Marijuana Smoking Research Articles

Anticoagulant drug-drug interactions with cannabinoids: Asystematic review.

This systematic review evaluates the extent to which the effect of anticoagulants may be altered in the presence of cannabinoids. The following databases were searched: EMBASE, PubMed, Web of Science, Scopus, PscycINFO, and CINAHL from database inception through May 2023. Search terms included cannabis AND anticoagulant AND drug interactions and related keywords. The major outcome was hemorrhage or thrombosis and if available the relative change in quantitative intensity of anticoagulation after cannabinoid exposure. The search generated 959 citations. After the removal of 440 duplicates, 519 citations were screened. Overall, with the exception of warfarin, evidence supporting an interaction between cannabinoids and anticoagulants is non-existent. Seven case reports evaluating an interaction with warfarin were reported. Cannabis doses involved were either extremely high (e.g., >260 mg/day of delta-9-tetrahydrocannabidiol [THC] or >600 mg/day of cannabidiol [CBD]) or were not known. Hemorrhage was identified in 14.2% (1/7) of reports and thrombosis in 0%. Quantitative anticoagulation levels were increased in patients on warfarin (elevated International Normalized Ratio [INR]) in six of seven cases. A maximum INR change was available in five of seven reports, ranging from +0.4 to +9.61. One report found no change in INR after 4 days of medical cannabis exposure. Another report outlined two separate episodes of INR elevation associated with bleeding requiring hospitalization and reversal after marijuana smoking. Four cases involved reduction in weekly warfarin dose ranging from 22% to 31%. The Drug Information Probability Score was calculated in six cases, with a score of probable for five cases and possible for one. Very low-quality data support a potential drug-drug interaction with warfarin and both THC and CBD. Clinician recognition of this potential interaction is important. Available evidence supports the need to conduct a drug interaction study between cannabinoids and warfarin to clarify the existence of an interaction.

Sensitivity Analysis-Based Validation of the Modified NERA Model for Improved Performance

Marijuana is an illicit narcotic with multiple negative health effects as it continues to pose a severe danger to the health of people in emerging regions. Marijuana is spread through interactions between users and non-users. This study utilizes first-order non-linear ordinary differential equations to modify the Non-user, Experimental, Recreational, and Addicted (NERA) users’ model by adding a new class known as the hospitalized class of marijuana smokers. Moreover, this paper focuses on validating the NERA model using the sensitivity analysis concept. The NERA model presented in a previous study for marijuana usage among the target population consists of four distinct stages: the first stage is known as the non-user stage and is represented by the letter N; the second stage is known as the experimental stage of marijuana smoking and is represented by the letter E; the third stage is known as the recreational stage of marijuana smoking and is represented by the letter R; the fourth stage is represented by the letter A; and this last stage is known as the addicted stage of marijuana smoking. The suggested mathematical method achieved the reproduction number () for marijuana use. The results of the sensitivity tests indicate how crucial a variety of variables are to the spread of marijuana. The parameters that have a key impact on marijuana consumption were discovered based on sensitivity analysis. All these procedures, including the reproductive number and invariant region, using the sensitivity analysis concept were utilized to validate the updated model. In this study, the NERA model is modified by utilizing first-order non-linear ordinary differential equations. Furthermore, as demonstrated by the graphical and technique sections, the proposed modified models were successfully validated for improved performance.

1.59 Cannabis Smoking Vs Vaping in Adolescents: A Review of the Literature

1.59 Cannabis Smoking Vs Vaping in Adolescents: A Review of the Literature

1.69 Where There's Smoke, There are Psychotic-Like Experiences? Secondhand Cannabis Smoke and Its Effects on Child Psychopathology

1.69 Where There's Smoke, There are Psychotic-Like Experiences? Secondhand Cannabis Smoke and Its Effects on Child Psychopathology

Adolescents' Depression and Anxiety Symptoms During the COVID-19 Pandemic: Longitudinal Evidence From COMPASS

PurposeThere is concern over the potentially detrimental impact of the COVID-19 pandemic on adolescents' mental health. We examined changes in depression and anxiety symptoms from before (2018-19) to the early (2019-20) and ongoing pandemic (2020-21) responses among Canadian adolescents in the context of a natural experiment. MethodsWe used linked survey data from 5,368 Canadian secondary school students who participated in three consecutive waves of the cannabis use, obesity, mental health, physical activity, alcohol use, smoking, and sedentary behaviour study during the 2018-19, 2019-20, and 2020-21 school year. Separate fixed effects models examined whether changes in depression (Center for Epidemiologic Studies Depression Scale Revised-10) and anxiety (General Anxiety Disorder-7) symptoms differed between two cohorts. The cohorts differed in the timing of their second data collection wave; one cohort participated before the pandemic and the other cohort participated in the early pandemic (spring 2020). ResultsDepression and anxiety symptoms increased during the early and ongoing pandemic periods in the overall sample and both cohorts. The two cohorts experienced similar elevations in their symptoms. Females and younger respondents presented greater elevations over time. The proportion of adolescents with significant depressive (29.4%) and moderate-to-severe anxiety (17.6%) symptoms at baseline increased by 1.5 times, reaching 44.8% and 29.8% in the ongoing pandemic period, respectively. DiscussionFindings suggest that internalizing symptoms have consistently increased since before the onset of COVID-19, particularly in the ongoing pandemic period; however, we found no evidence of the increase being due to the pandemic in the early COVID-19 period when comparing the two cohorts. Ongoing evaluation of adolescents' mental health is necessary to capture potentially dynamic impacts over time.

Diagnostic Criteria of Takotsubo Cardiomyopathy in the Clinical Setting: A Case Report

Introduction Takotsubo cardiomyopathy (TTS) is a rare condition related to stress featuring apical hypokinesis. Current guidelines suggest that the exclusion of other causal factors like myocarditis is required to diagnose TTS. However, we propose that the existing diagnostic criteria for TTS, particularly, required exclusion of myocarditis, adds to the challenge of making this diagnosis in the clinical setting. Hereby, we present a case with basal hypokinesis that could have been attributed to a conjunction of reverse Takotsubo syndrome (rTTS) with viral or toxic myocarditis. Case Presentation: A 29-year-old female complained of acute persistent chest pain, palpitations, and vomiting after smoking marijuana. She was tachycardic without hemodynamic instability or hypoxia. Electrocardiogram showed sinus tachycardia. Troponin peaked at 16.1 ng/ml. Urine drug screen was positive for amphetamines. Echocardiogram and catheterization showed left ventricular reduced ejection fraction (25-30%) with basal hypokinesia and apical hyperkinesis, suggestive of reversed Takotsubo cardiomyopathy. Cardiac magnetic resonance (CMR) also showed delayed contrast enhancement suggestive of myocarditis. Viral panel noted positive Coxsackie B titer on day 7 of hospitalization. She was treated with goal-directed medical therapy and repeat echocardiogram 6 days after showed normalized left ventricular systolic function. Discussion: Guidelines recommend the use of clinical history, inflammatory markers, and CMR to exclude infectious myocarditis before diagnosing rTTS. The clinical scenario in this case presented evidence of a catecholamine-related substance exposure known to trigger takotsubo cardiomyopathy and of an elevated Coxsackie B titer. The CMR showed features explainable by myocarditis and partially by rTTS. This case highlights the complexity of diagnosing TTS or rTTS with infective myocarditis as exclusion criteria. While imaging, history, and labs play a vital role, a lack of complete understanding about the pathophysiology of this disease as well as existing diagnostic criteria complicate the ability to make this diagnosis in the clinical setting.

Cannabigerol (CBG) signal enhancement in its analysis by gas chromatography coupled with tandem mass spectrometry

PurposeAccording to recent reports, cannabigerol (CBG) concentration level in blood and body fluids may have forensic utility as a highly specific albeit insensitive biomarker of recent cannabis smoking. While the analytical sensitivity of cannabidiol (CBD), Δ9-tetrahydrocannabinol (Δ9-THC), cannabichromene (CBC) or cannabinol (CBN) estimation by gas chromatography-mass spectrometry (GC–MS) is similar and sufficiently high, it is exceptionally low in the case of CBG (ca. 25 times lower than for the other mentioned cannabinoids). The purpose of this study is to explain the reasons for the extremely low analytical sensitivity of GC–MS in estimating CBG and to present possible ways of its improvement.MethodsNuclear magnetic resonance (NMR) data and GC–MS responses to CBG and its various derivatization and transformation products were studied.ResultsThe validation data of individual derivatives of CBG and its transformation products were established. CBG silylation/acylation or hydration allows to decrease LOD about 3 times, whereas the formation of pyranic CBG derivative leads to 10-times decrease of LOD. The paper enriches the literature of the subject by providing MS and NMR spectra, not published so far, for derivatives of CBG and its transformation products. The most likely cause of low GC–MS response to CBG is also presented.ConclusionsThe presented results shows that although the signal increase of CBG can be obtained through its derivatization by silylation and/or acylation, the greatest increase is observed in the case of its cyclization to the pyranic CBG form during the sample preparation process. The CBG cyclization procedure is very simple and workable in estimating this cannabinoid in blood/plasma samples.Graphical abstract

Depression as a risk factor for adverse outcomes and increased healthcare utilization in bariatric surgery patients.

Depression is strongly associated with obesity and iscommon among patients undergoing bariatric surgery. Little is known about the impact of depression on early postoperative outcomes or its association with substance use. The Michigan Bariatric Surgery Collaborative is a statewide quality improvement program that maintains a large clinical registry. We evaluated patients undergoing primary Roux-en-Y gastric bypass or sleeve gastrectomy between 2017 and 2022. Patients self-reported symptoms of depression (PHQ-8) and use of alcohol (AUDIT-C), smoking, prescription opiates, and marijuana at baseline. Preoperative PHQ-8 scores stratified patients based on severity: no depression (0-4), mild (5-9), moderate (10-14), or severe (15-24). We compared 30-day outcomes and substance use between patients with and without depression. Among 44,301 patients, 30.8% had some level of depression, with 19.8% mild, 7.5% moderate, and 3.5% severe. Patients with depression were more likely to have an extended length of stay (LOS) (> 3days) than those without depression (no depression 2.1% vs. severe depression 3.0%, p = 0.0452). There were no significant differences between no depression and severe depression groups in rates of complications (5.7% vs. 5.2%, p = 0.1564), reoperations (0.9%, vs. 0.8%, p = 0.7394), ED visits (7.7% vs. 7.8%, p = 0.5353), or readmissions (3.2% vs. 3.9%, p = 0.3034). Patients with severe depression had significantly higher rates of smoking (9.7% vs. 12.5%, p < 0.0001), alcohol use disorder (8.6% vs. 14.0%, p < 0.0001), opiate use (14.5% vs. 22.4%, p < 0.0001) and marijuana use (8.4%, vs. 15.5%, p = 0.0008). This study demonstrated that nearly one-third of patients undergoing bariatric surgery have depression, with over 10% in the moderate to severe range. There was a significant association between preoperative depressive symptoms and extended LOS after bariatric surgery, as well as higher rates of smoking and use of marijuana, prescription opiates and alcohol. There was no significant effect on adverse events or other measures of healthcare utilization.

Exploring the longitudinal associations between census division income inequality and BMI trajectories among Canadian adolescent: Is gender an effect modifier?

BackgroundIncome inequality is a structural determinant of health linked to increased risk of overweight and obesity, although its links to the health of adolescent populations are not well understood. This study investigated the longitudinal associations between census-division-level (CD) income inequality and BMI trajectories among Canadian adolescents, and determine if these associations vary by gender. MethodsStudy data are from the Cannabis use, Obesity, Mental health, Physical Activity, Alcohol use, Smoking, and Sedentary behaviour (COMPASS) cohort of adolescents attending secondary schools in Canada. Our sample included 14,675 adolescents who were followed up across three waves of the COMPASS study (2016–2017, 2017–2018, and 2018–2019) and linked to 30 CDs. Measures of income inequality and other area-level covariates were derived and linked to COMPASS participants using data from the 2016 Canadian Census. We utilized multilevel mixed-effects linear regression modelling to quantify the associations between income inequality and BMI and test for effect modification by gender. Sensitivity analyses were run excluding those with BMI scores in the range considered overweight or obesity at baseline. ResultsHigher CD income inequality was significantly associated with higher z-transformed BMI scores (β = 0.11, 95% CI = 0.034 to 0.19). The interaction term between income inequality and time was not statistically significant, indicating that this association remained constant over time. Once stratified by gender, the association between inequality and BMI became stronger for males (β = 0.14, 95% CI = 0.060 to 0.022) and attenuated for females (β = 0.063, 95% CI = −0.047 to 0.17). ConclusionAttending schools in CDs with higher income inequality was associated with higher BMI scores among male but not female adolescents. Further work is needed to investigate this discrepancy and identify the structural mechanisms that mediate the relationship between inequality and adolescent health.

Inequality's on Tap: A Longitudinal Study of Area-Level Income Inequality and Alcohol Consumption Among Canadian Adolescents

PurposeTo determine if income inequality at the census division level is associated with alcohol consumption and abuse among junior high and high school students. MethodsData on adolescents are from the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behavior (COMPASS) study. Participant data (n = 19,759) were collected during three survey waves (2016–2017, 2017–2018, and 2018–2019) and linked to 30 census divisions within four Canadian provinces. Data on income inequality and other area-level factors were derived from the 2016 Canadian census. Multilevel logistic regression modelling was used to quantify the associations between income inequality, monthly alcohol consumption, and binge drinking. ResultsAfter adjusting for covariates, students living in census divisions within the second and third quintiles of income inequality experienced an average 80% (OR = 1.80, 95% CI = 1.08–3.02) and 92% (OR = 1.92, 95% CI = 1.05–3.51) increased odds of engaging in monthly binge drinking, respectively, compared to those living in the first quintile. Similarly, adolescents living in census divisions within the second inequality quintile experienced an average 169% (OR = 2.69, 95% CI = 1.45, 4.99) increased odds of engaging in weekly binge drinking, compared to those living in the first quintile. There was no significant association between higher income inequality and current monthly alcohol consumption. DiscussionModerate area-level income inequality within census divisions was adversely associated with alcohol consumption among adolescents. Future work should investigate the potential mechanisms that mediate this relationship.

Does modern chemical analysis allow the identification of passive cannabis smokers?

Does modern chemical analysis allow the identification of passive cannabis smokers?

Use of Medical Cannabis by Patients With Cancer: Attitudes, Knowledge, and Practice.

Demand for medical cannabis (MC) is growing among Israeli patients with cancer. The study sought to assess factors contributing to the demand for MC among patients with cancer. Patients applying for a permit to receive MC at a pain and palliative clinic of a university-affiliated cancer center in Israel in 2020-2021 were asked to complete self-report questionnaires assessing attitudes, knowledge, and expectations regarding MC use. Findings were compared between first-time and repeat applicants. Repeat applicants were asked to report their indications for requesting MC, patterns of use, and treatment effect. The cohort included 146 patients: 63 first-time applicants and 83 repeat applicants. First-time applicants were more likely to consult sources other than their oncologist for MC-related information (P < 0.01) and expressed more concern about addiction (P < 0.001) and side effects (P < 0.05). They often erroneously assumed the treatment was subsidized (P < 0.001). Repeat applicants were younger (P < 0.05) and included more smokers (P < 0.05) and recreational cannabis users (P < 0.05); 56.6% were cancer survivors and 78% used high-potency MC. Most patients believed to some degree that MC is more effective than conventional medications for symptom control, and over half thought that MC helps to cure cancer. Misconceptions regarding the effectiveness of MC for symptom management and treatment may explain the motivation of patients with cancer to apply for a permit. There seems to be an association of young age, cigarette smoking, and recreational cannabis use with ongoing use of MC among cancer survivors.

Pharmacokinetics of delta-9-tetrahydrocannabinol following acute cannabis smoke exposure in mice; effects of sex, age, and strain.

Increased use of cannabis and cannabinoids for recreational and medical purposes has led to a growth in research on their effects in animal models. The majority of this work has employed cannabinoid injections; however, smoking remains the most common route of cannabis consumption. To better model real-world cannabis use, we exposed mice to cannabis smoke to establish the pharmacokinetics of Δ9THC and its metabolites in plasma and brain. To determine the time course of Δ9THC and two major metabolites [11-hydroxy-delta-9-tetrahydrocannabinol (11-OH-THC) and 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (11-COOH-THC)], male and female C57BL/6J mice were exposed to smoke from sequentially burning 5 cannabis cigarettes. Following smoke exposure, trunk blood and brains were collected at 6 time points (10-240min). Plasma and brain homogenates were analyzed for Δ9THC and metabolites using a validated ultraperformance liquid chromatography-tandem mass spectrometry method. To assess effects of age, sex, and mouse strain, we exposed mice of four strains (C57BL/6J, FVB, Swiss Webster, and 129S6/SvEv, aged 4-24months) to cannabis using the same smoke regimen. Samples were collected 10 and 40min following exposure. Lastly, to assess effects of dose, C57BL/6J mice were exposed to smoke from burning 3 or 5 cannabis cigarettes, with samples collected 40min following exposure. The pharmacokinetic study revealed that maximum plasma Δ9THC concentrations (Cmax) were achieved at 10 and 40min for males and females, respectively, while Cmax for brain Δ9THC was observed at 20 and 40min for males and females, respectively. There were no age or strain differences in plasma Δ9THC concentrations at 10 or 40min; however, 129S6/SvEv mice had significantly higher brain Δ9THC concentrations than FVB mice. Additionally, 3 cigarettes produced significantly lower plasma 11-COOH-THC concentrations compared to 5 cigarettes, although dose differences were not evident in plasma or brain concentrations of Δ9THC or 11-OH-THC. Across all experiments, females had higher levels of 11-COOH-THC in plasma compared to males. The results reveal robust sex differences in Δ9THC pharmacokinetics, and lay the groundwork for future studies using mice to model the pharmacodynamics of smoked cannabis.

Study of Addiction in COPD Patients in Abbassia Chest Hospital

Abstract Background and objectives Chronic obstructive pulmonary disease (COPD) is multi-factorial systemic disease that commonly associated with tobacco smoking, moreover, smoking cannabis substance become widely used. The aim of the study is determining the pattern of addiction pattern in patients with COPD, in addition to evaluating the impact of that substance in the disease course. Methods About 100 male patients with definite COPD diagnosis and history of regular substance abuse were enrolled in the study, all of them subjected to COPD assessment test (CAT) and addiction questionnaire. Results The mean age of the studied patients was (52.84 ± 10.21) years, and 15 % of them with overweight. Addiction with Hashish (cannabis) was the most prevalent among the studied groups (70%), while 3 and 2% of cases had used IV substance and Heroin respectively. The most predominant CAT score category were CAT score III and IV with frequency about 44% and 30% respectively. More than half of cases (52%) admitted to ICU because of substance abuse two times or more during the duration of the study. Conclusion The prevalence of Hashish (Cannabis) addiction was higher among COPD patients, and significantly associated with higher CAT score category, in addition to increase the frequency of repeated ICU admission with respiratory complication.

Cannabis smoke suppresses antiviral immune responses to influenza A in mice.

Despite its increasingly widespread use, little is known about the impact of cannabis smoking on the response to viral infections like influenza A virus (IAV). Many assume that cannabis smoking will disrupt antiviral responses in a manner similar to cigarette smoking; however, since cannabinoids exhibit anti-inflammatory effects, cannabis smoke exposure may impact viral infection in distinct ways. Male and female BALB/c mice were exposed daily to cannabis smoke and concurrently intranasally instilled with IAV. Viral burden, inflammatory mediator levels (multiplex ELISA), lung immune cells populations (flow cytometry) and gene expression patterns (RNA sequencing) were assessed in the lungs. Plasma IAV-specific antibodies were measured via ELISA. We found that cannabis smoke exposure increased pulmonary viral burden while decreasing total leukocytes, including macrophages, monocytes and dendritic cell populations in the lungs. Furthermore, infection-induced upregulation of certain inflammatory mediators (interferon-γ and C-C motif chemokine ligand 5) was blunted by cannabis smoke exposure, which in females was linked to the transcriptional downregulation of pathways involved in innate and adaptive immune responses. Finally, plasma levels of IAV-specific IgM and IgG1 were significantly decreased in cannabis smoke-exposed, infected mice compared to infected controls, only in female mice. Overall, cannabis smoke exposure disrupted host-defence processes, leading to increased viral burden and dampened inflammatory signalling. These results suggest that cannabis smoking is detrimental to the maintenance of pulmonary homeostasis during viral infection and highlight the need for data regarding the impact on immune competency in humans.

The Effect of Marijuana on the Voice

Marijuana is derived from the cannabis sativa plant originating in central and southeast Asia. In recent years, there was increasing popularity and use of marijuana in addition to the legalization of its recreational use in parts of the United States. Singing teachers should be fam iliar with the voice effects of marijuana so that they may counsel students about marijuana usage. The authors sent a web-based questionnaire to adult voice center patients. The survey was designed to collect relevant demographic data, past laryngeal history, marijuana use history, and beliefs about effects of marijuana on voice. Those who used marijuana reported voice symptoms that they attributed to marijuana use, including hoarseness, breathiness and weakness. Smoking marijuana may cause immediate and long-term voice dysfunction. No positive changes to the voice have been identified. Further research is necessary to evaluate changes to the voice and safety of marijuana use, but voice teachers should be aware of the common adverse effects.

Perceptions of Safety of Daily Cannabis vs Tobacco Smoking and Secondhand Smoke Exposure, 2017-2021

While rates of cigarette use are declining, more US adults are using cannabis. Perceptions of safety are important drivers of substance use and public policy; however, little is known about the comparative views of US adults on tobacco and cannabis safety. To compare public perceptions of safety of cannabis vs tobacco smoke and evaluate how perceptions may be changing over time. This longitudinal survey study was conducted using a web-based survey administered in 2017, 2020, and 2021. US adults participating in Ipsos KnowledgePanel, a nationally representative, population-based survey panel, were included. Data were analyzed from March 2021 through June 2023. Two questions directly compared the perception of safety of cannabis vs tobacco in terms of daily smoking and secondhand smoke exposure. Additional questions assessed perceptions of safety of secondhand tobacco smoke for adults, children, and pregnant women, with an analogous set of questions for secondhand cannabis smoke. A total of 5035 participants (mean [SD] age, 53.4 [16.2] years; 2551 males [50.7%]) completed all 3 surveys and provided responses for tobacco and cannabis risk questions. More than one-third of participants felt that daily smoking of cannabis was safer than tobacco, and their views increasingly favored safety of cannabis vs tobacco over time (1742 participants [36.7%] in 2017 vs 2107 participants [44.3%] in 2021; P < .001). The pattern was similar for secondhand cannabis smoke, with 1668 participants (35.1%) responding that cannabis was safer than tobacco in 2017 vs 1908 participants (40.2%) in 2021 (P < .001). Participants who were younger (adjusted odds ratio [aOR] for ages 18-29 years vs ≥60 years, 1.4 [95% CI, 1.1-1.8]; P = .01) or not married (aOR, 1.2 [95% CI, 1.0-1.4]; P = .01) were more likely to move toward safer views of cannabis use over time, while those who were retired (aOR vs working, 0.8 [95% CI, 0.7-0.9]; P = .01) were less likely to move toward a safer view of cannabis. Participants were also more likely to rate secondhand smoke exposure to cannabis vs tobacco as completely or somewhat safe in adults (629 participants [12.6%] vs. 119 participants [2.4%]; P < .001), children (238 participants [4.8%] vs. 90 participants [1.8%]; P < .001), and pregnant women (264 participants [5.3%] vs. 69 participants [1.4%]; P < .001). This study found that US adults increasingly perceived daily smoking and secondhand exposure to cannabis smoke as safer than tobacco smoke from 2017 to 2021. Given that these views do not reflect the existing science on cannabis and tobacco smoke, the findings may have important implications for public health and policy as the legalization and use of cannabis increase.

Parallel trajectories of vaping and smoking cannabis and their associations with mental and physical well-being among young adults

BackgroundVaping and smoking are common modes of using cannabis (THC) among young adults, but little is known about how patterns of cannabis vaping and smoking unfold over time or how using one or both types of products may differently affect mental and physical well-being. This study examines parallel processes of cannabis vaping and smoking over 5 years and mental and physical outcomes in a sample of young adults. MethodsAnnual surveys were conducted between 2016 and 2022 with a mostly California-based cohort of 2428 young adults. Parallel process growth mixture models examined trajectories of past-month frequency of cannabis vaping and smoking from ages 20 – 25. Classes were extracted based on parallel trajectories of vaped and smoked product use. Models assessed differences in self-reported mental (anxiety, depression) and physical (ailments, subjective overall) well-being outcomes in young adulthood across classes, adjusting for demographic characteristics and mental and physical well-being at pre-baseline (average age 19). ResultsFour cannabis vaping/smoking classes emerged: low use of cannabis (84.7%), decreasing smoking, low-moderate vaping (7.1%), stable moderate smoking, decreasing vaping (4.6%), and rapid increasing dual use (3.4%). Classes were similar on physical well-being indicators in young adulthood. The rapid increasing dual use class showed higher anxiety and depressive symptoms compared to other classes. ConclusionProgression to higher frequency of both vaping and smoking cannabis in young adulthood may contribute to poorer mental well-being compared to other use patterns. Targeted efforts to reduce dual vaping and smoking in young people who use cannabis may be needed.

Spontaneous Pneumothorax Secondary to Bullous Lung Emphysema Positive for Cannabinoids upon Toxicological Examination.

Cannabis can be related to respiratory diseases, but the relationship between smoking marijuana and the development of a pneumothorax has scarcely been investigated. We aimed to analyze, in patients with a history of cannabis smoking abuse submitted to lung apicectomy for a primary spontaneous pneumothorax (PSP), the correlation between the presence of cannabinoids in the resected lung and the detection of bullous emphysema within the same tissue. Patients undergoing lung apicectomy for a PSP were prospectively enrolled, and the correlation between the presence of cannabinoids in the resected lung tissue and histological finding of bullous emphysema was investigated with Fisher's exact test. There were 21 male patients, with a median age of 27 years. The cannabinoids found by the toxicological examination in surgical specimens were mainly delta-9-tetrahydrocannabinol (THC), cannabinol (CBN), and cannabidiol (CBD). In 14/21 patients, cannabinoids were detected in the resected lung tissue, and bullous emphysema was present in 13/14 of these (93%), while bullous emphysema was found in only 1/7 (14%) of the remaining patients who were negative for cannabinoids in the lung tissue, and the difference was found to be statistically significant (p < 0.0009). Our study demonstrated the presence of bullous emphysema in most cannabinoid-positive patients and its absence in most of those who were cannabinoid-negative, supporting the correlation between cannabinoids in the lung tissue and bullous emphysema with the development of a "secondary" spontaneous pneumothorax.

An intervention based on Well-Being Therapy to prevent alcohol use and other unhealthy lifestyle behaviors among students: a three-arm cluster randomized controlled trial

ABSTRACT Unhealthy lifestyle, such as alcohol use, and negative health outcomes have been associated with impairments in psychological well-being. The primary objective of the study was to test the efficacy of an intervention based on Well-Being Therapy to prevent or stem alcohol use, binge drinking and other unhealthy lifestyle among Italian adolescents in school settings. A three-arm cluster randomized controlled trial including three test periods (baseline, post-test, six-month follow-up) was implemented. Seven classes (144 students) were randomly assigned to receive well-being intervention (WBI), lifestyle intervention (LI), or no intervention (NI). Primary outcomes were alcohol use (AUDIT-C), binge drinking and other unhealthy lifestyle behaviors (i.e. unhealthy diet, physical inactivity, tobacco and cannabis smoking, poor sleep and Internet addiction). Linear mixed models and mixed-effects logistic regression were used to test the efficacy of WBI in comparison with LI and NI. At six-month follow-up, AUDIT-C total score increased more in NI in comparison with WBI (p = 0.044) and LI (p = 0.016), whereas the odds of being classified as at-risk drinker were lower in WBI (p = 0.038) and LI (p = 0.002), than NI. Only WBI showed a protective effect for cannabis use at post-test in comparison with NI (p = 0.003) and LI (p = 0.014). Sleep hours at night decreased more in NI than in LI (p = 0.027) at six months. Internet addiction decreased more in WBI (p = 0.002) and LI (p = 0.005) at post-test in comparison with NI. Although both interventions showed a positive impact on adolescent lifestyle, the positive effect of WBI on cannabis use underlines how this approach might be promising to stem adolescents’ substance use.