Marijuana, feijoada and the debate on drug legalization

The effects of chronic marijuana (MJ) use on brain function remain controversial. Because MJ is often used by human immunodeficiency virus (HIV) patients, the aim of this study was to evaluate whether chronic MJ use and HIV infection are associated with interactive or additive effects on brain chemistry and cognitive function. We evaluated 96 subjects (30 seronegative nondrug users, 24 MJ users, 21 HIV without MJ use, 21 HIV + MJ) using proton magnetic resonance spectroscopy and a battery of neuropsychological tests. The two primarily abstinent MJ user groups showed no significant differences on calculated estimates of lifetime grams of delta9-tetrahydrocannabinol exposure, despite some differences in usage pattern. The two HIV groups also had similar HIV disease severity (CD4 cell count, plasma viral load, HIV dementia staging, Karnofsky score). On two-way analyses of covariance, HIV infection (independent of MJ) was associated with trends for reduced N-acetyl aspartate (NA) in the parietal white matter and increased choline compounds (CHO) in the basal ganglia. In contrast, MJ (independent of HIV) was associated with decreased basal ganglia NA (-5.5%, p = 0.05), CHO (-10.6%, p = 0.04), and glutamate (-9.5%, p = 0.05), with increased thalamic creatine (+6.1%, p = 0.05). HIV + MJ was associated with normalization of the reduced glutamate in frontal white matter (interaction p = 0.01). After correction for age, education, or mood differences, MJ users had no significant abnormalities on neuropsychological test performance, and HIV subjects only had slower reaction times. These findings suggest chronic MJ use may lead to decreased neuronal and glial metabolites, but may normalize the decreased glutamate in HIV patients.

Questions surrounding the effects of chronic marijuana use on brain structure continue to increase. To date, however, findings remain inconclusive. In this comprehensive study that aimed to characterize brain alterations associated with chronic marijuana use, we measured gray matter (GM) volume via structural MRI across the whole brain by using voxel-based morphology, synchrony among abnormal GM regions during resting state via functional connectivity MRI, and white matter integrity (i.e., structural connectivity) between the abnormal GM regions via diffusion tensor imaging in 48 marijuana users and 62 age- and sex-matched nonusing controls. The results showed that compared with controls, marijuana users had significantly less bilateral orbitofrontal gyri volume, higher functional connectivity in the orbitofrontal cortex (OFC) network, and higher structural connectivity in tracts that innervate the OFC (forceps minor) as measured by fractional anisotropy (FA). Increased OFC functional connectivity in marijuana users was associated with earlier age of onset. Lastly, a quadratic trend was observed suggesting that the FA of the forceps minor tract initially increased following regular marijuana use but decreased with protracted regular use. This pattern may indicate differential effects of initial and chronic marijuana use that may reflect complex neuroadaptive processes in response to marijuana use. Despite the observed age of onset effects, longitudinal studies are needed to determine causality of these effects.

Marijuana is the most widely used illicit substance in the United States, and its use is especially prevalent among young adults. Over the past two decades, there has been an overall decline in perceived harmfulness of marijuana use in young adults ages 18-30, despite growing evidence that chronic marijuana use may be associated with cognitive impairment. There have been mixed results regarding the effects of chronic marijuana use on inhibitory control. Furthermore, previous literature has shown inconsistent results regarding processing speed in marijuana users. The current study examined inhibitory control and processing speed in chronic marijuana-using young adult college students and healthy controls ages 18-22. 33 healthy controls (mean age: 19.18 ± 1.13; 18 male) and 28 chronic marijuana users (mean age: 20.25 ± 1.17; 19 male) were included in the study. Chronic marijuana users had to have used marijuana ≥5 times/week over the past year to be eligible. Participants were instructed to remain abstinent from marijuana use for 12 hours prior to the study visit. The 30-day Timeline Followback (TLFB) was used to assess recent marijuana use and participants were asked to estimate age at first marijuana use and lifetime days of marijuana use. Participants completed the Stroop Color Word Task (SCWT), and the interference t-score was used as a measure of inhibitory control. Furthermore, we examined marijuana use characteristics (i.e. age at first use, lifetime marijuana use, and past 30-day marijuana use) in relation to performance on the SCWT. Additionally, exploratory analyses investigated differences in the color and word conditions of the SCWT between the two groups and as a function of marijuana use characteristics. Results indicated no significant group differences on the interference, word, and color conditions of the SCWT. Furthermore, there were no significant correlations between age at first use, lifetime marijuana use, and past 30-day marijuana use with any conditions of the SCWT, but, there was a trend for greater past 30-day marijuana use to be associated with poorer performance on the color condition (r(26) = -0.26, p = 0.09). These findings indicate that chronic, heavy marijuana use may not be associated with impairments in inhibitory control or processing speed, which is consistent with other studies examining current use, heavy use, and chronic use in adolescents, young adults, and adults. Further research is needed to determine whether chronic, heavy marijuana use during young adulthood affects higher-order cognitive functioning skills needed for success in college, starting a career, and transitioning into adulthood.

From Pot to Prescription: The Long, Strange Trip of Medical Marijuana

Animal literature suggests a connection between marijuana use and altered circadian rhythms. However, the effect has not yet been demonstrated in humans. The present study examined the effect of chronic marijuana use on human circadian function. Participants consisted of current users who reported smoking marijuana daily for at least a year and non-marijuana user controls. Participants took a neurocognitive assessment, wore actigraphs and maintained sleep diaries for three weeks. While no significant cognitive changes were found between groups, data revealed that chronic marijuana use may act as an additional zeitgeber and lead to increased entrainment in human users.

Effects of chronic marijuana use on testosterone, luteinizing hormone, follicle stimulating hormone, prolactin and cortisol in men and women

Patient: Female, 26-year-oldFinal Diagnosis: IntussusceptionSymptoms: Abdominal pain • nauseaMedication: —Clinical Procedure: CT scan • surgerySpecialty: Gastroenterology and Hepatology • General and Internal Medicine • SurgeryObjective:Unusual clinical courseBackground:Intussusception is a common phenomenon in children, but it is rare in adults. In the pediatric population, the presentation is commonly primary, without a lead point. However, up to 90% of intussusception cases arise due to a secondary cause – a pathological lead point – which the most common etiology in adults being malignancy. Herein, we present a case report of adult intussusception without a known cause.Case Report:A 26-year-old woman presented to the hospital with severe abdominal pain. She admitted to not passing stool or gas for 2 days. The patient’s social history was significant for chronic marijuana use. A computed tomography (CT) scan of the abdomen revealed a 6-cm in length intussuscepted segment of bowel in the descending colon distal to the splenic flexure with no obvious inciting mass. The patient was sent for emergent open abdominal surgery. Upon surgical exploration, the surgeons discovered that the intussusception had self-resolved. Aside from a small ball of stool, an intraoperative colonoscopy revealed no masses or polyps.Conclusions:Marijuana use is known to disrupt gastrointestinal (GI) mobility through receptors in the GI tract nerve plexuses. The incidence of chronic marijuana use and adult intussusception is documented in the literature. Conservative management with bowel rest is confirmed to be a suitable treatment option with a favorable outcome. Therefore, we present this case to increase awareness of the potential adverse effects of chronic marijuana use, and to prevent invasive treatment.

1.36 Impact of Marijuana Legislation on Marijuana- and Cannabidiol-Related Attitudes, Perceptions, and Behaviors Among Adolescents Receiving Mood Disorder Treatment in the United States and Their Parents

Impairments of human cognition and learning following chronic marijuana use are of serious concern, but have not been clearly demonstrated. To determine whether such impairments occurred, this study compared performance of adult marijuana users and non-users (N = 144 and N = 72, respectively) matched on intellectual functioning before the onset of drug use, i.e., on scores from standardized tests administered during the fourth grade of grammar school (Iowa Tests of Basic Skills). Subjects were given the twelfth grade versions of these tests (Iowa Tests of Educational Development) and other, computerized cognitive tests in successive test sessions. "Heavy" marijuana use (defined by use seven or more times weekly) was associated with deficits in mathematical skills and verbal expression in the Iowa Tests of Educational Development and selective impairments in memory retrieval processes in Buschke's Test. The retrieval impairments were restricted to words that were easy to visualize. Impairments depended on the frequency of chronic marijuana use, i.e., "light" and "intermediate" marijuana use (defined by use one to four and five to six times weekly, respectively) were not associated with deficits. Intermediate use was associated with superior performance in one condition ("fuzzy" concepts) of a Concept Formation test.

Introduction: The American College of Obstetrics and Gynecology advises against cannabis and cannabidiol (CBD) product use during pregnancy; despite this, recent studies suggest cannabis and CBD use is increasing during pregnancy. The objective of this study is to assess risk perceptions of cannabis and CBD use during pregnancy among pregnant and non-pregnant patients. Methods: The study design is multi-method; a cross-sectional survey assessing use behaviors and risk perceptions is supplemented with qualitative focus group discussions (FGDs). Recruitment for surveys was from outpatient obstetrics clinics and recruitment for FGDs was from the same clinics and a substance-use treatment clinic, from October 2022 to February 2023. The survey instrument was developed via combining question items from validated instruments that assess cannabis and CBD use and risk perceptions. Comparisons of response frequency distributions for pregnant versus non-pregnant participants were calculated with chi-square analysis for individual risk perception question items. Data from the FGDs were coded and analyzed via a deductive content analysis approach. Results: There were 261 survey respondents and 5 FGDs (n = 17). Of the surveys, 198 (75.9%) were currently pregnant, 55 (21.1%) were not pregnant, and 8 (3.1%) did not disclose pregnancy status. Approximately 5.0% (n = 13) reported currently breastfeeding. For the question, “How risky is it to use marijuana [cannabis] once or twice a week during pregnancy?”, pregnant versus non-pregnant participants responded most frequently with “great risk” (29.2% vs. 27.3%) and “not sure” (40.0% vs. 34.5%), where p = 0.88 (not significant) between pregnant vs. non-pregnant response distribution. For the question, “How risky is it to use CBD once or twice a week during pregnancy?” pregnant vs. non-pregnant participants responded most frequently with: “great risk” (22.1% vs. 20.0%), and “not sure” (52.3% vs. 41.8%), where p = 0.12 (not significant). Ever use of cannabis and CBD differed in pregnant versus non-pregnant patients (cannabis 36.0% pregnant vs. 65.5% non-pregnant; CBD 19.9% pregnant vs. 38.2% non-pregnant). Qualitative findings indicated that participants perceived that legalization of marijuana has resulted in reduction of stigma against users, but participants expressed mixed feelings toward the perception of marijuana safety due to legalization, though several participants described perceived benefits of marijuana use more generally. Conclusion: Findings indicate uncertainty of risk related to cannabis and CBD use during pregnancy regardless of current pregnancy or lactation status, despite prevalent ever use of cannabis and CBD in those who were pregnant. This suggests an urgent need for clearer risk communication about cannabis and CBD use in pregnancy.

Patterns of cannabidiol use among marijuana users in the United States.

Reports an error in "Chronic adolescent marijuana use as a risk factor for physical and mental health problems in young adult men" by Jordan Bechtold, Theresa Simpson, Helene R. White and Dustin Pardini (Psychology of Addictive Behaviors, 2015[Sep], Vol 29[3], 552-563). For the article, planned analyses using a Wald joint significance test examined whether four adolescent marijuana use trajectory groups differed on self-reported physical and mental health outcomes assessed at age 36. This omnibus test indicated that the groups did not significantly differ in terms of their probability of reporting targeted health problems. The results from this study generated considerable controversy, including requests for supplemental analyses. More details are included. (The following abstract of the original article appeared in record 2015-34684-001.) Some evidence suggests that youth who use marijuana heavily during adolescence may be particularly prone to health problems in later adulthood (e.g., respiratory illnesses, psychotic symptoms). However, relatively few longitudinal studies have prospectively examined the long-term physical and mental health consequences associated with chronic adolescent marijuana use. The present study used data from a longitudinal sample of Black and White young men to determine whether different developmental patterns of marijuana use, assessed annually from early adolescence to the mid-20s, were associated with adverse physical (e.g., asthma, high blood pressure) and mental (e.g., psychosis, anxiety disorders) health outcomes in the mid-30s. Analyses also examined whether chronic marijuana use was more strongly associated with later health problems in Black men relative to White men. Findings from latent class growth curve analysis identified 4 distinct subgroups of marijuana users: early onset chronic users, late increasing users, adolescence-limited users, and low/nonusers. Results indicated that the 4 marijuana use trajectory groups were not significantly different in terms of their physical and mental health problems assessed in the mid-30s. The associations between marijuana group membership and later health problems did not vary significantly by race. Findings are discussed in the context of a larger body of work investigating the potential long-term health consequences of early onset chronic marijuana use, as well as the complications inherent in studying the possible link between marijuana use and health effects.

Introduction: Dramatic shifts in marijuana laws, along with federal deregulation of hemp with the 2018 Farm Bill, have resulted in increased availability and use of cannabidiol (CBD) supplements throughout the United States (US). Given the rapid increase in CBD use in the U.S. general population, in this study, we aim to characterize primary care physician (PCP) attitudes and practice behaviors and to assess whether differences in provider attitudes and behaviors vary as a function of marijuana legalization (ML) status in the state of practice. Materials and Methods: Data are from an online provider survey on CBD supplement-related attitudes, beliefs, and behaviors administered to 508 PCPs as part of a larger mixed methods study. Participating PCPs were recruited from the Mayo Clinic Healthcare Network and provided medical care in primary care settings across four U.S. states (Minnesota, Wisconsin, Florida, and Arizona). Results: The survey response rate was 45.4% (n=236/508). According to providers, CBD was frequently brought up in PCP settings, typically by patients. PCPs were generally hesitant to screen for or discuss CBD with their patients and identified multiple barriers to open patient-provider dialogue about CBD. PCPs practicing in states that had passed ML were more receptive to patients using CBD supplements, whereas PCPs practicing in states that had not passed ML were more concerned about CBD-related side effects. Regardless of state ML status, most PCPs did not feel that they should be recommending CBD supplements to their patients. Most PCPs reported believing that CBD was unhelpful for most conditions for which it is marketed, with chronic non-cancer pain and anxiety/stress being exceptions. PCP respondents generally felt that they had insufficient knowledge/training around CBD. Conclusions: Results from this mixed methods study show that PCPs practicing in the U.S. rarely screen for or discuss CBD use with their patients and report several barriers to engage in proactive CBD-focused practice behaviors. Furthermore, survey results show that some PCP attitudes, practice behaviors, and barriers vary as a function of state ML status. These findings may guide medical education efforts and inform primary care practice modifications aimed at enhancing screening and monitoring of patient CBD use by PCPs.

Some evidence suggests that youth who use marijuana heavily during adolescence may be particularly prone to health problems in later adulthood (e.g., respiratory illnesses, psychotic symptoms). However, relatively few longitudinal studies have prospectively examined the long-term physical and mental health consequences associated with chronic adolescent marijuana use. The present study used data from a longitudinal sample of Black and White young men to determine whether different developmental patterns of marijuana use, assessed annually from early adolescence to the mid-20s, were associated with adverse physical (e.g., asthma, high blood pressure) and mental (e.g., psychosis, anxiety disorders) health outcomes in the mid-30s. Analyses also examined whether chronic marijuana use was more strongly associated with later health problems in Black men relative to White men. Findings from latent class growth curve analysis identified 4 distinct subgroups of marijuana users: early onset chronic users, late increasing users, adolescence-limited users, and low/nonusers. Results indicated that the 4 marijuana use trajectory groups were not significantly different in terms of their physical and mental health problems assessed in the mid-30s. The associations between marijuana group membership and later health problems did not vary significantly by race. Findings are discussed in the context of a larger body of work investigating the potential long-term health consequences of early onset chronic marijuana use, as well as the complications inherent in studying the possible link between marijuana use and health effects.

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