Concomitant Cannabis Research Articles

Descriptive epidemiology of injuries with concomitant cannabis use among adolescents and young adults in the United States: a cross-sectional study

Descriptive epidemiology of injuries with concomitant cannabis use among adolescents and young adults in the United States: a cross-sectional study

S51 Trends in Acute Pancreatitis With Cannabis Use Disorder and Subsequent Acute Kidney Injury in Young Adults: Evidence From Nationwide Cohort

Introduction: Cannabis has been a well-recognized etiology of acute pancreatitis (AP) over last decade with some controversies. With increased availability of cannabis for recreational and medicinal purposes in managing chronic pain, it is essential to evaluate potential risk to multi-organ system. However, there is scarcity of large-scale data on the burden and risk of AP and subsequent acute kidney injury (AKI) among cannabis users. Methods: Using weighted discharges from the National Inpatient Sample (2016-2019), young (18-44 years) patients primarily admitted for AP with concomitant cannabis use disorder (CUD) were identified. Primary endpoints included odds and trends in AP with vs. without CUD, subsequent trends in AKI with associated sex/racial disparities and all-cause mortality. Secondary endpoints included patient disposition, hospital stay, and cost. Results: Of total 395,215 AP admissions, 29,815 (7.5%) were among patients with CUD. Crude rate of AP in CUD cohort was slightly higher vs. non-CUD admissions (n=29,815, 1.4 % vs. n=365,400, 1.1%), however, with slightly lower odds when adjusted for confounders (aOR 0.94, 95%CI:0.90-0.97, p< 0.001). The AP-CUD cohort often consisted of younger (median 33 vs 35 years), male (67.5% vs. 53.9%), blacks (28.9% vs 17.6%), patients from lowest income quartile, Medicaid enrollees vs. non-CUD cohort. Alcohol abuse, smoking, and drug abuse were significant higher in the AP-CUD cohort. Rate of AKI in AP-CUD cohort was 7% vs 6.5 % in non-CUD. Interestingly, among AP-CUD cohort, the rate of AKI was higher in males (8.3%, ptrend =0.092) vs females (4.3%, ptrend =0.104) with steady trends. The burden and trend of AKI in AP-CUD cohort was higher in Hispanics (Hispanic 9.3%, black 8.6%, white 5.6%; H: 9.1% in 2016 to 11.9% in 2017 ptrend< 0.004) (Figure). There was no significant difference in all-cause mortality between CUD and non-CUD cohorts (aOR 0.40; 95%CI:0.16-1.03, p=0.058). Routine discharges and median length of stay were comparable between cohorts (3 days) with an average cost was $25,724 in the AP-CUD cohort. Conclusion: There was a higher crude rate of AP admissions in the young CUD cohort, however, when adjusted for confounders, CUD was not independently associated with higher risk of AP, subsequent inpatient mortality, or rising trends in AKI. Hispanics demonstrated concerning trends in AKI. Future studies are warranted assessing long-term impact of polysubstance use on AP admissions and outcomes.Figure 1.: Trends in Acute Kidney Injury among Acute Pancreatitis admissions with Cannabis users by sex and race.

S1059 Burden and Impact of Cannabis Use Disorder on Outcomes of IBD Patients With Alcohol Abuse: A National Inpatient Sample Analysis 2019

Introduction: Alcohol use disorder can potentially trigger Inflammatory bowel disease (IBD) flare-ups. With increasing use of cannabis for symptomatic relief in IBD, the impact of its chronic/habitual use on IBD outcomes remains unclear. Therefore, in this study we aimed to assess the burden and impact of concomitant cannabis use disorder (CUD) on IBD patients with known alcohol abuse. Methods: The National Inpatient Sample (2019) with relevant ICD-10 codes were used to identify Alcoholic Inflammatory Bowel Disease (IBD) patients and Cannabis Use Disorder (CUD). We compared demographics, comorbidities, and outcomes of alcoholic IBD patients with vs. without CUD. Primary endpoints were hospital outcomes [MACCE:all-cause mortality, acute myocardial infarction (MI), cardiac arrest and stroke], intestinal obstruction, colorectal cancer, colectomy, acute kidney injury[AKI], and sepsis) compared between CUD and non-CUD cohort among alcoholic IBD patients. Multivariable regression analyses were performed adjusting for demographics, hospital-level characteristics and relevant comorbidities. Results: Of 11,140 hospitalizations with IBD and alcohol abuse, 1130 (10%) concomitantly had CUD. Majority of the CUD cohort was white, male and the median age at admission was 40 years (IQR 33- 51). Most of them were Medicaid enrollees (41.2%) and belonged to lower 2 median household income national quartiles (31.7, 31.2%) The CUD cohort had a lower rate of traditional cardiovascular risk factors and pulmonary comorbidities except higher rate of tobacco use disorder vs. non-CUD cohort. Rates of intestinal obstruction (aOR 1.80; 95%CI:O.75-4.29) (p=0.187) and colorectal cancer (aOR 1.42; 95% CI:0.37-5.54)(p=0.610) were high among the CUD cohort (Table). However, neither of them attained statistical significance. Conclusion: Despite a higher burden of cardiovascular disease risk factors, the CUD cohort had comparable outcomes/complications in alcoholic IBD patients vs. non CUD cohort. Future prospective studies are warranted to confirm and validate these findings focusing on mode, dose and duration of recreational/medicinal use of cannabis in IBD patients with rising prevalence of polysubstance use in the US. Table 1. - Multivariate odds of in-hospital outcomes in IBD-Alcohol Abuse Patients with vs. without Cannabis Use Disorder Odds ratio 95% CI P value Lower Upper MACCE 0.95 0.41 2.21 0.909 Intestinal obstruction 1.80 0.75 4.29 0.187 GIH 0.54 0.29 1.02 0.590 Colorectal cancer 1.42 0.37 5.54 0.610 Acute Kidney Injury 0.60 0.35 1.02 0.061 Sepsis 0.43 0.10 1.82 0.250 MACCE - Major Adverse Cardiovascular and Cerebrovascular Events - all cause mortality, acute MI, cardiac arrest, stroke. Multivariate regression models were adjusted for : Age, Sex, Race, Median household income quartile, payer status, type of admission, hospital bed size, location, teaching status, hypertension, diabetes, dyslipidemia, obesity, PVD, Prior MI, Prior PCI, Prior CABG, drug abuse, smoking, Prior TIA & Stroke, Prior VTE.

Cannabis use and cognitive impairment in schizophrenia

IntroductionNeurocognitive deficits amongst patients with schizophrenia are considered one of schizophrenia’s central features. These deficits appear to be present from the first episode of psychosis (FEP) and certain cognitive impairments could be components of a genetic vulnerability to schizophrenia. Regarding research on cannabis and cognition in schizophrenia, different studies have assessed neurocognitive functions: memory, attention/vigilance, processing speed, verbal learning, executive functions, and verbal fluency.ObjectivesThe aim is to do a review of recent findings concerning the association of cannabis use with cognition in schizophrenia.MethodsA literature review was conducted using the PubMed search database.ResultsPatients with schizophrenia and concomitant cannabis use are associated with worse performance in immediate verbal learning, and in some studies with worse working memory performance. There is an improvement of verbal memory when they cease the cannabis’ consumption. Regarding attention capacity and memory types assessed, the results are controversial. In FEP, heavy cannabis use during the previous year correlates with slower processing speed. Also, FEP-patients with cannabis use but no family history of psychosis perform worse in executive functions, while those with a family history of psychosis perform better.ConclusionsThe studies of psychosis, cannabis and cognition differ in relevant aspects, which might be connected to the result variability. Therefore, before solid conclusions can be reached, it is important to carry out longitudinal studies to understand the changes in the cognitive variables, which can depend on the pattern of cannabis’ use (concurrent or prior to the FEP). Possible confounding variables that might be present should be acknowledged.DisclosureNo significant relationships.

Concomitant Cannabis Misuse and Associations with Depression, Pain and Substance Misuse among Patients Prescribed Opioids.

Background: Cannabis use is common among individuals with pain who are prescribed opioids, occurring in approximately 10% of this population. This study aims to explore the relationship between non-medical cannabis use and other health risks among individuals filling opioids at community pharmacies. Methods: This study was an exploratory secondary data analysis of a National Drug Abuse Treatment Clinical Trials Network (CTN)-sponsored study, Validation of a Community Pharmacy-Based Prescription Drug Monitoring Program Risk Screening, examining the relationship between risky cannabis use and depressive symptoms, pain, overdose, and other substance misuse among individuals filling opioid prescriptions in community pharmacies (N = 1440). Results: Participants reporting moderate- to high-risk compared to low-risk cannabis use were more likely to report depressive symptoms (adjusted OR = 1.67, 95% CI = 1.11–2.56), history of overdose (adjusted OR = 2.15, 95% CI = 1.34–3.44), and moderate- to high-risk use of alcohol (adjusted OR = 2.10, 95% CI = 1.28–3.45), opioids (adjusted OR = 2.50, 95% CI = 1.67–3.76), sedatives (adjusted OR = 2.58, 95% CI = 1.72–3.86), stimulants (adjusted OR = 4.79, 95% CI = 2.83–8.01), and tobacco (adjusted OR = 3.60, 95% CI = 2.47–5.24). Conclusions: Community pharmacies may be valuable sites for identifying, studying, and intervening with substance use problems.

Trends and Socioeconomic Health Outcomes of Cannabis Use Among Patients With Gastroparesis: A United States Nationwide Inpatient Sample Analysis.

Although cannabis may worsen nausea and vomiting for patients with gastroparesis, it may also be an effective treatment for gastroparesis-related abdominal pain. Given conflicting data and a lack of current epidemiological evidence, we aimed to investigate the association of cannabis use on relevant clinical outcomes among hospitalized patients with gastroparesis. Patients with a diagnosis of gastroparesis were reviewed from the National Inpatient Sample (NIS) database between 2008 and 2014. Gastroparesis was identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes with patients classified based on a diagnosis of cannabis use disorder. Demographics, comorbidities, socioeconomic status, and outcomes were compared between cohorts using χ2 and analysis of variance. Logistic regression was then performed and annual trends also evaluated. A total of 1,473,363 patients with gastroparesis were analyzed [n=33,085 (2.25%) of patients with concomitant cannabis use disorder]. Patients with gastroparesis and cannabis use disorder were more likely to be younger and male gender compared with nonusers (36.7±18.8 vs. 51.9±16.8; P<0.001 and 52.9% vs. 33.5%; P<0.001, respectively). Race/ethnicity was different between groups (P<0.001). Cannabis users had a lower median household income and were more likely to have Medicaid payor status (all P<0.001). Controlling for confounders, length of stay, and mortality were significantly decreased for patients with gastroparesis and cannabis use (all P<0.001). While patients with gastroparesis and cannabis use disorder were younger, with a lower socioeconomic status, and disproportionately affected by psychiatric diagnoses, these patients had better hospitalization outcomes, including decreased length of stay and improved in-hospital mortality.

The concomitant use of cannabis and cocaine coexists with increased LPS levels and systemic inflammation in male drug users

Illicit drug use can cause a variety of effects including alterations in the immune system. The aim of this study was to investigate the effects of illicit drugs on circulating lipopolysaccharide (LPS), systemic inflammation and oxidative stress markers in drug users. We evaluated the levels of soluble CD14 (sCD14), LPS, inflammatory (TNF-α and IL-6) and regulatory (IL-10) cytokines, as well as C-reactive protein (CRP), lipid peroxidation (TBARS) and total thiols in the peripheral blood of 81 men included in groups of cannabis (n = 21), cocaine (n = 12), cannabis-plus-cocaine users (n = 27), and non-drug users (n = 21). The use of cannabis plus cocaine leads to higher systemic levels of LPS, CRP, IL-6 and higher IL-6/IL-10 ratio, characterizing a proinflammatory profile. In contrast, a regulatory profile as viewed by lower systemic TNF-α and IL-6 levels and lower TNF-α/IL-10 ratio were observed in cannabis users compared to the control group. Moreover, cocaine users presented a lower content of non-enzymatic antioxidant thiol compared to control group, cannabis group and cannabis plus cocaine group. In conclusion, our results indicate that the use of cannabis contributes to an anti-inflammatory/or regulatory profile while the concomitant cannabis plus cocaine consumption coexists with increased circulating amounts of LPS and proinflammatory status.

The effect of concomitant cannabinoids during immune checkpoint inhibitor treatment of advanced stage malignancy.

e15064 Background: Immune checkpoint inhibitors are used in treatment of advanced neoplasms. Immunotherapy agents create a potent pro-inflammatory effect in cancer. The efficacy of immunotherapy may negatively be impacted by the use of anti-inflammatory agents. An anti-inflammatory effect of cannabinoids has been described in literature in several models. Recent data suggests a negative impact of cannabis on tumor response to immunotherapy. Methods: We retrospectively reviewed medical records of all patients with metastatic cancer who received at least 2 months of immune checkpoint inhibitors between August 2014 and August 2018. The patients were stratified by use of cannabis (cannabis vs non-cannabis users). Baseline patients’ characteristics were compared. Overall survival was estimated and compared between the two groups. An analysis was performed using analysis of variance, Student's t-test, correlation, chi-squared test, and logrank test. All data were analyzed with SPSS v. 26.0 and a p-value less than 0.05 was set to indicate statistical significance. Results: A total of 104 patients with advanced-stage malignancy met the inclusion criteria. The median age was 63.9±10.5 years, 48.1% males and 81.7% Caucasians. 41.3% of patients has lung adenocarcinoma, 20.3% has squamous cell carcinoma of the lung, 11.5% has squamous cell carcinoma of the head and neck and 26.9% have other tumor types. Twenty patients (19.2%) had brain metastasis and twenty-three patients (22.1%) had bone metastasis. Seventy patients (66.8%) received Nivolumab, and twenty-seven patients (26%) received Pembrolizumab. The mean duration of immunotherapy use was 10.2 months. Characteristics of patients were similar between the groups except for a higher prevalence of tobacco use in the cannabis group. Twenty-eight patients (26.9%) reported concomitant cannabis use during immunotherapy treatment, 23 were prescribed (dronabinol) and 5 used it recreationally (smoking marijuana/cannabis oil). Non-cannabis users had significantly longer overall survival (OS) compared to cannabis users (40 months vs 16 months, p = 0.004). Conclusions: This study shows significant association between the use of cannabis during immunotherapy treatment and worse OS. This can be explained by an anti-inflammatory effect of cannabis, which may decrease response to immune checkpoint inhibitors. This observation should be further investigated in randomized trials. Health care professionals should be aware of the potentially harmful effect of cannabis on cancer care.

Buprenorphine\u2013cannabis interaction in patients undergoing opioid maintenance therapy

Buprenorphine is a partial μ-opioid agonist widely used for opioid maintenance therapy (OMT). It is mainly metabolized to pharmacologically active norbuprenorphine by the cytochrome P450 (CYP) isozyme 3A4. This may give rise to drug–drug interactions under combinations with inhibitors or inducers of CYP3A4. Cannabis is a potential inhibitor of CYP3A4, and there is a large degree of concomitant cannabis use among OMT patients. We performed a retrospective analysis on liver healthy OMT patients substituted with buprenorphine, either with (n = 15) or without (n = 17) concomitant use of cannabis. Patients with additional illicit drugs or medications affecting CYP3A were excluded. Measured blood concentrations of buprenorphine and norbuprenorphine were compared between the two groups. Cannabis users and non-users received similar doses, but users had 2.7-fold higher concentrations of buprenorphine (p < 0.01) and 1.4-fold for norbuprenorphine (1.4-fold, p = 0.07). Moreover, the metabolite-to-parent drug ratio was 0.98 in non-users and 0.38 in users (p = 0.02). Female gender did not produce significant effects. These findings indicate that cannabis use decreases the formation of norbuprenorphine and elevates buprenorphine and norbuprenorphine concentrations in blood most probably by inhibition of CYP3A4. The pharmacokinetic interaction may give rise to enhanced or altered opioid activity and risk of intoxications. Physicians should inform patients about this risk and supervise cannabis users by regular control of buprenorphine blood levels, i.e., by therapeutic drug monitoring.

Distinct effects of cocaine and cocaine + cannabis on neurocognitive functioning and abstinence: A six-month follow-up study

Background and AimsCannabis use is frequent among individuals with cocaine use disorder. Despite recent non-controlled studies advocating a therapeutic role of smoked cannabis, there is a paucity of evidence-based data on potential therapeutic and cognitive side-effects of this association. MethodsWe examined 63 cocaine-addicted subjects who used cannabis more than 50 times in lifetime (COC + CAN), 24 cocaine-addicted patients who use cannabis less than 50 times (COC), and 36 controls (CON). Participants were evaluated with an extensive battery of neurocognitive tests after two weeks of supervised detoxification in an inpatient treatment program. Patients were followed up in one, three, and six months after discharge. ResultsBoth groups of patients performed worse than CON on working memory, processing speed, inhibitory control, mental flexibility, and decision making. COC + CAN performed worse than COC on speed processing, inhibitory control and sustained attention, while COC performed worse than COC + CAN on mental flexibility. Concomitant cannabis use did not decrease relapses to cocaine use after one, three and six months. Among COC + CAN, earlier cocaine and cannabis use, and impaired executive functioning were predictive of relapse on cocaine after six months. ConclusionOur results did not support the recommendation of smoked cannabis as a safe therapeutic approach for cocaine-addicted patients due to significant negative cognitive side-effects and absence of efficacy. Further studies investigating frontal brain morphology, neuromaturation, and prescription of the non-psychoactive constituent of cannabis sativa cannabidiol among cocaine-addicted patients who use cannabis are warranted.

Acute separate and combined effects of cannabinoid and nicotinic receptor agonists on MMN-indexed auditory deviance detection in healthy humans

The high prevalence of concomitant cannabis and nicotine use has implications for sensory and cognitive processing. While nicotine tends to enhance function in these domains, cannabis use has been associated with both sensory and cognitive impairments, though the underlying mechanisms are unclear. Additionally, the interaction of the nicotinic (nAChR) and cannabinoid (CB1) receptor systems has received limited study in terms of sensory/cognitive processes. This study involving healthy volunteers assessed the acute separate and combined effects of nabilone (a CB1 agonist) and nicotine on sensory processing as assessed by auditory deviance detection and indexed by the mismatch negativity (MMN) event-related potential. It was hypothesized that nabilone would impair auditory discriminability as shown by diminished MMN amplitudes, but not when administered in combination with nicotine. 20 male non-smokers and non-cannabis-users were assessed using a 5-stimulus ‘optimal’ multi-feature MMN paradigm within a randomized, placebo controlled design (placebo; nabilone [0.5 mg]; nicotine [6 mg]; and nicotine + nabilone). Treatment effects were region- and deviant-dependent. At the temporal regions (mastoid sites), MMN was reduced by nabilone and nicotine separately, whereas co-administration resulted in no impairment. At the frontal region, MMN was enhanced by co-administration of nicotine and nabilone, with no MMN effects being found with separate treatment. These neural effects have relevance for sensory/cognitive processes influenced by separate and simultaneous use of cannabis and tobacco and may have treatment implications for disorders associated with sensory dysfunction and impairments in endocannabinoid and nicotinic cholinergic neurotransmission.

Brief Report: Hazardous Cannabis Use and Monocyte Activation Among Methamphetamine Users With Treated HIV Infection.

The use of stimulants, such as methamphetamine, has been associated with greater immune activation in treated HIV infection. However, relatively little is known about whether concomitant cannabis use is associated with lower immune activation among HIV-positive stimulant users. HIV-positive, sexual minority men with biologically confirmed, recent methamphetamine use were enrolled in San Francisco, CA. In total, 78 methamphetamine-using sexual minority men with an undetectable HIV viral load (<40 copies/mL) completed self-report measures of cannabis use and substance use disorder severity. Plasma biomarkers of monocyte activation (ie, sCD14 and sCD163) and intestinal barrier integrity (iFABP) were measured. The associations of hazardous cannabis use with these measurements were examined after adjusting for substance use disorder severity, age, antiretroviral therapy regimen, CD4 T-cell count, and interleukin-6. Hazardous cannabis users had the highest mean sCD14 levels (2181 ng/mL) compared with nonhazardous users (1991 ng/mL) and nonusers (1859 ng/mL; P = 0.05). In adjusted analyses, greater cannabis use severity was associated with higher sCD14 compared with nonusers (unstandardized beta = 133.6 ng/mL, P = 0.03). Cannabis use severity was not significantly associated with sCD163 or iFABP. Hazardous cannabis use is independently associated with elevations in a clinically relevant marker of immune activation in methamphetamine users with treated HIV.

Early Somatosensory Processing Over Time in Individuals at Risk to Develop Psychosis.

Objective: Somatosensory evoked potentials (SEPs) enable the investigation of thalamocortical and early cortical processing. Previous studies reported alterations of SEPs in patients with schizophrenia as well as in individuals in the prodromal stage. Moreover, cannabis use as an environmental risk factor for the development of schizophrenia has been demonstrated to influence SEP parameters in individuals at risk to develop psychosis. The aim of this study was to explore the course of SEP changes and the impact of concomitant cannabis use in individuals at risk to develop psychosis who sought medical help.Methods: Median nerve SEPs including high-frequency oscillations (HFOs) superimposed on the primary cortical response (N20) were investigated using multichannel EEG in individuals (n = 54 at baseline) remaining at risk to develop psychosis at follow-up after 1 year (high-risk: n = 19; ultra-high-risk: n = 27) vs. subjects with conversion to psychosis (n = 8) and a healthy control group (n = 35). Longitudinal and cross-sectional analyses of SEP components as estimated by dipole source analysis were performed.Results: The longitudinal development of the N20 strength depended on cannabis use. In cannabis non-users, a greater decrease of N20 strengths over time was associated with more negative symptoms at baseline. At baseline, converters did not differ from subjects remaining at risk. At follow-up, converters showed increased low- and high-frequency activity than at-risk subjects and did not differ from controls.Conclusion: The results of this study lead to the suggestion that the deficits in early somatosensory processing in individuals at risk to develop psychosis may not represent a marker for a genetic risk for psychosis but rather reflect state-dependent factors such as negative symptoms. On the other hand, the transition to psychosis seems to represent an interstage between reduced sensory registration from the at-risk state and gating deficits in the chronic state.

P.2.12 The effect of chronic stress and concomitant cannabis exposure on behaviour and adult hippocampal neurogenesis in mice

P.2.12 The effect of chronic stress and concomitant cannabis exposure on behaviour and adult hippocampal neurogenesis in mice

Reduced Risk of Alcohol-Induced Pancreatitis With Cannabis Use.

Pancreatitis is an increasingly common clinical condition that causes significant morbidity and mortality. Cannabis use causes conflicting effects on pancreatitis development. We conducted a larger and more detailed assessment of the impact of cannabis use on pancreatitis. We analyzed data from 2012 to 2014 of the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample discharge records of patients 18years and older. We used the International Classification of Disease, Ninth Edition codes, to identify 3 populations: those with gallstones (379,125); abusive alcohol drinkers (762,356); and non-alcohol-non-gallstones users (15,255,464). Each study population was matched for cannabis use record by age, race, and gender, to records without cannabis use. The estimation of the adjusted odds ratio (aOR) of having acute and chronic pancreatitis (AP and CP) made use of conditional logistic models. Concomitant cannabis and abusive alcohol use were associated with reduced incidence of AP and CP (aOR: 0.50 [0.48 to 0.53] and 0.77 [0.71 to 0.84]). Strikingly, for individuals with gallstones, additional cannabis use did not impact the incidence of AP or CP. Among non-alcohol-non-gallstones users, cannabis use was associated with increased incidence of CP, but not AP (1.28 [1.14 to 1.44] and 0.93 [0.86 to 1.01]). Our findings suggest a reduced incidence of only alcohol-associated pancreatitis with cannabis use.

Association of Cannabis Use with Pancreatitis

Introduction: Acute and chronic pancreatitis (AP and CP) are painful inflammatory disorders causing substantial public health burden. The etiology of pancreatitis is clustered into three groups: alcohol, gallstones, and others (non-gallstones-non-alcohol). Containing potent anti-inflammatory cannabinoids, cannabis use (CU) could suppress pancreatitis, has shown in murine models. Furthermore, conflicting results are reported in other studies where cannabinoids have aggravated pancreatitis. However, human data are lacking, besides few reported cases. Therefore, we conducted a more extensive and detailed assessment of the impact of CU on pancreatitis. Methods: We collected data from 2012-2014 of the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (NIS) discharge records of patients 18-years and older, and identified three populations: those with gallstones (379,125); abusive alcohol drinkers (762,356); and non-gallstones-non-alcohol users (15,255,464). Within each population, CUsers were identified and matched by age, race, and gender to records without CU. Adjusted Odds Ratio (AOR) of having AP and CP were measured with conditional logistic models (SAS 9.4). Results: Concomitant cannabis among abusive alcohol use was associated with reduced odds of AP and CP (aOR: 0.50[0.48-0.53] and 0.77[0.71-0.84]). Strikingly, for individuals with gallstones, additional CU did not impact the incidence of AP or CP. Amongst non-gallstones-non-alcohol users, CU was associated with increased likelihood of CP, but not AP (1.28[1.14-1.44] and 0.93[0.86-1.01]). Conclusion: Our findings suggest reduced odds of only alcohol-associated pancreatitis with CU. Our results emphasize the urgent need for further studies to elucidate the modulatory effect of cannabis on pancreatitis among different risk groups.

Risperidone Provides Better Improvement of Sleep Disturbances Than Haloperidol Therapy in Schizophrenia Patients With Cannabis-Positive Urinalysis.

A high percentage of persons with Schizophrenia also uses Cannabis and this may potentially alter the therapeutic benefits of the antipsychotic medications prescribed. The aim of this study was to assess the impact of Cannabis usage on antipsychotic therapy of sleep disturbances in schizophrenia subjects. Male subjects, ≥18 years, admitted to the University Hospital of the West Indies psychiatric ward between October 2015 and October 2016, and diagnosed with schizophrenia were recruited for the study. Following written informed consent to the study, subjects were prescribed either risperidone monotherapy or haloperidol monotherapy orally for 14 days and classified as Cannabis users (CU) or non-users (non-CU), with presence/absence of Cannabis metabolite in urine samples. After 1 week of admission, subjects wore the Actiwatch-2 device, to record sleep data for 7 consecutive nights. Inferential statistical analysis involved non-parametric tests, expressed as median and inter-quartile ranges (IQR), with p<0.05 considered statistically significant. Fifty subjects were assessed, with a median (IQR) age of 28 (14) years. Majority (30; 60%) were CU, displaying longer sleep latency (SL) than non-CU when receiving haloperidol; but equivalent SL when receiving risperidone. In comparison to non-CU, the CU also displayed longer time in bed, but shorter durations asleep, awoke more frequently during the nights and for longer durations, whether receiving haloperidol or risperidone. This resulted in lower sleep efficiency for the CU (<85%) compared to the non-CU (≥85%). Over the study period, sleep efficiency was significantly improved for non-CU receiving either risperidone (p = 0.032) or haloperidol (p = 0.010); but was only significantly improved with risperidone for the CU (p = 0.045). It is apparent that the presence of Cannabis may be impacting the therapeutic benefits of antipsychotic drugs on sleep. In schizophrenia subjects with concomitant Cannabis use, risperidone is more beneficial than haloperidol in improving sleep efficiency.

Concomitant cannabis abuse/dependence in patients treated with opioids for non-cancer pain.

Cannabis use is common among patients taking prescription opioids, although rates of concomitant cannabis use disorder (CUD) have been largely unexamined. CUD may increase safety risks in those taking opioid pain medications but it is unknown whether cannabis and opioids function as substitutes (cannabis use is associated with less prescription opioid use), or rather as complements (cannabis is associated with increased use of prescription opioids). We examined rates of CUD in a national sample of Veterans Health Administration (VHA) patients (n = 1,316,464) with non-cancer pain diagnoses receiving opioid medications in fiscal year 2012. Using bivariate analysis to identify potentially confounding variables associated with CUD (e.g., psychotropic medication, other substance use disorders) in this population, we then utilized logistic regression to examine rates of cannabis use disorder among individuals receiving different numbers of opioid prescriptions (0, 1-2, 3-10, 11-19, 20+). Descriptive analysis, largely confirmed by logistic regression, demonstrated that greater numbers of prescription opioid fills were associated with greater likelihood of CUD. This relationship was reduced somewhat for those receiving the most opioid prescriptions (20+) in the logistic regression, which controlled for potentially confounding variables. These results warrant increased attention to CUDs among patients receiving numerous opioid prescriptions. Increasing legalization of cannabis is likely to further increase use and abuse of cannabis in patients prescribed opioids. These findings suggest that clinicians should be alert to concomitant CUD and prescription opioid use, as these substances appear to complement each other.

Ultra-Rapid Opiate Detoxification Followed by Nine Months of Naltrexone Maintenance Therapy in Iran

The aim of this retrospective study was to assess ultra-rapid opiate detoxification (UROD) and to estimate the retention rate in naltrexone maintenance treatment. 45 opiate-addicted male patients (DSM-IV 304.00; opiate per oral or per inhalation n=40, heroin intravenous n=5; concomitant cannabis abuse n=6) were detoxified by 6 h of naloxone infusion under general anesthesia with midazolam, propofol, clonidine and atracurium. Withdrawal signs were evaluated by the objective opiate withdrawal scale (OOWS, range 0-13) up to 24 h after awakening. After UROD, naltrexone 50 mg/day was prescribed for 9 months with assessments in 4-week intervals. Adverse events after UROD were prolonged unconsciousness (n=1), transient confusion (n=8) and depressive mood (n=6). The total sample showed a median OOWS score of 2 (mild withdrawal syndrome). The only two extreme outliers were found only in the subgroups "intravenous" (score 8) and "cannabis" (score 11). 96% (43/45) of the patients could be discharged the day after UROD. Thirty-six patients (80%) continued naltrexone therapy for the entire 9-month observation period. UROD and subsequently induction of naltrexone maintenance therapy can be regarded as safe and effective in patients with pure opiate addiction. Owing to cultural and economical factors our Iranian results may not correspond to European and American treatment modalities.

Cyclic Vomiting and Compulsive Bathing With Chronic Cannabis Abuse

Cannabis is commonly recognized for its antiemetic properties. However, chronic cannabis use can lead to paroxysmal vomiting. In some patients this vomiting can take on a pattern identical to cyclic vomiting syndrome. Interestingly cyclic vomiting syndrome has been associated with compulsive bathing which patients report can relieve their intense feelings of nausea and lessen their vomiting intensity. We report a case of a patient with chronic cannabis use who developed symptoms similar to cyclic vomiting syndrome who also engaged in compulsive bathing behavior as observed by members of the medical and nursing staff. The patient reported that frequent hot showers would prevent him from vomiting and also relieve his concomitant abdominal pain. Previous hospitalizations at our hospital for the same complaint also noted similar showering behavior. During the hospital stay, the patient agreed to engage in a outpatient drug rehabilitation program which he subsequently completed. Abstinence from cannabis use caused the patients vomiting symptoms and abdominal pain to disappear completely. Likewise, his compulsive showering behavior also ceased. Other investigators have reported similar findings in patients with cyclic vomiting syndrome who initially used cannabis to treat their vomiting episodes but subsequently found that it contributed to their vomiting. Our patient has lead us to conclude that in patients seen for chronic severe vomiting and abdominal pain which has no obvious structural or chemical etiology and which is accompanied by compulsive showering and/or bathing behavior a diagnosis of cyclic vomiting syndrome with concomitant cannabis abuse needs to be considered.