Recreational Use Research Articles

Risk assessment of toxic cyanobacterial blooms in recreational waters: A comparative study of monitoring methods

Toxic cyanobacterial blooms impose a health risk to recreational users, and monitoring of cyanobacteria and associated toxins is required to assess this risk. Traditionally, monitoring for risk assessment is based on cyanobacterial biomass, which assumes that all cyanobacteria potentially produce toxins. While these methods may be cost effective, relatively fast, and more widely accessible, they often lead to an overestimation of the health risk induced by cyanotoxins. Monitoring methods that more directly target toxins, or toxin producing genes, may provide a better risk assessment, yet these methods may be more costly, usually take longer, or are not widely accessible. In this study, we compared six monitoring methods (fluorometry, microscopy, qPCR of 16S and mcyE, ELISA assays, and LC-MS/MS), of which the last three focussed on the most abundant cyanotoxin microcystins, across 11 lakes in the Netherlands during the bathing water season (May-October) of 2019. Results of all monitoring methods significantly correlated with LC-MS/MS obtained microcystin levels (the assumed ‘golden standard’), with stronger correlations for methods targeting microcystins (ELISA) and microcystin genes (mcyE). The estimated risk levels differed substantially between methods, with 78 % and 56 % of alert level exceedances in the total number of collected samples for fluorometry and microscopy-based methods, respectively, while this was only 16 % and 6 % when the risk assessment was based on ELISA and LC-MS/MS obtained toxin concentrations, respectively. Integrating our results with earlier findings confirmed a strong association between microcystin concentration and the biovolume of potential microcystin-producing genera. Moreover, using an extended database consisting of 4265 observations from 461 locations across the Netherlands in the bathing water seasons of 2015 – 2019, we showed a strong association between fluorescence and the biovolume of potentially toxin-producing genera. Our results indicate that a two-tiered approach may be an effective risk assessment strategy, with first a biomass-based method (fluorometry, biovolume) until the first alert level is exceeded, after which the risk level can be confirmed or adjusted based on follow-up toxin or toxin gene analyses.

Persistent hiccups after acute COVID-19 successfully treated with chlorpromazine: a case report

IntroductionHiccups are among the rare complications of COVID-19 infections. There are several published reports of persistent hiccups presenting during the acute COVID-19 period. However, there are very few published reports of persistent hiccups occurring in the post-acute COVID-19 period. Consequently, most clinicians may not be aware of this rare presentation. This case highlights an atypical presentation of persistent hiccups that manifested during the post-acute COVID -19 period that clinicians need to be aware of. The caseadds to the ever increasing body of knowledge about symptoms and signs associated with Severe Acute Respiratory Syndrome Corona Virus type 2 (SARS CoV-2) infection.Case presentationA 27 year old male black Zambian patient presented to the emergency department of our hospital with persistent hiccup, 35 days after the initial acute episode of COVID-19. This was associated with breathlessness. There were no other symptoms. He had no history of pulmonary, gastrointestinal, neurological disease or malignancy. He did not take any alcohol or smoke. He had never used any recreational drugs. He was employed as a monitoring and evaluation officer at one of the main COVID centres in the capital. On examination, the patient was anxious. Blood pressure was 141/82, pulse rate was 95 beats per minute, respiratory rate was 26 breaths per minute, temperature was 36.8C and oxygen saturation was 97% on room air. Systemic examination was normal. Chest X-ray and abdominal ultrasonography were normal. A rapid COVID-19 antigen test, and COVID-19 Polymerase Chain Reaction (PCR) test that were done the following day were negative. All other haematological and biochemical tests, including D-dimer and C-reactive protein (CRP), were also normal. A diagnosis of post-acute COVID-19 associated hiccups was made. The patient responded well to treatment with chlorpromazine 25 mg 8 hourly. The hiccups disappeared completely after the fourth dose of chlorpromazine.ConclusionThis is one of the few published cases of COVID-19 associated persistent hiccups, occurring more than a month after the initial presentation. Most of the published cases report hiccups occurring in the acute COVID-19 period. Consequently, hiccups occurring in the post-acute COVID-19 period may not be attributable to COVID-19. This case has highlighted the need to consider post-acute COVID-19 in the differential diagnosis of persistent hiccup.

Structural insights into GABAA receptor potentiation by Quaalude

Methaqualone, a quinazolinone marketed commercially as Quaalude, is a central nervous system depressant that was used clinically as a sedative-hypnotic, then became a notorious recreational drug in the 1960s-80s. Due to its high abuse potential, medical use of methaqualone was eventually prohibited, yet it persists as a globally abused substance. Methaqualone principally targets GABAA receptors, which are the major inhibitory neurotransmitter-gated ion channels in the brain. The restricted status and limited accessibility of methaqualone have contributed to its pharmacology being understudied. Here, we use cryo-EM to localize the GABAA receptor binding sites of methaqualone and its more potent derivative, PPTQ, to the same intersubunit transmembrane sites targeted by the general anesthetics propofol and etomidate. Both methaqualone and PPTQ insert more deeply into subunit interfaces than the previously-characterized modulators. Binding of quinazolinones to this site results in widening of the extracellular half of the ion-conducting pore, following a trend among positive allosteric modulators in destabilizing the hydrophobic activation gate in the pore as a mechanism for receptor potentiation. These insights shed light on the underexplored pharmacology of quinazolinones and further elucidate the molecular mechanisms of allosteric GABAA receptor modulation through transmembrane binding sites.

Exploring the service needs and the common-suited strengthening paths for bicycle-sharing services based on the AIA-NRM technique in consideration of various users

ABSTRACT Near metro stations in urban areas, a public bicycle rental service allows users to rent bicycles for leisure, short-distance connections, and daily commuting. This study aims to explore the driving factors of bicycle-sharing service systems (BSSSs) and different users’ preferences and service needs (leisure & recreation users, short-connection users, and daily commuting users). The four driving forces (primary services, primary facilities, ancillary services, and ancillary facilities) are applied to evaluate the BSSSs. The researcher used the attention and importance analysis (AIA) technique to assess service driving factors’ attention and importance status in the bicycle-sharing service systems (BSSSs). The DEMATEL technique was also employed to establish a network relation map (NRM) approach for different users. The researcher also combines the AIA and NRM techniques to provide the AIA-NRM technique for identifying common applicable paths and enhancement strategies for the BSSS. Furthermore, this study analyzes various institutions and BSSS service providers from multiple users’ perspectives, determines the development direction of BSSSs, evaluates related challenges, and finds sustainable strategies for strengthening BSSSs.

Adolescent-onset cannabis use and parenting young children: an investigation of differential effectiveness of a digital parenting intervention

IntroductionThere is scant empirical work on associations between current and past cannabis use and parenting skills in parents of young children. As recreational cannabis use is now legal in nearly half of states in the U.S., cannabis use is becoming more ubiquitous.MethodsIn the current study, parents of toddler and pre-school age children were randomly assigned to participate in an app-based parenting skills program that included telehealth coaching (Family Check-Up Online; FCU-O), with a focus on parenting in the context of substance use. We aimed to test associations between adolescent-onset and current cannabis use and parent mental health and parenting skills, as well as whether effects of the FCU-O on parent mental health outcomes varied as a function of past cannabis use. Participants were 356 parents of children ages 1.5–5 participating in a randomized controlled trial of the FCU-O. Parents screened into the study if they reported current or past substance misuse or current depressive symptoms. After completing a baseline assessment, parents were randomly assigned to the FCU-O or control group and completed a follow-up assessment 3 months later. Parents retrospectively reported on the age when they initially used substances, as well as their current use.ResultsAfter accounting for current cannabis use, adolescent-onset cannabis use was significantly associated with higher symptoms of anxiety and depression, but not with parenting skills. Adolescent-onset cannabis use was found to significantly moderate the effect of the FCU-O on parents' anxiety symptoms. Specifically, the FCU-O was particularly effective in reducing anxiety symptoms for parents with adolescent-onset regular cannabis use, after accounting for current cannabis use.DiscussionAdolescent-onset regular cannabis use may be a risk factor for later mental health challenges in parents of children under 5. An app-based parenting intervention may be particularly helpful in reducing symptoms of anxiety for parents who used cannabis regularly as adolescents. The findings have significant implications for the prevention of multigenerational risk for substance use and mental health challenges.

(021) STEALTHING IS ASSOCIATED WITH NEGATIVE SEXUAL HEALTH OUTCOMES AMONG COLLEGE WOMEN, REGARDLESS OF WOMEN’S SEXUAL COMMUNICATION

Abstract Introduction Non-consensual condom removal (“stealthing”) occurs when a perpetrator either says that they will put on a condom but begins intercourse before doing so, or removes a condom before or during intercourse without their partner’s consent. Up to one third of women report experiencing stealthing (Latimer et al., 2018). Stealthing is associated with greater lifetime recreational drug use and sexual shame, as well as positive sexual outcomes like pleasure, desire, arousal, lubrication, and feelings of pleasure deservingness (blinded for review). Preliminary research on the gynecological and reproductive health outcomes of stealthing reveals that experiences of stealthing significantly predict gynecological infections, lifetime pregnancy, and condom use barriers (blinded for review). Intervention research highlights the necessity of prevention programming enhancing women’s sexual communication skills to increase agency in condom use and to prevent SV. However, stealthing is a deliberate choice of non-communication by a perpetrator, and thus it is unclear if women’s sexual communication can play a role in preventing negative health sequelae. Objective The present study examined if sexual communication comfort explains associations between stealthing experiences and a series of sexual outcomes (vaginal infection, ever pregnant, times pregnant, age pregnant, contraceptive use, condom use barriers and motivators, genital self-image, pleasure deservingness, pleasure assertiveness self-efficacy, and female sexual functioning) among a sample of college women. Methods A sample of 440 women (Mage = 20.3, SD = 2.24) from an online pool at a large Midwestern US university completed an online survey regarding sexual violence and sexual health. Measures included single items regarding lifetime history of vaginal infections, number of lifetime pregnancies (including parity and gravidity), age at first pregnancy, and current contraceptive use. Participants completed well-validated measures of condom use barriers and motivators, genital self-image, pleasure deservingness and assertiveness, and overall sexual functioning. We tested associations between stealthing and outcome of interest via linear regressions controlling for other forms of SV (force, coercion, intoxication) as well as lifetime number of sexual partners. We ran mediation models using the Hayes PROCESS Macro (Model 4). All analyses were completed in R version 4.2. Results Approximately one-third of participants (30.2%, n = 133) reported stealthing experiences. Stealthing was independently associated with a history of vaginal infection, ever having been pregnant, and condom use barriers related to partner pressure. Sexual communication skills did not significantly mediate associations between stealthing and any outcome variables of interest. Conclusions Despite SV prevention work emphasizing the utility of sexual communication skills in protecting women against both SV and negative sexual health outcomes, we found that sexual communication comfort did not mediate associations between stealthing and sexual wellbeing outcomes. Findings indicate that intervention resources would be better spent on preventing stealthing perpetration. Given findings relevant to pregnancy, addressing stealthing perpetration is particularly important following the repeal of Roe vs. Wade and new restrictions to abortion access in the United States. Disclosure No.

Prescription Painkiller Misuse in Hispanic and non-Hispanic Adults Ages 50 and Older: Trends and Correlates in a National Sample, 2015–2019

Background: Older adults, an increasingly diverse segment of the United States population, are a priority population for prescription painkiller misuse. This study documents trends and correlates of prescription painkiller misuse among Hispanic and non-Hispanic adults ages 50 and older. Methods: A secondary analysis of adults 50 years and older across 5 cohorts using the 2015–2019 National Survey on Drug Use and Health (unweighted n = 16,181, 8.5% Hispanic, and 54% female). Logistic regression modeling with complex survey design was used to examine trends in prescription painkiller misuse. Results: Over time, the prevalence of past year painkiller misuse significantly decreased for Hispanic respondents (56.1% relative decrease, p = 0.02); elevated proportions were observed across strata of demographic characteristics. Conclusions: Variability in the prevalence of painkiller misuse may be explained by demographic characteristics. Further, these results emphasize the importance of addressing comorbid recreational marijuana use when designing interventions to address painkiller misuse for older adults.

International property rights for Cannabis landraces and terroir products. The case of Moroccan Cannabis and hashish

BackgroundIn recent years, the cannabis industry has evolved from a world defined by the simplicity and ubiquity of illegality of recreational drug cannabis to a world marked by the legal and geographic complexity of ongoing depenalisation, decriminalisation, and legalisation processes. Within this landscape where drug Cannabis plants and their many derivatives see their legal status change, Cannabis cultigens and end products are increasingly likely to becoming subject to protection by intellectual property rights. This article delves into the implications of these changes for traditional Cannabis farmers, particularly in the Global South, as they face economic and legal threats amidst global legalisation efforts. It examines the potential role of appellations of origin in protecting local Cannabis cultigens and end products, focusing on Moroccan Cannabis and hashish as a case study. MethodsThe text resorts to the treaties and agreements regulating international property rights and plant variety protection, but also to the concepts of terroir and landrace and their definitions, in order to determine, by way of treaty interpretation and conceptual analysis, what type of legal and economic protections can apply to Cannabis landraces and terroir products. The analysis is also based on previous empirical research published by the author. ResultsThe text argues that appellations of origin are the best intellectual property protections possible for landraces and terroir products because what needs to be protected is not innovation and individual ownership, but tradition and collective ownership, and because appellations of origin are suitable collective intellectual property rights. It shows that appellations of origin are best suited to protect terroir products and landraces because their originality and distinctiveness are place-based originality and distinctiveness. ConclusionThe text concludes that appellations or origin offer the only existing intellectual property protection for preserving the distinctiveness of terroir cannabis products, and for landrace conservation. It acknowledges that neither appellations of origin nor existing plant variety protection laws can be legal forms of control of third parties’ uses of landraces but that appellations of origin can help protect terroir products and landraces by way of their associated agro-ecosystems.

Prevalence and Control of Pseudomonas aeruginosa in Tourist Facilities across the Canary Islands, Spain.

Pseudomonas aeruginosa is a common pathogen associated with recreational water facilities and poses risks to public health. However, data on the prevalence of P. aeruginosa in tourist destinations like the Canary Islands, Spain, remain limited. We assessed P. aeruginosa prevalence in 23 tourist facilities from 2016 to 2019. Compliance with water quality standards was evaluated, and 3962 samples were collected and analyzed. We examined different types of recreational water installations, including outer swimming pools, whirlpools, and cold wells. Of the sampled facilities, 31.2% did not comply with the current legislation's parametric values, mainly due to inadequate disinfectant levels, water temperature, and P. aeruginosa presence. The prevalence of P. aeruginosa was 4.8%, comparable to some European countries but lower than others. Cold wells displayed the highest non-compliance rate (89.2%) and yet exhibited a lower P. aeruginosa prevalence (1.9%) than outer swimming pools and whirlpools. Children's presence did not significantly impact P. aeruginosa contamination. Chlorine-based disinfectants are more effective than bromine-based ones in controlling P. aeruginosa. Regional variability in contamination was observed, with Fuerteventura showing lower colonization rates. Disinfectant levels play a critical role in P. aeruginosa control, and maintaining adequate levels is essential, particularly in bromine-treated installations. Our findings provide valuable insights into the prevalence and distribution of P. aeruginosa in recreational waters within tourist facilities. Tailored strategies are needed to ensure water safety in different Spanish regions. Continued monitoring and assessment, combined with artificial intelligence and machine learning, will enable the implementation of targeted interventions to protect the health of recreational water users.

Incidental finding of an arteriovenous malformation originating from the diaphragm: Case report and literature review

Arteriovenous malformations (AVMs) are defined as aberrant linkages between arteries and veins in the absence of a capillary network. This case report will discuss the incidental finding of an AVM likely originating from the diaphragm. A 65-year-old female presents for an umbilical hernia repair. Her past medical history is significant for HTN, type 2 diabetes mellitus, gastroesophageal reflux disease, and class 1 obesity. She has a past surgical history of hysteroscopy in 2020 and laparoscopy in 1996. She has no history of tobacco use, alcohol use, or recreational drug use. She is allergic to contrast. A computed tomography (CT) scan was ordered and incidentally showed a soft tissue mass in the left upper quadrant adjacent to the stomach and diaphragm, possibly a gastrointestinal stromal tumor (GIST) or splenule, in addition to diastasis of the abdominal wall. Biopsies of the esophagus, stomach, and duodenum from the esophagogastroduodenoscopy (EGD) were all benign. A nuclear medicine scan of the liver and spleen found an estimated 2.3 cm soft tissue nodule located between the fundus of the stomach and the left hemidiaphragm that does not demonstrate sulfa colloid uptake and is therefore not consistent with a splenule. This is the only incidence cited of an AVM originating from the diaphragm. We suspect that the origin of this AVM is the inferior phrenic artery. The decision for management for this case was to get a CT scan of the abdomen and chest to trace the path of the AVM and manage with surveillance.

Psychoactive Drug MDMA

MDMA, commonly known as ecstasy or molly, is a synthetic psychoactive drug with a complex history. It produces feelings of increased empathy, emotional connection, and heightened sensory perception. While recreational use of MDMA has been prevalent, recent research suggests significant therapeutic potential in treating mental health conditions like post-traumatic stress disorder (PTSD). This thesis will explore the pharmacological effects of MDMA, its historical and cultural significance, the current state of research on its therapeutic applications, and the ongoing debate regarding its legal status.

IgE-Mediated Allergy and Asymptomatic Sensitization to Cannabis Allergens-Review of Current Knowledge and Presentation of Six Cases.

Cannabis allergy is a relatively new phenomenon described in the 1970s. Its increased frequency has been observed over the last years due to the increasing therapeutic and recreational use of cannabis-based products. Sensitization possibly leading to allergy symptoms can occur not only through the smoking of cannabis, but also through ingestion, the inhalation of pollen, or direct contact. The severity of symptoms varies from benign pruritus to anaphylaxis. There is scant information available to support clinicians throughout the entire therapeutic process, starting from diagnosis and ending in treatment. In this review, we present six cases of patients in whom molecular in vitro testing revealed sensitization to cannabis extract and/or cannabis-derived nsLTP molecules (Can s 3). Based on these cases, we raise important questions regarding this topic. The article discusses current proposals and highlights the importance of further research not only on cannabis allergy but also on asymptomatic sensitization to cannabis allergens, which may be ascertained in some percentage of the population.

A multi-analyte assay of opioids in API and drug products using HPLC and HRMS

Surveillance testing is an essential component to ensuring safe, effective, and high-quality drug products are available in the commercially marketed US supply chain. Surveillance allows the agency to assess product quality and monitor for potential adulteration of drug products being used by consumers. Opioid drug products can be adulterated to enhance the effect of the intended active ingredient. Numerous accounts have been reported where fentanyl has been used as an adulterant in illicit street drugs such as heroin, cocaine, or methamphetamine. To efficiently surveil the legitimate opioid supply chain, an analytical method with the ability to simultaneously detect, identify and quantify opioid molecules is desired. In this study, a multi-opioid protocol (MOP) using liquid chromatography-high resolution mass spectrometry (HPLC-HRMS) technology was developed and validated for the detection and quantification of 27 opioid drugs.The MOP analytical procedure was applied to the analysis of drug substance and finished dosage forms. MOP was used to identify and quantify active pharmaceutical ingredients (API) listed on the label claim, and in the case of suspected economically motivated adulteration could identify and quantify undeclared opioid APIs. The analytical method analysis time was 16 minutes and the LOD and LOQ in full MS mode were (average) 0.3 and 0.8 ng/mL, respectively. The validation criteria parameters were satisfactory based on international guidelines (ICH).The MOP was successfully applied to the analysis of over 160 drug substances and finished products. For all samples tested in the study, their identities were confirmed, and assays met specifications. Overall, there was no evidence of illegal substitution or adulteration in any of the ingredients and products tested from the legitimate commercial marketed US supply chain.

Crafting effective regulatory policies for psychedelics: What can be learned from the case of cannabis?

AbstractThe turn of the century brought a resurgence of interest in psychedelics as a treatment for addiction and other psychiatric conditions, accompanied by extensive positive media attention and private equity investment. Government regulatory bodies in Australia, Israel, Canada and the United States now permit use of psychedelics for medical purposes. In the United States, citizen action and corporate financing have led to petitions and ballot initiatives to legalize psilocybin and other psychedelics for medical and recreational use. Given this momentum, policymakers must grapple with important questions that define whether and how psychedelics are made available to the public, as well as how companies produce and promote them. The current push to broaden the production, sale, and use of psychedelics bears many parallels to the movement to legalize cannabis in the United States and other nations—most notably, the use of poorly‐evidenced therapeutic claims to create a de facto recreational market via the health care system. Experience with cannabis highlights the value of debating the question of legalization for nonmedical use as such rather than misrepresenting it as a medical issue. The lessons of cannabis policy also suggest a need to challenge hyping of psychedelic research findings; to promote rigorous clinical research on dosing and potency; to minimize the influence of for‐profit industry in shaping policies to their economic advantage; and to coordinate federal, state, and local governments to regulate the manufacture, sale and distribution of psychedelic drugs (regardless of whether they are legalized for medical and/or recreational use).

Phenomenological exploration of young adults’ recreational cannabis use experiences and associated leisure meanings

Societal normalization and decriminalization of cannabis use challenge its traditional characterizations as deviant leisure. This study investigated cannabis users’ understandings of their consumption in/as leisure by utilizing hermeneutic phenomenology based on 16 in-depth interviews with young adults living in the U.S. states with legalized recreational cannabis. Findings suggest that young adults view recreational cannabis use as leisure due to the related state of mind (e.g., experiencing flow, relaxation, meditative state), consumption time patterns (e.g., reserving use as a reward for free, post-obligations time), leisure activity characteristics (e.g., an intrinsic act of getting high, accompanying other leisure pursuits), and pleasure associated with use (e.g., enjoyment, humor, social facilitator, sensory enhancement). This study contributes novel insights regarding normative leisure meanings associated with cannabis, which can be leveraged strategically in public health and drug education efforts. These findings are timely during the societal transition from criminalization to normalization and commercialization trends concerning cannabis.

Assessment of a Single Quadrupole Mass Spectrometer Combined with an Atmospheric Solids Analysis Probe for the On-Site Identification of Amnesty Bin Drugs.

The surging number of people who abuse drugs has a great impact on healthcare and law enforcement systems. Amnesty bin drug analysis helps monitor the "street drug market" and tailor the harm reduction advice. Therefore, rapid and accurate drug analysis methods are crucial for on-site work. An analytical method for the rapid identification of five commonly detected drugs ((3,4-methylenedioxymethamphetamine (MDMA), cocaine, ketamine, 4-bromo-2,5-dimethoxyphenethylamine, and chloromethcathinone)) at various summer festivals in the U.K. was developed and validated employing a single quadrupole mass spectrometer combined with an atmospheric pressure solids analysis probe (ASAP-MS). The results were confirmed on a benchtop gas chromatography-mass spectrometry instrument and included all samples that challenged the conventional spectroscopic techniques routinely employed on-site. Although the selectivity/specificity step of the validation assessment of the MS system proved a challenge, it still produced 93% (N = 279) and 92.5% (N = 87) correct results when tested on- and off-site, respectively. A few "partly correct" results showed some discrepancies between the results, with the MS-only unit missing some low intensity active ingredients (N-ethylpentylone, MDMA) and cutting agents (caffeine, paracetamol, and benzocaine) or detecting some when not present. The incorrect results were mainly based on library coverage. The study proved that the ASAP-MS instrument can successfully complement the spectroscopic techniques used for qualitative drug analysis on- and off-site. Although the validation testing highlighted some areas for improvement concerning selectivity/specificity for structurally similar compounds, this method has the potential to be used in trend monitoring and harm reduction.

Benefit–Risk Assessment in Sport and Recreation: Historical Development and Review of AS ISO 4980:2023

Risk management involves thinking about what could happen if someone is exposed to a hazard and the likelihood of this event. The vast majority of standards relating to risk management were written in the context of Occupational Health and Safety, as well as Work Health and Safety with the aim of eliminating all risks. In 2023 Standards, Australia published AS ISO 4980:2023: `Benefit-risk assessment for sport and recreational facilities, activities and equipment’. This standard provides a tool for applying risk management in the context of sport and recreation. AS ISO 4980:2023 is a departure from the traditional view of risk management standards in that it presents a view of risk that is not limited to viewing risk only as negative, but rather balances positive benefits with negative risks within the sport and recreation industry. This standard is also different in that it is based specifically on risk to sport and recreational users and not to employees and employers. The benefit that risk provides in the context of sports and recreational activities is placed on an equal footing with the traditional method of assessing risk. There is an expectation in sports and recreational activities that the user is making an implicit trade-off between the benefits and the inherent risks of the activity, including the potential for harm. This implied expectation is that exposure to risk can be positive. Positive risk and learning from making mistakes are not restricted to childhood development where graduated challenges are used but extend throughout our entire life. The goal of this paper is to draw public attention to the new and different perspective of risk on which AS ISO 4980:2023 is based and to provide an understanding of the concept of benefit–risk assessment. The implications of viewing non-workplace risk in a balanced way are discussed.

Clinical effects of cannabis compared to synthetic cannabinoid receptor agonists (SCRAs): a retrospective cohort study of presentations with acute toxicity to European hospitals between 2013 and 2020

Introduction Cannabis is the most common recreational drug worldwide and synthetic cannabinoid receptor agonists are currently the largest group of new psychoactive substances. The aim of this study was to compare the clinical features and outcomes of lone acute cannabis toxicity with lone acute synthetic cannabinoid receptor agonist toxicity in a large series of presentations to European emergency departments between 2013-2020. Methods Self-reported drug exposure, clinical, and outcome data were extracted from the European Drug Emergencies Network Plus which is a surveillance network that records data on drug-related emergency department presentations to 36 centres in 24 European countries. Cannabis exposure was considered the control in all analyses. To compare the lone cannabis and lone synthetic cannabinoid receptor agonist groups, univariate analysis using chi squared testing was used for categorical variables and non-parametric Mann-Whitney U- testing for continuous variables. Statistical significance was defined as a P value of <0.05. Results Between 2013-2020 there were 54,314 drug related presentations of which 2,657 were lone cannabis exposures and 503 lone synthetic cannabinoid receptor agonist exposures. Synthetic cannabinoid receptor agonist presentations had statistically significantly higher rates of drowsiness, coma, agitation, seizures and bradycardia at the time of presentation. Cannabis presentations were significantly more likely to have palpitations, chest pain, hypertension, tachycardia, anxiety, vomiting and headache. Discussion Emergency department presentations involving lone synthetic cannabinoid receptor agonist exposures were more likely to have neuropsychiatric features and be admitted to a psychiatric ward, and lone cannabis exposures were more likely to have cardiovascular features. Previous studies have shown variability in the acute toxicity of synthetic cannabinoid receptor agonists compared with cannabis but there is little comparative data available on lone exposures. There is limited direct comparison in the current literature between lone synthetic cannabinoid receptor agonist and lone cannabis exposure, with only two previous poison centre series and two clinical series. Whilst this study is limited by self-report being used to identify the drug(s) involved in the presentations, previous studies have demonstrated that self-report is reliable in emergency department presentations with acute drug toxicity. Conclusion This study directly compares presentations with acute drug toxicity related to the lone use of cannabis or synthetic cannabinoid receptor agonists. It supports previous findings of increased neuropsychiatric toxicity from synthetic cannabinoid receptor agonists compared to cannabis and provides further data on cardiovascular toxicity in lone cannabis use.

Life-threatening constrictive pericarditis accompanied by synthetic cannabinoid use: A case report and literature review

Rationale: Synthetic cannabinoids are increasingly used as recreational drugs and have been associated with adverse cardiovascular effects. However, reports of synthetic cannabinoids accompanied by constrictive pericarditis are limited. Patient’s concern: A 28-year-old male with a history of synthetic cannabinoid (Bonzai) abuse presented with chest discomfort, dyspnea, and lower extremity edema. Investigations revealed reduced left ventricular ejection fraction, elevated inflammatory markers, low electrocardiogram voltages, and atrial fibrillation. Diagnosis: Chest spiral computerized tomography scan and chest X-ray demonstrated pericardial calcification. Cardiac magnetic resonance imaging and right heart catheterization were done to confirm the possibility of constrictive pericarditis. Based on the patient’s addiction history and exclusion of rheumatologic and infectious causes, it was supposed that constrictive pericarditis and cardiomyopathy may be accompanied by synthetic cannabinoid use. Interventions: The patient received standard medical therapy, including loop diuretics for cardiomyopathy and constrictive pericarditis. Catheter ablation was recommended for his rhythm control, and he was planned for close monitoring of clinical and echocardiographic response and evaluation of the need for surgical pericardiectomy in the future. Outcomes: After 6 months follow-up, echocardiographic exam revealed no significant improvement in ventricular function. However, due to the high surgical risk, the patient’s poor compliance, and the continuation of drug abuse, he was not a good candidate for surgery according to our heart team’s decision. Lessons: Synthetic cannabinoids can trigger constrictive pericarditis, and clinicians should consider them when evaluating patients with compatible symptoms and exposure history. Further research on the cardiovascular effects of synthetic cannabinoids is needed and public education on potential harms is warranted.

Cannabis as a shareable commodity in a social discounting task.

Cannabis use and cannabis use disorder diagnoses continue to increase in United States college-aged students as more states legalize recreational cannabis. Previous studies have attempted to associate cannabis use with delay discount rates, which involves participants making choices for smaller sooner versus larger later hypothetical rewards. More smaller sooner choices result in higher discount rates and suggest increased impulsivity. Delay discounting studies have shown a significant, but small effect size with people who use cannabis more likely to choose the smaller sooner rewards, relative to people who do not use cannabis. The present study tested whether students with different experience using cannabis (people who currently use cannabis, people who formerly used cannabis, or people who never used cannabis) would be sensitive to sharing a proportion of hypothetical marijuana with another individual at a given social distance, as a putative measure for cannabis value. Results from two separate data sets showed that students classified as current cannabis users were significantly less likely to share a proportion of hypothetical marijuana across a range of social distances, relative to students that self-reported never using cannabis. Students classified as either former or current users were not statistically different. These results were consistent with previous delay discounting results and showed a medium effect size (η² ≥ 0.10) for each data set, both separately and when combined. These results indicate that social distance is a meaningful variable that can be used in a modified discounting task to assess differential cannabis value in a student population who are increasingly susceptible to cannabis use disorder. These results may have future clinical implications. Social discount rates for cannabis may be able to differentiate individuals who will continue recreational use versus individuals that may develop cannabis dependence problems. (PsycInfo Database Record (c) 2024 APA, all rights reserved).