Recreational Cannabis Use Research Articles

Bibliometric Analysis of Cannabis sativa Research: Trends, Challenges, and Future Directions.

Introduction: The use of medical Cannabis remains unregulated in several countries due to the scarcity of clinical studies with high scientific evidence that establish safety and efficacy of Cannabis products. This study aimed to comprehensively analyze how knowledge has been created in this field, as well as perform a bibliographic mapping to identify knowledge gaps, and investigate key authors and journals that have significantly contributed to advancing our understanding of Cannabis. Method: The study protocol was registered in the International Prospective Register of Systematic Review (CRD42020223084). A systematic search was conducted in the Cochrane Central Register of Controlled Trials, Lilacs, Google Scholar, PubMed, SciELO, Scopus, and Web of Science databases. The bibliographic analysis and mapping were registered using the VOSviewer, Sci2tool, CiteSpace, and PoP software. Results: The systematic search identified 27,597 records, with 17,020 duplicates, resulting in a total of 10,577 articles included. The authors who published the most were Marilyn Ann Huestis (n=108) and Sagnik Bhattacharyya (n=71), while Elisaldo A. Carlini and Raphael Mechoulam published 8 and 22 articles, respectively. The journals Drug and Alcohol Dependence (n=297), Psychopharmacology (n=159) and Addictive Behaviors (n=150) were the ones that published the most on Cannabis. The journals suggest that the articles are correlated with the adverse and toxicological effects of recreational Cannabis use; however, most articles focus on medical Cannabis. The peak of publications was in 2021 (n=1,481). The countries that published the most were the United States (n=9,735), while Brazil occupied the 11th position (n=422). Most publications were carried out in "Pharmacology and Pharmacy" (11.31%), followed by "Psychiatry" (7.66%) and "Medicine" (5.80%). The areas of "Neurosciences" (1.59%), "Biochemistry," "Genetics," and "Molecular Biology" (0.79%) were little explored. Conclusion: This study captured the characteristics of publications about Cannabis and clinical studies in the scientific literature, yielding >10,000 articles, representing a large literature review, to date. Therefore, the most productive countries included the United States, the United Kingdom, and Canada, while the most productive authors were Marilyn Ann Huestis and Sagnik Bhattacharyya, with a peak of publications in 2021. Finally, the most chosen journals were Drug and Alcohol Dependence and Psychopharmacology.

Cannabis for chronic pain: cardiovascular safety in a nationwide Danish study.

A rising number of countries allow physicians to treat chronic pain with medical cannabis. However, recreational cannabis use has been linked with cardiovascular side effects, necessitating investigations concerning the safety of prescribed medical cannabis. Using nationwide Danish registers, patients with chronic pain initiating first-time treatment with medical cannabis during 2018-21 were identified and matched 1:5 to corresponding control patients on age, sex, chronic pain diagnosis, and concomitant use of other pain medication. The absolute risks of first-time arrhythmia (atrial fibrillation/flutter, conduction disorders, paroxysmal tachycardias, and ventricular arrhythmias) and acute coronary syndrome were reported comparing medical cannabis use with no use. Among 1.88 million patients with chronic pain (46% musculoskeletal, 11% cancer, 13% neurological, and 30% unspecified pain), 5391 patients claimed a prescription of medical cannabis [63.2% women, median age: 59 (inter-quartile range 48-70) years] and were compared with 26 941 control patients of equal sex- and age composition. Arrhythmia was observed in 42 and 107 individuals, respectively, within 180 days. Medical cannabis use was associated with an elevated risk of new-onset arrhythmia {180-day absolute risk: 0.8% [95% confidence interval (CI) 0.6%-1.1%]} compared with no use [180-day absolute risk: 0.4% (95% CI 0.3%-0.5%)]: a risk ratio of 2.07 (95% CI 1.34-2.80) and a 1-year risk ratio of 1.36 (95% CI 1.00-1.73). No significant association was found for acute coronary syndrome [180-day risk ratio: 1.20 (95% CI 0.35-2.04)]. In patients with chronic pain, the use of prescribed medical cannabis was associated with an elevated risk of new-onset arrhythmia compared with no use-most pronounced in the 180 days following the initiation of treatment.

Elevated risk of prosthetic infections in cannabis users after shoulder arthroplasty.

An increasing number of states are beginning to legalize recreational cannabis use, and as such, more patients using cannabis are undergoing shoulder arthroplasty procedures. The present study sought to examine the impact of cannabis use on post-operative outcomes. The primary outcomes of interest were postoperative complications, which included infection, periprosthetic fractures, periprosthetic joint infections (PJI), dislocations, and aseptic loosening as well as medical complications. Secondary outcomes were risk factors for PJI and aseptic loosening at two-years. A private, nationwide, all-payer database (Pearldiver Technologies) was queried to identify shoulder arthroplasty patients from 2010 to 2020. Those not using tobacco or cannabis ("control", n = 10,000), tobacco users (n = 10,000), cannabis users (n = 155), and concurrent tobacco and cannabis users (n = 9,842) were identified. Risk factors for PJI and aseptic loosening at two-years were further quantified utilizing multivariable logistic regression analysis. Compared to non-users, cannabis users experienced the highest odds for PJI and aseptic revisions, which were followed by concurrent cannabis and tobacco users and tobacco-only users. Concurrent users, as well as tobacco users were at higher risk for dislocation. Cannabis use was the most significant risk factor for PJI, followed by concurrent use and male sex. Our study found cannabis use to cause greater risk for superficial and deep infection. More research involving randomized trials are needed to fully elucidate the impact of cannabis use on shoulder arthroplasty procedures. Clinically, these findings can appropriately guide surgeons and patients alike regarding expectations prior to undergoing TSA.

Cannabis reduction among adolescents as spillover from successful tobacco control

BackgroundNational programs that reduce adolescent cannabis use warrant renewed attention in light of current discussions to reform cannabis legislation, including the possibility of legalization for recreational use. This study measures the size of a decrease in a country's prevalence of adolescent cannabis use that accompanies a decrease in its prevalence of adolescents who had ever smoked a cigarette. MethodsData are from the European School Survey Project on Alcohol and Other Drugs (ESPAD), which is a collaborative effort of more than 40 European countries to surveil adolescent substance use. This study uses data from the seven survey administrations in 1995, 1999, 2003, 2007, 2011, 2015, and 2019. The main analysis is a fixed-effect regression analysis of country-level, four-year changes in adolescent lifetime cannabis use prevalence on country-level, four-year changes in adolescent lifetime cigarette use prevalence. ResultsDecreases in the national prevalence of adolescents who had ever smoked a cigarette were accompanied by decreases half as large in national prevalence of adolescent lifetime cannabis use. ConclusionFor European countries considering the legalization of adult recreational cannabis use, tobacco control can offer a tool to help counter potential increases in cannabis use among adolescents.

Sleep quality of adult recreational cannabis users: a systematic review of literature.

Human sleep is fundamental for the proper occurrence of organic functions. Hence, the lack of sleep can impair cognitive function, resulting in emotional problems, memory changes and disease onset. However, it is worth noting that sleep is influenced by outside factors, such as drug use. In this sense, the aim of this work is to analyze studies that had as their research object the influence of recreational marijuana on the sleep quality of adults. A high-sensitivity research was conducted in databases (Biblioteca Virtual em Saúde, Medline via Pubmed, Cochrane, Embase, Web of Science and Scopus) using descriptors linked to marijuana and sleep habits. Eighteen studies from four countries were included with a total sample size of 29,858 participants. It was identified that marijuana affects sleep characteristics-such as latency and duration-with these changes being more evident in users who make greater use of marijuana and in those who started premature use. It was observed that most articles demonstrated a detrimental effect of recreational cannabis use on the quality of sleep in adults.

Medicalization without Legalization: The European Policy for Medical and Recreational Cannabis Use

Medicalization without Legalization: The European Policy for Medical and Recreational Cannabis Use

The importance of medical cannabis for solving the problem of providing analgesia to palliative patients in Ukraine

One of the ways to solve the problem of pain relief for palliative patients in Ukraine is to expand the arsenal of painkillers through the use of medical cannabis. In many palliative di­seases, cannabis is able to alleviate other symptoms that accompany patients with incurable diseases at the end of their lives: nausea, lack of appetite, seizures, anxiety, depression. The procedure for the legalization of medical cannabis in Ukraine is coming to an end, which is a timely decision of the legislators and the government. Before the full-scale medical cannabis war, 2.3 million patients were needed. Since its inception, this need has increased to 5.5–6 million. The Ukrainian agricultural market and the pharmaceutical industry will eventually be able not only to provide the country with the necessary amount of plant raw materials for the production of medicines and other cannabis products, but also to earn profits from exports, providing part of the growing demand for cannabis in Europe in other countries of the world. But this will require good conditions for investors and a consistent state policy in the adoption of by-laws and the practical implementation of already adopted laws. The medical effects of herbal cannabis and preparations containing it depend on the content of the narcotic TetraHydroCannabiol (THC) and the non-narcotic CanaBiDiol (CBD). Consumer preferences for recreational cannabis are gradually flooding the market with high-THC, low-CBD herbal cannabis, which increases the risk of faster addiction, the frequency and severity of cannabis side effects such as psychotic disorders and cardiovascular crises. Ukraine needs to be prepared for the increase in the use of illicit recreational cannabis along with the increase in the use of medical cannabis, including among children and adolescents, and to counter these phenomena. But even despite these risks, significant positive medical and social consequences can be expected from the legalization of medical cannabis for palliative patients and war victims with post-traumatic stress disorders. Keywords: chronic pain, hospices, narcotic painkillers, non-narcotic painkillers, PTSD.

Organizational and legal measures to prepare the system of palliative and hospice care of Ukraine for the widespread use of medical cannabis

In Ukraine, the procedure for the legalization of medical cannabis, which is needed for approximately 6 million patients with cancer in the palliative stages, multiple sclerosis, epilepsy, lateral amniotic sclerosis, fibromyalgia, arthritis, HIV/AIDS, glaucoma, post-traumatic stress disorder, Alzheimer's, Parkinson's disease, Tourette, Lennox-Gastaut, Dravet syndromes, irritable bowel, back pain, chronic pain due to spinal cord injuries, diabetic neuropathy, postherpetic neuralgia, is being completed. Cannabis is necessary for such patients to overcome spasticity, chronic pain, nausea, vomiting, anorexia, increased eye pressure. It can be a supplement to treatment with other pharmaceuticals or an alternative to them. On the eve of the entry into force of the relevant law, it is necessary to determine the main directions for the rapid development of the necessary by-laws (clinical protocols, instructions, etc.) for the rapid start of the wide use of cannabis in clinical practice, in particular in palliative medicine. Using the methods of systematic analysis and bibliosemantic, a study of scientific literary sources in Google Scholar and PubMed was conducted to study the main properties of medical cannabis, the medical and social risks of its use, in particular side effects, the increase in illegal recreational use of herbal cannabis. The experience of other countries where medical cannabis has already been legalized (USA, Canada, Australia, Denmark, Germany, Israel, Switzerland) has been studied. The list of normative legal acts of Ukraine that can regulate the use of medical cannabis has been defined: 27 evidence-based clinical guidelines; 27 standards and protocols of medical care. Possible scenarios are identified and the necessary measures are proposed for the adoption of legal acts for the final decriminalization of cannabis, the determination and forecasting of the need for palliative patients, the creation of conditions for the cultivation of Ukrainian herbal cannabis and the manufacture of domestic pharmaceuticals, reimbursement of their cost to patients. Keywords: chronic pain, narcotic painkillers, marijuana, PTSD, anorexia.

Trajectory modeling of cannabis use over 30 years identifies five unique longitudinal patterns

Cannabis is the most prevalently used psychoactive substance in the United States. Cannabis has conflicting federal and state legal status in the US, however medical and recreational cannabis use are increasing. When assessing health outcomes, cannabis use classification has been modeled largely as current use status (never/former/current) or cumulative use (joint-years). These methods do not describe longitudinal patterns of use which may have unique relationships with health outcomes. We used cannabis use data spanning 30 years from the Coronary Artery Risk Development in Young Adults Cohort (CARDIA) to create trajectories of current cannabis use during young and middle adulthood. We identified 5 unique patterns of the probability of cannabis use during young and middle adulthood in the CARDIA Cohort. To support the cannabis probability trajectories, we qualitatively examined cumulative cannabis use as joint-years for each trajectory group. Trajectory group 5 had high probability of consistent cannabis use (0.8–0.9% probability of use) and had the highest number of joint-years (0.6 +/− 0.4). Trajectory group 1 who had a lower probability of cannabis use (0.05–0% probability of use) with the lowest number of joint-years (0.1 +/− 0.1).

Prenatal Exposure to Tobacco and Cannabis in Six Race/Ethnicity Groups during the First Three Years after Legalization of Cannabis for Recreational Use in California.

There are known health concerns linked to prenatal tobacco and cannabis exposures. This study aims to objectively determine the level of exposure to tobacco and cannabis in pregnant individuals from six race/ethnicity groups (Black, Hispanic, Asian Indian, Native American, Vietnamese, and White) in the first three years following legalization of recreational marijuana use in 2018 in California. We used a cross-sectional sample of prenatal screening program participants (2018-2020) from southern and central California (N = 925). Exposures were estimated by a lab analysis of cotinine (tobacco) and 11-hydroxy-Δ9-tetrahydrocannabinol (OH-THC, cannabis) in banked serum. Disparities in tobacco exposure were evident, with Black subjects experiencing the highest smoking rate (16%) followed by Native American (10%) and White (8%) subjects, and ≤2% among Hispanic, Asian Indian, and Vietnamese subjects. Environmental tobacco exposure generally showed a similar pattern of exposure to tobacco smoking across race/ethnicity groups. Cannabis detection ranged from 5% among Hispanic subjects to 12% and 13% among White and Black subjects, respectively, and was higher among tobacco users and those exposed to environmental tobacco smoke than those with no cotinine detected. Tobacco and cannabis exposure were generally greatest in younger subjects and those with indices of a lower economic status; however, among Black subjects, cannabis exposure was greatest in older subjects and those with a higher socioeconomic status. Race/ethnicity, age, and socioeconomic factors can inform targeting of high-exposure groups for intervention.

THE CANNABIS AND OLDER PERSONS STUDY: WHAT WE HAVE LEARNED

Abstract The Cannabis and Older Persons Study has examined the increasing use of cannabis among Americans over 60 years old since 2016 reflecting a variety of disciplinary perspectives and methodological approaches. The project team has published a dozen peer reviewed manuscripts and has secured competitive funding swards in California, Colorado, Illinois and Iowa. In this symposium, results from multiple COPS surveys collected from older adults are reviewed with three goals in mind. The first is to demonstrate how older cannabis users are not comparable to younger cannabis users in terms of motives and self-reported outcomes of use. The second is to distinguish therapeutic from recreational cannabis use among older persons by examining survey answers provided by persons with arthritis, cancer, caregivers of persons with Alzheimer’s disease, multiple sclerosis and terminal illnesses. The third goal is to differentiate life-time from naïve cannabis users and consider how cannabis may serve as an opioid avoidance or harm reduction strategy. Discussion considers the critical role policy makers, program administrators and clinicians assume in facilitating or hindering cannabis use, and directions for future research.

Cannabis use and incident atrial fibrillation in a longitudinal cohort

BackgroundCannabis use is increasing worldwide. While prior studies have reported an association between cannabis use and a higher risk of atrial fibrillation (AF), most were cross-sectional and generally relied on diagnostic coding to identify cannabis users, which may not be representative of the typical recreational cannabis user. ObjectiveThe purpose of this study was to examine the association between recreational cannabis use and lifetime AF risk. MethodsWe evaluated the AF risk of participants of the UK Biobank cohort who completed the cannabis use lifestyle questionnaire. Cannabis exposure was categorized as “Occasional Use” for less than 100 times used, “Frequent Use” for more than 100 times used, and “Never” users. AF events were identified using International Classification of Diseases codes. Cox models were used to estimate the hazard ratios (HRs) between cannabis use and incident AF and were subsequently adjusted for age, sex, race, alcohol, coffee, smoking, education, and baseline cardiovascular comorbidities. ResultsA total of 150,554 participants (mean age 63.4 ± 7.7 years; 86,487 (57.4%) female; and 33,442 (22.2%) using cannabis at least once) were followed for a mean period of 6.1 ± 0.6 years. After multivariable adjustment, there were no statistically significant differences in incident AF among occasional users (HR 0.98; 95% confidence interval 0.89–1.08) nor frequent users (HR 1.03; 95% confidence interval 0.81–1.32) as compared with never users. ConclusionIn a large prospective cohort study, there was no evidence that cannabis use was associated with a higher risk of incident AF. An evaluation of cannabis ingestion methods and quantification was not possible using the current data set.

Digital Interventions for Recreational Cannabis Use Among Young Adults: Systematic Review, Meta-Analysis, and Behavior Change Technique Analysis of Randomized Controlled Studies.

The high prevalence of cannabis use among young adults poses substantial global health concerns due to the associated acute and long-term health and psychosocial risks. Digital modalities, including websites, digital platforms, and mobile apps, have emerged as promising tools to enhance the accessibility and availability of evidence-based interventions for young adults for cannabis use. However, existing reviews do not consider young adults specifically, combine cannabis-related outcomes with those of many other substances in their meta-analytical results, and do not solely target interventions for cannabis use. We aimed to evaluate the effectiveness and active ingredients of digital interventions designed specifically for cannabis use among young adults living in the community. We conducted a systematic search of 7 databases for empirical studies published between database inception and February 13, 2023, assessing the following outcomes: cannabis use (frequency, quantity, or both) and cannabis-related negative consequences. The reference lists of included studies were consulted, and forward citation searching was also conducted. We included randomized studies assessing web- or mobile-based interventions that included a comparator or control group. Studies were excluded if they targeted other substance use (eg, alcohol), did not report cannabis use separately as an outcome, did not include young adults (aged 16-35 y), had unpublished data, were delivered via teleconference through mobile phones and computers or in a hospital-based setting, or involved people with mental health disorders or substance use disorders or dependence. Data were independently extracted by 2 reviewers using a pilot-tested extraction form. Authors were contacted to clarify study details and obtain additional data. The characteristics of the included studies, study participants, digital interventions, and their comparators were summarized. Meta-analysis results were combined using a random-effects model and pooled as standardized mean differences. Of 6606 unique records, 19 (0.29%) were included (n=6710 participants). Half (9/19, 47%) of these articles reported an intervention effect on cannabis use frequency. The digital interventions included in the review were mostly web-based. A total of 184 behavior change techniques were identified across the interventions (range 5-19), and feedback on behavior was the most frequently used (17/19, 89%). Digital interventions for young adults reduced cannabis use frequency at the 3-month follow-up compared to control conditions (including passive and active controls) by -6.79 days of use in the previous month (95% CI -9.59 to -4.00; P<.001). Our results indicate the potential of digital interventions to reduce cannabis use in young adults but raise important questions about what optimal exposure dose could be more effective, both in terms of intervention duration and frequency. Further high-quality research is still needed to investigate the effects of digital interventions on cannabis use among young adults. PROSPERO CRD42020196959; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=196959.

Associations between adult cannabis use and chronic health conditions in a nationally representative sample of the United States

ABSTRACT Background This study examined associations between cannabis use among U.S. adults with chronic health conditions in a nationally representative sample. Methods Four cross-sectional waves of data from the BRFSS were used, spanning 2017–2020. Multivariate logistic regression analyses assessed (a) whether number of self-reported chronic health conditions was associated with current cannabis use in the past 30-days, and (b) whether type of major chronic health conditions reported was associated with using cannabis for medical reasons in the past 30-days. Results From 2017 to 2020, the prevalence of past month cannabis use increased among all age groups, with the largest percent change occurring in the middle-aged adult group (6.5% to 10.8%). Individuals with more chronic health conditions had higher odds of using cannabis in the past month. Individuals who had arthritis, cancer (other than skin cancer), HIV/AIDS, COPD, and/or depressive disorder had higher odds of using cannabis for medical reasons. Conclusions As states across America weigh the implications of making medical and/or recreational cannabis use legal, future research should specifically explore persons with chronic diseases who are cannabis users, as these individuals may represent a high-risk population that is self-medicating to mask symptoms and may need more attention from medical and public health professionals.

Prevalence of Cannabis Use Disorder and Its Association with Major Adverse Cardiac Events in Patients with Sickle Cell Crisis: Insights from the National Inpatient Sample

Background: Cannabis use has grown in popularity, with the possible therapeutic advantages being widely debated, one of which is in Sickle Cell Crisis (SCC). With increasing surveys reporting overlapping use of recreational and medicinal cannabis and high addiction potential, the aim of this nationwide study is to investigate the relationship between cannabis use disorder (CUD) in SCC patients. Methods: Using ICD-10 codes, the National Inpatient Sample-2020 was utilized to identify adult (&amp;gt;18 years) hospitalized patients due to SCD with and without crisis and further divided into patients with SCC with CUD (SCC+CUD+) and patients with SCC without CUD (SCC+CUD-). The prevalence of CUD in SCC and Major Adverse Cardiac Events [MACE, Acute Myocardial Infarction (AMI); Atrial Fibrillation (AFib) and cardiac arrest] were the primary outcomes; other associated comorbidities, Length of Stay (LOS), and hospitalization costs were secondary outcomes. After examining the baseline features on descriptive analysis, to compare the variables, Pearson's chi-squared test and Mann- Whitney U test were used to compare categorical and continuous data, respectively. Multivariable analyses were performed, controlling covariates, to assess the odds of MACE in the CUD+ vs. CUD- cohort. Results: Out of a total of 77,610 SCC adult hospitalizations, 4,535 (5.8%, p&amp;lt;0.001) had CUD. The median age of hospitalization for the CUD+ cohort was lower (28 years) than for the CUD- cohort (31 years). They were often of black ethnicity (95.8% vs. 95.3%, p=0.03), Medicaid enrollees (55.3% vs. 46.3%, p&amp;lt;0.001), and were hospitalized as non-electively (98.6% vs. 97.5%, p&amp;lt;0.001) to urban teaching hospitals (87% vs. 85.5%, p&amp;lt;0.001) in the Southern (47.7% vs. 53.7%, p&amp;lt;0.001) region. Chronic Pulmonary diseases (29.3% vs. 24.1%, p&amp;lt;0.001), prior venous thromboembolism (21.1% vs. 25.3%, p&amp;lt;0.001), hypertension (17.3% vs. 23.3%, p&amp;lt;0.001) and depression (16.3% vs 13.5%, p&amp;lt;0.001) were the majorly associated comorbidities in both (SCC+CUD+) and (SCC+CUD-) cohorts. On analysis of MACE in SCD patients with crisis; AMI (0.6% vs 0.7%, p=0.28), AFib (0.3% for both, p&amp;lt;0.001), cardiac arrest (0.3% for both, p = 0.89) were comparable in both SCC cohorts with and without CUD, suggesting no significant difference in MACE between these patient groups except for AFib. However, after adjusting for confounders, on multivariable analysis, none of the MACE (AMI: OR=0.85, CI= 0.35-2.05, p=0.71; AFib: OR=0.81, CI= 0.39-1.69, p= 0.57; cardiac arrest: OR = 1.23, CI= 0.39-3.86, p= 0.71) were found to be significant, p&amp;gt;0.05 for all. In (SCC+CUD+) and (SCC+CUD-) patients, there was no difference observed in LOS (4 days in both) and hospitalization costs (USD 29,216 vs. USD 31,604). Conclusion: Our study evaluated the prevalence and association between CUD and its cardiovascular effects during SCC, bringing light on an essential and understudied association in SCC patients while adjusting for other major concomitant mixed substance abuses like tobacco and alcohol. The observed disparities in MACE require further exploration via prospective research to better understand the possible recreational and therapeutic implications of cannabis use in patients with SCC.

Multi-ancestry genome-wide association study of cannabis use disorder yields insight into disease biology and public health implications

As recreational use of cannabis is being decriminalized in many places and medical use widely sanctioned, there are growing concerns about increases in cannabis use disorder (CanUD), which is associated with numerous medical comorbidities. Here we performed a genome-wide association study of CanUD in the Million Veteran Program (MVP), followed by meta-analysis in 1,054,365 individuals (ncases = 64,314) from four broad ancestries designated by the reference panel used for assignment (European n = 886,025, African n = 123,208, admixed American n = 38,289 and East Asian n = 6,843). Population-specific methods were applied to calculate single nucleotide polymorphism-based heritability within each ancestry. Statistically significant single nucleotide polymorphism-based heritability for CanUD was observed in all but the smallest population (East Asian). We discovered genome-wide significant loci unique to each ancestry: 22 in European, 2 each in African and East Asian, and 1 in admixed American ancestries. A genetically informed causal relationship analysis indicated a possible effect of genetic liability for CanUD on lung cancer risk, suggesting potential unanticipated future medical and psychiatric public health consequences that require further study to disentangle from other known risk factors such as cigarette smoking.

The Synergistic Benefit Mechanism of Medical and Recreational Marijuana: Economic Gains of Cannabis Taxation based on US Federal Law for Corporate Governance and Sustainability

Purpose: Marijuana legalization is brought about by the demands of people as social utility either for medical or recreation consumption. It is essential that the control of cannabis fulfills the goals of corporate governance and sustainability. This paper aims to measure the profitability of marijuana taxation over a time period as trend analysis of economic gains.&#x0D; Methodology: The socio-legal taxation of marijuana in the United States follows a descriptive research design. The beneficial gains of marijuana as medical use created this substance to be controlled under contract law transactions. The removal of cannabis in US Pharmacopeia modified the tort law restriction for legalization of marijuana as recreational consumption. The recreational cannabis taxation together with medical marijuana state taxes are essential to fulfill the 4 pillars of corporate governance and sustainability for strengthening constitutional rights. The legalization of marijuana through votes of the people repeals the criminal punishments imposed by federal law to advocate the synergistic concepts of economic theory.&#x0D; Findings: State tax theory creates voluntary principles in transactions together with trend analysis in prices and demands of people resulting to efficiency in mutual gains through lessening the value of participation under a harmful environment. Hence, Pigouvian tax follows the public welfare of medical marijuana and common revenue of recreational cannabis diminishes the overall costs of social consumption. Federal laws control marijuana usage through Pigouvian taxes of medical use with lessened participation in externalities and common revenue in cannabis consumption, as a legalization process of other states in reinstating tort law for business purposes, while still enforcing criminal penalties to remaining states, in compliance with US federal laws, not in favor of medical and recreational marijuana use. The economic theory supports the legalization of medical and recreational cannabis use through taxation as profitable gains by allowing voluntary market transactions of marijuana as fulfillment to corporate governance and sustainability for more allocation of public funds. From 2002 to 2018, medical and recreational cannabis users increased to 70% of social utility through lessening the value of participation, a win-win in efficiency of economic design. In 2010, marijuana taxation generated $8.7 billion as federal public funds, with accompanied criminal penalties to other states.&#x0D; Recommendations: Economic theory is a conceptual design supporting the beneficial gains of legalizing marijuana via taxation. This economic design promotes fair responsibility of market gains while still in strict compliance of enforcing criminal punishments to violators. The people’s votes for legalization of marijuana taxation indicates that this economic policy has come by choice in a particular state as constitutional right of either a medical opinion or business ethics. However, cannabis is deemed to be a substance subject for criminal liabilities, similar to other patent drugs under taxation as well. Hence, it is suggested to create artificial intelligence using authorless works for clinical trials and other relevant studies subject to patent law of marijuana use, as advocacy of public welfare and safety since voluntary transactions are apparent harmful environment.

Abstract 14161: Recreational Cannabis Use and the Risk of Atrial Arrhythmias: Evidence From a Meta-Analysis of Observational Studies

Introduction: Tetrahydrocannabinol is known to induce sympathetic stimulation and endothelial dysfunction, potentially increasing the susceptibility to arrhythmias. While a recent AHA consensus document outlined various cardiovascular risks associated with cannabis use, there was a paucity of data linking its use with arrhythmias. Therefore, we sought to investigate the association between recreational cannabis use and the risk of atrial arrhythmias. Methods: Electronic databases were searched for articles published up to April 2023 for studies that assessed the effect of the recreational use of cannabis on the risk of atrial arrhythmias (atrial fibrillation/flutter, supraventricular tachycardia). The study was prospectively registered (PROSPERO CRD42023428219). Three reviewers independently appraised the data, with summary odds ratios (OR) and 95% confidence intervals (CIs) pooled using a random-effects model. Results: Our analysis included seventeen cohort studies with a total of 81,269,314 participants from North America, Europe and Oceania. Four studies were prospective observational in design. Mean age was 46 years [41-72] and mean female participation was 45% [31-83] across studies. Recreational use of cannabis was associated with a significantly higher risk of atrial arrhythmias (OR 1.55, 95% CI 1.13-2.13) with high degree of heterogeneity (I2=99%). On meta-regression, mean age was not a contributing factor for the observed effect (p=0.58). Conclusions: Recreational use of cannabis was associated with 1.5-fold increased risk of atrial arrhythmias. Prospective studies are warranted to further explore this relationship and the public health implications of cannabis utilization.

Abstract 17236: Risk of Incident Atrial Fibrillation Associated With Recreational Cannabis Use

Background: Cannabis use is increasing worldwide as legalization becomes more common. Prior studies have reported an association between cannabis use and increased risk of atrial fibrillation (AF). However, these have been cross-sectional and generally relied on diagnostic coding to identify cannabis users, which may not be representative of the typical recreational cannabis user. Goals: To examine the association between recreational cannabis use and AF risk. Methods: We utilized the UK Biobank, a prospective cohort study with serial assessments of lifestyle and medical diagnoses. Those who completed the cannabis use questionnaire and without prevalent AF were analyzed. Cannabis exposure was ascertained by self-reported lifetime use. AF events were identified using healthcare coding. Cox proportional hazard regression models were used to estimate the hazard ratios between the cannabis use groups and incident AF. Models were adjusted for age, sex, race, alcohol, coffee, smoking, education, and baseline cardiovascular comorbidities. Results: 157,305 participants (mean age 55.9 ± 7.7 years, 57.0% female, and 22.1% having used cannabis at least once) were followed for a mean 13.5 ± 1.7 years. Before multivariable adjustment, AF risk was found to be lower among occasional cannabis users (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.66 to 0.75, p &lt; 0.001) and frequent cannabis users (HR 0.63, 95% CI 0.53 to 0.75, p &lt; 0.001) compared to never users. However, after multivariable adjustment and compared to no cannabis use, neither occasional nor frequent cannabis use was associated with statistically significant differences in incident AF (HR 0.98, 95% CI 0.91 to 1.05, p = 0.58 and HR 0.98, 95% CI 0.82 to 1.18, p = 0.86 respectively) (Figure). Conclusions: Contrary to previous evidence relying on healthcare coding of cannabis use, this large prospective cohort study failed to reveal any evidence that cannabis use was associated with an increased risk of AF.

Attitudes of medical students regarding legalisation of cannabis and cannabis-education.

Recreational and medicinal use of cannabis is topical in the light of more permissive legislation regarding the substance worldwide. The primary purpose of this study is to determine the attitudes that final-year medical students at the University of Pretoria (UP) hold about recreational and medicinal use of cannabis, as well as determining if they feel they are being adequately trained in this regard. The research was conducted at Weskoppies Psychiatric Hospital, affiliated with the UP. The study follows a cross-sectional, comparative, quantitative design. Data were collected by means of a structured questionnaire. Final-year medical students were identified as participants via a convenience sampling technique. Participation was voluntary and anonymous. A total of 57 valid responses were recorded. The study shows that most medical students had permissive views about cannabis and that the majority feel that they are not being adequately trained to advise patients about medical cannabis in a lecture setting (64.9%, n = 37) or clinical setting (68.4%, n = 38). Results also show that previous personal experience with cannabis led to more permissive views. This study illustrates the need for academic research regarding medicinal cannabis but interestingly shows that medical students want more guidance from their training institution about the topic. This research shows that the conversation surrounding cannabis in medicine is continuous and universities should make a conscious effort to familiarise students with the topic.