Tetrahydrocannabinol Research Articles

Association of Tetrahydrocannabinol Content and Price in Herbal Cannabis Products Offered by Dispensaries in California: A Purview of Consumers/Patients.

Background and AimsThe U.S. legal cannabis market is saturated with products containing high levels of tetrahydrocannabinol (THC), with no distinction between medical and recreational programs. This omnipresence of potent cannabis products seems to be driven by the recreational realm, where cannabis with the highest THC content is prized. This prevalence of highly potent cannabis is conveyed to medical programs, which places consumers (patients) at higher risk for over consumption and cannabis use disorder. Thus, understanding what factors influence the market that patients face in medical cannabis programs could shed light on the risks of legal cannabis. The supply and demand dynamic of the US for-profit cannabis market could explain the current market composition; therefore, we postulate that a financial gain could influence the perpetuation of the prevalence of high THC products in legal cannabis dispensaries. We investigate whether THC content in popular cannabis products correlates with higher prices and assess whether some attributes (type of product, chemovars, or presence of cannabidiol (CBD) affect the association of THC with price.MethodsWe focus on the world's largest cannabis market, California. We randomly selected dispensaries across the state, screened for a web presence and product menu, determined the most prevalent product type, and collected THC and CBD concentration, price, and other product attributes.ResultsWe observed that herbal products were more common, they had THC concentrations greater than 10%, and THC concentrations positively correlated with price. This correlation existed in flower and preroll presentations, all chemovar, and independently of the level of CBD. CBD did not correlate with price; however, the presence of CBD diminished the THC and price correlation particularly in products with high THC (>15%).ConclusionsOverall, highly potent herbal cannabis products (>15% THC) are the majority of products offered and more expensive regardless of product type or chemovar in California dispensaries, suggesting that a financial gain contributes to the current market composition. Efforts to limit the availability of highly potent THC products and educate consumers about potential harms are needed.

In Vitro Effect of Δ9-Tetrahydrocannabinol and Cannabidiol on Cancer-Associated Fibroblasts Isolated from Lung Cancer.

There is evidence that demonstrates the effect of cannabinoid agonists inhibiting relevant aspects in lung cancer, such as proliferation or epithelial-to-mesenchymal transition (EMT). Most of these studies are based on evidence observed in in vitro models developed on cancer cell lines. These studies do not consider the complexity of the tumor microenvironment (TME). One of the main components of the TME is cancer-associated fibroblasts (CAFs), cells that are relevant in the control of proliferation and metastasis in lung cancer. In this work, we evaluated the direct effects of two cannabinoid agonists, tetrahydrocannabinol (THC) and cannabidiol (CBD), used alone or in combination, on CAFs and non-tumor normal fibroblasts (NFs) isolated from adenocarcinoma or from healthy lung tissue from the same patients. We observed that these compounds decrease cell density in vitro and inhibit the increase in the relative expression of type 1 collagen (COL1A1) and fibroblast-specific protein 1 (FSP1) induced by transforming growth factor beta (TGFβ). On the other hand, we studied whether THC and CBD could modulate the interactions between CAFs or NFs and cancer cells. We conditioned the culture medium with stromal cells treated or not with THC and/or CBD and cultured A549 cells with them. We found that culture media conditioned with CAFs or NFs increased cell density, induced morphological changes consistent with EMT, inhibited cadherin-1 (CDH1) gene expression, and induced an increase in the relative expression of cadherin-2 (CDH2) and vimentin (VIM) genes in A549 cells. These changes were inhibited or decreased by THC and CBD administered alone or in combination. In another series of experiments, we conditioned culture media with A549 cells treated or not with THC and/or CBD, in the presence or absence of TGFβ. We observed that culture media conditioned with A549 in the presence of TGFβ induced an increase in the expression of COL1A1 and VIM, both in CAFs and in non-tumor NFs. Both THC and CBD ameliorated these effects. In summary, the results presented here reinforce the usefulness of cannabinoid agonists for the treatment of some relevant aspects of lung cancer pathology, and demonstrate in a novel way their possible effects on CAFs as a result of their relationship with cancer cells. Likewise, the results reinforce the usefulness of the combined use of THC and CBD, which has important advantages in relation to the possibility of using lower doses, thus minimizing the psychoactive effects of THC.

Promising Health Benefits of Adjuvant Acmella and Zingiber Extracts Combined with Coenzyme Q10 Phytosomes, Supplementation in Chronic Pain Treated with Medical Cannabis: A Prospective and Open-Label Clinical Study.

Background Chronic pain is a condition where pain persists for months or even years. Nowadays, several drugs comprising of medical cannabis are utilized for chronic pain relief. Even if there are some associated side effects, the use of supplements can widen the reliable tools available for improving an individual's quality of life. Objective The aim of the present study was to evaluate the efficacy in terms of pain intensity, psychological well-being, and quality of life of a new dietary supplement in chronic pain subjects under current treatment with medical cannabis. Methods In this pilot study, 48 medical cannabis-treated subjects were supplemented with a dietary supplement containing a combination of standardized Zingiber officinalis and Acmella oleracea extracts in phytosome (Mitidol), coenzyme Q10 phytosome (Ubiqsome), and group B vitamins (B1, B6, and B12), twice daily for 90 days. In order to explore the benefits of the product as an adjuvant supplementation for pain relief, the pain intensity, measured by the visual analogue scale (VAS), the pain type, and quality, evaluated by the Italian Pain Questionnaire (QUID) and the possible reduction of therapeutic and/or painkiller doses were recorded. Results After 90 days, significant pain relief was detected in almost 70% of the subjects receiving the new dietary supplement, with sensory, emotional, and pain amelioration in one-third of them. A reduction in both tetrahydrocannabinol (THC) and cannabidiol (CBD) doses was also observed after 3 months of supplementation. These findings demonstrate new perspectives for the use of an innovative dietary supplement that combines Acmella and Zingiber extracts, Coenzyme Q10, and group B vitamins resulting in a beneficial long-term adjuvant in cannabis-treated pain subjects.

Fast and highly sensitive determination of tetrahydrocannabinol (THC) metabolites in hair using liquid chromatography-multistage mass spectrometry (LC-MS3 ).

In hair analysis, identification of 11-nor-9-carboxy-∆9 -tetrahydrocannabinol (THC-COOH), one of the major endogenously formed metabolites of the psychoactive cannabinoid tetrahydrocannabinol (THC), is considered unambiguous proof of cannabis consumption. Due to the complex hair matrix and low target concentrations of THC-COOH in hair, this kind of investigation represents a great analytical challenge. The aim of this work was to establish a fast, simple, and reliable LC-MS3 routine method for sensitive detection of THC-COOH in hair samples. Furthermore, the LC-MS3 method developed also included the detection of derivatized 11-hydroxy-∆9 -THC (11-OH-THC) as an additional marker of cannabis use. Hair sample preparation prior to detection of the two THC metabolites was based on digestion of the hair matrix under alkaline conditions followed by an optimized liquid-liquid extraction (LLE) procedure. Sample preparation by LLE proved to be more suitable than solid-phase extraction (SPE) due to less laborious and time-consuming steps while still yielding satisfactory results. A significant improvement in analytical detection was introduced by multistage fragmentation (MS3 ), which led to enhanced sensitivity and selectivity and thus low limits of quantification (0.1pg/mg hair). The MS3 method included two transitions for THC-COOH (m/z 343 → 299 → 245 and m/z 343 → 299 → 191) encompassing the quantifier (m/z 245) and the qualifier ion (m/z 191). The method was fully validated, and successful application to authentic toxicology case samples was demonstrated by the analysis of more than 2000 hair samples from cannabis users with THC-COOH concentrations determined ranging from 0.1 to >15 pg/mg hair.

A natural history study of medical cannabis consumption in pediatric autism in the United States

BackgroundAutism spectrum disorder is specifically approved for medical cannabis consumption in 20 U.S. states, the District of Columbia, and the Territory of Puerto Rico. Despite increased access, there is limited knowledge about who consumes medical cannabis, what they consume, and perceived effectiveness. We addressed these gaps by conducting a natural history study of medical cannabis consumption. MethodChildren and their families engaged with a large pediatric care system were recruited to complete a telephonic study regarding their medical cannabis consumption. All children had to be consuming approved medical cannabis products issued from a state that had legalized medical cannabis for the treatment of ASD or related behaviors (irritability, hyperactivity, anxiety) (N = 89). ResultsThe sample’s ‘level of support’ and gender-ratio reflected the general autism population (~33 % requiring ‘Very Substantial Support’ and ~80 % male). The most common treatment targets were ASD behaviors (repetitive behaviors) and irritability. More children consumed compounds with high cannabidiol (CBD) and low or no tetrahydrocannabinol (THC). While dose did not affect overall perceived effectiveness, compounds with high-levels of CBD and low-levels of THC (CBD-dominant) were perceived as more effective than CBD-only. ConclusionsThis “real world” study revealed that medical cannabis is being used to treat a wide range of behaviors. Our study also suggests that children consume CBD-rich products, and the effectiveness of CBD-dosing may be tied to the inclusion of THC in the compound. Future research should evaluate optimal dosing with a particular focus on the CBD-to-THC ratio.

Background: Nonalcoholic fatty liver disease (NAFLD) is the commonest cause of chronic liver disease worldwide, being nonalcoholic steatohepatitis (NASH) its most clinically relevant form. Given the risks associated with taking a liver biopsy, the design of accurate non-invasive methods to identify NASH patients is of upmost importance. BMP2 plays a key role in metabolic homeostasis; however, little is known about

Drug use is a growing problem in actual society. Usually, the first experience with drugs takes place during adolescence, being cannabis the most used illicit drug. Although cannabis could be considered a harmless drug, we are beginning to appreciate its consequences. Chronic exposure to addictive drugs has shown to imbalance glutamate homeostasis in Nucleus Accumbens (NAc), altering plasticity mechanisms such as long-term depression. Therefore, it is crucial to elucidate the mechanisms underlying these alterations and how to reverse them. It is known the activation of cannabinoid receptors in astrocytes modulate synaptic plasticity and could be involved in glutamate homeostasis. However, the functional role of astrocytes in alterations derived from chronic drug exposure is not fully understood. In this study, we analyzed how astrocytes contribute to alterations produced by tetrahydrocannabinol (THC). Using fiber photometry in vivo we analyzed astrocytic activity (Ca2+ and glutamate dynamics) in NAc after 1mg/kg THC chronic administration in wildtype and p38αMAPK-/- (Astrop38α) mice4 and we performed electrophysiology experiments to analyze synaptic plasticity. Moreover, we performed behavioral tests to assess whether THC had reinforcing properties or affected learning and memory. Furthermore, using a chemogenetic approaches (DREADDs) we activated NAc astrocytes to analyze their behavioral implications. We observed: 1)THC increases astrocytic calcium activity; 2)THC induces glutamate release in NAc in wildtype, but not Astrop38α; 3)NAc astrocytes are involved in learning; 4)Removal of p38αMAPK in NAc astrocytes restores THC-related impairments. Altogether, our results reveal astrocytes as critical elements for the maintenance of glutamate signaling, with a significant role in drug-use-related alterations.

NURS-04. Marijuana, Hemp, and the Child with Cancer: Education for Nurses

Abstract Many pediatric oncology patients report medical marijuana (MMJ) and hemp-based cannabidiol (CBD) use. Nearly 4,000 minors are registered users of marijuana in Colorado, the first state in the United States of America (USA) to legalize recreational marijuana. Medical marijuana is legalized in 37 states and four territories in the USA. Additionally, due to the bipartisan Farm Bill passed in December of 2018, hemp is federally legal. Forty-three countries have also legalized medical marijuana. With increased legality and many countries decriminalizing marijuana, the use of MMJ and hemp-based CBD is also increasing. This upsurge in use raises significant concerns with pharmacological interactions with CBD and the medications routinely administered to children with cancer (including chemotherapy). Cannabis-derived pharmaceuticals can also have pharmacological interactions. Nurses are the frontline for discussions with patients about MMJ and must be aware of the emerging field of MMJ in pediatric cancer. Education including the difference between tetrahydrocannabinol (THC) and CBD and their indications, extraction methods and safety, product types, infection control, and dosing considerations are important for nurses to learn. Nurses with increased knowledge will then help patients and families make educated and safer choices in treating their children for tumor treatment and side effect management with MMJ and hemp-based CBD. Additionally, nurses can influence patient care protocols and processes for alternative therapy administration enabling an open dialogue between providers, parents, and patients regarding treatments, symptoms, adverse effects, and drug interactions.

Sociodemographic characteristics and correlates of Delta-8 THC use in US adults

Introduction Recent reports suggest that Delta-8 THC use has surged during the past year. Although Delta-8 THC is believed to have relatively low psychoactive potency, its effects are not well characterized and the associated individual and public health risks are unknown.ObjectivesIdentify patterns of Delta-8 THC use among US adult cannabis users and examine associations with sociodemographic characteristics and cannabis use-related variables.MethodsWe surveyed 4,349 US adult cannabis users recruited via online advertisements. We calculated frequencies of sociodemographic characteristics in past 30-day Delta-8 THC users. Odds ratios were used to indicate associations between sociodemographic characteristics and past 30-day Delta-8 THC use.ResultsRespondents aged 45–64 years were significantly more likely than other age groups to have used Delta-8 THC during the past 30 days (odds ratio=1.48, 95% CI 1.04, 2.11). Fifty-eight percent of the sample had heard of Delta-8 THC, 66.8% of which had first heard of it during the last year and 37.1% first heard of it via social media. The most common methods of consumption were vaping concentrates and edibles. We identified motivations for use of Delta-8 THC that potentially indicate a preference for legal options and/or a perception that Delta-8 THC has medical benefits.ConclusionsThis study provides a snapshot of patterns of Delta-8 THC use among US adult cannabis users. Further investigation of the perceived medical benefits of Delta-8 THC, the role of social media in promoting its use, and the effectiveness of restrictions on Delta-8 THC products would provide further information to guide public health policy regarding Delta-8 THC.DisclosureNo significant relationships.

AHA's new statement focuses on cannabis and brain health

AHA's new statement focuses on cannabis and brain health

Cannabis Regulations Being Evaded by Use of Novel THC Isomers

Back to table of contents Previous article ViewpointsFull AccessCannabis Regulations Being Evaded by Use of Novel THC IsomersSamuel J. Dotson, M.D.Samuel J. DotsonSearch for more papers by this author, M.D.Published Online:25 May 2022https://doi.org/10.1176/appi.pn.2022.06.6.31The public discourse over the legal status of marijuana has largely centered on traditional cannabis products, including whole plant material and its major purified cannabinoids, delta-9-tetrahydrocannabinol (delta-9-THC) and cannabidiol (CBD). Many psychiatrists remain unaware, however, of the ways that nuanced legal distinctions between cannabis, marijuana, hemp, and these specific constituent molecules can profoundly impact the availability of these substances.Delta-9-THC is the molecule classically credited with the plant’s psychoactive properties, while CBD is nonintoxicating but has been reported to have anxiolytic and possible antipsychotic effects. Delta-9-THC, however, is not the only form of intoxicating THC in cannabis plants. THC is best understood as a family of natural and synthetic isomers that have varying activity at the CB1 receptor and can thereby induce a variety of desirable (for example, euphoria, relaxation) and undesirable psychoactive effects (for example, addiction, psychosis). Cannabis strains differ not only in their delta-9-THC and CBD content, but also i1n the trace content of these other THC isomers that naturally can include small amounts of delta-8-THC and delta-10-THC. DSM-5-TR nomenclature reflects this reality by using the broad term “cannabis use disorder” rather than exclusively focusing on one component molecule.Although Cannabis species have many uses beyond their controversial recreational and medicinal applications, their cultivation has long been limited within the United States by regulation of the Drug Enforcement Administration under the Controlled Substances Act. Congress therefore passed the Agriculture Improvement Act of 2018 (also known as “the 2018 Farm Bill”) in an effort to support the growth of America’s domestic hemp market.This law led to a rapid proliferation of hemp and CBD products within the United States. These products, however, can be easily converted into delta-8-THC and a variety of other intoxicating compounds including the THC-O acetate derivatives, hexahydrocannabinol (HHC), tetrahydrocannabiphorol (THCP), and tetrahydrocannabivarin (THCV). Manufacturers have subsequently used this loophole to create a new market for psychoactive THC isomers that are sold as “legal hemp derivatives.”These emerging psychoactive cannabinoids are now bypassing regulation around the country, and they have become especially popular in states that still have restrictive marijuana laws. Many are being marketed as “diet weed” or “marijuana light” in candylike packaging that gives an impression of safety, especially to adolescents. The few available clinical reports, however, show qualitatively similar effects to traditional delta-9-THC during short-term use. These molecules appear to primarily differ in their potency, with delta-8-THC being about two-thirds that of delta-9-THC, and delta-9-THC-O acetate being about twice as potent. Safety concerns are surfacing, but these discussions remain largely relegated to emergency medicine and public health circles with a focus on acute intoxication and contamination risks. The academic literature has thus far neglected the potential for long-term adverse impacts on mental health, which are especially salient for addiction and psychosis specialists.Throughout the United States, delta-8-THC has now become the fastest growing segment of the cannabis market. An industry report by the Brightfield Group found that consumers interested in switching from CBD to delta-8-THC are more likely to use the drug daily and more likely to have a mental illness than the average CBD consumer. Further supporting these concerns, a survey posted November 19, 2021, in Cannabis and Cannabinoid Research found that many people are using delta-8-THC to self-treat mental illness without informing their medical providers. Notably, the authors found that 35.6% of respondents had substituted the drug for their antidepressant, and 23.3% had done the same for their prescribed antipsychotic.Many communities are now struggling to regulate these products given the increasing power of the marijuana lobby. Without further research, policymakers and medical professionals will be left in an evidence vacuum. While we await more data, we can serve as advocates in our communities by educating politicians, parents, and patients on the known risks of traditional marijuana use, as well as the unknown and potential risks of novel THC isomers. ■Editor’s note: In May, the Food and Drug Administration issued warning letters to five companies illegally selling products labeled as containing delta-8 THC in ways that violate the Federal Food, Drug, and Cosmetic Act selling CBD and delta-8 THC products.Resources“What’s the Fate of Delta-8? Consumer, Product, and Regulatory Trends”“Consumer Experiences With Delta-8-THC: Medical Use, Pharmaceutical Substitution, and Comparisons With Delta-9-THC”Samuel J. Dotson, M.D., is a psycho-oncologist in the Department of Supportive Oncology at the Levine Cancer Institute and an attending psychiatrist in the Ambulatory Integrated Continuum for severe and persistent mental illness at Atrium Behavioral Health in Charlotte, N.C. ISSUES NewArchived

EVALI-RELATED PULMONARY TOXICITY

TYPE: Case Report TOPIC: Occupational and Environmental Lung Diseases INTRODUCTION: E-cigarette or vaping induced lung injury (EVALI) among those using tetrahydrocannabinol (THC) containing liquid products has been associated with additive Vitamin E Acetate (VEAc), the only common compound bronchoalveolar lavage (BAL) identified. We present a case of acute respiratory failure attributed to EVALI where treatment was based on VEAc role. CASE PRESENTATION: A 44 year old female complaining of dyspnea, cough, and hemoptysis presented with acute hypoxic respiratory failure requiring high flow nasal oxygen therapy in intensive care. She endorsed frequent vaping of THC containing liquid products. Further history revealed recent change in product supplier. CT chest demonstrated diffuse ground glass infiltrates (Figure 1). Labs showed increased white blood cells 12.6 THOU/mcL (3.6-10.5) and C- reactive protein 313 mg/L (<5). BAL deferred for unfavorable respiratory status. Initial treatment included methylprednisolone and bronchodilators. Hypoxia and dyspnea improved on prednisone taper enabling complete weaning of supplemental oxygen. DISCUSSION: As of 2020, 82% of EVALI cases have been attributed to THC containing liquid products. Suspected pathogenesis is linked to VEAc’s pulmonary effects including surfactant layer and viscosity alterations with lipid laden macrophages (LLM), however the driving element remains unclear. Despite routine bronchoscopy, nonspecific LLM findings challenge its diagnostic contribution in cases without suspcious alternative diagnoses. Characterizing radiographic patterns, including organizing pneumonia, ground glass opacities and subpleural sparing, may be advantageous. Continued investigation into EVALI pathogenesis and radiology can improve diagnosis and treatment. CONCLUSIONS: Understanding VEAc's influence on gas exchange can help focus treatment on alveolar recruitment through high flow oxygen therapy and anti-inflammatories. DISCLOSURE: Nothing to declare. KEYWORD: E- cigarette or vaping induced lung injury

Implications of Electronic Cigarettes on the Safe Administration of Sedation and General Anesthesia in the Outpatient Dental Setting.

Today the number of electronic cigarette users continues to rise as electronic cigarettes slowly, yet steadily overtake conventional cigarettes in popularity. This shift is often attributed to the misconception that electronic cigarettes are "safer" or "less dangerous" than conventional cigarettes. Recent studies have shown that electronic cigarettes are far from safe and that the inhaled agents and byproducts within vaping aerosols can have adverse effects on systemic and oral health like combustible tobacco products. The first electronic cigarettes were originally introduced as a tool for smoking cessation. However, newer iterations of electronic cigarette devices have been modified to allow the user to consume tetrahydrocannabinol (THC), the psychoactive component of cannabis, in addition to nicotine. As the popularity of these devices continues to rise, the number of patients seeking dental treatment who also consume electronic cigarettes will too. This article aims to shed light on the deleterious effects electronic cigarettes can have on systemic and oral health, as well as the special considerations for sedation and anesthesia providers treating patients who use electronic cigarettes.

Effect of harvest time on the compositional changes in essential oils, cannabinoids, and waxes of hemp (Cannabis sativa L.).

Demand for cannabinoid is growing, with the global market expected to reach $9.69 billion by 2025. Understanding how chemical composition changes in hemp at different harvest times is crucial to maximizing this industrial crop value. Important compositional changes in three different compound classes (essential oils, cannabinoids, and lipids) from inflorescences (tops), leaves, and stems of hemp (Cannabis sativa L., Finola variety) at different harvesting stages have been investigated. Over 85% of the total extracts from the tops were cannabinoids, while leaves demonstrated the greatest quantities of wax ester and sterols. Essential oil and cannabinoid increased in tops until full flowering (third harvest), reaching 2030 µg g−1 and 39 475 µg g−1, respectively. Cannabinoids decreased at seed maturity (final harvest) to 26 969 µg g−1. This demonstrates the importance of early harvesting to maximize cannabidiol (CBD), which is highly sought after for its therapeutic and pharmacological properties. A total of 21 161 µg g−1 of CBD was extracted from the tops at full flowering (third harvest); however, a significant increase (63%) in the banned psychoactive tetrahydrocannabinol (THC) was observed from budding (157 µg g−1 of biomass) to the full flowering (9873 µg g−1 of biomass). Harvesting the tops after budding is preferable due to the high CBD content and low amounts of THC.

A Comparison of High Drug Concentrations in Impaired Driving and Postmortem Casework in Harris County, TX.

Drug-impaired driving is a growing public safety issue. Addressing impairment due to drugs other than ethanol can be challenging for forensic toxicologists as many factors need to be considered including the type of drug(s), drug-drug interaction, the dose(s) and the individual's physiological condition and drug use history. Interpretation of blood drug test results is additionally difficult as drug concentrations in impaired driving cases may overlap levels typically viewed as toxic. This study compares blood concentrations of drugs in impaired driving cases to those in postmortem cases in Houston, TX, from 2014 to 2020. Blood drug concentrations from driving while intoxicated (DWI) or driving under the influence of drugs (DUID) cases submitted to Houston Forensic Science Center (HFSC) and Harris County Institute of Forensic Sciences (HCIFS) were compared to postmortem blood test results from HCIFS. Eight DWI/DUID cases had drugs that exceeded impaired driving concentrations reported in the literature. These drugs included fentanyl (220 ng/mL), oxycodone (680 ng/mL), hydrocodone (310 and 490 ng/mL), clonazepam (330 ng/mL), methamphetamine (3,500 and 7,100 ng/mL) and tetrahydrocannabinol (THC) (160 ng/mL). For oxycodone and hydrocodone, the presented DWI/DUID cases exceeded 91% and 96% of postmortem concentrations, respectively. The 7,100 ng/mL methamphetamine DWI/DUID result was greater than 98% of postmortem cases. The presented DWI/DUID concentrations were higher than all but one postmortem case for clonazepam and higher than all postmortem cases for THC. This study demonstrates that extremely high drug concentrations in DWI/DUID casework blur the line between therapeutic/recreational and toxic concentrations.

(Almost) Everything You Always Wanted to Know About Cannabis Science, but Were Afraid to Ask!

Aim: It is estimated that approximately 25% of cancer patients are currently taking cannabis to alleviate symptoms of their disease and/or cope with the side effects of their treatment. Patients want to learn more about cannabis from their cancer healthcare team, but most Radiation Therapists (RTs) feel too uninformed to discuss this subject. The purpose of this abstract is to provide information about cannabis that is relevant and useful for RTs. Process: Cannabis is a broad term used to describe organic products derived from the Cannabis plant. The unique group of active chemical compounds found in cannabis are called cannabinoids. Among the more than 100 different types of cannabinoids, the most abundant and well-studied are delta9 tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the primary intoxicating compound of cannabis, which is responsible the euphoric “high”. CBD is a non-intoxicating constituent of cannabis. Terpenes are the third most prevalent compound in cannabis, these give cannabis its distinctive fragrance. Plants are selectively bred to produce particular THC/CBD ratios, and there are more than 200 medical strains currently available from licensed producers in Canada. Cannabis comes in many forms, including dried flower, processed oil, pharmaceutical grade pills and topical patches. Cannabis can be ingested by inhalation, orally, sublingually and topically. Each of these methods has its own rate of onset and duration of effects, and differences in the bioavailability of cannabinoids. Cannabinoids are absorbed into the blood, then rapidly distributed into the brain and other high perfusion tissues. They are then metabolized by CYP liver enzymes and eventually eliminated via feces or urine. All forms of cannabinoids work on the endocannabinoid system within the human body, which consists of a series of neuromodulators and their associated receptors located throughout the brain, peripheral nervous system and immune system. Benefits/Challenges: Cancer patients most frequently take cannabis to improve nausea and appetite, pain, stress and sleep, with 51% - 83% self-reporting a major benefit. The Canadian Cannabis Act (2018) provides access to cannabis for those over 18yrs via medical cannabis programs, prescription pharmaceuticals, pharmacies, provincial websites and retail storefronts. Despite widespread availability, there are multiple precautions and contraindications when considering taking cannabis. These include patient risk factors (e.g. schizophrenia, cardio-metabolic disorders, respiratory conditions), drug-on-drug interactions (e.g. anti-coagulants, statins, SSRIs), lifestyle risk factors (e.g. driving, working, travelling) and the development of a use disorder. Short term harms associated with cannabis use include impaired cognitive and motor function, tachycardia, anxiety and paranoia. Long term harms include impaired learning and memory and development of chronic bronchitis. Evidence-based guidelines are now available to lower the risks associated with taking cannabis. Impact/Outcomes Most RTs have little knowledge about the therapeutic use of cannabis by cancer patients, and <15% of patients receive any information about cannabis from their healthcare team. This leaves our patients exposed to cannabis myths and misrepresentations found during internet searches. Educational opportunities are urgently needed to provide RTs with information about the science of cannabis so they can support and advise their patients.

Delta-8 THC use in US adults: Sociodemographic characteristics and correlates

BackgroundUse of novel cannabis products whose primary active compound is Delta-8 tetrahydrocannabinol (Delta-8 THC), an isomer of Delta-9 THC has recently surged. While Delta-8 THC has psychoactive effects and is potentially harmful, little is known about its use. We examined sociodemographic characteristics, motivations, and consumption patterns of Delta-8 THC in US adult cannabis users. MethodsCannabis-using adult online survey participants (N = 4,348) provided information on Delta-8 use, and other characteristics. We assessed frequencies of sociodemographics, patterns, and correlates of Delta-8 THC use. Regression models estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of associations between past 30-day Delta-8 THC use, sociodemographic and other characteristics. FindingsAmong past 30-day cannabis users, 16.7% reported Delta-8 THC use. The most common consumption method was vaping concentrated formulations of Delta-8 THC (41.2%). Primary motivations for use were its legal status and perceived therapeutic benefits. Males were more likely than females to report Delta-8 THC use (aOR = 1.4, 95% CI 1.2, 1.7). Respondents residing in states with restrictions on sales of Delta-8 THC products had lower odds of Delta-8 THC use (aOR = 0.7, 95% CI 0.57, 0.86). ConclusionsFindings provide initial insight into the current state of Delta-8 THC use in the US. Given the limited knowledge on use of Delta-8 THC, and considering emergence of reports indicating its harmful effects, there is urgent need for nationally representative data to investigate correlates of Delta-8 THC use (e.g., effectiveness of state-specific restrictions on its products). Such information can guide public-health policy around Delta-8 THC use.

Inhaled Marijuana and the Lung

Although vaping has recently increased as a mode of inhaling marijuana and has been associated with numerous and sometimes fatal cases of acute severe lung injury, smoking remains the most common method of inhaling marijuana and has been studied more extensively. Smoking marijuana has been shown to produce modest but significant short-term bronchodilation both in healthy subjects and in those with asthma. Long-term effects of habitual marijuana smoking include the following: (1) symptoms of chronic bronchitis (increased cough, sputum production, and wheezing); (2) modest effects on lung function in cross-sectional studies (no significant decrease in FEV1 but mild reductions in FEV1/forced vital capacity ratio, an increase in forced vital capacity and other lung volumes, reductions in specific airway conductance, and variable effects of maximal midexpiratory flow rates and diffusing capacity); and (3) variable effects on age-related decline in FEV1 in longitudinal studies. Most cohort and case-control studies have failed to show that marijuana smoking is a significant risk factor for lung cancer despite the presence of procarcinogenic components in marijuana smoke, although further study is warranted. The question whether marijuana smoking is associated with asthma is unclear and requires further investigation. Although delta-9 tetrahydrocannabinol, the principal psychoactive component of marijuana, has immunomodulatory properties that hypothetically could increase the risk of pneumonia, the few available studies in marijuana smokers have failed to find an increased risk of pneumonia in immunocompetent users, although effects in immunosuppressed individuals have been variable.

Text mining tweets on e-cigarette risks and benefits using machine learning following a vaping related lung injury outbreak in the USA

Electronic nicotine delivery systems (ENDS) (also known as ‘e-cigarettes’) can support smoking cessation, although the long-term health impacts are not yet known. In 2019, a cluster of lung injury cases in the USA emerged that were ostensibly associated with ENDS use. Subsequent investigations revealed a link with vitamin E acetate, an additive used in some ENDS liquid products containing tetrahydrocannabinol (THC). This became known as the EVALI (E-cigarette or Vaping product use Associated Lung Injury) outbreak. While few cases were reported in the UK, the EVALI outbreak intensified attention on ENDS in general worldwide. We aimed to describe and explore public commentary and discussion on Twitter immediately before, during and following the peak of the EVALI outbreak using text mining techniques. Specifically, topic modelling, operationalised using Latent Dirichlet Allocation (LDA) models, was used to discern discussion topics in 189,658 tweets about ENDS (collected April–December 2019). Individual tweets and Twitter users were assigned to their dominant topics and countries respectively to enable international comparisons. A 10-topic LDA model fit the data best. We organised the ten topics into three broad themes for the purposes of reporting: informal vaping discussion; vaping policy discussion and EVALI news; and vaping commerce. Following EVALI, there were signs that informal vaping discussion topics decreased while discussion topics about vaping policy and the relative health risks and benefits of ENDS increased, not limited to THC products. Though subsequently attributed to THC products, the EVALI outbreak disrupted online public discourses about ENDS generally, amplifying health and policy commentary. There was a relatively stronger presence of commercially oriented tweets among UK Twitter users compared to USA users.

Cannabis consumption and prosociality

The existing literature largely focuses on health risks and other pharmacodynamics of using cannabis, with fewer investigations of other normative psychological effects from consumption among otherwise healthy people. We measured several basic constructs of social psychology corresponding to the concept of prosociality among 146 healthy young adults between 18 and 25 years (M = 18.9, SD = 1.4) with varying detectable levels of tetrahydrocannabinol (THC) in their urine, controlling for participant’s sex, age, ethnicity, and childhood socio-economic status. Compared to THC-free individuals, cannabis users scored higher than non-users on validated measures of Prosocial Behaviors (d = .34, p = .04), the Empathy Quotient (d = .36, p < .01), Moral Harmlessness (d = .76, p < .01) and Moral Fairness (d = .49, p < .01), but exhibited a lower sense of Ingroup Loyalty (d = .33, p = .04). Relative to THC-free, same-sex individuals, female cannabis users scored significantly higher on measurements of Aggression (ds = .65 and .57, ps < .05) and male users scored higher on the Agreeableness dimension of personality (d = .91, p < .01).. Linear associations were found between the recency of last cannabis usage and the Prosocial Behaviors, Empathy Quotient, Moral Harmlessness, Moral Fairness and Agreeableness personality scores (rs from − .24 to .38, ps < .05). The findings suggest cannabis usage is associated with an increased sense of prosociality and prioritization of humanitarian behaviors that declines with time following cannabis consumption. Further research should focus on heterogeneity in the effects of cannabis consumption across users.

Alternative Options for Complex, Recurrent Pain States Using Cannabinoids, Psilocybin, and Ketamine: A Narrative Review of Clinical Evidence.

With emerging information about the potential for morbidity and reduced life expectancy with long-term use of opioids, it is logical to evaluate nonopioid analgesic treatments to manage pain states. Combinations of drugs can provide additive and/or synergistic effects that can benefit the management of pain states. In this regard, tetrahydrocannabinol (THC) and cannabidiol (CBD) modulate nociceptive signals and have been studied for chronic pain treatment. Psilocybin, commonly known as “magic mushrooms”, works at the serotonin receptor, 5-HT2A. Psilocybin has been found in current studies to help with migraines since it has a tryptamine structure and works similarly to triptans. Psilocybin also has the potential for use in chronic pain treatment. However, the studies that have looked at alternative plant-based medications such as THC, CBD, and psilocybin have been small in terms of their sample size and may not consider the demographic or genetic differences in the population because of their small sample sizes. At present, it is unclear whether the effects reported in these studies translate to the general population or even are significant. In summary, additional studies are warranted to evaluate chronic pain management with alternative and combinations of medications in the treatment of chronic pain.