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Maddison KJ, Kosky C, Walsh JH. Is There a Place for Medicinal Cannabis in Treating Patients with Sleep Disorders? What We Know so Far. Nat Sci Sleep 2022; 14:957-968. [PMID: 35611178 PMCID: PMC9124464 DOI: 10.2147/nss.s340949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/06/2022] [Indexed: 02/02/2023] Open
Abstract
The legalization of cannabis for medicinal, and in some countries, recreational, purposes in addition to growth in the cannabis industry has meant that cannabis use and interest in the area has increased rapidly over the past 20 years. Treatment of poor sleep and sleep disorders are two of the most common reasons for the current use of medicinal cannabis. However, evidence for the role of medical cannabis in the treatment of sleep disorders has not been clearly established, thus making it challenging for clinicians to make evidence-based decisions regarding efficacy and safety. This narrative review summarizes the highest quality clinical evidence currently available in relation to the use of medicinal cannabis for the treatment of sleep disorders including insomnia, obstructive sleep apnea, restless legs syndrome, rapid eye movement sleep behavior disorder, nightmare disorder and narcolepsy. A summary of the effect of cannabis on sleep quality and architecture is also presented. Currently, there is insufficient evidence to support the routine use of medicinal cannabis as an effective and safe treatment option for any sleep disorder. Nevertheless, emerging evidence is promising and warrants further investigation using standardized cannabinoid products and validated quantitative measurement techniques.
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Affiliation(s)
- Kathleen J Maddison
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Centre for Sleep Science, University of Western Australia, Perth, Western Australia, Australia
| | - Christopher Kosky
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Jennifer H Walsh
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Centre for Sleep Science, University of Western Australia, Perth, Western Australia, Australia
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Baumeister SE, Baurecht H, Nolde M, Alayash Z, Gläser S, Johansson M, Amos CI, Johnson EC, Hung RJ. Cannabis Use, Pulmonary Function, and Lung Cancer Susceptibility: A Mendelian Randomization Study. J Thorac Oncol 2021; 16:1127-1135. [PMID: 33852959 DOI: 10.1016/j.jtho.2021.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Because of widespread use, understanding the pulmonary effects of cannabis use is important; but its role independent from tobacco smoking is yet to be elucidated. We used Mendelian randomization (MR) to assess the effect of genetic liability to lifetime cannabis use and cannabis use disorder on pulmonary function and lung cancer. METHODS We used four single nucleotide polymorphisms associated with lifetime cannabis use (p value <5 × 10-8) from a genome-wide association study (GWAS) of 184,765 individuals of European descent from the International Cannabis Consortium, 23andme, and U.K. Biobank as instrumental variables. Seven single nucleotide polymorphisms (p value <5 × 10-8) were selected as instruments for cannabis use disorder from a GWAS meta-analysis of 17,068 European ancestry cases and 357,219 controls of European descent from Psychiatric Genomics Consortium Substance Use Disorders working group, Lundbeck Foundation Initiative for Integrative PsychiatricResearch, and deCode. To assess lung function, GWAS included 79,055 study participants of the SpiroMeta Consortium, and for lung cancer GWAS from the International Lung Cancer Consortium contained 29,266 cases and 56,450 controls. RESULTS MR revealed that genetic liability to lifetime cannabis use was associated with increased risk of squamous cell carcinoma (OR = 1.22, 95%, confidence interval = 1.07-1.39, p value = 0.003, q value = 0.025). Pleiotropy-robust methods and positive and negative control analyses did not indicate bias in the primary analysis. CONCLUSIONS The findings of this MR analysis suggest evidence for a potential causal association between genetic liability for cannabis use and the risk of squamous cell carcinoma. Triangulating MR and observational studies and addressing orthogonal sources of bias are necessary to confirm this finding.
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Affiliation(s)
- Sebastian-Edgar Baumeister
- Department of Epidemiology, Ludwig-Maximilian University of Munich, University Center for Health Sciences at the Klinikum (UNIKA-T) Augsburg, Augsburg, Germany; Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany; Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany.
| | - Hansjörg Baurecht
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany
| | - Michael Nolde
- Department of Epidemiology, Ludwig-Maximilian University of Munich, University Center for Health Sciences at the Klinikum (UNIKA-T) Augsburg, Augsburg, Germany; Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Zoheir Alayash
- Department of Epidemiology, Ludwig-Maximilian University of Munich, University Center for Health Sciences at the Klinikum (UNIKA-T) Augsburg, Augsburg, Germany
| | - Sven Gläser
- Department of Internal Medicine B Cardiology, Intensive Care, Pulmonary Medicine, and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany; Vivantes Klinikum Neukölln und Spandau, Klinik für Innere Medizin-Pneumologie und Infektiologie, Berlin, Germany
| | - Mattias Johansson
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Christopher I Amos
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Emma C Johnson
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Rayjean J Hung
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Tan WC, Bourbeau J, Aaron SD, Sin DD. Impact of marijuana smoking on lung function in older persons. Eur Respir J 2020; 55:55/2/1902390. [PMID: 32079671 DOI: 10.1183/13993003.02390-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Wan C Tan
- The University of British Columbia, Center for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Jean Bourbeau
- Research Institute McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Don D Sin
- The University of British Columbia, Center for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
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Tashkin DP, Roth MD. Pulmonary effects of inhaled cannabis smoke. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:596-609. [PMID: 31298945 DOI: 10.1080/00952990.2019.1627366] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: The smoke generated from cannabis delivers biologically active cannabinoids and a number of combustion-derived toxins, both of which raise questions regarding the impact of cannabis smoking on lung function, airway inflammation and smoking-related lung disease.Objectives: Review the potential effects of cannabis smoking on respiratory symptoms, lung function, histologic/molecular alterations in the bronchial mucosa, smoking-related changes in alveolar macrophage function and the potential clinical impact of cannabis smoking on chronic obstructive pulmonary disease, lung cancer and pulmonary infections.Methods: Focused literature review.Results: The carcinogens and respiratory toxins in cannabis and tobacco smoke are similar but the smoking topography for cannabis results in higher per-puff exposures to inhaled tar and gases. The frequency of chronic cough, sputum and wheeze and the presence of airway mucosal inflammation, goblet cell and vascular hyperplasia, metaplasia and cellular disorganization are similar between cannabis smokers and tobacco smokers. Cannabis smoke has modest airway bronchodilator properties but of unclear clinical significance. While clear evidence exists for progression to obstructive lung disease and emphysema in chronic tobacco smokers, the effects from habitual cannabis use are less clear. Evidence suggests that alveolar macrophages from cannabis smokers have deficits in cytokine production and antimicrobial activity not present in cells from tobacco smokers.Conclusions: Solid conclusions regarding the respiratory consequences of regular cannabis smoking are difficult to make due to a relative paucity of literature, confounding by concurrent tobacco smoking and reports of conflicting outcomes. Additional well-controlled clinical studies on the pulmonary consequences of habitual cannabis use are needed.
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Affiliation(s)
- Donald P Tashkin
- Department of Medicine, Division of Pulmonary & Critical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michael D Roth
- Department of Medicine, Division of Pulmonary & Critical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Leung JM, Obeidat M, Sadatsafavi M, Sin DD. Introduction to precision medicine in COPD. Eur Respir J 2019; 53:13993003.02460-2018. [DOI: 10.1183/13993003.02460-2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 01/12/2019] [Indexed: 11/05/2022]
Abstract
Although there has been tremendous growth in our understanding of chronic obstructive pulmonary disease (COPD) and its pathophysiology over the past few decades, the pace of therapeutic innovation has been extremely slow. COPD is now widely accepted as a heterogeneous condition with multiple phenotypes and endotypes. Thus, there is a pressing need for COPD care to move from the current “one-size-fits-all” approach to a precision medicine approach that takes into account individual patient variability in genes, environment and lifestyle. Precision medicine is enabled by biomarkers that can: 1) accurately identify subgroups of patients who are most likely to benefit from therapeutics and those who will only experience harm (predictive biomarkers); 2) predict therapeutic responses to drugs at an individual level (response biomarkers); and 3) segregate patients who are at risk of poor outcomes from those who have relatively stable disease (prognostic biomarkers). In this essay, we will discuss the current concept of precision medicine and its relevance for COPD and explore ways to implement precision medicine for millions of patients across the world with COPD.
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