcotics, and zolpidem. CONCLUSIONS Few IBD patients consulted their medical doctors about marijuana use or used prescription marijuana. Where recreational marijuana was available, usage rates were higher. Users reported benefits but also more IBD symptoms, depression, anxiety, and pain. Marijuana use may be higher in patients with IBD symptoms not well treated by conventional medical approaches.
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Affiliation(s)
- Ann Marie Kerlin
- Luther Rice College and Seminary, 3038 Evans Mill Rd, Lithonia, GA, 30038, USA.
| | - Millie Long
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Michael Kappelman
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Christopher Martin
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert S Sandler
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Abstract
The evolving legal cannabis landscape in the US continues to present novel regulatory challenges that necessitate the development of a Cannabis Regulatory Science. Two specific issues of concern within Cannabis Regulatory Science are (1) the impact that cannabis use has on the incidence, prevalence, and severity of mental disorders, and (2) how cannabis laws and regulations modify this impact. This paper first provides several conceptual points that are useful for evaluating the relationship between cannabis use and mental disorders. Second, it selectively reviews and comments on data relevant to the relationship between cannabis use and depression, several forms of anxiety, post-traumatic stress disorder, schizophrenia, and bipolar disorder. Next, regulatory and public health parallels between the nascent cannabis industry and the pharmaceutical, tobacco, and alcohol industries are discussed. The focus is on specific types of industry practices that may harm those with or at risk for mental disorders. Recommendations are then offered for legal cannabis regulations that could mitigate this harm. Last, future research goals are discussed for building the field of Cannabis Regulatory Science and addressing the potential negative impact of cannabis on those with mental disorders.
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Affiliation(s)
- Jacob T. Borodovsky
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States,The Dartmouth Institute for Health Policy and Clinical Practice, 74 College St. Hanover, NH 03755, United States
| | - Alan J. Budney
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States
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Weeding Out the Justification for Marijuana Treatment in Patients with Developmental and Behavioral Conditions. J Dev Behav Pediatr 2018. [PMID: 28622159 DOI: 10.1097/dbp.0000000000000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Alex is a 13-year-old adolescent with high-functioning autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD)-combined type, anxiety, and depression. He has been resistant to engaging in therapy and treatment with various medications has been unsuccessful. Alex's parents are concerned about his anxiety, isolation, oppositional behaviors, academic underachievement, truancy, and substance use. A recent altercation with his stepfather led to a police intervention and a brief removal of Alex from the home. Alex previously used alcohol and other drugs; at present, he reports that his current drug use consists of frequently smoking pot. Alex states that he uses marijuana to relieve his anxiety and does not understand why this is problematic as marijuana is now legal in his state.Kevin is a 24-year-old adult man with diagnoses of autism spectrum disorder, mild intellectual disability, and schizoaffective disorder. He has a long history of challenging and problematic behaviors including aggression toward self and others, property destruction, inappropriate sexual behaviors, elopement, emotional outbursts, anxiety, and suicidal ideation. Past diagnoses include bipolar affective disorder, depression, and intermittent explosive disorder. Kevin is notably obese and somnolent. His current medications include 8 psychotropic medications, 3 antiallergy medications, levothyroxine, and a fish oil supplement. His father reports that medications have gradually been added and dosages increased over time. Two weeks ago, his new psychiatrist initiated a trial of medical marijuana. His father hopes that the marijuana will allow Kevin's other medications to be decreased or discontinued.Linda is an 11-year-old girl with high-functioning autism spectrum disorder, anxiety, and ADHD-inattentive subtype. Anxiety has been her most impairing condition, and Linda has been responding well to a treatment with cognitive behavioral therapy and a selective serotonin reuptake inhibitor. She is also working with her therapist on strategies to address her symptoms of ADHD. Linda has had no side effects from her medication and she and her family have been pleased with her progress. At a follow-up appointment, her mother brings an article from the lay press authored by a parent who claims that marijuana "saved" her autistic son. Linda's mother asks if marijuana should be considered for her daughter.
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Kimbrel NA, Meyer EC, DeBeer BB, Gulliver SB, Morissette SB. The Impact of Cannabis Use Disorder on Suicidal and Nonsuicidal Self-Injury in Iraq/Afghanistan-Era Veterans with and without Mental Health Disorders. Suicide Life Threat Behav 2018; 48:140-148. [PMID: 28295524 PMCID: PMC5597481 DOI: 10.1111/sltb.12345] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/08/2016] [Indexed: 11/28/2022]
Abstract
The objective of this study was to assess the association between cannabis use disorder (CUD) and self-injury among veterans. As expected, after adjusting for sex, age, sexual orientation, combat exposure, traumatic life events, traumatic brain injury, posttraumatic stress disorder, depression, alcohol use disorder, and noncannabis drug use disorder, CUD was significantly associated with both suicidal (OR = 3.10, p = .045) and nonsuicidal (OR = 5.12, p = .009) self-injury. CUD was the only variable significantly associated with self-injury in all three models examined. These findings are consistent with prior research among civilians and suggest that CUD may also increase veterans' risk for self-injurious behavior.
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Affiliation(s)
- Nathan A. Kimbrel
- Durham Veterans Affairs Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Duke University Medical Center, Durham, NC, USA,Correspondence concerning this article should be sent to: Dr. Nathan A. Kimbrel, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705. Phone: (919) 286-0411, ext. 6759.
| | - Eric C. Meyer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA,Central Texas Veterans Health Care System, Temple, Texas, USA,Texas A&M University Health Science Center, College Station, Texas, USA
| | - Bryann B. DeBeer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA,Central Texas Veterans Health Care System, Temple, Texas, USA,Texas A&M University Health Science Center, College Station, Texas, USA
| | - Suzy B. Gulliver
- Warriors Research Institute, Baylor, Scott & White Healthcare System, Waco, TX, USA
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Mücke M, Weier M, Carter C, Copeland J, Degenhardt L, Cuhls H, Radbruch L, Häuser W, Conrad R. Systematic review and meta-analysis of cannabinoids in palliative medicine. J Cachexia Sarcopenia Muscle 2018; 9:220-234. [PMID: 29400010 PMCID: PMC5879974 DOI: 10.1002/jcsm.12273] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/06/2017] [Indexed: 12/23/2022] Open
Abstract
We provide a systematic review and meta-analysis on the efficacy, tolerability, and safety of cannabinoids in palliative medicine. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, PubMed, Scopus, and http://clinicaltrials.gov, and a selection of cancer journals were searched up until 15th of March 2017. Of the 108 screened studies, nine studies with a total of 1561 participants were included. Overall, the nine studies were at moderate risk of bias. The quality of evidence comparing cannabinoids with placebo was rated according to Grading of Recommendations Assessment, Development, and Evaluation as low or very low because of indirectness, imprecision, and potential reporting bias. In cancer patients, there were no significant differences between cannabinoids and placebo for improving caloric intake (standardized mean differences [SMD]: 0.2 95% confidence interval [CI]: [-0.66, 1.06] P = 0.65), appetite (SMD: 0.81 95% CI: [-1.14, 2.75]; P = 0.42), nausea/vomiting (SMD: 0.21 [-0.10, 0.52] P = 0.19), >30% decrease in pain (risk differences [RD]: 0.07 95% CI: [-0.01, 0.16]; P = 0.07), or sleep problems (SMD: -0.09 95% CI: [-0.62, 0.43] P = 0.72). In human immunodeficiency virus (HIV) patients, cannabinoids were superior to placebo for weight gain (SMD: 0.57 [0.22; 0.92]; P = 0.001) and appetite (SMD: 0.57 [0.11; 1.03]; P = 0.02) but not for nausea/vomiting (SMD: 0.20 [-0.15, 0.54]; P = 0.26). Regarding side effects in cancer patients, there were no differences between cannabinoids and placebo in symptoms of dizziness (RD: 0.03 [-0.02; 0.08]; P = 0.23) or poor mental health (RD: -0.01 [-0.04; 0.03]; P = 0.69), whereas in HIV patients, there was a significant increase in mental health symptoms (RD: 0.05 [0.00; 0.11]; P = 0.05). Tolerability (measured by the number of withdrawals because of adverse events) did not differ significantly in cancer (RD: 1.15 [0.80; 1.66]; P = 0.46) and HIV patients (RD: 1.87 [0.60; 5.84]; P = 0.28). Safety did not differ in cancer (RD: 1.12 [0.86; 1.46]; P = 0.39) or HIV patients (4.51 [0.54; 37.45]; P = 0.32) although there was large uncertainty about the latter reflected in the width of the CI. In one moderate quality study of 469 cancer patients with cancer-associated anorexia, megestrol was superior to cannabinoids in improving appetite, producing >10% weight gain and tolerability. In another study comparing megestrol to dronabinol in HIV patients, megestrol treatment led to higher weight gain without any differences in tolerability and safety. We found no convincing, unbiased, high quality evidence suggesting that cannabinoids are of value for anorexia or cachexia in cancer or HIV patients.
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Affiliation(s)
- Martin Mücke
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany.,Center for Rare Diseases Bonn (ZSEB), University Hospital of Bonn, Bonn, Germany.,Department of General Practice and Family Medicine, University Hospital of Bonn, Bonn, Germany
| | - Megan Weier
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.,Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Australia
| | - Christopher Carter
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
| | - Jan Copeland
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Henning Cuhls
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany.,Centre for Palliative Care, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Bonn, Bonn, Germany
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Shishko I, Oliveira R, Moore TA, Almeida K. A review of medical marijuana for the treatment of posttraumatic stress disorder: Real symptom re-leaf or just high hopes? Ment Health Clin 2018; 8:86-94. [PMID: 29955551 PMCID: PMC6007739 DOI: 10.9740/mhc.2018.03.086] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction: The incidence of posttraumatic stress disorder (PTSD) is common within the population and even more so among veterans. Current medication treatment is limited primarily to antidepressants. Such medicines have shown to produce low remission rates and may require 9 patients to be treated for 1 to have a response. Aside from the Veterans Affairs/Department of Defense guidelines, other guidelines do not recommend pharmacotherapy as a first-line option, particularly in the veteran population. Marijuana has been evaluated as an alternative and novel treatment option with 16 states legalizing its use for PTSD. Methods: A systematic search was conducted to evaluate the evidence for the use of marijuana for PTSD. Studies for the review were included based on a literature search from Ovid MEDLINE and Google Scholar. Results: Five studies were identified that evaluated the use of marijuana for PTSD. One trial was conducted in Israel and actively used marijuana. Three studies did not use marijuana in the treatment arm but instead evaluated the effects postuse. A retrospective chart review from New Mexico relied on patients to recall their change in PTSD symptoms when using marijuana. Three studies concluded there might be a benefit, but two discouraged its use. Although the two negative studies show a statistical difference in worse PTSD outcomes, clinical significance is unclear. Discussion: Conflicting data exist for the use of marijuana for PTSD; however, current evidence is limited to anecdotal experiences, case reports, and observational studies, making it difficult to make clinical recommendations.
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Affiliation(s)
- Ilona Shishko
- Clinical Pharmacy Specialist-Psychiatry, South Texas Veterans Health Care System, San Antonio, Texas; The University of Texas at Austin, Austin, Texas; UT Health Science Center San Antonio, San Antonio, Texas,
| | - Rosana Oliveira
- Clinical Pharmacy Specialist-Psychiatry, South Texas Veterans Health Care System, San Antonio, Texas; The University of Texas at Austin, Austin, Texas; UT Health Science Center San Antonio, San Antonio, Texas
| | - Troy A Moore
- Clinical Pharmacy Specialist-Psychiatry, Director, ASHP-Accredited PGY-2 Psychiatric Pharmacy Residency Program, Co-Director, Interprofessional Advanced Fellowship in Addiction Treatment, South Texas Veterans Health Care System, Assistant Professor, UTHSCSA Department of Psychiatry-Division of Community Recovery, Research and Training, South Texas Veterans Health Care System, San Antonio, Texas; The University of Texas at Austin, Austin, Texas; UT Health Science Center San Antonio, San Antonio, Texas
| | - Kenneth Almeida
- Clinical Pharmacy Specialist-Hepatology, Texas Liver Institute, San Antonio, Texas
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Metrik J, Bassett SS, Aston ER, Jackson KM, Borsari B. Medicinal versus Recreational Cannabis Use among Returning Veterans. TRANSLATIONAL ISSUES IN PSYCHOLOGICAL SCIENCE 2018; 4:6-20. [PMID: 30003119 PMCID: PMC6037171 DOI: 10.1037/tps0000133] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although increasing rates of cannabis use and cannabis use disorder (CUD) are well-documented among veterans, little is known about their use of cannabis specifically for medicinal purposes. The present study characterizes such use and compares veterans reporting cannabis use for medicinal (n = 66) versus recreational (n = 77) purposes on (a) sociodemographic factors, (b) psychiatric disorders (posttraumatic stress disorder [PTSD], major depressive disorder [MDD], and CUD), (c) other substance use, (d) reasons for cannabis use and cannabis-related problems, and (e) physical and mental health. METHODS Participants were veterans deployed post 9/11/2001 recruited from a Veterans Health Administration (VHA) facility (N = 143; mean [SD] age = 30.0 [6.6]; mean [SD] deployments = 1.7 [1.1]) who reported past-year cannabis use. RESULTS The most frequently endorsed conditions for medicinal cannabis (MC) use were anxiety/stress, PTSD, pain, depression, and insomnia. In logistic regression analyses adjusted for frequency of cannabis use, MC users were significantly more likely (OR = 3.16) to meet criteria for PTSD than recreational cannabis (RC) users. Relative to RC users, MC users reported significantly greater motivation for using cannabis to cope with sleep disturbance as well as significantly poorer sleep quality and worse physical health. CONCLUSIONS Veterans who use cannabis for medicinal purposes differ significantly in sleep, physical and mental health functioning than veterans who use cannabis for recreational purposes. PTSD and sleep problems may be especially relevant issues to address in screening and providing clinical care to returning veterans who are using cannabis for medicinal purposes.
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Affiliation(s)
- Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
- Providence VA Medical Center, Providence, RI, 02908, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02912, USA
| | - Shayna S. Bassett
- Department of Psychology, Social Sciences Research Center, University of Rhode Island, Kingston, RI, 02881, USA
| | - Elizabeth R. Aston
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Brian Borsari
- San Francisco VA Medical Center, San Francisco, CA, 94121, USA
- Department of Psychiatry, University of California – San Francisco, San Francisco, CA, 94103, USA
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Liszewski W, Stoff BK, Farah RS. The ethics of medical marijuana in dermatology. J Am Acad Dermatol 2018; 78:634-636. [PMID: 29447683 DOI: 10.1016/j.jaad.2017.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Walter Liszewski
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.
| | - Benjamin K Stoff
- Department of Dermatology, Emory University, Atlanta, Georgia; Emory Center for Ethics, Emory University, Atlanta, Georgia
| | - Ronda S Farah
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
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Mannes ZL, Burrell LE, Ferguson EG, Zhou Z, Lu H, Somboonwit C, Cook RL, Ennis N. The association of therapeutic versus recreational marijuana use and antiretroviral adherence among adults living with HIV in Florida. Patient Prefer Adherence 2018; 12:1363-1372. [PMID: 30100713 PMCID: PMC6067624 DOI: 10.2147/ppa.s167826] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Marijuana use is common among people living with HIV (PLWH), but its association with antiretroviral therapy (ART) adherence is unclear. This study examined the association between reason for marijuana use and ART adherence in a sample of adults living with HIV. PATIENTS AND METHODS Participants (N=703) recruited from seven community health centers in Florida completed a 45-minute questionnaire assessing demographics, symptoms of anxiety and depression, ART adherence, and substance use, including reasons for marijuana use. ART adherence was defined as the proportion of days in the last 30 days participants did not miss any medication and dichotomized as optimal (≥95%) and suboptimal (<95%). Multivariate logistic regression analysis assessed the association between therapeutic marijuana use to manage HIV symptoms (ie, improve appetite/gain weight, induce sleep, relieve nausea/vomiting, relieve pain, relieve anxiety/depression/stress) versus recreational marijuana use and ART adherence. RESULTS Approximately one third (33.2%) of the participants reported using marijuana in the past 3 months. Of marijuana users, 21.8% reported using marijuana only for therapeutic purposes to manage HIV-associated medical symptoms, while 78.2% reported recreational use. After controlling for covariates, therapeutic use of marijuana was not associated with ART adherence (AOR =1.19, 95% CI =0.60-2.38, p=0.602) while recreational marijuana users showed significantly greater odds of suboptimal ART adherence compared to nonusers (AOR =1.80, 95% CI =1.18-2.72, p=0.005). CONCLUSION Our results suggest differences in ART adherence between individuals who report recreational versus therapeutic marijuana use. Continued research examining the health implications of marijuana use among adults living with HIV is important as legalization of recreational and medical marijuana proliferates in the United States.
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Affiliation(s)
- Zachary L Mannes
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA,
| | - Larry E Burrell
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA,
| | - Erin G Ferguson
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA,
| | - Zhi Zhou
- Department of Epidemiology, College of Public Health and Health Professions
- Department of Epidemiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Huiyin Lu
- Department of Biostatistics, College of Public Health and Health Professions
- Department of Biostatistics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Charurut Somboonwit
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions
- Department of Epidemiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Nicole Ennis
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA,
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Bahorik AL, Campbell CI, Sterling SA, Leibowitz A, Travis A, Weisner CM, Satre DD. Adverse impact of marijuana use on clinical outcomes among psychiatry patients with depression and alcohol use disorder. Psychiatry Res 2018; 259:316-322. [PMID: 29100135 PMCID: PMC5742048 DOI: 10.1016/j.psychres.2017.10.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/14/2017] [Accepted: 10/16/2017] [Indexed: 02/01/2023]
Abstract
This study examined whether marijuana use was associated with clinically problematic outcomes for patients with depression and alcohol use disorder (AUD). The sample consisted of 307 psychiatry outpatients with mild to severe depression and past 30-day hazardous drinking/drug use, who participated in a trial of substance use treatment. Participants were assessed for AUD based on DSM-IV criteria. Measures of marijuana use, depression symptoms, and functional status related to mental health were collected at baseline, 3, and 6 months. Differences in these outcomes were analyzed among patients with and without AUD using growth models, adjusting for treatment effects. Marijuana was examined as both an outcome (patterns of use) and a predictor (impact on depression and functioning). Forty percent used marijuana and about half the sample met AUD criteria. Fewer patients with AUD used marijuana than those without AUD at baseline. Over 6 months, the proportion of patients with AUD using marijuana increased compared to those without AUD. Patients with AUD using marijuana had greater depressive symptoms and worse functioning than those without AUD. These findings indicate that marijuana use is clinically problematic for psychiatry outpatients with depression and AUD. Addressing marijuana in the context of psychiatry treatment may help improve outcomes.
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Affiliation(s)
- Amber L. Bahorik
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, USA,Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, USA,Send correspondence to: Amber L. Bahorik, PhD, Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143; Fax: 501.891.3606, Phone: 510.891.5980.
| | - Cynthia I. Campbell
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, USA,Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, USA
| | - Stacy A. Sterling
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, USA
| | - Amy Leibowitz
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, USA
| | - Adam Travis
- Kaiser Permanente Southern Alameda Department of Psychiatry, USA
| | - Constance M. Weisner
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, USA,Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, USA
| | - Derek D. Satre
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, USA,Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, USA
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The potential impact of cannabis legalization on the development of cannabis use disorders. Prev Med 2017; 104:31-36. [PMID: 28668544 PMCID: PMC5735001 DOI: 10.1016/j.ypmed.2017.06.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/24/2017] [Accepted: 06/26/2017] [Indexed: 01/21/2023]
Abstract
Specific provisions of legal cannabis legislation and regulation could influence cannabis initiation, frequency and quantity of use, and progression to cannabis use disorder. This brief essay highlights scientifically based principles and risk factors that underlie substance use and addiction that can be leveraged to inform policies that might mitigate the development and consequences of cannabis use disorder. Specifically, pharmacologic, access/availability, and environmental factors are discussed in relation to their influence on substance use disorders to illustrate how regulatory provisions can differentially affect these factors and risk for addiction. Relevant knowledge from research and experience with alcohol and tobacco regulation are also considered. Research designed to inform regulatory policy and to evaluate the impact of cannabis legislation on cannabis use and problems is progressing. However, definitive findings will come slowly, and more concerted efforts and resources are needed to expedite this process. In the meantime, policymakers should take advantage of the large body of scientific literature on substance use to foster empirically-guided, common sense approaches to cannabis policy that focus on prevention of addiction.
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Choi NG, DiNitto DM, Marti CN. Nonmedical versus medical marijuana use among three age groups of adults: Associations with mental and physical health status. Am J Addict 2017; 26:697-706. [DOI: 10.1111/ajad.12598] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/01/2017] [Accepted: 07/15/2017] [Indexed: 01/24/2023] Open
Affiliation(s)
- Namkee G. Choi
- University of Texas at Austin School of Social Work; 1925 San Jacinto Blvd; Austin Texas
| | - Diana M. DiNitto
- University of Texas at Austin School of Social Work; 1925 San Jacinto Blvd; Austin Texas
| | - Carl Nathan Marti
- University of Texas at Austin School of Social Work; 1925 San Jacinto Blvd; Austin Texas
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Affiliation(s)
- Thomas B. Strouse
- UCLA DGSOM Department of Psychiatry, Resnick Neuropsychiatric Hospital, Los Angeles, California
| | - Associate Editor
- UCLA DGSOM Department of Psychiatry, Resnick Neuropsychiatric Hospital, Los Angeles, California
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