Medical Marijuana Research Articles

Cannabis poisonings in Australia following the legalisation of medicinal cannabis, 2014-24: analysis of NSW Poisons Information Centre data.

Cannabis poisonings in Australia following the legalisation of medicinal cannabis, 2014-24: analysis of NSW Poisons Information Centre data.

“Overdried, Without Curing? F*Ck, this [Is Supposed to be] Government Licensed Skunk!” Medical Cannabis and the Refracted Publics Within an Online Polish Drug Forum

“Overdried, Without Curing? F*Ck, this [Is Supposed to be] Government Licensed Skunk!” Medical Cannabis and the Refracted Publics Within an Online Polish Drug Forum

Prevalence of cannabis consumption methods among people with medically recommended and nonmedical cannabis use in the United States.

Some cannabis consumption methods (e.g. smoking, vaping, dabbing) are associated with more harms than others (e.g. sublingual, transdermal). We aimed to examine differences in prevalence of cannabis consumption methods by people with medically recommended-only vs. nonmedical-only cannabis use. Cross-sectional, US nationally representative data from the 2022 National Survey on Drug Use and Health (NSDUH). 14 271 NSDUH participants aged ≥12 with past-year cannabis use. NSDUH asked respondents with past-year cannabis use about their consumption methods [i.e. smoking, vaping, eating or drinking, dabbing (consuming a concentrated form with a dab rig/pen), oral/sublingual, transdermal or taking pills] and if healthcare professionals recommended any cannabis use. If 'no', respondents were classified as having 'nonmedical-only cannabis use'. If 'yes', they were asked if all cannabis use was recommended and, if so, they were classified as having 'medically recommended-only cannabis use'; otherwise, they were classified as having 'medical and nonmedical cannabis use'. Among people reporting cannabis use, 10.7% [95% confidence interval (CI) = 9.7%-11.7%] reported medically recommended-only use, and 83.0% (95% CI = 81.7%-84.3%) reported nonmedical-only use. Smoking was the predominant method for nonmedical-only use (79.2%, 95% CI = 77.7%-80.7%) and for medically recommended-only use (73.7%, 95% CI = 68.8%-78.2%). Vaping prevalence (45.6%, 95% CI = 40.9%-50.4%) and eating/drinking prevalence (45.7%, 95% CI = 40.7%-50.7%) were similar among people with medically recommended-only use. Vaping prevalence was 1.3 times higher [adjusted prevalence ratio (APR) = 1.3, 95% CI = 1.2-1.4] for medically recommended-only than for nonmedical-only use (38.3%, 95% CI = 32.7%-44.3%). Dabbing prevalence was 1.5 times higher (APR = 1.5, 95% CI = 1.3-1.7) for medically recommended-only than for nonmedical-only use [24.4% (95% CI = 20.5%-28.8%) vs 16.4% (95% CI = 15.3%-17.7%)]. Higher prevalence of oral/sublingual and transdermal methods was associated with medically recommended-only use. Among people with past-year medically recommended-only cannabis use in the US, three-fourths reported smoking cannabis and almost half reported vaping and eating/drinking cannabis. Cannabis vaping prevalence and dabbing prevalence were 1.3-1.5 times higher, respectively, among people with medically recommended-only use than people with nonmedical-only use.

Characterization of Cannabis usage in individuals with non-cancer chronic pain in the state of Maine using the Behavioral Risk Factor Surveillance System (BRFSS)

BackgroundOne in 3 Mainers experiences chronic pain. Maine legalized medical and recreational cannabis usage in 2009 and 2016, respectively. To assess cannabis usage in Mainers with chronic pain, we obtained data from Maine’s Behavioral Risk Factor Surveillance System (BRFSS), an annual anonymous survey, from 2017 to 2020. Maine’s BRFSS began asking frequency of cannabis usage in 2017, with two follow-up questions regarding administration routes and reasons for use added in 2020.MethodsWe identified individuals with chronic pain as those that reported having a rheumatoid condition diagnosis, and controls as those who reported no such conditions. To focus on non-cancer chronic pain, we excluded individuals that had previous cancer diagnoses. For each of the three separate cannabis questions, we also excluded those that answered “don’t know/unsure” or “refused” for the question of interest or their sex. Data from 2017 to 2020 were used to analyze the question on frequency of usage, while data from 2020 alone were used to analyze the two follow-up questions. Data were stratified by sex and analyzed in Microsoft Excel and SigmaPlot.ResultsWe observed an increase of high-frequency users (21–30 days/last 30 days) and reduction of non-users for both sexes from 2017 to 2020, which was significant in controls (p < 0.05). The average age of cannabis users was lower than non-users, regardless of sex or pain status (p < 0.05). Regardless of pain status, although smoking was overall the most used administration route, more males tended to smoke cannabis while more females tended to eat it (p < 0.01). Individuals with pain, regardless of sex, were more likely to respond, “use it some other way” (p < 0.01). Pain group males, pain group females, and control group females were all more likely to report use for medical reasons (p < 0.001).ConclusionsSince the legalization of cannabis, Mainers have started to use it more frequently. High-frequency users are generally younger than non-users. Females and individuals with chronic pain are more likely to use cannabis for medical reasons, and to use administration routes other than smoking. Further characterization is warranted as cannabis usage becomes more prevalent in individuals both with and without chronic pain.

Patients' Perceptions of the Efficacy, Safety, and Quality of the Evidence of Medicinal Cannabis: A Survey of Australian Cancer Patients.

Despite the increased demand for medical cannabis (MC), MASCC guidelines state that there is insufficient evidence of its efficacy and safety. Although research has explored medical professionals' perceptions of MC, there is to our knowledge minimal research exploring patients' perceptions, particularly in an Australian cancer setting. A survey of Australian cancer patients attending oncology outpatient clinics was performed. Patients were ≥ 18 years and had a confirmed diagnosis of cancer (solid or hematological). A total of 413 patients were approached between April 2019 and March 2020 out of which 82% (350) consented to participate. A total of 19% (67/350) were using MC. Despite being used for symptom control, such as pain (61%), and, in some cases for perceived anticancer activity (12% to cure, and 16% to slow the cancer), only a minority of users believed that the evidence was of high quality for these indications (28% for physical benefits and 29% for anticancer activity). Nonusers were even more skeptical of the evidence for these indications (17% and 11%, respectively). Only a minority of patients (31% of users and 8% of nonusers) accessed information on MC from clinicians. Most instead relied on resources such as TV, friends, family, social media, and websites. This study demonstrates current real-world cancer patients' perceptions on the evidence for MC, the sources of information used to shape their health beliefs, and compares users to nonusers. The results highlight the need for treating teams to combat potential misinformation that patients may be accessing about MC and provide information on treatments with stronger evidence.

TRATAMENTO PARA EPILEPSIA COM USO DE CANABIDIOL

Dravet syndrome (DS), Lennox-Gastaut syndrome (LGS) and tuberous sclerosis complex (TSC) are extremely serious diseases present in the central nervous system that cause epileptic seizures that are refractory to conventional medications. Therefore, the objective of this study was to describe the effectiveness and the need for expanding studies and government measures on the use of medicinal cannabis as an alternative treatment for refractory epileptic seizures. The PubMed and BVS databases were used with the descriptors “Treatment”, “Epilepsy”, “Cannabidiol”, and the inclusion criteria used were articles published between 2021 and 2024, free full text and clinical trial type; duplicate articles and off-topic articles were excluded. After reading the articles and using the criteria, a total of 22 articles were kept, and it was observed that the main medication currently used for refractory epileptic seizures is Epidiolex, which has the active component cannabidiol in its formulation, being very beneficial for the syndromes mentioned in the pediatric population. However, it is still possible to observe that there is a high cost of this medication and a lack of accessibility. Thus, correlated with the complicated demands of legal filings, which are quite evident factors, especially in Brazil. Therefore, new studies and government measures are necessary, so that treatment with cannabidiol is recommended.

Reducing medical cannabis use risk among Veterans: A descriptive study

BackgroundCanadian Veterans experiencing chronic pain report concerns about accessing accurate information on the risks associated with medical cannabis (MC) use. The Lower Risk Cannabis Use Guidelines (LRCUG) were developed to equip individuals who use cannabis recreationally with safer-use strategies. Many of the harm reduction recommendations for recreational cannabis use are relevant and important considerations for MC use. The primary objective of our study was to assess Canadian Veterans’ awareness of and interest in the LRCUG, and engagement in potential higher-risk MC use behaviours.MethodsCanadian Armed Forces Veterans living with chronic pain (N = 582) were recruited online and through the Chronic Pain Centre of Excellence for Canadian Veterans. Participants completed measures on: cannabis use (never, past, current use), sources of cannabis knowledge, mental health, and awareness of and interest in receiving the LRCUG. Chi-Square and post-hoc analyses characterized the sample and assessed for demographic differences based on cannabis use status and awareness of the LRCUG. Engagement in higher-risk MC use behaviours were aligned to LRCUG recommendations, and detailed descriptively.ResultsVeterans who currently use cannabis were more likely to be unemployed (z = 3.62, p < .01), released as a Non-Commissioned Officer (z = -3.83, p < .01), and unable to work due a disability (z = -3.43, p < .01) than Veterans who do not currently use. Less than 30% of Veterans were aware of the LRCUG, with greater awareness among individuals who currently use cannabis (n = 356). Engagement in higher-risk MC use behaviours that contradicted LRCUG recommendations ranged from ~ 9% to ~ 85%. Approximately 9% of Veterans experienced co-morbid mental health concerns, yet their MC use was not for mental health purposes (LRCUG recommendation #7). Additionally, almost 85% of Veterans engaged in daily MC use (LRCUG recommendation #5). The majority of Veterans who currently use cannabis engaged in two or more higher-risk MC use behaviours (60.2%; LRCUG recommendation #12). Almost half of all Veterans received their cannabis information from a healthcare provider or the internet.ConclusionsOur study suggests the importance of safer use guidelines tailored for MC use. Development of lower-risk MC use guidelines can support prescribing practitioners and Veterans with information needed for safer and better-informed MC use decisions, tailored to patients’ needs and circumstances.

Cannabis for Chronic Pain: Mechanistic Insights and Therapeutic Challenges

Chronic pain represents a complex and debilitating condition that affects millions of people worldwide, significantly compromising their quality of life. The conventional approach to treating this type of pain often relies on the use of opioid analgesics and anti-inflammatory drugs. While these agents are effective in the short term, they present several limitations, including the risk of dependence, severe side effects, and, in some cases, ineffectiveness in reducing pain. In this context, medical cannabis has emerged as a promising therapeutic alternative, given its potential ability to relieve pain effectively with a favorable safety profile. This work aims to provide a comprehensive and up-to-date review of the existing literature on the effects of medical cannabis in the treatment of chronic pain. Cannabis sativa contains several pharmacologically active compounds, the most prominent of which are delta-9-tetrahydrocannabinol (∆9-THC) and cannabidiol (CBD), which interact with the body’s endocannabinoid system, thereby modulating the pain response. Clinical evidence has shown that cannabinoids can significantly reduce the intensity of chronic pain, particularly in cases of neuropathy, multiple sclerosis, arthritis, and other painful conditions that are unresponsive to conventional treatments. However, the full integration of medical cannabis into clinical practice faces significant obstacles, including the need for standardized dosing, long-term safety data, and regulatory frameworks. These issues, alongside concerns over adverse effects and drug interactions, must be addressed to unlock the full therapeutic potential of cannabinoids, particularly for chronic pain patients, who endure both physical suffering and the added burden of stress.

Role of Cannabis in the Management of Chronic Non-Cancer Pain: A Narrative Review.

Chronic non-cancer pain, defined by the Center for Disease Control and Prevention (CDC) as lasting beyond three months, significantly affects individuals' quality of life and is often linked to various medical conditions or injuries. Its management is complex. Cannabis, containing the key compounds Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), has garnered interest for its potential in pain management, though it remains controversial due to its psychoactive effects and illegal status in many countries. THC provides pain relief by blocking nociceptive stimuli but has psychoactive effects and may potentially induce dependency. CBD has calming and antipsychotic properties. The inhalation of cannabis offers quick relief but poses respiratory risks, while its oral administrations are safer but act more slowly. Short-term cannabis use can impair cognition and motor skills, while long-term use may lead to dependency and cognitive decline, especially if used from an early age. Adverse effects vary by gender and prior use, with addiction mainly linked to THC and influenced by genetics. Despite these risks, patients often report more benefits, such as improved quality of life and reduced opioid use, although the evidence remains inconclusive. The legal landscape for medical cannabis varies globally, with some positive public health outcomes like reduced opioid-related issues in areas where it is legalized. Cannabis shows promise in managing chronic pain, but its psychoactive effects and dependency risks necessitate cautious use. Future research should prioritize long-term clinical trials to establish optimal dosing, efficacy, and safety, aiding in the development of informed guidelines for safe cannabis use in chronic pain management. This review examines the use of cannabis in managing chronic non-cancer pain, focusing on its benefits, drawbacks, mechanisms, delivery methods, and impact on quality of life.

Cannabis use and atherosclerotic cardiovascular disease outcomes: A meta-analysis of multinational cohort data.

While an association between cannabis use and the risk of atherosclerotic cardiovascular diseases (ASCVD) has been reported numerous times, it remains inconclusive as to whether this link is causal in nature. We sought to consolidate data from observational studies to explore the association between ever use of cannabis and ASCVD outcomes, including myocardial infarction, stroke, and a combined measure of any adverse cardiovascular events in comparison to non-users or controls. We performed a systematic literature search on PubMed, Scopus, ScienceDirect, and Cochrane Library for relevant studies from inception until April 2024. Statistical analyses utilized RevMan 5.4 with a random effects model. The study protocol has been registered with PROSPERO (CRD42024530366). Our analysis incorporated data from 17 studies involving a total of 1,902,481 individuals aged between 18 and 74 years, with a mean follow-up duration of 8.5 years. Upon pooled analysis, no statistically significant association was found between cannabis use and the risk of myocardial infarction compared to non-users, with an RR of 1.25 (95% CI: 0.91-1.71, p = 0.17). Similarly, while the risk of stroke showed no significant association with cannabis use (RR: 1.38, 95% CI: 0.88 to 2.16, p = 0.16), a statistically significant association was observed between ever use of cannabis and the composite of any adverse cardiovascular events (RR: 1.48, 95% CI: 1.16-1.90, p = 0.002). The evident statistical correlations between cannabis use and adverse cardiovascular outcomes underscore its potential as a risk factor for cardiovascular disease, suggesting plausibility for a causal relationship between cannabis use and ASCVD. With rising trends in medical cannabis use and cannabis use disorder across age demographics, heightened risk awareness and informed decision-making regarding cannabis consumption are critical priorities in healthcare and public health initiatives.

The relationship of medical and recreational cannabis laws with opioid misuse and opioid use disorder in the USA: Does it depend on prior history of cannabis use?

Wider availability of cannabis through medical and recreational legalization (MCL alone and RCL+MCL) has been hypothesized to contribute to reductions in opioid use, misuse, and related harms. We examined whether state adoption of cannabis laws was associated with changes in opioid outcomes overall and stratified by cannabis use. Using National Survey on Drug Use and Health (NSDUH) data from 2015 to 2019, we estimated cannabis law associations with opioid (prescription opioid misuse and/or heroin use) misuse and use disorder. All logistic regression models (overall models and models stratified by cannabis use), included year and state fixed effects, individual level covariates, and opioid-related state policies. Stratified analyses were restricted to individuals who reported lifetime cannabis use prior to law adoption to reduce potential for collider bias. Estimates accounted for multiple comparisons using false discovery rate (FDR) corrections and sensitivity to unmeasured confounding using e-values. Overall, MCL and RCL adoption were not associated with changes in the odds of any opioid outcome. After restricting to respondents reporting past-year cannabis use, we observed decreased odds of past year opioid misuse (adjusted odds ratio [AOR]: 0.57 [95 % confidence interval [CI]: 0.38, 0.85]; FDR p-value: 0.07), among individuals in states with MCL compared to those in states without cannabis laws. RCLs were not associated with changes in the odds of any opioid outcome beyond MCL adoption. Comparing individuals in MCL alone states to those in states without such laws, we found an inconsistent pattern of decreased odds of opioid outcomes, which were more pronounced among people reporting cannabis use. The pattern did not hold for individuals in RCL states. In line with a substitution-oriented perspective, findings suggests that MCLs may be associated with reductions in opioid use among people using cannabis but additional work to replicate and expand on these findings is needed.

Optimization and Evaluation of Cannabis-Based Magistral Formulations: A Path to Personalized Therapy.

The official implementation of pharmaceutical-grade cannabis raw materials for medicinal use has permitted doctors to prescribe and pharmacists to prepare cannabis-based formulations. The objective of the pharmaceutical development and manufacturing process optimization work was to propose a suppository formulation containing doses of 25 mg and 50 mg of tetra-hydrocannabinol (∆-9-THC) as an alternative to existing inhalable or orally administered formulations. The formulation could be used for rectal or vaginal administration, thereby providing dosage control in the treatment of endometriosis and other conditions involving pain. In this study, two substrates from suppositories with standardized Cannabis extractum normatum (CEX) were used: cocoa butter and Witepsol® H15. The long-term stability of CEX was investigated over a period of up to 24 months. The concentrations of ∆-9-THC, cannabidiol (CBD), and cannabinol (CBN) were determined using an HPLC method. Furthermore, the water content of the extract, the ethanol residue, and the microbiological purity were determined. The pharmaceutical properties of CEX-incorporated suppositories, namely content uniformity, hardness, softening time, total deformation time, disintegration time, and the release profile of ∆-9-THC, CBD, and CBN, were evaluated in order to develop optimal preparation procedures for pharmacists. Following a 24-month stability study on CEX, no significant alterations in component content were observed beyond the specified requirements. The disintegration time, total deformation time, and hardness of the suppositories based on Witepsol® H15 with CEX were found to be longer and higher, respectively, than those of suppositories formulated with cocoa butter. In vitro studies demonstrated that suppositories prepared with Witepsol® H15 exhibited superior release of ∆-9-THC compared to those prepared with cocoa butter. We suggest that pharmacists making prescription drugs in a pharmacy setting in the form of medical marijuana suppositories will receive a better release profile of the drug by choosing Witepsol® H15 as a substrate.

The driving-related attitudes, beliefs and behaviours of cannabis users in the Australian Capital Territory following decriminalisation.

In January 2020, the government of the Australian Capital Territory (ACT) decriminalised the possession and cultivation of cannabis for personal use. This study explored the driving-related attitudes, beliefs and behaviours of ACT residents who are legally cultivating and consuming cannabis. A two-part cross-sectional study was conducted. Part-1: Cannabis users residing in the ACT were invited to complete an online survey. Part-2: Survey respondents who reported 'currently growing' cannabis were invited to submit a sample of their home-grown cannabis for phytocannabinoid analysis. Data from Parts 1 and 2 were used to estimate participants' usual Δ9-tetrahydrocannabinol (THC) intakes. N = 385 cannabis users completed all or part of the online survey and N = 52 submitted cannabis samples for phytocannabinoid analysis. Most participants (N = 224/330; 67.9%) reported waiting ≥7 h following cannabis use before driving. However, 21.5% (N = 71/330) reported waiting ≤3 h. These individuals had the highest cannabis and THC intakes of the sample (where known). Further analyses revealed that individuals who expressed less concern about roadside drug testing and the effects of non-medicinal and medicinal cannabis on driving, and who used cannabis more frequently, in larger amounts, and exclusively for non-medicinal purposes were more likely to report shorter 'wait times'. A small proportion of cannabis users in the ACT appear to be driving shortly (i.e., ≤3 h) after consuming considerable quantities of cannabis and THC. This behaviour puts them at risk of driving while impaired and incurring legal sanctions. Interventions alerting these individuals to these possible risks are, therefore, warranted.

An international survey on the knowledge, aTtitudes and clinical pAtternS of use of medical cannabis for caNcer care: the TASMAN study

BackgroundMedical cannabis (MC) has gained traction in oncology for managing cancer-related symptoms, but its integration faces challenges due to limited evidence, inconsistent guidelines, and varied legal frameworks. MethodsThe TASMAN study aimed to assess the knowledge, attitudes, and practices of oncologists and palliative care providers globally regarding MC use in cancer care. A survey of healthcare providers from diverse regions and income levels was conducted. Resultswe study included 179 participants (response rate: 51.1%), with an equal gender distribution (49.4% female) and a median age of 37 years. Participants were primarily oncologists (71.5%), practicing in university hospitals (40.2%) or cancer centres (32.4%), with over half from low- and middle-income countries. Most respondents (92.7%) were unaware of clinical guidelines for MC. A proportion of 44.1% were familiar with MC use, 78.8% recognized its role in cancer pain, and 34% identified its role in managing cachexia. Awareness of specific products was low, with only 10% familiar with specific cannabis products. Three-quarters of respondents (84.4%) did not prescribe MC routinely. Legal status and regulations were unclear for most participants; 40% noted cannabis as illegal. MC use and patient requests were more common in high-income countries and the EURO region, with palliative care providers demonstrating the highest awareness and prescription rates. ConclusionClearer regulations, standardized guidelines, and targeted education are essential to support the safe integration of MC into oncology and palliative care, ultimately improving the quality of life for cancer patients.

The association of state policies and opioid analgesic amount dispensed from retail pharmacies.

States have implemented multiple policies likely to influence opioid prescribing; few national general population studies examine those policies' effects on per-capita opioid morphine milligram equivalents (MME) dispensed. To examine state policies' effects on opioids per-capita MMEs dispensed at retail pharmacies. A longitudinal study of associations between MME per capita and implementation of policy interventions at different times across states. United States, 2006-2018 PATIENTS: Data representing approximately 90 % of prescriptions filled at retail pharmacies in the United States. States implementing (1) Pain management clinic laws, (2) operational Prescription Drug Monitoring Programs (PDMP), (3) mandatory PDMP use, (4) required continuing medical education for opioid prescribers, (5) medical cannabis dispensary laws, and (6) initial prescription duration limit laws. Monthly county-level opioid MME per-capita. Pain management clinic policies' effects were modest, not significantly associated with MME per-capita in the year following implementation, but negatively associated in subsequent years. Operational PDMP policies were negatively associated with MME per-capita in all five years following implementation. We found no evidence of significant effects of mandatory PDMP requirements, mandatory continuing medical education policies, or medical cannabis dispensary policies in any of the five years following policy implementation. Initial prescription duration limits were associated with increased per-capita MME dispensed in years 3-5 following implementation. Several state policies are associated with reductions in the total amount of opioid analgesic dispensed. Additional research should examine the policies' effects on clinical outcomes in both general and high-risk populations.

Cannabis use, sleep and mood disturbances among persons with epilepsy - A clinical and polysomnography study from a Canadian tertiary care epilepsy center.

Interest in anti-seizure properties of cannabinoids is increasing, with the rise in prevalence of recreational and medical cannabis use, especially across Canada. In a recent study on people with epilepsy (PWE), cannabis use showed a strong association with poor psychosocial health. Sleep and mood comorbidities are highly prevalent in epilepsy, and are common motivations for cannabis use. The primary objective of this study was to assess demographic, subjective and objectively assessed sleep quality and mood related differences among PWE who regularly use cannabis compared to those who do not. Consecutive consenting patients with a confirmed epilepsy diagnosis, admitted to our Epilepsy Monitoring Unit, over a 3-year period (2019-2022) were enrolled. Detailed epilepsy-related data and self-reported sleep [Pittsburgh Sleep quality index (PSQI)], Epworth Sleepiness Scale (ESS)], mood [(Beck's Depression Inventory (BDI) and Beck's Anxiety inventory (BAI)] and cannabis use related data were collected. Overnight polysomnography (PSG) was conducted on the first night of admission, with simultaneous 18-channel video-EEG. Sleep (PSG) scoring followed American Academy of Sleep Medicine guidelines by a scorer blinded to clinical details. Among 51 patients with similar seizure control, 25 (13 F) reported cannabis use (mean age 36.3+14.8 years) and were significantly younger than 26 (18 F) non-users (mean age 48.3+15 years). Cannabis users had significantly better subjective sleep quality (mean PSQI scores 7.2+2.9 vs 10.2+5.2 respectively). Most patients endorsed sleepiness (Cannabis users with ESS scores greater than 10; 91.3 %, 77.3 % in non-users) and moderate to extreme depression (BDI) scores. No significant differences were observed in objective sleep parameters. BDI score significantly predicted PSQI and ESS scores on multiple logistic regression analysis. Despite a significant age difference, self-reported sleep quality is better among PWE who report regular cannabis use compared to non-users. However, there is no significant difference in objective sleep quantity and quality from PSG between the two groups. Additionally, severity of depressive symptoms is a significant predictor of sleep quality and of excessive daytime sleepiness among PWE.

High air temperature reduces plant specialized metabolite yield in medical cannabis, and has cultivar-specific effects on inflorescence dry matter production

High air temperature reduces plant specialized metabolite yield in medical cannabis, and has cultivar-specific effects on inflorescence dry matter production

Preclinical Evidence for a Drug-Drug Interaction Between Cannabinol and Melatonin.

The worldwide legalization of medicinal cannabis has led to an increased use of products made by commercial operators. These products often contain minor cannabinoids such as cannabinol (CBN) which are advertised to improve sleep. Products are also available in which CBN is combined with conventional therapies, with a common product containing both CBN and the widely used sleep-aid melatonin. The combination of CBN and melatonin provides potential for a pharmacokinetic drug-drug interaction (DDI) given that cannabinoids are known to inhibit drug-metabolizing enzymes. Indeed, we recently reported that CBN potently inhibited the CYP1A2-mediated metabolism of caffeine. CYP1A2 is the major hepatic enzyme involved in the metabolism of melatonin; thus, in this study, we aimed to examine whether CBN inhibited CYP1A2-mediated metabolism of melatonin invitro and invivo. We found CBN potently inhibited CYP1A2-mediated metabolism of melatonin and increased the apparent oral bioavailability of melatonin in mice with a four-fold increase in the plasma melatonin exposure. Our results provide an additional example of a potential DDI involving melatonin.

Impact of medical and recreational cannabis laws on inpatient visits for asthma

AbstractObjectiveTo examine the impact of medical and recreational cannabis laws on inpatient visits for asthma and by payer‐type.Study Setting and DesignQuasi‐experimental difference‐in‐differences regression analysis was conducted while accounting for variations in cannabis laws implementation timing by states. Inpatient visits for asthma in states with a given type of cannabis law were compared with those in states that did not implement the specific law. Four different cannabis laws were examined in the study—initial passage of medical cannabis law, opening of a medical cannabis dispensary, home cultivation of medical cannabis, and recreational cannabis legalization.Data Sources and Analytic SampleState‐level quarterly inpatient visit data for asthma patients were utilized from the Healthcare Cost and Utilization Project Fast Stats database. The primary analysis included inpatient visits for asthma by all payer adult patients aged 19 and above in 38 states from 2005 to 2017, and the secondary analysis included inpatient visits for asthma by payer‐type (i.e., private, Medicare, Medicaid, uninsured).Principal FindingsStates with medical cannabis dispensaries and legalized recreational cannabis experienced 14.12% (2.14; 95% CI, 0.74–3.53; p &lt; 0.01) and 20.45% (3.08; 95% CI, 1.47–4.69; p &lt; 0.001) increases in inpatient visits for asthma compared with states without these policies, respectively. These increases in inpatient visits for asthma were primarily driven by populations covered by Medicare and private insurance, with Medicare population showing larger effects of both recreational cannabis laws and medical cannabis dispensaries.ConclusionsStates with medical cannabis dispensaries and legalized recreational cannabis experienced higher rate of inpatient visits for asthma compared with states without these policies. Clinicians and policymakers should consider strategies to curb adverse health outcomes of cannabis, that is likely to result in increased costs of healthcare.

The effects of plant density and duration of vegetative growth phase on agronomic traits of medicinal cannabis (Cannabis sativa L.): A regression analysis.

Empirical data on the effect of plant density (PD) and length of the vegetative phase (DVP) on plant growth, yield, and cannabinoid concentration of medicinal cannabis (Cannabis sativa L.) are still scarce, leading to a lack of specific cultivation recommendations. We conducted two greenhouse experiments to investigate the effect of PD in the range of 12-36 plants m-2 (D-trial) and DVP in the range of 1-4 weeks (V-trial) on plant morphology, biomass growth of individual plant organs, and CBD concentration of individual inflorescence fractions. Empirical models for the relationships between the investigated plant traits and PD/DVP were created using linear regression analysis preceded by a lack-of-fit test. An increase in PD led to a linear decrease in inflorescence yield per plant (p = 0.02), whereas a positive linear relationship was found for inflorescence yield (p = 0.0001) and CBD yield (p = 0.0002) per m2. Total area yields in the D-trial ranged from 119 to 247 g m-2 from lowest to highest PD. DVP showed a positive linear relationship with inflorescence yield on an individual plant (p = 0.0001) and area basis (p < 0.0001) along with most other relevant agronomic traits such as CBD production, plant size and lateral shoot length. Total area yields in the V-trial ranged from 295 to 571 g m-2 from lowest to highest DVP. The yield increase could be linked to the increased inflorescence number per plant rather than inflorescence size. In contrast to expectations, neither PD nor DVP had significant effects on the cannabinoid concentration gradient from upper to lower canopy layers. CBD concentrations in inflorescences from lower canopy layers were reduced by 23% in the V-trial and 46% in the D-trial. However, with increasing PD, the proportion of higher-concentrated inflorescence fractions from upper canopy layers increased from 46% to 68%, while an extension of DVP shifted this proportion only marginally from 45% to 50%. In the context of standardized production, we therefore advocate high-density production systems that increase the proportion of desired inflorescence fractions from upper canopy layers.