Cannabis Products Research Articles

The Pharmacology of Cannabinoids in Chronic Pain

Objective: Our objective is to provide an overview of the currently available scientific and clinical data supporting the use Cannabis and Cannabis-derived products for the treatment of chronic pain disorders. We also provide information for researchers, clinicians and patients to be better informed and understand the approach behind the recommendation of Cannabis as a potential adjuvant in the treatment/control of chronic pain. Background: Cannabis and its bioactive compounds have sparked interest in the field of pain treatment in spite of its controversial history and status as a controlled substance in many countries. With the increase in chronic pain, physicians and patients have started to look at alternative ways to treat pain aside from traditional treatments. One alternative is the use of cannabis to reduce/treat chronic pain disorders based on anecdotal accounts and the function of its phytocannabinoids. The two main cannabinoids in cannabis, THC and CBD, act on CB1 and CB2 receptors (in addition to several additional receptors). It is through these pleiotropic receptor interactions that these compounds elicit their biological function including the reduction of chronic pain. In this narrative review, we included the most recent evidence supporting the use of cannabis in the treatment of chronic pain disorders including chronic neuropathic pain, cancer-induced neuropathic pain, chronic musculoskeletal pain, and chronic headaches and migraines. Summary: Evidence suggests that cannabis and cannabinoids have an analgesic effect that arises from a combination of compounds and various receptor systems. These effects may be maximized with the use of a combination of cannabinoids. At the same time, the combination of cannabinoids helps to minimize the undesirable side effects of some cannabinoids such as the psychoactivity of THC. With these findings, further research is necessary to assess the analgesic properties of other cannabinoids like CBC and CBG, and their contributions to the reduction of pain.

The adverse public health effects of non-medical cannabis legalisation in Canada and the USA.

Cannabis consumption is legally prohibited in most countries in the world. Several countries are legalising cannabis for adult consumption. It is important to monitor the public health effects of these policy changes. In this paper, we summarise the evidence to date on the legalisation of adult non-medical cannabis use in Canada and the USA. We describe regulatory models for cannabis legalisation, changes in cannabis products and pricing, effects on the illicit cannabis market, changes in cannabis use, and changes in cannabis-related physical and mental health harms. We discuss the challenges in assessing the effects of cannabis legalisation on public health outcomes and emphasise the importance of continuous and rigorous monitoring of adverse health effects to inform the design of public health policies and regulations.

Multilevel determinants of cannabis prices in legal markets: Evidence from products sold in nearly 4000 cannabis dispensaries in the United States.

Following cannabis legalization, sales in legal markets have steadily increased. Policies influencing product prices are crucial for cannabis regulation and control. This study aimed to evaluate the determinants of cannabis prices at the product, dispensary, and state levels in legal markets in the United States. Nationwide data on product- and dispensary-level characteristics were collected in 2022 and merged with state-level policy data. The final analysis included 710,588 cannabis flower products from 3,693 dispensaries across 30 states and Washington D.C. with recreational and/or medical cannabis legalization. Multilevel mixed-effects regressions were used to estimate the associations between cannabis prices and product-, dispensary-, and state-level characteristics. Pre-rolls and dried flowers were analyzed separately. The average standardized price per gram was $11.72 for pre-rolls and $9.05 for dried flowers, with significant variations across states. A positive association was found between prices and THC level (THC elasticity of price = 0.17, 95 % CI: 0.088, 0.25) and a negative association was found between prices and item weight (weight elasticity of price = -0.18, 95 % CI: -0.22, -0.14). There was limited evidence of associations between prices and dispensary-level characteristics, such as dispensary type (medical vs. recreational), license status, and density of nearby competitors. State tax rates at the retail level were positively associated with prices. These relationships were consistent for both pre-rolls and dried flowers. Policies targeting potency and item weight may have substantial impacts on cannabis prices in legal markets. Future research is needed to examine how consumers respond to these policies.

Using in Vitro Signalling Profiles of Cannabis Products to Infer in Vivo Biological Responses

Using in Vitro Signalling Profiles of Cannabis Products to Infer in Vivo Biological Responses

Leveraging Cannabis-Centric Reddit Communities to Explore Patterns of Cannabis Product, Modes and Frequency of Use Between 2010-2019

Leveraging Cannabis-Centric Reddit Communities to Explore Patterns of Cannabis Product, Modes and Frequency of Use Between 2010-2019

Characterizing Hemp-Derived Alternative Cannabis Products Available Online and at National Retail Stores

Characterizing Hemp-Derived Alternative Cannabis Products Available Online and at National Retail Stores

Intossicazione severa da tetraidrocannabinolo

A 1-year-old girl was hospitalised with coma and seizures caused by acute THC intoxication (45 µg/l) due to hashish resin ingestion. Supportive therapy, including IV hydration and bromazepam, led to complete symptom resolution within 72 hours. This case highlights the diagnostic challenges and dangers of accidental cannabis product ingestion in children.

Feasibility pilot of a novel coaching intervention to optimize cannabis use for chronic pain management among Veterans

IntroductionChronic pain is common among Veterans, some of whom use cannabis for pain. We conducted a feasibility pilot study of a novel coaching intervention to help Veterans optimize use of medical cannabis products for pain management (NCT06320470).MethodsThe intervention drew from scientific literature, consultation with cannabis experts, Veteran input via a Community Advisory Board, and tenets of motivational interviewing. Participants were Veterans with chronic pain who endorsed current use or interest in using cannabis for pain management. Participants received up to 4 individual coaching sessions via videoconference, spaced approximately 2 weeks apart. We assessed feasibility (adherence, satisfaction, acceptability) and preliminary effects on pain symptoms 14 weeks after baseline. The primary outcome was the Patient Global Impression of Change (PGIC), and exploratory outcomes included domains from the Patient-Reported Outcomes Measurement Information System (PROMIS)-29.ResultsOf 22 enrolled participants, 17 attended 4 coaching sessions, 2 attended 3 sessions, and 2 attended 2 sessions. Among those who completed end of intervention surveys (16/21), 87.5% were very or completely satisfied with the intervention and 81.3% rated coaching as very or extremely helpful. All participants reported improvement on the PGIC, with 63% reporting much or very much improvement. Participants reported statistically significant decreased pain intensity (7.1/10 vs. 5.7/10) and pain interference (T-score 66.3 vs. 61.8), and increased social satisfaction (T-score 41.4 vs. 44.3). Participants noted helpful intervention factors, including co-developing a personalized plan, discussing questions/concerns, and trying different approaches to cannabis-based treatment.ConclusionsIn this feasibility pilot study of coaching on cannabis use for chronic pain among Veterans, participants were satisfied with the intervention and reported clinically significant improvements in pain symptoms. Our results support evaluating this intervention in a larger, efficacy trial.

Portrayal of Delta-8 Tetrahydrocannabinol (THC) on YouTube

Background Following the United States (U.S.) Federal Agriculture Improvement Act of 2018, many retailers began selling intoxicating cannabis products, including Delta-8 tetrahydrocannabinol (THC) as “hemp,” claiming that it provided a legal loophole to do so. This qualitative study assessed Delta-8 THC messaging on YouTube, the world’s second-most visited website. Methods In 2022, two researchers searched the terms “Delta 8” and “Delta-8” on YouTube; 47 unique videos were identified. A combination of inductive and deductive coding was used. The larger team discussed the coding after every ten videos and reached a consensus. Results Four overarching themes were identified related to Delta-8 THC: reasons to use, how to use, effects of using, and safety/harm reduction. Content creators used Delta-8 THC for its alleged federal legality, easy accessibility, and the psychoactive effects which they described as a more mild, euphoric high than ‘traditional’ cannabis. Some mentioned that the quality of the Delta-8 THC products may vary based on the purchase location, with online typically being favored over gas stations. Few videos were age-restricted. Conclusions This study provides an overview of public attitudes and beliefs regarding Delta-8 THC, as discussed on YouTube. Findings suggest media campaigns to correct misinformation and other prevention efforts are important.

The roles of cannabis potency and gender in cannabis dependence and anxiety in recent cannabis users with trauma exposure histories.

Over the past 20 years, levels of Δ9-tetrahydrocannabinol (THC) in cannabis have significantly increased, while levels of cannabidiol (CBD) have increased much less in comparison. Cannabis with higher THC potency (commonly assessed via THC:CBD ratio) may increase the risk for cannabis dependence and trigger/exacerbate anxiety. However, few studies of cannabis potency effects on cannabis dependence and anxiety have examined gender moderation. Additionally, there are issues with how cannabis potency is calculated via the THC:CBD ratio that may contribute to inconsistencies in the literature. N = 202 (55.8 % women) recent cannabis users (>1 g in the past month) with trauma histories - a group at high risk for anxiety and cannabis dependence - completed an online survey including a self-report measure of THC and CBD levels in participants' typically-used cannabis product. Cannabis potency was calculated as THC:CBD ratio (THC%/CBD%) and as relative THC proportion (THC%/[THC%+CBD%]). Cannabis dependence and anxiety levels were self-reported on the Cannabis Use Disorder Identification Test-Revised (CUDIT-R) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Consistent with prior findings in the general population, cannabis potency was significantly positively correlated with cannabis dependence, p = .002, and anxiety levels, p = .020, but only when assessed via THC proportion and not THC:CBD ratio. Consistent with prior research, women reported significantly higher anxiety levels but also unexpectedly, higher THC:CBD ratios, than men. No significant gender differences were found in the associations of either potency measure with either outcome variable. Results are consistent with recent reports of gender convergence in cannabis use prevalence. Additionally, these results identify relative THC proportion as a superior predictor of adverse cannabis and anxiety outcomes than the THC:CBD ratio in both men and women.

Using ecological momentary assessment to quantify Δ-9-tetrahydrocannabinol and cannabidiol use across different forms of cannabis: Feasibility in a sample of Canadian young adults reporting frequent cannabis use.

To establish the feasibility of using ecological momentary assessment (EMA) to estimate total quantities of Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) used across different forms of cannabis, and to assess the predictive validity of THC estimates for predicting acute cannabis-related consequences. 14-day EMA using a smartphone application to assess cannabis use in real time. Canada. Targeted sample of n = 42 young adults (59.52% women, mean age 25 years) reporting frequent cannabis use. Surveys completed immediately prior to cannabis use assessed the quantities, THC content and CBD content of various forms of cannabis to be used in the current session; participants also uploaded photos of the cannabis product labels when available. Surveys administered at fixed times throughout the day (84.81% completion rate) assessed acute cannabis-related consequences. Participants completed a total of 786 pre-cannabis surveys, of which 79.39% and 77.35% contained sufficient information to calculate total THC and CBD (in milligrams), respectively. High agreement was observed between participant-entered THC and CBD contents and those shown in corresponding photos of cannabis product labels. Aggregating across all products used, participants reported using an average of 141.41 [standard deviation (SD)=224.62, range = 0.00-2000.00] milligrams of THC (i.e. 28.28 standard five-milligram units) and 7.53 (SD = 34.87, range = 0.00-484.22) milligrams of CBD per day. Multilevel models revealed that participants were more likely to report acute negative consequences following sessions when their estimated THC use was higher than their typical THC use. At the between-person level, participants reporting more THC use on average across sessions were less likely to report negative consequences overall. Using ecological momentary assessment to estimate total quantities of Δ-9-tetrahydrocannabinol and cannabidiol used across different forms of cannabis appears to be feasible, with preliminary predictive validity for acute negative cannabis-related consequences.

The Index of Cannabis Equivalence (ICE): A User-Centered Approach to Standardization of Cannabis Dose–Response

ABSTRACT The increasing acceptance of cannabis use, and policy changes in several jurisdictions has led researchers and public health experts to call for a standard cannabis dose. Standard dosing units are useful tools for regulation, substance use guidelines, data collection, consistency of research, as a means of communicating low-risk recommendations and dose-related effects, and for self-monitoring. Efforts to standardize cannabis dose have focused on cannabinoid content without considering tolerance or mode. Cannabis users with diverse motivations for use and varying experience rated low, medium, and high doses across seven modes of use. The participants (N = 1368; 42% female) were 18–93 years of age (M = 31.64, SD = 14.70) who had a cannabis use history. The Index of Cannabis Equivalence (ICE) identified the following low-dose cannabis equivalencies: two puffs on a joint, pipe, herbal or concentrate vaporizer is equivalent to one hit on a bong, a 5 mg/THC edible, and ¼ dab of a concentrate. These findings are based on responses from users with lower tolerance, which may limit generalizability to those with higher tolerance. The ICE proposes standardized cannabis doses through user-derived ratings across different administration routes. The meaningful standardization of units of cannabis products in a manner similar to what has been achieved for alcohol represents a valuable step in establishing standard doses across different modes of cannabis administration.

Vaping nicotine and cannabis on the same occasion is linked to increased vaping consumption among young adults: a smartphone-based daily diary study

SignificanceVaping both nicotine and cannabis in the past 30 days (co-vaping) is common among young adults. It is unclear which co-vaping patterns may increase substance use and dependence. We examined day-level associations between vaping patterns with vaping quantity. MethodDaily assessments of vaping behaviors were collected via smartphone for 30 consecutive days among 111 young adults (aged 18-29, vaping nicotine/cannabis at least 20 days during the past month) in California, US, in 2023-2024. Participants reported daily use of nicotine/tobacco (e.g., e-cigarettes, cigarettes) and cannabis products (e.g., vaporized/combustible cannabis). Vaping intensities were the number of times a participant vaped nicotine/cannabis in an entire day. Vaping patterns on a given day were categorized into non-vaping, single-substance vaping, same-day different-occasion co-vaping, and same-occasion co-vaping. Generalized linear mixed-effect models examined day-level associations between these patterns and vaping intensity outcomes, controlling for covariates. ResultsOf the participants, 84.7% reported co-vaping and 15.3% reported single-substance vaping in the past 30 days. Of the 2,522 daily assessments, 42.7% were nicotine-only vaping, 9.7% cannabis-only vaping, 16.5% same-day different-occasion co-vaping, and 16.9% same-occasion co-vaping. Participants reported a greater intensity of vaping nicotine and cannabis on days with same-occasion co-vaping compared to days with other vaping patterns. Vaping intensities on days with same-day different-occasion co-vaping were greater than on days with single-substance vaping or non-vaping. ConclusionsCloser temporal proximity of co-vaping was associated with greater intensities of vaping nicotine and cannabis. Same-occasion co-vaping is linked to the greatest increase in vaping intensity. Interventions addressing this high-risk pattern are warranted.

Agricultural Agents: Utilizing Matrix Calibrations for the Accurate Quantification of Contaminants in Cannabis Products

Abstract Cannabis is an extremely complex matrix that has chemical properties that can make the quantitation of various analytes within the product difficult. As such, laboratories must develop methods that will account for the matrix effect and interferences that naturally occur in everyday samples. Although most analyses can be impacted by matrix, agricultural agent testing is impacted the most. If a laboratory wants to accurately identify and quantify compounds of interest, matrix calibrations, the use of internal standards, and robust method development are essential. This paper will provide data and evidence regarding the impact that a matrix can have on agricultural agent results and why the lack of matrix calibrations can be detrimental to the accurate identification and quantitation of the analytes. Additionally, tools for identifying matrix interferences and how to combat these issues will be discussed in further detail. Cannabis laboratories must focus on producing data that are accurate, reproducible, and legally defensible to help ensure consumer safety. Consumption, whether through inhalation or ingestion, of toxic agricultural agent residues can be extremely dangerous to the health of consumers and in the United States, third party laboratories have been assigned the responsibility of ensuring that all products on the market are safe. As such, this research and its supporting evidence play a critical role in the cannabis industry and the laboratories ability to protect the consumer.

Marijuana Poisoning in Canines in the Aburrá Valley (Antioquia-Colombia), 2023-2024.

Background and Aim: Marijuana poisoning in canines is still considered a taboo topic. Poisoning in pets is becoming increasingly common, in many cases resulting in severe clinical signs, such as ataxia, urinary incontinence, mydriasis, depression, and hyperesthesia. Colombia does not have any reliable test for the diagnosis of exposure to cannabis in animals, and it is not an obligation to report this kind of poisoning to the authorities. Therefore, the main objective of this study was to determine the frequency of cases compatible with tetrahydrocannabinoid (THC) poisoning in canines in the Aburrá valley (Antioquia-Colombia), 2023-2024. Materials and Methods: A cross-sectional study was conducted in the Aburrá valley (Antioquia-Colombia) from 2023 to 2024. Veterinary centers that were allowed to participate were visited, and the clinical records were examined on the canines that were diagnosed positive for marijuana poisoning. We examined the clinical record for different risk factors that could explain the poisoning. A descriptive statistic and a Chi-square test were used to identify risk factors; p < 0.05 were considered statistically significant. Results: One hundred and thirteen (113) cases compatible with cannabis poisoning were found in dogs. Puppies, crossbreeds, trim sizes, and canines whose owners have middle or high economic incomes were the most affected. In addition, a relation between the route of possible cannabis poisoning and the severe presentation of clinical signs was found, with ingestion and inhalation being the routes that generated a more pronounced sign. Likewise, a relationship between age and the most probable route of exposure was found, finding that puppies were more related to the ingestion of cannabis products. Conclusion: This is the first article in Colombia that was focused on determining the frequency of possible cannabis poisoning in canines. The dogs that are more susceptible to suffering cannabis poisoning are puppies and small-size dogs that are attended by veterinary medical centers and are in neighborhoods that are recognizable by people who have high salaries.

An international survey on the knowledge, aTtitudes and clinical pAtternS of use of medical cannabis for caNcer care: the TASMAN study

BackgroundMedical cannabis (MC) has gained traction in oncology for managing cancer-related symptoms, but its integration faces challenges due to limited evidence, inconsistent guidelines, and varied legal frameworks. MethodsThe TASMAN study aimed to assess the knowledge, attitudes, and practices of oncologists and palliative care providers globally regarding MC use in cancer care. A survey of healthcare providers from diverse regions and income levels was conducted. Resultswe study included 179 participants (response rate: 51.1%), with an equal gender distribution (49.4% female) and a median age of 37 years. Participants were primarily oncologists (71.5%), practicing in university hospitals (40.2%) or cancer centres (32.4%), with over half from low- and middle-income countries. Most respondents (92.7%) were unaware of clinical guidelines for MC. A proportion of 44.1% were familiar with MC use, 78.8% recognized its role in cancer pain, and 34% identified its role in managing cachexia. Awareness of specific products was low, with only 10% familiar with specific cannabis products. Three-quarters of respondents (84.4%) did not prescribe MC routinely. Legal status and regulations were unclear for most participants; 40% noted cannabis as illegal. MC use and patient requests were more common in high-income countries and the EURO region, with palliative care providers demonstrating the highest awareness and prescription rates. ConclusionClearer regulations, standardized guidelines, and targeted education are essential to support the safe integration of MC into oncology and palliative care, ultimately improving the quality of life for cancer patients.

ACUTE EFFECTS OF EDIBLE CANNABIS FOR OLDER ADULTS: THE GOOD, THE BAD, AND THE NEUTRAL

Abstract Many older adults use cannabis to alleviate pain, increase sleep quality, and mitigate symptoms of anxiety and/or depression. Yet few studies assess co-occurring effects of cannabis use that may be more salient to older adults. We recruited 234 participants (average age 70.46 (sd=5.83) who either did (n=175) or did not (n=59) want to use edible cannabis for pain, sleep disturbance or negative affect. We compared acute effects on balance, mood, and memory before and after consumption of edible cannabis products differing in cannabinoid ratio (CBD dominant, THC dominant, CBD+THC). Among older adults who used cannabis, we observed balance impairment from pre to 60-minutes post use (p&amp;lt;.01). Those who used cannabis experienced improvement in pain from pre to 60-minutes post use (p=.001) and higher concentrations of THC in blood (measured at time of use) were associated with greater decreases in pain (p&amp;lt;.05). Older adults who used cannabis also experienced increases in subjective intoxication (p&amp;lt;.001); higher THC in blood was associated with greater intoxication (p&amp;lt;.001) while higher CBD in blood was associated with lower intoxication (p&amp;lt;.05). There were few significant differences between those who did versus did not use cannabis on memory and cognitive tasks. We add to the growing literature examining cannabis use among older persons and identify significant outcomes experienced by those who use edible cannabis products. Disseminating this work among clinicians may facilitate more informed conversations with older persons who may consider cannabis as a therapeutic alternative.

Cannabis sativa: Extraction Methods for Phytocannabinoids -An Update

This review paper highlights and updates the recent robust extraction methods for phytocannabinoids, hydrodynamic extraction technology and use of vegetable oil as the solvent system. Hydrodynamic cannabis extraction is a recent development within the cannabis industry that can be used to produce full-spectrum cannabis extracts with high bioavailability. According to the patented hydrodynamic extraction technology by Clean Green Biosystems, Chennai, Tamilnadu, India, the system is the first of its kind to be able to use whole, freshly harvested cannabis materials. Clean Green Biosystems, Chennai, Tamilnadu, India reports that Hydyne is innovative new hydrodynamic extraction system that uses the entire fresh plant materials to preserve all the unique phytochemicals and phytonutrients compounds in a full spectrum/broad spectrum extract. Hydrodynamic system converts the cannabis plant material into a cannabis nano-emulsion by means of hydrodynamic force and ultrasonification by breaking the cell walls of the plant material and releases them into the aqueous phase. PhytoXTM (USA) is another new hydrodynamic extraction system developed by IASO Inc (Incline Village, Nevada, USA) that can process whole, fresh, un-dried cannabis plants, which maximizes plant utilization, reduces processing costs, and increases yields. Many traditional extraction methods can not guarantee the integrity of unstable compounds. Hydrodynamic extraction is designed to use fresh and whole plants, ensuring these volatile molecules are kept intact. Additionally, the distillation prevents the phytocannabinoids from thermal degradation, further protecting molecule integrity. The aroma of the resultant cannabis products is stronger than traditional extracts. Because the plant material is frozen in the preparation stage of the system, it allows the aromatic compounds to remain intact.

Part 2: Drug Interactions Involving Cannabis Products in Persons Aged 18 and Over: A Summary of Published Case Reports and Analysis of the FDA Adverse Event Reporting System.

The increasing utilization of cannabis products combined with lack of data regarding potential cannabis-prescription drug interactions is concerning. This study aimed to review published case reports and FDA Adverse Event Reporting System (FAERS) spontaneous reports to assess cannabis-drug interactions in persons aged 18 and over. A literature search identified 20 case reports that were each assessed for drug interaction causality using the Drug Interaction Probability Scale. Data collected from the FAERS revealed a greater proportion of reports mentioning serious outcomes, including death, when cannabis was used concomitantly with controlled substances compared to noncontrolled substances. Fisher's exact test showed a statistically significant difference between the controlled and noncontrolled groups (p = 0.043). Overall, these findings emphasize the need for additional research and vigilant monitoring of cannabis use when combined with other medications.

A Systematic Review: Assessment of the Metabolomic Profile and Anti-Nutritional Factors of Cannabis sativa as a Feed Additive for Ruminants.

Background:Cannabis sativa is a high-value crop that can be cultivated for ruminant's feed and medicinal purposes. The demand for Cannabis and Cannabis products has increased since the beginning of 21st century. Objectives: The increase in the production cost of high-protein feeds such as lucerne has led to an urgent need to investigate alternative high-protein sources. Methods: Cannabis has been identified as an alternative to lucerne due to its high protein content. Results: However, the cultivation and uses of Cannabis and its by-products in South Africa is limited due to the strict legislation. The metabolites and nutritional value of Cannabis are influenced by growing conditions and soil type. Furthermore, the available literature has shown that Cannabis contains anti-nutritional factors that may affect feed intake or bioavailability and digestibility. Conclusions: Therefore, it is crucial to employ a processing method that can reduce anti-nutritional factors to promote the feed intake and growth rate of sheep. Fermentation, as a processing method, can reduce anti-nutritional factors found in Cannabis, which will make it a palatable alternative feed supplement for ruminants such as Dorper sheep. Overall, this review paper aimed to examine the available literature on the use of Cannabis as an alternative high-protein feed supplement for Dorper sheep in South Africa.