Presence Of Cannabis Research Articles

Severe Hypoglycemic Brain Injury Associated with Diffuse Restricted Diffusion on MRI Brain Sparing Cerebellar Lobes (P10-7.006)

<h3>Objective:</h3> Report a case of severe hypoglycemia-induced brain injury in an adult with MRI brain showing extensive diffusion restriction mimicking hypoxic brain injury. <h3>Background:</h3> Hypoglycemia is commonly seen in clinical practice, with most often benign outcome when appropriately treated. However, severe hypoglycemia may be associated with transient or permanent neurologic deficits. Irreversible diffuse brain injury is more often documented in the pediatric population, in particular neonatal, though devastating injury can also happen in adults. Energy deprivation and other chemical cascades lead to neuronal necrosis. Though some overlap exists and imaging shares some similarities, neurochemistry and brain lesion distribution of hypoglycemia differs markedly from ischemia. We present a case of severe, prolonged hypoglycemia leading to diffuse hypoglycemic brain injury. <h3>Design/Methods:</h3> Case report <h3>Results:</h3> 71-year-old male with history of insulin-dependent diabetes and depression with suicidal ideations who presented to the emergency room (ER) after being found unconscious with a serum glucose of 14 mg/dl. The patient was intubated for airway protection due to GCS at 9 but without significant hypoxia, saturating 93% on room air. Despite aggressive glucose replacement, he had several hypoglycemic episodes on a 27-hour span. Laboratory testing was remarkable only for elevated creatinine kinase of 3047 mg/dl, and presence of cannabis on urine drug screen. Patient remained comatose, with only preserved corneal reflexes after weaned off sedation. Non-epileptic myoclonus was also observed, confirmed by EEG. MRI brain revealed diffuse restricted diffusion, predominantly in the cerebral cortex and deep basal ganglia but sparing cerebellar lobes. Patient did not survive. <h3>Conclusions:</h3> Severe hypoglycemia leads to energy depletion and neuronal death with some overlap with ischemic brain injury though significant radiologic differences can help differentiate both pathophysiologic processes. Cerebellar involvement is uncommon compared to ischemic injury due to highly effective glucose transporter which can help differentiate both types of injury. <b>Disclosure:</b> Dr. Ribeiro has nothing to disclose. Dr. Gatchoff has nothing to disclose. Dr. Delpirou Nouh has nothing to disclose. Dr. Moon has nothing to disclose.

Demographic trends associated with substance use disorder and risk for adverse obstetric outcomes with cannabis and opioid use disorders

Background Substance use disorders (SUDs) are increasing in the obstetric population, vary with demographic characteristics, and are associated with adverse pregnancy outcomes. Cannabis use disorder and opioid use disorder are two of the most common SUDs during pregnancy. Objective This study had two objectives. The first objective was to assess trends in any SUD diagnosis during delivery hospitalizations from 2000 to 2018 by maternal age, ZIP code income quartile, and hospital location and teaching status. The second objective was to determine risk for adverse pregnancy outcomes during delivery hospitalizations specifically in the presence of cannabis and opioid use disorder diagnoses. Study design We conducted a serial cross-sectional analysis of the 2000–2018 National Inpatient Sample. Delivery hospitalizations to women aged 15–54 years with substance use disorder diagnoses were identified. SUD included (i) cannabis use disorder; (ii) opioid use disorder; (iii) alcohol use disorder; and (iv) other drug use disorder. We used joinpoint regression to estimate the average annual percent change (AAPC) in any substance use disorder diagnoses with 95% confidence intervals (CIs) by (i) ZIP code income quartile, (ii) hospital location and teaching status, and (iii) maternal age. We used unadjusted and adjusted log-linear regression to evaluate the relationship between cannabis use disorder and opioid use disorder several adverse maternal outcomes. We report unadjusted and adjusted risk ratios (aRRs) as measures of effect. Results From 2000 to 2018, trends analyses broadly demonstrated increasing risk for SUD across demographic categories. In trends analyses stratified by ZIP code-income quartile, the proportion of deliveries with any SUD diagnosis increased across each income quartile with significant increases in the lowest income quartile (AAPC 4.6%, 95% CI 0.4%, 8.9%), second lowest quartile (AAPC 6.3%, 95% CI 5.3%, 7.4%), second highest quartile (AAPC 5.4%, 95% CI 4.1%, 6.8%), and highest quartile (AAPC 4.4%, 95% CI 2.1%, 6.8%). A larger increasing AAPC for SUD was present for deliveries in rural hospitals (AAPC 12.3%, 95% CI 9.8%, 14.9%) as compared to teaching (AAPC 5.7%, 95% CI 5.2%, 6.3%) and non-teaching urban hospitals (AAPC 7.0%, 95% CI 5.9%, 8.1%). By maternal age group, there was a significant larger AAPC for SUD for women aged 15–19 years (AAPC 8.5%, 95% CI 6.6%, 10.4%), 20–24 years (AAPC 9.0%, 95% CI 6.9%, 11.1%) and 25–29 years (AAPC 9.8%, 95% CI 9.1%, 10.6%) than women ≥30 years of age. Cannabis use disorder was associated with increased adjusted risk for preterm delivery (aRR 1.44, 95% CI 1.43, 1.45) and abruption and antepartum hemorrhage (aRR 1.77, 95% CI 1.75, 1.80). Opioid use disorder was associated with risk for non-transfusion severe maternal morbidity (aRR 1.73, 95% CI 1.67, 1.79), preterm delivery (aRR 1.75, 95% CI 1.74, 1.77), and abruption and antepartum hemorrhage (aRR 2.15, 95% CI 2.11, 2.19). Conclusion While substance use disorders are increasing in pregnancy across rural and urban settings, age groups, and income quartiles, several populations are associated with higher increased risks and trends. These findings support that SUDs are likely to continue to be of public health significance in diverse geographic and demographic settings.

Factors associated with early biological aging in older people with HIV

ABSTRACT Advances and availability of antiretroviral treatment has enabled a longer life expectancy for HIV population. However, with its chronicity, premature aging challenges the management of people living with HIV. This study, conducted between 2018–2020, aimed to identify an association between risk factors and premature aging, using the biological age estimated by artificial intelligence (AI) based on deep learning (Aging 3.0). This was a cross-sectional, analytical study, involving older people living with HIV (OPLHIV), 66.1% of whom were men. Premature aging was identified in 67.8%. The presence of cannabis and diabetes were significant (p = 0.045 and p = 0.042, respectively). For current and nadir CD4 + cell counts, participants were divided into groups comparing biological age (BA) and chronological age (CA). Just one group presented no premature aging, whereas the group with premature aging was subdivided into BA > CA up to 4 years and BA > CA in 5 or more years. In conclusion, premature aging was present in most of the OPLHIV. The use of cannabis was self-reported in those with higher BAs and those with a lower BA presented a higher prevalence of diabetes. Factors directly linked to HIV infection, lower current and nadir CD4 + counts were associated with premature aging.

Cannabis, an emerging aeroallergen in southeastern Spain (Region of Murcia)

The evolution of the behaviour of the Cannabis taxon in the Region of Murcia, Spain, has been analysed (in the cities of Cartagena, 1993–2020; Murcia, 2010–2020; and Lorca, 2010–2020). An attempt has been made to establish the origin of Cannabis pollen in this region to determine whether it is transported locally or from long distances based on air mass origins. Cannabis is an herbaceous, normally dioecious and anemophilous plant, which produces large quantities of pollen grains. It has been widely used for fibre (hemp), bird food (hempseed), essential oils and narcotics. The origin of Cannabis pollen grains has been established by calculating back trajectories at the altitudes of: 750, 1500 and 2500 m above mean sea level (m amsl); 350, 500 and 650 m amsl; and 10, 100 and 250 m amsl, using the HYSPLIT model. Considering this data, 29 days of Cannabis pollen potentially originating in Africa were identified in Cartagena, 19 days in Murcia and 15 days in Lorca. Of the remaining days, the air mass back trajectories showed local or regional pollen origins. These were 83 days in Cartagena, 61 days in Murcia and 57 days in Lorca. The presence of Cannabis in the bioaerosol of the Region of Murcia is irregular, and it is considered a minority pollen type. However, from 2017 to 2020, concentrations increased, with a positive and significant trend of 90% in the Annual Pollen Integral. The pollen season can be defined between June and August. This increase in the concentration of Cannabis pollen grains during this period coincides with an increase in local transport, suggesting the possibility of increased Cannabis cultivation in the study area.

Perceived effects of cannabis and changes in driving performance under the influence of cannabis

Objective Reports indicate that cannabis users will adapt their driving to compensate for the perceived drug effects of cannabis. This analysis examined the relationship between driver perceptions of their state contrasted with objective measures of their performance while operating a motor vehicle. Methods Data was collected from ten subjects in a study examining the effects of cannabis on driving performance. Driving performance was collected on the NADS quarter-cab miniSim, a limited field of view non-motion simulator, approximately two hours after cannabis inhalation. Driving measures of both lateral and longitudinal control were included in our analysis. Subjective measures of the effects of cannabis were collected at peak and prior to driving, using visual analog scales. Data were analyzed using the SAS GLM Select procedure with subjective effect, dosing condition (placebo vs 6.9% THC), and driving event as independent measures. The stepwise selection method was used. Results The analysis of each of the subjective effects showed significant differences between the placebo and the active cannabis dosed conditions. While we found variance in difference between group means, there was greater variability between subject values. We found that subjective measures were predictive of variance in driver inputs, such as steering frequency and steering reversal rate. Variance in SDLP and other driving performance measures, however, were predicted by dosing condition. Conclusions Overall, some of the effects perceived by the driver were better related to changes in driver inputs rather than the presence of cannabis itself. Changes in performance measures such as SDLP are better explained by dosing condition. Thus, driver’s perceptions may result in changes to driving behavior that could mitigate the effect of cannabis. For both lateral and longitudinal control, an increasing perception of stimulation produced a positive effect on performance. Our results provide a better understanding of how different strains of cannabis, which produce different subjective experiences for users, could impact driving safety. Specifically, we found drug effects that produce more stimulation results in less impact on driving, while those that produce a more stoned or high feeling results in a greater negative effect on driving.

Associated factors to abusive alcoholic beverage consumption in suicide victims

BackgroundSuicide is a worldwide phenomenon, as well as a challenge for public health, and alcoholic beverage abuse is one of the most important risk factors. However, the association between possible factors related to alcoholic beverage consumption in suicide victims has rarely been investigated. ObjectiveTo evaluate the factors associated with abusive alcoholic beverage consumption among people who died from suicide in the Brazilian Federal District (BFD). MethodA population-based and cross-sectional study with suicide victims in the BFD between 2016 and 2017. Information was collected about sociodemographic characteristics, autopsy appraisal, and drug use. A trained team evaluated all cases to define factors associated with abusive alcoholic beverage consumption. This outcome was measured using the Blood Alcohol Concentration. Poisson regression analysis was applied to calculate the Prevalence Ratios and respective populational confidence intervals. ResultsThe findings of the present study were collected from a database containing information related to 278 suicide victims. Being male and having cocaine identified in the toxicological test were the factors that showed a strong association with abusive alcohol beverage consumption in suicide victims. Other factors showed a slight association (PR < 1.5): having an education level with greater than 8 years of study, being black, having a professional occupation or being retired or pensioner, and having the presence of cannabis in the toxicological test. ConclusionSocioeconomic-demographic and behavioral factors proved to be positively associated with abusive alcoholic beverage consumption among suicide victims, suggesting the need for effective public health policy measures to combat this health problem.

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

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

Cannabis and psychomotor performance: A rational review of the evidence and implications for public policy

A previous US government analysis estimated that among those who acknowledge having driven following the consumption of an illicit substance, a majority of respondents, 70%, affirm having done so following the ingestion of cannabis. [4] While this total is far from negligible, it is far fewer than the number of respondents who acknowledge having driven while under the influence of alcohol. The presence of cannabis’ primary psychoactive ingredient, delta-9-tetrahydrocannabinol (THC), or THC’s primary metabolite, carboxy THC, has frequently been identified in the blood or urine of drivers involved in fatal traffic accidents. [5] Explanations for this result are two-fold. First, cannabis is by far the most widely used illicit drug among the US population, with non-governmental polling data indicating that nearly one out of two Americans admit having tried it. [6] Second, cannabis is the illicit substance most readily detectable by toxicological tests. The presence of THC may be detectable in the blood of occasional cannabis consumers for several hours after past use. [7] In more chronic users, THC may be present at relatively low blood levels for a

Inconsistent coroner interpretations of cardiac death in the presence of cannabis in urine

In Ireland, the Coroners Act 1962 is still in place and coroners are relatively autonomous. Coroners may be medical practitioners or lawyers. The Coroners Bill 2007 was never passed into law but did include the office of Chief Coroner whose job entails the provision of leadership and direction in all coronial matters. In England and Wales, the Coroners and Justice Act 2009 introduced a system of checks and balances with a Chief Coroner who must be a lawyer backed by Medical Examiners. The National Medical Examiner must issue guidance to District Medical Examiners to insure that they carry out their functions in an effective manner. Northern Ireland still operates with the Coroners Act (Northern Ireland) 1959. Scottish Law is based in large part on Roman law, and death investigations are carried out by the local public prosecutor called the Procurator Fiscal. In the era of continuing professional development and accreditation of professional standards and procedures, coroner’s law does not explicitly deal with the issue of quality assurance and professional audit in the common law jurisdictions of England, Wales, Northern Ireland, and the Republic of Ireland. In Ireland, the intention of Section 45 of the new 2007 Coroners Bill, is to allow the Attorney General to order a new inquest after consultation with the Chief Coroner when a problem arises. The only other appeal mechanism is a Judicial Review under Section 62 of the Bill. This is intended to modify a similar section of the Coroners Act 1962, Section 24. In Northern Ireland, the 1959 Coroners Act, Section 14, allows the Attorney General to order an inquest even where a coroner has already held an inquest. The Lord Chief Justice has a role in the regulation of practice and procedure. In England and Wales, under Section 40 (8) of the Coroners and Justice Act 2009, an appeal to the Chief Coroner may be made to amend a determination or finding. An appeal to the Court of Appeal against a decision of the Chief Coroner may only be made on a point of law under Section 40 (9). Consistency of interpretation of the same data is important in medical diagnosis. Coroners rely on the accuracy and competence of interpretations by expert witnesses who play an important role in the coronial system. The expert witness has a primary duty to the court rather than the client [1]. The Law Commission Report recommends that the court should rule on the experts’ areas of expertise before they give evidence [2]. This is particularly pertinent in evidence from pathologists. Can an expert in histopathology give definitive evidence in biochemical toxicology? The following cases illustrate the need for quality assurance in relation to coroners court proceedings. These cases involve the finding of cannabinoids in the urine in cases where the decedents died from acute myocardial infarction. The key article linking the triggering of acute myocardial infarction with cannabis smoking is the report that smoking cannabis increased the risk of myocardial infarction 4.8 times over baseline in the hour following the initiation of smoking. The relative risk for the second hour was 1.7 but the 95% confidence interval was 0.6–5.1 [3]. Cannabis declines to about 10% of peak levels in blood within 1–2 h [4]. Positive urine cannabinoids with zero W. Tormey (&) T. Moore School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland e-mail: billtormey@gmail.com

Screening for cannabis use disorders in an adolescent emergency department sample

Cannabis, more often than alcohol, is the drug mentioned in substance-related reasons for treatment of an adolescent in an emergency department (ED). This study examined the prevalence of DSM-IV cannabis and alcohol diagnoses in an adolescent ED sample, evaluated the performance (i.e. sensitivity and specificity) of DSM-IV cannabis symptoms and other screening items as indicators of cannabis diagnosis status, and examined parent-adolescent agreement on the presence of cannabis and alcohol diagnoses. Adolescents (ages 13–19, n=442) admitted to an ED for a non-substance-related injury were administered the diagnostic interview schedule for children (DISC). Parents ( n=272) of adolescents younger than age 18 completed the DISC–parent version to report on their child's drug use. A minority met criteria for a current DSM-IV cannabis or alcohol diagnosis: 7.9% for both alcohol and cannabis, 7.5% for cannabis-only, and 9.0% for alcohol-only. Frequency of cannabis use had the best overall performance in discriminating those with and without a cannabis diagnosis compared with items on perceived risk of cannabis use, peer cannabis use, and alcohol and cigarette use. Parent reports generally underestimated the adolescent's substance use. Questions on level of substance use generally provide an efficient method of screening adolescents for substance-related problems in an ED setting.

Cannabis and driving: A new perspective

Cannabis and driving is an emerging injury-prevention concern. The incidence of driving while affected by cannabis is rising in parallel with increased cannabis use in the community. Younger drivers are at particular risk. Improvements in research methodology, technology and laboratory testing methods have occurred in the last 10 years. These cast doubt on earlier results and conclusions. Studies now show that cannabis has a significant impairing effect on driving when used alone and that this effect is exaggerated when combined with alcohol. Of particular concern is the presence of cannabis as the sole psychoactive drug in an increasing number of road fatalities and the lack of any structural response to this problem. A review of testing methods, laboratory and real driving studies, and recent epidemiological studies is presented. Suggestions for methods of further data collection and future public policy are made.

Cannabis and driving: A new perspective

Cannabis and driving is an emerging injury-prevention concern. The incidence of driving while affected by cannabis is rising in parallel with increased cannabis use in the community. Younger drivers are at particular risk. Improvements in research methodology, technology and laboratory testing methods have occurred in the last 10 years. These cast doubt on earlier results and conclusions. Studies now show that cannabis has a significant impairing effect on driving when used alone and that this effect is exaggerated when combined with alcohol. Of particular concern is the presence of cannabis as the sole psychoactive drug in an increasing number of road fatalities and the lack of any structural response to this problem. A review of testing methods, laboratory and real driving studies, and recent epidemiological studies is presented. Suggestions for methods of further data collection and future public policy are made.

Cannabis psychosis in young psychiatric inpatients.

SummaryA survey of 25 consecutive admissions to a psychiatric hospital of patients aged 35 and under reveals that cannabis use is reported by up to 48% of patients, but that it could be verified by urine tests in only 17.4%. The presence of cannabis in the urine appeared to play little part in the phenomenology of the illness in all except one patient. A case history of this one identified patient with cannabis psychosis is described and discussed.