Medical Marijuana Use Research Articles

An Ethical Framework to Manage Patient Requests for Medical Marijuana.

An increasing number of states are legalizing marijuana use for medicinal purposes despite marijuana use remaining criminalized at the federal level and continued Schedule I status by the US Food and Drug Administration. Many of those states in which medical marijuana is legal require physician involvement to facilitate patient access. In addition, physicians may have ethical objections to medical marijuana use or may not believe there is adequate scientific evidence to support its use. The constellation of these factors creates an ethical quandary for physicians when approached by patients for assistance in accessing medical marijuana. This article provides an ethical framework that provides guidance to physicians in managing these patient requests taking into consideration the above ethically relevant factors.

When in Rome: Local Social Norms and Tournament Incentives

We investigate whether social capital influences the use and effectiveness of tournament structure of compensation. We find that pay differentials between the CEO and other executives, or tournament, are lower in U.S. counties with higher social capital. In addition, lower pay differentials are associated with better firm performance in regions with higher social capital. We use a variety of experiments which are shown to change social capital, such as legalization of medical and recreational use of marijuana or moving corporate headquarters. Our results remain robust. These findings suggest that social capital impact firms’ compensation setting decisions and firm performance.

Differences in 30-Day Marijuana Use by Sexual Orientation Identity: Population-Based Evidence from Seven States.

Purpose: The objective of this study was to compare 30-day marijuana use by sexual orientation identity. Methods: Data came from the 2016-2017 Behavioral Risk Factor Surveillance System. Prevalence estimates and logistic regression models compared 30-day marijuana use controlling for sociodemographic characteristics. Results: Lesbian women, gay men, and bisexual adults were more likely to use marijuana compared with heterosexual adults. Other characteristics predicting marijuana use included frequent mental distress, cigarette smoking, and binge drinking. Conclusion: Health professionals should identify the risk factors for elevated marijuana use, especially as more states legalize medical and recreational marijuana use despite uncertain health risks.

Documentation of medical marijuana use in cancer patients.

Medical marijuana is often used as adjuvant therapy in cancer patients for symptom management, although limited evidence-based studies evaluating its efficacy or safety exist. Similar to over-the-counter medications, supplements, or herbal products, documentation of medical marijuana is important to monitor efficacy, potential adverse effects, or interactions. The objective of this quality improvement study was to improve the consistency of medical marijuana documentation in cancer patients by assessing current practices; educating healthcare team members about the importance of documentation and newly established documentation process; and evaluating the new documentation process. This three-part quality improvement study was approved by the Institutional Review Board. In part I, a voluntary survey was sent via email to Cancer Center healthcare personnel to assess the current documentation process of medical marijuana. In part II, a best practice process for documenting medical marijuana in the electronic medical record was established. Medical marijuana was to be listed as a historical medication in the medication list. In-person and electronic education sessions were offered to Cancer Center clinical staff. The education emphasized the importance of documenting medical marijuana use and provided a detailed process for electronic medical record documentation. A pre- and post-test to assess understanding was also included. Part III was a retrospective chart review to evaluate documentation practices of certified medical marijuana users in the Cancer Center. Patients included in the study were greater than 18 years old and certified for medical marijuana use on or after 1 January 2018. Department of Corrections patients were excluded. Descriptive statistics were used for data analysis. The survey results in part I demonstrated a lack of consistency in the documentation of medical marijuana in the Cancer Center. The pre- and post-test scores measured in part II showed a significant improvement in understanding after education was provided. The average pre-test score was a 61 and post-test score was 88, indicating an average increase of 27 points. A larger increase in test scores was observed in those attending the in-person education than the online sessions (p < 0.002). The results of the retrospective chart review in part III revealed 56 patients who met inclusion criteria, but only 39 patients were alive and evaluated at the time of the retrospective chart review. Of the 39 patients, 22 never completed the patient registration process and therefore, would never have been able to obtain medical marijuana. Seven patients had medical marijuana properly documented in their medication list and 10 patients were missing documentation in the medication list, showing room for improvement in documentation practices. This quality improvement study led to the implementation of medical marijuana documentation in the medication list. Education increased healthcare team members understanding of medical marijuana utilization and the importance of documentation.

Self-Reported Efficacy of Cannabis for Endometriosis Pain

Study Objective To survey endometriosis patients about their experience with marijuana and cannabidiol (CBD) for management of endometriosis and pelvic pain symptoms, and to identify the prevalence of medical marijuana use among women with endometriosis. Design Survey. Setting Online REDCap survey accessed through email invitation survey link. Patients or Participants 137 clinic patients with an ICD-10 code for an endometriosis diagnosis, 347 patients from the mailing list of the Endometriosis Association (EA). Interventions A customized survey with 55 to 75 questions based on branching logic, inquiring about pelvic pain history, demographics, and experience with marijuana and CBD for management of pelvic pain. Measurements and Main Results Of 240 EA participants responding, 77 (32.1%) reported having tried marijuana, with the majority of these participants (52 of 77, 67.5%) reporting marijuana to be very or moderately effective. Of 124 clinic participants responding, 58 (46.8%) reported having tried marijuana, with the majority of patients (44 of 58, 75.9%) reporting marijuana to be very or moderately effective. 67 (27.8%) EA participants reported having tried CBD, with half (50%, 34 of 67) reporting CBD to be very or moderately effective. 57 (46.0%) clinic participants reported having tried CBD, with the majority (64.9%, 37 of 57) reporting CBD to be very or moderately effective. Amongst both participant groups, Marijuana was most likely to be reported as very effective (40.2% of EA participants, 53.4% of clinic participants), while CBD was most likely to be reported as moderately effective (31.4% of EA participants, 36.8% of clinic participants). Conclusion Use of medical marijuana and CBD amongst women with endometriosis is common. Both marijuana and CBD are reported as moderately or very effective for pelvic pain by the majority of women who have tried them, with marijuana reported as more effective than CBD.

UNANTICIPATED CONSEQUENCES OF MARIJUANA LEGALIZATION

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: A nineteen year old male, never a tobacco smoker, with no significant history, presented to clinic after three episodes of spontaneous pneumothorax in two months. CASE PRESENTATION: After presenting to clinic, he denied smoking, substance use, and environmental exposures. Physical exam was unremarkable. Between his first and second events, CT scans revealed apical bullae. His three episodes required thorascopy, left apical bullectomy, and pleurectomy. Pathology showed respiratory bronchiolitis and inflammation with abundant eosinophils, raising suspicion for undisclosed smoking habits. The patient retroactively admitted to smoking marijuana and inhaling heated oils daily for “medical purposes,” due to chronic back pain, and had obtained a “medical card” to purchase marijuana. DISCUSSION: This case of respiratory bronchiolitis and bullae due to marijuana and heated oil inhalation exemplifies unintended consequences of marijuana legalization, and delineates a perception that marijuana use is largely harmless. It suggests that there is confusion regarding the distinction between recreational and medical marijuana, among users and medical providers. Moreover, it outlines a perceived probability that obtaining a license for marijuana use permits recreational procurement, by way of claiming to be affected by a condition which may not have entirely objective diagnostic criteria. CONCLUSIONS: Marijuana is one of the most commonly used substances, and has been used extensively in medicine. Chronic pain is the most common reason for use of medical marijuana, which is legalized and approved for specific uses. Despite known complications, marijuana use remains prevalent and may become the first Schedule I substance to traverse the gap between substance use and medical therapy. Amid constituent compounds, cannabidiol is believed to correlate with analgesia, and whether it can be administered without exposing lung parenchyma to inflammatory states is worth exploring. Describing the risks and benefits of marijuana can bolster public knowledge as its legal status continues to broaden. Reference #1: Peacock A, Leung J, Larney S, et al. Global statistics on alcohol, tobacco and illicit drug use: 2017 status report. Addiction. 2018:113(10):1905-1926. Reference #2: Aggarwal SK, Carter GT, Sullivan MD, et al. Medicinal use of cannabis in the United States: historical perspectives, current trends, and future directions. J Opioid Manag. 2009;5:153–168. Reference #3: Wilkinson S, Yarnell S, Radhakrishnan R, Ball S, D’Souza D. Marijuana Legalization: Impact on Physicians and Public Health. Annu Rev Med. 2016;67:253-466. DISCLOSURES: No relevant relationships by Humberto Choi, source=Web Response No relevant relationships by Charlie Lin, source=Web Response

2907 Knowledge and Perception of Gastroenterologists Regarding Medical Marijuana Use in Patients With Inflammatory Bowel Disease

INTRODUCTION: Inflammatory bowel disease is a chronic debilitating condition whose cause is still not completely understood. Goals of therapy include relief of symptoms, mucosal healing, decrease in need for hospitalization and surgery and improved quality of life. Giventhe varying results achieved with conventional medical therapy, patients are turning to a variety of complementary and alternative options for relief, cannabis products being one of the most common. In 2014, Puerto Rico (PR) legalized medicinal marijuana including Crohn's and ulcerative colitis as indications. We questioned whether the gastroenterology community was prepared to confidently and correctly answer the questions brought by their patients. The purpose of this study was to collect data regarding Puerto Rican gastroenterologists' knowledge, comfort and perceptions regarding medical cannabis use in patients with IBD. METHODS: An anonymous 20 question online survey was distributed among gastroenterologists and trainees who are members of the Puerto Rican Gastroenterology Association. The protocol was approved by the MSC IRB. RESULTS: Forty-five responses (25% response rate) were received and analyzed. Participants were mostly males (69%) between the ages of 25-45 (63%) and mainly have private practices (56%) in the metropolitan area (60%). 71% of physicians see less than 15 patients with IBD in one month. Most of the participants (85%) feel informed regarding IBD practice guidelines, and uninformed (51%) regarding their knowledge of the endocannabinoid system. 20% of participants are aware of the requirements to obtain medical marijuana in PR and only 42% know the approved indication. 75% of physicians think that cannabis should be a therapeutic option for IBD patients, however only 40% would recommend it to their patients. 46% of participants reported that their patients have used cannabis for IBD, and pain (80%) is the most common reason. 86% of gastroenterologists cite medical literature as the leading factor in their decision to recommend its use or not and 100% of them would be interested in receiving more information regarding this topic. CONCLUSION: Puerto Rican gastroenterologists are misinformed regarding medical cannabis use in patients with IBD. Although the study sample is small, it highlights the need for education in our community to improve patient care. Strategies to address this concern are needed and would be well received by physicians.

Medical marijuana. What can we learn from the experiences in Canada, Germany and Thailand?

Cannabis policies are changing globally, and medical marijuana programs are part of these changes. Drawing from the examples of two high-income (Canada, an early adopter of medical marijuana, and Germany, a late adopter) and one middle-income (Thailand) countries, we illustrate two main pressures underlying these recent changes. First, in many high-income countries, cannabis has been used to self-medicate for different ailments and diseases, even though there is no evidence of effectiveness for many of these conditions. Second, the cannabis industry is pressuring governments and decision-makers to allow for medical marijuana use with lenient regulations—without specifying medical conditions (indications) and requiring only a prescription from a health professional to obtain it. As a result, demand is likely to increase, even in countries with low prevalence of use. Cannabis policy-makers need to consider a balance between the medical benefits of medical marijuana and the potential public health consequences and cost.

Attitudes and Beliefs About Medical Usefulness and Legalization of Marijuana among Cancer Patients in a Legalized and a Nonlegalized State

Background: There is a growing preference for the use of marijuana for medical purposes, despite limited evidence regarding its benefits and potential safety risks. Legalization status may play a role in the attitudes and preferences toward medical marijuana (MM). Objectives: The attitudes and beliefs of cancer patients in a legalized (Arizona) versus nonlegalized state (Texas) regarding medical and recreational legalization and medical usefulness of marijuana were compared. Settings/Subjects: Two hundred adult cancer patients were enrolled from outpatient Palliative Care centers at Banner MD Anderson Cancer Center in Gilbert, AZ (n = 100) and The University of Texas MD Anderson Cancer Center in Houston, TX (n = 100). Design and Measurements: Adult cancer patients seen by the Palliative Care teams in the outpatient centers were evaluated. Various physical and psychosocial assessments were conducted, including a survey of attitudes and beliefs toward marijuana. Results: The majority of individuals support legalization of marijuana for medical use (Arizona 92% [85-97%] vs. Texas 90% [82-95%]; p = 0.81) and belief in its medical usefulness (Arizona 97% [92-99%] vs. Texas 93% [86-97%]; p = 0.33) in both states. Overall, 181 (91%) patients supported legalization for medical purposes whereas 80 (40%) supported it for recreational purposes (p < 0.0001). Patients preferred marijuana over current standard treatments for anxiety (60% [51-68%]; p = 0.003). Patients found to favor legalizing MM were younger (p = 0.027), had worse fatigue (p = 0.015), appetite (p = 0.004), anxiety (p = 0.017), and were Cut Down, Annoyed, Guilty, and Eye Opener-Adapted to Include Drugs (CAGE-AID) positive for alcohol/drugs (p < 0.0001). Conclusion: Cancer patients from both legalized and nonlegalized states supported legalization of marijuana for medical purposes and believed in its medical use. The support for legalization for medical use was significantly higher than for recreational use in both states.

Medical marijuana use for pediatric oncology patients: single institution experience

Medical marijuana (MM) is widespread in many medical fields, including oncology, with limited use in pediatric oncology where research is scarce and often shows conflicting results. This research focuses on alleviating side effects of anticancer treatment as an integral part of supportive and palliative care of children with cancer. We report our experience with MM treatment in 50 children, adolescents, and young adults with different types of cancer during 2010–2017. The main indications for prescriptions were nausea and vomiting, decreased mood, disturbed sleep, and pain. The medication was supplied to 30 patients via oil drops (60%) and 11 via smoking (22%), followed by vaporization, capsules, or combinations of various routes. Positive effects were reported by verbal children and parents in 80% of cases. MM was generally well tolerated with few patients reporting toxicity, with the most common adverse reactions being burning in the throat and anxiety attacks in subjects who chose to smoke the product. We conclude that MM may serve as a potentially useful complementary therapy to conventional supportive treatment of children suffering from cancer at the end of life. Further research is needed on the safety and efficacy and the consequences of prolonged use in pediatric populations.

Marijuana as a Substitute for Prescription Medications: A Qualitative Study

Background: Over the past few decades in the United States, marijuana for medical purposes has become increasingly prevalent. Initial qualitative and epidemiological research suggests that marijuana may be a promising substitute for traditional pharmacotherapies. Objectives: This qualitative study examined perceptions relating to (1) using medical marijuana in comparison to other prescription medications and (2) user perception of policy issues that limit adoption of medical marijuana use. Methods: Qualitative interviews were conducted with Rhode Island medical marijuana card holders (N = 25). The interviews followed a semi-structured agenda designed to collect information from participants about their reasons for, and perceptions of, medical marijuana use. All interviews were audio recorded, transcribed verbatim, and de-identified. Qualitative codes were developed from the agenda and emergent topics raised by the participants. Results: Three themes emerged related to medical marijuana use, including (1) comparison of medical marijuana to other medications (i.e., better and/or fewer side effects than prescription medications, improves quality of life), (2) substitution of marijuana for other medications (i.e., in addition to or instead of), and (3) how perception of medical marijuana policy impacts use (i.e., stigma, travel, cost, and lack of instruction regarding use). Conclusions: Several factors prevent pervasive medical marijuana use, including stigma, cost, and the inability for healthcare providers to relay instructions regarding dosing, strain, and method of use. Findings suggest that medical patients consider marijuana to be a viable alternative for opioids and other prescription medications, though certain policy barriers inhibit widespread implementation of marijuana as a treatment option.

Density of Medical Marijuana Dispensaries and Current Marijuana Use among Young Adult Marijuana Users in Los Angeles

Background: While tobacco and alcohol studies have focused on density of outlets as a determinant of consumption, research has begun examining the effects of medical marijuana (MM) dispensaries on marijuana use. Objectives: Examine the relationship between density of MM dispensaries and frequency of marijuana use among young adult medical marijuana patients (MMP) and nonpatient users (NPU). Methods: Young adult marijuana users (n = 329) aged 18- to 26-year old were sampled in Los Angeles in 2014–2015 and separated into MMP (n = 198) and NPU (n = 131). In 2014, 425 operational MM dispensaries were identified within the City of Los Angeles. Sequential multilevel Poisson random effect models examined density of MM dispensaries per square mile and 90 d marijuana use among MMP and NUP at the ZIP code level while controlling for demographic, behavioral, and community characteristics. Results: Density of MM dispensaries was not related to 90 d use of marijuana (days of use or hits per day) among either MMP or NPU. MMP reported significantly greater days of marijuana use in the past 90 d compared to NPU but no differences were found for hits per day. African–Americans reported significantly greater hits per day compared to whites. Hispanics reported significantly fewer hits per day compared to non-Hispanics. Conclusion: Concentration of MM dispensaries surrounding young adult marijuana users in Los Angeles was unrelated to days of marijuana use irrespective of having a MM recommendation or not. Rather, individual factors related to consumer choices and behaviors were more important in determining recent marijuana use among MMP and NPU.

Medical Marijuana in the Pediatric Population With Epilepsy-What You Should Know.

This article discusses the controversial but promising topic of medical marijuana (MM) use in the pediatric population with epilepsy. Included is the importance of MM throughout history, the pharmacodynamics and pharmacokinetics, and a literature review that provides anecdotal evidence of the positive effect MM has on children suffering from seizures. From this literature review, dosage for treatment and management is provided. Also discussed is the recent FDA-approved pharmaceutical grade CBD product, Epidiolex, for treatment of two pediatric-onset seizure syndromes, Lennox-Gastaut and Dravet. Clinical implications regarding adverse side effects of MM use are also discussed. The aim of this article is to arm providers with contemporary knowledge on the risks and benefits of MM use in the pediatric population with epilepsy, which may boost their skills and confidence in educating and advocating for children with seizures. This novel, ever-changing medication is in the forefront of history and the news, making this topic especially important for review.

Evaluation of Colorado oncology providers on the use of medical marijuana.

10511 Background: There is a lack of knowledge regarding medical marijuana use in cancer patients. More information is needed due to increase in both state approvals and access to medical marijuana. We hypothesized that variation in provider knowledge, attitudes, and behaviors exists across all professions in oncology, which contributes to a lack of both provider awareness of patient use and patient education on marijuana use. Methods: A survey was distributed to oncology providers in the state of Colorado. The primary objective was to describe provider knowledge, attitudes, and behaviors regarding medical marijuana use in cancer patients. Other objectives were identifying educational needs for oncology providers to feel comfortable recommending medical marijuana and reporting provider interest in future marijuana studies. Results: We received responses from 172 oncology providers; 48 advanced practice providers, 47 physicians, 53 registered nurses, 17 pharmacists, and 7 other. Most providers (73.3%) believe marijuana provides a medical benefit to cancer patients, and 81.5% believe it should be available as a prescription drug. Yet, 60.1% had not recommend its use to any cancer patient in the past 6 months, and 54.3% are not comfortable recommending or suggesting it to a patient to manage cancer related symptoms. Major concerns included uncertain dosing (83%), limited knowledge of available products and where to get them (73.1%), and interactions with other medications (64.9%). Providers reported that educational programs for healthcare providers (79.3%), more clinical data (74%), and endorsed clinical guidelines (67.5%) would increase their comfort level in recommending medical marijuana. The areas of research most interesting or important were specific product information and doses (77.6%), efficacy for specific side effects (77.6%), and drug-drug interactions (74.7%). Conclusions: Regardless of profession, the majority of oncology providers in Colorado do not recommend and do not feel comfortable recommending or suggesting medical marijuana to a cancer patient, yet most believe it provides medical benefit. Providers believe there is a need for education and research on the use of medical marijuana in oncology patients.

FABP1 controls hepatic transport and biotransformation of \u03949-THC

The increasing use of medical marijuana highlights the importance of developing a better understanding of cannabinoid metabolism. Phytocannabinoids, including ∆9-tetrahydrocannabinol (THC), are metabolized and inactivated by cytochrome P450 enzymes primarily within the liver. The lipophilic nature of cannabinoids necessitates mechanism(s) to facilitate their intracellular transport to metabolic enzymes. Here, we test the central hypothesis that liver-type fatty acid binding protein (FABP1) mediates phytocannabinoid transport and subsequent inactivation. Using X-ray crystallography, molecular modeling, and in vitro binding approaches we demonstrate that FABP1 accommodates one molecule of THC within its ligand binding pocket. Consistent with its role as a THC carrier, biotransformation of THC was reduced in primary hepatocytes obtained from FABP1-knockout (FABP1-KO) mice. Compared to their wild-type littermates, administration of THC to male and female FABP1-KO mice potentiated the physiological and behavioral effects of THC. The stark pharmacodynamic differences were confirmed upon pharmacokinetic analyses which revealed that FABP1-KO mice exhibit reduced rates of THC biotransformation. Collectively, these data position FABP1 as a hepatic THC transport protein and a critical mediator of cannabinoid inactivation. Since commonly used medications bind to FABP1 with comparable affinities to THC, our results further suggest that FABP1 could serve a previously unrecognized site of drug-drug interactions.

P020 Weeding out misinformation: An analysis of the online information available to patients on medical marijuana use in IBD

BACKGROUND: Inflammatory Bowel Disease (IBD), including Crohn's Disease and Ulcerative Colitis, are among several chronic conditions approved for treatment with medical marijuana. Although evidence based on observational and animal studies is minimal, it is suspected that modulation of endocannabinoid receptors may improve inflammation and therefore symptoms associated with IBD. Individuals increasingly use the internet to gain information about alternative therapies. However, there are no studies that have evaluated online resources addressing medical marijuana and IBD. The study evaluated the readability and quality of online information readily accessible to patients and assessed the therapeutic claims, precautionary warnings, and evidence to support the use of cannabis in IBD. METHODS: A Google search using the terms “Marijuana IBD” was performed. Exclusion criteria included all veterinarian websites, duplicates and those which were non-accessible. Websites were then categorized by intended audience, either professional or consumer. Readability was determined using the validated Flesch-Kincaid Grade Level Calculation. The validated DISCERN questionnaire was used to assess quality, with scores rated as Excellent 66–75, Very Good 56–65, Good 46–55, Average 36–45, or Poor ≤35. Websites were reviewed for therapeutic claims, inclusion of references, precautionary information about marijuana use and whether they discussed approved treatments for IBD. Statistical analysis using a 2-tailed Fisher's Exact Test and a Two Sample T-test were used with a P-value set at &lt;0.05. RESULTS: 100 websites were assessed with 89 websites meeting criteria for analysis. 75 (84%) were intended for consumers and 14 (16%) were for medical professionals. The average Flesch-Kincaid Grade level was 13.3, with no significant difference (P = 0.41) between consumer (13.2 grade level) and professional (14.0 grade level) websites. Quality was rated as “Average” (mean DISCERN score 42.6), with no significant difference (P = 0.08) based upon intended audience. Consumer websites offered significantly more (P = 0.04) claims of improvement in disease pathology and less frequently listed references (P = 0.002) than websites geared towards medical professionals. There was no significant difference between consumer and professional focused websites in the discussion of the approved therapy (P = 0.38). 19 of 89 (21.3%) websites included precautionary information regarding marijuana use in IBD with no significant difference in consumer sites compared to those for medical professionals (P = 0.17). CONCLUSION(S): This study demonstrated that a multitude of online resources exist with information on medical marijuana as alternative therapy for IBD patients. The majority of these websites were intended for consumers, however their readability grade level exceeds the National Institutes of Health 6th grade recommended reading level for medical information. While the quality of information was considered “Average” using a validated measure, there was variability in available evidence-based references and inconsistency in the inclusion of precautionary information as well as the therapeutic claims made by different websites. It is critical that readily available online information about cannabis therapy in IBD be readable, evidence-based and comprehensive in order to allow for informed medical decisions.

581 Medical marijuana use in dermatology: Clinical experiences, new research, and potential ethical dilemmas

Medical marijuana is an emerging therapy in dermatology. Cannabinoids can be separated into endocannabinoids, phytocannabinoids, and synthetic cannabinoids. In this presentation, the experiences of a clinical group with over 150 dermatology patients treated with medical marijuana are reviewed, and encompass a variety of conditions, including but not limited to psoriasis, atopic dermatitis, and acne. The latest medical literature, including indications for medical marijuana, mechanisms of action, possible adverse effects and ethical dilemmas are also reviewed. In addition to the previously listed dermatological conditions, potential uses of marijuana in dermatology include skin cancer and seborrheic dermatitis. Treatment with medical marijuana has also been investigated in difficult to treat conditions such as scleroderma, pruritus, Kaposi Sarcoma and hidradenitis suppuritiva.

Quantitation of Cannabinoids in Breath Samples Using a Novel Derivatization LC-MS/MS Assay with Ultra-High Sensitivity.

As the legalization of medical and recreational marijuana use expands, measurement of tetrahydrocannabinol (THC) in human breath has become an area of interest. The presence and concentration of cannabinoids in breath have been shown to correlate with recent marijuana use and may be correlated with impairment. Given the low concentration of THC in human breath, sensitive analytical methods are required to further evaluate its utility and window of detection. This paper describes a novel derivatization method based on an azo coupling reaction that significantly increases the ionization efficiency of cannabinoids for LC-MS/MS analysis. This derivatization reaction allows for a direct derivatization reaction with neat samples and does not require further sample clean-up after derivatization, thus facilitating an easy and rapid "derivatize & shoot" sample preparation. The derivatization assay allowed for limits of quantitation (LOQ's) in the sub-pg/mL to pg/mL range for the five cannabinoids in breath samples, i.e., only 5~50 femtograms of an analyte was required for quantitation in a single analysis. This ultrahigh sensitivity allowed for the quantitation of cannabinoids in all breath samples collected within 3 hours of smoking cannabis (n = 180). A linear correlation between THC and cannabinol (CBN) in human breath was observed, supporting the hypothesis that CBN is converted from THC during the combustion of cannabis. The derivatization method was also applied to the analysis of cannabinoids in whole blood samples, achieving LOQ's at ten-pg/mL to sub-ng/mL level. This azo coupling-based derivatization approach provided the needed analytical sensitivity for the analysis of THC in human breath samples using LC-MS/MS and could be a valuable tool for the analysis of other aromatic compounds in the future.

The Effect of Medical Marijuana Laws on the Health and Labor Supply of Older Adults: Evidence from the Health and Retirement Study

Older adults are at elevated risk of reducing labor supply due to poor health, partly because of high rates of symptoms that may be alleviated by medical marijuana. Yet, surprisingly little is known about how this group responds to medical marijuana laws (MMLs). We quantify the effects of state medical marijuana laws on the health and labor supply of adults age 51 and older, focusing on the 55 percent with one or more medical conditions with symptoms that may respond to medical marijuana. We use longitudinal data from the Health and Retirement Study to estimate event study and differences-in-differences regression models. Three principle findings emerge from our analysis. First, active state medical marijuana laws lead to lower pain and better self-assessed health among older adults. Second, state medical marijuana laws lead to increases in older adult labor supply, with effects concentrated on the intensive margin. Third, the effects of MMLs are largest among older adults with a health condition that would qualify for legal medical marijuana use under current state laws. Findings highlight the role of health policy in supporting work among older adults and the importance of including older adults in assessments of state medical marijuana laws.

Patterns of Marijuana Use and Health Impact: A Survey Among Older Coloradans.

Access to recreational and medical marijuana is common in the United States, particularly in states with legalized use. Here, we describe patterns of recreational and medical marijuana use and self-reported health among older persons using a geographically sampled survey in Colorado. The in-person or online survey was offered to community-dwelling older persons aged above 60 years. We assessed past-year marijuana use including recreational, medical, or both; methods of use; marijuana source; reasons for use; sociodemographic and health factors; and self-reported health. Of 274 respondents (mean age = 72.5 years, 65% women), 45% reported past-year marijuana use. Of these, 54% reported using marijuana both medically and recreationally. Using more than one marijuana method or preparation was common. Reasons for use included arthritis, chronic back pain, anxiety, and depression. Past-year marijuana users reported improved overall health, quality of life, day-to-day functioning, and improvement in pain. Odds of past-year marijuana use decreased with each additional year of age. The odds were lower among women and those with higher self-reported health status; odds of use were higher with past-year opioid use. Older persons with access to recreational and medical marijuana described concurrent use of medical and recreational marijuana, use of multiple preparations, and overall positive health impacts.