Marijuana Smoking Research Articles

Outcomes of lung transplantation from donors with a history of substance abuse

ObjectiveThe study objective was to determine whether donor substance abuse (opioid overdose death, opioid use, cigarette or marijuana smoking) impacts lung acceptance and recipient outcomes. MethodsDonor offers to a single center from 2013 to 2019 were reviewed to determine if lung acceptance rates and recipient outcomes were affected by donor substance abuse. ResultsThere were 3515 donor offers over the study period. A total of 154 offers (4.4%) were opioid use and 117 (3.3%) were opioid overdose deaths. A total of 1744 donors (65.0%) smoked cigarettes and 69 donors (2.6%) smoked marijuana. Of smokers, 601 (35.0%) had less than 20 pack-year history and 1117 (65.0%) had more than 20 pack-year history. Substance abuse donors were younger (51.5 vs 55.2 P < .001), more often male (65.6 vs 54.8%, P < .001), more often White (86.2 vs 68.7%, P < .001), and had hepatitis C (8.3 vs 0.8%, P < .001). Donor acceptance was significantly associated with brain dead donors (odds ratio, 1.56, P < .001), donor smoking history (odds ratio, 0.56, P < .001), hepatitis C (odds ratio, 0.35, P < .001), younger age (odds ratio, 0.98, P < .001), male gender (odds ratio, 0.74, P = .004), and any substance abuse history (odds ratio, 0.50, P < .001), but not opioid use, opioid overdose death, or marijuana use. Recipient survival was equivalent when using lungs from donors who had opioid overdose death, who smoked marijuana, or who smoked cigarettes for less than 20 patient-years or more than 20 patient-years, and significantly longer in recipients of opioid use lungs. There was no significant difference in time to chronic lung allograft dysfunction for recipients who received lungs from opioid overdose death or with a history of opioid use, marijuana smoking, or cigarette smoking. ConclusionsDonor acceptance was impacted by cigarette smoking but not opioid use, opioid overdose death, or marijuana use. Graft outcomes and recipient survival were similar for recipients of lungs from donors who abused substances.

Measuring PM2.5 concentrations from secondhand tobacco vs. marijuana smoke in 9 rooms of a detached 2-story house

The widespread legalization of recreational marijuana raises growing concerns about exposure to secondhand marijuana smoke. An important location for marijuana smoking is the home, but few measurements of air pollutant concentrations in the home are available for a marijuana joint fully smoked in one of its rooms. We used research grade calibrated real-time continuous PM2.5 air monitors in controlled 5-hour experiments to measure fine particle concentrations in the 9 rooms of a detached, two-story, 4-bedroom home with either a tobacco cigarette or a marijuana joint fully smoked in the home's living room. The master bedroom's door was closed, and the other bedroom doors were open, as was the custom of occupants of this residence. In two experiments with a Marlboro tobacco cigarette smoked by a machine in the living room, the 5-hour mean PM2.5 concentrations in 9 rooms of the home were 15.2 μg/m3 (SD 5.6 μg/m3) and 15.0 μg/m3 (SD 3.7 μg/m3). In contrast, three experiments with pre-rolled marijuana joints smoked in the same manner in the living room produced 5-hour mean PM2.5 concentrations of 38.9 μg/m3 (SD 10.6 μg/m3), 79.8 μg/m3 (SD 25.7 μg/m3) and 80.7 μg/m3 (SD 28.8 μg/m3). In summary, the average secondhand PM2.5 concentrations from smoking a marijuana joint in the home were found to be 4.4 times as great as the secondhand PM2.5 concentrations from smoking a tobacco cigarette. Opening 3 windows by 12.7 cm reduced the high PM2.5 concentrations from marijuana smoking by 67 %, but the PM2.5 levels still exceeded those produced by tobacco smoking with the windows closed.

Association between Prenatal Marijuana and Tobacco Smoke Exposures and Small for Gestational Age at Birth.

The aim of this study was to determine the association of prenatal marijuana exposure with and without tobacco smoke exposure and small for gestational age (SGA) at birth. We conducted a secondary analysis of the prospective Lifestyle and Early Achievement in Families (LEAF) cohort enrolled from 2010 to 2015. We included singleton nonanomalous liveborn pregnancies. We assessed marijuana use inclusive of any pregnancy urine specimen with a Δ9-THC-COOH concentration of more than 15 ng/mL by mass spectrometry, self-report on questionnaire, and/or electronic health record; and self-reported maternal tobacco use. Because of the high co-frequency of marijuana with tobacco exposure in pregnancy and the known association between tobacco and fetal growth restriction, we modeled the exposure as: both marijuana and tobacco (hereafter "co-use"), only marijuana, only tobacco, and neither (reference). Incidence of SGA in each group was compared with the neither group. The primary outcome was SGA less than 10th percentile, and secondarily less than 5th percentile, using parity-specific definitions per 2017 US natality reference data. Among 325 assessed mothers, 46% had neither exposure, 11% had only prenatal marijuana exposure, 20% only tobacco exposure, and 23% co-use exposure. A third (33%) of infants were SGA less than 10th percentile and 20% SGA less than 5th percentile. Marijuana exposure only was associated with an increased risk of SGA less than 10th percentile (43 vs. 26%; adjusted relative risk [aRR]: 1.66; 95% confidence interval [CI]: 1.02-2.69), and SGA less than5th percentile (30 vs. 13%; aRR: 2.26; 95% CI: 1.15-4.47). Tobacco was not associated with SGA less than 10th percentile, but was with SGA less than 5th percentile (26 vs. 13%; aRR: 2.01; 95% CI: 1.13, 3.56). Co-use was not associated with increased SGA risk in multivariate analysis, but was in sensitivity analysis when tobacco use was defined using a cotinine assay rather than self-report (SGA <10th percentile, aRR: 1.97; 95% CI: 1.24-3.15) and (SGA <5th percentile, aRR: 2.03; 95% CI: 1.09-3.78). Prenatal marijuana exposure in addition to tobacco may increase the risk of SGA. Given the rising prevalence of marijuana use in pregnancy, further research is warranted to understand how in utero marijuana exposure may impact fetal growth and birth weight with and without tobacco exposure. · Marijuana and tobacco are commonly used together in pregnancy.. · Prenatal marijuana and tobacco exposure may increase the risk of a small for gestational age infant.. · Further research is warranted to understand how in utero marijuana exposure impacts fetal growth..

Assessing the influence of cannabis and alcohol use on different visual functions: A comparative study

This study aimed to assess and compare the influence of alcohol intake and cannabis smoking on different visual functions. A total of 64 young and healthy volunteers took part in the study. All undertook several randomised experimental sessions in which different visual functions, namely distance stereopsis, retinal straylight, visual discrimination capacity, and contrast sensitivity, were tested. Cannabis smokers (N = 30) took a baseline session and a session after smoking a cannabis cigarette, whereas alcohol users (N = 34) underwent a baseline session, a session after a low alcohol intake (Alcohol 1), and a session after a moderate to high alcohol intake (Alcohol 2). All visual functions were impaired by cannabis and alcohol use, particularly for the Cannabis and Alcohol 2 groups. The deterioration of all visual variables was higher for the Alcohol 2 than for the Alcohol 1 and Cannabis groups, except for retinal straylight, the deterioration of which was equal for the Cannabis group, and distant stereopsis, which was more impaired for the Cannabis group. The Alcohol 2 group experienced the most impairing conditions, although very similar to the cannabis group, and that factors other than the experimental conditions, such as sex and age, also influenced these visual changes. Alcohol and cannabis use clearly impair vision. The deterioration caused by cannabis is similar to, but slightly lower than, that produced by a moderate to high alcohol intake, with the experimental conditions, sex and age all having an impact on the variability of visual deterioration.

Man With Finger Ulcerations

A 49-year-old otherwise healthy man presented to the emergency department with blue discoloration and ulceration of his fingers. He described 6 weeks of waxing and waning painful skin breakdown on his fingertips with intermittent spontaneous drainage. Review of systems was otherwise unremarkable. He endorsed a history of heavy marijuana smoking but no tobacco use. Examination showed pitting of both hands with areas of ulceration on the fingertips (Figure 1). The Allen test for insufficient palmar arterial supply was positive.

Pathological Changes among Norvegicus Rattus Exposed on Novel Smoked Bambusa Vulgaris (Bamboo) Leaf: Cigarette Substitute during COVID-19 Lockdown in Nigeria

Background: This research titled; Pathology changes among Norvegicus Rattus exposed on novel smoked Bambusa vulgaris: Cigarette substitute during COVID 19 lockdown in Nigeria is stimulated following increase use of the aforementioned substances as a substitute to drugs during covid -19 lock down in Nigeria where a number of psychoactive substances were limited and restricted for months, both known addicts to cannabis and cigarette smoking and frustration induced initial smokers engaged massively on the use of bamboo leaf and that had continued after years of the lockdown.&#x0D; Methods: The experimental subjects were grouped into acute and chronic for both smoked and the control. Norvegicus rattus subjects were exposed to the 0.01g/g bamboo vulgaris dry leaf smoke twice daily for 21 and 42 days (acute and chronic) exposure respectively. The Animals were sacrificed and the organs harvested following ethical procedures for animal killing. The brain and lungs were divided and parts subjected into histopathological examination using formalin fixed paraffin processed methods stained with both routine and special stains, and the other parts were homogenized to investigate the oxidative stress biomarkers.&#x0D; Results: Histopathology results first revealed a severe cellular injury in both lungs and brain compare to the normal control; significance (p&lt;0.5) elevation found in MDA and reduced SOD, Gpx, GSH and catalase correlate the histology results with oxidative stress biomarkers.&#x0D; Conclusion: Smoking Bambusa vulgaris dry leaf is been found in this study to be more harmful to the respiratory system and brain in more rapid manner compared to conventional abused substances and should be discourage using state agency and enlightenment campaign

Fatal intoxication involving 2,5-dimethoxy-4-chloroamphetamine (DOC): A case report

2,5-dimethoxy-4-chloroamphetamine (DOC) is a substituted alpha-methylated phenethylamine, which was identified for the 1st time in 2009 in France, but is not classified as an illegal narcotic. This report presents a fatal intoxication involving consumption of DOC with analysis of multiple matrices. A 26-year-old man was found dead in his friend's apartment after a party. At place, numerous bottles of alcohol were discovered. The man was known as a cannabis smoker. Except the observation of a multi-visceral congestion and oedematous lungs, no obvious cause of death was identified at autopsy. Peripheral blood (PB), cardiac blood (CB), urine and bile were collected. Immunological screening for amphetamine, methamphetamine, opiates, cannabinoids, cocaine, buprenorphine, methadone and MDMA was performed on urine. Quantification of cannabinoids was performed on PB by GC-MS/MS. Analysis of ethanol and other volatile compounds was performed on PB and urine using HS-GC-MS. Ethylglucuronide (EtG) was quantified in PB and urine by GC-MS/MS. General unknown screening (GUS) was performed on PB by GC-MS and LC-PDA/MS. DOC was quantified in bloods, urine and bile by UHPLC-MS/MS after liquid-liquid extraction, using MBDB-d5 as internal standard. The assay was validated on whole blood for linearity (range: 2.0 to 500 ng/mL), selectivity, precision and accuracy at limit of quantification (LOQ: 2.0 ng/mL) and at high-level concentration (High QC: 400 ng/mL). The dilution process was validated in urine (dilution factor 1/10). Immunological screening was positive for cannabinoids. Confirmation in PB quantified THC, 11-OH-THC and THC-COOH at 3.40, 2.10 and 36.0 ng/mL, respectively. Ethanol analyses were negative but EtG was quantified at 0.48 μg/mL and 161 μg/mL in PB and urine, respectively. Mirtazapine was quantified at therapeutic concentration (20 ng/mL) in PB. DOC was detected on GUS by GC-MS and LC-PDA/MS. The method of DOC quantification was validated by measurement of accuracy and precision at the LOQ (104% and 12.6%) and at the High QC (97.4% and 8.5%). The 10-fold dilution process in urine was validated in term of accuracy (100%) and precision (4.1%). Selectivity was validated by analyzing 6 blank samples and no interference was observed at DOC retention time. In the present case, DOC was quantified at 104 ng/mL, 322 ng/mL, 648 ng/mL and 371 ng/mL in PB, CB, urine and bile respectively. Presence of cannabinoids and EtG in blood and urine suggest alcohol and cannabis consumption several hours preceding the death. Reports of use of DOC have mainly described non-fatal intoxications, with reported blood concentrations from < 10 to 18 ng/mL (Abbara. TOXAC 2017;29:82–89). At our best knowledge, only one fatal case has been reported in the literature (Barnett. JAT 2014;38:589–591), in which DOC blood and urine concentrations were 377 and 3193 ng/mL. Difference between PB and CB concentrations in the present case could be explain by postmortem redistribution. In the present case, the circumstances of death, autopsy findings and toxicological results were consistent with a toxic cause of death by DOC overdose in association with cannabis consumption.

Prenatal exposure to Cannabis smoke induces early and lasting damage to the brain

Cannabis is the most widely used illegal drug during pregnancy, however, the effects of gestational exposure to Cannabis smoke (CS) on the central nervous system development remain uncharacterised. This study investigates the effects of maternal CS inhalation on brain function in the offspring. Pregnant mice were exposed daily to 5 min of CS during gestational days (GD) 5.5–17.5. On GD 18.5 half of the dams were euthanized for foetus removal. The offspring from the remaining dams were euthanized on postnatal days (PND) 20 and 60 for evaluation. Brain volume, cortex cell number, SOX2, histone-H3, parvalbumin, NeuN, and BDNF immunoreactivity were assessed in all groups. In addition, levels of NeuN, CB1 receptor, and BDNF expression were assessed and cortical primary neurons from rats were treated with Cannabis smoke extract (CSE) for assessment of cell viability. We found that male foetuses from the CS exposed group had decreased brain volume, whereas mice at PND 60 from the exposed group presented with increased brain volume. Olfactory bulb and diencephalon volume were found lower in foetuses exposed to CS. Mice at PND 60 from the exposed group had a smaller volume in the thalamus and hypothalamus while the cerebellum presented with a greater volume. Also, there was an increase in cortical BDNF immunoreactivity in CS exposed mice at PND 60. Protein expression analysis showed an increase in pro-BDNF in foetus brains exposed to CS. Mice at PND 60 presented an increase in mature BDNF in the prefrontal cortex (PFC) in the exposed group and a higher CB1 receptor expression in the PFC. Moreover, hippocampal NeuN expression was higher in adult animals from the exposed group. Lastly, treatment of cortical primary neurons with doses of CSE resulted in decreased cell viability. These findings highlight the potential negative neurodevelopmental outcomes induced by gestational CS exposure.

EP-68 A Case of Spontaneous Pneumomediastinum due to Marijuana usage- A rare cause

Abstract Pneumomediastinum without trauma or clear secondary cause is called Spontaneous pneumomediastinum with an incidence between 0.001%-0.014% and most commonly seen in young males. Marijuana smoking has rarely been identified as a possible cause of spontaneous pneumomediastinum, which is likely caused by barotrauma during breathing manoeuvres. Fewer than 10 case reports have been reported in the literature on Marijuana causing Spontaneous pneumomediastinum. We present a 24year male who presented with dysphagia, swelling and crackling under the skin of his neck for the past 12hours, half an hour after blowing his nose. There was no chest pain or dyspnoea, and he was hemodynamically stable with normal blood investigations. He smokes cannabis regularly and occasionally does cocaine. On examination, surgical emphysema was felt on both sides of the neck; the systemic examination was unremarkable. CT thorax demonstrated extensive pneumomediastinum and surgical emphysema from the angle of the jaw throughout the neck and down to the right subcapsular region. No pneumothorax was seen, and lung parenchyma was unremarkable. However, to rule out the clinical suspicion of oesophageal rupture, he had a CT oesophagus with oral contrast, which showed no extravasation of contrast from the oesophagus. The patient was admitted for observation, and the Chest X-ray after 12hours dint show pneumothorax. He was clinically well, tolerating oral feeds, so he was discharged with oral antibiotics as a prophylactic cover as per UGI surgeons. The knowledge about this rare cause would help the physicians diagnose and educate the patients on the risk involved in using Marijuana.

Abstract P3005: Cannabinoid Receptor 1 Antagonist Genistein Attenuates Marijuana-Induced Vascular Inflammation

Epidemiological studies reveal that marijuana increases the risk of cardiovascular disease (CVD); however, little is known about the mechanism. Δ 9 -tetrahydrocannabinol (Δ 9 -THC), the psychoactive component of marijuana, binds cannabinoid receptor 1 (CB1/CNR1) in the vasculature and is implicated in CVD. A UK Biobank analysis found that cannabis is an independent risk factor for CVD. We found that marijuana smoking activated inflammatory cytokines implicated in CVD. In silico virtual screening identified genistein, a soybean isoflavone, as a putative CB1 antagonist. Human-induced pluripotent stem cell-derived endothelial cells (hiPSC-ECs) were used to model Δ 9 -THC induced inflammation and oxidative stress via NF-κB signaling. Knockdown of the CB1 receptor with siRNA, CRISPR interference (CRISPRi), and genistein attenuate the effects of Δ 9 -THC. In mice, genistein blocked Δ 9 -THC-induced endothelial dysfunction in wire myograph, reduced atherosclerotic plaque, and had minimal penetration of the central nervous system (CNS). Genistein is a peripherally restricted CB1 antagonist that attenuates Δ 9 -THC-induced atherosclerosis.

Differences in those who prefer smoking cannabis to other consumption forms for mental health: what can be learned to promote safer methods of consumption?

Smoking cannabis in medical users is associated with exposure to harmful toxins. It is important to characterize cannabis-use profiles and risk-factors for medical cannabis users who smoke cannabis. 100 members of a medical cannabis dispensary with mental health concerns were interviewed in detail about their cannabis use. Forty seven percent of participants preferred smoking only, 18% preferred vaporizing, 25% preferred both smoking and vaping, and 10% preferred oral ingestion methods. Smokers differed from other users in multiple ways, including a greater preference for THC-dominant chemovars, and more frequent and greater amount of cannabis consumption. Smoking was also associated with greater rates of alcohol use disorder. These results may inform harm-reduction approaches to decrease the number of individuals smoking cannabis and use less harmful methods of medical cannabis ingestion.

Differences between adults who smoke cigarettes daily and do and do not co-use cannabis: Findings from the 2020 ITC four country smoking and vaping survey

BackgroundLittle is known about population-level differences between adults who exclusively smoke cigarettes and those who smoke cigarettes and also use cannabis (co-consumers). Thus, this study describes differences on sociodemographic, cigarette-dependence, health and behavioral variables, and risk perceptions associated with smoking cannabis. MethodsThis cross-sectional study included 6941 respondents from the 2020 ITC Four Country Smoking and Vaping Survey (US, Canada, Australia, England). Adult daily cigarette smokers were included and categorized as: cigarette-only smokers (never used cannabis/previously used cannabis, but not in the past 12 months, n = 4857); occasional co-consumers (cannabis use in the past 12 months, but < weekly use, n = 739); or regular co-consumers (use cannabis ≥ weekly, n = 1345). All outcomes were self-reported. Regression models were conducted on weighted data. ResultsOverall, 19.9 % of respondents reported regular cannabis co-use and 10.1 % reported occasional co-use. Regular co-use was highest in Canada (27.2 %), followed by the US (24.4 %), England (12.7 %) and Australia (12.3 %). Compared to cigarette-only smokers, regular co-consumers were more likely to be male and report chest/breathing problems (p < 0.001). All co-consumers were more likely to be younger, have lower income, be experiencing financial stress, reside in Canada, have depressive symptoms, use alcohol more frequently and binge drink, use other tobacco/nicotine products, and perceive smoking cannabis as low health risk and less harmful than smoking cigarettes (all p < 0.001). Cigarette dependence measures were similar between co-consumers and cigarette-only smokers (all p ≥ 0.05). ConclusionsAlthough there were no differences on cigarette dependence measures between daily cigarette smokers who do and do not use cannabis, there are several other risk factors that may affect tobacco use and abstinence among co-consumers (e.g., greater depression, high-risk alcohol consumption). Thus, tobacco cessation treatment may require multi-pronged strategies to address other health behaviors. Continued surveillance is needed to determine the nature and health implications of co-use considering changing policies, markets, and products.

Increased Levels of the Acrolein Metabolite 3-Hydroxypropyl Mercapturic Acid in the Urine of e-Cigarette Users.

Carcinogen and toxicant uptake by e-cigarette users have not been fully evaluated. In the study reported here, we recruited 30 e-cigarette users, 63 nonsmokers, and 33 cigarette smokers who gave monthly urine samples over a period of 4-6 months. Their product use status was confirmed by measurements of exhaled CO, urinary total nicotine equivalents, cyanoethyl mercapturic acid (CEMA), and total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol. Urinary biomarkers of exposure to the carcinogens acrolein (3-hydroxypropyl mercapturic acid, 3-HPMA), benzene (S-phenyl mercapturic acid, SPMA), acrylonitrile (CEMA), and a combination of crotonaldehyde, methyl vinyl ketone, and methacrolein (3-hydroxy-1-methylpropyl mercapturic acid, HMPMA) were quantified at each visit. Data from subject visits with CEMA > 27 pmol/mL were excluded from the statistical analysis of the results because of possible unreported exposures to volatile combustion products such as secondhand cigarette smoke or marijuana smoke exposure; this left 22 e-cigarette users with 4 or more monthly visits and all 63 nonsmokers. Geometric mean levels of 3-HPMA (1249 versus 679.3 pmol/mL urine) were significantly higher (P = 0.003) in e-cigarette users than in nonsmokers, whereas levels of SPMA, CEMA, and HMPMA did not differ between these two groups. All analytes were significantly higher in cigarette smokers than in either e-cigarette users or nonsmokers. The results of this unique multimonth longitudinal study demonstrate consistent significantly higher uptake of the carcinogen acrolein in e-cigarette users versus nonsmokers, presenting a warning signal regarding e-cigarette use.

Magnetic restricted-access carbon nanotubes for SPME to determine cannabinoids in plasma samples by UHPLC-MS/MS

This manuscript describes the development of magnetic restricted-access carbon nanotubes (M-RACNTs) for use as SPME sorbent to determine cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) in human plasma samples by UHPLC-MS/MS. The adsorptive phase was immobilized on an SPME device by electromagnetic interactions between the M-RACNTs and a cylindrical neodymium magnet (3-mm diameter x 8-mm height) attached to a stainless-steel rod (3-mm diameter x 40-mm height). The M-RACNTs were synthesized by incorporating Fe3O4 magnetic nanoparticles (MNPs) into commercial carbon nanotubes (CNTs); then the surface of the resulting sorbent was further coated with a layer of bovine serum albumin (BSA). Characterization techniques (SEM, FTIR, and Zeta potential) confirmed the presence of both MNPs and BSA layer dispersed through the structure of the CNTs. The M-RACNTs presented adequate sorption capacity, stable physical/chemical characteristics, and appropriate magnetic properties. Protein exclusion capacity (about 98.5%) was attributed to the chemical diffusion barrier created by the BSA network at the outer surface of the sorbent. The SPME parameters (sample pH, equilibrium time, and desorption conditions) were optimized by design of experiments (fraction factorial planning). The method (validated according to the FDA guidelines) presented adequate selectivity and linearity (coefficient of determination higher than 0.99) at concentrations ranging from the lower limit of quantification (LLOQ) (10 ng mL−1) to the upper limit of quantification (ULOQ) (300 ng mL−1) for both CBD and THC. Precision and accuracy varied from 4.47 to 19.84% (LLOQ) and −6.90 to 17.78% (LLOQ), respectively. Carry-over and matrix effect were not significant. The method was successfully applied to determine plasmatic CBD levels in healthy volunteers attending a single session of oral drug administration and THC levels in frequent cannabis smokers.

Case Report of Bipolar Disorder with Substance Use Disorder; Comorbidity or Confounders?

Objective: Bipolar disorder commonly presents with substance use and there is the diagnostic challenge of one being a sequela of the other or the two being co-morbid conditions. The distinction is important as the effective treatment of the primary condition can lead to a concomitant remittance of the other. A misdiagnosis and a consequent ineffective treatment on the other hand, can lead to worsening prognosis of both conditions in the person. This aims at bringing attention to this diagnostic dilemma and the need to hone skills for proper diagnosis and eventual effective treatment.Case Presentation: Ms. KK is a 28-year-old divorcee and Human Resources Manager who presented with gregariousness, sleep difficulty and smoking of marijuana for two months. She had resumed smoking of marijuana after some 6 months break. She admitted to suicidal ideation and behaviours even though she also had many big plans to transform mental healthcare in Ghana. She was admitted a year earlier as schizophrenia for less than a week after which she had a divorce. Ms. KK was referred for management of substance induced psychosis to include residential rehabilitation. She was managed after review for bipolar disorder with substance use disorder. She was treated with long-acting second generation antipsychotic and she quit smoking with the remission of her mood symptoms after two months.Conclusion: Mood disorders can occur with substance use disorder as a co-morbid condition or part of the symptomatology of mood disorder. Substance use disorder can also present with mood symptoms or unmask mood disorders. When the correct diagnosis of aprimary mood disorder, bipolar disorder in this case, with co-morbid substance use disorder is made, effective treatment of the mood disorder can remit substance use.

Predictors of reported alcohol intake during the first and second waves of the COVID-19 pandemic in Canada among middle-aged and older adults: results from the Canadian Longitudinal Study on Aging (CLSA)

ObjectiveTo examine proportions and predictors of change in alcohol intake and binge drinking during the first 2 waves of the COVID-19 pandemic among middle-aged and older participants in the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Questionnaire Study.MethodsA total of 28,559 (67.2% of the potential sample) CLSA participants consented to the study with 24,114 completing the exit survey (fall 2020). Descriptive statistics and logistic regressions to examine predictors of change (increase or decrease) in alcohol intake and binge drinking were performed.ResultsAmong alcohol users, 26.3% reported a change in alcohol consumption during the first 10 months of the pandemic. Similar percentages increased (13.0%) or decreased (13.3%) consumption. In our mutually adjusted logistic regression model, odds of change in alcohol intake were greater for younger age, higher income, current cannabis smoker, positive screen for depression, anxiety, and loneliness. The magnitude of all associations for decreased intake was less than that of increased intake, and the directions were opposite for male sex and age. Predictors of current binge drinking (27.9% of alcohol users) included male sex, younger age, higher education and income, cannabis use, depression, and anxiety.ConclusionFactors predictive of potentially worrisome alcohol use (i.e. increased intake, binge drinking) included younger age, sex, greater education and income, living alone, cannabis use, and worse mental health. Some of these factors were also associated with decreased intake, but the magnitudes of associations were smaller. This information may help direct screening efforts and interventions towards individuals at risk for problematic alcohol intake during the pandemic.

Examining impairment and kinetic patterns associated with recent use of hemp-derived Δ8-tetrahydrocannabinol: case studies

BackgroundAs a result of the legalization of U.S. industrial hemp production in late 2018, products containing hemp-derived Δ8-tetrahydrocannabinol (Δ8-THC) are increasing in popularity. Little, however, is known regarding Δ8-THC’s impairment potential and the associated impacts on roadway and workplace safety, and testing for Δ8-THC is not yet common. The present study explored impairment patterns and cannabinoid kinetics associated with recent use of Δ8-THC.MethodsHemp-derived Δ8-THC concentrate was administered by vaporization ad libitum to three male frequent cannabis users aged 23–25 years. In addition to self-assessments of impairment using a 10-point scale, horizontal gaze nystagmus (HGN) was evaluated in each subject as a physical means of assessing impairment before and after vaporization. To examine cannabinoid kinetic patterns, exhaled breath and capillary blood samples were collected prior to vaporization up to 180 min post-vaporization and analyzed by liquid chromatography high-resolution mass spectrometry for cannabinoid content using validated methods. The impairment and cannabinoid kinetic results were then compared to analogous results obtained from the same three subjects after they had smoked a ∆9-THC cannabis cigarette ad libitum in a previous study to determine whether any similarities existed.ResultsPatterns of impairment after vaporizing Δ8-THC were similar to those observed after smoking cannabis, with self-assessed impairment peaking within the first hour after use, and then declining to zero by 3 h post-use. Likewise, HGN was observed only after vaporizing, and by 3 h post-vaporization, evidence of HGN had dissipated. Cannabinoid kinetic patterns observed after vaporizing Δ8-THC (short ∆8-THC half-lives of 5.2 to 11.2 min at 20 min post-vaporization, presence of key cannabinoids cannabichromene, cannabigerol, and tetrahydrocannabivarin, and breath/blood Δ8-THC ratios > 2 within the first hour post-vaporization) were also analogous to those observed for ∆9-THC and the same key cannabinoids within the first hour after the same subjects had smoked cannabis in the previous study.ConclusionsHemp-derived Δ8-THC and Δ9-THC from cannabis display similar impairment profiles, suggesting that recent use of Δ8-THC products may carry the same risks as cannabis products. Standard testing methods need to incorporate this emerging, hemp-derived cannabinoid.

Ventricular Tachycardia Revealing a Coronary Artery Spasm in a Young Cannabis Smoker in the Absence of Coronary Artery Disease: A Case Report

Vasospastic angina (VA), is characterized by symptoms of coronary angina caused by coronary vasospasm, usually in the absence of atherosclerotic changes. It typically presents with chest pain, which can be accompanied by transient electrocardiographic changes, if visualized during the attack. It can also rarely present with severe manifestations of acute myocardial angina, ventricular tachycardia (VT), ventricular fibrillation or cardiac arrest. We report the case of a 25-year-old male patient, with cannabis smoking habit, admitted for palpitations which had revealed a VT in the electrocardiogram (ECG), and for whom a coronary angiography was realised showing a coronary artery spasm (CAS) with no sign of atherosclerotic occlusion.

Trends in the co-occurrence of substance use and mental health symptomatology in a national sample of US post-secondary students from 2009 to 2019

Objective: This study examined joint trends over time in associations between substance use (heavy drinking, cannabis, and cigarette smoking) and mental health concerns (depression, anxiety, and suicidal ideation) among US post-secondary students. Participants: Data came from 323,896 students participating in the Healthy Minds Study from 2009 to 2019, a national cross-sectional survey of US post-secondary students. Weighted two-level logistic regression models with a time by substance interaction term were used to predict mental health status. Results: Use of each substance was associated with a greater odds of students endorsing depression, anxiety, and suicidal ideation. Over time, the association with mental health concerns strengthened substantially for cannabis, modestly for heavy drinking, and remained stable for smoking. Conclusion: Given co-occurrence is common and increasing among post-secondary students, college and university health systems should prioritize early identification, psychoeducation, harm-reduction, and brief interventions to support students at risk.

Changes in Expression of DNA-Methyltransferase and Cannabinoid Receptor mRNAs in Blood Lymphocytes After Acute Cannabis Smoking.

BackgroundCannabis use is a component risk factor for the manifestation of schizophrenia. The biological effects of cannabis include effects on epigenetic systems, immunological parameters, in addition to changes in cannabinoid receptors 1 and 2, that may be associated with this risk. However, there has been limited study of the effects of smoked cannabis on these biological effects in human peripheral blood cells. We analyzed the effects of two concentrations of tetrahydrocannabinol (THC) vs. placebo in lymphocytes of a subset of participants who enrolled in a double-blind study of the effects of cannabis on driving performance (outcome not the focus of this study).MethodsTwenty four participants who regularly use cannabis participated in an experiment in which they smoked cannabis cigarettes (5.9 or 13.4% THC) or placebo (0.02%) ad libitum. Blood samples were drawn at baseline and several times after smoking. Lymphocytes were separated and stored at –80°C for further analysis. Samples were analyzed for mRNA content for cannabinoid receptors 1 (CB1) and 2 (CB2), methylation and demethylating enzymes (DNMT, TET), glucocorticoid receptor (NRC3) and immunological markers (IL1B, TNFα) by qPCR using TaqMan probes. The results were correlated with THC whole blood levels during the course of the day, as well as THCCOOH baseline levels. Statistical analyses used analysis of variance and covariance and t-tests, or non-parametric equivalents for those values which were not normally distributed.ResultsThere were no differences in background baseline characteristics of the participants except that the higher concentration THC group was older than the low concentration and placebo groups, and the low concentration THC group had higher baseline CB2 mRNA levels. Both the 5.9 and 13.4% THC groups showed increased THC blood levels that then decreased toward baseline within the first hour. However, there were no significant differences between THC blood levels between the 5.9 and 13.4% groups at any time point. At the 4-h time point after drug administration the 13.4% THC group had higher CB2 (P = 0.021) and DNMT3A (P = 0.027) mRNA levels than the placebo group. DNMT1 mRNA levels showed a trend in the same direction (P = 0.056). The higher 13.4% THC group had significantly increased CB2 mRNA levels than the 5.9% concentration group at several post drug administration time points and showed trends for difference in effects for between 5.9 and 13.4% THC groups for other mRNAs. TET3 mRNA levels were higher in the 13.4% THC group at 55 min post-cannabis ingestion. When the high and lower concentration THC groups were combined, none of the differences in mRNA levels from placebo remained statistically significant. Changes in THC blood levels were not related to changes in mRNA levels.ConclusionOver the time course of this study, CB2 mRNA increased in blood lymphocytes in the high concentration THC group but were not accompanied by changes in immunological markers. The changes in DNMT and TET mRNAs suggest potential epigenetic effects of THC in human lymphocytes. Increases in DNMT methylating enzymes have been linked to some of the pathophysiological processes in schizophrenia and, therefore, should be further explored in a larger sample population, as one of the potential mechanisms linking cannabis use as a trigger for schizophrenia in vulnerable individuals. Since the two THC groups did not differ in post-smoking blood THC concentrations, the relationship between lymphocytic changes and the THC content of the cigarettes remains to be determined.