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van Amsterdam J, van den Brink W. Cannabis Use Variations and Myocardial Infarction: A Systematic Review. J Clin Med 2024; 13:5620. [PMID: 39337107 PMCID: PMC11433637 DOI: 10.3390/jcm13185620] [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: 08/19/2024] [Revised: 09/09/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Cannabis use is associated with an increased risk of coronary heart disease (CHD), including angina pectoris (AP), and myocardial infarction (MI). However, it is not clear whether cannabis use is an independent risk factor of AP and/or MI, because cannabis is often smoked together with tobacco. We investigated whether cannabis is an independent risk factor of MI and whether this risk is similar in cannabis smokers, cannabis vapers, and those who use cannabis edibles. Methods: A systematic review was performed, according to the PRISMA guidelines and using Medline (PubMed), Embase, and Google Scholar as databases. Results: Twenty-two eligible papers were identified. After adjustment for concurrent tobacco use, cannabis smoking remained significantly associated with incidents of MI, with aORs ranging between 1.03 and 5.24, and particularly high aORs in the younger age group. In never-tobacco smokers, frequent cannabis smoking was also associated with a significant MI risk (aOR = 1.88). Frequent and current cannabis use in any form other than smoking (e.g., vaping, but mostly ingestion) was not associated with a significantly increased cardiovascular risk (frequent use: aOR = 1.00 ns; current use: aOR = 1.31 ns). Conclusions: Like tobacco smoking, cannabis smoking may independently provoke MI. Vaping and ingestion of cannabis might be less harmful, probably because absence of combustion prevents exposure to certain toxins in cannabis smoke, including carbon monoxide.
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Affiliation(s)
- Jan van Amsterdam
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands;
- Research Program Compulsivity, Impulsivity & Attention, Amsterdam Neuroscience, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands;
- Research Program Compulsivity, Impulsivity & Attention, Amsterdam Neuroscience, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
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Ayyagari MM, Heim D, Sumnall HR, Monk RL. Contextual factors associated with subjective effects of cannabis: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 164:105822. [PMID: 39059675 DOI: 10.1016/j.neubiorev.2024.105822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 07/05/2024] [Accepted: 07/20/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Cannabis is consumed in various social and environmental settings, and such contexts may be important predictors of subjective effects. The aim of this systematic review and meta-analysis was to examine the relationship between contextual factors and subjective effects of cannabis. METHODS A PRISMA-guided search of MEDLINE, Embase, PsycINFO, Global Health, and Google Scholar yielded 29 studies. RESULTS Study type (Ecological Momentary Assessment or Experimental) was a significant predictor of intoxication effects, and experimental studies had a greater pooled effect size (z =.296,95 % CI [.132,.478], p=.004) than Ecological Momentary Assessment (EMA) studies (z =.071,95 % CI [.011,.130], p =.02). Contextual conditions (environment, social group, expectancy, time of day, day of week) were not significant predictors of cannabis effects. CONCLUSION Findings did not point to a significant association between contextual conditions and subjective effects. However, as current literature is methodologically weak, it may be premature to conclude that subjective effects are not shaped by contextual factors. In view of policy and therapeutic implications, replications and study refinements are recommended.
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Affiliation(s)
| | - Derek Heim
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Harry R Sumnall
- School of Psychology & Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - Rebecca L Monk
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
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Wallace AL, Huestis MA, Sullivan RM, Wade NE. Amygdala volume and depression symptoms in young adolescents who use cannabis. Behav Brain Res 2024; 472:115150. [PMID: 39009188 DOI: 10.1016/j.bbr.2024.115150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/20/2024] [Accepted: 07/12/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION Both cannabis use and depressive symptomology increase in prevalence throughout adolescence. Concurrently, the brain is undergoing neurodevelopment in important limbic regions, such as the amygdala. Prior research indicates the amygdala may also be related to cannabis use and depressive symptoms. We aimed to investigate the effects of adolescent cannabis use on amygdala volumes as well as the interaction of cannabis use and amygdala morphometry on depressive symptoms in youth. METHOD Two-hundred-twenty-four participants (ages 12-15), balanced by sex assigned at birth, were selected from a sub-sample of the Adolescent Brain Cognitive Development (ABCD) Study based on hair toxicology and self-report measures of cannabis use. Participants positive for cannabinoids in hair and/or self-reported cannabis use were demographically matched to youth with no self-reported or confirmed cannabis use. The guardians of these youth reported depression symptoms on the Child Behavioral Checklist. Linear mixed effect models were run investigating cannabis use group on amygdala volumes bilaterally, controlling for whole brain volume and random effects of scanner type. Additional analyses examined cannabis group status and bilateral amygdala volume on depression symptoms. RESULTS Cannabis use was not significantly associated with amygdala volume but was associated with increased depressive symptoms (p<0.01). Cannabis group interacted with amygdala volume, such that individuals with smaller volumes had increased depressive symptoms within the cannabis group (p's<0.01-0.02). CONCLUSION Aberrations in amygdala volume based on cannabis use were not found in early adolescence; however, more depressive symptoms were related to cannabis group. Youth who use cannabis and have smaller amygdala volumes were at increased risk for depressive symptomology, suggesting potential neurovulnerabilities to cannabis use.
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Affiliation(s)
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Natasha E Wade
- Department of Psychiatry, University of California, San Diego, USA.
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Hasler WL, Alshaarawy O, Venkatesan T. Cannabis use patterns and association with hyperemesis: A comprehensive review. Neurogastroenterol Motil 2024:e14895. [PMID: 39164887 DOI: 10.1111/nmo.14895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 05/23/2024] [Accepted: 07/31/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND Cannabis use in the general population is prevalent and is rising because of increased acceptance of its use, legalization in most US states, and perceived health benefits. Cannabis product potency has dramatically increased with higher delta-9-tetrahydrocannabinol content. Cannabis has documented antiemetic properties and cannabinoid pharmaceuticals are used in disorders like chemotherapy-induced nausea and vomiting. PURPOSE Forty to eighty percent of cyclic vomiting syndrome (CVS) patients use cannabis products, which reportedly reduce stress as well as nausea and vomiting. Cannabinoid hyperemesis syndrome (CHS) has a presentation similar to CVS, but is associated with longstanding, high dose cannabis use, and is thought to be relieved by sustained cannabis abstinence. Most CHS patients have used cannabis on a daily or near-daily basis for more than 2 years. Compulsive hot-water bathing behaviors are reported by most CHS patients, but are not specific for this disorder as they are also noted by about half of CVS patients. Episodic vomiting associated with cannabis use contributes to extensive health resource use, including emergency department visits and inpatient hospitalizations, and impacts patients and their families negatively. Treatment for CHS overlaps with CVS although cannabis abstinence remains the cornerstone of its management. Challenges associated with cannabis use cessation in CHS include patient skepticism of the role of cannabis as a cause of symptoms, perceived benefits of cannabis, and a lack of other effective therapies. In this review, we highlight cannabis use patterns in the US and discuss diagnosis and management of CHS and gaps in knowledge about this disorder.
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Affiliation(s)
- William L Hasler
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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Kruger DJ, Gerlach J, Kruger JS, Mokbel MA, Clauw DJ, Boehnke KF. Physicians' Attitudes and Practices Regarding Cannabis and Recommending Medical Cannabis Use. Cannabis Cannabinoid Res 2024; 9:e1048-e1055. [PMID: 37098170 DOI: 10.1089/can.2022.0324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
Introduction: Medical cannabis users tend not to trust or rely on health care providers regarding cannabis advice. Previous surveys of physicians have focused on favorability toward medical cannabis. The current study assesses how physicians interact with patients regarding cannabis in their day-to-day practice, and whether and how they address important topics such as use patterns and substituting cannabis for medications. We predicted that physicians would generally perceive cannabis dispensary staff and caretakers as not competent in addressing patient health needs and would not be likely to use their recommendations. Methods: Physicians in a university-affiliated health system completed an anonymous online survey. The survey assessed physicians' cannabis related education experiences, perceptions of their knowledge of and competence regarding medical cannabis, and the content of cannabis related discussions with patients. We also examined perceptions of the sources of influence on patients regarding cannabis and physicians' attitudes toward medical cannabis dispensary staff and medical cannabis caregivers (MCCs). Results: A few physicians (10%) had ever signed a medical cannabis authorization form for their patients, consistent with their perceptions of low knowledge and competence in this area. Discussions on cannabis primarily focus on risks (63%) rather than dosage (6%) and harm reduction (25%). Physicians see their influence on patients as weak compared with other information sources and have generally unfavorable attitudes toward medical cannabis dispensary staff and MCCs. Conclusion: Greater integration of medical cannabis knowledge is needed at all levels of medical and clinical education to address the potential harm to patients if they receive no guidance. Continued research is needed to provide a strong scientific basis for developing treatment guidelines and standardized medical education for medical cannabis use.
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Affiliation(s)
- Daniel J Kruger
- Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph Gerlach
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jessica S Kruger
- School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Majd A Mokbel
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel J Clauw
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin F Boehnke
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
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Sajdeya R, Rouhizadeh M, Cook RL, Ison RL, Bai C, Jugl S, Gao H, Mardini MT, Dasa O, Zandbiglari K, Adiba FI, Winterstein AG, Price CC, Pearson TA, Seubert CN, Tighe PJ. Cannabis use and acute postoperative pain outcomes in older adults: a propensity matched retrospective cohort study. Reg Anesth Pain Med 2024:rapm-2024-105633. [PMID: 38950932 DOI: 10.1136/rapm-2024-105633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/20/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION Cannabis use is increasing among older adults, but its impact on postoperative pain outcomes remains unclear in this population. We examined the association between cannabis use and postoperative pain levels and opioid doses within 24 hours of surgery. METHODS We conducted a propensity score-matched retrospective cohort study using electronic health records data of 22 476 older surgical patients with at least 24-hour hospital stays at University of Florida Health between 2018 and 2020. Of the original cohort, 2577 patients were eligible for propensity-score matching (1:3 cannabis user: non-user). Cannabis use status was determined via natural language processing of clinical notes within 60 days of surgery and structured data. The primary outcomes were average Defense and Veterans Pain Rating Scale (DVPRS) score and total oral morphine equivalents (OME) within 24 hours of surgery. RESULTS 504 patients were included (126 cannabis users and 378 non-users). The median (IQR) age was 69 (65-72) years; 295 (58.53%) were male, and 442 (87.70%) were non-Hispanic white. Baseline characteristics were well balanced. Cannabis users had significantly higher average DVPRS scores (median (IQR): 4.68 (2.71-5.96) vs 3.88 (2.33, 5.17); difference=0.80; 95% confidence limit (CL), 0.19 to 1.36; p=0.01) and total OME (median (IQR): 42.50 (15.00-60.00) mg vs 30.00 (7.50-60.00) mg; difference=12.5 mg; 95% CL, 3.80 mg to 21.20 mg; p=0.02) than non-users within 24 hours of surgery. DISCUSSION This study showed that cannabis use in older adults was associated with increased postoperative pain levels and opioid doses.
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Affiliation(s)
- Ruba Sajdeya
- University of Florida, Gainesville, Florida, USA
| | | | | | | | - Chen Bai
- University of Florida, Gainesville, Florida, USA
| | | | - Hanzhi Gao
- University of Florida, Gainesville, Florida, USA
| | | | - Osama Dasa
- University of Florida, Gainesville, Florida, USA
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Yu R, Kong DL, Liao C, Yu YJ, He ZW, Wang Y. Natural products as the therapeutic strategies for addiction. Biomed Pharmacother 2024; 175:116687. [PMID: 38701568 DOI: 10.1016/j.biopha.2024.116687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/05/2024] Open
Abstract
World Drug Report 2023 concluded that 296 million people abused drugs, 39.5 million became addiction and 494,000 died as a direct or indirect result of addiction. Addiction has become a growing problem that affects individuals, their families, societies, countries and even the world. However, treatment for addiction is only limited to some developed countries because of the high cost, difficult implementation, and time consuming. Therefore, there is an urgent need to develop a low-cost, effective drug for the development of addiction treatment in more countries, which is essential for the stability and sustainable development of the world. In this review, it provided an overview of the abuse of common addictive drugs, related disorders, and current therapeutic regimen worldwide, and summarized the mechanisms of drug addiction as reward circuits, neuroadaptation and plasticity, cognitive decision-making, genetics, and environment. According to their chemical structure, 43 natural products and 5 herbal combinations with potential to treat addiction were classified, and their sources, pharmacological effects and clinical trials were introduced. It was also found that mitragine, ibogine, L-tetrahydropalmatine and crocin had greater potential for anti-addiction.
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Affiliation(s)
- Rui Yu
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China
| | - De-Lei Kong
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Cai Liao
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China
| | - Ya-Jie Yu
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China
| | - Zhen-Wei He
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Yun Wang
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China.
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Ehlke SJ, Fitzer SA, Shipley JL, Braitman AL. Exploring the intersection of sexual identity and route of administration in relation to cannabis use among young adult females. Am J Addict 2024; 33:290-296. [PMID: 37830429 DOI: 10.1111/ajad.13487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/14/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Rates of cannabis use continue to increase with sexual minority women (SMW) reporting greater use than heterosexual women. Along with these increasing trends, the routes of administration (ROA) for cannabis are evolving. The current study examined associations between cannabis ROA and frequency of use, as well as differences across sexual identity (heterosexual vs. SMW). METHODS Participants were 949 young adult (18-25 years old) women (29.8% SMW) who reported past month cannabis use and were recruited through Amazon Mechanical Turk. Number of cannabis use days and each ROA used (joint, pipe, blunt, bong, vape, edible, and ointment) in the past 30 days were measured. Analysis of covariance models examined if sexual identity moderated the association between each ROA and cannabis use frequency. RESULTS Among the full sample, joints were the most common ROA (78.6%); cannabis vaping was the most common noncombustible ROA (25.9%). SMW were more likely than heterosexual women to use each ROA except for joints. SMW who used pipes or edibles reported greater cannabis use frequency, compared to those who did not; there were no differences in frequency of use across ROA for heterosexual women. DISCUSSION AND CONCLUSIONS SMW may use a greater variety of ROA, potentially increasing the harms associated with cannabis. Marketing strategies targeting the sexual minority community may increase the likelihood of using various cannabis ROA and subsequent use. SCIENTIFIC SIGNIFICANCE Findings further our knowledge about how young adult women are using cannabis, and highlight how ROA may contribute to the disparities observed among SMW.
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Affiliation(s)
- Sarah J Ehlke
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
| | - Samantha A Fitzer
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Jennifer L Shipley
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Abby L Braitman
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
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Hall W, Manthey J, Stjepanović D. Cannabis use and cannabis use disorders and their treatment in the Europe. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01776-1. [PMID: 38489067 DOI: 10.1007/s00406-024-01776-1] [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: 08/07/2023] [Accepted: 02/02/2024] [Indexed: 03/17/2024]
Abstract
This paper introduces the special issue on cannabis use in Europe. It describes data on the prevalence of cannabis use in Europe and the more limited data on the prevalence of cannabis use disorders, one of the most common forms of drug problem treated in many countries in Europe. It summarises what research has indicated about the adverse effects of acute and chronic cannabis use and discusses potential health system responses that may reduce some of these harms. These include public education about the risks of cannabis use; screening and brief interventions in primary medical settings; and specialist treatment for cannabis use disorders. It briefly indicates the special issues that may need to be addressed in dealing with the high rates of comorbidity between cannabis use disorders, other types of drug use disorders, and common mental disorders.
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Affiliation(s)
- Wayne Hall
- The National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia.
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Daniel Stjepanović
- The National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
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Shah K, Farwa UE, Vanaparti A, Patel S, Kanumuri M, Vashishth O, Hossain N, Dahiya R, Banala M, Enamorado FRP, Patel AS, Nadeem H, Kanani R, Desai HD, Sharma KH, Tripathi S. Global epidemiology of cannabis use disorders and its trend from 1990 to 2019: Benchmarking analysis of the global burden of disease study. J Family Med Prim Care 2024; 13:881-889. [PMID: 38736814 PMCID: PMC11086777 DOI: 10.4103/jfmpc.jfmpc_824_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/16/2023] [Accepted: 08/01/2023] [Indexed: 05/14/2024] Open
Abstract
Introduction Cannabis is one of the most widely used psychoactive substances globally, with an increasing trend in its legalization for both medical and recreational purposes in various countries. While cannabis offers potential therapeutic benefits, its regular use can lead to the development of Cannabis Use Disorders (CUDs). Understanding the epidemiology of CUDs is crucial in assessing the public health burden associated with cannabis use. Methods Epidemiological parameters of CUDs were assessed using the Global Burden of Disease (GBD) methodology across different age-groups, years, sexes, and locations worldwide from 1990-2019. Results Globally, for both sexes combined, prevalent cases of CUDs increased steadily from 17.1 million(95%UI=12.7-22.8million) in 1990 to 23.8-million(95%UI=17.8-30.9 million) in 2019. All age-adjusted highest number of incidence observed in High-Income-North-America(HINA)(121/100,000), followed by Australasia(100/100,000), Oceania(83.97/100,000), Tropical Latin America(69.59/100,000). Globally, age-standardized disability-adjusted life years rate(ASDR) observed higher in HINA, followed by Australasia, and Western-Europe. In male, all-age incidence counts increased from 1.7 million(95%UI=1.3-2.4million) in 1990 to 2.4 million(95%UI=1.8-3.2 million) in 2019. The highest annual percentage of change in age-standardized incidence rate(ASIR) was found in East-Asia (22%) followed by Middle-East and North-Africa(MENA)(15%). The age group of 15-24 years exhibited the highest burden of CUDs. Conclusion The widespread occurrence of CUDs on a global scale poses a substantial challenge to public health. Understanding the impact of CUDs and implementing evidence-based interventions is crucial in mitigating the associated individual, societal, and economic burdens. Continued research, collaboration, and knowledge dissemination are essential to inform policies, prevention efforts, and treatment strategies aimed at addressing CUDs on a global-scale.
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Affiliation(s)
- Kinjal Shah
- Department of Public Health Administration, Rutgers University, Edward J. Bloustein School of Planning and Public Policy, New Jersey, United States of America
| | - Umm E. Farwa
- Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Ankitha Vanaparti
- Department of Internal Medicine, Kakatiya Medical College, Hyderabad, Telangana, India
| | - Savan Patel
- Department of Internal Medicine, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Manisha Kanumuri
- Department of Psychiatry, Mediciti Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Oshin Vashishth
- Department of Internal Medicine, St. Martinus University, Willemstad, Curaçao
| | - Nadia Hossain
- Department of Internal Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Roopali Dahiya
- Department of Internal Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, Delhi, India
| | - Mallareddy Banala
- Department of Internal Medicine, Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India
| | | | - Abhiraj S. Patel
- Department of Internal Medicine, Our Lady of Fatima University College of Medicine, Valenzuela, Philippines
| | - Huzaifa Nadeem
- Department of Psychiatry, CMH Lahore Medical College, Combined Military Hospital, Lahore, Pakistan
| | - Ravi Kanani
- Department of Research Wing, Gujarat Adani Institute of Medical Sciences, Bhuj, Gujarat, India
| | - Hardik D. Desai
- Department of Research Wing, Gujarat Adani Institute of Medical Sciences, Affiliated to K.S.K.V University, Bhuj, Gujarat, India
| | - Kamal H. Sharma
- Department of Cardiology, U N Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Sharanya Tripathi
- Department of Internal Medicine, G.M.E.R.S Medical College, M.S. University, Gotri, Vadodara, Gujarat, India
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11
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Marshall A, Fai C, Han J, Yule AM, Jangi S. Rising Inpatient Utilization and Costs of Cannabis Hyperemesis Syndrome Hospitalizations in Massachusetts After Cannabis Legalization. J Clin Gastroenterol 2024; 58:247-252. [PMID: 37224284 DOI: 10.1097/mcg.0000000000001857] [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] [Received: 06/18/2022] [Accepted: 03/27/2023] [Indexed: 05/26/2023]
Abstract
GOALS We described the demographics, inpatient utilization, and cost of services among patients hospitalized for putative cannabinoid hyperemesis syndrome (CHS) predating and postdating cannabis legalization in Massachusetts. BACKGROUND As the recreational use of cannabis has been widely legalized nationally, the resulting shifts in clinical presentation, health care utilization, and estimated costs of CHS hospitalizations remain unclear in the postlegalization era. STUDY We performed a retrospective cohort study among patients admitted to a large urban hospital between 2012 and 2021, before and after the date of cannabis legalization in Massachusetts (Dec 15, 2016). We examined the demographic and clinical characteristics of patients admitted for putative CHS, the utilization of hospital services, and estimated inpatient costs pre and postlegalization. RESULTS We identified a significant increase in putative CHS hospitalizations pre and post-cannabis legalization in Massachusetts (0.1% vs 0.02% of total admissions per time period, P < 0.05). Across 72 CHS hospitalizations, patient demographics were similar pre and postlegalization. Hospital resource utilization increased postlegalization, with increased length of stay (3 d vs 1 d, P < 0.005), and need for antiemetics ( P < 0.05). Multivariate linear regression confirmed that postlegalization admissions were independently associated with increased length of stay ( Β = 5.35, P < 0.05). The mean cost of hospitalization was significantly higher postlegalization ($18,714 vs $7460, P < 0.0005), even after adjusting for medical inflation ($18,714 vs $8520, P < 0.001) with intravenous fluid administration and endoscopy costs increased ( P < 0.05). On multivariate linear regression, hospitalization for putative CHS during postlegalization predicted increased costs ( Β = 10,131.25, P < 0.05). CONCLUSIONS In the postlegalization era of cannabis in Massachusetts, we found increased putative CHS hospitalizations, with a concomitant increased length of hospital stay and total cost per hospitalization. As cannabis use increases, the recognition and costs of its deleterious effects are necessary to incorporate into future clinical practice strategies and health policy.
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Affiliation(s)
| | - Caitlin Fai
- Department of Internal Medicine, Tufts Medical Center
| | - John Han
- Tufts University School of Medicine
| | - Amy M Yule
- Department of Psychiatry, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Sushrut Jangi
- Tufts University School of Medicine
- Department of Internal Medicine, Tufts Medical Center
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12
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Boehnke KF, Wu CL, Clauw DJ. Thoughtfully Integrating Cannabis Products Into Chronic Pain Treatment. Anesth Analg 2024; 138:5-15. [PMID: 38100797 PMCID: PMC10730114 DOI: 10.1213/ane.0000000000005904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Cannabis products (CPs) and cannabis-based medicines (CBMs) are becoming increasingly available and are commonly used for pain management. The growing societal acceptance of cannabis and liberalization of cannabis laws allows patients to access CPs with minimal clinical oversight. While there is mechanistic plausibility that CPs and CBMs may be useful for pain management, the clinical trial literature is limited and does not refute or support the use of CBMs for pain management. Complicating matters, a large and growing body of observational literature shows that many people use CPs for pain management and in place of other medications. However, products and dosing regimens in existing trials are not generalizable to the current cannabis market, making it difficult to compare and reconcile these 2 bodies of literature. Given this complexity, clinicians need clear, pragmatic guidance on how to appropriately educate and work with patients who are using CBMs for pain management. In this review, we narratively synthesize the evidence to enable a clear view of current landscape and provide pragmatic advice for clinicians to use when working with patients. This advice revolves around 3 principles: (1) maintaining the therapeutic alliance; (2) harm reduction and benefit maximization; and (3) pragmatism, principles of patient-centered care, and use of best clinical judgment in the face of uncertainty. Despite the lack of certainty CPs and chronic pain management use, we believe that following these principles can make most of the clinical opportunity presented by discussions around CPs and also enhance the likelihood of clinical benefit from CPs.
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Affiliation(s)
- Kevin F. Boehnke
- Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Christopher L. Wu
- Department of Anesthesiology, Pain Medicine and Critical Care; Hospital for Special Surgery; New York, NY, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel J. Clauw
- Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
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13
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Chao KY, Liu SH, Chou CC, Chen CI, Cheng W. Legalization of marijuana or not? Opinions from over 38,000 residents in Taiwan. BMC Public Health 2023; 23:1954. [PMID: 37814243 PMCID: PMC10563234 DOI: 10.1186/s12889-023-16834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Marijuana is legal in many Western countries and Thailand. In Taiwan, Marijuana remains a category-2 narcotic; however, some legislative candidates recently advocated legalization of medical marijuana. This study surveyed a large sample of Taiwanese to gain a better understanding of the public's knowledge and attitudes towards legalizing marijuana. METHODS This cross-sectional mixed-methods study included demographic data and responses to a survey questionnaire, "Knowledge and Attitudes of Legalizing Marijuana" (KALM). The survey included 15 statements about four categories: public health, social impact, medical applications of THC (Δ9-tetrahydrocannabinol), and legal and tax consequences; and two yes/no questions about medical use and legalization of marijuana. Knowledge was scored as disagree = 0, no knowledge = 2, or agree = 4; attitude was scored from 0 = very unimportant to 4 = very important. Responses to an open-ended question asking for additional comments/concerns were analysed with content analysis. The survey was conducted from February 15 to March 1, 2023. RESULTS Data were analysed from 38,502 respondents, aged 15 to > 56 years. Most were female (67.1%) and parents (76.4%). Scores were higher for respondents who were parents, religious, ≥ 36 years of age, had a high-income status, no history of substance abuse, knowledge of medical marijuana, and did not support legalization of marijuana. Medical personnel had greater knowledge of marijuana, but their attitude indicated they viewed legalization as less important. In the open-ended question, many respondents requested more information about marijuana be provided to the public before considering legalization. CONCLUSIONS Taiwanese respondents considered legalization of marijuana a significant concern, especially as it relates to impacts on public health.
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Affiliation(s)
- Kuo-Yu Chao
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Hsiang Liu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chih-Chiang Chou
- Department of Psychiatry, Centro Hospitalar Conde de São Januário, Macau SAR, China
| | - Ching-I Chen
- Department of Psychiatry, Kee-Lung Hospital, Ministry of Health and Welfare, KeeLung, Taiwan
| | - Wei Cheng
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
- Department of Pathology, Kee-Lung Hospital, Ministry of Health and Welfare, 268, Xin 2nd Road, Xinyi District, KeeLung, 201203, Taiwan.
- Department of Nursing, Deh Yu College of Nursing and Health, Kee-Lung, Taiwan.
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14
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Boehnke KF, Martel MO, Smith T, He Y, Bergmans RS, Kruger DJ, Andwele M, Bevan S, Williams DA, Fitzcharles M. Medicinal Cannabis Use for Rheumatic Conditions in the US Versus Canada: Rationale for Use and Patient-Health Care Provider Interactions. ACR Open Rheumatol 2023; 5:443-453. [PMID: 37519131 PMCID: PMC10502834 DOI: 10.1002/acr2.11592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/20/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE Understanding how medical cannabis (MC) use is integrated into medical practice for rheumatic disease management is essential. We characterized rationale for MC use, patient-physician interactions around MC, and MC use patterns among people with rheumatic conditions in the US and Canada. METHODS We surveyed 3406 participants with rheumatic conditions in the US and Canada, with 1727 completing the survey (50.7% response rate). We assessed disclosure of MC use to health care providers, MC authorization by health care providers, and MC use patterns and investigated factors associated with MC disclosure to health care providers in the US versus Canada. RESULTS Overall, 54.9% of US respondents and 78.0% of Canadians reported past or current MC use, typically because of inadequate symptom relief from other medications. Compared to those in Canada, fewer US participants obtained MC licenses, disclosed MC use to their health care providers, or asked advice on how to use MC (all P values <0.001). Overall, 47.4% of Canadian versus 28.2% of US participants rated their medical professionals as their most trusted information source. MC legality in state of residence was associated with 2.49 greater odds of disclosing MC use to health care providers (95% confidence interval: 1.49-4.16, P < 0.001) in the US, whereas there were no factors associated with MC disclosure in Canada. Our study is limited by our convenience sampling strategy and cross-sectional design. CONCLUSION Despite widespread availability, MC is poorly integrated into rheumatic disease care, with most patients self-directing use with minimal or no clinical oversight. Concerted efforts to integrate MC into education and clinical policy is critical.
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Affiliation(s)
| | | | | | - Ying He
- University of MichiganAnn Arbor
| | | | | | | | - Sian Bevan
- Arthritis Society CanadaTorontoOntarioCanada
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15
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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16
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 226] [Impact Index Per Article: 226.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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17
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Crocker CE, Emsley J, Tibbo PG. Mental health adverse events with cannabis use diagnosed in the Emergency Department: what are we finding now and are our findings accurate? Front Psychiatry 2023; 14:1093081. [PMID: 37304435 PMCID: PMC10247977 DOI: 10.3389/fpsyt.2023.1093081] [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: 11/08/2022] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
We have previously reviewed the types and numbers of cannabis-associated adverse events that have mental health presentations that are encountered in the Emergency Department. A particular challenge in examining these events is disentangling cannabis use adverse events from adverse events associated with use of multiple recreational substances. Since that review was published, cannabis legalization for recreational use has greatly expanded world-wide and with these changes in the legal climate has come clearer information around the frequency of adverse events seen in the Emergency Department. However, as we examined the current state of the literature, we also examined some of research designs and the biases that may be impacting the validity of the data in this field. The biases both of clinicians and researchers as well as research approaches to studying these events may be impacting our ability to assess the interaction between cannabis and mental health. For example, many of the studies performed examining cannabis-related admissions to the Emergency Department were administrative studies that relied on front line clinicians to identify and attribute that cannabis use was associated with any particular admission. This narrative review provides an overview on what we currently know about mental health adverse events in the Emergency Department with a focus on the mental health impacts both for those with and without a history of mental illness. The evidence that cannabis use can adversely impact genders and sexes differently is also discussed. This review outlines what the most common adverse events related to mental health with cannabis use are; as well as noting the most concerning but much rarer events that have been reported. Additionally, this review suggests a framework for critical evaluation of this field of study going forward.
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Affiliation(s)
- Candice E. Crocker
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Jason Emsley
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
- IWK Children’s Health Centre, Halifax, NS, Canada
| | - Philip G. Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, Nova Scotia Health, Halifax, NS, Canada
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18
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Dowd AN, Zamarripa CA, Sholler DJ, Strickland JC, Goffi E, Borodovsky JT, Weerts EM, Vandrey R, Spindle TR. A cross-sectional survey on cannabis: Characterizing motives, opinions, and subjective experiences associated with the use of various oral cannabis products. Drug Alcohol Depend 2023; 245:109826. [PMID: 36871378 PMCID: PMC10044512 DOI: 10.1016/j.drugalcdep.2023.109826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Cannabis-infused products available for oral consumption include food and drink items (i.e., edibles) (e.g., baked goods, gummy-, chocolate-, and hard-candies, beverages/drinks) as well as non-food formulations (e.g., oils/tinctures, pills/capsules). This study characterized the motives, opinions, and subjective experiences associated with the use of these seven subtypes of oral cannabis products. METHODS This web-based survey collected cross-sectional, self-report data from a convenience sample of 370 adults regarding various use-motives, self-reported cannabinoid content, subjective experiences, and opinions related to ingesting oral cannabis products with alcohol and/or food. Advice participants had received about modifying oral cannabis product effects, in general, was also collected. RESULTS Participants reported consuming cannabis baked goods and gummy candies most frequently over the past year (68% and 63%, respectively). Participants were less likely to use oils/tinctures for enjoyment/desire relative to other product types and more likely to use oils/tinctures for therapeutic purposes (e.g., medication-replacement). Self-reported cannabinoid content was highly variable across participants and within product subtype. Participants reported feeling stronger and longer-lasting effects when consuming oral cannabis products on an empty stomach and 43% received advice to "eat a snack or meal" to mitigate effects that are too strong, which contrasts with controlled studies. Finally, 43% of participants reported modifying their experiences with alcohol at least some of time. CONCLUSIONS These findings underscore the need to further evaluate use-motives as well as the interaction between dietary factors, cannabinoid pharmacokinetics, and subjective drug effects and the interactive effects of oral cannabis products and alcohol in a controlled laboratory setting.
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Affiliation(s)
- Ashley N Dowd
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA.
| | - C Austin Zamarripa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Dennis J Sholler
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Elia Goffi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Jacob T Borodovsky
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Elise M Weerts
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Tory R Spindle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
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19
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Holt AK, Poklis JL, Peace MR. The history, evolution, and practice of cannabis and E-cigarette industries highlight necessary public health and public safety considerations. JOURNAL OF SAFETY RESEARCH 2023; 84:192-203. [PMID: 36868647 PMCID: PMC10829760 DOI: 10.1016/j.jsr.2022.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/29/2022] [Accepted: 10/25/2022] [Indexed: 06/18/2023]
Affiliation(s)
- Alaina K Holt
- Department of Forensic Science, Virginia Commonwealth University, Richmond, VA, United States; Integrative Life Sciences Doctoral Program, Virginia Commonwealth University, Richmond, VA, United States.
| | - Justin L Poklis
- Department of Pharmacology & Toxicology, Virginia Commonwealth University, Richmond, VA, United States.
| | - Michelle R Peace
- Department of Forensic Science, Virginia Commonwealth University, Richmond, VA, United States.
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20
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Correction to: The Potential Proconvulsant Effects of Cannabis: a Scoping Review. J Med Toxicol 2023; 19:54-60. [PMID: 36322377 PMCID: PMC9813313 DOI: 10.1007/s13181-022-00915-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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21
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Hughes AR, Grusing S, Lin A, Hendrickson RG, Sheridan DC, Marshall R, Horowitz BZ. Trends in intentional abuse and misuse ingestions in school-aged children and adolescents reported to US poison centers from 2000-2020. Clin Toxicol (Phila) 2023; 61:64-71. [PMID: 36469528 DOI: 10.1080/15563650.2022.2120818] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/17/2022] [Accepted: 08/30/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT Childhood and adolescent misuse and abuse exposures remain a serious public health challenge in the United States. This study aimed to describe recent trends and patterns of intentional substance misuse and abuse exposures among school-aged children and adolescents in the United States. METHODS This study was a retrospective cohort study of intentional misuse and abuse exposures in children 6 through 18 years reported to the National Poison Data System (NPDS) from January 1, 2000, through December 31, 2020. Demographic trends, reported clinical effects, treatments, management sites, and health outcomes were assessed overall and within four age categories: 6-9, 10-12, 13-15, and 16-18. RESULTS Between 2000 and 2020, there were 338,727 cases regarding intentional misuse and abuse exposures for children ages 6 through 18 years old. Overall, misuse/abuse ingestions fluctuated over time, with a peak in 2011. The majority of intentional misuse/abuse ingestions occurred in males (58.3%), and more than 80% of all reported exposure cases occurred in youth aged 13 to 18. 32.6% of ingestions resulted in worse than minor clinical outcomes. Older age groups had a greater number of severe medical outcomes compared to younger age groups. Major or life-threatening exposures (including those resulting in death) were more common in males. Overall, deaths were rare (n = 450), 0.1%). Male sex, older age, abuse ingestions, exposure site of a public area or other residence, and multiple ingested substances were other factors associated with increased mortality. Marijuana exposure rates had the highest average monthly increase overall, with the most dramatic rise occurring from 2017 to 2020. Edible marijuana preparations accounted for the highest increase in call rates compared with all other forms of marijuana. DISCUSSION AND CONCLUSION With over 330,000 poison center cases reported during the 20-year study period, intentional substance misuse and abuse exposures substantially impact the pediatric population. The substances most commonly misused/abused are more widely available substances such as over-the-counter medications, household products and pharmaceuticals commonly prescribed to youth. Differences in age and sex were evident, with males and adolescents more likely to abuse and misuse substances. Our study describes an upward trend in marijuana misuse/abuse exposures among youth, especially those involving edible products. These findings highlight an ongoing concern about the impact of rapidly evolving cannabis legalization on this vulnerable population.
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Affiliation(s)
- Adrienne R Hughes
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
- Oregon-Alaska Poison Center, Portland, OR, USA
| | - Sara Grusing
- Oregon Health and Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Amber Lin
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Robert G Hendrickson
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
- Oregon-Alaska Poison Center, Portland, OR, USA
| | - David C Sheridan
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Rebecca Marshall
- Child Psychiatry, Oregon Health and Science University, Portland, OR, USA
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22
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Vargas G, Shrier LA, Chadi N, Harris SK. High-Potency Cannabis Use in Adolescence. J Pediatr 2023; 252:191-197.e1. [PMID: 35977620 DOI: 10.1016/j.jpeds.2022.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Gabriela Vargas
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Center for Adolescent Behavioral Health Research, Boston Children's Hospital, Boston, MA
| | - Nicholas Chadi
- Université de Montréal, Montréal, Quebec, Canada; Ste-Justine Hospital Research Center, Montréal, Quebec, Canada
| | - Sion K Harris
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Center for Adolescent Behavioral Health Research, Boston Children's Hospital, Boston, MA
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23
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Ilonze OJ, Vidot DC, Breathett K, Camacho-Rivera M, Raman SV, Kobashigawa JA, Allen LA. Cannabis Use and Heart Transplantation: Disparities and Opportunities to Improve Outcomes. Circ Heart Fail 2022; 15:e009488. [PMID: 36252094 PMCID: PMC9772032 DOI: 10.1161/circheartfailure.122.009488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Heart transplantation (HT) remains the optimal therapy for many patients with advanced heart failure. Use of substances of potential abuse has historically been a contraindication to HT. Decriminalization of cannabis, increasing cannabis use, clinician biases, and lack of consensus for evaluating patients with heart failure who use cannabis all have the potential to exacerbate racial and ethnic and regional disparities in HT listing and organ allocation. Here' we review pertinent pre-HT and post-HT considerations related to cannabis use' and relative attitudes between opiates and cannabis are offered for context. We conclude with identifying unmet research needs pertaining to the use of cannabis in HT that can inform a standardized evaluation process.
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Affiliation(s)
- Onyedika J. Ilonze
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN
| | - Denise C. Vidot
- University of Miami School of Nursing and Health Studies, Coral Gables, FL
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN
| | | | - Subha V. Raman
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN
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Moreno-Sanz G, Madiedo A, Lynskey M, Brown MRD. “Flower Power”: Controlled Inhalation of THC-Predominant Cannabis Flos Improves Health-Related Quality of Life and Symptoms of Chronic Pain and Anxiety in Eligible UK Patients. Biomedicines 2022. [DOI: .ezproxy.mnsu.edu/10.3390/biomedicines10102576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
In November 2018, the UK’s Home Office established a legal route for eligible patients to be prescribed cannabis-based products for medicinal use in humans (CBPMs) as unlicensed medicines. These include liquid cannabis extracts for oral administration (“oils”) and dried flowers for inhalation (“flos”). Smoking of CBPMs is expressly prohibited. To date, THC-predominant cannabis flowers remain the most prescribed CBPMs in project Twenty21 (T21), the first multi-center, prospective, observational UK cannabis patient registry. This observational, prospective data review analyzes patient-reported outcome measures (PROMS) collected by T21 associated with the inhalation of KHIRON 20/1, the most prescribed CBPM in the project. PROMS collected at baseline and at subsequent 3-month follow-up included health-related quality of life (HRQoL), general mood, and sleep. Condition-specific measures of illness severity were performed with the Brief Pain Inventory Short Form (BPI-SF) and the Generalized Anxiety Disorder 7-Item Scale (GAD-7). Participants (N = 344) were mostly males (77.6%, average age = 38.3) diagnosed mainly with chronic pain (50.9%) and anxiety-related disorders (25.3%). Inhalation of KHIRON 20/1 was associated with a marked increase in self-reported HRQoL, general mood, and sleep (N = 344; p < 0.001). Condition-specific assessments showed significant improvements in pain severity (T = 6.67; p < 0.001) and interference (T = 7.19; p < 0.001) in patients using KHIRON 20/1 for chronic pain (N = 174). Similar results were found for patients diagnosed with anxiety-related disorders (N = 107; T = 12.9; p < 0.001). Our results indicate that controlled inhalation of pharmaceutical grade, THC-predominant cannabis flos is associated with a significant improvement in patient-reported pain scores, mood, anxiety, sleep disturbances and overall HRQoL in a treatment-resistant clinical population.
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25
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Moreno-Sanz G, Madiedo A, Lynskey M, Brown MRD. " Flower Power": Controlled Inhalation of THC-Predominant Cannabis Flos Improves Health-Related Quality of Life and Symptoms of Chronic Pain and Anxiety in Eligible UK Patients. Biomedicines 2022; 10:biomedicines10102576. [PMID: 36289837 PMCID: PMC9599241 DOI: 10.3390/biomedicines10102576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022] Open
Abstract
In November 2018, the UK’s Home Office established a legal route for eligible patients to be prescribed cannabis-based products for medicinal use in humans (CBPMs) as unlicensed medicines. These include liquid cannabis extracts for oral administration (“oils”) and dried flowers for inhalation (“flos”). Smoking of CBPMs is expressly prohibited. To date, THC-predominant cannabis flowers remain the most prescribed CBPMs in project Twenty21 (T21), the first multi-center, prospective, observational UK cannabis patient registry. This observational, prospective data review analyzes patient-reported outcome measures (PROMS) collected by T21 associated with the inhalation of KHIRON 20/1, the most prescribed CBPM in the project. PROMS collected at baseline and at subsequent 3-month follow-up included health-related quality of life (HRQoL), general mood, and sleep. Condition-specific measures of illness severity were performed with the Brief Pain Inventory Short Form (BPI-SF) and the Generalized Anxiety Disorder 7-Item Scale (GAD-7). Participants (N = 344) were mostly males (77.6%, average age = 38.3) diagnosed mainly with chronic pain (50.9%) and anxiety-related disorders (25.3%). Inhalation of KHIRON 20/1 was associated with a marked increase in self-reported HRQoL, general mood, and sleep (N = 344; p < 0.001). Condition-specific assessments showed significant improvements in pain severity (T = 6.67; p < 0.001) and interference (T = 7.19; p < 0.001) in patients using KHIRON 20/1 for chronic pain (N = 174). Similar results were found for patients diagnosed with anxiety-related disorders (N = 107; T = 12.9; p < 0.001). Our results indicate that controlled inhalation of pharmaceutical grade, THC-predominant cannabis flos is associated with a significant improvement in patient-reported pain scores, mood, anxiety, sleep disturbances and overall HRQoL in a treatment-resistant clinical population.
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Affiliation(s)
| | | | | | - Matthew R. D. Brown
- Zerenia Clinics, London SW1X 9AE, UK
- The Royal Marsden Hospital, London SW3 6JJ, UK
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Zeiger JS, Silvers WS, Naimi DR, Skypala IJ, Ellis AK, Connors L, Jeimy S, Nayak AP, Bernstein JA, Zeiger RS. Impact of cannabis knowledge and attitudes on real-world practice. Ann Allergy Asthma Immunol 2022; 129:441-450. [PMID: 35472594 PMCID: PMC9869714 DOI: 10.1016/j.anai.2022.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/18/2022] [Accepted: 04/12/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Increased cannabis consumption worldwide challenges allergists because of an upsurge in cannabis allergy and need to discuss cannabis with patients. OBJECTIVE To determine the knowledge, attitudes, and practices regarding cannabis among allergists and their approach to recognizing and diagnosing suspected cannabis allergy. METHODS The International Allergist Canna Knowledge, Attitudes, and Practices Survey was completed by members from 3 International Allergy Societies. Survey questions included the following: 13 on cannabis attitudes, 7 on cannabis knowledge, and 4 on real-world allergy practices. Knowledge level was dichotomized and Statistical Package for the Social Sciences TwoStep Cluster Analysis grouped participants by attitudes. Multivariate analysis determined the relationship of knowledge and attitude to practice delivery. RESULTS Of 570 eligible surveys started, 445 (78.1%) were completed. Participants were 49.7% of female sex, 65.9% aged 24 to 56 years, approximately 70% in practice for more than or equal to 10 years, and 29.2% practicing in an area where cannabis use is illegal. Of the respondents, 43.1% reported consulting on patients with suspected cannabis allergy and 54.7% had undertaken skin prick testing, in vitro cannabis testing, or both. Statistically significant differences were found between the 3 societies for most variables analyzed. Analysis of attitudes revealed 3 clusters named Traditional, Progressive, and Unsure. Those with more progressive attitudes toward cannabis and who had more knowledge were more comfortable speaking to patients about cannabis and more often asked patients on how often and how they used cannabis (all P < .001). CONCLUSION Varying knowledge and attitudes toward cannabis affecting comfort communicating with patients about cannabis were found in members of 3 allergy societies supporting the need for more cannabis research and education.
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Affiliation(s)
| | - William S Silvers
- Canna Research Foundation, Boulder, Colorado; University of Colorado School of Medicine, Denver, Colorado
| | - David R Naimi
- Naval Hospital Camp Pendleton, Oceanside, California
| | - Isabel J Skypala
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Anne K Ellis
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lori Connors
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samira Jeimy
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada
| | - Ajay P Nayak
- Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jonathan A Bernstein
- University of Cincinnati College of Medicine, Bernstein Allergy Group, Cincinnati, Ohio
| | - Robert S Zeiger
- Canna Research Foundation, Boulder, Colorado; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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Kluger BM, Huang AP, Miyasaki JM. Cannabinoids in movement disorders. Parkinsonism Relat Disord 2022; 102:124-130. [PMID: 36038457 DOI: 10.1016/j.parkreldis.2022.08.014] [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: 07/16/2021] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION On the basis of both scientific progress and popular lore, there is growing optimism in the therapeutic potential of cannabis (marijuana) and cannabinoid-based chemicals for movement disorders. There is also notable skepticism regarding the scientific basis for this therapeutic optimism and significant concerns regarding the safety and regulation of cannabinoid products, particularly those available without prescription. METHODS In recognition of the high interest and controversial nature of this subject, the meeting committee of the International Parkinson and Movement Disorders Society arranged for a talk on cannabis at the 2019 annual meeting's Controversies in Movement Disorders plenary session. This paper summarizes the highlights of this session. RESULTS The endocannabinoid system is strongly tied to motor function and dysfunction, with basic research suggesting several promising therapeutic targets related to cannabinoids for movement disorders. Clinical research on cannabinoids for motor and nonmotor symptoms in Parkinson's disease, Huntington's disease, Tourette's syndrome, dystonia, and other movement disorders to date are promising at best and inconclusive or negative at worst. Research in other populations suggest efficacy for common symptoms like pain. While social campaigns against recreational cannabinoid use focus on cognitive changes in adolescents, the long-term sequelae of regulated medical use in older adults with movement disorders is unknown. The overall risks of cannabinoids may be similar to other commonly used medications and include falls and apathy. CONCLUSION Further research is greatly needed to better understand the actual clinical benefits and long-term side effects of medical cannabis products for movement disorders indications and populations.
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Affiliation(s)
- Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Andrew P Huang
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Trends in the use of cannabis products in Canada and the USA, 2018 – 2020: Findings from the International Cannabis Policy Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103716. [DOI: 10.1016/j.drugpo.2022.103716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 11/22/2022]
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The Potential Proconvulsant Effects of Cannabis: a Scoping Review. J Med Toxicol 2022; 18:223-234. [PMID: 35352276 PMCID: PMC9198115 DOI: 10.1007/s13181-022-00886-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Cannabis' effect on seizure activity is an emerging topic that remains without consensus and merits further investigation. We therefore performed a scoping review to identify the available evidence and knowledge gaps within the existing literature on cannabis product exposures as a potential cause of seizures in humans. METHODS A scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews guidelines. The PubMed and Scopus databases were searched over a 20-year period from the date of the database query (12/21/2020). Inclusion criteria were (1) English language original research articles, (2) inclusion of human subjects, and (3) either investigation of seizures as a part of recreational cannabinoid use OR of exogenous cannabinoids as a cause of seizures. RESULTS A total of 3104 unique articles were screened, of which 68 underwent full-text review, and 13 met inclusion/exclusion criteria. Ten of 11 studies evaluating acute cannabis exposures reported a higher seizure incidence than would be expected based on the prevalence of epilepsy in the general and pediatric populations (range 0.7-1.2% and 0.3-0.5% respectively). The remaining two studies demonstrated increased seizure frequency and/or seizure-related hospitalization in recreational cannabis users and those with cannabis use disorder. CONCLUSIONS This scoping review demonstrates that a body of literature describing seizures in the setting of cannabis exposure exists, but it has several limitations. Ten identified studies showed a higher than expected incidence of seizures in populations exposed to cannabis products. Based on the Bradford Hill criteria, delta-9 tetrahydrocannabinol (THC) may be the causative xenobiotic for this phenomenon.
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Choi NG, DiNitto DM, Marti CN, Baker SD. Management site and level of health care for cannabis- and synthetic cannabinoid-related poison control center cases involving older adults, 2016-2019. Drug Chem Toxicol 2022; 45:1739-1747. [PMID: 33406940 PMCID: PMC11137738 DOI: 10.1080/01480545.2020.1868494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/17/2020] [Accepted: 12/19/2020] [Indexed: 01/25/2023]
Abstract
Increasing numbers of older adults use cannabis and cannabis-derived products that can have adverse effects. This study examined management site and level of healthcare services for older adult poison control center cases involving cannabis products. Using the American Association of Poison Control Centers' (PCC) National Poison Data System, 2016-2019, we extracted the 3109 cases aged 50+ for which cannabis was the only or primary substance. Multinomial logistic regression models were fit to examine associations between specific cannabis forms and management/care site (on site [mostly at home], at a healthcare facility [HCF], or no follow-up due to referral refusal or leaving against medical advice) and level of healthcare services for cases managed at a HCF. The results show that between 2016 and 2019, PCC cannabis cases involving older adults increased twofold, largely due to cases of cannabidiol, edibles, and concentrated extracts. Plant form and synthetic cannabinoid cases declined substantially. Compared to plant forms, synthetic cannabinoid cases had 4.22 (95% CI = 2.59-6.89) greater odds of being managed at, rather than outside, a HCF and 2.17 (1.42-3.31) greater odds of critical care unit admission. Although e-cigarette cases, compared to plant form cases, had lower odds of being managed at a HCF, HCF-managed e-cigarette cases had 3.43 greater odds (95% CI = 1.08-10.88) of critical care unit admission. Synthetic cannabinoid cases also had 1.86 (95% CI = 1.03-3.35) greater odds of no follow-up, and the presence of a secondary substance was also a significant factor. Stricter regulations for listing chemical ingredients and providing safety guidelines are needed for cannabis-derived products.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Diana M. DiNitto
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - C. Nathan Marti
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
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Boehnke KF, Davis AK, McAfee J. Applying Lessons From Cannabis to the Psychedelic Highway. JAMA HEALTH FORUM 2022; 3:e221618. [PMID: 36219016 DOI: 10.1001/jamahealthforum.2022.1618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Kevin F. Boehnke
- Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor
| | - Alan K. Davis
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jenna McAfee
- Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor
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Phillips KT, Pedula KL, Choi NG, Tawara KAK, Simiola V, Satre DD, Owen-Smith A, Lynch FF, Dickerson J. Chronic health conditions, acute health events, and healthcare utilization among adults over age 50 in Hawai'i who use cannabis: A matched cohort study. Drug Alcohol Depend 2022; 234:109387. [PMID: 35279458 DOI: 10.1016/j.drugalcdep.2022.109387] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/14/2022] [Accepted: 02/28/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Research on cannabis-related health outcomes in diverse older adults is limited. The current study utilized a matched cohort study design to compare older adults in Hawai'i with identified cannabis diagnoses and matched controls on chronic health conditions, acute health events, and healthcare utilization from 2016 to 2020. METHOD Patients age 50 + were identified using ICD-10 diagnostic codes for cannabis use, abuse, and dependence using electronic health record data from an integrated health system (Kaiser Permanente Hawai'i). Those with cannabis diagnoses (n = 275) were compared to matched non-using controls (n = 275; based on age, sex) on chronic health conditions (coronary heart disease, hypertension, COPD, chronic non-cancer pain), acute health events (myocardial infarction, respiratory symptoms, stroke, persistent or cyclic vomiting, injuries), and healthcare utilization (outpatient, inpatient, and emergency department visits) following case identification for two years. RESULTS Participants were 19.3% Native Hawaiian/Pacific Islander, 24.4% Asian, 47.8% White, and 8.5% Other/Unknown, with an average age of 62.8 years (SD=7.3). Adjusting for covariates as possible, participants with a cannabis diagnosis had significantly greater risk of coronary heart disease, chronic non-cancer pain, stroke, myocardial infarction, cyclic vomiting, and injuries, over time, compared to controls. Cannabis use was associated with any and greater frequency of outpatient, inpatient, and emergency department visits. CONCLUSIONS In a diverse sample, older adults who used cannabis had worse health conditions and events and used more health services over a two-year period. Future studies should evaluate cannabis-related health outcomes, effects of cannabis problem severity, as well as implications for healthcare in aging populations.
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Affiliation(s)
- Kristina T Phillips
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA.
| | - Kathryn L Pedula
- Hawai'i Permanente Medical Group, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Namkee G Choi
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Kylee-Ann K Tawara
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA; School of Public Health, University of Washington, Seattle, WA, USA
| | - Vanessa Simiola
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Ashli Owen-Smith
- School of Public Health, Georgia State University, Atlanta, GA, USA; Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Frances F Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA; OCHIN Research, Portland, OR, USA
| | - John Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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Burillo-Putze G, Richards JR, Rodríguez-Jiménez C, Sanchez-Agüera A. Pharmacological management of cannabinoid hyperemesis syndrome: an update of the clinical literature. Expert Opin Pharmacother 2022; 23:693-702. [DOI: 10.1080/14656566.2022.2049237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - John R. Richards
- Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Consuelo Rodríguez-Jiménez
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, Spain
- Clinical Pharmacology Department, Hospital Universitario de Canarias, Tenerife, Spain
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Wang GS, Buttorff C, Wilks A, Schwam D, Tung G, Banerji S, Dart RC, Pacula RL. Comparison of hospital claims and poison center data to evaluate health impact of opioids, cannabis and synthetic cannabinoids. Am J Emerg Med 2022; 53:150-153. [PMID: 35051702 PMCID: PMC8956045 DOI: 10.1016/j.ajem.2022.01.004] [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: 10/30/2021] [Revised: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Over the past 10 years, opioids and cannabis have garnered significant attention due to misuse and legalization trends. Different datasets and surveillance mechanisms can lead to different conclusions the due to a variety of factors. The primary objective of this study was to compare and describe trends of opioid, cannabis, and synthetic cannabinoid-related healthcare encounters and poison center (PC) cases in Colorado, a state that has legalized cannabis. METHODS This was a retrospective study comparing hospital claims data (Colorado Hospital Association (CHA)) and poison center cases to describe opioid, cannabis and synthetic cannabinoid-related healthcare encounters and exposures in Colorado from 2013 to 2017 using related genetic codes and International Statistical Classification of Disease codes. RESULTS Both datasets observed increases in cannabis related encounters and exposures after recreational cannabis legalization in 2014. CHA reported an increase for cannabis-related ER visits from 14,109 in 2013 to 18,118 in 2017 while PC noted a 74.4% increase in cannabis-related cases (125 to 218). CHA inpatient visits associated with cannabis also increased (8311 in 2013 to 14,659 in 2017). On the other hand, Opioid-related exposures to the PC fell (1092 in 2013 to 971 in 2017) while both Opioid-related ER visits (8580 in 2013 to 12,928 in 2017) and inpatient visits in CHA increased (9084 in 2013 to 13,205). CONCLUSIONS This study demonstrates the differences in surveillance methodology for concurrent drug abuse epidemics using hospital claims and PC data. Both systems provide incomplete reports, but in combination can provide a more complete picture.
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Affiliation(s)
- George Sam Wang
- University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Department of Pediatrics, 13123 East 16th Ave B251, Aurora, CO 80045, United States of America.
| | | | - Asa Wilks
- RAND Corporation, United States of America.
| | | | - Greg Tung
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Department of Health Systems, Management & Policy
| | - Shireen Banerji
- Rocky Mountain Poison and Drug Safety, Denver Health Hospital AuthorityShireen, United States of America.
| | - Richard C Dart
- Rocky Mountain Poison and Drug Safety, Denver Health Hospital Authority
| | - Rosalie Liccardo Pacula
- University of Southern California, Sol Price School of Public Policy, Schaeffer Center for Health Policy & Economics, United States of America.
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Rhew IC, Guttmannova K, Kilmer JR, Fleming CB, Hultgren BA, Hurvitz PM, Dilley JA, Larimer ME. Associations of cannabis retail outlet availability and neighborhood disadvantage with cannabis use and related risk factors among young adults in Washington State. Drug Alcohol Depend 2022; 232:109332. [PMID: 35123361 PMCID: PMC8890768 DOI: 10.1016/j.drugalcdep.2022.109332] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study examined associations of local cannabis retail outlet availability and neighborhood disadvantage with cannabis use and related risk factors among young adults. METHODS Data were from annual cross-sectional surveys administered from 2015 to 2019 to individuals ages 18-25 residing in Washington State (N = 10,009). As outcomes, this study assessed self-reported cannabis use at different margins/frequencies (any past year, at least monthly, at least weekly, at least daily) and perceived ease of access to cannabis and acceptability of cannabis use in the community. Cannabis retail outlet availability was defined as the presence of at least one retail outlet within a 1-kilometer road network buffer of one's residence. Sensitivity analyses explored four other spatial metrics to define outlet availability (any outlet within 0.5-km, 2-km, and the census tract; and census tract density per 1000 residents). Census tract level disadvantage was a composite of five US census variables. RESULTS Adjusting for individual- and area-level covariates, living within 1-kilometer of at least one cannabis retail outlet was statistically significantly associated with any past year and at least monthly cannabis use as well as high perceived access to cannabis. Results using a 2-km buffer and census tract-level metrics for retail outlet availability showed similar findings. Neighborhood disadvantage was statistically significantly associated with at least weekly and at least daily cannabis use and with greater perceived acceptability of cannabis use. CONCLUSIONS Results may have implications for regulatory and prevention strategies to reduce the population burden of cannabis use and related harms.
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Affiliation(s)
- Isaac C Rhew
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, University of Washington, Box 357238, Seattle, WA 98195-7238, USA.
| | - Katarina Guttmannova
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, University of Washington, Box 357238, Seattle, WA 98195-7238, USA.
| | - Jason R Kilmer
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, University of Washington, Box 357238, Seattle, WA 98195-7238, USA.
| | - Charles B Fleming
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, University of Washington, Box 357238, Seattle, WA 98195-7238, USA.
| | - Brittney A Hultgren
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, University of Washington, Box 357238, Seattle, WA 98195-7238, USA.
| | - Philip M Hurvitz
- Center for the Studies in Demography and Ecology, University of Washington, Seattle, WA, USA; Department of Urban Design and Planning, University of Washington, Seattle, WA, USA.
| | - Julia A Dilley
- Oregon Public Health Division, 800 NE Oregon Street, #260, Portland, OR 97232, USA.
| | - Mary E Larimer
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, University of Washington, Box 357238, Seattle, WA 98195-7238, USA.
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Hill KP, Gold MS, Nemeroff CB, McDonald W, Grzenda A, Widge AS, Rodriguez C, Kraguljac NV, Krystal JH, Carpenter LL. Risks and Benefits of Cannabis and Cannabinoids in Psychiatry. Am J Psychiatry 2022; 179:98-109. [PMID: 34875873 DOI: 10.1176/appi.ajp.2021.21030320] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The United States is in the midst of rapidly changing laws regarding cannabis. The increasing availability of cannabis for recreational and medical use requires that mental health clinicians be knowledgeable about evidence to be considered when counseling both patients and colleagues. In this review, the authors outline the evidence from randomized double-blind placebo-controlled trials for therapeutic use of cannabinoids for specific medical conditions and the potential side effects associated with acute and chronic cannabis use. METHODS Searches of PubMed and PsycInfo were conducted for articles published through July 2021 reporting on "cannabis" or "cannabinoids" or "medicinal cannabis." Additional articles were identified from the reference lists of published reviews. Articles that did not contain the terms "clinical trial" or "therapy" in the title or abstract were not reviewed. A total of 4,431 articles were screened, and 841 articles that met criteria for inclusion were reviewed by two or more authors. RESULTS There are currently no psychiatric indications approved by the U.S. Food and Drug Administration (FDA) for cannabinoids, and there is limited evidence supporting the therapeutic use of cannabinoids for treatment of psychiatric disorders. To date, evidence supporting cannabinoid prescription beyond the FDA indications is strongest for the management of pain and spasticity. CONCLUSIONS As cannabinoids become more available, the need for an evidence base adequately evaluating their safety and efficacy is increasingly important. There is considerable evidence that cannabinoids have a potential for harm in vulnerable populations such as adolescents and those with psychotic disorders. The current evidence base is insufficient to support the prescription of cannabinoids for the treatment of psychiatric disorders.
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Affiliation(s)
- Kevin P Hill
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Mark S Gold
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Charles B Nemeroff
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - William McDonald
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Adrienne Grzenda
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Alik S Widge
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Carolyn Rodriguez
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Nina V Kraguljac
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - John H Krystal
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Linda L Carpenter
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
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Boehnke KF, Yakas L, Scott JR, DeJonckheere M, Litinas E, Sisley S, Clauw DJ, Williams DA, McAfee J. A mixed methods analysis of cannabis use routines for chronic pain management. J Cannabis Res 2022; 4:7. [PMID: 35016733 PMCID: PMC8750808 DOI: 10.1186/s42238-021-00116-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 12/26/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The wide heterogeneity of available cannabis products makes it difficult for physicians to appropriately guide patients. In the current study, our objective was to characterize naturalistic cannabis use routines and explore associations between routines and reported benefits from consuming cannabis. METHODS We performed a mixed methods analysis of n=1087 cross-sectional survey responses from adults with self-reported chronic pain using cannabis for symptom management in the USA and Canada. First, we qualitatively analyzed responses to an open-ended question that assessed typical cannabis use routines, including administration routes, cannabinoid content, and timing. We then sub-grouped responses into categories based on inhalation (smoking, vaporizing) vs. non-inhalation (e.g., edibles). Finally, we investigated subgroups perceptions of how cannabis affected pain, overall health, and use of medications (e.g., substituting for opioids, benzodiazepines). Substitutions were treated as a count of medication classes, while responses for both pain and health were analyzed continuously, with - 2 indicating health declining a lot or pain increasing a lot and 2 indicating that health improved a lot or pain decreased a lot. RESULTS Routines varied widely in terms of administration routes, cannabinoid content, and use timing. Overall, 18.8%, 36.2%, and 45% used non-inhalation, inhalation, and non-inhalation + inhalation routes, respectively. Those who used inhalation routes were younger (mean age 46.5 [inhalation] and 49.2 [non-inhalation + inhalation] vs. 56.3 [inhalation], F=36.1, p<0.001), while a higher proportion of those who used non-inhalation routes were female (72.5% non-inhalation vs. 48.3% inhalation and 65.3% non-inhalation + inhalation, X2=59.6, p<0.001). THC-rich products were typically used at night, while CBD-rich products were more often used during the day. While all participants reported similarly decreased pain, participants using non-inhalation + inhalation administration routes reported larger improvements in health than the non-inhalation (mean difference = 0.32, 95% CI: 0.07-0.37, p<0.001) and inhalation subgroups (mean difference = 0.22, 95% CI: 0.07-0.37, p=0.001). Similarly, the non-inhalation + inhalation group had significantly more medication substitutions than those using non-inhalation (mean difference = 0.62, 95% CI: 0.33-0.90, p<0.001) and inhalation administration routes (mean difference = 0.45, 95% CI: 0.22-0.69, p<0.001), respectively. CONCLUSIONS Subgrouping medical cannabis patients based on administration route profile may provide useful categories for future studies examining the risks and benefits of medical cannabis.
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Affiliation(s)
- Kevin F Boehnke
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Laura Yakas
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
| | - J Ryan Scott
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Daniel J Clauw
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
| | - David A Williams
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jenna McAfee
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
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Bechard M, Cloutier P, Lima I, Salamatmanesh M, Zemek R, Bhatt M, Suntharalingam S, Kurdyak P, Baker M, Gardner W. Cannabis-related emergency department visits by youths and their outcomes in Ontario: a trend analysis. CMAJ Open 2022; 10:E100-E108. [PMID: 35135825 PMCID: PMC9259464 DOI: 10.9778/cmajo.20210142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cannabis-related emergency department visits can be an entry point for youths to mental health and substance use care systems. We aimed to examine trends in cannabis-related emergency department visits as a function of youths' age and sex. METHODS Using administrative data, we examined all visits to emergency departments in Ontario, Canada, from 2003 to 2017, by youth aged 10-24 years (grouped as 10-13, 14-18 and 19-24 yr) to determine trends in cannabis-related emergency department visits. Cannabis-related visits were identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes for cannabis poisoning and mental disorders due to cannabinoids. We categorized presentations as "less severe" versus "more severe" using scores assigned by nurses at triage. RESULTS We examined 14 697 778 emergency department visits. Cannabis-related visits increased from 3.8 per 10 000 youths (95% confidence interval [CI] 3.5-4.0) in 2003 to 17.9 (95% CI 17.4-18.4) in 2017, a 4.8-fold increase (95% CI 4.4-5.1). Rates increased for both sexes and each age group. Males were more likely to have a visit than females (rate ratios ≥ 1.5 in 2003 and 2017). The number of cannabis-related visits in 2017 was 25.0 per 10 000 (95% CI 24.0-25.9) among youth aged 19-24 years, 21.9 per 10 000 (95% CI 20.9-22.9) among those aged 14-18 years, and 0.8 per 10 000 (95% CI 0.5-1.0) among those aged 10-13 years. In 2017, 88.2% (95% CI 87.3%-89.0%) of cannabis-related visits and 58.1% (95% CI 58.0%-58.2%) of non-cannabis-related visits were triaged as "more severe," (rate ratio 1.52, 95% CI 1.50-1.53). Similarly, in 2017, 19.0% (95% CI 18.0%-20.1%) of cannabis-related visits and 5.8% (95% CI 5.7%-5.8%) of non-cannabis-related visits resulted in hospital admission (rate ratio 3.3, 95% CI 3.1-3.5). INTERPRETATION Rates of cannabis-related emergency department visit by youths aged 10-24 years increased almost fivefold from 2003 to 2017, with increases in visit severity and hospital admissions. These trends describe an emerging public health problem, and research is needed to identify the causes of this increase and the health and social consequences of cannabis-related visits for these youths.
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Affiliation(s)
- Melanie Bechard
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Paula Cloutier
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Isac Lima
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Mina Salamatmanesh
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Roger Zemek
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Maala Bhatt
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Sinthuja Suntharalingam
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Paul Kurdyak
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - Melissa Baker
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont
| | - William Gardner
- Department of Pediatrics (Bechard, Zemek, Bhatt), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Cloutier, Salamatmanesh, Zemek, Bhatt, Gardner); ICES uOttawa (Lima); Department of Psychiatry (Suntharalingam, Gardner), University of Ottawa, Ottawa, Ont.; The Centre for Addiction and Mental Health (Kurdyak); Department of Psychiatry (Kurdyak), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Baker); School of Epidemiology and Public Health (Gardner), University of Ottawa, Ottawa, Ont.
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Abstract
Cannabis use in the United States is growing at an unprecedented pace. Most states in the United States have legalized medical cannabis use, and many have legalized nonmedical cannabis use. In this setting, health care professionals will increasingly see more patients who have questions about cannabis use, its utility for medical conditions, and the risks of its use. This narrative review provides an overview of the background, pharmacology, therapeutic use, and potential complications of cannabis.
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Affiliation(s)
- Deepika E Slawek
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Susanna A Curtis
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. https://twitter.com/DrSusieC2
| | - Julia H Arnsten
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. https://twitter.com/DrArnsten
| | - Chinazo O Cunningham
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. https://twitter.com/DrChinazo
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Masonbrink AR, Richardson T, Hall M, Catley D, Wilson K. Trends in Adolescent Cannabis-Related Hospitalizations by State Legalization Laws, 2008-2019. J Adolesc Health 2021; 69:999-1005. [PMID: 34511329 DOI: 10.1016/j.jadohealth.2021.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/06/2021] [Accepted: 07/21/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Adolescent cannabis use is associated with adverse health outcomes. The impact of cannabis legalization on adolescent cannabis-related hospitalizations remains unknown. We sought to assess whether state cannabis legalization is associated with adolescent cannabis-related hospitalizations. METHODS We conducted a retrospective cohort study of adolescent (11-17 years) hospitalizations at children's hospitals between January 1, 2008 and December 31, 2019 using the Inpatient Essentials database. We investigated differences in adolescent cannabis-related diagnosis during a hospitalization by state cannabis legalization status, including states with no legal use to medical cannabis laws (MCLs) and states with MCLs to nonmedical (>21 years old) cannabis laws (NMCLs). RESULTS Of 1,898,432 adolescent hospitalizations in 18 states and Washington, DC, there were 37,562 (2%) hospitalizations with a cannabis-related diagnosis, with 8,457 (23%) in states with no legal use, 20,444 (54%) in MCL states, and 8,661 (23%) in NMCL states. There was an increase in adjusted odds of a cannabis-related hospitalization in MCL (odds ratio 1.05, 95% confidence interval 1.04-1.06) and NMCL states (odds ratio 1.03, 95% confidence interval 1.02-1.03) between 2008 and 2019. Characteristics associated with the greatest increase in adjusted odds of a cannabis-related hospitalization postpolicy change included adolescents without an underlying mental health or other substance use disorder in MCL and NMCL states (p < .001) and younger age in NMCL states (13 vs. 16 and 17 years old, p = .02 and p = .02). CONCLUSIONS Cannabis-related adolescent hospitalizations at children's hospitals are increasing, with a disproportionate increase postlegalization in states with NMCLs. Interventions are warranted to increase cannabis use identification and treatment among at-risk adolescents in the hospital-based setting.
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Affiliation(s)
- Abbey R Masonbrink
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
| | - Troy Richardson
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Department of Pediatrics, Children's Hospital Association, Lenexa, Kansas
| | - Matt Hall
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Department of Pediatrics, Children's Hospital Association, Lenexa, Kansas
| | - Delwyn Catley
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Karen Wilson
- Department of Pediatrics, Mount Sinai Health System and Kravis Children's Hospital, New York, New York
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41
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Howard J, Wurzelbacher S, Osborne J, Wolf J, Ruser J, Chadarevian R. Review of cannabis reimbursement by workers' compensation insurance in the U.S. and Canada. Am J Ind Med 2021; 64:989-1001. [PMID: 34532872 DOI: 10.1002/ajim.23294] [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: 07/21/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 11/08/2022]
Abstract
Changing public attitudes about cannabis consumption have currently led 36 U.S. states and the District of Columbia to approve laws that make cannabis available to consumers with qualifying medical conditions. This article reviews the 36 states and the District of Columbia with medical cannabis access laws to determine if the state or the District also allows reimbursement of the costs of cannabis for a work-related health condition under that state's or District's workers' compensation insurance (WCI) laws and administrative regulations. The legal basis for a state allowing or not allowing WCI reimbursement is described. The review found that only six of the 36 states expressly allow cannabis WCI reimbursement, six expressly prohibit it, 14 states do not require reimbursement, and 10 states, and the District of Columbia, are silent on the issue. The article describes the role of the insurer, treating physician, and worker in obtaining WCI reimbursement in the six states that expressly allow cannabis WCI reimbursement. Comparisons are made to how selected Canadian provinces and territories administer cannabis reimbursement under Canada's new national cannabis legalization law. The article discusses the future role of cannabis legalization in the United States and the evolving role of cannabis from an international perspective.
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Affiliation(s)
- John Howard
- Office of the Director National Institute for Occupational Safety and Health Washington District of Columbia USA
| | - Steven Wurzelbacher
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health Center for Workers’ Compensation Studies Cincinnati Ohio USA
| | - Jamie Osborne
- Office of the Director National Institute for Occupational Safety and Health Atlanta Georgia USA
| | - Jennifer Wolf
- International Association of Accident Boards and Commissions Middleton Wisconsin USA
| | - John Ruser
- Workers Compensation Research Institute Cambridge Massachusetts USA
| | - Raji Chadarevian
- Medical Regulation and Informatics National Council on Compensation Insurance Boca Raton Florida USA
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Hendrickson RG, Dilley JA, Hedberg K, Jeanne TL, Love JS, Thompson JA, Choo EK. The burden of cannabis-attributed pediatric and adult emergency department visits. Acad Emerg Med 2021; 28:1444-1447. [PMID: 33966297 PMCID: PMC11215941 DOI: 10.1111/acem.14275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/22/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Robert G Hendrickson
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Oregon Poison Center, Portland, Oregon, USA
| | - Julia A Dilley
- Public Health Division, Oregon Health Authority, Multnomah County Health Department, Portland, Oregon, USA
| | - Katrina Hedberg
- Oregon Health Authority, Public Health Division, Portland, Oregon, USA
| | - Thomas L Jeanne
- Public Health Division, Oregon Health Authority, Multnomah County Health Department, Portland, Oregon, USA
- Oregon Health Authority, Public Health Division, Portland, Oregon, USA
| | - Jennifer S Love
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Oregon Poison Center, Portland, Oregon, USA
| | - John A Thompson
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Oregon Poison Center, Portland, Oregon, USA
| | - Esther K Choo
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon, USA
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Morean ME, Davis DR, Kong G, Bold KW, Camenga DR, Suttiratana S, Lee J, Rajeshkumar L, Krishnan-Sarin S. Demographic and substance use-related differences among high school adolescents who vape cannabis versus use other cannabis modalities. Drug Alcohol Depend 2021; 228:109104. [PMID: 34607191 PMCID: PMC8595758 DOI: 10.1016/j.drugalcdep.2021.109104] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/07/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Vaping is the second most common modality of using cannabis following smoking. We examined differences in demographics and substance use behaviors between adolescent cannabis vapers and those exclusively using other cannabis modalities. METHODS In 2019, 4875 students from six Connecticut high schools completed school-wide, online surveys. Past-month cannabis users (n = 931; 52.8% female, 16.38(1.27) years old, 44.9% non-Hispanic White) reported on cannabis modalities used (e.g., combustible, vaporizable, edible) and were classified as cannabis vapers or non-vapers. Cannabis vapers reported on device type used to vape cannabis: a cannabis-specific device or modified/hacked e-cigarette. Unadjusted and adjusted relationships were examined to identify demographic and substance-related differences between cannabis vapers and non-vapers. RESULTS 56.3% of past-month cannabis users reported vaping cannabis. Cannabis vapers reported using both cannabis-specific vaporizers (91.9%) and modifying/hacking e-cigarettes (23.7%). Cannabis vapers, relative to other cannabis users, were more likely to be male, White, initiate cannabis use at a younger age; endorse past-month use of all cannabis modalities, alcohol, and e-cigarettes; and report smoking and dabbing cannabis more frequently; consuming more drinks per drinking day; and using e-cigarettes at a younger age and more frequently. CONCLUSIONS Relative to other cannabis modalities, vaping was associated with increased use of several cannabis products and other substances. Adolescent past-month cannabis users reported modifying e-cigarettes to vape cannabis. Findings suggest that regulations should be implemented to prevent e-cigarettes from being modifiable for use with cannabis and highlight the importance of assessing different cannabis use modalities, as vaping was associated with distinct substance-related risks.
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Affiliation(s)
- Meghan E. Morean
- Yale School of Medicine, Dept. of Psychiatry, 34 Park Street, New Haven, CT, 06519, USA,Corresponding author:
| | - Danielle R. Davis
- Yale School of Medicine, Dept. of Psychiatry, 34 Park Street, New Haven, CT, 06519, USA
| | - Grace Kong
- Yale School of Medicine, Dept. of Psychiatry, 34 Park Street, New Haven, CT 06519, USA.
| | - Krysten W. Bold
- Yale School of Medicine, Dept. of Psychiatry, 34 Park Street, New Haven, CT, 06519, USA
| | - Deepa R. Camenga
- Yale School of Medicine, Dept. of Emergency Medicine, 464 Congress Avenue (Suite 260), New Haven, CT, 06519, USA
| | - Sakinah Suttiratana
- Yale School of Public Health, Dept. of Chronic Disease Epidemiology, 60 College Street, New Haven, CT 06520, USA.
| | - Juhan Lee
- Yale School of Medicine, Dept. of Psychiatry, 34 Park Street, New Haven, CT 06519, USA.
| | - Lavanya Rajeshkumar
- Yale School of Medicine, Dept. of Psychiatry, 34 Park Street, New Haven, CT 06519, USA.
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Abstract
OBJECTIVE Cannabis Hyperemesis Syndrome (CHS) is characterized by recurrent episodes of intractable emesis associated with heavy use of cannabis. Recognition of CHS can be problematic due to the lack of specific biomarkers, which can point the clinician to the diagnosis. We present, retrospectively, a series of adolescent/young adult patients who presented to a pediatric gastroenterology (GI) service with acute on chronic nausea and vomiting, subsequently found to have CHS with associated elevated urinary cannabis metabolite concentrations. METHODS We describe 15 patients referred to our pediatric GI division for intractable emesis with spot urinary cannabis metabolite carboxy-THC (THC-COOH) concentrations from January 1, 2018 through April 20, 2019. Urinary testing was performed using gas chromatography mass-spectrometry (GC-MS) in a manner consistent with Clinical Laboratory Improvement Amendments (CLIA) requirements at Mayo Clinic laboratory (Rochester, MN). The laboratory cutoffs were 3.0 ng/mL. Data was extracted via chart review and analyzed via online statistical application. RESULTS Fifteen patients (seven females, eight males) were studied with an average age of 17.7 years. All patients reported frequent cannabis use for at least 1 month and exhibited intractable, non-bilious emesis for at least 2 weeks. Twelve patients also reported weight loss. Two patients had underlying gastrointestinal disease (one with Crohn disease and one with irritable bowel syndrome). All patients had essentially normal GI workup including laboratory tests, imaging studies and endoscopies.Fourteen of 15 patients had urinary THC-COOH concentrations >100 ng/mL, with seven individuals exhibiting levels >500 ng/mL. One patient had a urinary TCH-COOH concentration level under 100 ng/mL had not used cannabis for 2 weeks. Most other patients had used cannabis within 2 days of providing a urine sample. The Binomial test for CHS patients with urinary THC-COOH levels over 100 ng/mL was significant with a P-value of <0.0005 (one tail test). CONCLUSION CHS is associated with an elevated urinary THC-COOH level usually exceeding 100 ng/mL, which is indicative of significant chronic cannabis exposure. In patients with a history consistent with CHS, urine THC-COOH testing may help guide the diagnostic evaluation of these patients and decrease the need for further workup.
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Slawek DE, Arnsten J, Sohler N, Zhang C, Grossberg R, Stein M, Cunningham CO. Daily and near-daily cannabis use is associated with HIV viral load suppression in people living with HIV who use cocaine. AIDS Care 2021; 33:1350-1357. [PMID: 32748649 PMCID: PMC7858684 DOI: 10.1080/09540121.2020.1799922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 07/06/2020] [Indexed: 12/26/2022]
Abstract
Disparities remain in HIV viral load (VL) suppression between people living with HIV (PLWH) who use cocaine and those who do not. It is not known how cannabis use affects VL suppression in PLWH who use cocaine. We evaluated the relationship between cannabis use and VL suppression among PLWH who use cocaine. We conducted a secondary data analysis of 119 baseline interviews from a randomized controlled trial in the Bronx, NY (6/2012 to 1/2017). Participants were adult PLWH prescribed antiretrovirals for ≥16 weeks, who endorsed imperfect antiretroviral adherence and used cocaine in the past 30-days. In bivariate and multivariable regression analyses, we examined how cannabis use, is associated with VL suppression among PLWH who use cocaine. Participants were a mean age of 50 years; most were male (64%) and non-Hispanic black (55%). Participants with VL suppression used cocaine less frequently than those with no VL suppression (p < 0.01); cannabis use was not significantly different. In regression analysis, compared with no use, daily/near-daily cannabis use was associated with VL suppression (aOR = 4.2, 95% CI: 1.1-16.6, p < 0.05). Less-frequent cannabis use was not associated with VL suppression. Further investigation is needed to understand how cannabis use impacts HIV outcomes among PLWH who use cocaine.
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Affiliation(s)
- Deepika E. Slawek
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
| | - Julia Arnsten
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
| | - Nancy Sohler
- City University of New York School of Medicine, New York, NY, USA
| | | | - Robert Grossberg
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
| | - Melissa Stein
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
| | - Chinazo O. Cunningham
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
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Noelle C, Susan H, Robert K, Shelby S, Andrew M. QTc prolongation in cannabis hyperemesis syndrome patients exposed to antiemetics: A retrospective chart review. Am J Emerg Med 2021; 53:285.e7-285.e8. [PMID: 34607736 DOI: 10.1016/j.ajem.2021.09.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the risk of QT prolongation in patients treated for Cannabis Hyperemesis Syndrome (CHS) in the emergency department. METHODS This was a retrospective comprehensive chart review of patients in the University of Colorado Health Emergency Department. Charts were identified by ICD9/10 codes from January 1, 2012 to December 31, 2014 for cannabis use and data were manually abstracted. We performed chi-square and odds ratios, stratified by drug, to determine differences in medication induced QTc prolongation and performed logistic regression to predict prolongation greater than 500 ms. We captured adverse events from medications as a secondary outcome. RESULTS We found 282 cases of CHS during the study period. There were no significant differences between the median post-medication QTc value stratified by drug when all medications were analyzed simultaneously. A multiple logistic regression model showed that only a potassium below 3.0 mmol/L predicted QT prolongation greater than 500 msec. CONCLUSION Anti-emetics used to treat CHS did not result in significant QTC prolongation in this cohort.
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Affiliation(s)
- Carrillo Noelle
- University of Colorado School of Medicine, Aurora, CO, United States.
| | - Hammerman Susan
- University of Colorado School of Medicine, Aurora, CO, United States; Columbia University School of Law, New York City, NY, United States.
| | - Klemisch Robert
- Washington University School of Medicine, Medical Critical Care, St. Louis, MO, United States
| | - Shelton Shelby
- University of Colorado School of Medicine, Aurora, CO, United States.
| | - Monte Andrew
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, CO, United States.
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Ladha KS, Mistry N, Wijeysundera DN, Clarke H, Verma S, Hare GMT, Mazer CD. Recent cannabis use and myocardial infarction in young adults: a cross-sectional study. CMAJ 2021; 193:E1377-E1384. [PMID: 34493564 PMCID: PMC8443297 DOI: 10.1503/cmaj.202392] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cannabis use is increasing among young adults, but its effects on cardiovascular health are poorly understood. We aimed to assess the association between recent cannabis use and history of myocardial infarction (MI) in young adults (aged 18-44 yr). METHODS We performed a cross-sectional study using pooled data from the 2017 and 2018 cohorts of the American Behavioral Risk Factor Surveillance System survey of US adults. We analyzed the association between any recent cannabis use and history of MI using a weighted logistic regression model that adjusted for demographic factors, socioeconomic factors, health-related behaviours, concomitant substance use and other comorbidities. We also assessed this association after stratifying by frequency of use and by primary method of consumption. RESULTS Among 33 173 young adults (18.5 million weighted), 4610 respondents (3.2 million weighted) reported recent cannabis use (17.5%, 95% confidence interval [CI] 16.8%-18.2%). A history of MI was more frequent among recent cannabis users (n = 61 of 4610, 1.3%) relative to nonusers (n = 240 of 28 563 [0.8%], adjusted odds ratio [OR] 2.07, 95% CI 1.12-3.82). A history of MI was associated with cannabis use of more than 4 times per month (adjusted OR 2.31, 95% CI 1.18-4.50), and with smoking as a primary method of consumption (adjusted OR 2.01, 95% CI 1.02-3.98). INTERPRETATION Our study provides evidence supporting an association between recent cannabis use and history of MI in young adults. Increasing cannabis use in an at-risk population could have negative implications for cardiovascular health.
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Affiliation(s)
- Karim S Ladha
- Department of Anesthesia (Ladha, Mistry, Wijeysundera, Hare, Mazer), St. Michael's Hospital, Unity Health Toronto and Institute of Health Policy, Management, and Evaluation (Ladha, Wijeysundera) and Institute of Medical Sciences (Mistry, Mazer) and Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network (Clarke) and Division of Cardiac Surgery (Verma), St. Michael's Hospital, Unity Health Toronto and Department of Surgery (Verma) and Department of Physiology (Hare, Mazer), University of Toronto, Toronto, Ont
| | - Nikhil Mistry
- Department of Anesthesia (Ladha, Mistry, Wijeysundera, Hare, Mazer), St. Michael's Hospital, Unity Health Toronto and Institute of Health Policy, Management, and Evaluation (Ladha, Wijeysundera) and Institute of Medical Sciences (Mistry, Mazer) and Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network (Clarke) and Division of Cardiac Surgery (Verma), St. Michael's Hospital, Unity Health Toronto and Department of Surgery (Verma) and Department of Physiology (Hare, Mazer), University of Toronto, Toronto, Ont
| | - Duminda N Wijeysundera
- Department of Anesthesia (Ladha, Mistry, Wijeysundera, Hare, Mazer), St. Michael's Hospital, Unity Health Toronto and Institute of Health Policy, Management, and Evaluation (Ladha, Wijeysundera) and Institute of Medical Sciences (Mistry, Mazer) and Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network (Clarke) and Division of Cardiac Surgery (Verma), St. Michael's Hospital, Unity Health Toronto and Department of Surgery (Verma) and Department of Physiology (Hare, Mazer), University of Toronto, Toronto, Ont
| | - Hance Clarke
- Department of Anesthesia (Ladha, Mistry, Wijeysundera, Hare, Mazer), St. Michael's Hospital, Unity Health Toronto and Institute of Health Policy, Management, and Evaluation (Ladha, Wijeysundera) and Institute of Medical Sciences (Mistry, Mazer) and Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network (Clarke) and Division of Cardiac Surgery (Verma), St. Michael's Hospital, Unity Health Toronto and Department of Surgery (Verma) and Department of Physiology (Hare, Mazer), University of Toronto, Toronto, Ont
| | - Subodh Verma
- Department of Anesthesia (Ladha, Mistry, Wijeysundera, Hare, Mazer), St. Michael's Hospital, Unity Health Toronto and Institute of Health Policy, Management, and Evaluation (Ladha, Wijeysundera) and Institute of Medical Sciences (Mistry, Mazer) and Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network (Clarke) and Division of Cardiac Surgery (Verma), St. Michael's Hospital, Unity Health Toronto and Department of Surgery (Verma) and Department of Physiology (Hare, Mazer), University of Toronto, Toronto, Ont
| | - Gregory M T Hare
- Department of Anesthesia (Ladha, Mistry, Wijeysundera, Hare, Mazer), St. Michael's Hospital, Unity Health Toronto and Institute of Health Policy, Management, and Evaluation (Ladha, Wijeysundera) and Institute of Medical Sciences (Mistry, Mazer) and Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network (Clarke) and Division of Cardiac Surgery (Verma), St. Michael's Hospital, Unity Health Toronto and Department of Surgery (Verma) and Department of Physiology (Hare, Mazer), University of Toronto, Toronto, Ont
| | - C David Mazer
- Department of Anesthesia (Ladha, Mistry, Wijeysundera, Hare, Mazer), St. Michael's Hospital, Unity Health Toronto and Institute of Health Policy, Management, and Evaluation (Ladha, Wijeysundera) and Institute of Medical Sciences (Mistry, Mazer) and Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network (Clarke) and Division of Cardiac Surgery (Verma), St. Michael's Hospital, Unity Health Toronto and Department of Surgery (Verma) and Department of Physiology (Hare, Mazer), University of Toronto, Toronto, Ont.
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Innovative and emerging applications of cannabis in food and beverage products: From an illicit drug to a potential ingredient for health promotion. Trends Food Sci Technol 2021. [DOI: 10.1016/j.tifs.2021.06.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Wang GS, Buttorff C, Wilks A, Schwam D, Tung G, Pacula RL. Changes in Emergency Department Encounters for Vomiting After Cannabis Legalization in Colorado. JAMA Netw Open 2021; 4:e2125063. [PMID: 34533572 PMCID: PMC8449280 DOI: 10.1001/jamanetworkopen.2021.25063] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE Cannabis hyperemesis syndrome is an emerging clinical issue associated with cannabis use. Legalization of cannabis has led to an increase in vomiting-related illnesses in health care settings. OBJECTIVE To examine whether legalization of cannabis in Colorado has been associated with increases in vomiting-related emergency department (ED) visits. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional design was used to assess the increase in ED claims for vomiting reported to the Colorado Hospital Association between January 1, 2013, and December 31, 2018, in counties that had no prior cannabis dispensaries before legalization compared with those that did. A total of 820 778 patients seeking care through Colorado EDs were included in the analysis. EXPOSURES The number of medical and recreational cannabis dispensaries per county per quarter. MAIN OUTCOMES AND MEASURES County per capita rate of vomiting-related ED claims per quarter. RESULTS Vomiting-related ED health care encounters increased from 119 312 in 2013 to 153 699 in 2018 (29% increase). Over this period, 203 861 patients (25%) were aged 0 to 18 years; 114 201 (14%) were aged 19 to 25 years, and 502 771 (61%) were aged 26 years or older; 510 584 patients (62%) were female. Additional recreational dispensaries were associated with increased vomiting-related ED visits (incidence rate ratio, 1.03; 95% CI, 1.01-1.05), but counties with high baseline medical dispensary exposure experienced smaller increases in vomiting-related ED visits than counties with no baseline medical dispensary exposure (incidence rate ratio, 0.97; 95% CI, 0.95-0.99). Counties with a high number of medical marijuana dispensaries had increases at a 5.8% slower rate than counties with none. CONCLUSIONS AND RELEVANCE The findings of this study suggest that cannabis legalization in Colorado is associated with an increase in annual vomiting-related health care encounters with regard to exposure to these markets. It may be useful for health care clinicians to be aware of cannabis hyperemesis syndrome and inquire about cannabis use when appropriate.
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Affiliation(s)
- George Sam Wang
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora
| | | | - Asa Wilks
- RAND Corporation, Santa Monica, California
| | | | - Gregory Tung
- Department of Health Systems, Management & Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus
| | - Rosalie Liccardo Pacula
- Sol Price School of Public Policy, Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
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Changes in Rates of Hospitalizations due to Cannabis Harms in Ontario, Canada Before the Legalization of Nonmedical Cannabis: Retrospective Population-level Study Between 2003 and 2017. J Addict Med 2021; 16:e177-e184. [PMID: 34387560 DOI: 10.1097/adm.0000000000000906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the burden of hospitalizations due to cannabis harms in Ontario, Canada before Canada's legalization of nonmedical cannabis. METHODS We conducted a retrospective population-level study that included all individuals living in Ontario between 2003 and 2017. We described patterns of hospitalizations due to cannabis harms in men and women by demographics, socioeconomic factors, and mental health comorbidities. We calculated annual crude rates of hospitalizations due to cannabis harms and assessed time trends using Poisson regression models. RESULTS There were 39,092 hospitalizations due to cannabis harms among 32,811 unique individuals. Annual hospitalizations due to a cannabis harm increased by 280% between 2003 and 2017 (1712 vs 4730), with increases noted for all age groups and sexes. Rates of hospitalizations due to cannabis harms were greater in young adults, low-income individuals, and those with mental health comorbidities. Overall, the rate of hospitalizations due to cannabis harms increased on average by 7.8% per year (95% CI 7.5-8.0). Women aged 15 to 24 experienced the largest average annual increase (12.2% per year, 95% CI 11.5 to 12.8). CONCLUSIONS There are distinct patterns of hospitalizations due to cannabis harms in different priority populations. Young women aged 15 to 24 are a key demographic that is disproportionately burdened with a rapid increase in hospitalizations due to cannabis harms. Jurisdictions considering new approaches to cannabis control policy and addiction services should consider the rising burden of harms faced by youth and young adults when planning interventions.
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