Marijuana Smoking Research Articles

Cannabinoid hyperemesis syndrome complicated by pneumomediastinum: implications for pediatrics

Background. Cannabinoid hyperemesis syndrome / CHS (prolonged and frequent use of high-dose cannabis) in the pediatric population has been increasingly reported over the last decade. CHS can lead to life-threatening complications such as pneumomediastinum, which warrant careful consideration for surgical intervention. Case Presentation. A 17-year-old female with no significant past medical history presented to the emergency department with abdominal, chest and back pain (worse with deep inspiration), nausea, and vomiting for 24 hours. Upon further history, the patient reported a similar episode six months ago, being a cannabis smoker (at least once a day) in the last two years. Chest X-ray revealed a subtle abnormal lucency along the anteroposterior window and anterior mediastinum, consistent with a small amount of pneumomediastinum without any other acute intrathoracic abnormalities. Follow-up chest computed tomography with contrast showed multiple foci of air within the anterior and posterior mediastinum tracking up to the thoracic inlet. There was no evidence of contrast extravasation; however, small esophageal perforation could not be excluded. Given uncomplicated pneumomediastinum (without frank contrast extravasation) the patient was treated medically with piperacillin-tazobactam, metronidazole, and micafungin for microbial prophylaxis; hydromorphone for pain control; as well as with pantoprazole, ondansetron, and promethazine. Nutrition was provided via total parenteral nutrition. The evolution was favorable (no signs of occult esophageal perforation occurred), being advanced to a soft diet on hospital day eight, solid food diet on day nine, at which point antibiotics were discontinued, and the patient was subsequently discharged. Conclusion. CHS in increasingly encountered in the pediatric setting due to rising prevalence of cannabis use. The management of CHS and potentially life-threatening complications such as pneumomediastinum should be given careful consideration. Pneumomediastinum can be a harbinger of esophageal perforation that may warrant urgent surgical intervention.

Chest CT Findings in Marijuana Smokers.

Background Global consumption of marijuana is increasing, but there is a paucity of evidence concerning associated lung imaging findings. Purpose To use chest CT to investigate the effects of marijuana smoking in the lung. Materials and Methods This retrospective case-control study evaluated results of chest CT examinations (from October 2005 to July 2020) in marijuana smokers, nonsmoker control patients, and tobacco-only smokers. We compared rates of emphysema, airway changes, gynecomastia, and coronary artery calcification. Age- and sex-matched subgroups were created for comparison with tobacco-only smokers older than 50 years. Results were analyzed using χ2 tests. Results A total of 56 marijuana smokers (34 male; mean age, 49 years ± 14 [SD]), 57 nonsmoker control patients (32 male; mean age, 49 years ± 14), and 33 tobacco-only smokers (18 male; mean age, 60 years ± 6) were evaluated. Higher rates of emphysema were seen among marijuana smokers (42 of 56 [75%]) than nonsmokers (three of 57 [5%]) (P < .001) but not tobacco-only smokers (22 of 33 [67%]) (P = .40). Rates of bronchial thickening, bronchiectasis, and mucoid impaction were higher among marijuana smokers compared with the other groups (P < .001 to P = .04). Gynecomastia was more common in marijuana smokers (13 of 34 [38%]) than in control patients (five of 32 [16%]) (P = .039) and tobacco-only smokers (two of 18 [11%]) (P = .040). In age-matched subgroup analysis of 30 marijuana smokers (23 male), 29 nonsmoker control patients (17 male), and 33 tobacco-only smokers (18 male), rates of bronchial thickening, bronchiectasis, and mucoid impaction were again higher in the marijuana smokers than in the tobacco-only smokers (P < .001 to P = .006). Emphysema rates were higher in age-matched marijuana smokers (28 of 30 [93%]) than in tobacco-only smokers (22 of 33 [67%]) (P = .009). There was no difference in rate of coronary artery calcification between age-matched marijuana smokers (21 of 30 [70%]) and tobacco-only smokers (28 of 33 [85%]) (P = .16). Conclusion Airway inflammation and emphysema were more common in marijuana smokers than in nonsmokers and tobacco-only smokers, although variable interobserver agreement and concomitant cigarette smoking among the marijuana-smoking cohort limits our ability to draw strong conclusions. © RSNA, 2022 See also the editorial by Galvin and Franks in this issue.

Association Between Cannabis Smoking and Academic Achievement in High-School Students

Background: Cannabis smoking can affect academic achievement, and depressive symptoms and family dysfunction are also associated with it. The study’s objective was to establish the relationship between cannabis smoking and academic achievement, linked to clinically important depressive symptoms and family dysfunction. Methods: A cross-sectional study was designed. The authors quantified lifetime cannabis smoking, perception of academic achievement, clinically important depressive symptoms, and family dysfunction. The crude association between cannabis smoking and academic achievement was computed; after it was adjusted by clinically important depressive symptoms and family dysfunction. Results: 1,462 students between 13 and 17 participated in the research; 11.6% reported lifetime cannabis smoking, 30.8% poor-fair academic achievement; 7.1% clinically important depressive symptoms; and 76.1% family dysfunction. Lifetime cannabis smoking was significantly associated with poor-fair academic achievement after adjusting for clinically important depressive symptoms and family dysfunction (OR = 1.61, 95%CI 1.16 - 2.24). Conclusion: Lifetime cannabis smoking is related to poor-fair academic achievement among high-school students in Santa Marta, Colombia.

Abstract 10022: Marijuana Smoke or Vaporizer Aerosol Impairs Endothelial Function Regardless of Drying Regimen or Cannabinoid Profile

Introduction: Marijuana smoke and vaporizer aerosol adversely affect the cardiovascular system. Most US marijuana research has used research marijuana from the University of Mississippi supplied through the National Institute on Drug Abuse (NIDA). NIDA marijuana is dried at high temperature with maximum of 10% THC, but real-world material is gently dried and is ~20% THC. Because NIDA marijuana differs from what is currently used by the public in terms of THC content and drying regimen, skepticism regarding relevance to the real world is limiting the impact of results obtained from this material. Here, we validated the use of NIDA research marijuana in the study of vascular effects of cannabis. Hypothesis: Exposure to marijuana smoke or vaporizer aerosol, regardless of the cannabinoid profile or drying regimen, impairs endothelial function. Methods: We exposed groups of rats (n=8) to smoke or Volcano vaporizer aerosol from materials obtained from U Miss (Placebo (&lt;0.01% THC hot), 4.2% THC hot and gentle dried pair, 10% THC hot), from Biopharmaceutical Research Company (Castroville, CA) (20% THC gentle dried), commercial hemp with negligible THC content, and clean air. Exposure was pulsatile, 5s/min over 5 mins. Endothelial function was measured as flow-mediated dilation (FMD) and pre- vs. post-exposure FMD (10 and 30 mins after end of exposure) differences were analyzed. Results: We observed significant impairment of FMD after exposure to pulsatile smoke from marijuana with varied cannabinoid profiles and drying regimens (p≤.006), with no effect from clean air (p=.13). No significant recovery of FMD was observed in any group 30 mins after marijuana smoke exposure (p≥.32). Pulsatile exposure to aerosol generated from the same materials impaired FMD in all groups (p≤.001) except clean air (p=.23). Conclusions: Acute exposure to marijuana smoke/aerosol impairs endothelial function regardless of the drying regimens or the cannabinoid profile of the marijuana product.

In-Home Cannabis Smoking Among a Cannabis-Using Convenience Sample from the Global Drug Survey: With Weighted Estimates for U.S. Respondents.

Introduction: Secondhand and thirdhand tobacco smoke exposure most often occur at home, but little is known about occurrences of in-home cannabis smoking. We ascertained in-home cannabis smoking reported by all cannabis-using (i.e., used in the last 12 months) respondents to the Global Drug Survey (GDS; international-GDS sample), and among U.S. cannabis-using respondents (US-GDS sample). Materials and Methods: We used data collected November 2019-January 2020 for the 2020 GDS, an annual anonymous, cross-sectional survey; respondents were 16+ years old, from 191 countries. We estimated any and daily in-home cannabis smoking in the last 30 days among international-GDS respondents (n=63,797), using mixed effects logistic regression. US-GDS respondents (n=6,580) were weighted to the covariate distribution of the nationally representative 2018 National Survey on Drug Use and Health cannabis-using sample, using inverse odds probability weighting, to make estimates more generalizable to the U.S. cannabis-using population. Results: For the international-GDS cannabis-using respondents, any in-home cannabis smoking was reported by 63.9% of men, 61.9% of women, and 68.6% of nonbinary people; and by age (<25 years old=62.7%, 25-34 years old=65.0%, and 35+ years old=62.8%). Daily in-home cannabis smoking was highest among nonbinary (28.7%) and respondents 35+ years of age (28.0%). For the weighted US-GDS cannabis-using respondents, any in-home cannabis smoking was reported by 49.8% of males and 61.2% of females; and by age (<25 years old=62.6%, 25-34 years old=41.8%, 35+ years old=57.9%). Weighted daily in-home smoking was 23.2% among males and 37.1% among females; by age (<25 years old=34.8%, 25-34 years old=27.8%, and 35+ years old=21.6%). Conclusions: There was high daily cannabis smoking in homes of international-GDS and US-GDS respondents who used cannabis in the last 12 months. In part, due to cannabis legalization, the number of users worldwide has increased over the past decade. Criminal stigma historically associated with cannabis continues to drive those users indoors. In this context, our findings support further investigation of cannabis use behavior to understand how often people are exposed to secondhand and thirdhand cannabis smoke and the consequences of that exposure.

Impairment of Endothelial Function by Cigarette Smoke Is Not Caused by a Specific Smoke Constituent, but by Vagal Input From the Airway.

Exposure to tobacco or marijuana smoke, or e-cigarette aerosols, causes vascular endothelial dysfunction in humans and rats. We aimed to determine what constituent, or class of constituents, of smoke is responsible for endothelial functional impairment. We investigated several smoke constituents that we hypothesized to mediate this effect by exposing rats and measuring arterial flow-mediated dilation (FMD) pre- and post-exposure. We measured FMD before and after inhalation of sidestream smoke from research cigarettes containing normal and reduced nicotine level with and without menthol, as well as 2 of the main aldehyde gases found in both smoke and e-cigarette aerosol (acrolein and acetaldehyde), and inert carbon nanoparticles. FMD was reduced by all 4 kinds of research cigarettes, with extent of reduction ranging from 20% to 46% depending on the cigarette type. While nicotine was not required for the impairment, higher nicotine levels in smoke were associated with a greater percent reduction of FMD (41.1±4.5% reduction versus 19.2±9.5%; P=0.047). Lower menthol levels were also associated with a greater percent reduction of FMD (18.5±9.8% versus 40.5±4.8%; P=0.048). Inhalation of acrolein or acetaldehyde gases at smoke-relevant concentrations impaired FMD by roughly 50% (P=0.001). However, inhalation of inert carbon nanoparticles at smoke-relevant concentrations with no gas phase also impaired FMD by a comparable amount (P<0.001). Bilateral cervical vagotomy blocked the impairment of FMD by tobacco smoke. There is no single constituent or class of constituents responsible for acute impairment of endothelial function by smoke; rather, we propose that acute endothelial dysfunction by disparate inhaled products is caused by vagus nerve signaling initiated by airway irritation.

Project DABE: Empathy among Spanish Medical Students

IntroductionEmpathy refers to an aspect of personality, important in interpersonal relationships and in communication, considered to be an important value in the medical profession. In the present study, we have studied empathy in a sample of more than 5,000 medical students of all 43 medical schools in Spain. MethodsThe data belong to the DABE project, a study that included mental health variables and that was applied through a web survey just before COVID-19 pandemic restrictions started. To measure empathy, we used the Jefferson Empathy Scale (Student Version), which comprises 20 items relating to three underlying components, Perspective Taking, Compassionate Care, and Standing in the Patient’s Shoes. ResultsEmpathy global score was high and it increased progressively every year during medical school. Empathy score was greater in the female students, with a 20% of participants showed high levels of empathy, again more in women. High empathy was associated with students having greater social support, more interest and participation in everyday experiences and satisfaction with social activities. The three components of empathy were also greater in women than in men. Empathy scores were significantly lower in those students that reported smoking and also in the students that reported use of frequent use of cannabis. DiscussionEmpathy scores are high in the spanish medical students population, with a 20% of them showing high levels. Empathy scores increase longitudinally during medical school, are greater in female students and lower in those smoking either tobacco or cannabis.

PSAT327 Can Cannabis Use Lead to Central Hypothyroidism

Abstract Background Marijuana has been legalized for medical use in 36 states and for recreational use in 18 states. Its effects on thyroid function and hypothalamic-pituitary-thyroid axis in humans is not known. Clinical Case 72 years old male presented to his primary care physician with occasional difficulty swallowing. He reported fatigue for 4-5 years, trouble falling asleep for 2 months, weight gain 8 pounds over last few weeks, occasional diarrhea, and intermittent episodes of heat intolerance. His past medical history included controlled type 2 diabetes mellitus, recurrent herpes simplex infection, arthritis of hip joints, short-term memory loss, anemia, carpal tunnel syndrome and benign prostatic hyperplasia. Medications included glimepiride, lisinopril, acyclovir, tamsulosin, finasteride, escitalopram. He had been smoking marijuana regularly since he was a teenager. He denied using any other supplements. His physical exam was normal with stable vital signs and normal BMI. His labs showed a low TSH (0.096 mcIU/mL, n: 0.358-3.8 mcIU/mL), normal free T4 (0.90 ng/dL, n: 0.76-1.46 ng/dL), normal total T3 (70 ng/dL, n: 60-180 ng/dL). Review of his labs showed low TSH for last 4 years progressively getting worse with normal free T4 levels. TSH-receptor antibody and TPO Antibody level were negative. His white cell count, hemoglobin and platelets were normal. His electrolytes, kidney function and liver function tests were also normal. Thyroid Ultrasound showed 2 small sub-centimeter hypoechoic nodules in the left thyroid lobe. Two years ago, a radioactive Iodine scan showed normal iodine uptake. A recent radioactive iodine uptake scan showed generalized decreased iodine uptake with no evidence of graves’ disease or toxic multinodular goiter. Conclusion Currently there are no controlled studies on the effect of marijuana use on thyroid function in humans. A cross-sectional analysis using National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012 showed recent marijuana use was significantly associated with lower levels of TSH but was not associated with thyroid dysfunction (1). This study suggests that marijuana use is associated with low TSH levels. This could be due to hypothalamic suppression of TSH or may indicate a protective role against hypothyroidism. Older studies in rodents showed that cannabis exposure may lead to suppression of TSH and hypothalamic function (2). The data related to human subjects is scarce. Therefore, pathophysiologic mechanisms are speculative, although animal data support potential mechanism of hypothalamic suppression.

ODP165 Atypical DKA? Think Cannabis!

Abstract Diabetic ketoacidosis (DKA) can be life threatening if not recognized and treated promptly. DKA is characterized by hyperglycemia, acidosis, ketosis and elevated anion gap. The presence of these metabolic derangements is essential to make the diagnosis. The use of cannabis has been associated with atypical acid-base profile in DKA which may contribute to confusion in diagnosis and treatment. Case A 20-year-old man with type 1 diabetes since age 10 presented to the emergency department with 4 days of nausea, vomiting and elevated blood glucose (BG). Emesis occurred up to 6 times daily and started 2 days prior to hyperglycemia. He was unable to correct BG with rapid acting insulin. Moderate urine ketones were present. He denied symptoms of diarrhea, fever, sore throat, runny nose or cough and reported adherence to insulin regimen. Physical exam was remarkable for dry mucous membranes and mild epigastric tenderness. Lab evaluation showed BG of 268 (70-110mg/dL), sodium 133 (135-145 mmol/L), potassium 3.6 (3.5- 5.1 mmol/L), chloride 95 (98-107 mmol/L), bicarbonate 22 (22-32 mmol/L), creatinine 0.8 (0.6–1.2 mg/dL), Anion gap 16, beta-hydroxybutyrate 3.38 (&amp;lt;0.27 mmol/L). He had normal white blood cell count and infectious work up was unremarkable. The patient was started on continuous IV fluids and was managed with intermittent subcutaneous rapid acting insulin in addition to basal insulin. After anion gap closure he was transitioned to his home doses of insulin. Prior to discharge, the patient discretely asked about the effects of smoking marijuana on BG and subsequently disclosed he had increased his use of marijuana recently. Discussion Diabetic keto-alkalosis may present as a result of recurrent vomiting that leads to gastric acid loss. Cannabis use has been linked to an increased risk of diabetic keto-alkalosis. The underlying mechanism is hypothesized to be related to cannabis effects on the stomach causing delayed gastric emptying and leading to cyclic nausea and vomiting. One study conducted to investigate acid-base parameters seen in atypical DKA in Type 1 Diabetes referred to this as "Hyperglycemic Ketosis due to Cannabis Hyperemesis Syndrome" (HK-CHS) recommending obtaining urine drug screen in patients with atypical DKA 1 . Attention should be drawn to this phenomenon as cannabis use has grown with its legalization in many states. Individuals with T1D presenting with ketosis but normal or elevated pH and/or serum bicarbonate may confuse clinicians and delay proper diagnosis. When the patient does not disclose cannabis use voluntarily, taking a thorough social history is critical to making the correct diagnosis. Reference: 1. Akturk HK, Snell-Bergeon J, Kinney GL, Champakanath A, Monte A, Shah VN. Differentiating diabetic ketoacidosis and hyperglycemic ketosis due to cannabis hyperemesis syndrome in adults with type 1 diabetes. Diabetes Care 2021 December 8,: dc211730 Presentation: No date and time listed

Medical Cannabis in Canadian Schools: A Scoping Review of Existing Policies.

Objective: An increasing number of children and youth in Canada are taking medical cannabis for complex medical conditions. While they deserve safe and consistent access to pharmacotherapy throughout the day, administrative policies on cannabis use in schools are inconsistent. A scoping review identified policies and publications associated with medical cannabis in Canadian schools. Methods: Five databases (Scopus, PubMed, CINAHL, EMBASE, and Web of Science) were searched to identify scientific literature. Legislation in each province and territory and Ministry of Education webpages were reviewed for pertinent laws and policies regarding cannabis use in schools. Results: The scientific search resulted in 1289 articles. The five included articles pertain to implications for school nurses in the United States, which are not relevant to the Canadian context. A search of Ministry of Education websites identified only one policy with information regarding medical cannabis in schools (from Ontario). Federal legislation (the Cannabis Act) does not specifically address medical cannabis in schools, and there is a lack of consistency in terminology and clarity within provincial and territorial laws. All provinces and territories prohibit smoking and vaping of cannabis on school property and some provinces prohibit any method of cannabis consumption. Conclusions: In Canada, there is a lack of guidance for medical cannabis administration, storage, and disposal in schools, with some policies explicitly prohibiting this type of treatment. This shifts the burden to families to individually create plans school by school. A federally harmonized approach to supporting children who take cannabis for medical purposes ought to be explored.

UHPLC-MS-MS Determination of THC, CBD, and their Metabolites in Whole Blood of Light Cannabis Smokers.

"Light cannabis" is a product legally sold in Europe with Δ9-tetrahydrocannabinol (THC) concentration lower than 0.2% and variable cannabidiol (CBD) content. In this study, we aimed to assess the time-courses of THC and metabolites (11-nor-9-carboxy-THC and 11-hydroxy-THC) and CBD and metabolites (CBD-7-oic acid, 7-hydroxy-CBD, 6α-hydroxy-CBD, and 6β-hydroxy-CBD) in whole blood of 10 healthy participants after smoking one or four light cannabis cigarettes (0.16% THC and 5.8% CBD). Blood samples were collected 0.5 to 4 h after administration. Blood analysis was performed by reversed-phase ultra-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS-MS) in multiple reaction monitoring mode, after glucuronide hydrolysis and liquid-liquid extraction in basic and acidic conditions. The method was validated following the most recent guidelines in toxicology: the method was linear, accurate, precise, and sensitive (lower limits of quantification ranged from 0.005 to 0.01 ng/mL); carryover, matrix effect, recovery, process efficiency, and dilution integrity were also assessed. As previously reported, the main metabolites of THC were THC-COOH, then 11-OH-THC, and the main metabolites of CBD were 7-OH-CBD, then 7-COOH-CBD. The time of first collection, which likely occurred after the maximal concentration of most of the analytes, and the short monitoring time, up to 4 h after smoking, limited the evaluation of the pharmacokinetic parameters.

Influence of personality on acute smoked cannabis effects on simulated driving.

A recent study of the impact of smoked cannabis on simulated driver behavior demonstrated a reduction in mean speed after smoked cannabis. Previous research identified an association between personality and individual differences and acute drug effects. The present study examined the impact of personality on the reduction in mean speed after smoking cannabis under single- and dual-task driving conditions originally reported by Brands et al. (2019). Sixty-one participants randomly assigned to the active drug condition completed a battery of self-report questionnaires measuring various personality constructs and subsequently operated a driving simulator before and 30 min after smoking a 12.5% Δ9-tetrahydrocannabinol (THC) cigarette. Linear regression modeling tested the influence of self-reported driving errors, lapses, and violations, driver vengeance, psychological distress, impulsivity, and sensation seeking on the reduction in speed after smoking cannabis. After adjusting for the influence of sex, blood THC concentration, and predrug mean speed, impulsivity was a significant predictor of change in speed under both single- (β = -.45, t = -3.94, p < .001) and dual- (β = -.35, t = -2.74, p = .008) task driving conditions after cannabis. Higher trait impulsivity was significantly associated with greater reductions in driving speed after cannabis use, which may reflect greater sensitivity to drug effects and a stronger compensatory response. Further multidisciplinary study, including neurochemical, genetic, and psychological components, would be beneficial in helping to better understand how impulsivity and other personality or individual differences may impact the effects of cannabis on driver behavior and performance. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

S1729 Drug-Induced Pancreatitis: Meth, Cannabis, or Meth-Laced Cannabis?,

Introduction: Drug-induced pancreatitis (DIP) is a rare entity with a 0.1 to 2% incidence of acute pancreatitis cases. Methamphetamine is a serotonergic drug used as a stimulant. It has infrequently been observed to cause pancreatic and hepatic damage due to its keen vasoconstrictive properties. Cannabis in its recreational form has also been linked with drug-induced pancreatitis. We report a 36-year-old female who presented with findings of acute pancreatitis revealing a drug-induced etiology. Case Description/Methods: The patient is a 36-year-old previously healthy female who presented with diffuse, sudden in onset abdominal pain, radiating to the back, aggravated with food without alleviating factors of 3 days duration. She reported nausea on the first day of her pain along with a single episode of nonbilious vomiting that had self-subsided. Social history was remarkable for smoking marijuana since her teenage years unremarkable for alcohol and tobacco use. She reported resorting to street, methamphetamine laced marijuana, the past month. The patient was vitally stable with a physical exam remarkable for epigastric and left lower quadrant tenderness with negative peritoneal signs. Laboratory tests showed elevated lipase, amylase, and CRP with normal liver function tests, hematocrit, BUN, bilirubin, triglycerides, and phosphocalcium balances. Ultrasound was done corroborating the absence of obstruction. Computed tomography (CT) abdomen was subsequently performed showing irregular contour of the pancreatic margins, blurring of peripancreatic fat planes, soft-tissue stranding, and trace-free fluid at the pancreatic body and tail without bile duct dilatation. Serological survey for mumps virus, cytomegalovirus (CMV), epstein barr virus (EBV), and human immunodeficiency virus (HIV) was negative. Anti-nuclear antibodies (ANA), neutrophil anti-cytoplasmic antibody (ANCA), and serum Ig G4 were also negative. She was diagnosed with mild acute pancreatitis with the culprit agent being methamphetamine-laced cannabis. The patient was followed up 3 months after agent cessation with marked symptomatic improvement and unremarkable lab work. Discussion: This case highlights that methamphetamine might also be the precipitating cause of pancreatitis in street marijuana-associated pancreatitis cases. Drug-induced pancreatitis is often challenging because there are no unique clinical characteristics to distinguish drugs from other etiologies, let alone the possibility of identifying one potential drug versus another.

RECREATIONAL NITROUS OXIDE INHALATION AS AN UNUSUAL CAUSE OF SPONTANEOUS PNEUMOMEDIASTINUM AND PNEUMORRHACHIS SECONDARY TO BAROTRAUMA

RECREATIONAL NITROUS OXIDE INHALATION AS AN UNUSUAL CAUSE OF SPONTANEOUS PNEUMOMEDIASTINUM AND PNEUMORRHACHIS SECONDARY TO BAROTRAUMA

S547 Rising Inpatient Utilization and Costs of Cannabis Hyperemesis Syndrome Hospitalizations in Massachusetts Following Cannabis Legalization

Introduction: As cannabis legalization has become widespread, we sought to describe the demographics, inpatient utilization, and cost of services among patients hospitalized for cannabinoid hyperemesis syndrome (CHS) predating and postdating cannabis legalization in Massachusetts. Methods: We performed a retrospective cohort study of patients admitted to Tufts Medical Center in Boston, Massachusetts (MA) with CHS pre- and post-Dec 15, 2016, the date of cannabis legalization in MA. We examined the demographic and clinical characteristics of admitted patients as well as utilization of hospital services including length of stay, laboratory services, antiemetic drugs, intravenous fluids, endoscopies, imaging, gastroenterology consulting services and intensive care requirements both pre- and post- legalization. We also estimated inpatient cost pre- and post- legalization. Results: We identified 63 patients admitted between 2012-2020 with CHS across 72 hospitalizations, with more admissions post-legalization (n=57) than pre-legalization (n=15). Patient demographics were similar pre- and post- cannabis legalization, with a mean age of 33, 52% identifying as female, and the majority smoking cannabis as the primary route of administration. Utilization of hospital resources increased post-legalization for CHS, with increased length of stay (3 days vs 1 day, p< .005) and increased anti-emetic use (3 days vs 1 day, p< 0.05) compared to pre-legalization, with multivariate linear regression confirming that post-legalization admissions were independently associated with increased length of stay (B=5.35, p< 0.05). The mean cost of hospitalization per patient post-legalization was significantly higher than for pre-legalization ($18,714 vs $7,460, p< .0005), with intravenous fluid administration and endoscopy costs significantly increased post-legalization (p< 0.05). On multivariate linear regression, hospitalization for CHS during post-legalization significantly predicted increased costs (B=10,131.25, p< 0.05). (Table) Conclusion: In the post-legalization era of cannabis in Massachusetts, we found increased hospitalizations due to CHS, with a concomitant increase length of hospital stay and total cost per patient. As cannabis use increases, the recognition, measurement, and cost of the deleterious effects are necessary to incorporate into future practice strategies and public health policy development. Table 1. - Demographics Pre-legalization (n=12 patients) Post-legalization(n=51patients) p-value Number of hospital admissions 15 57 NA Female gender n, (frequency) 4 (33.3) 29 (50.9) 0.25 Age mean, (st dev) 35.5 (11.5) 32.9 (13.5) 0.32 Cannabis type used n, (frequency) Smoking 6 (50.0) 31 (60.8) 0.53 Vaping 0 2 (3.9) - Edibles 0 2 (3.9) - More than one type 0 1 (2.0) - Not reported 6 (50.0) 15 (29.4) - Cannabis use frequency n, (frequency) Less than daily 0 9 (17.6) 0.19 At least daily 3 (25.0) 24 (47.1) 0.21 Multiple times daily 3 (25.0) 8 (15.7) 0.42 Unknown 6 (50.0) 10 (19.6) - Utilization of Services Pre-legalization (n=15 hospitalizations) Post-legalization (n=57 hospitalizations) p-val Length of inpatient stay, days median, (IQR) 1.0 (1.0-2.0) 3.0 (1.0-4.0) < 0.005 Cannabis urine screen positivity n, (frequency) 10 (66.7) 37 (64.9) 1.0 Cannabis urine screen not performed n, (frequency) 4 (26.7) 16 (28.1) 1.0 Basic metabolic panel, days median, (IQR) 2 (1.0-2.8) 2.0 (0.25-3.0) 0.79 Antiemetics, days median, (IQR) 1.0 (1.0-2.5) 3.0 (2.0-4.0) < 0.05 Intravenous fluids, days median, (IQR) 1.0 (1.0-2.0) 1.0 (1.0-2.0) 0.32 Endoscopies performed n, (frequency) 3.0 (20.0) 14.0 (24.5) 1.00 Imaging studies performed n, (frequency) 12.0 (80.0) 43.0 (75.4) 1.00 GI consults n, (frequency) 5.0 (33.3) 26.0 (45.6) 0.57 ICU-level care needed days median, (IQR) 0.0 9.0 (15.8) 0.19 Cost of Services Pre-legalization (n=15 hospitalizations) Post-legalization (n=57 hospitalizations) p-value Mean inpatient charge $7460 $18,714 < 0.0005 IVF charges, mean $551 $745 < 0.05 Endoscopy charges, mean $1512 $2360 < 0.05

Social Impact of Cannabis Smoking on Smokers in Owerri West LGA, Nigeria

Cannabis is a weed derived from the cannabis sativa plant. It is usually smoked to get intoxicated. This is act though rampant; seem not to have been socially accepted by the society. Thus, smokers of cannabis are labelled criminals and irresponsible even though these labels may be mere stereotype. In view of this, the study investigated the social impact of cannabis smoking on cannabis smokers. It tried to find out how cannabis smoking has affected the social relationship of cannabis smokers. The study adopted the labelling theory of Howard Becker because it explains the stereotypical stigma attached to cannabis smokers. The study adopted a qualitative research design and interviewed 2 criminologists, a Nigeria Drug, Law Enforcement Agency (NDLEA) commandant, 2 NDLEA officials and 10 cannabis smokers. Both primary and secondary sources of data collection techniques were adopted for this study however; findings were further discussed for better comprehension. The findings of this study revealed that, people do not disassociate themselves from cannabis smokers even though they believe cannabis smokers are criminals and are irresponsible because most criminals smoke cannabis. It was also revealed that smoking cannabis does not make individuals prone to criminal activities because it is not addictive but, could become a habit. Based on these findings, the study recommends that, government and non-government agencies (NGOs) create awareness on the negative consequences of smoking cannabis through the mass media and social media. It was also recommended that; the public be sensitized against negative stereotypes against cannabis users. In furtherance to this, law enforcement agencies should enforce the laws against cannabis and other drug producers, distributors and sellers so as to curb the spread of cannabis use in Owerri West LGA and Nigeria at large.

Animal evidence considered in determination of cannabis smoke and Δ9 -tetrahydrocannabinol as causing reproductive toxicity (developmental endpoint); Part I. Somatic development.

On December 11, 2019, California's Developmental and Reproductive Toxicant Identification Committee (DARTIC) met to consider the addition of cannabis smoke and Δ9 -THC to the Proposition 65 list as causing reproductive toxicity (developmental endpoint). As the lead state agency for implementing Proposition 65, the Office of Environmental Health Hazard Assessment (OEHHA) reviewed and summarized the relevant scientific literature in the form of a hazard identification document (HID). Here we provide reviews based on the HID: shortened, revised, and reformatted for a larger audience. While the HID included both human and animal data, this set of three reviews will highlight the animal-derived data pertaining to somatic development (Part I), neurodevelopmental effects (Part II), and proposed neurodevelopmental mechanisms of action (Part III). Endogenous cannabinoids (eCBs) and their receptors serve many critical functions in normal development. Δ9 -THC can interfere with these functions. Mechanistic studies employed techniques including: blocking Δ9 -THC binding to endocannabinoid (EC) receptors, inhibiting Δ9 -THC metabolism, and/or using animals expressing knockout mutations of EC receptors. Apical somatic effects of cannabis smoke or Δ9 -THC reported in whole animal studies included decreases in offspring viability and growth. Mechanistic studies discussed in Part I focused on Δ9 -THC effects on early embryos and implantation, immune development, and bone growth. In reaching its decision to list cannabis and Δ9 -THC as a developmental toxicant under California's Proposition 65, the DARTIC considered biological plausibility and the consistency of mechanistic information with effects reported in human and whole animal studies.

Animal evidence considered in determination of cannabis smoke and Δ9 -tetrahydrocannabinol as causing reproductive toxicity (developmental endpoint): Part III. Proposed neurodevelopmental mechanisms of action.

This review summarizes the most common potential pathways of neurodevelopmental toxicity due to perinatal exposure to Δ9 -tetrahydrocannabinol (Δ9 -THC) that lead to behavioral and other adverse outcomes (AOs). This is Part III in a set of reviews highlighting the animal-derived data considered by California's Developmental and Reproductive Toxicant Identification Committee (DARTIC) in 2019. The Hazard Identification Document (HID) provided to the DARTIC included a summary of human, whole animal, and mechanistic data on the neurodevelopmental toxicity of cannabis smoke and Δ9 -THC. The literature search for mechanistic data has been updated through 2020. We focus on mechanistic pathways relating to behavioral and other neurodevelopmental outcomes of perinatal exposure to Δ9 -THC. The endocannabinoid system (EC system) plays a crucial role in many processes involved in neurodevelopment and exposure to Δ9 -THC can alter these processes. Whole animal studies report changes in cognitive ability, behavior, and motor function after prenatal exposure to Δ9 -THC. Findings from mechanistic studies add to this evidence and further provide information regarding the pathways leading to these outcomes. Neuromechanistic studies can bridge the gaps between molecular initiating events and apical neurodevelopmental endpoints caused by a chemical. They offer insight into potential alterations in the same pathways by other chemicals that can also result in AOs. Studies of cannabinoid receptor agonist-induced molecular alterations and provide deep biological plausibility at the mechanistic level for the cognitive, behavioral, and motor impairments observed in animal studies after perinatal exposure to Δ9 -THC.

Frequent Cannabis Smoking and Association with Prediabetes and Diabetes in Early Adulthood

Background: Cannabis use in young adulthood has been linked with increased risk of prediabetes later in life. However, many previous studies have only used fasting blood samples to determine risk for type 2 diabetes (T2D), which may not detect early changes in glucose homeostasis. The objective of this study was to determine the association between cannabis use and risk for prediabetes and T2D in young adults using several measures of glucose homeostasis, including an oral glucose tolerance test (OGTT). Methods: The Meta-CHEM study is a subset (N=84) of overweight and obese young adults aged 22–25 years from the Children&amp;#x27;s Health Study (CHS). Participants underwent a single clinical visit which included a 2-hour OGTT and questionnaire about cannabis smoking habits in the past year. Participants were classified as non-smokers, light cannabis smokers (smoke &amp;#x3c;once a week), and heavy cannabis smokers (smoke &amp;#x3e;once a week). Those smoking more than one cigarette in the past week were excluded from the study. Participants were classified as having prediabetes or T2D if they had a HbA1c &amp;#x3e;5.6%, fasting glucose &amp;#x3e;99 mg/dL, and/or 2-hour OGTT glucose &amp;#x3e;139 mg/dL. Logistic regression was used to assess the associations between cannabis smoking habits and metabolic outcomes after adjusting for age, sex, education, body mass index, Hispanic ethnicity, physical activity, and alcohol consumption. Results: 52 (62%) participants were non-diabetic, 28 (33%) had pre-diabetes, and 4 (0.05%) had T2D. 25 (30%) participants were nonsmokers, 47 (56%) were light cannabis smokers, and 12 (14%) were heavy cannabis smokers. The odds of having prediabetes or T2D was 7.3 times higher among heavy smokers (95% CI: 0.94, 7.7), and 1.5 times higher among light smokers (CI: 0.43, 6.0) than nonsmokers (P-value for trend = 0.03). Conclusion: Cannabis use in overweight and obese young adults was significantly associated with risk of having prediabetes or T2D.

Animal evidence considered in determination of cannabis smoke and Δ9 -tetrahydrocannabinol (Δ9 -THC) as causing reproductive toxicity (developmental endpoint); Part II. Neurodevelopmental effects.

This review focuses on neurodevelopmental effects observed in animal studies of cannabis smoke and Δ9 -THC. Effects in offspring after preconceptional, prenatal, or perinatal exposure to cannabis smoke or Δ9 -THC were considered. Locomotor and exploratory behavior effects were noted in rats. Cognitive effects observed included impairment of memory and learning, attention deficits, time taken to complete tasks (rats) and alterations in response to visual stimuli (rats/monkeys). Emotionality was observed in rodents as an increase in separation-induced ultrasonic vocalizations, reduced social interaction and play behavior, and increased generalized anxiety. Increased rate of acquisition of morphine self-administration and/or enhanced sensitivity towards the rewarding effects of morphine or heroin were observed in adult rats prenatally exposed to Δ9 -THC. Expression of cannabinoid receptors was examined in rodent studies along with behavioral parameters. Altered mRNA levels of genes relevant to synaptic plasticity in the nucleus accumbens (the brain region associated with compulsivity, addiction vulnerability, and reward sensitivity) were noted. Findings in zebrafish supported effects in mammalian models. Neurochemical effects on specific brain regions and neurotransmitter systems seen in these animal studies appear to impact cognitive function, motor activity, and drug sensitivity. Mechanistic studies provided evidence for the biological plausibility of effects observed. Observations from animal studies of changes in motor behavior, cognitive performance, emotionality and susceptibility to drug sensitivity later in life were among the findings from animal and human studies considered by California's Developmental and Reproductive Toxicant Identification Committee, in concluding that cannabis smoke and Δ9 -THC are developmental toxicants.