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Many states have legalized medical cannabis with various reported therapeutic benefits. However, there is little data assessing the effects of cannabis on surgical outcomes. We sought to compare post-operative pancreatic resection complications between cannabis users and non-users. This is a single-center, retrospective review of patients who underwent Whipple or distal pancreatectomy from 1/2017-12/2020. The primary outcome was any in-hospital complication, using Clavien-Dindo. Multivariable regression analysis was performed. There were 486 patients who underwent Whipple (n=346, 71.2%) or distal pancreatectomy (n=140, 28.8%). Overall, 21.4% (n=104) reported cannabis use, of whom 80.8% were current users. Cannabis users were younger (60 vs. 66 years, p < 0.001), and more likely to have smoked tobacco (p=0.04), but otherwise had similar demographics as non-users. There were 288 (59.3%) patients who developed an in-hospital complication (grade 1–2, 75.3%; grade 3–5, 24.7%). A trend towards increased complications was observed with tobacco smoking (OR 1.33, 95% CI 0.91–1.94, p=0.14), but no association of cannabis use with complications was observed (OR 0.93, 95% CI 0.58–1.47 , p=0.74). A significant proportion of patients undergoing pancreatic resection report cannabis use. These results suggest that there was no association between cannabis use and post-operative complications, future prospective evaluation is warranted. [Display omitted] [ABSTRACT FROM AUTHOR]

Pedestrian fatality rates in the US began to increase in 2009, after three decades of decline. This increase is occurring at the same time policy makers are encouraging walking as a healthy and sustainable transportation mode. The increase in pedestrian fatalities is also concurrent with the spread of liberalization of marijuana use laws across the US. Has the liberalization of marijuana laws contributed to the increase in pedestrian fatalities? Using a Poisson regression generalized difference in difference design, we measure the relationship between pedestrian fatalities and liberalization of marijuana laws. We employ randomization inference since persistent idiosyncratic shocks in the state time series may create spurious correlations that inflate type 1 error rates for conventional hypothesis tests. Consistent with the alcohol substitution hypothesis, we find both medical and recreational marijuana laws are followed by a statistically significant reduction in daytime fatalities involving alcohol. Both are also followed by a reduction in nighttime fatalities involving alcohol, but the declines are not statistically significant. • Pedestrian fatality rates in the US began to rise in 2009, concurrent with the liberalization of marijuana use laws. • Daytime alcohol related pedestrian fatalities fall after medical (p = 0.007) and recreational (p = 0.004) marijuana laws. • Nighttime alcohol related fatalities fall after medical (p = 0.383) and recreational (p = 0.348) marijuana laws. • Findings are consistent with the alcohol substitution hypothesis. [ABSTRACT FROM AUTHOR]

• In the United States, hemp and marijuana are both Cannabis sativa, differentiated only by whether the plant on dry weight basis is above or below 0.3% Δ9-tetrahydrocannabinol (Δ9-THC). • Pod-based vaping products were devised for discreet vaping and originated in the cannabis industry. • Cannabis vaping is correlated with younger age, higher education, and higher income. • Thorough and transparent labelling of chemicals present in cannabis vaping products is not widespread industry practice. • A federally unregulated cannabis industry and variable state-to-state regulations has enabled low quality products to enter the marketplace which can lead to adverse events and consumer confusion. • Unified and enforced state regulations or federal regulations supported by quality testing and robust research are needed for consumer confidence and safety in cannabis vaping products. [ABSTRACT FROM AUTHOR]

Cannabis is increasingly accepted by medical organizations for medicinal and research purposes. A traceability system is required for monitoring and controlling the use of cannabis. This work aimed to investigate the relationship between critical success factors (CSFs) for creating the innovation framework that affects the implementation of the cannabis traceability system. These factors are identified based on the digital supply chain by structural modeling. Additionally, the issue of patients' safety is a crucial factor that needs to be considered. Total Interpretive Structural Modeling (TISM) and fuzzy MICMAC analysis techniques were applied to investigate the relationship between CSFs. Finally, the 14 CSFs affecting cannabis traceability systems were determined. The research results discovered that system reliability is the most significant key factor with the greatest influence and contribution to the achievement. The five CSFs based on TISM comprise harmonized strategic orientation, inter-organization collaboration, standardization, government regulations, and customer awareness. According to the conclusive dependence–driving power diagram, they have the most driving power in the implementation and operation traceability system. The innovation framework helps to establish the traceability system in a way that works well. This will build trust in the supply chain and prevent abuse and substandard products. [ABSTRACT FROM AUTHOR]

The phytocomplex of Cannabis is made up of approximately 500 substances: terpeno-phenols metabolites, including Δ-9-tetrahydrocannabinol and cannabidiol, exhibit pharmacological activity. Medical Cannabis has several pharmacological potential applications, in particular in the management of chronic and neuropathic pain. In the literature, a few data are available concerning cannabis pharmacokinetics, efficacy and safety. Thus, aim of the present study was the evaluation of cannabinoid pharmacokinetics in a cohort of patients, with chronic and neuropathic pain, treated with inhaled medical cannabis and decoction, as a galenic preparation. In this study, 67 patients were enrolled. Dried flower tops with different THC and CBD concentrations were used: Bedrocan® medical cannabis with THC level standardized at 19% and with a CBD level below 1%, Bediol® medical cannabis with THC and CBD level standardized at similar concentration of 6.5% and 8%, respectively. Cannabis was administered as a decoction in 47 patients and inhaled in 11 patients. The blood withdrawn was obtained before the new dose administration at the steady state and metabolites plasma concentrations were measured with an UHPLC-MS/MS method. Statistically significant differences were found in cannabinoids plasma exposure between inhaled and oral administration of medical cannabis , between male and female and cigarette smokers. For the first time, differences in cannabinoid metabolites exposures between different galenic formulations were suggested in patients. Therapeutic drug monitoring could be useful to allow for dose adjustment, but further studies in larger cohorts of patients are required in order to confirm these data. [Display omitted] • Cannabis shows different pharmacological applications, in particular in the management of pain. • Cannabinoids pharmacokinetics description in patients with chronic and neuropathic pain. • Differences in cannabinoids plasma exposure between route of administration. [ABSTRACT FROM AUTHOR]

Cannabis use represents the most commonly illicit drug intake worldwide. m-Health interventions have the potential to play a key role in the fight against cannabis intake issues. A steadily increasing number of m-Health apps are currently available on commercial app stores to support psychoactive substance users. This study aims at exploring technical and functional characteristics of available m-Health-apps intended for non-medical Cannabis Use and Dependence (CUD). We carried out a scoping review following guidance from Arksey & O'Malley. We searched in Pubmed, Scopus and Web of Science databases end of March 2021. Only five papers fitted our inclusion criteria out of 113 studies. Four out of five included studies reported a decrease of cannabis use and adequate feasibility and acceptability of m-Health apps. Most of these studies used self-reported questionnaires. More studies are need to rigourously assess the usability and effective of m-Health apps for CUD. [ABSTRACT FROM AUTHOR]

Cannabis sativa , widely known as 'Marijuana' poses a dilemma for being a blend of both good and bad medicinal effects. The historical use of Cannabis for both medicinal and recreational purposes suggests it to be a friendly plant. However, whether the misuse of Cannabis and the cannabinoids derived from it can hamper normal body physiology is a focus of ongoing research. On the one hand, there is enough evidence to suggest that misuse of marijuana can cause deleterious effects on various organs like the lungs, immune system, cardiovascular system, etc. and also influence fertility and cause teratogenic effects. However, on the other hand, marijuana has been found to offer a magical cure for anorexia, chronic pain, muscle spasticity, nausea, and disturbed sleep. Indeed, most recently, the United Nations has given its verdict in favour of Cannabis declaring it as a non-dangerous narcotic. This review provides insights into the various health effects of Cannabis and its specialized metabolites and indicates how wise steps can be taken to promote good use and prevent misuse of the metabolites derived from this plant. [ABSTRACT FROM AUTHOR]

Objectives: Although there is a growing body of evidence suggesting that cannabinoids may relieve symptoms of some illnesses, they are relatively high-cost therapies compared with illicit growth and supply. This article aimed to comprehensively review economic evaluations of medicinal cannabis for alleviating refractory symptoms associated with chronic conditions.Methods: Seven electronic databases were searched for articles published up to September 6, 2020. The quality of reporting of economic evaluations was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. The extracted data were grouped into subcategories according to types of medical conditions, organized into tables, and reported narratively.Results: This review identified 12 cost-utility analyses conducted across a variety of diseases including multiple sclerosis (MS) (N = 8), pediatric drug-resistant epilepsies (N = 2), and chronic pain (N = 2). The incremental cost-effectiveness ratio varied widely from cost saving to more than US$451 800 per quality-adjusted life-year depending on the setting, perspectives, types of medicinal cannabis, and indications. Nabiximols is a cost-effective intervention for MS spasticity in multiple European settings. Cannabidiol was found to be a cost-effective for Dravet syndrome in a Canadian setting whereas a cost-utility analysis conducted in a US setting deemed cannabidiol to be not cost-effective for Lennox-Gastaut syndrome. Overall study quality was good, with publications meeting 70% to 100% (median 83%) of the Consolidated Health Economic Evaluation Reporting Standards checklist criteria.Conclusions: Medicinal cannabis-based products may be cost-effective treatment options for MS spasticity, Dravet syndrome, and neuropathic pain, although the literature is nascent. Well-designed clinical trials and health economic evaluations are needed to generate adequate clinical and cost-effectiveness evidence to assist in resource allocation. [ABSTRACT FROM AUTHOR]

Medical cannabis is increasingly used as an alternative therapy for various conditions, including chronic pain, multiple sclerosis, epilepsy, and cancer-related symptoms. However, it is crucial to ensure that patients receive the intended dose of tetrahydrocannabinol (THC) from inhaled cannabis for optimal therapeutic effect without overdose risk. This requires a comprehensive understanding of the factors that influence the pharmacokinetics (PKs) of THC in the respiratory system. However, accurate estimation of lung dosimetry and blood concentration of inhaled THC remains challenging partially because the influence of diversified patient-specific puff patterns on inhaled THC transport, deposition, and translocation is still not well quantified. To address the knowledge gap mentioned above, this study employed a hybrid computational fluid-particle dynamics (CFPD) and PK model to evaluate factors that influence delivered doses of THC to the human respiratory system and the resultant THC-plasma concentration-time profile. Specifically, this study compared multiple puff waveforms for inhalation-holding-exhalation (IHE) with total puff volumes from 55 to 82 ml for 2 or 3 s, hold durations from 0 to 5 s, and three puff waveforms (i.e., square, sinusoidal, and realistic). THC deposition in the airways was recorded during all phases for each case using either 452,849 particles per second for the 1.128-μm monodisperse cases or 399,866 particles per second for the polydisperse cases, with the mass median aerodynamic diameter (MMAD) of 1.128 μm. Pulmonary air-THC particle flow transport dynamics, THC particle deposition data, and THC vapor absorption were predicted using CFPD for four airway regions, then scaled by region-specific bioavailability factors. The deposited THC mass in airway regions represents the initial mass entering a 3-compartment PK model, to predict the THC-plasma concentration-time profiles. The CFPD-PK results revealed significant variability in THC transport, deposition, and plasma concentration based on IHE factors. Specifically, larger puff volumes and longer holding times enhanced THC deposition in deeper airways and increased THC-plasma concentrations. Realistic transient puff waveforms predicted higher particle deposition and THC-plasma concentrations than simplified square waveforms. Polydisperse particle distributions show more realistic deposition patterns than monodisperse particle simulations. This study provides insights into the complexity of THC inhalation therapy, emphasizing the importance of considering individualized puff patterns and realistic particle size distributions in accurately predicting therapeutic outcomes, which is highly related to THC deposition in the lung and THC plasma concentration. These findings and the CFPD-PK modeling framework offer guidance for clinicians in prescribing personalized THC dosages, support regulatory science in evaluating inhalation devices, and contribute to ongoing research aimed at optimizing THC delivery for maximum therapeutic effectiveness while minimizing potential overdose risks. • A CFPD-PK model is used to investigate puff waveform influence on THC transport and translocation. • Longer hold times enhance THC lung deposition and increase THC blood levels. • Larger puff volumes and longer puff duration boost THC blood levels and respiratory deposition. • Realistic puff waveforms outperform square ones in predicting THC transport and effects. • Polydisperse particles show more accurate THC deposition patterns than monodisperse. [ABSTRACT FROM AUTHOR]

Background/purpose: One effective way to deal with dentin hypersensitivity is to develop materials to seal the tubules. The porous bio-calcium carbonate-silica (BCCS) contained well-dispersed CaCO3 would form calcium phosphates to seal the dentinal tubules when mixed with an acidic solution. The acidic hydrothermal treatment and calcination to isolate the BCCS from the agricultural waste like equisetum grass was used, which would be more environmentally friendly than chemically synthesized mesoporous biomaterials. The aim of this study was to develop mesoporous materials from natural resources to occlude the dentinal tubules which could be more environmentally-friendly.Methods: Dentin disc samples were prepared and treated with different methods as follows: (1) BCCS mixed with H3PO4; (2) BCCS mixed with KH2PO4; (3) Seal & Protect® was used as a comparison group. Sealing efficacy was evaluated by measuring the depths and percentages of precipitate occlusion in dentinal tubules with SEM.Results: The N2 adsorption-desorption isotherm of the BCCS demonstrated a pore size of around 15.0 nm and a surface area of 61 m2g-1. From the results of occlusion percentage and depth, the BCCS treated with H3PO4 or KH2PO4 demonstrated promising sealing efficacy than the commercial product.Conclusion: This synthetic process used the agricultural waste equisetum grass to produce bio-calcium carbonate-silica would be environmentally friendly, which has great potential in treating exposed dentin related diseases. [ABSTRACT FROM AUTHOR]

Context: Studies show that patients with cancer use cannabis to manage symptoms and side effects. Medical cannabis is regulated by Health Canada; authorization patterns among cancer patients have not been well described.Objectives: The aim of the study is to describe medical cannabis authorization in Alberta, Canada.Methods: The Alberta Cancer Registry was used to identify all patients aged 18 years and older diagnosed with invasive cancer from April 1, 2014 to December 31, 2016. These cases were linked to records from the College of Physicians and Surgeons of Alberta. Univariate and multivariate logistic regression models were constructed to determine factors associated with medical cannabis authorization.Results: We identified 41,889 patients with cancer between April 1, 2014 and December 31, 2016. Of these patients, 1070 (2.6%) had a medical cannabis authorization. Fifty-one percent (541 of 1070) were authorized to use medical cannabis within one year of diagnosis, 52% (248 of 549) within one year of the start of systemic therapy, and 41% (128 of 312) within one year of the start of radiation therapy. Patients aged 18-29 (odds ratio [OR] 12.4; 95% CI 7.8-19.8), patients living in the Calgary zone (OR 1.8; 95% CI 1.6-2.1), those with advanced disease (Stage III/IV: OR 1.2; 95% CI 1.0-1.4), and those receiving systemic therapy (OR 2.0; 95% CI 1.7-2.4) were more likely to have an authorization for medical cannabis (P < 0.001).Conclusion: A small proportion of patients with cancer were authorized to use medical cannabis between 2014 and 2016 in Alberta. Authorization was associated with a cancer diagnosis and receiving treatment. Younger patients, those with advanced stage disease, and those undergoing systemic treatment were predictors of medical cannabis authorization. [ABSTRACT FROM AUTHOR]

Purpose: Interest in the use of artisanal cannabinoids in pediatric epilepsy has increased but safety and utility data are lacking. Our aim was to prospectively characterize the use of oral cannabis extracts (OCE) in a refractory pediatric epilepsy population.Methods: Families considering the use of an OCE were enrolled in a prospective observational study. Baseline seizure frequency was assessed over a period of 4 weeks. Seizure frequency, CBD and THC-COOH levels were assessed every 4 weeks during a 12-week treatment period. Response was defined as at least a 50% reduction in seizure frequency over the final 8 weeks of the study relative to baseline.Results: Consent was obtained in 32 children; 11 were excluded from analysis (3 failed to complete baseline data, 3 started OCE before completing baseline period and 5 did not start OCE) leaving 21 to be included in subsequent analyses. Median age was 10.3 years (IQR 6.8-12.6), 13 (62%) were male and median seizure frequency was 2.7 seizures/day during the baseline period. The median of the high dose of CBD that was administered during the observation period was of 0.9 (0.6-2.2) mg/kg/day. Of the 21 subjects who were included in the analysis, 5 (24%) were responders. OCE was stopped early in 3 subjects (14%) due to a perceived increase in seizures. THC-COOH and CBD blood levels did not have a significant association with response status (p = 0.95 CBD, p = 0.53 THC-COOH, N = 14).Conclusion: The observed response rate in this study is similar to placebo rates in prospective randomized trials of pharmaceutical grade products and the withdrawal rate is greater than rates obtained with retrospective methods. Doses of OCE administered were lower than doses used in randomized trials. [ABSTRACT FROM AUTHOR]

Context: Although medical cannabis (MC) policies continue to evolve around the world, the integration of MC into clinical practice remains highly debated within the medical community.Objectives: Relying on the Theory of Planned Behavior (TPB), this study aim was to identify underlying factors that influence physicians' intentions to recommend MC to patients and to examine whether there are differences in the strength of these associations across three medical specialties (family medicine, oncology, and pain medicine).Methods: 247 physicians completed questionnaires including measures of TPB constructs (attitudes, subjective norms, and perceived behavioral control) and intentions to recommend MC to two clinical vignettes describing medical background of a cancer and a chronic pain patient. Regression models were used to measure the extent to which perceived knowledge and TPB constructs predict physicians' intentions to recommend MC.Results: Physicians' intentions to recommend MC to the cancer patient vignette was higher than their intentions to recommend to the chronic pain patient vignette. Intentions to recommend MC to the patient with cancer were associated with more favorable attitudes toward MC, whereas intentions to recommend MC to the patient with chronic pain were associated with more favorable attitudes, higher levels of perceived control, and lower levels of perceived knowledge.Conclusion: Clinical practices related to MC may be influenced by nonmedical factors, and this may be particularly prevailing in the field of chronic pain, suggesting that MC may be particularly contentious in this field. [ABSTRACT FROM AUTHOR]

Analysis of cannabis has gained new importance worldwide, mainly for quality control within the legalized recreational and medical cannabis industry, but also for forensic differentiation between drug-type cannabis and legal products such as fiber hemp and CBD-rich/THC-poor cannabis. We herein present an HPLC-DAD method for quantitative analysis of major neutral and acidic cannabinoids in herbal cannabis and hashish: Δ9-tetrahydrocannabinol (THC), Δ9-tetrahydrocannabinolic acid A (THCA), cannabidiol (CBD), cannabidiolic acid (CBDA), and cannabinol (CBN). Plant material was dried, homogenized and extracted with a mixture of methanol/hexane. Chromatographic separation of the analytes was achieved on a core-shell C8 column using gradient elution with water/acetonitrile containing 0.1% formic acid. The analytical run time was 13 min and analytes were detected at 210 nm. The method is selective, sensitive, accurate, and precise, as confirmed through validation according to ICH and AOAC guidelines. Linearity in herbal cannabis ranged from 0.04 to 4.00% for the neutral cannabinoids, and from 0.40 to 20% for the acids. Linear ranges in hashish samples were 0.13-13.33% and 1.33-66.66%, respectively. The presented method was successfully applied to characterize 110 cannabis samples seized by the Swiss police, demonstrating its applicability for routine cannabis potency testing in the forensic setting. [ABSTRACT FROM AUTHOR]

An ethnobotanical survey at Amandawe in the KwaZulu-Natal province of South Africa with 37 participants has revealed 110 new medicinal species records (ca. 31% of the total of 359 species), 560 newly recorded Zulu vernacular names and name variations (66% of the total of 859 names), 60 newly recorded praise names (88% of the total of 69) and 1106 new use-records (78% of the total of 1423 medicinal uses that were recorded at Amandawe). The Fabaceae and Asteraceae each accounted for 8.6% of the species, far outnumbering the other 98 families recorded. The subcategory 'tonics' had the highest number of plant species (156), followed by dermatological (125) and gastro-intestinal (102), while ophthalmic (11), endocrine system (11) and anthelmintics (22) had among the lowest numbers of species. The most popular medicinal plants (as indicated by their Species Popularity Index value) were Cannabis sativa (1.00), Leucas lavandulifolia (1.00), Pittosporum viridiflorum (1.00), Spilanthes mauritiana (1.00) and Tetradenia riparia (0.97), while the most important medicinal plants (as indicated by their Cultural Importance Index values) were Tetradenia riparia (1.84), Spilanthes mauritiana (1.62), Microglossa mespilifolia (1.32) and Leucas lavandulifolia (1.30). Zulu medicinal ethnobotany has long been regarded to be thoroughly documented, yet our findings suggest that contemporary medicinal plant use has not yet been adequately documented. • A survey of medicinal plants at Amandawe in KwaZulu-Natal revealed many novelties. • 110 new medicinal species records (ca. 31% of the total of 359 species recorded). • 560 newly recorded Zulu vernacular names (66% of the total of 859 names). • 1106 new use-records (78% of 1423 medicinal uses that were recorded). • Despite many previous studies, Zulu medicinal ethnobotany remains poorly recorded. [ABSTRACT FROM AUTHOR]

Medical cannabis is becoming increasingly popular for many different ailments and improvement of general well-being. Particularly CBD-rich extracts are easily available via online pharmacies, health stores or directly from producers. However, almost all of the extracts contain small amounts of THC. Thus, in case of continuous or heavy use of CBD rich cannabis, THC concentrations in hair may rise above accepted legal limits. In our study, we investigated THC, CBN and CBD in hair samples from regular CBD rich cannabis users. The goals were to determine levels of the cannabinoids in hair and to evaluate a possible correlation between regular CBD intake and CBD levels in hair. All participants consumed cannabis extracts from the same producer. It contained CBD at different concentrations and small amounts of THC with a CBD/THC concentration ratio of 30. The self-declared CBD dosage ranged from 4 to 128mg CBD/day, corresponding to a daily THC intake of 0.1 to 4.3mg. After extraction and derivatization, hair samples were analysed using a validated GC/MS-MS method. CBD concentrations ranged from 10 to 325pg/mg of hair, but no significant correlation was observed between CBD concentrations and the daily dose. THC was detected in one sample only at a concentration below our cut-off, whereas CBN was not detected. In this study, we showed that even after repeated consumption of CBD-rich cannabis extracts in medium to high doses, consumers are generally tested negative for THC in hair. [ABSTRACT FROM AUTHOR]

Abstract Medical marijuana laws (MMLs) represent a major change of marijuana policy in the U.S. Previous research shows that these laws increase marijuana use among adults. In this paper, we estimate the effects of MMLs on secondary and post-secondary students' time use using data from the American Time Use Survey. We apply a difference-in-differences research design and estimate flexible fixed effects models that condition on state fixed effects and state-specific time trends. We find no effect of MMLs on secondary students' time use. However, we find that college students in MML states spend approximately 20% less time on education-related activities and 20% more time on leisure activities than their counterparts in non-MML states. These behavioral responses largely occur during weekends and summer when students have more spare time. Finally, the impacts of MMLs are heterogeneous and stronger among part-time college students, who are more likely to be first-generation college goers and to come from underrepresented racial and ethnic groups. [ABSTRACT FROM AUTHOR]

• The method for preparing a modified eucalypt extract with a pronounced antistaphylococcal activity, has been developed;. • The formulation of a stable nanoemulsified aqueous eucalypt extract is introduced;. • The aqueous gel consisting of nanoemulsified eucalypt extract and PEO was developed for a semi-solid extrusion 3D printing. Overcoming the health threatening consequences of staphylococcal infections and their negative socio-economic effects have become a priority in the medical, pharmaceutical, food and many other sectors globally. Staphylococcal infections are a big challenge for a global health care, since they are difficult to be diagnosed and treated. Therefore, the development of new medicinal products of plant-origin is timely and important, because bacteria have a limited ability to develop resistance to such products. In the present study, a modified eucalypt (Eucalyptus viminalis L.) extract was prepared and further enhanced by using different excipients (surface active agents) to obtain a water-miscible 3D-printable extract (nanoemulsified aqueous eucalypt extract). Phytochemical and antibacterial studies of the eucalypt leaves extracts were conducted as a preliminary investigation for 3D-printing experiments of the extracts. The nanoemulsified aqueous eucalypt extract was mixed with polyethylene oxide (PEO) to form a gel applicable for semi-solid extrusion (SSE) 3D printing. The key process parameters in a 3D-printing process were identified and verified. The printing quality of the 3D-lattice type eucalypt extract preparations was very good, demonstrating the feasibility of using an aqueous gel in SSE 3D printing also exhibiting compatibility of the carrier polymer (PEO) with the plant extract. The SSE 3D-printed eucalypt extract preparations presented a rapid dissolution in water within 10–15 min, suggesting the applicability of these preparations e.g., in oral immediate-release applications. [Display omitted] [ABSTRACT FROM AUTHOR]

The article discusses various treatments for neuropathic pain (NeP), focusing on the evidence and recommendations by the National Institute for Health and Care Excellence (NICE) of Great Britain and other expert groups. Topics include the benefits of combination therapies for NeP compared with monotherapy, the potential of pain phenotyping to personalised therapies, and the pharmacological approach to manage NeP.

Objective: To determine if regular use of marijuana has an impact on time to pregnancy.Design: Retrospective review of cross-sectional survey data from male and female respondents aged 15-44 years who participated in the 2002, 2006-2010, and 2011-2015 National Survey of Family Growth.Setting: Not applicable.Participant(s): The National Survey of Family Growth is a nationally representative population-based sample derived from stratified multistage area probability sampling of 121 geographic areas in the U.S. Our analytic sample was participants who were actively trying to conceive.Intervention(s): Exposure status was based on the respondents' answers regarding their marijuana use in the preceding 12 months.Main Outcome Measure(s): The main outcome was estimated time to pregnancy, which was hypothesized before analysis to be delayed by regular marijuana use.Result(s): A total of 758 male and 1,076 female participants responded that they were actively trying to conceive. Overall, 16.5% of men reported using any marijuana while attempting to conceive, versus 11.5% of women. The time ratio to pregnancy for never smokers versus daily users of marijuana in men was 1.08 (95% confidence interval 0.79-1.47) and in women 0.92 (0.43-1.95), demonstrating no statistically significant impact of marijuana use on time to pregnancy.Conclusion(s): Our study suggests that neither marijuana use nor frequency of marijuana use was associated with time to pregnancy for men and women. [ABSTRACT FROM AUTHOR]

Pain associated with integumentary wounds is highly prevalent, yet it remains an area of significant unmet need within health care. Currently, systemically administered opioids are the mainstay of treatment. However, recent publications are casting opioids in a negative light given their high side effect profile, inhibition of wound healing, and association with accidental overdose, incidents that are frequently fatal. Thus, novel analgesic strategies for wound-related pain need to be investigated. The ideal methods of pain relief for wound patients are modalities that are topical, lack systemic side effects, noninvasive, self-administered, and display rapid onset of analgesia. Extracts derived from the cannabis plant have been applied to wounds for thousands of years. The discovery of the human endocannabinoid system and its dominant presence throughout the integumentary system provides a valid and logical scientific platform to consider the use of topical cannabinoids for wounds. We are reporting a prospective case series of three patients with pyoderma gangrenosum that were treated with topical medical cannabis compounded in nongenetically modified organic sunflower oil. Clinically significant analgesia that was associated with reduced opioid utilization was noted in all three cases. Topical medical cannabis has the potential to improve pain management in patients suffering from wounds of all classes. [ABSTRACT FROM AUTHOR]

Little is known about the distribution of cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) to patients participating in state medical cannabis programs. The Minnesota cannabis program requires third-party testing of products with limited formulations of cannabis for distribution to patients. To characterize the distribution of cannabis products, their CBD/THC content, and dosing among patients with qualifying conditions. This is a retrospective analysis of ∼50% of registered users receiving medical cannabis in Minnesota (June 16, 2016, to November 15, 2019). Data included formulation, CBD/THC prescribed doses, and qualifying conditions. The primary end points were calculated using daily dose and duration of use. Comparisons were made for CBD and THC total daily dose dispensed, patient age, and approved product. Nonparametric statistical tests were used (significance was set at p < 0.05). A total of 11,520 patients were listed with 1 qualifying condition. The most common condition was intractable pain (60.0%). Median dispensation duration varied from 53 days (cancer) to 322 days (muscle spasms). Most (≥62.8%) patients across all qualifying conditions received both CBD and THC. Median THC dose was lower in older (≥65 years) compared with younger adults with intractable pain (p < 0.0001) and cancer patients (p = 0.0152), and the same pattern was found CBD dose with seizure (p = 0.0498) patients. For commercial products with Food and Drug Administration indications, the median CBD total daily dose was 86.9% lower than the recommended doses for patients with seizures (Epidiolex: Jazz Pharmaceuticals, Palo Alto CA) and median THC total daily dose was 65.3% (Syndros: Benuvia Manufacturing, Round Rock, TX) or 79.3% lower (Marinol: Banner Pharmacaps, Inc., High Point, NC) for cancer patients. A majority of patients received products containing both CBD and THC. Dosages varied by age group and were lower than recommended for conditions with Food and Drug Administration-approved products. Complex pharmacokinetics of THC and CBD, possible age-related changes in physiology, unknown efficacy, and potential for drug interactions all increase the need for monitoring of patients receiving cannabis products. (Curr Ther Res Clin Exp. 2023; 84:XXX–XXX) [ABSTRACT FROM AUTHOR]

Traffic policies show growing concerns about driving under the influence of cannabis, since cannabinoids are one of the most frequently encountered psychoactive substances in the blood of drivers who are drug-impaired and/or involved in accidents, and in the context of a legalization of medical marijuana and of recreational use. The neurobiological mechanisms underlying the effects of cannabis on safe driving remain poorly understood. In order to better understand its acute and long-term effects on psychomotor functions involved in the short term ability and long-term fitness to drive, experimental research has been conducted based on laboratory, simulator or on-road studies, as well as on structural and functional brain imaging. Results presented in this review show a cannabis-induced impairment of actual driving performance by increasing lane weaving and mean distance headway to the preceding vehicle. Acute and long-term dose-dependent impairments of specific cognitive functions and psychomotor abilities were also noted, extending beyond a few weeks after the cessation of use. Some discrepancies found between these studies could be explained by factors such as history of cannabis use, routes of administration, dose ranges, or study designs (e.g. treatment blinding). Moreover, use of both alcohol and cannabis has been shown to lead to greater odds of making an error than use of either alcohol or cannabis alone. Although the correlation between blood or oral fluid concentrations and psychoactive effects of THC needs a better understanding, blood sampling has been shown to be the most effective way to evaluate the level of impairment of drivers under the influence of cannabis. The blood tests have also shown to be useful to highlight a chronic use of cannabis that suggests an addiction and therefore a long-term unfitness to drive. Besides blood, hair and repeated urine analyses are useful to confirm abstinence. [ABSTRACT FROM AUTHOR]

We developed a novel immunoassay for herbal cannabis based on a new immunoassay principle that uses Ultra Quenchbody ("UQ-body"), a recombinant antibody Fab fragment fluorolabeled at the N-terminal regions. When the antigen binds to anti-Δ(9)-tetrahydrocannabinol (THC) UQ-body, the fluorescence intensity (FI) decreases. The analytical conditions of the immunoassay were optimized based on the FI reduction rate (FIRR). Following are the steps in the final analytical procedure: (1) 10mg of samples were extracted with 1ml of a 60:40 mixture of methanol and phosphate-buffered saline (PBS); (2) the extract was filtered through a centrifugal 0.2-μm polytetrafluoroethylene membrane filter; (3) the filtrate was diluted 100 times with extraction solvent; (4) 6-μl diluted solution was mixed with 19-μl PBS and 75-μl UQ-body solution; and (5) FIRR was measured under 275-mV excitation light. Herbal cannabis samples containing ≥4.0-mg/g THC gave FIRRs of ≥5.2%. FIRRs of negative samples (cigarette, tea, spice, and so-called "synthetic marijuana") were ≤3.1%. When setting the FIRR threshold to 5.0%, cannabis samples containing ≥4.0-mg/g THC were correctly judged as positive without being affected by false positives caused by the negative samples. This detection limit was lower than total THC level (10-200mg/g) in most herbal cannabis samples seized in Japan. In seven of the 10 cannabis samples, the results of the UQ-body test were comparable with those of the Duquenois-Levine test. Thus, the UQ-body-based immunoassay is presumed to be an effective and objective drug screening method for herbal cannabis; however, to show the true usefulness, it is necessary to test a number of real case samples in the field situation. [ABSTRACT FROM AUTHOR]

Unlabelled: Since 2013 in the Italian market has been introduced the Nabiximols, a drug containing two of the main active cannabinoids: Δ(9)-tetrahydrocannabinol (Δ(9)-THC) and cannabidiol (CBD). This drug has been approved in Italy in the treatment of Multiple Sclerosis (MS). It is an oral spray formulation and each puff of 100μl contains 2.7mg of Δ(9)-THC and 2.5mg of CBD. In the present study we analyzed urine and blood samples collected from a group of 20 patients treated with Nabiximols in order to evaluate: blood Δ(9)-THC concentrations in relation to the dose administered and the duration of treatment and the potentiality of this medication to be used for drug habit.Methods: The study was conducted on a sample group of patients affected by MS, of both sexes, age: 49-61 years, treated with Nabiximols for short (28 days) or long-term. The results of our study allow affirming that it is unlikely to use this medication for drug habit or to sale it in the black market because of the low blood concentrations available and of its high costs. These statements were confirmed by: (a) the low Δ(9)-THC concentrations in the pharmaceutical formulation; (b) the low blood concentrations produced by Nabiximols administration, more than 10 times smaller than the blood concentrations known to produce psychotropic effects; (c) the presence of CBD (Δ(9)-THC natural antagonist); (d) the route of administration (inhaled, not smoked). [ABSTRACT FROM AUTHOR]

Cannabis is a genus of annual flowering plant. Cannabis is often divided into 3 species-Cannabis sativa, Cannabis indica, and Cannabis ruderalis-but there is significant disagreement about this, and some consider them subspecies of the same parent species. Cannabis sativa can grow to 5-18 feet or more, and often has a few branches. Cannabis indica typically grows 2-4 feet tall and is compactly branched. Cannabis ruderalis contains very low levels of Δ-9-tetrahyocannabinol so is rarely grown by itself. Cannabis ruderalis flowers as a result of age, not light conditions, which is called autoflowering. It is principally used in hybrids, to enable the hybrid to have the autoflowering property. There are > 700 strains of cannabis, often with colorful names. Some are strains of 1 of the 3 subspecies. Many are crossbred hybrids. The strains can be named in a variety of ways: smell or lineage are common ways of naming. There are only a few rules about how the strains are named, and most strains' names do not follow the rules. There are 4 basic preparations of marijuana: bhang, hasish, oil (or hash oil), and leaves and/or buds. In medical marijuana trials, subjective outcomes are frequently used but blind breaking can introduce significant bias. Blind breaking occurs when patients figure out if they are in the control or the treatment group. When this occurs, there is significant overestimation of treatment effect. [ABSTRACT FROM AUTHOR]

Context The use of the cannabis plant ( Cannabis sativa L.) for the palliative treatment of cancer patients has been legalized in multiple jurisdictions including Israel. Yet, not much is currently known regarding the efficacy and patterns of use of cannabis in this setting. Objectives To analyze the indications for the administration of cannabis among adult Israeli cancer patients and evaluate its efficacy. Methods Efficacy and patterns of use of cannabis were evaluated using physician-completed application forms, medical files, and a detailed questionnaire in adult cancer patients treated at a single institution. Results Of approximately 17,000 cancer patients seen, 279 (<1.7%) received a permit for cannabis from an authorized institutional oncologist. The median age of cannabis users was 60 years (range 19–93 years), 160 (57%) were female, and 234 (84%) had metastatic disease. Of 151 (54%) patients alive at six months, 70 (46%) renewed their cannabis permit. Renewal was more common among younger patients and those with metastatic disease. Of 113 patients alive and using cannabis at one month, 69 (61%) responded to the detailed questionnaire. Improvement in pain, general well-being, appetite, and nausea were reported by 70%, 70%, 60%, and 50%, respectively. Side effects were mild and consisted mostly of fatigue and dizziness. Conclusion Cannabis use is perceived as highly effective by some patients with advanced cancer and its administration can be regulated, even by local authorities. Additional studies are required to evaluate the efficacy of cannabis as part of the palliative treatment of cancer patients. [ABSTRACT FROM AUTHOR]

Cannabis cultivation for medical purposes in Brazil has been increased in the last years. While cannabis crops are prohibited, hundreds patients have been granted with judicial authorizations and there is little information about the cultivation conditions, yields and chemical profiles of the plants. Cannabis plants contain hundreds of compounds, with cannabinoids and terpenes the main drivers of their toxicological and pharmacological properties. Besides the cannabinoids, terpene contents are useful for the chemotaxonomic classification of different varieties, and their role in forensic analyses should be further delineated. The present study monitored cannabis crops of fifteen participants who were granted special licenses by the Brazilian Courts in Rio de Janeiro and São Paulo. The cultivation conditions were monitored and five cannabinoids (tetrahydrocannabinol acid-THCA, tetrahydrocannabinol-THC, cannabidiolic acid-CBDA, cannabidiol-CBD and cannabinol-CBN) and nineteen terpenes were quantified in cannabis flowers. The total grow cycle of thirty-five cannabis plants ranged from 10 to 24 weeks. The dry flower yields ranged 22-90 g per plant. Most cannabis specimens were CBD-rich varieties (CBD levels from 1.6% to 16.7%, and THC levels from 0.0% to 2.6%, n = 22) used to treat epileptic patients. The THC-rich varieties contained CBD levels ranging from 0.03% to 0.8%, and THC levels from 0.7% to 20.1%, n = 11. Fewer of the samples contained THC:CBD ratios of approximately 1:1 (CBD levels of 3.3-3.8% and THC levels of 2.2-3.7%, n = 2). The most abundant terpenes in the cannabis flowers were beta-caryophyllene, alpha-humulene, guaiol and alpha-bisabolol. CBD-rich varieties showed significant higher levels of beta-caryophyllene and alpha-humulene in comparison with THC-rich varieties. Overall, the study herein provides data concerning medical cannabis crops grown in a region of Brazil that not only guide individual medical cannabis cultivation methods but also aid forensic analyses. [ABSTRACT FROM AUTHOR]

Cannabis (Cannabis sativa L.) for medical purposes has been legalized again in many countries in recent years. Currently, only two major cannabinoids (Δ9-THC and CBD) are considered in the legislation and medication, which is not sufficient in case of dried plant material or resulting extract. Other substances (mainly terpenes/terpenoids), or their specific combinations, could influence the resulting therapeutic effect for specific oncology diagnosis and specific patients. Six different genotypes (Conspiracy Kush, Jilly Bean, Jack Cleaner 2, Jack Skellington, Nordle and Nurse Jackie) were cultivated indoor at the Czech University of Life Sciences Prague. Ethanol extracts taken from the inflorescences were assayed for their content of main cannabinoids and terpenes/terpenoids. The extracts were used for in vitro cytotoxicity studies on hepatocarcinoma human cell lines Hep-G2 and colorectal carcinoma human cell lines Caco-2 and Ht-29. Healthy lung fibroblast MRC-5 and healthy intestinal cells FHs 74 Int were used to compare selectivity of cytotoxicity. The average content of Δ9-THC in extracts was 59.1 ± 2.43%, and of CBD 1.84 ± 0.17%. The content of main cannabinoids in the Nurse Jackie genotype extract was significantly greater than that of the other genotypes. Overall, more than 60 different terpenes/terpenoids were identified in the extracts. The major terpenes/terpenoids detected in most genotypes were limonene, linalool, α-terpineol, β-caryophyllene, trans -α-bergamotene, α-humulene, β-caryophyllene oxide, guaiol, γ-eudesmol, β-eudesmol and α-bisabolol. Differences in the terpene composition of individual genotypes were caused by minor terpenoids, such as β-ocimene, isopulegol acetate, β-elemene, β-selinene and spathulenol. All extracts were highly cytotoxic to Ht-29 colorectal carcinoma cells and showed positive selectivity compared to healthy FHs 74 Int colon cells. The Jack Cleaner 2 extract was cytotoxic to all cell lines tested at the lowest concentrations (8.48 ± 2.4–16.14 ± 0,07 μg/mL), but was positively selective only for colorectal cancer cells, especially Ht-29 and to a lesser extent for Caco-2. Similarly, the Nordle extract showed positive selectivity for Ht-29 and Caco-2 only. Jilly Bean was unique in this study, in that its extract functioned on all cell lines at the highest concentrations (20.13 ± 3.05–49.88 ± 1.5 μg/mL), whilst also being highly positively selective in all carcinoma lines (Ht-29, Caco-2 and Hep-G2 hepatocarcinoma) compared to healthy cell lines (FHs 74 Int and MRC-5). The results suggest that Δ9-THC and CBD are responsible for the in vitro cytotoxicity of the extracts, but observed differences in selectivity reveal their synergies with other substances. According to chemical analysis, higher concentrations of myrcene, β-elemene, β-selinene and α-bisabolol oxide found in the Jilly Bean genotype may positively affect the selectivity of cytotoxic activity. It is therefore vital that similar studies are performed on other cell lines, in order to be able to recommend these cannabis genotypes for preclinical and clinical studies, which are still lacking. • Two major cannabinoids and more than 60 terpenes/terpenoids have been identified in extracts. • Composition of cannabis extracts modifies cytotoxicity on various human cell lines. • All tested extracts were selectively cytotoxic to colorectal cancer cells Ht-29. • One of the six extracts tested was selectively cytotoxic for all cancer lines tested. [ABSTRACT FROM AUTHOR]

Abstract: Cannabis products (marijuana, hashish, cannabis oil) are the most frequently abused illegal substances worldwide. Delta-9-tetrahydrocannabinol (THC) is the main psychoactive component of Cannabis sativa plant, whereas cannabidiol (CBD) and cannabinol (CBN) are other major but no psychoactive constituents. Many studies have already been carried out on these compounds and chemical research was encouraged due to the legal implications concerning the misuse of marijuana. The aim of this study was to determine THC, CBD and CBN in a significant number of cannabis samples of Albanian origin, where cannabis is the most frequently used drug of abuse, in order to evaluate and classify them according to their cannabinoid composition. A GC–MS method was used, in order to assay cannabinoid content of hemp samples harvested at different maturation degree levels during the summer months and grown in different areas of Albania. This method can also be used for the determination of plant phenotype, the evaluation of psychoactive potency and the control of material quality. The highest cannabinoid concentrations were found in the flowers of cannabis. The THC concentrations in different locations of Albania ranged from 1.07 to 12.13%. The influence of environmental conditions on cannabinoid content is discussed. The cannabinoid content of cannabis plants were used for their profiling, and it was used for their classification, according to their geographical origin. The determined concentrations justify the fact that Albania is an area where cannabis is extensively cultivated for illegal purposes. [Copyright &y& Elsevier]

Abstract: In the last 15years there has been a major shift in the laws governing medical use of cannabis in the United States. Corresponding with this change there has been escalating interest in the role that cannabis, commonly referred to as marijuana, and cannabinoids play in the care of patients with cancer. This review will examine cannabis’ and cannabinoids’ current and potential roles in cancer care. Specifically, we will examine five areas of cannabis medicine: (1) pharmacologic properties of cannabis; (2) its potential role in the development of human cancers, particularly smoking-related malignancies; (3) cannabinoids’ potential as anti-cancer therapies; (4) cannabis and cannabinoids in the palliation of common cancer-associated symptoms; (5) current legal status of cannabis for medical purposes in the United States. [Copyright &y& Elsevier]

Summary: Traumatic brain injury (TBI) remains one of the leading causes of mortality and morbidity worldwide in individuals under the age of 45 years, and, despite extensive efforts to develop neuroprotective therapies, there has been no successful outcome in any trial of neuroprotection to date. In addition to recognizing that many TBI clinical trials have not been optimally designed to detect potential efficacy, the failures can be attributed largely to the fact that most of the therapies investigated have been targeted toward an individual injury factor. The contemporary view of TBI is that of a very heterogenous type of injury, one that varies widely in etiology, clinical presentation, severity, and pathophysiology. The mechanisms involved in neuronal cell death after TBI involve an interaction of acute and delayed anatomic, molecular, biochemical, and physiological events that are both complex and multifaceted. Accordingly, neuropharmacotherapies need to be targeted at the multiple injury factors that contribute to the secondary injury cascade, and, in so doing, maximize the likelihood of a successful outcome. This review focuses on a number of such multifunctional compounds that have shown considerable success in experimental studies and that show maximum promise for success in clinical trials. [Copyright &y& Elsevier]

To contrast comorbidities, prescription opioid and benzodiazepine use between medical cannabis (MC) cardholders in Arkansas compared to a matched control group. Methods This cross-sectional retrospective study used the Arkansas All Payers' Claims Database (APCD) linked to a medical cannabis cardholder file from July 2017 through June 2018. [Extracted from the article]

Cannabis sativa contains numerous cannabinoids, with D9-tetrahydrocannabinol (THC) and cannabidiol (CBD), the primary cannabinoids. Both possess potent anti-inflammatory and immunosuppressive properties, but THC has significant psychoactive properties. Yeshuron's phase 2 study of CBD plus standard GVHD prophylaxis found low rates of grade 2-4 acute(A-) GVHD, and compared with 101 historical controls given standard GVHD prophylaxis, the hazard ratio of developing grades 2-4 A-GVHD was.3 (P =.0002). Kalytera Therapeutics announced a Phase 2a study of CBD for treatment of Grade 3 - 4 A-GVHD, including 9/ 10 responses, of which 7 were complete remission (CR). We report a case of steroid refractory eczematous GVHD successfully treated with a CBD predominant medical cannabis product. A 35 year old woman with T-cell Acute Lymphoblastic Leukemia with CNS involvement in complete remission underwent matched related donor stem cell transplant (SCT) conditioned with Etoposide, TBI 1200 cGy. GvHD prophylaxis was Alemtuzumab, Tacrolimus. A rash developed on day 126 post transplant involving face and scalp and within 1 week involved 100% BSA with itching, facial and orbital swelling, ankle/feet swelling. Skin biopsy revealed an eczematous variant of GvHD known to be very aggressive, difficult to control with immunosuppression , and carries a poor prognosis. Phototherapy and steroid ointment provided initial benefit and regression of rash but it recurred within 6 months. Ruxolitinib provided no benefit. Systemic steroids were restarted at 1mg/kg/ day with minimal benefit. Photopheresis offered only minimal response. Ibrutinib was added. With steroids, photopheresis and ibrutinib she had only marginal response. Numerous infectious complications including soft tissue skin infections required multiple admissions. At 16 months post SCT, she began a medical cannabis product manufactured by VIREO HEALTH, consisting of a high CBD:THC ratio (19:1) oral solution containing CBD 47.5mg/ml and THC 2.5mg/ml. A daily dose of 6 ml provided 285 mg CBD and 15mg THC daily comparable to the 300 mg CBD Kalytera product. Toxicity was sleepiness; thus it was dosed in the evening. There was a definite response within 3 months, allowing discontinuation of ibrutinib and photopheresis. By 2 years post SCT, her GVHD had resolved with only mild itching and flakiness. Her response is sustained 1 year after starting CBD. She remains on 6 ml daily. This adds to the evidence of the anti- inflammatory and immunosuppressive effects of medical cannabis and its activity for the treatment of active GVHD. THC and CBD are anti-inflammatory via CB2 receptors. THC inhibits T-lymphocyte expansion in a murine BMT model. The THC component may have both therapeutic benefit and dose limiting toxicity. Further studies are warranted to explore the role, optimal dose of medical cannabis, in the management of GVHD. [ABSTRACT FROM AUTHOR]

Objectives: To examine attitudes and beliefs about medical cannabis (MC), and specifically about its application for pain management, across medical students in Israel and Thailand.Design: Cross-sectional survey which measured attitudes and beliefs about MC. Participants were additionally asked to rate the perceived efficacy of MC for different medical conditions that are related to pain (arthritis, chronic pain, fibromyalgia and multiple sclerosis). Pearson's Chi-squared test was used to compare between students from the participating universities.Results: 430 medical students participated, 37.9 % (n = 163) from Israel and 62.1 % (n = 267) from Thailand. Personal cannabis use was reported by 55.6 % of the Israeli and only by 6.9 % of the Thai students (p < .001). Israeli secular students, compared to those from Thailand, were more likely to recommend MC for patient treatment, less concerned about serious physical and mental health risks, and more inclined to support legalization of recreational cannabis. Israeli students reported more permissive attitudes toward MC, but reported feeling less prepared to answer patient/client questions about MC than their Thai counterparts.Conclusions: The findings of this study accentuate the need for curriculum designed around MC use to promote students' preparedness to serve patients in pain or with other medical conditions that may benefit from MC use. [ABSTRACT FROM AUTHOR]

The application of long-lasting antibacterial microorganism materials has presented enormous challenges, especially when infection by pathogenic bacteria triggers global public health and safety issues. In this study, PPCL@PDA-TAEG melt-blown membranes with rechargeable, storable, and antibacterial property are constructed by grafting bisbenzophenone-structured 4,4, -terephthaloyl diphthalic anhydride photosensitizer and epigallocatechin gallate antibacterial agent on the PPCL melt-blown membranes. Result shows that after chemical grafting, the synergistic effects of rechargeable and antibacterial performance on the melt-blown membrane are achieved under ordinary daylight irradiation. Moreover, the resultant melt-blown membranes show enhanced chemical stability, and the UV–vis absorption peak intensity remains above 80% after 1 month of storage under dark conditions. The sterilization rate of Staphylococcus aureus and Escherichia coli can reach 99.9% and 95%, respectively. The air permeability and moisture permeability of PPCL@PDA-TAEG melt-blown membranes are 22.3% and 43.7% higher, respectively, than those of PPCL melt-blown membranes. This facile and low-cost method for preparing PPCL@PDA-TAEG melt-blown membranes provides a new strategic direction for designing biomedical medical materials with long-lasting antibacterial efficacy. [Display omitted] • Photodynamic TDPA material is first synthesized by TDPA photosensitizer and EGCG antibacterial agent. • TDPA-EGCG melt-blown membrane has rechargeable ability and efficient bactericidal ability in sunlight and darkness. • TDPA-EGCG melt-blown membrane has long-term storage stability and sterilization rate in the dark. [ABSTRACT FROM AUTHOR]

As the frequency of cannabis-based therapy increases, the ability to distinguish intake of cannabis-based medicines from recreational cannabis use becomes desirable. Minor cannabinoids have been suggested to indicate recreational cannabis use in biological matrices but are unreliable when presumably also present in directly plantderived medicines. Thus, for therapeutics such as medical cannabis, Sativex® and Dronabinol, a more thorough investigation of cannabinoid profiles is required to identify possible distinguishing markers. In this study, 16 phytocannabinoids were quantified in samples of seized and medical cannabis, Sativex® and Dronabinol from two different manufacturers, using a validated LC-MS/MS method. Analytes included delta-9- tetrahydrocannabinol, tetrahydocannabinolic acid A, cannabidiol, cannabidiolic acid, cannabigerol, cannabigerolic acid, cannabinol, cannabinolic acid, cannabichromene, cannabichromenic acid, cannabicyclol, cannabicyclolic acid, tetrahydrocannabivarin, tetrahydrocannabivarinic acid, cannabidivarin and cannabidivarinic acid. Resultant cannabinoid profiles were compared, and markers were suggested. Characteristics of Sativex® included a specific cannabidiol/tetrahydrocannabinol ratio and presence of cannabichromene, while acidic cannabinoids, cannabigerol and cannabinol occurred in only low amounts. As expected, the predominant ingredient in Dronabinol was tetrahydrocannabinol, but minor cannabinoids were quantified as well. Medical marihuana and seized cannabis were compared separately in a principal component analysis. Several medical marihuana varieties were found to significantly differ from seized cannabis, mostly regarding contents of tetrahydocannabinolic acid A and tetrahydrocannabivarinic acid and cannabidiolic and cannabidivarinic acid respectively. [ABSTRACT FROM AUTHOR]

Objectives: To assess knowledge, attitudes and beliefs regarding medical cannabis among Israeli medical, nursing, social work and other health related students as well as to outline the formation of an instrument for standardized data collection on these topics.Methods: An invitation to participate with a link for the online survey was sent to all students pursuing a degree in medicine, nursing, social work, and other health disciplines in the Ben Gurion University of the Negev, Israel. The instrument included 32 items that measured knowledge, attitudes and beliefs regarding medical cannabis. In addition, demographic data were collected and participants were asked about the frequency of medical or recreational cannabis use.Results: Among the 763 participants, 596 were females (78 %), and the mean age was 25.8 years. While the reported personal use of medical cannabis was minimal (1.9 %), cannabis use for recreational purposes was relatively common (54.0 %). The vast majority believed that medical cannabis holds significant health benefits but expressed concerns regarding potential risks of cannabis use. Additionally, the vast majority of students felt unprepared to answer patients' questions about medical cannabis and expressed a desire to receive more training. Several significant differences between the different academic disciplines were observed.Conclusions: In light of current regulatory and scientific developments, it is apparent that students of health professions will need a greater level of understanding of medical cannabis than previous generations of students. This study emphasizes the ample need for more knowledge and formal education to students of health and related professions. [ABSTRACT FROM AUTHOR]

Objectives: It has been previously demonstrated that healthcare professionals would like additional education on medical cannabis. However, there has not yet been a review of the status of medical cannabis curriculum for medical and allied healthcare trainees worldwide, even though future healthcare workers will be placed on the forefront of patient care and must be prepared to counsel patients. This study was designed to address this gap in knowledge.Design: A search syntax was generated and databases PubMed, ERIC, CINAHL, and Web of Science were searched for relevant articles. A grey literature search of Google Scholar, MedEd, Medline, and the Proquest Dissertations and Theses section was also performed. All titles and abstracts were screened. Selected articles were subsequently screened using predetermined inclusion and exclusion criteria.Results: Allied healthcare trainees lacked sufficient knowledge about medical cannabis and did not feel prepared to counsel patients on this subject. Additionally, they expressed a growing interest in medical cannabis and would like more standardized education on the topic. Finally, faculty and deans in various institutions agreed on the need to educate students on the subject, and aimed to implement courses on medical cannabis or expand their existing curricula.Conclusions: While the medical cannabis landscape is developing, medical and allied health students are not properly educated and knowledgeable on this emerging field of clinical care. The findings suggest that the implementation of competencies-based curricula on medical cannabis is essential for medical and allied healthcare trainees to have the appropriate level of knowledge to counsel and educate their patients. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate medical marijuana patients' perceptions of therapeutic benefits for self-reported medical conditions.Design: The study was a concurrent mixed methods study with adult medical marijuana patients. Survey data were collected using a web-based survey, and interviews were conducted in person or over the phone.Setting: The study recruited 196 medical marijuana patients to complete surveys and 13 patients to participate in qualitative interviews in Florida.Measures: A validated patient survey was distributed via Florida medical marijuana social media groups to examine the therapeutic benefits of the cannabis plant for medical conditions and overall well-being. Concurrently, qualitative interviews were conducted to understand barriers and facilitators to accessing medical cannabis and explore preferences for different forms and strains, as well as any unexpected side effects.Results: Patients used medical cannabis for relief of chronic pain or depression, followed by arthritis and nausea. Survey results indicated 89 % of patients reported "great relief" for their medical condition. Over 76 % of patients reported a score of 8 or higher on a 10-point scale that their medical condition had improved, and over 68 % reported a score of 8 or higher that medical cannabis had reduced their pain. Interviews indicated medical cannabis was effective for pain relief and reducing the use of prescription medicines, but the drug was perceived as too expensive.Conclusions: Medical marijuana patients were positive about the health benefits they received and the fact they were able to reduce or eliminate many prescription medications; however, there were concerns about the costs. [ABSTRACT FROM AUTHOR]

The world acceptance of medical cannabis slowly widens. Cannabinoids are known as the main therapeutic active compounds in the cannabis plant, yet their bioactive physiological effects are still unknown. In this study, the mode of action of nine selected cannabinoids was examined using a bioluminescent bacterial panel, as well as the extracts of six different cannabis varieties and cannabinoids standards artificial mixtures. The bacterial panel was composed of genetically modified E. coli bacteria that is commonly found in the gut microbiome, to which a lux operon was added to various stress promoters. The panel was exposed to the cannabinoids in order to identify bacterial defense mechanism, via the aforementioned specific stress types response. This enables the understanding of the toxicity mode of action of cannabinoids. From all the tested cannabinoids, only delta-9-tetrahydrocannabinol (THC) and delta-9-tetrahydrocannabinolic acid A (THCA) produced a genotoxic effect, while the other tested cannabinoids, demonstrated cytotoxic or oxidative damages. Unlike pure cannabinoids, cannabis plant extracts exhibited mostly genotoxicity, with minor cytotoxicity or oxidative stress responses. Moreover, cannabinoids standards artificial mixtures produced a different response patterns compared to their individual effects, which may be due to additional synergistic or antagonistic reactions between the mixed chemicals on the bacterial panel. The results showed that despite the lack of cannabigerol (CBG), cannabidivarin (CBDV), cannabinol (CBN), and cannabichromene (CBC) in the artificial solution mimicking the CN6 cannabis variety, a similar response pattern to the cannabinoids standards mixture was obtained. This work contributes to the understanding of such correlations and may provide a realistic view of cannabinoid effects on the human microbiome. Cannabinoids are known as the main therapeutic active compounds in the cannabis plant, yet their bioactive physiological effects are still unknown. In this study, the mode of action of nine selected cannabinoids was examined using a bioluminescent bacterial panel, as well as cannabis plant extracts and mixtures. The bacterial panel was composed of genetically modified E. coli bacteria that is commonly found in the gut microbiome, to which a lux operon was added to various stress promoters. The panel was exposed to the cannabinoids in order to identify the bacterial toxicity defense mechanism. Image 1 • Cannabinoids toxicity mode of action was tested by a bioluminescent bacterial panel. • Three stress types were compared: genotoxic, cytotoxic and oxidative effects. • Genetically modified E. coli bacteria were used as a model of the gut microbiome. • THC/TCHA had genotoxic effects, other cannabinoids had cytotoxic/oxidative effects. • Cannabis extracts had genotoxic effects due to synergistic/antagonistic reactions. [ABSTRACT FROM AUTHOR]