Evidence for Cannabidiol as a Medication for the Treatment of Neurological, Psychiatric, Behavioral and Substance Use Disorders in Adolescents

Taking Note of Over-the-Counter Remedies for Adolescents With Cannabis Dependence

Substance use disorders in children and adolescents are a significant cause of concern as they can have long term implications in practically every sphere. The etiological factors that contribute to substance use disorders are complex and the formulation must amalgamate and synthesize all the different factors including the predisposing, perpetuating, precipitating and protective factors in order to plan management. Interventions must stem from this comprehensive formulation and must be child-focused, multidisciplinary, multisystemic, with strong family participation and community involvement. The treating team must actively collaborate with the young person and help him/her understand the rationale for treatment in order for them to engage in it. Assessment and treatment of comorbidities are an important part of intervention package. Skill training for problem solving, emotional regulation, social skills, and communication are an essential part of the treatment for substance use disorders in adolescents. Relapse prevention strategies, including how to seek help when there is a lapse must be part and parcel of the interventions delivered to the young person. Substance use disorder interventions must be part of a larger plan that addresses other areas of concern in the young person's life. While there are few studies, and so a relatively weak and preliminary evidence base for pharmacotherapeutic interventions, early evidence shows that their combination with psychosocial interventions may have a synergistic effect on substance use reduction. Substance use disorders affect the entire family and the community at large and thus must be treated holistically, but by individualising the treatment to suit the needs of that particular child and family.

A prospective study of familial conflict, psychological stress, and the development of substance use disorders in adolescence

To examine the relationship between a childhood diagnosis of attention deficit hyperactivity disorder (ADHD) with or without oppositional defiant disorder (ODD)/conduct disorder (CD) and the development of later alcohol/drug use disorder [psychoactive substance use disorder (PSUD)] and nicotine dependence in a large European sample of ADHD probands, their siblings and healthy control subjects. Subjects (n = 1017) were participants in the Belgian, Dutch and German part of the International Multicenter ADHD Genetics (IMAGE) study. IMAGE families were identified through ADHD probands aged 5-17 years attending out-patient clinics, and control subjects from the same geographic areas. After a follow-up period (mean: 4.4 years) this subsample was re-assessed at a mean age of 16.4 years. PSUD and nicotine dependence were assessed using the Diagnostic Interview Schedule for Children, Alcohol Use Disorders Identification Test, Drug Abuse Screening Test and Fagerström test for Nicotine Dependence. The ADHD sample was at higher risk of developing PSUD [hazard ratio (HR) = 1.77, 95% confidence interval (CI) = 1.05-3.00] and nicotine dependence (HR = 8.61, 95% CI = 2.44-30.34) than healthy controls. The rates of these disorders were highest for ADHD youth who also had CD, but could not be accounted for by this comorbidity. We did not find an increased risk of developing PSUD (HR = 1.18, 95% CI = 0.62-2.27) or nicotine dependence (HR = 1.89, 95% CI = 0.46-7.77) among unaffected siblings of ADHD youth. A childhood diagnosis of attention deficit hyperactivity disorder is a risk factor for psychoactive substance use disorder and nicotine dependence in adolescence and comorbid conduct disorder, but not oppositional defiant disorder, further increases the risk of developing psychoactive substance use disorder and nicotine dependence.

This review aims to examine prescribed short-term opioid use in adolescents to treat acute pain. The review will analyze the influence of opioid use on future non-medical opioid use (misuse) or substance use disorders (addiction) in adolescents and young adults. Prescription opioids are medically indicated for acute pain. Descriptive studies of administrative datasets and surveys implicate adolescent opioid exposure as a risk factor for subsequent opioid misuse and addiction. This review will provide a synthesis of the literature on the association between prescribed opioid exposure to treat acute pain in adolescents and the subsequent development of opioid misuse or substance use disorders in adolescents and young adults. This review will consider quantitative studies on opioid misuse or substance use disorders in Canadian and US adolescents and young adults (12 to 25 years of age). Studies must include exposure during adolescence (12 to 17 years of age) to legitimately prescribed short-term opioid use to treat acute pain. Studies on chronic pain or exposure to opioids for longer duration (more than 30 doses or more than 7 days) will be excluded. This review will follow the JBI methodology for systematic reviews of etiology and risk. Published and unpublished studies will be sourced from multiple databases and resources. Two independent reviewers will screen, appraise, and extract data from studies that meet the inclusion criteria. Data synthesis will be conducted and a Summary of Findings will be presented. PROSPERO CRD42020179635.

Clearing the haze around medicinal cannabis

Background Preclinical and clinical studies suggest a promising potential of cannabidiol (CBD) for the treatment of substance use disorders (SUD). We therefore aimed to assess the prevalence, patterns, and self-perceived benefits of non-prescription CBD use among SUD patients. Methods A sample of 469 SUD patients treated as inpatients was included to this study. Information on CBD use was assessed by a standardized questionnaire. The sociodemographic and clinical data were extracted from the electronic medical database. Results About one-third of the SUD patients reported that they had used CBD at least once, but only about 9% of them were using CBD on a regular basis for more than a year. More than 40% of those patients using CBD for more than a year reported that CBD helped them to relax and to sleep better, and more than 30% of them reported that it helped them to reduce pain and to feel less anxious. Conclusions Regular use of CBD does not seem to be a common phenomenon among SUD patients, presumably due to its lack of psychotropic effects. However, the results provide a weak indication of self-perceived beneficial effects of long-term CBD use regarding agitation, sleep disorders, anxiety, and pain.

Introduction: Cannabidiol (CBD) is one of the two primary phytocannabinoids found in cannabis. Its diverse pharmacological properties suggest potential benefits for a wide range of medical conditions. The primary objective of this study was to estimate the prevalence of CBD use among patients being treated for substance use disorder. Additionally, we aimed to characterize the pattern of CBD use and describe the profiles of users. Methods: Patients admitted to two substance use disorder departments between May 6, 2020, and July 23, 2021, were included in the study. Sociodemographic, medical and substance use data, including CBD use, were collected. A multiple correspondence analysis (MCA) was performed to identify substance uses most frequently correlated with CBD use. Multivariate analyses were also conducted to identify factors associated with CBD use. Results: The prevalence of CBD use in the past 12 months among the 183 patients was 38.2%. However, at the time of the study, 63% had stopped using CBD, primarily due to its perceived ineffectiveness and cost. CBD was commonly consumed via inhalation, either by smoking the plant or using e-cigarette liquids. The MCA revealed that while there is no typical profile of CBD users, they were more likely to use sedative substances rather than stimulants. CBD users were younger and more likely to have psychiatric comorbidities. Conclusion: The prevalence of CBD use was notably high. Given the significant risk of drug interactions with CBD and its wide variability in composition, it is crucial for clinicians to routinely inquire about CBD use. The potential for self-therapeutic or recreational use in these patients appears to be underestimated.

Cannabidiol (CBD) is a natural phytochemical agent and one of the most abundant found in Cannabis sativa. It is known to exhibit pharmacological properties on various condition such as relieving-inflammation, pain, epilepsy, and anxiety effect. There has been an increasing trend globally in the use of CBD as a supplement in pets. Consequently, there are various CBD products being marketed that are specifically available for pets. Veterinarians and pet owners are concerned that following ingestion, different CBD formulations may result in a CBD level circulating in the blood that may affect the safe use and efficacy of CBD in pets. Several pharmacokinetics studies in animals have been mainly conducted with an oily form of CBD. To date, there is a lack of data regarding direct comparisons in animals among the CBD plasma kinetic profiles from an oral administration of the various preparation forms. Therefore, the current study evaluated and compared the plasma CBD levels from a single oral administration using four different CBD preparations-liquid (an oil-based form, a nanoemulsion form, or a water-soluble form) or a semi-solid form (as CBD mixed in a treat) in dogs. In total, 32 healthy, crossbreed dogs were randomly assigned into 4 groups and treated according to a 1-period, 4-treatment parallel-design. The three liquid forms were dosed at 5 mg/kg body weight, while the single semi-solid form was given at 50 mg/treat/dog. The results showed that the CBD plasma profile from the administration of a water-soluble form was comparable to that of the oil-based group. The nanoemulsion-based form tended to be rapidly absorbed and reached its peak sooner than the others. However, the CBD in all preparations reached the maximum plasma concentration within 3 h post-dose, with an average range of 92-314 μg/L. There were significant differences among certain parameters between the liquid and semi-solid forms. This was the first study to provide pharmacokinetics data regarding CBD in water soluble, nanoemulsion-based, and semi-solid forms for dogs as companion animals. The current data should facilitate the scrutiny of CBD plasma profiles based on different formulations via an oral route in dogs.

Objectives To examine older adults’ cannabidiol (CBD) use and its associations with cannabis use and physical/mental health and other substance use problems. Methods Using the 2022 National Survey on Drug Use and Health (N = 10,516 respondents age 50+), we fitted generalized linear models (GLM) with Poisson and log link using CBD as the dependent variable in the 50–64 and the 65+ age groups. Results In the 50–64 age group, 18.3% and 18.0% reported past-year CBD and cannabis, respectively, use. In the 65+ age group, the percentages were 14.3% and 8.0%. GLM results showed significant positive associations with both medical and non-medical cannabis use in both age groups. CBD use was positively associated with physical/mental health and illicit drug use problems in the 50–64 age group and with disordered psychotherapeutic drug use in the 65+ age group. Minoritized older adults had a lower likelihood of CBD use. Conclusions CBD use is common, more so than cannabis especially in the 65+ age group and positively correlated with both medical and nonmedical cannabis use. Clinical Implications Research is needed to examine therapeutic benefits and negative effects of CBD use in late life. Public health education is needed for growing numbers of older-adult CBD users.

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Substance Use Disorders

Objective This study examines Cannabidiol (CBD) use among college students, including prevalence, frequency, intention, method of consumption, and relationship to general and social anxiety. Methods Data for this cross-sectional study was collected from 4,183 undergraduate students through an online survey at one large university in the south-eastern United States. The survey measured CBD use, general anxiety, and social anxiety. Regression models were used to test the impact of anxiety on CBD use. Results Almost half (48.51%) of students reported using CBD at least once, with 29.41% using it once a month or more. The most common uses were to reduce anxiety and to improve sleep. Additional reasons for use included forming social connections, and because it is new and exciting. General anxiety and social anxiety were both predictive of higher CBD use. Conclusions To our knowledge, this is the largest study examining CBD use among college students. These results contribute to this nascent area of substance use research and have implications for various settings and providers.

In this study, it was aimed to examine the effects of problem solving therapy, which is a cognitive behavioral method, on adolescents diagnosed with alcohol and substance use disorder. A semi-structured interview and intelligence test were administered to adolescents with diagnosis of substance use disorder to identify comorbidities. 46 adolescents who met the inclusion criteria were divided into two groups. Problem solving therapy was applied to the first group for 5 weeks, once a week, while the other group continued their routine controls in the center. Beck Depression Inventory, Screen for Child Anxiety Disorders, Revised Social Problem Solving Inventory, Addiction Profile Index and Treatment Motivation Questionnaire were administered to the groups at the beginning of the study and at the end of the 5th week and the results were analyzed. Sociodemographic and substance use characteristics, comorbid psychopathologies and scale mean scores of the groups in the first evaluation were found to be similar to each other. Although the depression and anxiety scores decreased significantly in both groups, no significant difference was found between the groups. Problemsolving skills and treatment motivation increased in the therapy group and decreased in the control group. The difference between groups was found to be significant (p=0.045, 0.037 for problem solving and treatment motivation respectively). While the severity of addiction decreased in therapy group, it increased in control group, but the difference was not significant. This study is important in that it shows that psychosocial interventions strengthen the treatment of substance use disorder in adolescents. In our country, no other study was evaluating the effects of the intervention methods in addicted adolescents was found. Future studies with larger sample sizes and where the long-term results of substance use disorder are evaluated are needed.

Detection and Outcomes of Substance Use Disorders in Adolescents Seeking Mental Health Treatment

Introduction: Cannabidiol (CBD) is a cannabinoid compound found in cannabis that has been gaining attention over the past few years in the medical community. Unlike tetrahydrocannabinol, also found in cannabis, it does not have psychoactive effects. It is easily obtainable, mixed in an oil or gummy form, and available in different strengths and flavors. CBD is used for pain, anxiety, depression and insomnia. While marijuana use has been widely studied in patients with Inflammatory Bowel Disease (IBD), there are few studies on the use and effects of CBD in this population. The purpose of this survey based study is to determine the number of IBD patients using CBD products, why they use them and if they perceive any benefits. Methods: 229 patients over the age of 18 with a diagnosis of IBD, from two gastroenterology outpatient clinics in Suffolk county, NY were invited to participate in an anonymous survey from June 1st to June 16th, 2022. The survey consisted of 13 questions pertaining to demographics, IBD related history, cancer history and CBD use. The surveys were completed in the office or by telephone. Data was entered into an anonymous database for interpretation. Results: Of the 229 patients, 10.5% used CBD products (n=24). Of the CBD users, more than half (66.7%, n=11) were female, 14 had Crohn’s disease while the rest had Ulcerative colitis, 37.5% (n=9) were on biologic therapy, and 9 (37.5%) had an IBD related surgery. Anxiety (62.5%, n=15), insomnia (54.2%, n=13) and pain (41.7%, n=10) were the most commonly reported reasons for use of CBD. Increase in appetite (25%, n=6) and nausea and vomiting (20.8%, n=5) were also reasons for use but were not reported as frequently. The majority of patients (87.5 %, n=21) felt that CBD helped their symptoms. Conclusion: IBD patients frequently suffer from pain, anxiety, insomnia and depression. There has been a rise in the use of CBD products in patients with various medical conditions. In our small study, we found that only 10.5% of IBD patients use CBD products, mainly for anxiety, insomnia and pain, compared with arthritis where reported use is 50% or more. Patients with IBD who have a complicated disease process often seek alternative therapies and are therefore at risk for substance use. Until there are large clinical trials to assess the role and safety profile of CBD in IBD patients, clinicians should be aware of its use in this population.Figure 1. : Cannabidiol (CBD) use in Inflammatory Bowel Disease Patients