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Addiction (Abingdon, England) Dec 2023Many countries have recently legalized medicinal and recreational cannabis. With increasing use and access come the potential for harms. We aimed to examine the effect... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Many countries have recently legalized medicinal and recreational cannabis. With increasing use and access come the potential for harms. We aimed to examine the effect of cannabis legalization/decriminalization on acute poisoning.
METHODS
A systematic review and meta-analysis registered with PROSPERO (CRD42022323437). We searched Embase, Medline, Scopus and Cochrane Central Register of Controlled Trials from inception to March 2022. No restrictions on language, age or geography were applied. Abstracts from three main clinical toxicology conferences were hand-searched. Included studies had to report on poisonings before and after changes in cannabis legislation, including legalization and decriminalization of medicinal and recreational cannabis. Where possible, relative risk (RR) of poisoning after legalization (versus before) was calculated and pooled. Risk of bias was assessed with ROBINS-I.
RESULTS
Of the 1065 articles retrieved, 30 met inclusion criteria (including 10 conference abstracts). Studies used data from the United States, Canada and Thailand. Studies examined legalization of medicinal cannabis (n = 14) and decriminalization or legalization of recreational cannabis (n = 21). Common data sources included poisons centre records (n = 18) and hospital presentations/admissions (n = 15, individual studies could report multiple intervention types and multiple data sources). Most studies (n = 19) investigated paediatric poisoning. Most (n = 24) reported an increase in poisonings; however, the magnitude varied greatly. Twenty studies were included in quantitative analysis, with RRs ranging from 0.81 to 29.00. Our pooled estimate indicated an increase in poisoning after legalization [RR = 3.56, 95% confidence interval (CI) = 2.43-5.20], which was greater in studies that focused on paediatric patients (RR = 4.31, 95% CI = 2.30-8.07).
CONCLUSIONS
Most studies on the effect of medicinal or recreational cannabis legalization/decriminalization on acute poisoning reported a rise in cannabis poisoning after legalization/decriminalization. Most evidence is from US legalization, despite legalization and decriminalization in many countries.
Topics: Humans; United States; Child; Cannabis; Medical Marijuana; Legislation, Drug; Hallucinogens; Canada
PubMed: 37496145
DOI: 10.1111/add.16280 -
Pharmacopsychiatry May 2024Chronic pain is primarily conceptualized as a disease in its own right when it is associated with emotional distress and functional impairment. Pathophysiologically,... (Review)
Review
Chronic pain is primarily conceptualized as a disease in its own right when it is associated with emotional distress and functional impairment. Pathophysiologically, dysfunction of the cortico-mesolimbic connectome is of major importance, with overlapping signals in the nociceptive and stress systems. The endocannabinoid system plays an important role in the central processing of nociceptive signals and regulates the central stress response. Clinically, there is moderate evidence that cannabis-based medicines (CBM) can contribute to a significant reduction in pain, especially the associated pain affect, and improvement in physical function and sleep quality in a proportion of patients with chronic pain. The analgesic effect appears to be largely independent of the cause of pain. In this context, CBM preferentially regulates stress-associated pain processing.
Topics: Humans; Chronic Pain; Medical Marijuana; Animals; Cannabis
PubMed: 38198809
DOI: 10.1055/a-2231-6630 -
Die Anaesthesiologie Sep 2023
Topics: Cannabis; Hallucinogens; Cannabinoid Receptor Agonists
PubMed: 37581641
DOI: 10.1007/s00101-023-01328-7 -
Neonatal Network : NN Jul 2023Numerous drugs ingested during pregnancy can impact the developing fetus. Although some effects are apparent at birth as overt teratogenicity or profound neonatal...
Numerous drugs ingested during pregnancy can impact the developing fetus. Although some effects are apparent at birth as overt teratogenicity or profound neonatal withdrawal, others become apparent only after a careful long-term follow-up into childhood. Shifting legal and cultural attitudes toward marijuana have led to increased use during pregnancy. This shift should prompt health care providers to carefully consider the drug's mechanism of action, its interaction with the placenta, and the potential consequences of fetal exposure. The primary psychoactive compound in marijuana is Δ9-tetrahydrocannabinol (THC), which agonizes endogenous cannabinoid receptors. Cannabinoid receptors are present in the fetal brain early in gestation and appear to have an important role in the developing central nervous system. THC crosses the placenta in sufficient quantities to raise concerns about exogenous exposure during fetal development. Robust follow-up studies suggest that marijuana use during pregnancy contributes to suboptimal fetal growth. At school age, heavy prenatal marijuana exposure predicts challenges in executive function (specifically, memory and reasoning) and externalizing behavior (e.g., hyperactivity and inattention). Memory and behavioral problems persist into early adulthood. These challenges coincide with a higher risk of heavy marijuana use in offspring. In concert with a suboptimal environment, young adults may experience a higher risk of global cognitive impairment and/or delinquency. Importantly, these adverse outcomes appear to be mitigated by postnatal factors including home environment. Ongoing studies in the modern era will be vital to enhance our understanding of the mechanisms by which THC impacts the fetus and confirm or refute knowledge regarding long-term impact. This knowledge will inform both health care providers and parents in collaborative decision-making to optimize the outcome of children.
Topics: Pregnancy; Female; Infant, Newborn; Child; Humans; Adult; Cannabis; Dronabinol; Receptors, Cannabinoid; Central Nervous System; Placenta
PubMed: 37491043
DOI: 10.1891/NN-2022-0040 -
Journal of Dental Education Aug 2023This article seeks to determine dental students' knowledge, attitudes, and perceptions toward patients' marijuana use and whether dental students would like additional...
PURPOSE/OBJECTIVES
This article seeks to determine dental students' knowledge, attitudes, and perceptions toward patients' marijuana use and whether dental students would like additional marijuana education.
METHODS
Predoctoral dental students were invited in 2021 to complete a questionnaire regarding marijuana's oral health effects, their comfort discussing marijuana with patients and their interest in additional training.
RESULTS
Among participants (n = 206, 32.7% response rate), most were familiar with smoked, smokeless and edible methods, but only 39.3% were familiar with topical applications. Only 29.6% of preclinical and 32.2% of clinical Doctor of Dental Medicine students agreed that smoking marijuana was detrimental to one's health, compared to 64.6% of internationally trained Advanced Standing students. Significantly more clinical students (70.6%) could identify how often they treat patients having used marijuana compared to the estimates of preclinical students (36.7%), although 44.2% of all students indicated they were unsure. Not surprisingly, more preclinical students were uncomfortable treating patients during routine dental procedures (45.6% preclinical vs. 32.8% clinical) and when administering local anesthesia (45.6% preclinical vs. 38.8% clinical) due to not yet providing direct patient care. A majority of both preclinical (92.2%) and clinical (89.7%) students agreed they would benefit from more marijuana education. Clinical students preferred adding a brief introductory seminar while preclinical students preferred multiple lectures throughout the curriculum.
CONCLUSION
As states legalize medical and recreational marijuana use, dental schools need to evaluate marijuana education in their curriculum and develop resources so students can feel comfortable and confident in their ability to identify and safely treat patients who use marijuana.
Topics: Humans; Cannabis; Students, Dental; Health Knowledge, Attitudes, Practice; Oral Health; Curriculum; Surveys and Questionnaires; Attitude of Health Personnel
PubMed: 37160756
DOI: 10.1002/jdd.13232 -
Molecules (Basel, Switzerland) Nov 2023Cannabis plants have been used in medicine since ancient times. They are well known for their anti-diabetic, anti-inflammatory, neuroprotective, anti-cancer,... (Review)
Review
Cannabis plants have been used in medicine since ancient times. They are well known for their anti-diabetic, anti-inflammatory, neuroprotective, anti-cancer, anti-oxidative, anti-microbial, anti-viral, and anti-fungal activities. A growing body of evidence indicates that targeting the endocannabinoid system and various other receptors with cannabinoid compounds holds great promise for addressing multiple medical conditions. There are two distinct avenues in the development of cannabinoid-based drugs. The first involves creating treatments directly based on the components of the cannabis plant. The second involves a singular molecule strategy, in which specific phytocannabinoids or newly discovered cannabinoids with therapeutic promise are pinpointed and synthesized for future pharmaceutical development and validation. Although the therapeutic potential of cannabis is enormous, few cannabis-related approved drugs exist, and this avenue warrants further investigation. With this in mind, we review here the medicinal properties of cannabis, its phytochemicals, approved drugs of natural and synthetic origin, pitfalls on the way to the widespread clinical use of cannabis, and additional applications of cannabis-related products.
Topics: Cannabis; Cannabinoids; Cannabinoid Receptor Agonists; Endocannabinoids; Hallucinogens; Cannabidiol; Dronabinol
PubMed: 38067416
DOI: 10.3390/molecules28237686 -
Journal of the American Academy of... Mar 2024Marijuana legalization (ML) processes for medical and recreational use in the United States have been prompted by the potential for positive downstream legal effects of...
Marijuana legalization (ML) processes for medical and recreational use in the United States have been prompted by the potential for positive downstream legal effects of decriminalization, including fewer cannabis-related arrests and prosecutions, which have historically disproportionately impacted minoritized communities. However, ML evolved through primarily political processes, with minimal scientific guidance to inform policies. Commercialization has increased youth cannabis access, diversion of parental cannabis, and proliferation of high-potency products, which, along with early use, are associated with poor mental health outcomes. Taken together, these findings raise concerns about the impact of medical (MML) and recreational marijuana legalization (RML) on youth mental health.
Topics: Humans; Adolescent; United States; Cannabis; Marijuana Smoking; Legislation, Drug; Parents; Suicide
PubMed: 37890663
DOI: 10.1016/j.jaac.2023.10.007 -
Scientific Reports Nov 2023Several observational studies have investigated the association between cannabis use and intraocular pressure, but its association with primary open-angle glaucoma... (Meta-Analysis)
Meta-Analysis
Several observational studies have investigated the association between cannabis use and intraocular pressure, but its association with primary open-angle glaucoma (POAG) remains unclear. In this study, we leveraged human genetic data to assess through Mendelian randomization (MR) whether cannabis use affects POAG. We used five single-nucleotide polymorphisms (SNPs) associated with lifetime cannabis use (P-value < 5 × 10) from a genome-wide association study (GWAS) (N = 184,765) by the International Cannabis Consortium, 23andMe, and UK Biobank and eleven SNPs associated with cannabis use disorder (P-value < 5 × 10) from a GWAS meta-analysis of (17,068 cases and 357,219 controls of European descent) from Psychiatric Genomics Consortium Substance Use Disorders working group, Lundbeck Foundation Initiative for Integrative Psychiatric Research, and deCode. We associated the selected five SNPs from the GWAS of lifetime cannabis use and the eleven SNPs from the GWAS of cannabis use disorder, with the largest to date GWAS meta-analysis of POAG (16,677 cases and 199,580 controls). MR analysis suggested no evidence for a causal association of lifetime cannabis use and cannabis use disorder with POAG (odds ratio (OR) of outcome per doubling of the odds of exposure (95% confidence interval): 1.04 (0.88; 1.23) for lifetime cannabis use and 0.97 (0.92; 1.03) for cannabis use disorder). Sensitivity analyses to address pleiotropy and weak instrument bias yielded similar estimates to the primary analysis. In conclusion, our results do not support a causal association between cannabis use and POAG.
Topics: Humans; Genome-Wide Association Study; Cannabis; Mendelian Randomization Analysis; Glaucoma, Open-Angle; Marijuana Abuse; Polymorphism, Single Nucleotide
PubMed: 37949880
DOI: 10.1038/s41598-023-45872-z -
Neuroscience and Biobehavioral Reviews Nov 2023Schizophrenia (SCZ) is a multifactorial neurodevelopmental disorder caused by genetic and environmental alterations, especially during prenatal stages. On the other... (Review)
Review
Schizophrenia (SCZ) is a multifactorial neurodevelopmental disorder caused by genetic and environmental alterations, especially during prenatal stages. On the other hand, cannabis consumption in adolescence has been also linked to an increased risk of developing SCZ. The combination of both hits has been proposed as the dual hit hypothesis of SCZ. We systematically reviewed prenatal environmental alterations and cannabis consumption during adolescence that are associated with an increased risk of SCZ, following the PRISMA model. The analysis focused on dual animal models where the first hit is prenatal environmental exposure and the second hit consists of postnatal cannabis exposure. The articles were evaluated by three independent reviewers based on inclusion criteria. We extracted the first author´s name, year, model species, sex and analysis. The articles reported on dual murine models and their effects on weight, behavior, genetics, electrophysiology and brain structure and function. We conclude that the defects caused by the dual hits depend on the sex of the model, as well as type of hits.
Topics: Pregnancy; Female; Mice; Animals; Humans; Schizophrenia; Cannabis; Rodentia; Brain; Risk Factors; Prenatal Exposure Delayed Effects
PubMed: 37783300
DOI: 10.1016/j.neubiorev.2023.105409 -
Health Economics Jan 2024Legalization of use and retail sales of recreational marijuana in U.S. states and the associated potential increase in access to marijuana and normalization of its use...
Legalization of use and retail sales of recreational marijuana in U.S. states and the associated potential increase in access to marijuana and normalization of its use by adults could lead to increased use by adolescents. Studies have found that states with legal recreational marijuana have higher rates of adolescent use and frequency of use compared to states without legal use. We examined changes in student office discipline referrals (ODRs) for substance use offenses in Oregon middle and high schools before and after the legalization of recreational marijuana relative to comparison schools in other states. We found that rates of substance use related ODRs in middle schools increased by 0.14 per 100 students (30% of the mean) with legalization relative to comparison schools. This increase was moderated by the presence of a marijuana outlet within one mile of the school. We found no statistically discernible changes in high school ODRs. Marijuana use in adolescence has been linked to negative health and social consequences, including academic problems, mental health issues, and impaired driving. Potential adverse impact on adolescents and investments in school-based prevention programs could be important considerations for policymakers and public health officials when evaluating marijuana legalization.
Topics: Adolescent; Humans; Cannabis; Marijuana Smoking; Marijuana Use; Schools; Substance-Related Disorders; Legislation, Drug
PubMed: 37801408
DOI: 10.1002/hec.4763