Medical Cannabis Legalization Research Articles

M113 - The Relationship Between Medical and Recreational Cannabis Legalization With Opioid Misuse Among Individuals Reporting Medically Recommended Cannabis Use

M113 - The Relationship Between Medical and Recreational Cannabis Legalization With Opioid Misuse Among Individuals Reporting Medically Recommended Cannabis Use

Regulation of The Use of Marijuana for Medical Purposes: A Comparison of Civil Law and Common Law Legal Systems

This study aims to determine the Regulation of the Use of Marijuana for Medical Purposes: Comparison of Civil Law and Common Law Legal Systems. This research uses normative juridical research methods using literature studies derived from Legislation, scientific journals, books related to medical cannabis discourse and analyzed qualitatively. Regulations related to Class I Narcotics in Indonesia are regulated in Law Number 35 of 2009 and Regulation of the Minister of Health of the Republic of Indonesia Number 30 of 2023. The use of cannabis as medicine is an urgent need. European countries are at the forefront of legalizing medical cannabis. Some European countries with a Civil Law legal system have different regulations in legalizing marijuana for medical purposes based on ownership restrictions. Meanwhile, countries with a Common Law legal system establish medical cannabis legalization policies based on the needs of patients, the quality of health provision, and the protection of patient rights. This study concludes that countries with a Common Law legal system have a pragmatic, case-based legal style that functions through logical reasoning while countries with a Civil Law legal system are more about practical implications.

Cannabis use in a Canadian long-term care facility: a case study

BackgroundFollowing the legalization of cannabis in Canada in 2018, people aged 65 + years reported a significant increase in cannabis consumption. Despite limited research with older adults regarding the therapeutic benefits of cannabis, there is increasing interest and use among this population, particularly for those who have chronic illnesses or are at end of life. Long-term Care (LTC) facilities are required to reflect on their care and policies related to the use of cannabis, and how to address residents’ cannabis use within what they consider to be their home.MethodsUsing an exploratory case study design, this study aimed to understand how one LTC facility in western Canada addressed the major policy shift related to medical and non-medical cannabis. The case study, conducted November 2021 to August 2022, included an environmental scan of existing policies and procedures related to cannabis use at the LTC facility, a quantitative survey of Healthcare Providers’ (HCP) knowledge, attitudes, and practices related to cannabis, and qualitative interviews with HCPs and administrators. Quantitative survey data were analyzed using descriptive statistics and content analysis was used to analyze the qualitative data.ResultsA total of 71 HCPs completed the survey and 12 HCPs, including those who functioned as administrators, participated in the interview. The largest knowledge gaps were related to dosing and creating effective treatment plans for residents using cannabis. About half of HCPs reported providing care in the past month to a resident who was taking medical cannabis (54.9%) and a quarter (25.4%) to a resident that was taking non-medical cannabis. The majority of respondents (81.7%) reported that lack of knowledge, education or information about medical cannabis were barriers to medical cannabis use in LTC. From the qualitative data, we identified four key findings regarding HCPs’ attitudes, cannabis access and use, barriers to cannabis use, and non-medical cannabis use.ConclusionsWith the legalization of medical and non-medical cannabis in jurisdictions around the world, LTC facilities will be obligated to develop policies, procedures and healthcare services that are able to accommodate residents’ use of cannabis in a respectful and evidence-informed manner.

Systematic Review and Meta-Analysis: Medical and Recreational Cannabis Legalization and Cannabis Use Among Youth in the United States

Dramatic changes in state-level cannabis laws (CL) over the past 25 years have shifted societal beliefs throughout the United States, with unknown implications for youth. In the present study, we conducted an updated systematic review and meta-analysis examining estimated effects of medical cannabis legalization (MCL) and recreational cannabis legalization (RCL) on past-month cannabis use among US youth. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, followed by a subsequent meta-analysis investigating the associations between state-level cannabis laws (ie, MCL vs non-MCL, and RCL vs non-RCL) and past-month cannabis use prevalence among US adolescents and young adults. Supplemental analyses examined age-group effects and design-related factors. Our search identified 4,604 citations, 34 and 30 of which were included in qualitative and quantitative analyses, respectively. Meta-analysis of MCL studies identified no significant association between MCL and change in past-month youth cannabis use (odds ratio [OR]= 0.981, 95% CI= 0.960, 1.003). Meta-analysis of RCL studies showed significantly increased odds of past-month cannabis use (OR= 1.134, 95% CI= 1.116-1.153). Meta-analysis of more recent studies, however, showed a significantly increased odds of past-month cannabis use among both adolescents and young adults (OR= 1.089, 95% CI= 1.015,1.169, and OR= 1.221, 95% CI= 1.188,1.255, respectively). Cannabis legalization has complex and heterogenous effects on youth use that may differ across law types. Our meta-analytic results showed modest positive effects of RCL on past-month cannabis use (more so in young adults than in adolescents) and minimal effects of MCL on these outcomes in US youth. Given the shift toward recreational legalization, additional focus on RCL effects is warranted.

Attitudes and Knowledge of Medical Students in South of Israel Toward Medical Cannabis.

Public and medical interest in the use of cannabis has increased in Israel and the world over recent years. The aim of the study was to assess the attitudes of medical students from the Faculty of Health Sciences of Ben-Gurion University of the Negev on the use of medical cannabis. This is a cross-sectional study using a self-administered questionnaire completed by medical students from Ben-Gurion University of the Negev, Beer-Sheva, Israel. Attitudes and knowledge toward the use of medical cannabis were evaluated. A total of 243 medical students participated in the study. Of these, 111 (46.1%) were from preclinical years. The mean age was 27.31 ± 3.07, and 138 (57.3%) were female students. Most students (N = 193, 79.4%) agreed to a great degree or to a very great degree that there was a role for cannabis for medical purposes. Most students thought that medical cannabis should be recommended for use by pain specialists (N = 231, 95.1%), by oncologists (N = 208, 85.6%), and by psychiatrists (N = 192, 79%). A little more than half of the participants (N = 127, 52.5%) would agree to be licensed, as future physicians, to prescribe medical cannabis. A logistic regression analysis found that the students strongly agreed with legalization of medical cannabis and students who strongly agreed that medical cannabis should be in the health basket predicted a very strong agreement about its use (OR = 2.623, P ≤ 0.002, and OR = 3.285, P ≤ 0.001, respectively). Most medical students support the use of medical cannabis for medical purposes and are in favor of its legalization. As physicians of the future, it is important to assess the attitudes of medical students on medical cannabis.

Cannabis-involvement in emergency department visits for self-harm following medical and non-medical cannabis legalization

AimsCannabis use may increase the risk of self-harm, but whether legalization of cannabis is associated with changes in self-harm is unknown. We examined changes in cannabis-involvement in emergency department (ED) visits for self-harm after the liberalization of medical and legalization of non-medical cannabis in Canada. MethodsThis repeated cross-sectional study used health administrative data to identify all ED visits for self-harm in individuals aged ten and older between January 2010 and December 2021. We identified self-harm ED visits with a co-diagnosis of cannabis (main exposure) or alcohol (control condition) and examined changes in rates of visits over four distinct policy periods (pre-legalization, medical liberalization, non-medical legalization with restrictions, and non-medical commercialization/COVID-19) using Poisson models. ResultsThe study included 158,912 individuals with one or more self-harm ED visits, of which 7810 (4.9 %) individuals had a co-diagnosis of cannabis use and 24,761 (15.6 %) had a co-diagnosis of alcohol use. Between 2010 and 2021, the annual rate of ED visits for self-harm injuries involving cannabis per 100,000 individuals increased by 90.1 % (3.6 in 2010 to 6.9 in 2021 per 100,000 individuals), while the annual rate of self-harm injuries involving alcohol decreased by 17.3 % (168.1 in 2010 to 153.1 in 2021 per 100,000 individuals). The entire increase in visits relative to pre-legalization occurred after medical liberalization (seasonally adjusted Risk Ratio [asRR] 1.71 95 % CI 1.09–1.15) with no further increases during the legalization with restrictions (asRR 1.77 95%CI 1.62–1.93) or commercialization/COVID-19 periods (asRR 1.63 95%CI 1.50–176). ConclusionsCannabis-involvement in self-harm ED visits almost doubled over 12 years and may have accelerated after medical cannabis liberalization. While the results cannot determine whether cannabis is increasingly causing self-harm ED visits or whether cannabis is increasingly being used by individuals at high risk of self-harm, greater detection for cannabis use in this population and intervention may be indicated.

Digitalization of services in the field of patients’ rights protection: current state and prospects for the development of legislation

This scientific article is devoted to the current problems of digital transformation in the field of health care and the introduction of electronic medical services. The main directions of introduction of the digitalization process in the sphere of medicines circulation in Ukraine are revealed, the attention is focused on the positive and negative moments of digitalization in the sphere of medicines circulation in Ukraine. Possible areas for improving digitalization in the field of circulation of medicines in Ukraine are identified, as well as the need to improve the legal regulation of digitalization in the field of circulation of medicines in Ukraine in order to protect the rights and interests of patients in the field of medicines. The article analyses the current state of legal regulation of digitalisation in the healthcare sector of Ukraine and the readiness to provide quality electronic healthcare services to patients. The authors have identified the need to adopt and amend regulations that would regulate the development of the electronic healthcare system, in particular, the introduction of an electronic public health system; electronic document management in the field of healthcare; implementation of measures to ensure the safety of medicines and the creation of an electronic prescription; expansion of the functions of the electronic system of state registers; automation of medical services; and legalisation of medical cannabis.
 The article examines the problems of legalisation of cannabis for medical purposes in Ukraine. International legal acts and standards in the field of narcotic drugs and psychotropic substances are analysed. The authors review national legislative acts regulating the production and trafficking of narcotic drugs, psychotropic substances and precursors.
 The article examines the German experience of legal support for patients’ access to the necessary medical cannabis treatment for various diseases and post-traumatic stress disorders. The article identifies the specifics of legal regulation of medical cannabis treatment services. The authors outline two types of medical cannabis treatment services - general and special, which differ in procedural features.

Recreational and Medical Cannabis Legalization and Opioid Prescriptions and Mortality

While some have argued that cannabis legalization has helped to reduce opioid-related morbidity and mortality in the US, evidence has been mixed. Moreover, existing studies did not account for biases that could arise when policy effects vary over time or across states or when multiple policies are assessed at the same time, as in the case of recreational and medical cannabis legalization. To quantify changes in opioid prescriptions and opioid overdose deaths associated with recreational and medical cannabis legalization in the US. This quasiexperimental, generalized difference-in-differences analysis used annual state-level data between January 2006 and December 2020 to compare states that legalized recreational or medical cannabis vs those that did not. Recreational and medical cannabis law implementation (proxied by recreational and medical cannabis dispensary openings) between 2006 and 2020 across US states. Opioid prescription rates per 100 persons and opioid overdose deaths per 100 000 population based on data from the US Centers for Disease Control and Prevention. Between 2006 and 2020, 13 states legalized recreational cannabis and 23 states legalized medical cannabis. There was no statistically significant association of recreational or medical cannabis laws with opioid prescriptions or overall opioid overdose mortality across the 15-year study period, although the results also suggested a potential reduction in synthetic opioid deaths associated with recreational cannabis laws (4.9 fewer deaths per 100 000 population; 95% CI, -9.49 to -0.30; P = .04). Sensitivity analyses excluding state economic indicators, accounting for additional opioid laws and using alternative ways to code treatment dates yielded substantively similar results, suggesting the absence of statistically significant associations between cannabis laws and the outcomes of interest during the full study period. The results of this study suggest that, after accounting for biases due to possible heterogeneous effects and simultaneous assessment of recreational and medical cannabis legalization, the implementation of recreational or medical cannabis laws was not associated with opioid prescriptions or opioid mortality, with the exception of a possible reduction in synthetic opioid deaths associated with recreational cannabis law implementation.

Nurse’s Attitudes and Perceptions Towards Medical Cannabis Legalization in Thailand

Objective: To determine the attitudes and perceptions among nurses towards legalization of cannabis for medical use in Thailand.Material and Methods: This anonymous, cross-sectional paper and online survey was conducted from May 2020 to November 2021. Data collection was done using the Cannabis as Medicine: Thai Nurse’s Attitudes and Perceptions Survey. Descriptive statistics were used to analyze the data.Results: This study included 287 Thai registered nurses across Thailand. The top 3 positive attitudes and perceptions among the nurses were: 1) currently, most patients use or intend to use cannabis oil, 2) it’s not uncommon if nurses with advanced cancer decide to use cannabis oil, and 3) a patient’s values and beliefs in cannabis oil can them feel better. The top 3 negative attitudes and perceptions were: 1) cannabis reduces tumor growth in advanced cancer stages, 2) nurses administer medical cannabis as other medications; and (3) nurses like taking care of patients with the non-medicinal use of cannabis.Conclusion: Thai registered nurses were more likely to have negative attitudes towards medical cannabis. The respondents required to increase their knowledge about medical cannabis. Understanding Thai nurses’ attitudes and perceptions towards medical cannabis use is necessary to see their insider views, the difficulties they face, and provide room for improvement to enhance the benefits and safety of medical cannabis use. Future research with larger sample sizes is recommended to strengthen the quality of evidence.

Nurse’s Attitudes and Perceptions Towards Medical Cannabis Legalization in Thailand

Objective: To determine the attitudes and perceptions among nurses towards legalization of cannabis for medical use in Thailand.Material and Methods: This anonymous, cross-sectional paper and online survey was conducted from May 2020 to November 2021. Data collection was done using the Cannabis as Medicine: Thai Nurse’s Attitudes and Perceptions Survey. Descriptive statistics were used to analyze the data.Results: This study included 287 Thai registered nurses across Thailand. The top 3 positive attitudes and perceptions among the nurses were: 1) currently, most patients use or intend to use cannabis oil, 2) it’s not uncommon if nurses with advanced cancer decide to use cannabis oil, and 3) a patient’s values and beliefs in cannabis oil can them feel better. The top 3 negative attitudes and perceptions were: 1) cannabis reduces tumor growth in advanced cancer stages, 2) nurses administer medical cannabis as other medications; and (3) nurses like taking care of patients with the non-medicinal use of cannabis.Conclusion: Thai registered nurses were more likely to have negative attitudes towards medical cannabis. The respondents required to increase their knowledge about medical cannabis. Understanding Thai nurses’ attitudes and perceptions towards medical cannabis use is necessary to see their insider views, the difficulties they face, and provide room for improvement to enhance the benefits and safety of medical cannabis use. Future research with larger sample sizes is recommended to strengthen the quality of evidence.

Legalization of medical cannabis in Ukraine: issues of criminal law protection

The article discusses the legalization of medical cannabis in Ukraine. The main draft laws on the regulation of the circulation of hemp plants (Cannabis) for medical, industrial purposes, scientific and scientific and technical activities, the state of their consideration and the main conclusions of the specialized committees of the Verkhovna Rada were analyzed.
 It has been established that the process of legalizing medical cannabis involves a special mechanism of organizational and legal regulation of activities related to the cultivation of cannabis for medical purposes, transportation, processing of plants and extracts of cannabis, the manufacture of appropriate medical devices using them as raw materials, as well as the conduct of scientific research. Such a mechanism establishes the procedure for obtaining permits, restrictions and rules for cultivation, transportation, processing, production and sale in terms of organizational, administrative and legal aspects.
 The article notes that the current regulations do not cover social relations in the field of the production of medicinal products based on cultivated medical cannabis, and such activity itself may be associated with a corruption component in terms of permit procedures, the activities of control and inspection bodies and institutions, dishonesty of private laboratories, etc. It is proposed to conclude that the process of regulating sowing, cultivation, production of medical cannabis, etc. is in the realm of civil, economic, and administrative procedures, but ensuring legality and compliance with the rules and mechanisms established by these industries requires the participation of criminal-legal means. Such measures include the establishment of new and revisions of existing criminal prohibitions in order to ensure the criminal protection of social relations that may occur in connection with the legalization of medical cannabis.
 Key words: medical cannabis, cannabis, license, criminal law protection, criminal liability, narcotic substances, medicinal products.

Investigating Cannabis-Use Among Students Attending High Schools Within the Cherokee Nation Reservation 2017 and 2019

Oklahoma’s medical cannabis is some of the least restrictive in the US. Previous research suggests that American Indian/Alaska Native (AIAN) have higher rates of cannabis use than other racial or ethnic groups. The goals of this paper are, first, to look at cannabis use among high school students living on the Cherokee Nation Reservation before (2017) and after (2019) medical cannabis because legal in Oklahoma (2018) utilizing the Cherokee Nation Youth Risk Behavior Survey (CNYRBS). Second, to describe the socio-demographic characteristics of youth using cannabis in the Cherokee Nation Reservation. Data were retrieved from the 2017 and 2019 CNYRBS. The data for this study included 1,216 high school students who completed the 2017 and 1,476 who completed the 2019 CNYRBS. After removal of incomplete records, there were 2,602 students whose data was analyzed in this study. Data were weighted to be representative of public-school students attending grades 9–12 within Cherokee Nation Reservation. Despite the legalization of medical cannabis in Oklahoma in 2018, there was no change in cannabis use among youth between 2017 and 2019. There were variations in cannabis use based on demographic factors and other substance uses. AIAN individuals had higher odds of current cannabis use compared to non-Hispanic White students, but there were no differences based on ethnicity. Additionally, the use of cigarettes, e-cigarettes, alcohol, and illegal drugs were associated with increased odds of cannabis use among both current and former users compared to those who had never used it. There was no spike in use among youth at least immediately after the legalization of cannabis in the Cherokee Nation Reservation. There were socio-demographic as well as substance use disparities in the use of cannabis.

Impact of Recreational Cannabis Legalization on Adolescent Cannabis Use in Washington State

An important public concern about the impact of recreational cannabis legalization is how it may affect adolescent cannabis use. Prior research on this issue has primarily focused on the implications of medical cannabis legalization for adolescents and used data that cover a relatively short post-legalization period. This study extends this line of research by examining the relationship between recreational cannabis legalization and adolescent cannabis use in Washington State, using the National Survey of Drug Use and Health (NSDHU) data from 2005 to 2019. Based on a quasi-experimental research design, this study found some evidence suggesting a positive effect of recreational legalization on the prevalence of adolescent cannabis use and cannabis initiation. Findings suggest the need to create a cannabis regulatory environment that minimizes adolescent access to this drug.

Medical cannabis laws lower individual market health insurance premiums.

To evaluate the impact of medical cannabis laws (MCLs) on health insurance premiums. We study whether cannabis legalization significantly impacts aggregate health insurer premiums in the individual market. Increases in utilization could have spillover effects to patients in the form of higher health insurance premiums. We use 2010-2021 state-level U.S. private health insurer financial data from the National Association of Insurance Commissioners. We examined changes to individual market health insurance premiums after the implementation of medical cannabis laws. We employed a robust difference-in-differences estimator that accounted for variation in policy timing to exploit temporal and geographic variation in state-level medical cannabis legalization. Seven years after the implementation of Medical Cannabis laws, we observe lower health insurer premiums in the individual market. Starting seven years post-MCL implementation, we find a reduction of $-1662.7 (95% confidence interval [CI -2650.1, -605.7]) for states which implemented MCLs compared to the control group, a reduction of -$1541.8 (95% confidence interval [CI 2602.1, -481.4]) in year 8, and a reduction of $-1625.8, (95% confidence interval [CI -2694.2, -557.5]) in year 9. Due to the nature of insurance pooling and community rating, these savings are appreciated by cannabis users and non-users alike in states that have implemented MCLs. The implementation of MCLs lowers individual-market health insurance premiums. Health insurance spending, including premiums, comprises between 16% and 34% of household budgets in the United States. As healthcare costs continue to rise, our findings suggest that households that obtain their health insurance on the individual (i.e., not employer sponsored) market in states with MCLs appreciate significantly lower premiums.

Pros and Cons of Medical Cannabis Legalization in Indonesia

Pros and Cons of Medical Cannabis Legalization in Indonesia

Optimized chromatographic methods for the identification and quantification of terpenes in Cannabis sativa oil for medicinal use

Cannabis sativa is a plant species with numerous active principles, so the list of its therapeutic uses is expanding. In this sense, there are numerous evidences of the possible medicinal use of terpenes, as well as their synergism with cannabinoids (entourage effect). Thus, as more countries contemplate the legalization and authorization of medical cannabis, the number of cannabis extraction and analysis laboratories is increasing to meet the demand, requiring adequate analytical tools. In response to numerous inquiries from physicians, analytical laboratories and users, the PROBIEN chromatography laboratory has selected two methods for the analysis of terpenes in Cannabis oil by gas chromatography technique (GC-FID). The methods are described using HP-5 and Innowax columns. The external standard method was used for the quantitative determination of β-Pinene, Myrcene, p-Cymene, Limonene, Linalool, α-Terpineol, Nerol and Geraniol. good peak separation and reproducibility were observed, appropriate for the identification and quantification of the main terpenes in Cannabis extracts. The area/concentration ratio was linear in the range of 0.0005 to 2.0 mg/ml. The described methods allow the identification and quantification of the major terpenes in Cannabis oil for an adequate quality control.

Evaluating the Supporting Evidence of Medical Cannabis Claims Made on Clinic Websites: Cross-Sectional Study.

Since the legalization of medical cannabis in Canada in 2013, prescription of cannabis for medical purposes has become commonplace and a multibillion dollar industry has formed. Much of the media coverage surrounding medical cannabis has been positive in nature, leading to Canadians potentially underestimating the adverse effects of medical cannabis use. In recent years, there has been a large increase in clinic websites advertising the use of medical cannabis for health indications. However, little is known about the quality of the evidence used by these clinic websites to describe the effectiveness of cannabis used for medical purposes. We aimed to identify the indications for medical cannabis reported by cannabis clinics in Ontario, Canada, and the evidence these clinics cited to support cannabis prescription. We conducted a cross-sectional web search to identify all cannabis clinic websites within Ontario, Canada, that had physician involvement and identified their primary purpose as cannabis prescription. Two reviewers independently searched these websites to identify all medical indications for which cannabis was promoted and reviewed and critically appraised all studies cited using the Oxford Centre for Evidence-Based Medicine Levels of Evidence rubric. A total of 29 clinics were identified, promoting cannabis for 20 different medical indications including migraines, insomnia, and fibromyalgia. There were 235 unique studies cited on these websites to support the effectiveness of cannabis for these indications. A high proportion (36/235, 15.3%) of the studies were identified to be at the lowest level of evidence (level 5). Only 4 clinic websites included any mention of harms associated with cannabis. Cannabis clinic websites generally promote cannabis use as medically effective but cite low-quality evidence to support these claims and rarely discuss harms. The recommendation of cannabis as a general therapeutic for many indications unsupported by high-quality evidence is potentially misleading for medical practitioners and patients. This disparity should be carefully evaluated in context of the specific medical indication and an individualized patient risk assessment. Our work illustrates the need to increase the quality of research performed on the medical effects of cannabis.

Genome-Scale Metabolic Reconstruction, Non-Targeted LC-QTOF-MS Based Metabolomics Data, and Evaluation of Anticancer Activity of Cannabis sativa Leaf Extracts.

Over the past decades, Colombia has suffered complex social problems related to illicit crops, including forced displacement, violence, and environmental damage, among other consequences for vulnerable populations. Considerable effort has been made in the regulation of illicit crops, predominantly Cannabis sativa, leading to advances such as the legalization of medical cannabis and its derivatives, the improvement of crops, and leaving an open window to the development of scientific knowledge to explore alternative uses. It is estimated that C. sativa can produce approximately 750 specialized secondary metabolites. Some of the most relevant due to their anticancer properties, besides cannabinoids, are monoterpenes, sesquiterpenoids, triterpenoids, essential oils, flavonoids, and phenolic compounds. However, despite the increase in scientific research on the subject, it is necessary to study the primary and secondary metabolism of the plant and to identify key pathways that explore its great metabolic potential. For this purpose, a genome-scale metabolic reconstruction of C. sativa is described and contextualized using LC-QTOF-MS metabolic data obtained from the leaf extract from plants grown in the region of Pesca-Boyaca, Colombia under greenhouse conditions at the Clever Leaves facility. A compartmentalized model with 2101 reactions and 1314 metabolites highlights pathways associated with fatty acid biosynthesis, steroids, and amino acids, along with the metabolism of purine, pyrimidine, glucose, starch, and sucrose. Key metabolites were identified through metabolomic data, such as neurine, cannabisativine, cannflavin A, palmitoleic acid, cannabinoids, geranylhydroquinone, and steroids. They were analyzed and integrated into the reconstruction, and their potential applications are discussed. Cytotoxicity assays revealed high anticancer activity against gastric adenocarcinoma (AGS), melanoma cells (A375), and lung carcinoma cells (A549), combined with negligible impact against healthy human skin cells.

Cannabis regulatory system in European Union countries, forensic concept of "doping dose" and medico-legal implications.

Cannabis is the most widely used illicit psychoactive substance in the world. In recent years, in many European Union countries, there has been a decriminalisation of the use and personal possession of cannabis for recreational purposes. There has been a spread of medical cannabis, as well as marketing of cannabis products at low concentrations of delta-9-tetrahydrocannabinol (Delta-9-THC), the major chemical to which cannabis owes its psychotropic effect. The percentage limit of this substance, only recently set by the European Court of Justice, must be distinguished from the "doping dose" of Delta-9-THC, namely, the dose which causes psychotropic effect in the consumer. Our study analyses and summarises the regulations in the countries of the European Union on the penalisation of recreational cannabis, the legalisation of medical cannabis and limits on percentage of THC imposed locally. Based on the analysis of a recent judgment of the Italian Supreme Court of Cassation, we discuss the importance of the role of the forensic toxicologist in the scientific definition of "doping dose". The distinction between the doping dose of THC and the percentage of THC contained in the marketed cannabis product is vital when establishing fair punishment in the event of a crime.

Endocannabinoid system components as potential neuroimmune therapeutic targets in tinnitus.

Research interest in understanding tinnitus has increased severalfold in the last decade to find a cure for this auditory disorder. Hyperacusis can also accompany tinnitus, although the mechanisms involved in hyperacusis and tinnitus are different. Millions of people suffer from some degree of tinnitus with hearing loss. Tinnitus is believed to be a form of sensory epilepsy, spawning neuronal hyperactivity from the cochlear nucleus and inferior colliculus of the auditory brainstem region. Cannabis has been used for recreation, medicinal purposes, and served as an entheogen from time immemorial. With the current and increasing global medical and recreational cannabis legalization, there is renewed enthusiasm for the use of cannabinoid drugs, and the role of the endocannabinoid system (ECS) in several health disorders including tinnitus which is associated with COVID-19. The ECS signaling pathways have been proposed to affect the underlying pathophysiology of tinnitus. Cannabinoid receptors (CBRs) have been found in the auditory system, raising interest in ECS signaling in hearing and tinnitus. However, previous studies mostly in animal models of tinnitus did not investigate the involvement of CB2Rs but focused on CB1R-based responses, which suggested that CB1R ligands had no effect and may even be harmful and worsen tinnitus. With new molecular techniques and transgenic approaches used to dissect the complexity of the ECS, the role of ECS/CB2R neuroimmunological function in the auditory system and tinnitus is emerging. This perspective proposes the role of emerging neuroimmune crosstalk of the ECS in sound-sensing structures of the auditory system as a potential pharmacogenomic therapeutic target using cannabinoid CB2R ligands in tinnitus in the era of the COVID-19 pandemic.