Marijuana Smoking Research Articles

In Case You Haven't Heard…

To add to the list of drinking games sold on Amazon, there are now too‐many‐to‐count marijuana smoking games. With titles such as “Do or Smoke” (subtitled “Win or Get Baked”), these games are, of course, for adults only. We are thinking that the folks who win, or who “do” in the “do or…” games, are the most likely to keep winning. As an old friend who liked to gamble in Las Vegas used to say, “don't drink when you're playing, that's throwing your money away.”

Association between chronic disease and substance use among older adults in Tennessee.

Substance use and misuse have a negative impact on health care outcomes, specifically in the older adult population. Older adults are at risk due to several factors occurring toward the end of life such as changing family dynamics, loss of friends and loved ones, and chronic diseases. Substance use in older adults with chronic diseases in rural areas remains poorly studied. This study examines older adults greater than 55 of age in the state of Tennessee, U.S.A. Data was extracted from the 2019 National Behavioral Risk Factor Surveillance System (BRFSS) with a subsample for the State of Tennessee (N = 6242) and individuals over age 55 (N = 3389). At least 33.7% (N = 1143) of older adults have a chronic disease, and 24.4% (N = 828) have at least two or more chronic diseases. Alcohol use in the past month was reported in 29.4% of older adults; however, chronic disease status was not associated with alcohol use. Marijuana use and smoking in the past month were significant for older adults with two or more chronic diseases. Low income and less high school education were associated with chronic disease and smoking. Marijuana use and smoking were found to be significant in older adults with chronic disease, but not with alcohol use. Preventative measures such as screening tools, education, and providing resources to patients should be targeted to populations at risk to promote overall health outcomes.

Spontaneous secondary pneumothorax due to cannabis-induced bullous lung disease: a case report.

The authors describe a case of an adult male with a past medical history of spontaneous pneumothorax and long-standing marijuana use presenting with dyspnoea who was found to have a secondary spontaneous pneumothorax requiring invasive treatment. The aetiology of lung injury due to heavy marijuana smoke may be from direct tissue injury from inhaled irritants and the method of which marijuana smoke is inhaled compared with tobacco smoke. Chronic marijuana use should be considered when evaluating structural lung disease and pneumothorax in the setting of minimal tobacco use.

Effects of Smoking Marijuana on the Respiratory System: A Systematic Review.

The prevalence of marijuana use and its derivatives has surged over the past century, largely due to increasing legalization globally. Despite arguments advocating its benefits, marijuana smoking exposes the lungs to harmful combustion byproducts, leading to various respiratory issues such as asthma, pneumonia, emphysema, and chronic obstructive pulmonary disease. We embarked on an extensive literature search, utilizing PubMed/Medline, Scopus, Web of Science, and Google Scholar databases, identifying 200 studies. After the elimination of duplicates, and meticulous review of abstracts and full texts, 55 studies were included in our analysis. Current literature demonstrates that marijuana use negatively impacts lung function, triggering symptoms like chronic cough, sputum production, and wheezing, and diminishing FEV1/FVC ratio in spirometry tests. Moreover, prolonged or chronic marijuana use augments the risk of respiratory function impairment. While the carcinogenic effects of marijuana are still contested, a weak correlation between marijuana use and lung cancer has been observed in some studies. Additionally, instances of other pathologies linked to marijuana use have been reported, including the development of COPD, pulmonary bullae, spontaneous pneumothorax, pleuritic pain, chronic pulmonary aspergillosis, hemoptysis, and pulmonary Langerhans cell histiocytosis. The evidence underscores that marijuana use is detrimental to respiratory health. In light of the escalating trend of marijuana use, particularly among the youth, it is imperative to advocate public health messages discouraging its consumption.

PM2.5 exposure to marijuana smoke on golf courses and other public outdoor locations: A pilot observational study

Secondhand exposure to cannabis smoke occurs in public outdoor locations due to outdoor smoking or leakage of indoor smoking. Very little is known regarding the actual levels of exposure. This study examined PM2.5 exposure to marijuana smoke, focusing on one type of public outdoor location – golf courses where illegal marijuana consumption is increasingly common. Based on 24 visits to 10 courses over a 6-month period, >20 % visits encountered marijuana smoke, with peak PM2.5 exposures up to 149 μg/m3. The levels of exposure depended upon the source type (smoking versus vaping) and the proximity to the smoker/vaper. Ten additional investigations were performed to measure marijuana secondhand exposure in other public outdoor locations (near a smoker in a public park, near a parked car with in-car smoking/vaping, and near a residential garage with indoor smoking/vaping). 23 encounters of marijuana exposure events were documented in total. Average outdoor exposures to PM2.5 close to public outdoor smoking and vaping (on golf courses and a public park) were >3 times as high as those near a car or a building with indoor marijuana emissions. The average outdoor exposure caused by the leakage of in-car secondhand smoke was higher than that caused by in-building emissions.

Location and home rules of cannabis use – Findings from marijuana use and environmental survey 2020, a nationally representative survey in the United States

Cannabis combustion and aerosolization may be associated with adverse health for users and nonusers through secondhand and thirdhand exposure. As cannabis regulation becomes more lenient, understanding where cannabis is used and whether homes have rules restricting use is needed. This study aimed to identify locations, presence of other people, and in-home rules of cannabis use in the United States (U.S.). This secondary analysis of 3,464 inhalation-based (smoking, vaping, dabbing) cannabis users in past 12 months drew from a cross-sectional probability-based online panel of 21,903 U.S. adults in early 2020, providing nationally representative estimates. We describe presence of other people and location at most recent use (smoking, vaping, dabbing, respectively). We also describe household restrictions on in-home cannabis smoking by cannabis smokers vs non-smokers, and by presence of children in home. Cannabis smoking, vaping, and dabbing most often occurred at users’ own homes (65.7%, 56.8%, and 46.9%, respectively). More than 60% of smoking, vaping, and dabbing occurred with someone else present. About 68% of inhalation-based cannabis users (70% and 55%, smokers and non-smokers, respectively) did not have complete restrictions on in-home cannabis smoking; among them, over a quarter lived with children under 18. In the U.S., inhalation-based cannabis use most commonly occurs at home, with others present and a substantial proportion of users lacking complete in-home cannabis smoking restrictions, raising risks of secondhand and thirdhand smoke exposure. These circumstances demand residential interventions for developing bans on indoor cannabis smoking, especially around vulnerable children.

The Detection of Acute Risk of Self-injury Project: Protocol for an Ecological Momentary Assessment Study Among Individuals Seeking Treatment

Background Nonsuicidal self-injury (NSSI) is a major mental health concern. Despite increased research efforts on establishing the prevalence and correlates of the presence and severity of NSSI, we still lack basic knowledge of the course, predictors, and relationship of NSSI with other self-damaging behaviors in daily life. Such information will be helpful for better informing mental health professionals and allocating treatment resources. The DAILY (Detection of Acute rIsk of seLf-injurY) project will address these gaps among individuals seeking treatment. Objective This protocol paper presents the DAILY project’s aims, design, and materials used. The primary objectives are to advance understanding of (1) the short-term course and contexts of elevated risk for NSSI thoughts, urges, and behavior; (2) the transition from NSSI thoughts and urges to NSSI behavior; and (3) the association of NSSI with disordered eating, substance use, and suicidal thoughts and behaviors. A secondary aim is to evaluate the perspectives of individuals seeking treatment and mental health professionals regarding the feasibility, scope, and utility of digital self-monitoring and interventions that target NSSI in daily life. Methods The DAILY project is funded by the Research Foundation Flanders (Belgium). Data collection involves 3 phases: a baseline assessment (phase 1), 28 days of ecological momentary assessment (EMA) followed by a clinical session and feedback survey (phase 2), and 2 follow-up surveys and an optional interview (phase 3). The EMA protocol consists of regular EMA surveys (6 times per day), additional burst EMA surveys spaced at a higher frequency when experiencing intense NSSI urges (3 surveys within 30 minutes), and event registrations of NSSI behavior. The primary outcomes are NSSI thoughts, NSSI urges, self-efficacy to resist NSSI, and NSSI behavior, with disordered eating (restrictive eating, binge eating, and purging), substance use (binge drinking and smoking cannabis), and suicidal thoughts and behaviors surveyed as secondary outcomes. The assessed predictors include emotions, cognitions, contextual information, and social appraisals. Results We will recruit approximately 120 individuals seeking treatment aged 15 to 39 years from mental health services across the Flanders region of Belgium. Recruitment began in June 2021 and data collection is anticipated to conclude in August 2023. Conclusions The findings of the DAILY project will provide a detailed characterization of the short-term course and patterns of risk for NSSI and advance understanding of how, why, and when NSSI and other self-damaging behaviors unfold among individuals seeking treatment. This will inform clinical practice and provide the scientific building blocks for novel intervention approaches outside of the therapy room that support people who self-injure in real time. International Registered Report Identifier (IRRID) DERR1-10.2196/46244

N-acetylcysteine for smoking cessation among dual users of tobacco and cannabis: Protocol and rationale for a randomized controlled trial

BackgroundTobacco and cannabis co-use is a growing public health problem. The synergistic effects of cannabis and nicotine on neurobiological systems that mediate reward and shared environmental cues reinforcing use may make tobacco smoking cessation more difficult. N-acetylcysteine (NAC), an FDA-approved medication and over-the-counter supplement, has shown promise in animal studies and randomized controlled trials (RCTs) in reducing tobacco and cannabis craving and use. NAC's potential efficacy in treating addiction may be attributable to its central nervous system effects in reducing excessive glutamatergic activity, oxidative stress, and inflammation. To date, no RCT has examined NAC for smoking cessation among dual users of tobacco and cannabis. MethodIn a double-blind, placebo-controlled RCT, we will examine NAC for smoking cessation among dual users of tobacco and cannabis. Sixty adult cigarette-cannabis co-users are randomized to receive NAC 3600 mg per day or placebo over 8 weeks. Participants in both groups receive 8 weekly cognitive behavioral therapy sessions addressing smoking cessation and cannabis reduction. Outcomes are assessed at Weeks 0, 4, 8, and 12. Primary aims are to determine NAC's efficacy in decreasing cigarette craving, nicotine dependence, and use; and cannabis craving and use. Exploratory aims include examination of changes in neurocognition with NAC and their potential mediational effects on cigarette and cannabis use outcomes. ConclusionResults will inform smoking cessation treatment among dual users of tobacco and cannabis.ClinicalTrials.gov Identifier: NCT04627922.

The association of alcohol dependence and consumption during adolescence with depression in young adulthood, in England: a prospective cohort study

The role of alcohol use in the development of depression is unclear. We aimed to investigate whether alcohol dependence, but not high frequency or quantity of consumption, during adolescence increased the risk of depression in young adulthood. In this prospective cohort study, we included adolescents who were born to women recruited to the Avon Longitudinal Study of Parents and Children in Avon, UK, with delivery dates between April 1, 1991, and Dec 31, 1992. Alcohol dependence and consumption were measured at about age 16 years, 18 years, 19 years, 21 years, and 23 years using the self-reported Alcohol Use Disorders Identification Test, and at about age 18 years, 21 years, and 23 years using items corresponding to DSM-IV symptoms. The primary outcome was depression at age 24 years, assessed using the Clinical Interview Schedule Revised. Analyses were probit regressions between growth factors for alcohol dependence and consumption and depression, before and after adjustments for confounders: sex, housing tenure, maternal education, maternal depressive symptoms, parents' alcohol use, conduct problems at age 4 years, being bullied from age 12-16 years, and frequency of smoking cigarettes or cannabis. Adolescents were included in analyses if they had data from at least one timepoint for alcohol use and confounders. We included 3902 adolescents (2264 [58·0%] female; 1638 [42·0%] male) in our analysis, and 3727 (96·7%) of 3853 participants with data on ethnicity were White. After adjustments, we found a positive association between alcohol dependence at 18 years of age (latent intercept) and depression at 24 years of age (probit coefficient 0·13 [95% CI 0·02 to 0·25]; p=0·019), but no association between rate of change (linear slope) and depression (0·10 [-0·82 to 1·01]; p=0·84). There was no evidence of an association between alcohol consumption and depression (latent intercept probit coefficient -0·01 [-0·06 to 0·03]; p=0·60; linear slope 0·01 [-0·40 to 0·42]; p=0·96) after adjustments. Psychosocial or behavioural interventions that reduce the risk of alcohol dependence during adolescence could contribute to preventing depression in young adulthood. UK Medical Research Council and Alcohol Research UK (grant number MR/L022206/1).

Transcriptional Alterations Induced by Delta-9 Tetrahydrocannabinol in the Brain and Gonads of Adult Medaka

With the legalization of marijuana smoking in several states of the United States and many other countries for medicinal and recreational use, the possibility of its release into the environment cannot be overruled. Currently, the environmental levels of marijuana metabolites are not monitored on a regular basis, and their stability in the environment is not well understood. Laboratory studies have linked delta 9-tetrahydrocannabinol (Δ9-THC) exposure with behavioral abnormalities in some fish species; however, their effects on endocrine organs are less understood. To understand the effects of THC on the brain and gonads, we exposed adult medaka (Oryzias latipes, Hd-rR strain, both male and female) to 50 ug/L THC for 21 days spanning their complete spermatogenic and oogenic cycles. We examined transcriptional responses of the brain and gonads (testis and ovary) to Δ9-THC, particularly molecular pathways associated with behavioral and reproductive functions. The Δ9-THC effects were more profound in males than females. The Δ9-THC-induced differential expression pattern of genes in the brain of the male fish suggested pathways to neurodegenerative diseases and pathways to reproductive impairment in the testis. The present results provide insights into endocrine disruption in aquatic organisms due to environmental cannabinoid compounds.

(012) Cannamoms' & the "Postpotum" Stage: Assessment of Cannabis Use and Potential Benefits for Mental Health, Sexual Function & Pleasure, and Parenting Among Postpartum Mothers

Abstract Introduction Public opinion on cannabis continues to shift as more people emerge from the “green closet” in support of both recreational and medicinal use. ‘Cannamoms,’ a subgroup of cannabis users, represent moms who use cannabis to manage both physical and mental postpartum changes; these moms are attempting to diminish the stigma surrounding cannabis while making the case for how it can be beneficial for postpartum mental health, sex and parenting. For centuries, cannabis has been cited for its multiple benefits, including its anti-depressant and anti-anxiety properties (Zaske, 2018; Stoner, 2017) and its potential to improve sexual health, functioning and pleasure (Kasman et al., 2020; Wiebe & Just, 2019; Testa et al., 2019; Lynn et al., 2019; Sun & Eisenberg, 2017); though multiple studies exist on these topics alone, few have been carried out to investigate how cannabis has the potential to benefit postpartum moms specifically in these areas. Objective The purpose of this study is to investigate how cannabis has the potential to be beneficial for moms during the postpartum stage, specifically as it relates to improving mental health, sex and parenting. Methods Postpartum moms (participants) were invited to participate in two uncompensated Instagram surveys on May 8, 2021 and May 8, 2022. The survey included 3 poll questions, 4 question & answer sections (Q&A’s) and 1 personal interview. The survey assessed baseline demographics, cannabis use habits and the ways in which participants use cannabis to benefit their mental health, sex lives, and approaches to parenting. A meta-analysis of existing research was also performed to support study findings. Results A total of 107 participants between the ages of 18 and 45 were surveyed via Instagram polling, Q&As and personal interviews. Participants reside in the United States and represent multiple racial & ethnic groups (33% Caucasian, 24% Hispanic/Latinx, 25% Black/African American, 1% Native/American Indian, 1% Asian American/Pacific Islander, & 13% Two or more races). 61% of participants endorsed regular use of cannabis, mostly through smoking cannabis flower (46%) or consuming cannabis edibles (36%). Of those participants, 75% agreed that cannabis improves their mental health (including symptoms of depression and anxiety); 89% agreed that cannabis improves their sex lives; and 89% agreed that cannabis improves their approach to parenting. Conclusions Cannabis use among postpartum mothers is associated with improved mental health, better sex and better parenting. These results suggest a need for more research on the potential benefits of safe & responsible cannabis use during the postpartum stage. Disclosure No

Trends of cannabis use and related harms before and after legalization for recreational purpose in a developing country in Asia

BackgroundThailand was the first country in Asia to legalize the use and purchase of cannabis leaves in February 2021 and the whole plant in June 2022 after the 2019 allowance for medical purposes. The study explored trends in cannabis use in Thailand before and after the recreational cannabis allowance was imposed.MethodsCannabis and other variables of substance use, cannabis use disorder, and attitude towards cannabis of the Thai population aged 18 to 65 years in 2019 (n = 5,002), 2020 (n = 5,389) and 2021 (n = 5,669) were obtained from annual surveys conducted in the last two months of each year by the Centre for Addiction Studies. The surveys were repeat cross-sectional surveys of the general population of Thailand. Repeated variables from at least two annual surveys were included for analysis using the Chi-square test and the t-test.ResultsThe prevalence of cannabis use in the past year had increased from 2.2% in 2019 to 2.5% and 4.2% in 2020 and 2021 respectively, while those of methamphetamine, alcohol, and tobacco use had decreased. Trends in past-year drinking/eating cannabis products had increased, especially among the middle age group (40–49 years) from 2.1% (95% confidence interval (CI): 1.3, 3.1) in 2019 and 1.1% (95% CI: 0.6, 1.9) in 2020 to 3.8% (95% CI: 2.8, 5.0) in 2021. The younger population aged 18–19 had an increase in cannabis smoking from 0.9% (95% CI: 0.1, 3.3) in 2019 to 2.0% (95% CI: 0.5, 5.1) and 2.2% (95% CI: 0.7, 5.1) in 2020 and 2021 respectively. Symptoms of cannabis use disorder among cannabis users increased from 2019 to 2020 and then reversed afterwards in 2021. Thais had greater health knowledge about the benefits and harms of cannabis and had attitudes toward more harm of cannabis in 2021; however, 35.6% or a third of the sample in 2021 truly believed that cannabis was a cure for cancer, and 23.2% or one-fourth were uncertain or did not believe that cannabis was addictive.ConclusionsAlthough most of the substances had a lower prevalence of use during the COVID-19 pandemic in Thailand, cannabis had a higher use after legalization. Thai youth had a growing trend to smoke cannabis.

In what settings and social contexts do young adults vape or smoke cannabis? Findings from a web-based diary pilot study

BackgroundVaping is an increasingly common mode of cannabis use among young adults. Despite potential to inform targeted prevention, settings and social contexts where young adults vape and/or smoke cannabis have rarely been investigated. We addressed this question in a diverse young adult sample. MethodsData were collected weekly in a web-based daily diary format for six weeks. The analytic sample consisted of the 108 participants (of the 119 enrolled) who used cannabis during the assessment period (mean age = 22.06; 23.78% college students; 65.74% female; 5.56% Asian, 22.22% Black, 16.67% Latinx, 2.78% Multi-racial or Other and 52.77% White). Cannabis use was queried separately for vaping and smoking; respondents reported all settings (14 options) and social contexts (7 options) where they used. ResultsFor both vaping and smoking cannabis, the most common settings were home (vaping: 56.97%, smoking: 68.72% [significantly lower for vaping]), friend’s home (vaping: 22.49%, smoking: 21.49%), and car (vaping: 18.80%, smoking: 12.99%). The most common social contexts were with friends (vaping: 55.96%, smoking: 50.61%), with significant other (vaping: 25.19%, smoking: 28.53%), and alone (vaping: 25.92%, smoking: 22.62%). Compared to non-students, college students reported vaping on a significantly higher proportion (27.88% vs. 16.50%) of cannabis use days. ConclusionsVery similar patterns in settings and social contexts were observed for vaping as smoking and in prevalence of vaping and smoking cannabis across demographic groups. The few notable exceptions have implications for vaping related public health measures: targeting reducing vaping outside the home, particularly in cars, and implementing prevention programming on college campuses.

Differential inflammatory profile in the lungs of mice exposed to cannabis smoke with varying THC:CBD ratio.

Cannabis contains cannabinoids including Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC causes the psychoactive effects of cannabis, and both THC and CBD are thought to be anti-inflammatory. Cannabis is typically consumed by inhaling smoke that contains thousands of combustion products that may damage the lungs. However, the relationship between cannabis smoke exposure and alterations in respiratory health is poorly defined. To address this gap in knowledge, we first developed a mouse model of cannabis smoke exposure using a nose-only rodent inhalation exposure system. We then tested the acute effects of two dried cannabis products that differ substantially in their THC-CBD ratio: Indica-THC dominant (I-THC; 16-22% THC) and Sativa-CBD dominant (S-CBD; 13-19% CBD). We demonstrate that this smoke exposure regime not only delivers physiologically relevant levels of THC to the bloodstream, but that acute inhalation of cannabis smoke modulates the pulmonary immune response. Cannabis smoke decreased the percentage of lung alveolar macrophages but increased lung interstitial macrophages (IMs). There was also a decrease in lung dendritic cells as well as Ly6Cintermediate and Ly6Clow monocytes, but an increase in lung neutrophils and CD8+ T cells. These immune cell changes were paralleled with changes in several immune mediators. These immunological modifications were more pronounced when mice were exposed to S-CBD compared to the I-THC variety. Thus, we show that acute cannabis smoke differentially affects lung immunity based on the THC:CBD ratio, thereby providing a foundation to further explore the effect of chronic cannabis smoke exposures on pulmonary health.

Dental students' knowledge, attitudes, and perceptions about marijuana and its effects on patients' oral health.

This article seeks to determine dental students' knowledge, attitudes, and perceptions toward patients' marijuana use and whether dental students would like additional marijuana education. Predoctoral dental students were invited in 2021 to complete a questionnaire regarding marijuana's oral health effects, their comfort discussing marijuana with patients and their interest in additional training. Among participants (n=206, 32.7% response rate), most were familiar with smoked, smokeless and edible methods, but only 39.3% were familiar with topical applications. Only 29.6% of preclinical and 32.2% of clinical Doctor of Dental Medicine students agreed that smoking marijuana was detrimental to one's health, compared to 64.6% of internationally trained Advanced Standing students. Significantly more clinical students (70.6%) could identify how often they treat patients having used marijuana compared to the estimates of preclinical students (36.7%), although 44.2% of all students indicated they were unsure. Not surprisingly, more preclinical students were uncomfortable treating patients during routine dental procedures (45.6% preclinical vs. 32.8% clinical) and when administering local anesthesia (45.6% preclinical vs. 38.8% clinical) due to not yet providing direct patient care. A majority of both preclinical (92.2%) and clinical (89.7%) students agreed they would benefit from more marijuana education. Clinical students preferred adding a brief introductory seminar while preclinical students preferred multiple lectures throughout the curriculum. As states legalize medical and recreational marijuana use, dental schools need to evaluate marijuana education in their curriculum and develop resources so students can feel comfortable and confident in their ability to identify and safely treat patients who use marijuana.

Variable Delta-9-Tetrahydrocannabinol Pharmacokinetics and Pharmacodynamics After Cannabis Smoking in Regular Users.

Despite its federally restricted status, cannabis is widely used medicinally and recreationally. The pharmacokinetics (PK) and central nervous system (CNS) effects of tetrahydrocannabinol (THC), the major psychoactive cannabinoid, are not well understood. The objective of this study was to develop a population PK model of inhaled THC, including sources of variability, and to conduct an exploratory analysis of potential exposure-response relationships. Regular adult cannabis users smoked a single cannabis cigarette containing 5.9% THC (Chemovar A) or 13.4% THC (Chemovar B) ad libitum. THC concentrations in whole blood were measured and used to develop a population PK model to identify potential factors contributing to interindividual variability in THC PK and to describe THC disposition. Relationships between model-predicted exposure and heart rate, change in composite driving score on a driving simulator, and perceived highness were evaluated. From the 102 participants, a total of 770 blood THC concentrations were obtained. A two-compartment structural model adequately fit the data. Chemovar and baseline THC (THC BL ) were found to be significant covariates for bioavailability, with Chemovar A having better THC absorption. The model predicted that heavy users-those with the highest THC BL -would have significantly higher absorption than those with lighter previous use. There was a statistically significant relationship between exposure and heart rate, and exposure and perceived highness. THC PK is highly variable and related to baseline THC concentrations and different chemovars. The developed population PK model showed that heavier users had higher THC bioavailability. To better understand the factors affecting THC PK and dose-response relationships, future studies should incorporate a wide range of doses, multiple routes of administration, and different formulations relevant to typical community use.

Blood cannabinoid molar metabolite ratios are superior to blood THC as an indicator of recent cannabis smoking

Introduction Cannabis use is a growing concern in transportation and workplace incidents. Because Δ9-tetrahydrocannabinol is detectable after acute psychoactive effects have resolved, it has limitations as an indicator of recent usage or potential impairment. Methods In an observational study of driving and psychomotor performance, we measured whole blood Δ9-tetrahydrocannabinol plus its metabolites 11-hydroxy-Δ9-tetrahydrocannabinol and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol by liquid chromatography with tandem mass spectrometry at baseline and 30 min after starting a 15-minute interval of smoking cannabis in 24 occasional and 32 daily cannabis smokers. We calculated two blood cannabinoid molar metabolite ratios: 1) [Δ9-tetrahydrocannabinol] to [11-nor-9-carboxy-Δ9-tetrahydrocannabinol] and 2) ([Δ9-tetrahydrocannabinol] + [11-hydroxy-Δ9-tetrahydrocannabinol]) to [11-nor-9-carboxy-Δ9-tetrahydrocannabinol]. We compared these to blood [Δ9-tetrahydrocannabinol] alone as indicators of recent cannabis smoking. Results Median Δ9-tetrahydrocannabinol concentrations increased from 0 (<limit of detection 0.2 µg/L) at baseline to 5.6 µg/L post-smoking in occasional users. Among daily users, these were 2.7 µg/L at baseline and 21.3 µg/L post-smoking. Median molar metabolite ratio 1 increased from 0 at baseline to 0.62 post-smoking in occasional users and from 0.08 at baseline to 0.44 post-smoking in daily users. The median molar metabolite ratio 2 increased from 0 to 0.76 in occasional users and from 0.12 to 0.54 among daily users. A molar metabolite ratio 1 cut-point of 0.18 yielded 98% specificity, 93% sensitivity, and 96% accuracy for identifying recent cannabis smoking. A molar metabolite ratio 2 cut-point of 0.27 yielded 98% specificity, 91% sensitivity, and 95% accuracy. The receiver operating characteristic curves for molar metabolite ratio 1 and molar metabolite ratio 2 were not statistically different (P > 0.38). By comparison, a cut-point for Δ9-tetrahydrocannabinol of 5.3 µg/L yielded 88% specificity, 73% sensitivity, and 80% accuracy. Conclusions In occasional and daily users, the blood cannabinoid molar metabolite ratios were superior to whole blood Δ9-tetrahydrocannabinol as indicators of recent cannabis smoking. We recommend measurement and reporting of Δ9-tetrahydrocannabinol, 11-hydroxy-Δ9-tetrahydrocannabinol, and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol, and their molar metabolite ratios in forensic and safety investigations.

Single Cerebral Metastasis Mimicking Pyogenic Abscess in a Patient with Lung Adenocarcinoma.

HomeRadiology: Imaging CancerVol. 5, No. 3 Images in CancerFree AccessSingle Cerebral Metastasis Mimicking Pyogenic Abscess in a Patient with Lung AdenocarcinomaVíctor Pérez-Riverola , Olalla Vázquez Muiños, Mario Prenafeta Moreno, Roser Monmany Badia, Khalid El-Hamshari Rebollo, Esther Granell MorenoVíctor Pérez-Riverola , Olalla Vázquez Muiños, Mario Prenafeta Moreno, Roser Monmany Badia, Khalid El-Hamshari Rebollo, Esther Granell MorenoAuthor AffiliationsFrom the Department of Neuroradiology, UDIAT-CD, Hospital Universitari Parc Taulí, Parc del Taulí 1, 08208 Sabadell, Spain.Address correspondence to V.P.R. (email: [email protected]).Víctor Pérez-Riverola Olalla Vázquez MuiñosMario Prenafeta MorenoRoser Monmany BadiaKhalid El-Hamshari RebolloEsther Granell MorenoPublished Online:Apr 7 2023https://doi.org/10.1148/rycan.230004MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In As clinical signs of infection are often absent in patients with pyogenic abscesses, differential diagnosis with cerebral metastases is based on MRI findings.However, both entities often manifest as ring-enhancing lesions. Pyogenic brain abscesses usually show restricted diffusion in the lesion core and the dual-rim sign at susceptibility-weighted imaging. The dual-rim sign consists of two concentric rims bordering the lesion: a complete, smooth outer hypointense rim representing the fibrocollagenous capsular wall and an inner hyperintense rim representing a zone of granulation tissue (1). At perfusion imaging, the capsule of a cerebral abscess has a lower relative cerebral blood volume than the necrotic or cystic peripheral wall of a tumor due to microvessel angiogenesis by the tumor (2).Some cerebral metastases also show restricted diffusion, which does not correlate with the histologic type of the primary cancer (3). Proposed mechanisms for restricted diffusion in metastases include intracellular edema in viable tumor cells during transition to complete liquefactive necrosis (4) and a highly viscous mucin concentration (5).Key findings that help distinguish these atypical metastases from pyogenic abscess include high peripheral wall relative cerebral blood volume and absence of the dual-rim sign (Figure).Brain MR images in a 37-year-old male patient, a heavy tobacco and cannabis smoker, after a first seizure. (A) Contrast-enhanced T1-weighted MR image shows a smooth, ring-enhancing nodular right frontal lobe lesion surrounded by abundant vasogenic edema. (B, C) On diffusion-weighted images, the central core shows restricted diffusion. (D) On susceptibility-weighted image, a hypointense smooth ring completely surrounds the lesion, simulating a capsule. (E) The relative cerebral blood volume of the lesion’s peripheral wall (arrows) is high (mean relative cerebral blood volume ratio: 7.61 ± 2.70 [SD]). Chest CT findings (not shown) detected a cavitary pulmonary mass. Tests for tuberculosis and bronchoalveolar lavage fluid analysis were negative. Chest CT findings were initially misinterpreted as an infectious process. Follow-up brain MRI 8 weeks after starting antibiotics showed enlargement of the frontal lobe lesion, new ring-enhancing cerebral and cerebellar lesions, and signs of leptomeningeal carcinomatosis in the posterior fossa. The patient was diagnosed with lung adenocarcinoma following lung lesion biopsy.Download as PowerPointOpen in Image Viewer Disclosures of conflicts of interest: V.P.R. No relevant relationships. O.V.M. No relevant relationships. M.P.M. No relevant relationships. R.M.B. No relevant relationships. K.E.H.R. No relevant relationships. E.G.M. No relevant relationships.Keywords: MRI, MR-Diffusion-weighted Imaging, MR-Perfusion, Metastasis, Neuro-oncology, Lung Adenocarcinoma, Pyogenic AbscessAuthors declared no funding for this work.

Outcomes of Multiple Sclerosis Patients following Admission for Acute Ischemic Stroke in the United States (P14-5.004)

<h3>Objective:</h3> To understand the characteristics of Multiple Sclerosis (MS) patients admitted for Acute Ischemic Stroke (AIS) and any differences in outcomes. <h3>Background:</h3> While MS can influence various pathways in the body, there is a lack of research on the impact the disease has on outcomes following an AIS. <h3>Design/Methods:</h3> The 2019 National Inpatient Sample (NIS) was queried to explore the characteristics and outcomes of MS patients admitted for AIS. <h3>Results:</h3> Our study found 2100 (0.4%) AIS patients who also had a diagnosis of MS. More MS patients were females (70.2%), while non-MS patients were more likely to be males (50.8%) (p&lt;0.05). Both groups comprised a higher proportion of patients classified as White (75.4% among MS cases and 67.9% among non-MS cases, p&lt;0.05). MS patients also had a lower prevalence of old myocardial infarct (6.4% vs. 7.5%), but it was not statistically significant (p=0.066). We also found that MS patients were less likely to be diabetic (34.4% vs. 39.3%), hypertensive (77.4% vs. 86.1%), and hyperlipidemia (55.7% vs. 60.8%) compared to non-MS cases of AIS. However, more MS patients with AIS had a smoking history (44.5% vs. 40.1%) and cannabis use (2.4% vs. 1.6%). Finally, we also found that the MS cases were younger, with a mean age of 62.89 years vs. 69.97 years, had a shorter stay of 4.91 days vs. 5.04 days, and a lower mean hospital charge ($67,201 vs. $71,186). During their stay, 1.9% of MS patients admitted with AIS died (vs. 3.7% in non-MS cases). After adjusting for multiple confounders, the adjusted odds ratio of death among MS patients with AIS compared to non-MS patients was 0.555 (95% confidence interval 0.405–0.760, p&lt;0.05). <h3>Conclusions:</h3> MS patients admitted with AIS have a lower mortality risk than non-MS cases. This can be related to the differences seen in age and multiple comorbidities. <b>Disclosure:</b> Dr. Sanikommu has nothing to disclose. Dr. Sombans has nothing to disclose. Dr. Ramphul has nothing to disclose. Dr. Verma has nothing to disclose. Dr. Ramphul has nothing to disclose. Dr. Jairam Das Lohana has nothing to disclose. Dr. Meena has nothing to disclose. Dr. Kumari has nothing to disclose. Dr. Gonzalez Mejias has nothing to disclose. Dr. Kumar has nothing to disclose. Dr. Arti has nothing to disclose.

Psychopathology and Pattern of Remission of Cannabis-Induced Psychotic Disorder.

Objective: To analyze the psychopathology and pattern of remission in cannabis-induced psychotic disorder with treatment.Methods: This was a prospective cohort study of a group of patients admitted with new-onset psychosis, cannabis use, and no evidence of other drug abuse from January 1 to June 31, 2019, to the psychiatry inpatient department of a multispecialty tertiary care hospital in Kerala, India. Patients were evaluated at admission and after 1 week in the hospital and 1 month after discharge using the Structured Clinical Interview for the Positive and Negative Syndrome Scale and the Clinical Global Impressions-Severity of illness scale.Results: Fifty-six male subjects were recruited for the study. The mean age of the subjects was 22.2 years, and the majority were active smokers of nicotine and cannabis. Total duration of abuse and family history of substance use in first-degree relatives correlated with severity of psychosis. Hostility, excitement, and grandiosity were the predominant positive symptoms, and these symptoms showed a steady reduction toward the end of the study. The most frequent negative symptoms were emotional withdrawal, passive or apathetic social withdrawal, and difficulty in abstract thinking, and these symptoms also showed significant improvement (P < .001 for all). For symptoms such as somatic concern and guilt feelings, significant treatment response was noted only in the initial week (P < .001).Conclusions: Cannabis-induced psychosis in the Indian setting presents with predominant positive symptoms and minimal affective symptoms. The steady improvement noted with complete cessation of cannabis indicates a possible contributory role for cannabis in precipitating psychosis.