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Erridge S, Wang C, Troup L, Sodergren MH. Awareness of medical cannabis regulations among UK police officers - a cross-sectional study. Med Leg J 2024:258172241237650. [PMID: 38757607 DOI: 10.1177/00258172241237650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Cannabis-based products for medicinal use were rescheduled in the UK in November 2018. The primary outcomes of this cross-sectional survey were to assess awareness of legislation governing these products among UK police officers and whether they had received appropriate training. 200 police officers completed the survey, and 57 (28.5%) respondents did not know these products were legal on prescription in the UK. 177 (88.5%) police officers believed they would benefit from more training on them and how to identify legal medical cannabis patients. Education on the legalities of cannabis-based products for medicinal use and why they are prescribed is necessary to improve knowledge among police officers.
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Affiliation(s)
- Simon Erridge
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, UK
- Curaleaf Clinic, London, UK
| | - Claire Wang
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, UK
| | - Lucy Troup
- School of Education and Social Sciences, University of the West of Scotland, UK
| | - Mikael H Sodergren
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, UK
- Curaleaf Clinic, London, UK
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2
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Burgess A, Hays HL, Badeti J, Spiller HA, Rine NI, Gaw CE, Ding K, Smith GA. Delta-8 tetrahydrocannabinol, delta-10 tetrahydrocannabinol, and tetrahydrocannabinol-O acetate exposures reported to America's Poison Centers. Clin Toxicol (Phila) 2024:1-11. [PMID: 38686923 DOI: 10.1080/15563650.2024.2340115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Since the passage of the Farm Bill in 2018, the availability of synthetic tetrahydrocannabinols has increased, including delta-8 tetrahydrocannabinol, delta-10 tetrahydrocannabinol, and tetrahydrocannabinol-O acetate. The objective of this study is to investigate the characteristics of delta-8 tetrahydrocannabinol, delta-10 tetrahydrocannabinol, and tetrahydrocannabinol-O acetate exposures reported to United States poison centers from 2021 to 2022. METHODS National Poison Data System data were analyzed, including year, individual demographics, substance category and type, reason for exposure, highest level of health care received, and medical outcome. United States Census Bureau data were used to calculate population-based rates. RESULTS There were 5,022 reported cases involving delta-8 tetrahydrocannabinol, delta-10 tetrahydrocannabinol, and tetrahydrocannabinol-O acetate as the primary substance reported to United States poison centers from 1 January 2021 to 31 December 2022. The rate of exposure per 100,000 United States population increased by 89.1 percent from 0.55 in 2021 to 1.04 in 2022. Children less than 6 years old accounted for 30.1 percent of cases, with a mode at age 2 years (representing 8.9 percent of cases). Most cases involved delta-8 tetrahydrocannabinol (98.1 percent), were single-substance exposures (94.3 percent), or occurred in a residence (95.9 percent). Ingestions accounted for 94.2 percent of cases, including 95.1 percent among children less than 6 years old. The leading reason for exposure was unintentional-general (40.2 percent), followed by abuse (33.1 percent). The most common related clinical effects were mild central nervous system depression (25.0 percent), tachycardia (23.0 percent), and agitation (15.6 percent). More than one-third (38.4 percent) of cases experienced a serious medical outcome, and 10.3 percent were admitted to a noncritical care unit and 5.3 percent to a critical care unit. DISCUSSION AND LIMITATIONS The National Poison Data System is limited by its passive surveillance design. Delta-8 tetrahydrocannabinol, delta-10 tetrahydrocannabinol, and tetrahydrocannabinol-O acetate have toxic effects, and reports to United States poison centers increased from 2021 to 2022. Unintentional ingestions by young children are of particular concern. CONCLUSIONS Opportunities exist to improve regulation, with accompanying enforcement, of these products and to educate the public about their potential toxicity.
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Affiliation(s)
- Alice Burgess
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- University of Colorado School of Medicine, Denver, CO, USA
| | - Hannah L Hays
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jaahnavi Badeti
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Henry A Spiller
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Natalie I Rine
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christopher E Gaw
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kele Ding
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- College of Education, Health and Human Service, Kent State University, Kent, OH, USA
| | - Gary A Smith
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Child Injury Prevention Alliance, Columbus, OH, USA
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Yoon HI, Lee SH, Ryu D, Choi H, Park SH, Jung JH, Kim HY, Yang JS. Non-destructive assessment of cannabis quality during drying process using hyperspectral imaging and machine learning. Front Plant Sci 2024; 15:1365298. [PMID: 38736441 PMCID: PMC11082398 DOI: 10.3389/fpls.2024.1365298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/11/2024] [Indexed: 05/14/2024]
Abstract
Cannabis sativa L. is an industrially valuable plant known for its cannabinoids, such as cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC), renowned for its therapeutic and psychoactive properties. Despite its significance, the cannabis industry has encountered difficulties in guaranteeing consistent product quality throughout the drying process. Hyperspectral imaging (HSI), combined with advanced machine learning technology, has been used to predict phytochemicals that presents a promising solution for maintaining cannabis quality control. We examined the dynamic changes in cannabinoid compositions under diverse drying conditions and developed a non-destructive method to appraise the quality of cannabis flowers using HSI and machine learning. Even when the relative weight and water content remained constant throughout the drying process, drying conditions significantly influenced the levels of CBD, THC, and their precursors. These results emphasize the importance of determining the exact drying endpoint. To develop HSI-based models for predicting cannabis quality indicators, including dryness, precursor conversion of CBD and THC, and CBD : THC ratio, we employed various spectral preprocessing methods and machine learning algorithms, including logistic regression (LR), support vector machine (SVM), k-nearest neighbor (KNN), random forest (RF), and Gaussian naïve Bayes (GNB). The LR model demonstrated the highest accuracy at 94.7-99.7% when used in conjunction with spectral pre-processing techniques such as multiplicative scatter correction (MSC) or Savitzky-Golay filter. We propose that the HSI-based model holds the potential to serve as a valuable tool for monitoring cannabinoid composition and determining optimal drying endpoint. This tool offers the means to achieve uniform cannabis quality and optimize the drying process in the industry.
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Affiliation(s)
| | | | | | | | | | | | | | - Jung-Seok Yang
- Smart Farm Research Center, Korea Institute of Science and Technology (KIST), Gangneung, Gangwon, Republic of Korea
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Patton AL, Pacheco IC, Seither JZ, Brown JT, Walterscheid JP, Karschner EL. Cross-Reactivity of 24 Cannabinoids and Metabolites in blood using the immunalysis cannabinoids direct enzyme-linked immunosorbent assay kit. J Anal Toxicol 2024:bkae036. [PMID: 38648393 DOI: 10.1093/jat/bkae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024] Open
Abstract
With a wider availability of synthetic and semi-synthetic cannabinoids in the consumer space, there is a growing impact on public health and safety. Forensic toxicology laboratories should keep these compounds in mind as they attempt to remain effective in screening for potential sources of human performance impairment. Enzyme-linked immunosorbent assay (ELISA) is a commonly utilized tool in forensic toxicology, as its efficiency and sensitivity make it useful for rapid and easy screening for a large number of drugs. This screening technique has lower specificity, which allows for broad cross-reactivity among structurally-similar compounds. In this study, the Cannabinoids Direct ELISA kit from Immunalysis was utilized to assess the cross-reactivities of 24 cannabinoids and metabolites in whole blood. The assay was calibrated with 5 ng/mL of 11-nor-9-carboxy-Δ9-tetrahydrocannabinol and the analytes of interest were evaluated at concentrations ranging from 5 to 500 ng/mL. Most parent compounds demonstrated cross-reactivity ≥ 20 ng/mL, with increasing alkyl side chain length relative to Δ9-tetrahydrocannabinol resulting in decreased cross-reactivity. Of the 24 analytes, only the carboxylic acid metabolites, 11-nor-9-carboxy-Δ8-tetrahydrocannabinol, 11-nor-9(R)-carboxy-hexahydrocannabinol, and 11-nor-9(S)-carboxy-hexahydrocannabinol, were cross-reactive at levels ≤ 10 ng/mL. Interestingly, 11-nor-9(R)-carboxy-hexahydrocannabinol demonstrated cross-reactivity at 5 ng/mL, where its stereoisomer 11-nor-9(S)-carboxy-hexahydrocannabinol, did not. As more information emerges about the prevalence of these analytes in blood specimens, it is important to understand and characterize their impact on current testing paradigms.
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Affiliation(s)
- Amy L Patton
- Division of Forensic Toxicology, Armed Forces Medical Examiner System, 115 Purple Heart Drive, Dover AFB, DE 19902, USA
- SNA International, LLC, contractor supporting the Armed Forces Medical Examiner System, Alexandria, VA 22314, USA
| | - Igor C Pacheco
- Division of Forensic Toxicology, Armed Forces Medical Examiner System, 115 Purple Heart Drive, Dover AFB, DE 19902, USA
| | - Joshua Z Seither
- Division of Forensic Toxicology, Armed Forces Medical Examiner System, 115 Purple Heart Drive, Dover AFB, DE 19902, USA
| | - Jordan T Brown
- Division of Forensic Toxicology, Armed Forces Medical Examiner System, 115 Purple Heart Drive, Dover AFB, DE 19902, USA
| | - Jeffrey P Walterscheid
- Division of Forensic Toxicology, Armed Forces Medical Examiner System, 115 Purple Heart Drive, Dover AFB, DE 19902, USA
| | - Erin L Karschner
- Division of Forensic Toxicology, Armed Forces Medical Examiner System, 115 Purple Heart Drive, Dover AFB, DE 19902, USA
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Gurgenci T, Hardy J, Good C, Good P. Preliminary Results from a Phase IV Surveillance Study of Medical Cannabis Use in Australian Patients With Advanced Cancer Receiving Palliative Care. J Palliat Med 2024. [PMID: 38608233 DOI: 10.1089/jpm.2023.0358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Introduction: Our research group is conducting three large randomized placebo-controlled trials of medicinal cannabis for cancer symptoms. All participants are invited to take part in a posttrial surveillance study. Methods: Participants were given the manufacturers dosing instructions and liberty to titrate to effect. Data were collected on symptoms (Edmonton Symptom Assessment Scale [ESAS] score), perceived benefits, adverse effects, satisfaction with the product, and dose/frequency. Results: Twenty-six percent of eligible participants consented to take part in the surveillance study. Most participants changed their self-titrated dose at least once. Pain, sleep, and mood were the most frequently cited symptoms which improved. Fatigue, nausea, and cognitive impairment were the most frequently mentioned adverse effects. Conclusion: Participants felt confident making changes to their medicinal cannabis dose within the limits suggested by the manufacturer of each product. A number of benefits and adverse effects were ascribed to the product. Benefits were similar to those described in previous studies.
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Affiliation(s)
- Taylan Gurgenci
- Department of Palliative Care, Cancer Services, Mater Adults Hospital Brisbane, Brisbane, Queensland, Australia
| | - Janet Hardy
- Department of Palliative Care, Cancer Services, Mater Adults Hospital Brisbane, Brisbane, Queensland, Australia
| | - Christopher Good
- Department of Palliative Care, Cancer Services, Mater Adults Hospital Brisbane, Brisbane, Queensland, Australia
| | - Phillip Good
- Department of Palliative Care, Cancer Services, Mater Adults Hospital Brisbane, Brisbane, Queensland, Australia
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Blebea NM, Pricopie AI, Vlad RA, Hancu G. Phytocannabinoids: Exploring Pharmacological Profiles and Their Impact on Therapeutical Use. Int J Mol Sci 2024; 25:4204. [PMID: 38673788 PMCID: PMC11050509 DOI: 10.3390/ijms25084204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Phytocannabinoids, a diverse group of naturally occurring compounds extracted from the Cannabis plant, have attracted interest due to their potential pharmacological effects and medicinal uses. This comprehensive review presents the intricate pharmacological profiles of phytocannabinoids while exploring the diverse impacts these substances have on biological systems. From the more than one hundred cannabinoids which were identified in the Cannabis plant so far, cannabidiol (CBD) and tetrahydrocannabinol (THC) are two of the most extensively studied phytocannabinoids. CBD is a non-psychoactive compound, which exhibits potential anti-inflammatory, neuroprotective, and anxiolytic properties, making it a promising candidate for a wide array of medical conditions. THC, known for its psychoactive effects, possesses analgesic and antiemetic properties, contributing to its therapeutic potential. In addition to THC and CBD, a wide range of additional phytocannabinoids have shown intriguing pharmacological effects, including cannabichromene (CBC), cannabigerol (CBG), and cannabinol (CBN). The endocannabinoid system, made up of the enzymes involved in the production and breakdown of endocannabinoids, cannabinoid receptors (CB1 and CB2), and endogenous ligands (endocannabinoids), is essential for preserving homeostasis in several physiological processes. Beyond their effects on the endocannabinoid system, phytocannabinoids are studied for their ability to modify ion channels, neurotransmitter receptors, and anti-oxidative pathways. The complex interaction between phytocannabinoids and biological systems offers hope for novel treatment approaches and lays the groundwork for further developments in the field of cannabinoid-based medicine. This review summarizes the state of the field, points out information gaps, and emphasizes the need for more studies to fully realize the therapeutic potential of phytocannabinoids.
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Affiliation(s)
- Nicoleta Mirela Blebea
- Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, “Ovidius” University from Constanța, 900470 Constanța, Romania;
| | - Andreea Iulia Pricopie
- Biochemistry and Chemistry of Environmental Factors Department, Faculty of Pharmacy, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania
| | - Robert-Alexandru Vlad
- Pharmaceutical Technology and Cosmetology Department, Faculty of Pharmacy, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania
| | - Gabriel Hancu
- Pharmaceutical and Therapeutic Chemistry Department, Faculty of Pharmacy, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Târgu Mures, Romania
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Duncan RS, Riordan SM, Gernon MC, Koulen P. Cannabinoids and endocannabinoids as therapeutics for nervous system disorders: preclinical models and clinical studies. Neural Regen Res 2024; 19:788-799. [PMID: 37843213 PMCID: PMC10664133 DOI: 10.4103/1673-5374.382220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/08/2023] [Accepted: 07/01/2023] [Indexed: 10/17/2023] Open
Abstract
Cannabinoids are lipophilic substances derived from Cannabis sativa that can exert a variety of effects in the human body. They have been studied in cellular and animal models as well as in human clinical trials for their therapeutic benefits in several human diseases. Some of these include central nervous system (CNS) diseases and dysfunctions such as forms of epilepsy, multiple sclerosis, Parkinson's disease, pain and neuropsychiatric disorders. In addition, the endogenously produced cannabinoid lipids, endocannabinoids, are critical for normal CNS function, and if controlled or modified, may represent an additional therapeutic avenue for CNS diseases. This review discusses in vitro cellular, ex vivo tissue and in vivo animal model studies on cannabinoids and their utility as therapeutics in multiple CNS pathologies. In addition, the review provides an overview on the use of cannabinoids in human clinical trials for a variety of CNS diseases. Cannabinoids and endocannabinoids hold promise for use as disease modifiers and therapeutic agents for the prevention or treatment of neurodegenerative diseases and neurological disorders.
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Affiliation(s)
- R. Scott Duncan
- Department of Ophthalmology, School of Medicine, University of Missouri, Kansas, MO, USA
| | - Sean M. Riordan
- Department of Ophthalmology, School of Medicine, University of Missouri, Kansas, MO, USA
| | - Matthew C. Gernon
- Department of Ophthalmology, School of Medicine, University of Missouri, Kansas, MO, USA
| | - Peter Koulen
- Department of Ophthalmology, School of Medicine, University of Missouri, Kansas, MO, USA
- Department of Biomedical Sciences, School of Medicine, University of Missouri, Kansas, MO, USA
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Daniels R, Yassin OA, Toribio JM, Gascón JA, Sotzing G. Re-Examining Cannabidiol: Conversion to Tetrahydrocannabinol Using Only Heat. Cannabis Cannabinoid Res 2024; 9:486-494. [PMID: 36516105 DOI: 10.1089/can.2022.0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: In the last decade, the market for Cannabidiol (CBD) has grown to become a near $2 billion dollar industry in the United States alone. This growth can be attributed to a growing social acceptance of marijuana, a more detailed understanding of many health benefits attributed to cannabinoids, and the low cost and wide availibility of hemp-derived cannabinoids. Due to the complex legal histories of marijuana and cannabinoids, the stability and safety of CBD is still an area of interest as research has been restricted globally. Conversion of CBD to its psychoactive isomers, most notably delta-9-Tetrahydrocannabinol (Δ9-THC), presents a significant safety issue for consumers and producers of CBD products. Methods: Previous studies investigating the stability of CBD have focused mainly on replicating conditions experienced during long-term storage at room temperature or lower. Here, we report the thermal stability of CBD at 175°C. Dynamic 1H-NMR experiments and computational electronic structure calculations were used to characterize possible reaction paths from CBD to THC. Results: After 30 minutes of heating, Δ9-THC was produced in detectable amounts in aerobic and anaerobic conditions without an acid catalyst. Conclusions: Our findings support an energetically feasible reaction route that is favorable due to both an increase in phenol acidity at high temperatures and the presence of intramolecular OH-π hydrogen bonding.
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Affiliation(s)
- Robert Daniels
- Department of Chemistry, University of Connecticut, Storrs, Connecticut, USA
| | - Omer A Yassin
- Department of Chemistry, University of Connecticut, Storrs, Connecticut, USA
| | - John M Toribio
- Department of Chemistry, University of Connecticut, Storrs, Connecticut, USA
| | - José A Gascón
- Department of Chemistry, University of Connecticut, Storrs, Connecticut, USA
| | - Gregory Sotzing
- Department of Chemistry, University of Connecticut, Storrs, Connecticut, USA
- Polymer Program, University of Connecticut, Storrs, Connecticut, USA
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Murphy M, Erridge S, Holvey C, Coomber R, Rucker JJ, Sodergren MH. A cohort study comparing the effects of medical cannabis for anxiety patients with and without comorbid sleep disturbance. Neuropsychopharmacol Rep 2024; 44:129-142. [PMID: 38155535 PMCID: PMC10932782 DOI: 10.1002/npr2.12407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Research on cannabis-based medicinal products (CBMPs) in anxiety remains inconclusive due to a paucity of high-quality evidence. Studies indicate a bidirectional relationship between generalized anxiety disorder (GAD) and sleep disruption, but it is unclear how this affects CBMP treatment outcomes. This study aims to compare the patient-reported outcome measures (PROMs) of patients prescribed CBMPs for GAD, with and without impaired sleep. METHODS Changes in PROMs were recorded from baseline to 1, 3, 6, and 12 months between those with impaired or unimpaired sleep. Multivariate logistic regression was applied to compare factors associated with a clinically significant improvement in GAD-7 at 12 months. Secondary outcomes included adverse event incidence and frequency. RESULTS Of the 302 patients that fit the inclusion criteria, mean GAD-7, single-item sleep quality, and EQ-5D-5L index values improved at all time points (p < 0.001). A relationship between sleep impairment and clinically significant changes in GAD-7 at 1 and 3 months was identified (p ≤ 0.01). On multivariate regression, only baseline GAD severity was associated with an increased likelihood of observing a clinically significant improvement in anxiety (p < 0.001). Seven hundred and seven (234%) adverse events were reported by 55 (18.21%) participants. CONCLUSIONS This study observed an association between CBMP treatment and improvements in anxiety in patients with GAD. While patients with comorbid sleep disruption had greater improvements in anxiety, the differences were not maintained in a multivariate analysis. Baseline anxiety severity may be a predictor for CBMP treatment outcomes.
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Affiliation(s)
- Matthew Murphy
- Medical Cannabis Research GroupDepartment of Surgery and CancerImperial College LondonLondonUK
| | - Simon Erridge
- Medical Cannabis Research GroupDepartment of Surgery and CancerImperial College LondonLondonUK
- Sapphire Medical ClinicsLondonUK
| | | | - Ross Coomber
- Sapphire Medical ClinicsLondonUK
- St. George's Hospital NHS TrustLondonUK
| | - James J. Rucker
- Department of Psychological MedicineKings College LondonLondonUK
- South London & Maudsley NHS Foundation TrustLondonUK
| | - Mikael H. Sodergren
- Medical Cannabis Research GroupDepartment of Surgery and CancerImperial College LondonLondonUK
- Sapphire Medical ClinicsLondonUK
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Torres J, Miller C, Apostol M, Gross J, Maxwell JR. The impact of recreational cannabinoid legalization on utilization in a pregnant population. Front Public Health 2024; 12:1278834. [PMID: 38444440 PMCID: PMC10912290 DOI: 10.3389/fpubh.2024.1278834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024] Open
Abstract
Background Marijuana potency and utilization both continue to increase across the United States. While the overall prevalence of cannabinoid utilization during pregnancy has been surveyed in various studies, the direct impact of changing governmental policies on pregnancy use is less characterized. Thus, we aimed to investigate how the legalization of recreational cannabinoid products impacted use during pregnancy in the state of New Mexico. Methods Participants who had a live birth during two study epochs were included: pre-legalization (Epoch 1: 1 January 2019-31 March 2021) and post-legalization (Epoch 2: 1 November 2021-30 November 2022). Participants were further divided into case group [prenatal cannabinoid exposure (PCE)] vs. control (no PCE), with cases being identified by documented self-report or a positive laboratory toxicology test for cannabinoid use during pregnancy. Results A total of 1,191 maternal/infant dyads were included in Epoch 1, and 378 maternal/infant dyads were included in Epoch 2. In Epoch 1, 788 dyads were controls with 403 cases, while Epoch 2 had 292 controls and 86 cases. Interestingly there was a significant decrease in self-report or positive laboratory toxicology tests in Epoch 2 compared to Epoch 1. Infants born following PCE in both Epoch groups were more commonly born via Cesarean section, had significantly smaller birth weight, length, and head circumference as well as significantly lower Apgar scores at 1 and 5 min. Conclusion The finding of decreased reported cannabinoid use in the post-legalization group is contradictory to previous studies which have shown increased rates of cannabinoid use after legalization. This could be due to multiple factors including changes in screening practices, the COVID-19 pandemic, and lack of commercialization of THC products. Additional studies are needed to further characterize how changing governmental policies impacts utilization during pregnancy.
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Affiliation(s)
- Jacob Torres
- School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Colton Miller
- School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Michael Apostol
- School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Jessica Gross
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, NM, United States
| | - Jessie R. Maxwell
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
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Arsenault TL, Prapayotin-Riveros K, Ammirata MA, White JC, Dimkpa CO. Compliance Testing of Hemp ( Cannabis sativa L.) Cultivars for Total Delta-9 THC and Total CBD Using Gas Chromatography with Flame Ionization Detection. Plants (Basel) 2024; 13:519. [PMID: 38498421 PMCID: PMC10892002 DOI: 10.3390/plants13040519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
The United States Agriculture Improvement Act passed in December of 2018 legalized the growing of Cannabis sativa containing not more than 0.3% total Delta-9 tetrahydrocannabinol (THC) in the country. While Cannabis sativa has been cultivated for hundreds of years, the illegal status of the plant in the United States, and elsewhere, has hindered the development of plant cultivars that meet this legal definition. To assess sampling strategies, and conformance to the THC limit, 14 cultivars of hemp were grown and tested by using gas chromatography with flame ionization detection for total delta-9 THC and total cannabidiol (CBD) during 2020, 2021 and 2022. Each year, samples of fresh plant material were collected from each cultivar weekly, beginning in mid-August and ending in late October, to examine the rate of increase in THC and CBD for different cultivars and select individual plants. The sampling demonstrated that both CBD and THC increase rapidly over a 1-2-week time frame with maximum concentrations (about 16% and 0.6%, respectively) around late September to early October. The testing of individual plants on the same day for select cultivars showed that while the ratio of CBD to THC remains constant (about 20:1 in compliant hemp) during the growing season, the individual plants are highly variable in concentration. Whereas previous studies have shown cultivar-dependent variability in THC production, this study demonstrated a novel plant-to-plant variability in the levels of THC within the same hemp cultivar. Understanding variability within and between hemp cultivars is useful to determine field sampling strategies and to assess the risk of crop embargoes to growers by compliance regulators.
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Affiliation(s)
- Terri L. Arsenault
- Department of Analytical Chemistry, The Connecticut Agricultural Experiment Station, New Haven, CT 06511, USA; (K.P.-R.); (M.A.A.); (J.C.W.); (C.O.D.)
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Nouh RA, Kamal A, Oyewole O, Abbas WA, Abib B, Omar A, Mansour ST, Abdelnaser A. Unveiling the Potential of Cannabinoids in Multiple Sclerosis and the Dawn of Nano-Cannabinoid Medicine. Pharmaceutics 2024; 16:241. [PMID: 38399295 PMCID: PMC10891830 DOI: 10.3390/pharmaceutics16020241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 02/25/2024] Open
Abstract
Multiple sclerosis is the predominant autoimmune disorder affecting the central nervous system in adolescents and adults. Specific treatments are categorized as disease-modifying, whereas others are symptomatic treatments to alleviate painful symptoms. Currently, no singular conventional therapy is universally effective for all patients across all stages of the illness. Nevertheless, cannabinoids exhibit significant promise in their capacity for neuroprotection, anti-inflammation, and immunosuppression. This review will examine the traditional treatment for multiple sclerosis, the increasing interest in using cannabis as a treatment method, its role in protecting the nervous system and regulating the immune system, commercially available therapeutic cannabinoids, and the emerging use of cannabis in nanomedicine. In conclusion, cannabinoids exhibit potential as a disease-modifying treatment rather than merely symptomatic relief. However, further research is necessary to unveil their role and establish the safety and advancements in nano-cannabinoid medicine, offering the potential for reduced toxicity and fewer adverse effects, thereby maximizing the benefits of cannabinoids.
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Affiliation(s)
- Roua A. Nouh
- Biotechnology Graduate Program, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt; (R.A.N.); (O.O.); (W.A.A.); (A.O.)
| | - Ahmed Kamal
- Biochemistry Department, Faculty of Science, Suez University, P.O. Box 43221, Suez 43533, Egypt;
| | - Oluwaseyi Oyewole
- Biotechnology Graduate Program, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt; (R.A.N.); (O.O.); (W.A.A.); (A.O.)
| | - Walaa A. Abbas
- Biotechnology Graduate Program, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt; (R.A.N.); (O.O.); (W.A.A.); (A.O.)
| | - Bishoy Abib
- Department of Chemistry, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt; (B.A.); (S.T.M.)
| | - Abdelrouf Omar
- Biotechnology Graduate Program, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt; (R.A.N.); (O.O.); (W.A.A.); (A.O.)
| | - Somaia T. Mansour
- Department of Chemistry, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt; (B.A.); (S.T.M.)
| | - Anwar Abdelnaser
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, P.O. Box 74, New Cairo 11835, Egypt
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Robinson GI, Ye F, Lu X, Laviolette SR, Feng Q. Maternal Delta-9- Tetrahydrocannabinol Exposure Induces Abnormalities of the Developing Heart in Mice. Cannabis Cannabinoid Res 2024; 9:121-133. [PMID: 36255470 DOI: 10.1089/can.2022.0180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Cannabis is increasingly being consumed by pregnant women for recreational purposes as well as for its antiemetic and anxiolytic effects despite limited studies on its safety during pregnancy. Importantly, phytocannabinoids found in cannabis can pass through the placenta and enter the fetal circulation. Recent reports suggest gestational cannabis use is associated with negative fetal outcomes, including fetal growth restriction and perinatal intensive care, however, the effects of delta-9-tetrahydrocannabinol (THC) on fetal heart development remains to be elucidated. Materials and Methods: We aimed to determine the outcomes of maternal THC exposure on fetal heart development in mice by administering 0, 5, or 10 mg/kg/day of THC orally to C57BL/6 dams starting at embryonic day (E)3.5. Offspring were collected at E12.5 for molecular analysis, at E17.5 to analyze cardiac morphology or at postnatal day (PND)21 to assess heart function. Results: Maternal THC exposure in E17.5 fetuses resulted in an array of cardiac abnormalities with an incidence of 44% and 55% in the 5 and 10 mg/kg treatment groups, respectively. Maternal THC exposure in offspring resulted in ventricular septal defect, higher semilunar valve volume relative to orifice ratio, and higher myocardial wall thickness. Notably, cell proliferation within the ventricular myocardium was increased, and expression of multiple cardiac transcription factors was downregulated in THC-exposed E12.5 fetuses. Furthermore, heart function was compromised with lower left ventricular ejection fraction, fractional shortening, and cardiac output in PND21 pups exposed to THC compared to controls. Discussion: The results show that maternal THC exposure during gestation induces myocardial hyperplasia and semilunar valve thickening in the fetal heart and postnatal cardiac dysfunction. Our study suggests that maternal cannabis consumption may induce abnormalities in the developing heart and cardiac dysfunction in postnatal life.
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Affiliation(s)
- Gregory I Robinson
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Fang Ye
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Xiangru Lu
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Steven R Laviolette
- Department of Anatomy and Cell Biology, and Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Qingping Feng
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
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14
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Gibson LP, Mueller RL, Winiger EA, Klawitter J, Sempio C, Williams S, Bryan AD, Bidwell LC, Hutchison KE. Cannabinoid Exposure and Subjective Effects of THC and CBD in Edible Cannabis Products. Cannabis Cannabinoid Res 2024; 9:320-334. [PMID: 36378267 PMCID: PMC10874820 DOI: 10.1089/can.2022.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The popularity of edible cannabis products continues to grow in states with legal cannabis access, but few studies have investigated the acute effects of these commercially available products. The present study sought to explore the effects of three commercially available edible products with different levels of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Methods: A sample of regular cannabis users (N=99) were evaluated. Fifty participants completed the study procedures in-person, whereas 49 participants completed the study procedures remotely via Zoom. Subjective effects and plasma cannabinoid levels (in-person participants only) were assessed before and 2 h after participants self-administered one of three products ad libitum: a THC-dominant edible product, a CBD-dominant edible product, or a THC+CBD edible product. Results: At the 2-h post-use assessment, among in-person participants, plasma THC and CBD levels were robustly correlated with self-reported milligrams of THC and CBD consumed, respectively. Across all three conditions, in-person and remote participants experienced (1) an increase in subjective intoxication and elation, (2) a decrease in tension, and (3) no change in paranoia from pre-use to post-use. At post-use, participants who used a CBD product reported less intoxication relative to participants who used a THC+CBD or THC-only product. Participants who used a THC+CBD product reported consuming less THC-and displayed lower plasma THC levels (in-person participants)-relative to participants who used a THC-only product, despite reporting similar levels of positive (intoxication, elation, liking) and psychotomimetic (paranoia, tension) effects. Psychotomimetic effects were very low among both in-person and remote participants across all three conditions, and there were no post-use differences across conditions. Conclusions: Findings suggest that experienced users who consumed a THC+CBD product reported similar levels of positive and psychotomimetic effects relative to those who consumed a THC-only product, despite consuming less THC and displaying lower plasma THC concentrations. Given the potential harms associated with acute cannabis reward and long-term THC exposure, further research is needed to establish whether edible cannabis products with CBD pose less risk to users. Future studies should examine whether these effects generalize to samples of infrequent users, who may have less experience with edible cannabis use. ClinicalTrials.gov ID: NCT03522103.
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Affiliation(s)
- Laurel P. Gibson
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Raeghan L. Mueller
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Evan A. Winiger
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jost Klawitter
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, Colorado, USA
- Department of Anesthesiology, University of Colorado, Aurora, Colorado, USA
| | - Cristina Sempio
- Department of Anesthesiology, University of Colorado, Aurora, Colorado, USA
| | - Sarah Williams
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Angela D. Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - L. Cinnamon Bidwell
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, Colorado, USA
| | - Kent E. Hutchison
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Smith SA, Le GH, Teopiz KM, Kwan ATH, Rhee TG, Ho RC, Wu J, Cao B, Ceban F, McIntyre RS. Effects of cannabidiol and Δ 9- tetrahydrocannabinol on cytochrome P450 enzymes: a systematic review. Drug Metab Rev 2024; 56:164-174. [PMID: 38655747 DOI: 10.1080/03602532.2024.2346767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
Due to legal, political, and cultural changes, the use of cannabis has rapidly increased in recent years. Research has demonstrated that the cannabinoids cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) inhibit and induce cytochrome P450 (CYP450) enzymes. The objective of this review is to evaluate the effect of CBD and THC on the activity of CYP450 enzymes and the implications for drug-drug interactions (DDIs) with psychotropic agents that are CYP substrates. A systematic search was conducted using PubMed, Scopus, Scientific Electronic Library Online (SciELO) and PsychINFO. Search terms included 'cannabidiol', 'tetrahydrocannabinol', and 'cytochrome P450'. A total of seven studies evaluating the interaction of THC and CBD with CYP450 enzymes and psychotropic drugs were included. Both preclinical and clinical studies were included. Results from the included studies indicate that both CBD and THC inhibit several CYP450 enzymes including, but not limited to, CYP1A2, CYP3C19, and CYP2B6. While there are a few known CYP450 enzymes that are induced by THC and CBD, the induction of CYP450 enzymes is an understudied area of research and lacks clinical data. The inhibitory effects observed by CBD and THC on CYP450 enzymes vary in magnitude and may decrease the metabolism of psychotropic agents, cause changes in plasma levels of psychotropic medications, and increase adverse effects. Our findings clearly present interactions between THC and CBD and several CYP450 enzymes, providing clinicians evidence of a high risk of DDIs for patients who consume both cannabis and psychotropic medication. However, more clinical research is necessary before results are applied to clinical settings.
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Affiliation(s)
- Sarah Ann Smith
- Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Gia Han Le
- Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada
| | - Angela T H Kwan
- Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Public Health Sciences, University of CT School of Medicine, Farmington, Connecticut, USA
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Jie Wu
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Bing Cao
- School of Psychology and Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, P. R. China
| | - Felicia Ceban
- Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Kassim FM, Tod S, Rodger J, Hood SD, Lee JWY, Albrecht MA, Martin-Iverson MT. Nabilone Impairs Spatial and Verbal Working Memory in Healthy Volunteers. Cannabis Cannabinoid Res 2024; 9:199-211. [PMID: 36201240 DOI: 10.1089/can.2022.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Memory impairments and psychosis-like experiences can be adverse effects of cannabis use. However, reports on the cognitive impact of cannabis use are not consistent. There are also limited studies on the psychotomimetic effects of cannabinoid compounds to reveal the association between cannabis and psychosis. Therefore, we investigated the effect of acute cannabinoid intoxication on verbal working memory (VWM) and spatial working memory (SWM) following oral doses of the synthetic cannabinoid agonist, nabilone (1-2 mg, oral). We further investigated the effect of nabilone on psychosis-like experiences (schizotypy scores) and associations of schizotypy with VWM and SWM. Methods: Healthy participants (n=28) completed spatial and digit span tasks across different delay conditions (0, 6, 12, and 18 sec) after receiving nabilone (1-2 mg, PO) or placebo in a randomized, double-blind, counterbalanced, crossover manner. A subset of participants completed a short battery of schizotypy measures (n=25). Results: Nabilone impaired VWM (p=0.03, weak effect size η2=0.02) and SWM (p=0.00016, η2=0.08). Nabilone did not significantly change overall schizotypy scores. Schizotypy scores were negatively correlated with working memory (WM) averaged across all delays and both modalities, under placebo (ρ=-0.41, p=0.04). In addition, there were significant negative correlations between occasions of cannabis use and overall WM averaged scores across drug treatments (ρ=-0.49, p=0.007) and under placebo (ρ=-0.45, p=0.004). The results showed that the drug effect in the less frequent cannabis users was more pronounced on the SWM (p<0.01) and VWM (p<0.01), whereas there appeared to be little drug effect in the frequent cannabis users. Conclusion: Low doses of synthetic cannabinoid impaired SWM and VWM, indicating that exogenous activation of the cannabinoid system influences cognitive performance. Further, the results replicated previous findings that schizotypy is correlated with deficits in WM. Clinical Trial Registry Name: Nabilone and caffeine effects on the perceptions of visually, auditory, tactile and multimodal illusions in healthy volunteers. Clinical Trial Registration Number: CT-2018-CTN-02561 (Therapeutic Goods Administration Clinical Trial Registry) and ACTRN12618001292268 (The Australian New Zealand Clinical Trials Registry).
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Affiliation(s)
- Faiz M Kassim
- Psychopharmacology Research Unit, Discipline of Pharmacology, School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Sophie Tod
- Psychopharmacology Research Unit, Discipline of Pharmacology, School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Jennifer Rodger
- Experimental and Regenerative Neurosciences, School of Biological Sciences, University of Western Australia, Crawley, Western Australia, Australia
- Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Sean D Hood
- Division of Psychiatry, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Joseph W Y Lee
- Division of Psychiatry, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Matthew A Albrecht
- Western Australian Centre for Road Safety Research, School of Psychological Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Mathew T Martin-Iverson
- Psychopharmacology Research Unit, Discipline of Pharmacology, School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
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Wong-Salgado P, Soares F, Moya-Salazar J, Ramírez-Méndez JF, Moya-Salazar MM, Apesteguía A, Castro A. Therapeutic Potential of Cannabinoid Profiles Identified in Cannabis L. Crops in Peru. Biomedicines 2024; 12:306. [PMID: 38397908 PMCID: PMC10886879 DOI: 10.3390/biomedicines12020306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 02/25/2024] Open
Abstract
Cannabis is a plant that is cultivated worldwide, and its use is internationally regulated, but some countries have been regulating its medicinal, social, and industrial uses. This plant must have arrived in Peru during the Spanish conquest and remains widely cultivated illicitly or informally to this day. However, new regulations are currently being proposed to allow its legal commercialization for medicinal purposes. Cannabis contains specific metabolites known as cannabinoids, some of which have clinically demonstrated therapeutic effects. It is now possible to quantitatively measure the presence of these cannabinoids in dried inflorescences, thus allowing for description of the chemical profile or "chemotype" of cannabinoids in each sample. This study analyzed the chemotypes of eight samples of dried inflorescences from cannabis cultivars in four different regions of Peru, and based on the significant variation in the cannabinoid profiles, we suggest their therapeutic potential. The most important medical areas in which they could be used include the following: they can help manage chronic pain, they have antiemetic, anti-inflammatory, and antipruritic properties, are beneficial in treating duodenal ulcers, can be used in bronchodilators, in muscle relaxants, and in treating refractory epilepsy, have anxiolytic properties, reduce sebum, are effective on Methicillin-resistant Staphylococcus aureus, are proapoptotic in breast cancer, can be used to treat addiction and psychosis, and are effective on MRSA, in controlling psoriasis, and in treating glioblastoma, according to the properties of their concentrations of cannabidiol, cannabigerol, and Δ9-tetrahydrocannabinol, as reviewed in the literature. On the other hand, having obtained concentrations of THC, we were able to suggest the psychotropic capacity of said samples, one of which even fits within the legal category of "non-psychoactive cannabis" according to Peruvian regulations.
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Affiliation(s)
- Pedro Wong-Salgado
- CANNAVITAL, Clínica Especializada en Terapias con Cannabinoides, Lima 15022, Peru;
- RENATU Research Group, Faculty of Pharmacy and Biochemistry, Universidad Nacional Mayor de San Marcos, Lima 15039, Peru; (F.S.); (A.C.)
- Centro de Estudios del Cannabis del Perú, Lima 15022, Peru;
| | - Fabiano Soares
- RENATU Research Group, Faculty of Pharmacy and Biochemistry, Universidad Nacional Mayor de San Marcos, Lima 15039, Peru; (F.S.); (A.C.)
- Centro de Estudios del Cannabis del Perú, Lima 15022, Peru;
- REAJA Laboratory, Curitiba 80045-180, Brazil
| | - Jeel Moya-Salazar
- Faculties of Health Science, Universidad Privada del Norte, Lima 15001, Peru
| | - José F. Ramírez-Méndez
- CANNAVITAL, Clínica Especializada en Terapias con Cannabinoides, Lima 15022, Peru;
- Centro de Estudios del Cannabis del Perú, Lima 15022, Peru;
| | - Marcia M. Moya-Salazar
- Centro de Estudios del Cannabis del Perú, Lima 15022, Peru;
- Cannabis and Stone Unit, Nesh Hubbs, Lima 15001, Peru
| | - Alfonso Apesteguía
- Centro de Información, Control Toxicológico y Apoyo a la Gestión Ambiental CICOTOX, Faculty of Pharmacy and Biochemistry, Universidad Nacional Mayor de San Marcos, Lima 15039, Peru;
| | - Americo Castro
- RENATU Research Group, Faculty of Pharmacy and Biochemistry, Universidad Nacional Mayor de San Marcos, Lima 15039, Peru; (F.S.); (A.C.)
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Safi K, Sobieraj J, Błaszkiewicz M, Żyła J, Salata B, Dzierżanowski T. Tetrahydrocannabinol and Cannabidiol for Pain Treatment-An Update on the Evidence. Biomedicines 2024; 12:307. [PMID: 38397910 PMCID: PMC10886939 DOI: 10.3390/biomedicines12020307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024] Open
Abstract
In light of the current International Association for the Study of Pain (IASP) clinical practice guidelines (CPGs) and the European Society for Medical Oncology (ESMO) guidelines, the topic of cannabinoids in relation to pain remains controversial, with insufficient research presently available. Cannabinoids are an attractive pain management option due to their synergistic effects when administered with opioids, thereby also limiting the extent of respiratory depression. On their own, however, cannabinoids have been shown to have the potential to relieve specific subtypes of chronic pain in adults, although controversies remain. Among these subtypes are neuropathic, musculoskeletal, cancer, and geriatric pain. Another interesting feature is their effectiveness in chemotherapy-induced peripheral neuropathy (CIPN). Analgesic benefits are hypothesized to extend to HIV-associated neuropathic pain, as well as to lower back pain in the elderly. The aim of this article is to provide an up-to-date review of the existing preclinical as well as clinical studies, along with relevant systematic reviews addressing the roles of various types of cannabinoids in neuropathic pain settings. The impact of cannabinoids in chronic cancer pain and in non-cancer conditions, such as multiple sclerosis and headaches, are all discussed, as well as novel techniques of administration and relevant mechanisms of action.
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Affiliation(s)
| | | | | | | | | | - Tomasz Dzierżanowski
- Palliative Medicine Clinic, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
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Erridge S, Leung O, Holvey C, Coomber R, Beri S, Khan S, Weatherall MW, Rucker JJ, Platt MW, Sodergren MH. An observational study of clinical outcome measures in patients treated with cannabis-based medicinal products on the UK Medical Cannabis Registry. Neuropsychopharmacol Rep 2023; 43:616-632. [PMID: 38057993 PMCID: PMC10739137 DOI: 10.1002/npr2.12403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION While there is increasing evidence of the effects of cannabis-based medicinal products (CBMPs) on health-related quality of life (HRQoL), a major limitation of the current literature is the heterogeneity of studied CBMPs. This study aims to analyze changes in HRQoL in patients prescribed a homogenous selection of CBMPs. METHODS Primary outcomes were changes in patient-reported outcomes (PROMs) at 1, 3, 6, and 12 months from baseline. The secondary outcome was an adverse events analysis. Statistical significance was defined as p < 0.050. RESULTS 1378 patients prescribed Adven® CBMPs (Curaleaf International, Guernsey, UK) were included in the final analysis. 581 (42.16%) participants were current users of cannabis at baseline. 641 (46.51%), 235 (17.05%), and 502 (36.43%) patients were treated with oils, dried flowers, or a combination of the two, respectively. Improvements were found in all PROMs in each route of administration at 1, 3, 6, and 12 months from baseline (p < 0.010). Those prescribed dried flower only or both oils and dried flower experienced greater improvements in GAD-7, SQS, and EQ-5D-5L index values at 12 months (p < 0.050). There was no difference in outcomes between those prescribed dried flower only or dried flower with oils (p > 0.050). 3663 (265.82%) adverse events were reported by 297 (21.55%) patients. CONCLUSION There was an associated improvement in self-reported anxiety, sleep quality, and HRQoL in patients treated with the CBMPs. Those prescribed treatment formulations including dried flower were most likely to show a clinical improvement. However, these results must be interpreted with caution given the limitations of study design.
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Affiliation(s)
- Simon Erridge
- Imperial College Medical Cannabis Research Group, Department of Surgery and CancerImperial College LondonLondonUK
- Sapphire Medical ClinicsLondonUK
| | - Ophilia Leung
- Imperial College Medical Cannabis Research Group, Department of Surgery and CancerImperial College LondonLondonUK
| | | | - Ross Coomber
- Sapphire Medical ClinicsLondonUK
- St. George's Hospital NHS TrustLondonUK
| | - Sushil Beri
- Imperial College Medical Cannabis Research Group, Department of Surgery and CancerImperial College LondonLondonUK
- Sapphire Medical ClinicsLondonUK
| | - Shaheen Khan
- Sapphire Medical ClinicsLondonUK
- Guy's & St. Thomas' NHS Foundation TrustLondonUK
| | - Mark W. Weatherall
- Sapphire Medical ClinicsLondonUK
- Buckinghamshire Healthcare NHS TrustAmershamUK
| | - James J. Rucker
- Sapphire Medical ClinicsLondonUK
- Department of Psychological MedicineKings College LondonLondonUK
- South London & Maudsley NHS Foundation TrustLondonUK
| | | | - Mikael H. Sodergren
- Imperial College Medical Cannabis Research Group, Department of Surgery and CancerImperial College LondonLondonUK
- Sapphire Medical ClinicsLondonUK
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Ittiphakorn P, Erridge S, Holvey C, Coomber R, Rucker JJ, Sodergren MH. UK Medical Cannabis Registry: An analysis of clinical outcomes of medicinal cannabis therapy for attention-deficit/hyperactivity disorder. Neuropsychopharmacol Rep 2023; 43:596-606. [PMID: 38058251 PMCID: PMC10739081 DOI: 10.1002/npr2.12400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/08/2023] Open
Abstract
AIM This study aims to analyze the health-related quality of life (HRQoL) and safety outcomes in attention-deficit/hyperactivity disorder (ADHD) patients treated with cannabis-based medicinal products (CBMPs). METHODS Patients were identified from the UK Medical Cannabis Registry. Primary outcomes were changes in the following patient-reported outcome measures (PROMs) at 1, 3, 6, and 12 months from baseline: EQ-5D-5L index value, generalized anxiety disorder-7 (GAD-7) questionnaire, and the single-item sleep quality score (SQS). Secondary outcomes assessed the incidence of adverse events. Statistical significance was defined as p < 0.050. RESULTS Sixty-eight patients met the inclusion criteria. Significant improvements were identified in general HRQoL assessed by EQ-5D-5L index value at 1, 3, and 6 months (p < 0.050). Improvements were also identified in GAD-7 and SQS scores at 1, 3, 6, and 12 months (p < 0.010). 61 (89.71%) adverse events were recorded by 11 (16.18%) participants, of which most were moderate (n = 26, 38.24%). CONCLUSION An association between CBMP treatment and improvements in anxiety, sleep quality, and general HRQoL was observed in patients with ADHD. Treatment was well tolerated at 12 months. Results must be interpreted with caution as a causative effect cannot be proven. These results, however, do provide additional support for future evaluation within randomized controlled trials.
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Affiliation(s)
- Pim Ittiphakorn
- Medical Cannabis Research Group, Department of Surgery and CancerImperial College LondonLondonUK
| | - Simon Erridge
- Medical Cannabis Research Group, Department of Surgery and CancerImperial College LondonLondonUK
- Sapphire Medical ClinicsLondonUK
| | | | - Ross Coomber
- Sapphire Medical ClinicsLondonUK
- St. George's Hospital NHS TrustLondonUK
| | - James J. Rucker
- Department of Psychological MedicineKings College LondonLondonUK
- South London & Maudsley NHS Foundation TrustLondonUK
| | - Mikael H. Sodergren
- Medical Cannabis Research Group, Department of Surgery and CancerImperial College LondonLondonUK
- Sapphire Medical ClinicsLondonUK
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21
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Hunziker S, Morosoli F, Zuercher K, Tscherter A, Grunt S. Prescription Practices of Cannabinoids in Children with Cerebral Palsy Worldwide-A Survey of the Swiss Cerebral Palsy Registry. Children (Basel) 2023; 10:1838. [PMID: 38136040 PMCID: PMC10742030 DOI: 10.3390/children10121838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
Cannabinoids are prescribed to children with cerebral palsy despite limited evidence. We aimed to assess cannabinoid prescribing practices in children with cerebral palsy, focusing on indications, types of preparations used, and tolerability. Furthermore, we investigated how physicians acquire knowledge about cannabinoid medication. We asked physicians with expertise in the care of children with cerebral palsy about their prescribing practices for cannabinoids. Data were collected through an online survey, which was distributed by email. In addition to the demographic information of participants, we also inquired about the indications for the prescription of cannabinoids, experiences regarding efficacy, and observed side effects of the therapy. Seventy physicians from Europe, North America, and Australia completed the survey. Forty-seven participants were experienced in treating of children with cerebral palsy with cannabinoids. The most common indication was epilepsy (69%), followed by spasticity (64%) and pain (63%). The preparations and doses prescribed varied considerably. Half of the participants evaluated the effect of the cannabinoids as moderate. Twenty-nine physicians reported side effects, most frequently, drowsiness (26%), somnolence (19%), fatigue (13%), and diarrhea (13%). Despite the lack of evidence to date, cannabinoids are used to treat children with cerebral palsy in a wide variety of indications. Randomized controlled trials in this vulnerable patient group are therefore of utmost importance.
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Affiliation(s)
- Sandra Hunziker
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Federico Morosoli
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Freiburgstr. 15, CH-3010 Bern, Switzerland
| | - Kathrin Zuercher
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Anne Tscherter
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Sebastian Grunt
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Freiburgstr. 15, CH-3010 Bern, Switzerland
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22
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Falck Jørgensen C, Schou Rasmussen B, Linnet K, Thomsen R. Evidence of 11-Hydroxy-hexahydrocannabinol and 11-Nor-9-carboxy-hexahydrocannabinol as Novel Human Metabolites of Δ 9- Tetrahydrocannabinol. Metabolites 2023; 13:1169. [PMID: 38132851 PMCID: PMC10744638 DOI: 10.3390/metabo13121169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
(-)-trans-Δ9-tetrahydrocannabinol (Δ9-THC) is the primary psychoactive compound in the Cannabis sativa plant. Δ9-THC undergoes extensive metabolism, with the main human phase I metabolites being 11-hydroxy-tetrahydrocannabinol (11-OH-THC) and 11-nor-9-carboxy-tetrahydrocannabinol (THC-COOH). Early animal studies have indicated that the 9-10 double bond may be reduced in vivo to yield 11-hydroxy-hexahydrocannabinol (11-OH-HHC) and 11-nor-9-carboxy-hexahydrocannabinol (HHC-COOH). These metabolites have not been confirmed in humans. In this study, we aimed to investigate whether this metabolic transformation occurs in humans. A range of cannabinoids and metabolites, including 11-OH-HHC and HHC-COOH, were measured in whole blood from 308 authentic forensic traffic cases, of which 222 were positive for Δ9-THC. HHC-COOH and 11-OH-HHC were detected in 84% and 15% of the Δ9-THC positive cases, respectively, and the estimated median concentration of HHC-COOH was 7%, relative to that of THC-COOH. To corroborate the in vivo findings, Δ9-THC and its metabolites 11-OH-THC and THC-COOH were incubated with pooled human liver microsomes. HHC-COOH was detected in both the Δ9-THC and 11-OH-THC incubations, while 11-OH-HHC was only detectable in the 11-OH-THC incubation. Hexahydrocannabinol was not detected in any of the incubations, indicating that it is 11-OH-THC or the corresponding aldehyde that undergoes double bond reduction with subsequent oxidation of the aliphatic alcohol to HHC-COOH. In summary, the presented data provide the first evidence of HHC-COOH and 11-OH-HHC being human phase I metabolites of Δ9-THC. These findings have implications for interpretation of analytical results from subjects exposed to Δ9-THC or HHC.
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Affiliation(s)
- Christian Falck Jørgensen
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Frederik V’s vej 11, DK-2100 Copenhagen, Denmark (K.L.); (R.T.)
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23
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Gabarin A, Yarmolinsky L, Budovsky A, Khalfin B, Ben-Shabat S. Cannabis as a Source of Approved Drugs: A New Look at an Old Problem. Molecules 2023; 28:7686. [PMID: 38067416 PMCID: PMC10707504 DOI: 10.3390/molecules28237686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
Cannabis plants have been used in medicine since ancient times. They are well known for their anti-diabetic, anti-inflammatory, neuroprotective, anti-cancer, anti-oxidative, anti-microbial, anti-viral, and anti-fungal activities. A growing body of evidence indicates that targeting the endocannabinoid system and various other receptors with cannabinoid compounds holds great promise for addressing multiple medical conditions. There are two distinct avenues in the development of cannabinoid-based drugs. The first involves creating treatments directly based on the components of the cannabis plant. The second involves a singular molecule strategy, in which specific phytocannabinoids or newly discovered cannabinoids with therapeutic promise are pinpointed and synthesized for future pharmaceutical development and validation. Although the therapeutic potential of cannabis is enormous, few cannabis-related approved drugs exist, and this avenue warrants further investigation. With this in mind, we review here the medicinal properties of cannabis, its phytochemicals, approved drugs of natural and synthetic origin, pitfalls on the way to the widespread clinical use of cannabis, and additional applications of cannabis-related products.
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Affiliation(s)
- Adi Gabarin
- The Department of Clinical Biochemistry & Pharmacology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel; (A.G.); (L.Y.); (B.K.)
| | - Ludmila Yarmolinsky
- The Department of Clinical Biochemistry & Pharmacology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel; (A.G.); (L.Y.); (B.K.)
| | - Arie Budovsky
- Research and Development Authority, Barzilai University Medical Center, Ashkelon 7830604, Israel;
| | - Boris Khalfin
- The Department of Clinical Biochemistry & Pharmacology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel; (A.G.); (L.Y.); (B.K.)
| | - Shimon Ben-Shabat
- The Department of Clinical Biochemistry & Pharmacology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel; (A.G.); (L.Y.); (B.K.)
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Chhabra M, Ben-Eltriki M, Paul A, Lê ML, Herbert A, Oberoi S, Bradford N, Bowers A, Rassekh SR, Kelly LE. Cannabinoids for symptom management in children with cancer: A systematic review and meta-analysis. Cancer 2023; 129:3656-3670. [PMID: 37635461 DOI: 10.1002/cncr.34920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/20/2023] [Accepted: 05/02/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Despite the widespread use of medical cannabis, little is known regarding the safety, efficacy, and dosing of cannabis products in children with cancer. The objective of this study was to systematically appraise the existing published literature for the use of cannabis products in children with cancer. METHODS This systematic review, registered with the International Prospective Register of Systematic Reviews (CRD42020187433), searched four databases: MEDLINE, Embase, PsycINFO, and the Cochrane Library. Abstracts and full texts were screened in duplicate. Data on types of cannabis products, doses, formulations, frequencies, routes of administration, indications, and clinical and demographic details as well as reported efficacy outcomes were extracted. Data on cannabinoid-related adverse events were also summarized. RESULTS Out of 34,611 identified citations, 19 unique studies with a total of 1927 participants with cancer were included: eight retrospective chart reviews, seven randomized controlled trials, two open-label studies, and two case reports. The included studies reported the use of various cannabis products for the management of symptoms. Cannabinoids were commonly used for the management of chemotherapy-induced nausea and vomiting (11 of 19 [58%]). In controlled studies, somnolence, dizziness, dry mouth, and withdrawal due to adverse events were more commonly associated with the use of cannabinoids. Across all included studies, no serious cannabis-related adverse events were reported. CONCLUSIONS Although there is evidence to support the use of cannabis for symptom management, in children with cancer, there is a lack of rigorous evidence to inform the dosing, safety, and efficacy of cannabinoids. Because of the increasing interest in using cannabis, there is an urgent need for more research on medical cannabis in children with cancer.
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Affiliation(s)
- Manik Chhabra
- Department of Pharmacology and Therapeutics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mohamed Ben-Eltriki
- Department of Pharmacology and Therapeutics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Arun Paul
- Department of Pharmacology and Therapeutics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mê-Linh Lê
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anthony Herbert
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, South Brisbane, Queensland, Australia
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, South Brisbane, Queensland, Australia
| | - Alison Bowers
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, South Brisbane, Queensland, Australia
| | - S Rod Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Manitoba, Canada
| | - Lauren E Kelly
- Department of Pharmacology and Therapeutics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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25
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Takashina S, Minamoto K, Nunome M, Katehashi H, Katagi M, Inoue K. Quality test of cannabidiol profiling in CBD oil products and evaluation of residual THC at high temperature based on liquid chromatography coupled with tandem mass spectrometry. Biomed Chromatogr 2023; 37:e5697. [PMID: 37394894 DOI: 10.1002/bmc.5697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023]
Abstract
Cannabidiol (CBD) oil products are available in Japan as cosmetics, fragrances, food and items. Herein, quality testing of cannabinoid profiling in CBD oil products and the evaluation of possible residual tetrahydrocannabinol (THC) in these products using liquid chromatography-tandem mass spectrometry (LC-MS/MS) was conducted. A simple, sensitive, and selective LC-MS/MS assay (electrospray positive ion mode) was employed for the simultaneous quantification of eight cannabinoids. This quantification with three different oil samples showed that accuracy rates ranged from 87.7 to 106.9% (RSD > 3.5%). Furthermore, the quantification limit of THC is 0.001 mg/g of CBD oil products for suitable levels lower than the regulatory value. Notably, this method was used to evaluate CBD oil products from the Japanese market. Additionally, we investigated the THC conversion in CBD oil products at a high temperature (70°C) which has a minor effect on CBD stability in oil products with additives. Herein, the developed LC-MS/MS assay is applied to monitor the quality of CBD, trace THC and other components in CBD oil products.
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Affiliation(s)
- Shiori Takashina
- College of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Kyosuke Minamoto
- College of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Mari Nunome
- College of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Hidenao Katehashi
- Forensic Science Laboratory, Osaka Prefectural Police Headquarters, Osaka, Japan
| | - Munehiro Katagi
- Department of Legal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Koichi Inoue
- College of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu, Shiga, Japan
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26
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Varshney K, Patel A, Ansari S, Shet P, Panag SS. Cannabinoids in Treating Parkinson's Disease Symptoms: A Systematic Review of Clinical Studies. Cannabis Cannabinoid Res 2023; 8:716-730. [PMID: 37253174 DOI: 10.1089/can.2023.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Background: Parkinson's disease (PD) is a serious neurodegenerative condition impacting many individuals worldwide. There is a need for new non-invasive treatments of PD. Cannabinoids in the form of cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) may offer utility as treatment, and our objective was hence to conduct a systematic review regarding the clinical evidence for the efficacy and safety of cannabinoids in treating PD. Methods: Screening, data extraction, and quality assessments were all conducted by multiple reviewers, with discrepancies resolved by consensus. Results: After conducting searches in 4 different databases, 673 articles were screened. Thirteen articles were deemed eligible for inclusion in this review. It was shown that cannabis, CBD, and nabilone (a synthetic form of THC) were capable of consistently improving motor symptoms more than a placebo. All treatments improved various non-motor symptoms, particularly with cannabis improving pain intensity, and CBD improving psychiatric symptoms in a dose-dependent manner. Adverse effects were usually minor, and, in the case of CBD, rare (except at very high doses). Conclusion: Cannabinoids have been shown to safely offer important potential in treating motor symptoms in PD and some non-motor symptoms. More large-scale randomized control trials for specific forms of cannabinoid treatments are required to determine their overall efficacy.
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Affiliation(s)
- Karan Varshney
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
- School of Preventive and Population Health, Monash University, Melbourne, Victoria, Australia
| | - Akash Patel
- College of Dentistry, University of Illinois Chicago, Chicago, Illinois, USA
| | - Siraaj Ansari
- Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Pavan Shet
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | - Sohan Singh Panag
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
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27
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Fernandes JAB, Filev R, Fidalgo TM. Cannabinoids for Substance Use Disorder Treatment: What Does the Current Evidence Say? Cannabis Cannabinoid Res 2023; 8:703-715. [PMID: 37262132 DOI: 10.1089/can.2023.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Background: The prevalence of Substance Use Disorder (SUD) is increasing along with the need to develop approaches to reduce the harm associated with substance use, including investigating alternatives such as cannabinoids, which show promising results, although the current evidence is limited. This scoping review focuses on the limitations and potentials of cannabinoid-based treatments for SUDs. Methods: We examined between-subject randomized controlled trials (RCTs) investigating the use of CBD and THC as pharmacological treatment for SUDs in adults, with the procedures attending the expectations of the Preferred Reporting Items for Scoping reviews and Meta-Analyses (PRISMA) for Scoping Reviews guidelines and assessed risk of bias using the Cochrane Risk of Bias Assessment Tool 2. Results: Ten RCTs were included, with six demonstrating low risk of bias, and positive results were found for treating Cannabis Use Disorder, while contradictory results were found for Opioid Use Disorder, and inconclusive results for treating Cocaine Use Disorder. Conclusions: CBD and THC demonstrate potential for treating some SUDs, but evidence is limited. Robust RCTs with larger samples and longer follow-up periods are necessary to assess carefully developed outcomes for different SUD patients. New cannabinoid-based medications and scientific-based policies may advance SUD treatment. A comprehensive approach to treatment and careful methodological choices may benefit patients with SUD.
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Affiliation(s)
- João Ariel Bonar Fernandes
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato Filev
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thiago M Fidalgo
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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28
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Chisari CG, Guadagno J, Adjamian P, Vila Silvan C, Greco T, Bagul M, Patti F. A post hoc evaluation of the shift in spasticity category in individuals with multiple sclerosis-related spasticity treated with nabiximols. Ther Adv Neurol Disord 2023; 16:17562864231195513. [PMID: 37745913 PMCID: PMC10515604 DOI: 10.1177/17562864231195513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/30/2023] [Indexed: 09/26/2023] Open
Abstract
Background Over 80% of individuals with multiple sclerosis (MS) experience MS-associated spasticity (MSS). In many European countries, after failure of first-line treatments, moderate or severe MSS can be treated with nabiximols, a cannabis-based add-on treatment. Objective This post hoc analysis assessed the shift of participants treated with nabiximols from higher (severe or moderate) to lower (moderate or mild/none) spasticity. Methods Previously published data from two randomised controlled trials (RCTs), GWSP0604 (NCT00681538) and SAVANT (EudraCT2015-004451-40), and one large real-world study (consistent with EU label), all enriched for responders, were re-analysed. Spasticity severity, measured using the 0-10 numerical rating scale (spasticity NRS), was categorised as none/mild (score <4), moderate (score ⩾4-7), or severe (score ⩾7). Results In the two RCTs, the shift of participants with severe MSS into a lower category was significantly greater at week 12 for those receiving nabiximols versus placebo [GWSP0604: OR (95% CI), 4.4 (1.4, 14.2), p = 0.0125; SAVANT: 5.2 (1.2, 22.3), p = 0.0267]. In all three studies, over 80% of assessed patients with severe spasticity at baseline reported a shift into a lower category of spasticity after 12 weeks. Conclusions A meaningful proportion of MSS patients treated with nabiximols shifted to a lower category of spasticity severity, typically maintained to the end of the 12-week study period.
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Affiliation(s)
- Clara Grazia Chisari
- Department of Medical and Surgical Sciences and Advanced Technologies ‘GF Ingrassia’, Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Joe Guadagno
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Peyman Adjamian
- GW Pharmaceuticals, Cambridge, UK
- Jazz Pharmaceuticals, Inc., Dublin, Ireland
| | | | - Teresa Greco
- Jazz Pharmaceuticals – Gentium Srl, Villa Guardia, Italy
| | - Makarand Bagul
- GW Pharmaceuticals, Cambridge, UK
- Jazz Pharmaceuticals, Inc., Dublin, Ireland
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies ‘GF Ingrassia’, Multiple Sclerosis Center, University of Catania Italy
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29
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Piercey CJ, Mataczynski M, Stallsmith VT, Emery NN, Karoly HC. Examining Associations Between Cannabis Use Disorder and Measures of Weekly and Within-Day Cannabis Frequency, Quantity, and Potency in College Students. Cannabis Cannabinoid Res 2023. [PMID: 37699241 DOI: 10.1089/can.2022.0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Background: College student cannabis use has increased significantly in recent years, and individuals aged 18-25 are at elevated risk for development of cannabis use disorder (CUD). While weekly cannabis use frequency is a commonly used measure of cannabis consumption, there is increasing scientific interest in exploring more nuanced measures of cannabis use. Currently, limited research exists examining the clinical utility of cannabis quantity, within-day frequency, and potency variables. Methods: We used cross-sectional survey data from a sample of 617 undergraduate students in the state of Colorado. A two-part model-building approach was leveraged to examine whether within-session cannabis quantity and within-day cannabis use frequency were associated with odds of experiencing any CUD symptoms and total number of CUD symptoms endorsed. We also examined whether cannabis flower potency was associated with odds of experiencing any CUD symptoms and total number of CUD symptoms endorsed among a subset (N=288) of the sample who reported knowledge of the cannabinoid content of their most frequently used products. Results: Weekly flower use frequency (odds ratio [OR]=1.27, p<0.001) and weekly concentrate use frequency (OR=1.10, p=0.044) were positively associated with increased odds of experiencing any CUD symptoms, but cannabis quantity and within-day frequency variables were not. In addition, no association was found between flower potency and odds of endorsing any CUD symptoms. Among individuals endorsing at least one symptom, weekly flower use frequency (incident rate ratio [IRR]=1.06, p<0.001) was positively associated with total symptom count, but weekly concentrate use frequency, cannabis quantity variables, and within-day frequency variables were not. Among individuals endorsing symptoms, a positive association was found between flower potency and total symptom count (IRR=1.01, p=0.008). Conclusion: Current methods of assessing within-session cannabis quantity and within-day cannabis use frequency may lack clinical utility in examining college student CUD symptoms over and above weekly cannabis use frequency. Cannabis flower potency may prove useful in assessment of CUD symptom severity, but further research is warranted.
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Affiliation(s)
- Cianna J Piercey
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Maggie Mataczynski
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Vanessa T Stallsmith
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Noah N Emery
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Hollis C Karoly
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
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30
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Mohanraj PS, Das A, Sen A, Prithviraj M. Brain-Derived Neurotrophic Factor Levels in Cannabis Use Disorders - A Systematic Review and Meta-Analysis. Cureus 2023; 15:e45960. [PMID: 37900486 PMCID: PMC10600331 DOI: 10.7759/cureus.45960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
The prevalence of cannabis use disorders has become a noteworthy global public health issue. Understanding the neurobiological factors associated with cannabis use disorder (CUD) is crucial for creating effective interventions. One such factor, the brain-derived neurotrophic factor (BDNF), has been linked to the onset and persistence of addictive behaviors. This systematic review aims to summarize the existing literature on BDNF levels in individuals with CUD to provide a comprehensive overview of the current evidence. A systematic search was conducted using electronic databases (PubMed, Scopus) for relevant studies. The search approach yielded a total of 785 articles, with 559 located in the PubMed database and 226 in Scopus. Studies reporting BDNF levels in individuals with CUD compared to healthy controls were included in this study. Ultimately, eight articles were included in this systematic review. The primary emphasis of these studies was on individuals who were cannabis users or had a dependency on cannabis. There is considerable variation in the estimated effect size among included studies due to heterogeneity; hence, a random effect model was used for meta-analysis. The findings of our study suggest that the effect size of BDNF levels was 0.25 with 95% CI (-0.55; 1.05) in cannabis users, which was not statistically significant (p-value=0.54). Therefore, it is important to interpret the results with caution, and additional research is warranted to investigate the potential factors contributing to this heterogeneity.
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Affiliation(s)
- Palani S Mohanraj
- Biochemistry, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Arani Das
- Physiology, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Aniruddha Sen
- Biochemistry, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Manoj Prithviraj
- Psychiatry, All India Institute of Medical Sciences, Gorakhpur, IND
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31
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Hosseini SM, Gharouni A, Motamed Shariati M. Vogt-Koyanagi-Harada disease with a unilateral presentation in a patient with marijuana overuse: Role of multimodal imaging in suspected patients. Clin Case Rep 2023; 11:e7879. [PMID: 37675413 PMCID: PMC10477722 DOI: 10.1002/ccr3.7879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/20/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023] Open
Abstract
Key Clinical Message Harada disease could uniquely present with only unilateral symptoms, as was seen in our patient. However, multimodal imaging including ICG angiography could show bilateral involvement. Considering the immunomodulatory effects of Cannabis, the absence of inflammatory findings and the unusual presentation of the disease, in our case, may have been caused by the use of marijuana. Abstract To report a patient addicted to marijuana with the diagnosis of Vogt-Koyanagi-Harada (VKH) disease with a unilateral presentation. A 24-year-old man presented to us with painless decreased vision in his right eye (RE) and photophobia 3 days ago. No history of significant family or past medical history was documented. Spectral-domain optical coherence tomography (SD-OCT) of the RE showed multiple areas of subretinal fluid in the macula. Indocyanine green angiography (ICGA) revealed round hypocyanescent dark dots (HDD) of similar size, evenly distributed in both eyes. With the diagnosis of VKH disease, anti-inflammatory treatment was started. To our knowledge, this is the first reported case of suspected VKH in a patient with marijuana overuse. Regarding the complex effects of tetrahydrocannabinol (THC), the active ingredient of marijuana, on the vascular and immune systems, reaching a definite conclusion is not possible. This report shows the value of multimodal imaging in patients with unusual presentations.
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Affiliation(s)
| | - Ahmad Gharouni
- Eye Research Center, Mashhad University of Medical SciencesMashhadIran
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Corzo HH, Hillers-Bendtsen AE, Barnes A, Zamani AY, Pawłowski F, Olsen J, Jørgensen P, Mikkelsen KV, Bykov D. Corrigendum: Coupled cluster theory on modern heterogeneous supercomputers. Front Chem 2023; 11:1256510. [PMID: 37654900 PMCID: PMC10466216 DOI: 10.3389/fchem.2023.1256510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 09/02/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fchem.2023.1154526.].
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Affiliation(s)
| | | | | | - Abdulrahman Y. Zamani
- Department of Chemistry and Biochemistry and Center for Chemical Computation and Theory, University of California, Merced, CA, United States
| | - Filip Pawłowski
- Department of Chemistry and Biochemistry, Auburn University, Auburn, AL, United States
| | - Jeppe Olsen
- Department of Chemistry, Aarhus University, Aarhus, Denmark
| | - Poul Jørgensen
- Department of Chemistry, Aarhus University, Aarhus, Denmark
| | - Kurt V. Mikkelsen
- Department of Chemistry, University of Copenhagen, Copenhagen, Denmark
| | - Dmytro Bykov
- Oak Ridge National Laboratory, Oak Ridge, TN, United States
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Beck PJ, Reddy A. Cannabis Pen-Induced Psychosisin a First-Time Adolescent User. Psychopharmacol Bull 2023; 53:61-65. [PMID: 37601084 PMCID: PMC10434310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Cannabis is a widely used illicit substance that is historically consumed via smoking, but alternative methods of cannabis consumption have been growing in popularity over the past several decades. One such modality is vaporization, which can appeal specifically to adolescent consumers given these pen devices' ease of concealment, lack of characteristic odor, and marketability. Cannabis products designed for vaping often have higher concentrations of the psychoactive component of cannabis, tetrahydrocannabinol (THC), when compared with traditional cannabis leaf smoking. This can increase the intensity of cannabis-related effects such as analgesia, relaxation, appetite stimulation, and reduced nausea and emesis, but also potentially increases the risk for adverse effects such as dysphoria, and more severely, cannabis-induced psychosis (CIP). Here, we present the case of an adolescent female who was brought after school to our emergency department presenting with symptoms of acute psychosis. Her subsequent workup was effectively normal apart from a urine drug screen positive for THC, which the patient confirmed was due to use of a cannabis pen prior to leaving school that day. This prompted the diagnosis of CIP, which was self-limited and resolved without significant intervention. We use this case to provide the symptomatology and treatment of CIP secondary to cannabis pen use, as well as more broadly discuss the potential implications of cannabis vaping on adolescent neurodevelopment, substance use, and psychiatric comorbidities.
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Affiliation(s)
- Patrick J Beck
- Beck, Virginia Tech Carilion School of Medicine, Roanoke VA
| | - Abhishek Reddy
- Reddy, MD, Virginia Tech Carilion School of Medicine, Roanoke VA; Department of Psychiatry and Behavioral Medicine, Roanoke VA
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Brubacher JR, Chan H, Erdelyi S, Yuan Y, Daoust R, Vaillancourt C, Rowe B, Lee J, Mercier E, Atkinson P, Davis P, Clarke D, Taylor J, Macpherson A, Emond M, Al-Hakim D, Horwood C, Wishart I, Magee K, Rao J, Eppler J. High-'n'-dry? A comparison of cannabis and alcohol use in drivers presenting to hospital after a vehicular collision. Addiction 2023; 118:1507-1516. [PMID: 36898848 DOI: 10.1111/add.16186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023]
Abstract
DESIGN This was a prospective observational study. BACKGROUND AND AIMS The characteristics of cannabis-involved motor vehicle collisions are poorly understood. This study of injured drivers identifies demographic and collision characteristics associated with high tetrahydrocannabinol (THC) concentrations. SETTING The study was conducted in 15 Canadian trauma centres between January 2018 and December 2021. CASES The cases (n = 6956) comprised injured drivers who required blood testing as part of routine trauma care. MEASUREMENTS We quantified whole blood THC and blood alcohol concentration (BAC) and recorded driver sex, age and postal code, time of crash, crash type and injury severity. We defined three driver groups: high THC (THC ≥ 5 ng/ml and BAC = 0), high alcohol (BAC ≥ 0.08% and THC = 0) and THC/BAC-negative (THC = 0 = BAC). We used logistic regression techniques to identify factors associated with group membership. FINDINGS Most injured drivers (70.2%) were THC/BAC-negative; 1274 (18.3%) had THC > 0, including 186 (2.7%) in the high THC group; 1161 (16.7%) had BAC > 0, including 606 (8.7%) in the high BAC group. Males and drivers aged less than 45 years had higher adjusted odds of being in the high THC group (versus the THC/BAC-negative group). Importantly, 4.6% of drivers aged less than 19 years had THC ≥ 5 ng/ml, and drivers aged less than 19 years had higher unadjusted odds of being in the high THC group than drivers aged 45-54 years. Males, drivers aged 19-44 years, rural drivers, seriously injured drivers and drivers injured in single-vehicle, night-time or weekend collisions had higher adjusted odds ratios (aORs) for being in the high alcohol group (versus THC/BAC-negative). Drivers aged less than 35 or more than 65 years and drivers involved in multi-vehicle, daytime or weekday collisions had higher adjusted odds for being in the high THC group (versus the high BAC group). CONCLUSIONS In Canada, risk factors for cannabis-related motor vehicle collisions appear to differ from those for alcohol-related motor vehicle collisions. The collision factors associated with alcohol (single-vehicle, night-time, weekend, rural, serious injury) are not associated with cannabis-related collisions. Demographic factors (young drivers, male drivers) are associated with both alcohol and cannabis-related collisions, but are more strongly associated with cannabis-related collisions.
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Affiliation(s)
- J R Brubacher
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - H Chan
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - S Erdelyi
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - Y Yuan
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - R Daoust
- Department of Emergency Medicine, University of Montréal, Montréal, QC, Canada
| | - C Vaillancourt
- Department of Emergency Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - B Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - J Lee
- Department of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - E Mercier
- Department of Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - P Atkinson
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, St John, NB, Canada
| | - P Davis
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - D Clarke
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada
| | - J Taylor
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - A Macpherson
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - M Emond
- Department of Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - D Al-Hakim
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - C Horwood
- Department of Emergency Medicine, Memorial University, St John, NB, Canada
| | - I Wishart
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - K Magee
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - J Rao
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - J Eppler
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
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Stack SK, Wheate NJ, Moloney NC, Abelev SV, Barlow JW, Schubert EA. The Effectiveness and Adverse Events of Cannabidiol and Tetrahydrocannabinol Used in the Treatment of Anxiety Disorders in a PTSD Subpopulation: An Interim Analysis of an Observational Study. J Pharm Technol 2023; 39:172-182. [PMID: 37529155 PMCID: PMC10387818 DOI: 10.1177/87551225231180796] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Background: Anxiety is a condition for which current treatments are often limited by adverse events (AEs). Components of medicinal cannabis, cannabidiol (CBD) and tetrahydrocannabinol (THC), have been proposed as potential treatments for anxiety disorders, specifically posttraumatic stress disorder (PTSD). Objective: To evaluate quality-of-life outcomes after treatment with various cannabis formulations to determine the effectiveness and associated AEs. Methods: An interim analysis of data collected between September 2018 and June 2021 from the CA Clinics Observational Study. Patient-Reported Outcomes Measurement Information System-29 survey scores of 198 participants with an anxiety disorder were compared at baseline and after treatment with medicinal cannabis. The data of 568 anxiety participants were also analyzed to examine the AEs they experienced by the Medical Dictionary for Regulatory Activities organ system class. Results: The median doses taken were 50.0 mg/day for CBD and 4.4 mg/day for THC. The total participant sample reported significantly improved anxiety, depression, fatigue, and ability to take part in social roles and activities. Those who were diagnosed with PTSD (n = 57) reported significantly improved anxiety, depression, fatigue, and social abilities. The most common AEs reported across the whole participant cohort were dry mouth (32.6%), somnolence (31.3%), and fatigue (18.5%), but incidence varied with different cannabis formulations. The inclusion of THC in a formulation was significantly associated with experiencing gastrointestinal AEs; specifically dry mouth and nausea. Conclusions: Formulations of cannabis significantly improved anxiety, depression, fatigue, and the ability to participate in social activities in participants with anxiety disorders. The AEs experienced by participants are consistent with those in other studies.
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Affiliation(s)
- Sophie K. Stack
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nial J. Wheate
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | | | - Elise A. Schubert
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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36
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Shapira G, Israel-Elgali I, Grad M, Avnat E, Rachmany L, Sarne Y, Shomron N. Hippocampal differential expression underlying the neuroprotective effect of delta-9- tetrahydrocannabinol microdose on old mice. Front Neurosci 2023; 17:1182932. [PMID: 37534036 PMCID: PMC10393280 DOI: 10.3389/fnins.2023.1182932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/14/2023] [Indexed: 08/04/2023] Open
Abstract
Delta-9-tetrahydrocannabinol (THC) is the primary psychoactive compound of the cannabis plant and an exogenous ligand of the endocannabinoid system. In previous studies, we demonstrated that a single microdose of THC (0.002 mg/kg, 3-4 orders of magnitude lower than the standard dose for rodents) exerts distinct, long-term neuroprotection in model mice subjected to acute neurological insults. When administered to old, healthy mice, the THC microdose induced remarkable long-lasting (weeks) improvement in a wide range of cognitive functions, including significant morphological and biochemical brain alterations. To elucidate the mechanisms underlying these effects, we analyzed the gene expression of hippocampal samples from the model mice. Samples taken 5 days after THC treatment showed significant differential expression of genes associated with neurogenesis and brain development. In samples taken 5 weeks after treatment, the transcriptional signature was shifted to that of neuronal differentiation and survival. This study demonstrated the use of hippocampal transcriptome profiling in uncovering the molecular basis of the atypical, anti-aging effects of THC microdose treatment in old mice.
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Affiliation(s)
- Guy Shapira
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Edmond J Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv, Israel
| | - Ifat Israel-Elgali
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
| | - Meitar Grad
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eden Avnat
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lital Rachmany
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yosef Sarne
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Shomron
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Edmond J Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
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37
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Gibson LP, Bryan AD. Running High: Cannabis Users' Subjective Experience of Exercise During Legal Market Cannabis Use Versus No Use in a Naturalistic Setting. Cannabis Cannabinoid Res 2023. [PMID: 37440169 DOI: 10.1089/can.2022.0338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Background: The use of cannabis with various forms of exercise (e.g., running) has received increased media attention in recent years, contradicting the popular stereotype that cannabis is associated with sedentary behavior. Although cross-sectional evidence suggests a positive association between cannabis use and exercise engagement, to date, the acute effects of cannabis on exercise remain unclear. Methods: The present within-subjects crossover study compared participants' experiences of running after ad libitum use of legal market cannabis (cannabis run) to running without cannabis (non-cannabis run) in a real-world setting. Participants (n=49) were cannabis users between the ages of 21 and 49 years (mean=30.82, standard deviation [SD]=6.21). The majority of participants were male (61.5%) and non-Hispanic White (81.6%). Results: Participants (n=49) ran an average of 3.88 miles (SD=2.28) during their cannabis and non-cannabis runs. Although participants ran an average of 31 seconds/mile slower during their cannabis run, this difference was not statistically significant (p=0.12). Participants reported experiencing (1) less negative affect (p=0.03), (2) greater feelings of positive affect (p<0.001), tranquility (p=0.004), enjoyment (p=0.004), and dissociation (p=0.001), and (3) more runner's high symptoms (p<0.001) during their cannabis (vs. non-cannabis) runs. Participants also reported lower pain levels after their cannabis (vs. non-cannabis) run (p=0.03). Perceived exertion did not differ between runs (p=0.33). Cannabis form, cannabinoid content, and feelings of "high" were largely unrelated to participants' experience of exercise while under the influence of cannabis. Conclusions: Results suggest that acute cannabis use may be associated with a more positive exercise experience among regular cannabis users. Research using varied methodologies, a range of exercise modalities, and diverse populations is needed to establish the long-term harms and benefits associated with this behavior, as well as the generalizability of these findings to other populations and settings.
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Affiliation(s)
- Laurel P Gibson
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
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Sousa A, DiFrancisco-Donoghue J. Cannabidiol and Tetrahydrocannabinol Use in Parkinson's Disease: An Observational Pilot Study. Cureus 2023; 15:e42391. [PMID: 37621812 PMCID: PMC10446505 DOI: 10.7759/cureus.42391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND There is a need for more research examining the use of cannabis, tetrahydrocannabinol (THC), and cannabidiol (CBD) products in people with Parkinson's disease (PD), especially given the recent increase in the use of these products. OBJECTIVES Given the recent increase in over-the-counter CBD use as well as the prescription of medical cannabis by treating physicians, the utilization method, effects on motor and non-motor symptoms, side effects, and attitude toward cannabis use were examined in a naturalistic sample of patients with PD. METHODS A total of 15 individuals with PD, eight of whom were prescribed CBD/THC treatment and seven who were not taking any CBD/THC product, were assessed cross-sectionally. Participants completed structured neuropsychological testing, motor assessment, and questionnaires regarding mood, subjective cognition, and symptom levels. T-tests were completed for quantitative measures and descriptive data were examined and described. Due to the small sample size, Shapiro-Wilk tests for normality were utilized and Mann-Whitney U analyses were completed when appropriate. RESULTS We found a wide range of prescribed products and methods as well as variability in perceived benefits and untoward effects, even in our small sample. Individuals with PD who were taking a CBD/THC product had lower global cognition scores on the Montreal Cognitive Assessment (MoCA) but no detectable differences among more specific neuropsychological measures. They also had more non-motor symptoms of PD but no differences in motor symptom levels. Qualitatively, some participants with PD who were taking CBD/THC reported improved pain levels, sleep, and reductions in anxiety. A few negative effects were endorsed, including sleepiness, concentration difficulties, and forgetfulness. CONCLUSION CBD/THC utilization in PD is varied. In our small sample, individuals who utilized the treatment had lower MoCA scores, more non-motor symptoms, and descriptively reported improvements in sleep, anxiety, and pain, and had side effects of sleepiness and cognitive difficulty. Future studies should focus on clinical trials with standardized CBD/THC methods of use.
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Affiliation(s)
- Amber Sousa
- Osteopathic Manipulative Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Joanne DiFrancisco-Donoghue
- Osteopathic Manipulative Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
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Leczycki M, Zaki P, Espiridion ED. Moon Rock Cannabis-Induced Psychosis and New-Onset Seizures in a 20-Year-Old Male. Cureus 2023; 15:e42752. [PMID: 37654922 PMCID: PMC10468007 DOI: 10.7759/cureus.42752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
"Moon rock" cannabis is a type of new and highly potent preparation of cannabis, which is made of a strain of cannabis dipped in hash oil and sprinkled with kief crystals, effectively increasing the concentration of δ-9-tetrahydrocannabinol (THC), the main psychoactive compound in cannabis, well beyond what is naturally found in the cannabis plant. The use of increasingly potent forms of cannabis has far-reaching health implications, including psychiatric and neurologic effects, which are not yet fully understood. This case report summarizes existing knowledge of the association of cannabis use with psychosis and seizures and describes a novel case of "moon rock" cannabis-induced psychosis and new-onset seizures.
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Affiliation(s)
- Martin Leczycki
- Psychiatry, Reading Hospital - Tower Health, West Reading, USA
| | - Peter Zaki
- Neurosurgery, Drexel University College of Medicine, Philadelphia, USA
| | - Eduardo D Espiridion
- Psychiatry, Reading Hospital - Tower Health, West Reading, USA
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA
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Lake S, Haney M, Cooper ZD. Sex differences in the subjective and reinforcing effects of smoked cannabis. Addict Biol 2023; 28:e13301. [PMID: 37369126 PMCID: PMC10300354 DOI: 10.1111/adb.13301] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/07/2023] [Accepted: 04/30/2023] [Indexed: 06/29/2023]
Abstract
Preclinical studies have shown sex-based differences in the reinforcing effects of cannabinoid 1 receptor agonists such as delta-9-tetrahydrocannabinol (THC). This study sought to test whether these sex differences translate to humans by assessing the subjective and reinforcing effects of smoked cannabis in male and female volunteers. We pooled data (n = 68; 55M, 13F) from two within-subject randomized controlled trials of healthy, ≥weekly cannabis users comparing the subjective and reinforcing effects of smoked active (~25 mg THC) versus placebo cannabis (0-mg THC). Subjective ratings of drug effects and mood were measured using visual analogue scales, and reinforcing effects were measured with a cannabis self-administration task. Sex-dependent outcomes were explored using generalized linear mixed models. Under active cannabis conditions, female participants reported greater reductions from baseline in cannabis craving and significantly higher cannabis-specific ratings of strength, liking, willingness to take again and good effect, compared with males (interaction p < 0.05). Placebo and active cannabis were self-administered by 22% and 36% of male participants, respectively, and by 15% and 54% of female participants, respectively. Receipt of active cannabis significantly increased likelihood of self-administration (p = 0.011), but a sex difference was not detected (p = 0.176). Although females were more sensitive to certain positive subjective effects of active cannabis, they were not more likely than males to self-administer it. These findings highlight the need to test sex differences as a primary objective in experimental studies and may shed light on accelerated trajectories from initiation to cannabis use disorder observed among women.
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Affiliation(s)
- Stephanie Lake
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, Suite 38-418, Los Angeles, CA, 90095
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095
| | - Margaret Haney
- Department of Psychiatry, Division on Substance Use Disorders, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY, 10032
| | - Ziva D. Cooper
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, Suite 38-418, Los Angeles, CA, 90095
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, 757 Westwood Plaza, Suite 3325, Los Angeles, CA, 90095
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Zaiachuk M, Suryavanshi SV, Pryimak N, Kovalchuk I, Kovalchuk O. The Anti-Inflammatory Effects of Cannabis sativa Extracts on LPS-Induced Cytokines Release in Human Macrophages. Molecules 2023; 28:4991. [PMID: 37446655 DOI: 10.3390/molecules28134991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Inflammation is the response of the innate immune system to any type of injury. Although acute inflammation is critical for survival, dysregulation of the innate immune response leads to chronic inflammation. Many synthetic anti-inflammatory drugs have side effects, and thus, natural anti-inflammatory compounds are still needed. Cannabis sativa L. may provide a good source of anti-inflammatory molecules. Here, we tested the anti-inflammatory properties of cannabis extracts and pure cannabinoids in lipopolysaccharide (LPS)-induced inflammation in human THP-1 macrophages. We found that pre-treatment with cannabidiol (CBD), delta-9-tetrahydrocannabinol (THC), or extracts containing high levels of CBD or THC reduced the level of induction of various cytokines. The CBD was more efficient than THC, and the extracts were more efficient than pure cannabinoids. Finally, IL-6, IL-10, and MCP-1 cytokines were most sensitive to pre-treatments with CBD and THC, while IL-1β, IL-8, and TNF-α were less responsive. Thus, our work demonstrates the potential of the use of cannabinoids or/and cannabis extracts for the reduction of inflammation and establishes IL-6 and MCP-1 as the sensitive markers for the analysis of the effect of cannabinoids on inflammation in macrophages.
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Affiliation(s)
- Mariia Zaiachuk
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Santosh V Suryavanshi
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Nazar Pryimak
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Igor Kovalchuk
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Olga Kovalchuk
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
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Corzo HH, Hillers-Bendtsen AE, Barnes A, Zamani AY, Pawłowski F, Olsen J, Jørgensen P, Mikkelsen KV, Bykov D. Coupled cluster theory on modern heterogeneous supercomputers. Front Chem 2023; 11:1154526. [PMID: 37388945 PMCID: PMC10303140 DOI: 10.3389/fchem.2023.1154526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/11/2023] [Indexed: 07/01/2023] Open
Abstract
This study examines the computational challenges in elucidating intricate chemical systems, particularly through ab-initio methodologies. This work highlights the Divide-Expand-Consolidate (DEC) approach for coupled cluster (CC) theory-a linear-scaling, massively parallel framework-as a viable solution. Detailed scrutiny of the DEC framework reveals its extensive applicability for large chemical systems, yet it also acknowledges inherent limitations. To mitigate these constraints, the cluster perturbation theory is presented as an effective remedy. Attention is then directed towards the CPS (D-3) model, explicitly derived from a CC singles parent and a doubles auxiliary excitation space, for computing excitation energies. The reviewed new algorithms for the CPS (D-3) method efficiently capitalize on multiple nodes and graphical processing units, expediting heavy tensor contractions. As a result, CPS (D-3) emerges as a scalable, rapid, and precise solution for computing molecular properties in large molecular systems, marking it an efficient contender to conventional CC models.
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Affiliation(s)
| | | | | | - Abdulrahman Y. Zamani
- Department of Chemistry and Biochemistry and Center for Chemical Computation and Theory, University of California, Merced, CA, United States
| | - Filip Pawłowski
- Department of Chemistry and Biochemistry, Auburn University, Auburn, AL, United States
| | - Jeppe Olsen
- Department of Chemistry, Aarhus University, Aarhus, Denmark
| | - Poul Jørgensen
- Department of Chemistry, Aarhus University, Aarhus, Denmark
| | - Kurt V. Mikkelsen
- Department of Chemistry, University of Copenhagen, Copenhagen, Denmark
| | - Dmytro Bykov
- Oak Ridge National Laboratory, Oak Ridge, TN, United States
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Stith SS, Li X, Brockelman F, Keeling K, Hall B, Vigil JM. Understanding feeling "high" and its role in medical cannabis patient outcomes. Front Pharmacol 2023; 14:1135453. [PMID: 37292156 PMCID: PMC10244544 DOI: 10.3389/fphar.2023.1135453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction: We measure for the first time the associations between subjective patient experiences of feeling "high" and treatment outcomes during real-time Cannabis flower consumption sessions. Methods: Our study uses data from the mobile health app, Releaf App™, through which 1,882 people tracked the effects of Cannabis flower on a multitude of health conditions during 16,480 medical cannabis self-administration sessions recorded between 6/5/2016 and 3/11/2021. Session-level reported information included plant phenotypes, modes of administration, potencies, baseline and post-administration symptom intensity levels, total dose used, and real-time side effect experiences. Results: Patients reported feeling high in 49% of cannabis treatment sessions. Using individual patient-level fixed effects regression models and controlling for plant phenotype, consumption mode, tetrahydrocannabinol (THC) and cannabidiol (CBD) potencies, dose, and starting symptom level, our results show that, as compared to sessions in which individuals did not report feeling high, reporting feeling high was associated with a 7.7% decrease in symptom severity from a mean reduction of -3.82 on a 0 to 10 analog scale (coefficient = -0.295, p < 0.001) with evidence of a 14.4 percentage point increase (p < 0.001) in negative side effect reporting and a 4.4 percentage point (p < 0.01) increase in positive side effect reporting. Tetrahydrocannabinol (THC) levels and dose were the strongest statistical predictors of reporting feeling high, while the use of a vaporizer was the strongest inhibitor of feeling high. In symptom-specific models, the association between feeling high and symptom relief remained for people treating pain (p < 0.001), anxiety (p < 0.001), depression (p < 0.01) and fatigue (p < 0.01), but was insignificant, though still negative, for people treating insomnia. Although gender and pre-app cannabis experience did not appear to affect the relationship between high and symptom relief, the relationship was larger in magnitude and more statistically significant among patients aged 40 or less. Discussion: The study results suggest clinicians and policymakers should be aware that feeling high is associated with improved symptom relief but increased negative side effects, and factors such as mode of consumption, product potency, and dose can be used to adjust treatment outcomes for the individual patient.
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Affiliation(s)
- Sarah S. Stith
- Department of Economics, University of New Mexico, Albuquerque, NM, United States
| | - Xiaoxue Li
- Department of Economics, University of New Mexico, Albuquerque, NM, United States
| | | | | | - Branden Hall
- MoreBetter, Ltd., Hyattsville, MD, United States
| | - Jacob M. Vigil
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
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Wang C, Erridge S, Holvey C, Coomber R, Usmani A, Sajad M, Guru R, Holden W, Rucker JJ, Platt MW, Sodergren MH. Assessment of clinical outcomes in patients with fibromyalgia: Analysis from the UK Medical Cannabis Registry. Brain Behav 2023:e3072. [PMID: 37199833 DOI: 10.1002/brb3.3072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION There are limited therapeutic options for individuals with fibromyalgia. The aim of this study is to analyze changes in health-related quality of life and incidence of adverse events of those prescribed cannabis-based medicinal products (CBMPs) for fibromyalgia. METHODS Patients treated with CBMPs for a minimum of 1 month were identified from the UK Medical Cannabis Registry. Primary outcomes were changes in validated patient-reported outcome measures (PROMs). A p-value of <.050 was deemed statistically significant. RESULTS In total, 306 patients with fibromyalgia were included for analysis. There were improvements in global health-related quality of life at 1, 3, 6, and 12 months (p < .0001). The most frequent adverse events were fatigue (n = 75; 24.51%), dry mouth (n = 69; 22.55%), concentration impairment (n = 66; 21.57%), and lethargy (n = 65; 21.24%). CONCLUSION CBMP treatment was associated with improvements in fibromyalgia-specific symptoms, in addition to sleep, anxiety, and health-related quality of life. Those who reported prior cannabis use appeared to have a greater response. CBMPs were generally well-tolerated. These results must be interpreted within the limitations of study design.
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Affiliation(s)
- Claire Wang
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Simon Erridge
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
- Sapphire Medical Clinics, London, UK
| | | | - Ross Coomber
- Sapphire Medical Clinics, London, UK
- St. George's Hospital NHS Trust, London, UK
| | | | | | | | | | - James J Rucker
- Sapphire Medical Clinics, London, UK
- Department of Psychological Medicine, Kings College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Michael W Platt
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
- Sapphire Medical Clinics, London, UK
| | - Mikael H Sodergren
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
- Sapphire Medical Clinics, London, UK
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Nali MC, McMann TJ, Purushothaman V, Li Z, Cuomo RE, Liang BA, Mackey TK. Assessing Characteristics and Compliance of Online Delta-8 Tetrahydrocannabinol Product Sellers. Cannabis Cannabinoid Res 2023. [PMID: 37200462 DOI: 10.1089/can.2022.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Introduction: The debate over the legal status of many cannabis- and hemp-derived products, including delta-8 tetrahydrocannabinol (THC), is in question. Although low concentrations of delta-8 THC are legal at the Federal level, many states have implemented their own regulations to both allow and restrict its use and sale. Of concern, sellers with unknown legal credentials have appeared online and are actively selling this product. Materials and Methods: We characterized the marketing, sale, and compliance of online delta-8 THC sellers using (1) data collected from the Twitter Application Programming Interface with delta-8 THC-related keywords; (2) unsupervised topic modeling using the Biterm Topic Model to identify clusters of tweets involved in marketing and selling; (3) inductive coding to identify marketing and selling characteristics; and (4) web forensics and simulated shopping to determine compliance with state restrictions for delta-8 THC sales. Results: In total, 110 unique hyperlinks associated with 7085 tweets that included marketing and selling activity for delta-8 THC were collected. From these links, we conducted simulated purchasing in January 2021 to identify compliant and noncompliant websites. Among the vendors, age verification was not found in over half of websites (59, 53.63%); 60 (54.55%) did not report a physical address; and 74 (65.45%) sold delta-8 products direct-to-consumer. Sixty-seven (90.54%) of detected vendors shipped delta-8 products to addresses in states that prohibit sales. Forty-three (64.18%) of Internet Protocol addresses were located within the United States; all others were international. Conclusion: Our analysis suggests that online storefronts are illegally selling and shipping cannabinoid derivatives to U.S. consumers. Further research is needed to understand downstream health and regulatory impacts from this unregulated access.
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Affiliation(s)
- Matthew C Nali
- Department of Anesthesiology, University of California, San Diego, School of Medicine, San Diego, California, USA
- Global Health Policy and Data Institute, San Diego, California, USA
- S-3 Research, San Diego, California, USA
| | - Tiana J McMann
- Global Health Policy and Data Institute, San Diego, California, USA
- S-3 Research, San Diego, California, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, California, USA
| | - Vidya Purushothaman
- Global Health Policy and Data Institute, San Diego, California, USA
- San Diego Supercomputer Center, University of California, San Diego, La Jolla, California, USA
| | - Zhuoran Li
- Global Health Policy and Data Institute, San Diego, California, USA
- S-3 Research, San Diego, California, USA
- San Diego Supercomputer Center, University of California, San Diego, La Jolla, California, USA
| | - Raphael E Cuomo
- Department of Anesthesiology, University of California, San Diego, School of Medicine, San Diego, California, USA
- Global Health Policy and Data Institute, San Diego, California, USA
| | - Bryan A Liang
- Global Health Policy and Data Institute, San Diego, California, USA
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, California, USA
- S-3 Research, San Diego, California, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, California, USA
- San Diego Supercomputer Center, University of California, San Diego, La Jolla, California, USA
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Anis S, Zalomek C, Korczyn AD, Lassman S, Rosenberg A, Gurevich T. Licensed Medical Cannabis Use in Gilles de la Tourette Syndrome: A Retrospective Long-term Follow-Up. Cannabis Cannabinoid Res 2023. [PMID: 37172308 DOI: 10.1089/can.2022.0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
Background: Medical cannabis (MC) is widely used in clinical practice to treat Gilles de la Tourette syndrome (GTS). However, legislation, multiple modes of administration, and inconsistent plant preparations have limited trials to assess its benefits and long-term safety. For the past decade, licensed MC has been authorized in Israel for use in resistant GTS. We aimed to describe subjects' satisfaction, consumption habits, and THC dose increment during long-term usage. Materials and Methods: A retrospective longitudinal data collection (up to 9 years) on cannabis use habits and structured questionnaires evaluating disease characteristics and MC influence from GTS subjects being treated in the Movement Disorders Unit of the Tel-Aviv Medical Center, Israel. Results: Twenty-five patients (84% male) participated in the study. The mean duration of MC use was 4.0±2.3 years (range 0.5-10). The majority of patients (96%) consumed MC primarily, but not exclusively, through inhalation methods such as smoking or vaporizing dried inflorescence. A linear increase was observed in mean monthly THC dose (p<0.0001) with an average increase of 0.6-0.7 g/year. MC led to a subjectively reported reduction in tics (75% average reduction) and symptoms associated with common comorbidities of GTS. MC was generally well tolerated, although most participants (88%) reported experiencing side effects. Conclusions: A subset of GTS subjects who use MC long term under clinical observation may subjectively improve control of symptoms. Subject-led dose increase can indicate emerging tolerance. Large randomized controlled and observational long-term trials are required to confirm these observations.
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Affiliation(s)
- Saar Anis
- Movement Disorder Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Departments of Neurology, Physiology and Pharmacology, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Corinne Zalomek
- Departments of Neurology, Physiology and Pharmacology, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amos D Korczyn
- Departments of Neurology, Physiology and Pharmacology, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Simon Lassman
- St George's Hospital, University of London, London, United Kingdom
- Arrow Project for Medical Research, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Alina Rosenberg
- School of Public Health, Epidemiology, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tanya Gurevich
- Movement Disorder Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Departments of Neurology, Physiology and Pharmacology, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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Beers J, Authement AK, Isoherranen N, Jackson KD. Cytosolic Enzymes Generate Cannabinoid Metabolites 7-Carboxycannabidiol and 11-Nor-9-carboxy tetrahydrocannabinol. ACS Med Chem Lett 2023; 14:614-620. [PMID: 37197460 PMCID: PMC10184666 DOI: 10.1021/acsmedchemlett.3c00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023] Open
Abstract
The cannabinoids cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) undergo extensive oxidative metabolism in the liver. Although cytochromes P450 form the primary, pharmacologically active, hydroxylated metabolites of CBD and THC, less is known about the enzymes that generate the major in vivo circulating metabolites of CBD and THC, 7-carboxy-CBD and 11-carboxy-THC, respectively. The purpose of this study was to elucidate the enzymes involved in forming these metabolites. Cofactor dependence experiments with human liver subcellular fractions revealed that 7-carboxy-CBD and 11-carboxy-THC formation is largely dependent on cytosolic NAD+-dependent enzymes, with lesser contributions from NADPH-dependent microsomal enzymes. Experiments with chemical inhibitors provided evidence that 7-carboxy-CBD formation is mainly dependent on aldehyde dehydrogenases and 11-carboxy-THC formation is mediated also in part by aldehyde oxidase. This study is the first to demonstrate the involvement of cytosolic drug-metabolizing enzymes in generating major in vivo metabolites of CBD and THC and addresses a knowledge gap in cannabinoid metabolism.
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Affiliation(s)
- Jessica
L. Beers
- Division
of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina 27599, United States
| | - Aurora K. Authement
- Department
of Pharmaceutics, University of Washington
School of Pharmacy, Seattle, Washington 98195, United States
| | - Nina Isoherranen
- Department
of Pharmaceutics, University of Washington
School of Pharmacy, Seattle, Washington 98195, United States
| | - Klarissa D. Jackson
- Division
of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina 27599, United States
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Breivogel CS, Brenseke BM, Eldeeb K, Nichols K, Jonas A, Mistry AH, Barbalato L, Luibil N, Howlett AC, Leone-Kabler S, Hilgers RPH, Pulgar VM. Effects of Δ 9- Tetrahydrocannabinol and the Aminoalkylindole K2/Spice Constituent JWH-073 on Cardiac Tissue and Mesenteric Vascular Reactivity. Cannabis Cannabinoid Res 2023. [PMID: 37010379 DOI: 10.1089/can.2022.0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Background: Although use of Cannabis sativa is not associated with serious adverse effects, recreational use of aminoalkylindole (AAI) cannabinoid receptor agonists found in K2/Spice herbal blends has been reported to cause adverse cardiovascular events, including angina, arrhythmia, changes in blood pressure, ischemic stroke, and myocardial infarction. Δ9-Tetrahydrocannabinol (Δ9-THC) is the primary CB1 agonist found in cannabis and JWH-073 is one of the AAI CB1 agonists found in K2/Spice brands sold to the public. Methods: This study used in vitro, in vivo, and ex vivo approaches to investigate potential differences on cardiac tissue and vascular effects betweenJWH-073 and Δ9-THC. Male C57BL/6 mice were treated with JWH-073 or Δ9-THC and cardiac injury was assessed by histology. Effects of JWH-073 and Δ9-THC on H9C2 cell viability and ex vivo mesenteric vascular reactivity were also determined. Results: JWH-073 or Δ9-THC induced typical cannabinoid effects of antinociception and hypothermia but did not promote death of cardiac myocytes. No differences in cell viability were observed in cultured H9C2 cardiac myocytes after 24 h of treatment. In isolated mesenteric arteries from drug-naive animals, JWH-073 produced significantly greater maximal relaxation (96%±2% vs. 73%±5%, p<0.05) and significantly greater inhibition of phenylephrine-mediated maximal contraction (Control 174%±11%KMAX) compared with Δ9-THC (50%±17% vs. 119%±16%KMAX, p<0.05). Discussion: These findings suggest that neither cannabinoid at the concentrations/dose studied caused cardiac cell death, but JWH-073 has the potential for greater vascular adverse events than Δ9-THC through an increased vasodilatory effect.
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Affiliation(s)
- Chris S Breivogel
- Department of Pharmaceutical and Clinical Sciences, Campbell University, Buies Creek, North Carolina, USA
| | - Bonnie M Brenseke
- School of Osteopathic Medicine, Campbell University, Buies Creek, North Carolina, USA
| | - Khalil Eldeeb
- School of Osteopathic Medicine, Campbell University, Buies Creek, North Carolina, USA
- Al Azhar Damietta Faculty of Medicine, New Damietta, Egypt
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katlyn Nichols
- Department of Pharmaceutical and Clinical Sciences, Campbell University, Buies Creek, North Carolina, USA
| | - Amreen Jonas
- Department of Pharmaceutical and Clinical Sciences, Campbell University, Buies Creek, North Carolina, USA
| | - Artik H Mistry
- Department of Pharmaceutical and Clinical Sciences, Campbell University, Buies Creek, North Carolina, USA
| | - Laura Barbalato
- School of Osteopathic Medicine, Campbell University, Buies Creek, North Carolina, USA
| | - Nicholas Luibil
- School of Osteopathic Medicine, Campbell University, Buies Creek, North Carolina, USA
| | - Allyn C Howlett
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sandra Leone-Kabler
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rob P H Hilgers
- Department of Pharmaceutical and Clinical Sciences, Campbell University, Buies Creek, North Carolina, USA
| | - Victor M Pulgar
- Department of Pharmaceutical and Clinical Sciences, Campbell University, Buies Creek, North Carolina, USA
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Biomedical Research Infrastructure Center, Winston-Salem State University, Winston-Salem, North Carolina, USA
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49
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Yucel MA, Ozcelik I, Algul O. Machine learning study: from the toxicity studies to tetrahydrocannabinol effects on Parkinson's disease. Future Med Chem 2023; 15:365-377. [PMID: 36942739 DOI: 10.4155/fmc-2022-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Aim: Investigating molecules having toxicity and chemical similarity to find hit molecules. Methods: The machine learning (ML) model was developed to predict the arylhydrocarbon receptor (AHR) activity of anti-Parkinson's and US FDA-approved drugs. The ML algorithm was a support vector machine, and the dataset was Tox21. Results: The ML model predicted apomorphine in anti-Parkinson's drugs and 73 molecules in FDA-approved drugs as active. The authors were curious if there is any molecule like apomorphine in these 73 molecules. A fingerprint similarity analysis of these molecules was conducted and found tetrahydrocannabinol (THC). Molecular docking studies of THC for dopamine receptor 1 (affinity = -8.2 kcal/mol) were performed. Conclusion: THC may affect dopamine receptors directly and could be useful for Parkinson's disease.
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Affiliation(s)
- Mehmet Ali Yucel
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Erzincan Binali Yildirim University, Erzincan, 24100, Turkey
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Mersin University, Mersin, 33169, Turkey
| | - Ibrahim Ozcelik
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Erzincan Binali Yildirim University, Erzincan, 24100, Turkey
| | - Oztekin Algul
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Erzincan Binali Yildirim University, Erzincan, 24100, Turkey
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Mersin University, Mersin, 33169, Turkey
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Dumbraveanu C, Strommer K, Wonnemann M, Choconta JL, Neumann A, Kress M, Kalpachidou T, Kummer KK. Pharmacokinetics of Orally Applied Cannabinoids and Medical Marijuana Extracts in Mouse Nervous Tissue and Plasma: Relevance for Pain Treatment. Pharmaceutics 2023; 15:853. [PMID: 36986714 PMCID: PMC10057980 DOI: 10.3390/pharmaceutics15030853] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Cannabis sativa plants contain a multitude of bioactive substances, which show broad variability between different plant strains. Of the more than a hundred naturally occurring phytocannabinoids, Δ9-Tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) have been the most extensively studied, but whether and how the lesser investigated compounds in plant extracts affect bioavailability or biological effects of Δ9-THC or CBD is not known. We therefore performed a first pilot study to assess THC concentrations in plasma, spinal cord and brain after oral administration of THC compared to medical marijuana extracts rich in THC or depleted of THC. Δ9-THC levels were higher in mice receiving the THC-rich extract. Surprisingly, only orally applied CBD but not THC alleviated mechanical hypersensitivity in the mouse spared nerve injury model, favoring CBD as an analgesic compound for which fewer unwanted psychoactive effects are to be expected.
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Affiliation(s)
- Cristiana Dumbraveanu
- Institute of Physiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Bionorica Research GmbH, 6020 Innsbruck, Austria
| | | | | | - Jeiny Luna Choconta
- Institute of Physiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | | | - Michaela Kress
- Institute of Physiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Theodora Kalpachidou
- Institute of Physiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Kai K. Kummer
- Institute of Physiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
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