A Comprehensive Review of Cannabis Potency in the United States in the Last Decade

This review examines the concentration of seven major cannabinoids, including Δ⁹-tetrahydrocannabinol (THC) and cannabidiol (CBD), in illicit herbal cannabis products seized by the Drug Enforcement Administration (DEA) over the last 10 years in the United States. Cannabis samples received from DEA regional laboratories were analyzed by a validated gas chromatography with flame ionization detection method, and the results are given in the report. A total of 14,234 samples of herbal cannabis have been analyzed over the last 10 years (between January 1, 2009, and December 31, 2019). The number of samples received over the last 5 to 6 years has decreased dramatically owing to the legalization of marijuana for either medical or recreational purposes in many U.S. states. The results showed that the mean Δ⁹-THC concentration has increased over the last 10 years, from 9.75% in 2009 to 14.88% in 2018 and 13.88% in 2019. The mean Δ⁹-THC:CBD ratio rose substantially from 24.81 in 2009 to 103.48 in 2017. A decrease in THC:CBD ratio was recorded in the last 2 years, 54.39 in 2018 and 24.58 in 2019, indicating the trend in the production of more high-CBD-containing products. Our results showed an overall increase in potency of illicit cannabis, from approximately 10% in 2009 to approximately 14% in 2019. These results are in agreement with other potency monitoring programs in several European countries. There appears to be a recent trend of the inclusion of higher CBD levels containing chemovars in illicit cannabis.

Changes in Cannabis Potency Over the Last 2 Decades (1995-2014): Analysis of Current Data in the United States

BACKGROUND

Marijuana is the most widely used illicit drug in the United States and all over the world. Reports indicate that the potency of cannabis preparation has been increasing. This report examines the concentration of cannabinoids in illicit cannabis products seized by the U.S. Drug Enforcement Administration over the last 2 decades, with particular emphasis on Δ(9)-tetrahydrocannabinol and cannabidiol.

METHODS

Samples in this report were received over time from materials confiscated by the Drug Enforcement Administration and processed for analysis using a validated gas chromatography with flame ionization detector method.

RESULTS

Between January 1, 1995, and December 31, 2014, 38,681 samples of cannabis preparations were received and analyzed. The data showed that although the number of marijuana samples seized over the last 4 years has declined, the number of sinsemilla samples has increased. Overall, the potency of illicit cannabis plant material has consistently increased over time since 1995 from ~4% in 1995 to ~12% in 2014. The cannabidiol content has decreased on average from ~.28% in 2001 to <.15% in 2014, resulting in a change in the ratio of Δ(9)-tetrahydrocannabinol to cannabidiol from 14 times in 1995 to ~80 times in 2014.

CONCLUSIONS

There is a shift in the production of illicit cannabis plant material from regular marijuana to sinsemilla. This increase in potency poses higher risk of cannabis use, particularly among adolescents.

Larva therapy in wound management

The use of maggots for wound debridement has a long history and has lately gained ground in several countries. We collected prospective data to examine the current use of larva therapy (LT) in the UK. Quantitative information was collected on 70 patients treated in nine hospitals. LT is used primarily to treat leg ulcers and generally involves three applications of larvae at two to three day intervals. This method is judged effective in wound debridement and promotes the growth of granulation tissue. Wound exudate, odour, infection and pain are all reduced by the treatment. Adverse reactions are infrequent but include pain, bleeding, pyrexia and influenza-like symptoms. Prevention of hospital admission and surgery, reduced need for antibiotics and reduced hospital stay are all identified as outcomes of LT. The nurse practitioners who used LT believed it to have an important role in wound management. A randomized clinical trial, comparing LT with other debriding agents, is required for evaluation of cost effectiveness.

Pelvic abscess after colon and rectal surgery--what is optimal management?

PURPOSE

The aim of this study was to compare treatment outcomes in the management of pelvic abscess (PA) after rectal surgery.

METHODS

Over a 12-year period all PAs occurring in the patients undergoing colorectal resection were retrospectively reviewed. The APACHE II Score was used to stratify illness.

RESULTS

Postoperative PA developed in 56 patients after cancer (32 percent), ulcerative colitis (26 percent), diverticular disease (24 percent), and Crohn's colitis (18 percent)/surgery. Overall, 24 (43 percent) of PAs were after operations for inflammatory bowel disease and 43 (77 percent) of PAs were after intrapelvic intestinal anastomoses. PAs were treated by 1) antibiotics alone (11/56), 2) percutaneous computerized tomography-guided catheter drainage (13/56), 3) transperineal drainage (15/56), or 4) laparotomy (17/56). Recurrent PAs developed in 11/56 (19 percent) after initial treatment, of which 7 required additional surgery. These recurrences were evenly distributed between treatment groups. There were three deaths as a result of PA, two after laparotomy and one after percutaneous drainage. Long-term sequela in patients with intestinal anastomosis included loss of intestinal continuity (10/43) and anastomotic stenosis (7/43). There was no difference in APACHE II Score among the four treatment groups. The mortality rate was 75 percent among patients whose APACHE II Scores were greater than 15. The development of a PA after colon and rectal surgery was associated with a 5 percent mortality and 41 percent functional morbidity (23 percent permanent stoma and 18 percent symptomatic stricture rate).

CONCLUSION

Using clinical judgment, if PA is amenable to computerized tomography-guided percutaneous or transperineal drainage, one of these techniques should be attempted initially in the hemodynamically stable nonseptic patient. Long-term functional disability is common after PA in rectosigmoid surgery in patients who undergo pelvic/intestinal anastomosis.

Effect of simultaneous administration of betamethasone and triiodothyronine (T3) on the development of functional pulmonary maturation in fetal rabbit

Recent experimental evidence suggests that a combination of glucocorticoid and thyroid hormone may be more effective than either hormone alone in accelerating morphologic as well as biochemical mammalian fetal lung maturation. We have demonstrated that IM administration of T3 to the rabbit doe is associated with enhanced functional fetal lung maturation. We investigated the effect of simultaneous administration of T3 and betamethasone on the development of functional fetal lung maturation and the duration of survival after premature delivery. On day 25 and 26 of pregnancy, T3 (175 micrograms/kg/dose) betamethasone (85 micrograms/kg/dose), T3 plus betamethasone or the appropriate amount of the vehicles were injected. The functional fetal pulmonary maturity and the duration of survival after premature delivery were assessed on day 27 of gestation. Although enhanced functional fetal lung maturation was observed after T3 or betamethasone administration, there was no additive effect after simultaneous administration of both. The duration of survival on premature delivery was enhanced in betamethasone but not T3 or T3 plus betamethasone group when compared to control. Further animal experimentation seems necessary before a clinical trial of T3 plus betamethasone therapy is considered.

Pharmacokinetic study of ceftazidime in bone and serum of patients undergoing hip and knee arthroplasty

Twenty-eight patients undergoing hip arthroplasty and 15 undergoing knee arthroplasty, received chemoprophylaxis with ceftazidime 1.0 g administered intravenously at the time of induction of anaesthesia, followed by two doses of 500 mg given intramuscularly 6 and 12 h later. The mean bone concentration in hip arthroplasty showed a general rise towards a maximum of approximately 20 mg/kg when the exposure time (interval between antibiotic injection and removal of bone sample) was 35-40 min, with values ranging from 4.4 to 21.2 mg/kg (mean 14.4 mg/kg). The patients undergoing knee arthroplasty present a complicated pharmacokinetic problem, as the use of a tourniquet limits the exposure time. Bone concentrations of ceftazidime were highest at sampling times greater than 20 min in these patients (mean level of 15.9 mg/kg for femoral bone and 13.1 mg/kg for tibial bone).

Elastogenesis in healing wounds in bats

Full-thickness square wounds were made in the webs of fruit bats. Elastin was laid down in the healing scars of these wounds in two forms--as single fibers under the regenerated epidermis, and as bundles of fine fibers taking their origin and orientation from the cut ends of the web elastin bundles. This process continued over a period of 6 months, during which time other components of the scar became reduced in amount. The arrangement of the new elastin in the scar tissue was thus a replica of that seen in the normal web. There are indications in this study that elastin imparts elasticity to the scar.

Satellite cells and myogenesis; a study in the fruit-bat web

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