Widespread Legalization Research Articles

The Effect of Cannabis Consumption During Lactation on the Macronutrient Concentrations in Breast Milk.

Introduction: Human breast milk macronutrients play a vital role in the development of breastfed infants and are known to be influenced by several factors. There is limited information on the influence of cannabis use during lactation on these macronutrients. Given the rising use of cannabis among lactating women with its widespread legalization, this study aimed to examine the association of cannabis use during lactation on breast milk macronutrients. Materials and Methods: A cross-sectional study design was used and 637 breast milk samples with measured macronutrients were utilized. Of these, 165 samples that had detectable cannabis metabolites were defined as the study group, and 472 samples from mothers who did not report cannabis use and from mothers who reported cannabis use but did not have measurable metabolites of cannabis in their milk samples were defined as the control group. Multivariable linear regression models were used to assess the association of presence of cannabis metabolites with protein, carbohydrates, fat, and calories in breast milk. Results: Greater protein levels (95% confidence interval [CI]: 0.112-0.376; p < 0.001) and lower fat levels (95% CI: -0.217, -0.018; p = 0.020) were found in the milk exposed to cannabis compared with reported nonexposure. The presence of cannabis was associated with an increase of 0.244 mg/dL in protein and a reduction of 11% in fats in breast milk. The levels of energy and carbohydrates were not significantly different among the two groups. Conclusions: This study demonstrated a statistically significant association between the presence of metabolites of cannabis in breast milk and protein and fat concentrations in breath milk. Further studies are required toward building the body of evidence to determine safety of cannabis use during lactation.

Enhancing Methodological Approaches for Studying Health Effects of High-Concentration THC Products.

For public health protection, informed decision-making relies on having a robust foundation of evidence concerning risks and their prevention. Application of an evidence-based framework depends on the availability of pertinent, scientifically sound data generated by well-directed and valid research endeavors. In this essay, we address the current state of research in humans and the evidential base concerning high-concentration delta-9-tetrahydrocannabinol (delta-9-THC) products, which are readily available in the United States. Furthermore, we explore the intricate challenges faced in carrying out research on these products, which reflect the full range of study design issues: measurement of exposure and outcomes, confounding, selection bias, and the generalizability of findings. We offer recommendations to guide future research toward providing more informative evidence. By following these recommendations, researchers and funders on this emerging topic could move toward generating the valid and comprehensive evidence needed to effectively inform public health initiatives and guide policy decisions regarding high-concentration delta-9-THC products and their use. The urgency of generating such evidence cannot be overstated, given the widespread legalization and increasing availability and use of these products. (Am J Public Health. 2024;114(S8):S639-S644. https://doi.org/10.2105/AJPH.2024.307724).

UBER IN EXURBIA: Peripheral Platformization, Post‐Suburbanization and the Public–Private Ridehail Partnership in the Toronto City Region

AbstractAfter their widespread legalization, ridehailing companies Uber and Lyft soon embarked on a new stage of their respective business models: the initiation of a wave of strategic partnerships with local and regional transit agencies across the North American continent. This article accounts for this trend by putting forward the concept of the public–private ridehail partnership (PPRP). It aims to render visible the PPRP as a variously contradictory attempt to splice Uber and Lyft's platform‐based business models with the existing social and physical realities of North American post‐suburban space. While conceived as a strategic response to pressing sub‐ and exurban problems such as low physical densities, widespread car centrism and extensive transit undersupply, the PPRP, as I argue, is neither able to adequately address these dilemmas nor to ultimately resolve them. Rather, the PPRP latches onto old—and sets in motion new—powerful dynamics of heightened uneven development and continued urban entrepreneurialism. Each of these two dynamics is explored through empirical analyses of two recent PPRPs in the Toronto city region: the Lyft–Metrolinx pilot carried out between July and December 2019; and Uber's ongoing partnership with the town of Innisfil, located about 80 km north of downtown Toronto.

Cannabis and Cannabinoid Signaling: Research Gaps and Opportunities.

Cannabis and its products have been used for centuries for both medicinal and recreational purposes. The recent widespread legalization of cannabis has vastly expanded its use in the United States across all demographics except for adolescents. Meanwhile, decades of research have advanced our knowledge of cannabis pharmacology and particularly of the endocannabinoid system with which the components of cannabis interact. This research has revealed multiple targets and approaches for manipulating the system for therapeutic use and to ameliorate cannabis toxicity or cannabis use disorder. Research has also led to new questions that underscore the potential risks of its widespread use, particularly the enduring consequences of exposure during critical windows of brain development or for consumption of large daily doses of cannabis with high content Δ 9-tetrahydrocannabinol. This article highlights current neuroscience research on cannabis that has shed light on therapeutic opportunities and potential adverse consequences of misuse and points to gaps in knowledge that can guide future research. SIGNIFICANCE STATEMENT: Cannabis use has escalated with its increased availability. Here, the authors highlight the challenges of cannabis research and the gaps in our knowledge of cannabis pharmacology and of the endocannabinoid system that it targets. Future research that addresses these gaps is needed so that the endocannabinoid system can be leveraged for safe and effective use.

Cannabinoids: Potential for Modulation and Enhancement When Combined with Vitamin B12 in Case of Neurodegenerative Disorders.

The enduring relationship between humanity and the cannabis plant has witnessed significant transformations, particularly with the widespread legalization of medical cannabis. This has led to the recognition of diverse pharmacological formulations of medical cannabis, containing 545 identified natural compounds, including 144 phytocannabinoids like Δ9-THC and CBD. Cannabinoids exert distinct regulatory effects on physiological processes, prompting their investigation in neurodegenerative diseases. Recent research highlights their potential in modulating protein aggregation and mitochondrial dysfunction, crucial factors in conditions such as Alzheimer's Disease, multiple sclerosis, or Parkinson's disease. The discussion emphasizes the importance of maintaining homeodynamics in neurodegenerative disorders and explores innovative therapeutic approaches such as nanoparticles and RNA aptamers. Moreover, cannabinoids, particularly CBD, demonstrate anti-inflammatory effects through the modulation of microglial activity, offering multifaceted neuroprotection including mitigating aggregation. Additionally, the potential integration of cannabinoids with vitamin B12 presents a holistic framework for addressing neurodegeneration, considering their roles in homeodynamics and nervous system functioning including the hippocampal neurogenesis. The potential synergistic therapeutic benefits of combining CBD with vitamin B12 underscore a promising avenue for advancing treatment strategies in neurodegenerative diseases. However, further research is imperative to fully elucidate their effects and potential applications, emphasizing the dynamic nature of this field and its potential to reshape neurodegenerative disease treatment paradigms.

Typical Sources and Locations of Marijuana among US Young Adults: Differences by Sexual Minority Status

Background: With the widespread legalization of cannabis and use among all age groups, location and source of cannabis remains to be researched, especially among minority populations. Methods: We pooled data from the 2018–2019 National Survey on Drug Use and Health and investigated differences by sexual minority status of where individuals obtained cannabis. Results: Results found that gay/lesbian and bisexual individuals who reported use were more likely to get marijuana from buying it, trading it for something else and getting it for free or sharing someone else’s, compared to heterosexual individuals. Furthermore, more than one in five lesbian/gay individuals reported obtaining marijuana from someone they just met while nearly 25% of bisexual women reported obtaining marijuana from a friend. Conclusions: Findings from the present study may inform harm reduction and policy initiatives.

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.

The Use of Cannabis and Its Effects on Postpartum Depression

Cannabis use and depression management have been studied, with a preponderance of exacerbating effects, but there are few studies on postpartum depression (PPD). Depression affects a significant number of women, with a portion of it manifesting as PPD in childbearing women in the United States each year. The pharmacologic management approaches have disadvantages such as side effects, cost-benefit ratio, contraindications, use reluctance, medication adherence, and stigmatization in patients. Anecdotal claims of medical cannabis' therapeutic benefits have led to widespread legalization in several regions, making cannabis and its extracts a possible alternative. Cannabis is widely used during pregnancy and in general. Even though substance use disorders exacerbating depression symptoms have been reported, there are increasing reports and evidence about the therapeutic benefit of dose-dependent cannabis or its extracts in some depression symptoms, such as acute psychosocial stress relief, its purported anxiolytic effect, appetite, and sleep quality, thus stimulating more interest that may be inferred to depression. PPD marijuana use is unclear. This paper reviewed works of literature that claimed cannabis' therapeutic benefit in treating depression and, by extension, PPD. Our findings show the link between cannabis and PPD has not been fully explored. Self-reported studies link marijuana uses to positive mood, anxiety relief, sleep regulation, nausea and vomiting reduction, and appetite stimulation-all PPD symptoms. Others opposed postpartum marijuana use.

Cannabis Use Disorder in the Setting of Primary Total Hip Arthroplasty: Understanding the Epidemiology, Demographic Characteristics, and Inpatient Postoperative Outcomes.

Cannabis use is expected to increase in the context of its decriminalization and legalization in several states. The purpose of this study was to report on the epidemiologic and demographic characteristics and inpatient postoperative outcomes of patients with cannabis use disorder (CUD) undergoing primary total hip arthroplasty (THA). The National Inpatient Sample registry was used to identify patients undergoing THA between 2006 and 2015. Patients were stratified into groups with and without CUD. Epidemiology, comorbidity, and outcomes data were comparatively analyzed between these two groups. A total of 2,838,742 THAs were performed during the study period. The prevalence of CUD significantly increased from 0.10% in 2006 to 0.39% in 2015 (P < 0.0001). Patients with CUD were significantly younger, more likely to be male, had higher rates of Medicaid insurance and were more likely to be non-Hispanic Black and less likely to be non-Hispanic White when compared with the control group. When comparing patients with and without CUD, there was no significant difference in the composite any complication variable and no significant difference in seven of eight individual in-hospital complications assessed, with the exception being higher genitourinary complications in the CUD group. There were no significant differences in discharge disposition or length of stay. Although CUD is significantly associated with various demographic, comorbidity, and hospital characteristics, it is not significantly associated with in-hospital complications, discharge disposition, and length of stay outcomes in the immediate in-hospital, postoperative period. It is critical for clinicians and public health professionals to understand the characteristics and expected inpatient outcomes of this evolving population of patients with CUD undergoing THA, particularly in the context of widespread legalization. Level III.

Regular recreational Cannabis users exhibit altered neural oscillatory dynamics during attention reorientation.

Cannabis is the most widely used illicit drug in the United States and is often associated with changes in attention function, which may ultimately impact numerous other cognitive faculties (e.g. memory, executive function). Importantly, despite the increasing rates of cannabis use and widespread legalization in the United States, the neural mechanisms underlying attentional dysfunction in chronic users are poorly understood. We used magnetoencephalography (MEG) and a modified Posner cueing task in 21 regular cannabis users and 32 demographically matched non-user controls. MEG data were imaged in the time-frequency domain using a beamformer and peak voxel time series were extracted to quantify the oscillatory dynamics underlying use-related aberrations in attentional reorienting, as well as the impact on spontaneous neural activity immediately preceding stimulus onset. Behavioral performance on the task (e.g. reaction time) was similar between regular cannabis users and non-user controls. However, the neural data indicated robust theta-band synchronizations across a distributed network during attentional reorienting, with activity in the bilateral inferior frontal gyri being markedly stronger in users relative to controls (p's < 0.036). Additionally, we observed significantly reduced spontaneous theta activity across this distributed network during the pre-stimulus baseline in cannabis users relative to controls (p's < 0.020). Despite similar performance on the task, we observed specific alterations in the neural dynamics serving attentional reorienting in regular cannabis users compared to controls. These data suggest that regular cannabis users may employ compensatory processing in the prefrontal cortices to efficiently reorient their attention relative to non-user controls.

Effects of marijuana on reproductive health: preconception and gestational effects.

Recent widespread legalization changes have promoted the availability of marijuana and its increased potency and perceived safety. The limited evidence on reproductive and perinatal outcomes from marijuana exposure is enough to warrant concern and action. The objective of this review is to provide a current and relevant summary of the recent literature surrounding this topic. The available published studies on the effect of marijuana exposure on reproductive health and pregnancy outcomes are conflicting. Human studies are often observational or retrospective and confounded by self-report and polysubstance use. However, the current, limited evidence suggests that marijuana use adversely affects male and female reproductive health. Additionally, prenatal marijuana exposure has been reported to be associated with an increased risk of preterm birth and small for gestational age infants. With the increasing prevalence of marijuana use, there is an urgent need for evidence-driven recommendations and guidelines for couples interested in conception, affected by infertility or who are expecting. At this time, no amount of marijuana use during conception or pregnancy is known to be well tolerated and the limited available evidence suggests that the safest choice is to abstain.

Dangers of simultaneous alcohol and marijuana use

Two recent studies funded by the National Institute on Drug Abuse (NIDA) have found that simultaneous alcohol and marijuana use (SAM) results in more negative consequences than sequential use of both substances. In addition, college students who used both substances sequentially had more negative consequences than those who used alcohol only. In another study, young adults drank more alcohol on days when they also used marijuana than on days when they only drank alcohol. Finally, young adults reported more harm on days when they used both substances than on days when they used only one or the other. The combination of the pervasive use of alcohol in this age group and the widespread legalization of marijuana creates the need to look at SAM and associated negative consequences. Negative consequences included blackouts, vomiting, risky behavior, driving under the influence, and physical dependence. There were also cognitive, academic, social, and self‐care effects.

NIDA warns of simultaneous alcohol and marijuana use

Recent studies have found that simultaneous alcohol and marijuana use (SAM) results in more negative consequences than sequential use of both substances, the National Institute on Drug Abuse reported last week. In addition, college students who used both substances sequentially had more negative consequences than those who used alcohol only. In another study, young adults drank more alcohol on days when they also used marijuana than on days when they only drank alcohol. Finally, young adults reported more harms on days when they used both substances than on days when they used only one or the other. The combination of the pervasive use of alcohol in this age group and the widespread legalization of marijuana creates the need to look at SAM and associated negative consequences. Negative consequences included blackouts, vomiting, risky behavior, driving under the influence and physical dependence. There were also cognitive, academic, social and self‐care effects.

Cannabinoid Interactions with Cytochrome P450 Drug Metabolism: a Full-Spectrum Characterization.

Medicinal cannabis use has increased exponentially with widespread legalization around the world. Cannabis-based products are being used for numerous health conditions, often in conjunction with prescribed medications. The risk of clinically significant drug-drug interactions (DDIs) increases in this setting of polypharmacy, prompting concern among health care providers. Serious adverse events can result from DDIs, specifically those affecting CYP-mediated drug metabolism. Both cannabidiol (CBD) and Δ9-tetrahydrocannabinol (Δ9-THC), major constituents of cannabis, potently inhibit CYPs. Cannabis-based products contain an array of cannabinoids, many of which have limited data available regarding potential DDIs. This study assessed the inhibitory potential of 12 cannabinoids against CYP-mediated drug metabolism to predict the likelihood of clinically significant DDIs between cannabis-based therapies and conventional medications. Supersomes™ were used to screen the inhibitory potential of cannabinoids in vitro. Twelve cannabinoids were evaluated at the predominant drug-metabolizing isoforms: CYP3A4, CYP2D6, CYP2C9, CYP1A2, CYP2B6, and CYP2C19. The cannabinoids exhibited varied effects and potencies across the CYP isoforms. CYP2C9-mediated metabolism was inhibited by nearly all the cannabinoids with estimated Ki values of 0.2-3.2 μM. Most of the cannabinoids inhibited CYP2C19, whereas CYP2D6, CYP3A4, and CYP2B6 were either not affected or only partially inhibited by the cannabinoids. Effects of the cannabinoids on CYP2D6, CYP1A2, CYP2B6, and CYP3A4 metabolism were limited so in vivo DDIs mediated by these isoforms would not be predicted. CYP2C9-mediated metabolism was inhibited by cannabinoids at clinically relevant concentrations. In vivo DDI studies may be justified for CYP2C9 substrates with a narrow therapeutic index.

Cannabis: The Uncertain Path from Agricultural Commodity to Luxury Consumable

Widespread legalization is turning cannabis into big business. As cultivation, manufacturing, and retail sales expand in size and sophistication, the industry appears to be evolving into a commodity market. This paper reviews the state of cannabis with respect to factors that contribute to the success of other luxury consumables such as wine and perfume. While many of these factors are available to cannabis, they exist in only rudimentary form today. Certain features of cannabis culture that present obstacles to the development of a luxury ethos are also discussed.

236 The association between recent cannabis use and nightly sleep duration in adults in the USA from 2005-2018

Abstract Introduction Shifts in medicolegal attitudes towards cannabis, coupled with widespread legalization, have led to North America having the highest prevalence of cannabis use worldwide. Amongst other known physiologic effects, regular cannabis use can cause changes to sleep duration and quality. The purpose of this study was to examine the relationship between recent cannabis use and sleep duration using a nationally representative data set. Methods A cross-sectional analysis of adults was undertaken using the National Health and Nutrition Examination Survey (NHANES) data from 2005–2018. Respondents were dichotomized by whether or not they had used cannabis in the past 30 days. The primary outcome was inadequate nightly sleep duration, defined as self-reported sleep duration less than 6 hours per night. Secondary outcomes were related to self-reported issues with sleep. Multiple logistic regression was used to adjust for potential confounders and survey sample weights were considered in the model. Results Compared to those with no recent cannabis use (n=18,631), recent users (n=3,135) were more likely to report less than 6 hours of sleep per night (aOR 1.33 95% 1.13–1.57, p&amp;lt;0.001). Recent users were also more likely to report difficulty falling asleep, staying asleep, or sleeping too much in the past two weeks (aOR 1.21, 95% CI: 1.09–1.35, p&amp;lt;0.001), and having ever mentioned these issues to a physician (aOR 1.21, 95% CI: 1.07–1.37, p=0.003). Respondents using cannabis at least 20 of the past 30 days were characterized as heavy users, and were even more likely than moderate users to report insufficient sleep. These results did not significantly differ between years of survey administration. Conclusion Recent cannabis use was associated with inadequate nightly sleep duration in adults and demonstrates a dose-dependent relationship. Although this relationship is complex and our findings cannot suggest directionality, they highlight the need to further characterize the sleep health of regular cannabis users in the general population. This is especially prudent as cannabinoids are becoming widely accepted for recreational use and increasingly prescribed as medical therapy. Support (if any):

Effects of Chronic Cannabis Use on the Neural Dynamics Underlying Attentional Reorientation

Cannabis is the most widely used illicit drug in the United States and is often associated with changes in attention function, which may ultimately impact numerous other cognitive faculties (e.g., memory, executive function). Importantly, despite the increasing rates of cannabis use and widespread legalization in the United States, the neural mechanisms underlying attentional dysfunction in chronic users are poorly understood.

Modeling cannabinoids from a large-scale sample of Cannabis sativa chemotypes.

The widespread legalization of Cannabis has opened the industry to using contemporary analytical techniques for chemotype analysis. Chemotypic data has been collected on a large variety of oil profiles inherent to the cultivars that are commercially available. The unknown gene regulation and pharmacokinetics of dozens of cannabinoids offer opportunities of high interest in pharmacology research. Retailers in many medical and recreational jurisdictions are typically required to report chemical concentrations of at least some cannabinoids. Commercial cannabis laboratories have collected large chemotype datasets of diverse Cannabis cultivars. In this work a data set of 17,600 cultivars tested by Steep Hill Inc., is examined using machine learning techniques to interpolate missing chemotype observations and cluster cultivars into groups based on chemotype similarity. The results indicate cultivars cluster based on their chemotypes, and that some imputation methods work better than others at grouping these cultivars based on chemotypic identity. Due to the missing data and to the low signal to noise ratio for some less common cannabinoids, their behavior could not be accurately predicted. These findings have implications for characterizing complex interactions in cannabinoid biosynthesis and improving phenotypical classification of Cannabis cultivars.

Characteristics of secondhand cannabis smoke from common smoking methods: Calibration factor, emission rate, and particle removal rate

Abstract The widespread legalization of recreational cannabis use raises growing concerns about exposure to secondhand cannabis smoke (SCS). However, few studies are characterizing fine particulate matter (PM2.5) exposure from SCS. Here, we determined PM2.5 calibration factors (CFs) for SCS from four common cannabis consuming methods—glass pipe smoking, joint smoking, bong smoking, and cannabis pen vaping—for widely used optical monitors (SidePak™ AM510, TSI Inc., Shoreview, MN) by comparing the monitors with gravimetric mass measurements. We furthermore investigated the emission rate, particle size distribution, and particle removal rate of SCS. The CFs of SidePak PM2.5 monitors measuring the four types of SCS were 0.31 (SE = 0.02), 0.39 (SE = 0.02), 0.40 (SE = 0.01), and 0.44 (SE = 0.03), respectively. The arithmetic mean emission rates of the four SCS sources were ~2–6 times that of secondhand tobacco smoke (STS) on a per-puff basis. The fresh SCS (1-min after smoking) showed a bimodal size distribution—one mode located at ~380–420 nm and another at ~800–840 nm. Under low-ventilation conditions, the indoor removal rates of SCS from cannabis vaping were slightly higher (i.e., 0.61–0.77/h) than those for the other three sources (i.e., 0.35–0.53/h).

Cannabis Withdrawal Syndrome Affects Nearly Half of Those Who Quit

Back to table of contents Previous article Next article Clinical & ResearchFull AccessCannabis Withdrawal Syndrome Affects Nearly Half of Those Who QuitTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:16 Jul 2020https://doi.org/10.1176/appi.pn.2020.6a4AbstractPrevalence of cannabis withdrawal syndrome is greatest among inpatients.iStock/pabloborcaNearly half of people who regularly use cannabis experience cannabis withdrawal syndrome when they try to stop, according to a meta-analysis published online in JAMA Network Open in April. The highest prevalence occurs among patients in inpatient settings, followed by those in outpatient settings. According to the DSM-5, symptoms of cannabis withdrawal syndrome may arise within seven days of quitting or reducing the use of cannabis and include irritability, aggression, nervousness, anxiety, problems with sleep, changes in appetite, depressed mood, and physical symptoms such as headaches, sweating, and nausea.“Cannabis withdrawal syndrome is clinically relevant and not something we should trivialize. It may be a reason people have difficulty quitting,” lead author Anees Bahji, M.D., a psychiatry resident at Queen’s University in Kingston, Ontario, told Psychiatric News. “The symptoms are terrible, which can set people up for a cycle where they try to make the symptoms go away by using cannabis again.”Bahji and his colleagues analyzed data from 47 studies that included a total of 23,528 participants. They found that the overall prevalence of cannabis withdrawal syndrome in people who used cannabis regularly and then tried to quit was 47%. When the researchers broke the data down according to setting, they found the prevalence of cannabis withdrawal syndrome was 87% among inpatients, 54% among outpatients, and 17% among people in the general population who used cannabis.Cannabis withdrawal syndrome may prompt patients to use cannabis again in an effort to stave off symptoms. —Anees Bahji, M.D.Bahji offered some possible reasons for the higher prevalence among inpatients, as it is unlikely that they are admitted because they are experiencing cannabis withdrawal.“This is speculation, but inpatients might be forced to withdraw from cannabis if they cannot continue to use it while admitted to hospital,” he said. “As well, people with other psychiatric conditions or substance use disorders might be more susceptible to cannabis withdrawal.”The researchers found that the prevalence of cannabis withdrawal syndrome was higher among people who also used tobacco or other substances compared with those who did not. Although the meta-analysis was not designed to determine why, Bahji said that it’s not uncommon for people who use cannabis to use other substances because co-occurring substance use tends to be the norm, rather than the exception.Bahji said that although cannabis withdrawal syndrome was first recognized in the fifth edition of DSM seven years ago, many health professionals and patients are not aware of it and that the study’s results should call attention to it as a medical condition.“A lot of people don’t get treatment because cannabis isn’t seen as a ‘hard drug.’ That does a disservice to them because even though the severity [of cannabis withdrawal] might be less than what we’d see with opioids or other drugs, the fact that there is such a high prevalence of it tells us that this might be a huge issue,” Bahji explained.He added that the results are noteworthy at a time when more and more states are legalizing cannabis use for medical and recreational use.“When something is made legal, it might be perceived as safe, and some people may go ahead and use it,” he said, adding that the impact of widespread legalization on cannabis use and public health may not be apparent until several years down the road. Yet he stopped short of dismissing cannabis for medical use entirely. “I’m interested in seeing where the research goes because part of me believes there may be a therapeutic use for cannabis. I just think it will take a long time to tease that out—what component of cannabis should be used, how much should be used, and who could benefit from it.”The authors reported no outside funding for this study. ■“Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids: A Systemic Review and Meta-Analysis” is posted here. ISSUES NewArchived