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Understanding differences in post-legalization patterns of marijuana between rural and urban environments has the potential to go a long way towards targeting intervention efforts aimed at reducing marijuana use disorders. Data come from the National Survey on Drug Use and Health (NSDUH, 2015–2019, N = 210,392). Survey-weighted multivariable linear and logistic regression analyses were used to assess the relationship between key marijuana-related variables and the status of medical marijuana use in each state with interaction terms for rural versus urban status. Among the entire sample, the prevalence of marijuana abuse and dependence were 0.7% and 1.8%, respectively. Among marijuana users, the average number of days on which marijuana was used was 131.3 (SD = 136.3) days. Those living in states with legalized medical marijuana reported use on a greater number of days (B = 10.69; 95% CI: 5.26, 16.13) with frequency of use increasing as rurality increased, compared to a core based statistical area (CBSA) of ≥1 million: a CBSA of <1 million residents (B = 23.02; 95% CI: 17.38, 28.66) and non-CBSA (B = 37.62; 95% CI: 22.66, 52.58). We also observed lower odds of driving under the influence of marijuana in states where medical marijuana was legal (aOR = 0.86; 95% CI: 0.77, 0.95). We observed an increase in the frequency of marijuana use and a decrease in driving under the influence of marijuana in states with legalized medical marijuana use relative to those states where it remained illegal. We also observed key moderation based on rural-urban status. This body of results suggests that problematic marijuana use may be on the rise following the legalization of marijuana use, but also that corresponding protective attitudes exist. [ABSTRACT FROM AUTHOR]

As cannabinoid-based medications gain popularity in the treatment of refractory medical conditions, it is crucial to examine the neurocognitive effects of commonly prescribed products to ensure associated safety profiles. The present study aims to investigate the acute effects of a standard 1 mL sublingual dose of CannEpil®, a medicinal cannabis oil containing 100 mg cannabidiol (CBD) and 5 mg Δ9-tetrahydrocannabinol (THC) on neurocognition, attention, and mood. A randomised, double-blind, placebo-controlled, within-subjects design assessed 31 healthy participants (16 female, 15 male), aged between 21 and 58 years, over a two-week experimental protocol. Neurocognitive performance outcomes were assessed using the Cambridge Neuropsychological Test Automated Battery, with the Profile of Mood States questionnaire, and the Bond-Lader Visual Analogue Scale used to assess subjective state and mood. CannEpil increased Total Errors in Spatial Span and Correct Latency (median) in Pattern Recognition Memory, while also increasing Efficiency Score (lower score indicates greater efficiency) relative to placebo (all p <.05). Subjective Contentedness (p <.01) and Amicability (p <.05) were also increased at around 2.5 h post dosing, relative to placebo. Drowsiness or sedative effect was reported by 23 % of participants between three to six hours post CannEpil administration. Plasma concentrations of CBD, THC, and their metabolites were not significantly correlated with any observed alterations in neurocognition, subjective state, or adverse event occurrence. An acute dose of CannEpil impairs select aspects of visuospatial working memory and delayed pattern recognition, while largely preserving mood states among healthy individuals. Intermittent reports of drowsiness and sedation underscore the inter-individual variability of medicinal cannabis effects on subjective state. (ANZCTR; ACTRN12619000932167; https://www.anzctr.org.au) [ABSTRACT FROM AUTHOR]

Cannabis use may increase the risk of self-harm, but whether legalization of cannabis is associated with changes in self-harm is unknown. We examined changes in cannabis-involvement in emergency department (ED) visits for self-harm after the liberalization of medical and legalization of non-medical cannabis in Canada. This repeated cross-sectional study used health administrative data to identify all ED visits for self-harm in individuals aged ten and older between January 2010 and December 2021. We identified self-harm ED visits with a co-diagnosis of cannabis (main exposure) or alcohol (control condition) and examined changes in rates of visits over four distinct policy periods (pre-legalization, medical liberalization, non-medical legalization with restrictions, and non-medical commercialization/COVID-19) using Poisson models. The study included 158,912 individuals with one or more self-harm ED visits, of which 7810 (4.9 %) individuals had a co-diagnosis of cannabis use and 24,761 (15.6 %) had a co-diagnosis of alcohol use. Between 2010 and 2021, the annual rate of ED visits for self-harm injuries involving cannabis per 100,000 individuals increased by 90.1 % (3.6 in 2010 to 6.9 in 2021 per 100,000 individuals), while the annual rate of self-harm injuries involving alcohol decreased by 17.3 % (168.1 in 2010 to 153.1 in 2021 per 100,000 individuals). The entire increase in visits relative to pre-legalization occurred after medical liberalization (seasonally adjusted Risk Ratio [a s RR] 1.71 95 % CI 1.09–1.15) with no further increases during the legalization with restrictions (a s RR 1.77 95%CI 1.62–1.93) or commercialization/COVID-19 periods (a s RR 1.63 95%CI 1.50–176). Cannabis-involvement in self-harm ED visits almost doubled over 12 years and may have accelerated after medical cannabis liberalization. While the results cannot determine whether cannabis is increasingly causing self-harm ED visits or whether cannabis is increasingly being used by individuals at high risk of self-harm, greater detection for cannabis use in this population and intervention may be indicated. • Of the 158,912 self-harm ED visits in Ontario, Canada between 2010 and 2021, 4.9 % involved cannabis. • The annual rate of self-harm ED visits with cannabis involvement increased by 90.1 %. • Medical cannabis liberalization was associated with these increases. [ABSTRACT FROM AUTHOR]

Children receiving palliative care have life-limiting or life-threatening conditions, which include symptoms ranging from unpleasant to intolerable suffering. We describe three diverse cases of medical marijuana within ambulatory pediatric palliative care, highlighting use for spasticity, refractory seizures, and cancer-related symptoms. Included are caregiver perspectives of their child's experience with medical marijuana. This population has high potential for positive effects from medical marijuana therapy, particularly for maximizing quality of life. [ABSTRACT FROM AUTHOR]

Despite evidence showing that recreational cannabis use is associated with a higher risk of psychotic disorders, this risk has not been well characterized for patients using medical cannabis. Therefore, this study assessed the risk of emergency department (ED) visits and hospitalization for psychotic disorders (the study outcome) among adult patients authorized to use medical cannabis. We performed a retrospective cohort study on patients authorized to use medical cannabis in a group of Ontario cannabis clinics between 2014 and 2019. Using clinical and health administrative data, each patient was matched by propensity scores to up to 3 population-based controls. Conditional Cox proportional hazards regressions were used to assess the risk. Among 54,006 cannabis patients matched to 161,265 controls, 39 % were aged ≤50 years, and 54 % were female. Incidence rates for psychotic disorders were 3.00/1000 person-years (95%CI: 2.72–3.32) in the cannabis group and 1.88/1000 person-years (1.75–2.03) in the control group. A significant association was observed, with an adjusted hazard ratio of 1.38 (95%CI: 1.19–1.60) in the total sample and 1.63 (1.40–1.91) in patients without previous psychotic disorders. The results suggest that cannabis authorization should include a benefit-risk assessment of psychotic disorders to minimize the risk of events requiring emergency attention. [ABSTRACT FROM AUTHOR]

• The state level legalization of medical marijuana contradicts federal regulations and presents potential challenges for schools of nursing (SON). • This paper discusses this issue from the perspective of SON for prelicensure nursing students and potential challenges they could face. • Challenges include updating school level drug usage policies to address medical marijuana use, monitoring of medicinal versus recreational use of medical marijuana by prelicensure nursing students, safe use of medical marijuana if permitted by students, and the role of clinical partners who host prelicensure nursing students during traditional clinical experiences. National interest in and usage of medical marijuana has been growing. Medical marijuana use has been legalized in most states within the United States (US), yet it remains illegal under federal law. This creates a conflict for those interested in using or supporting medical marijuana use, especially in healthcare and education. The conflict created by legalizing use at the state level only creates difficult situations for schools of nursing's (SON) prelicensure nursing programs to address usage in relation to their drug usage policies. A literature review was conducted to identify prelicensure nursing student knowledge, use, and attitudes toward medical marijuana. As a result, findings related to these trends in prelicensure nursing student use were identified. From these findings, considerations for prelicensure nursing programs are discussed. [ABSTRACT FROM AUTHOR]

Cannabis use for medical purposes is legalized across 39 states and the District of Columbia in the U.S. The objective of this study was to evaluate temporal trends and correlates of cannabis use for medical purposes in the U.S. Data from the 2013−2020 National Survey on Drug Use and Health were used. Since 2013, medical cannabis use has been assessed using a dichotomous question asking whether any medical cannabis use was recommended by a doctor among those who used cannabis in the past 12 months. A modified Poisson model was used to estimate the average annual percentage change in medical cannabis use from 2013 to 2020. The analyses were repeated for key sociodemographic and clinical subgroups. Data were analyzed from September to November 2022. The prevalence of U.S. residents using cannabis for medical purposes increased significantly from 1.2% in 2013–2014 to 2.5% in 2019–2020, with an average annual percentage change of 12.9% (95% CI=10.4, 15.5), and many of sociodemographic and clinical subgroups showed similar significant increases in cannabis use for medical purposes. In the multivariable-adjusted model, living in a state that legalized medical cannabis remained significantly associated with medical cannabis use (AOR=4.10; 95% CI=3.68, 4.56). The study documents a continued nationwide increase in the use of cannabis for diverse medical purposes between 2013 and 2020, two decades after the first state passed legalizing legislation. [ABSTRACT FROM AUTHOR]

• Almost half the sample reported driving immediately after consuming cannabis. • 26.8% of participants reported waiting a sufficient time to avoid drug driving. • 173,455 drug driving events were anticipated by the sample in the next year. • Medically prescribed users were willing to wait longer before driving. • Offending behaviours stem from a history of drug use, and a lack of perceived risk. This study aimed to explore the length of time cannabis users typically wait between drug consumption and driving a vehicle, and what factors influence such decisions. A total of 839 Australian cannabis users participated in an online survey (26.3% had a prescription for cannabis). Participants ranged in age between 18 years and 75 years (M = 43.3) and 38.2% were female. Driving immediately after consuming cannabis was reported by 41.6% of the sample and waiting 1 h was the next most common response (17%). About one-quarter of participants reported that they waited at least 4 h, thus driving at a time they may no longer be impaired (26.8%). Factors that predicted waiting less time included: a greater frequency of drug consumption (times per day and per month), earlier age of cannabis use onset, using cannabis without a prescription, reporting past-year driving within four hours of consuming cannabis with an illegal drug, and lower perceptions of risk related to driving after consuming cannabis. Participants were asked to report how many days in the next year they would drive within four hours of cannabis consumption, with the most common response being 365 days (37.9% of sample). Given cannabis use is likely to increase through impending decriminalisation and expansion of prescription access, identifying ways to educate cannabis users and extend the length of time they wait between consumption and driving is critical for road safety. [ABSTRACT FROM AUTHOR]

With expanding legalization and cultural acceptance of cannabis, consumption among older adults in institutional care settings is increasing. State-by-state regulations vary widely and are evolving rapidly, adding layers of complexity to institutional policy and transitions of care. Owing to its current federal legal status, physicians cannot prescribe or dispense medical cannabis—they may only issue a recommendation for medical cannabis consumption. Furthermore, owing to the federally illicit status of cannabis, institutions accredited through the Centers for Medicare and Medicaid Services (CMS) may risk their CMS contracts if they accept cannabis in their facilities. Institutions should clarify their policy around the specific cannabis formulations approved for on-site storage and administration, including safe handling and appropriate storage. Inhalation dosage forms of cannabis require additional considerations in institutional settings, such as secondhand exposure prevention and adequate ventilation. As with other controlled substances, institutional policies to prevent diversion are essential, such as secure storage, staff procedures, and inventory documentation. Cannabis consumption should be included in patient medical histories, medication reconciliation, medication therapy management, and other evidence-based methods to reduce the risk of potential medication-cannabis interactions during transitions of care. [ABSTRACT FROM AUTHOR]

• Prospective study of 3554 patients starting cannabis treatment. • Patient characteristics failed to accurately predict the 6-month dose following the titration. • Higher THC doses was associated with improvements in pain and quality of life. • Sublingual therapy was associated with more side effects and less improvement in pain. • Higher CBD doses was associated with more side effects in the inhalation method. Medical cannabis is an increasingly prevalent treatment for a wide variety of indications, yet there is still no uniformly accepted protocol for the titration of cannabinoid doses. We aimed to develop a model to predict the stable THC and CBD dosages after six months of treatment using available baseline patient characteristics. In this prospective study, we included all consecutive adult patients (age 18 and above) who exclusively used a single method of cannabis delivery. Telephone interviews were conducted six months post-treatment initiation to assess changes in symptoms and side effects. We prospectively analyzed THC and CBD dosages with respect to demographic variables and patient characteristics in two main groups divided according to cannabis administration method – inhalation or sublingual oil. A total of 3,554 patients were included in the study (2,724 exclusively inhaled cannabis and 830 exclusively consumed cannabis as sublingual oil). The daily THC and CBD doses were significantly higher in the inhalation group than in the sublingual group (p <.001). None of the four models predicting THC and CBD doses in the two groups had satisfactory prediction ability (adjusted R-squared between 0.007 and 0.09). Male gender, unemployed status, tobacco smoking and a lack of concern about cannabis treatment were associated with a higher inhaled THC dose (p <.001). Models based on patient characteristics failed to accurately predict the final titration doses of CBD and THC for both inhalation and sublingual administration. Clinical guidelines should maintain a highly individual approach for cannabinoid dosing. [ABSTRACT FROM AUTHOR]

• Examined risk perceptions of driving under the influence of cannabis (DUIC) and alcohol (DUIA). • Compared perceptions of non-medical (ie. recreational) to medical or dual-purpose cannabis users. • Medical or dual-purpose users were more likely to agree that DUIC is safer than DUIA. • No difference found in perception that DUIC increases collision risk. • No difference found in perception that risk of police enforcement is higher for DUIA than DUIC. Reduced perception of potential harm resulting from cannabis use is associated with greater risk of driving under the influence of cannabis (DUIC). Understanding risk perceptions of DUIC among subgroups of users will positively inform targeting and content of anti-DUIC driver education and public awareness campaigns. The current study compared DUIC-related risk perceptions among individuals who use cannabis exclusively for non-medical purposes versus those who use cannabis for exclusively medical or for both medical and non-medical purposes (i.e., dual-purpose users). Data were drawn from a regionally stratified cross-sectional general population telephone survey of adults (18 + years) in Ontario, Canada conducted in 2017. Respondents who reported past-year use of cannabis and answered questions regarding DUIC risk perceptions were selected (weighted N = 343). Modified Poisson regression models with robust standard error estimation were conducted for three attitudes: disagree that DUIC increases motor vehicle collision risk, agree that DUIC is safer than driving under the influence of alcohol (DUIA), agree that chances of being caught by police for DUIA higher than DUIC. In addition to type of cannabis user (non-medical only versus medical or dual-purpose), covariates included demographic characteristics and past-year alcohol and cannabis use frequency. Adjusting for other covariates, regression analyses indicated that medical or dual-purpose cannabis users were 45 % more likely than non-medical users to agree that DUIC is safer than DUIA (Adjusted Prevalence Ratio = 1.45, 95 %CI = 1.10, 1.91, p = 0.007). No other differences in risk perception between medical or dual-purpose and non-medical cannabis users were found. Although no difference between medical or dual-purpose and non-medical cannabis users was found in perceptions of collision risk associated with DUIC or risk of police enforcement, the perception that DUIC is safer than DUIA was stronger among medical or dual-purpose than non-medical users. Recognizing that the shift in public perception of DUIA as a high-risk behaviour contributed to reductions in incidence of DUIA, results of the current study support education and awareness campaigns that target medical or dual-purpose users and emphasize that, like DUIA, DUIC is also a high-risk behaviour. [ABSTRACT FROM AUTHOR]

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]

Acute and chronic pain management remains an ongoing challenge for hand surgeons. This has been compounded by the ongoing opioid epidemic in the United States. With the increasing legalization of medical and recreational cannabis throughout the United States and other countries, previous societal stigmas about this substance keep evolving, and recognition of medical cannabis as an opioid-sparing pain management alternative is growing. A review of the current literature demonstrates a strong interest from patients regarding the use of medical cannabis for pain control. Current evidence demonstrates its efficacy and safety for chronic musculoskeletal and neuropathic pain. However, definitive conclusions regarding the efficacy of cannabis for pain control in hand and upper extremity conditions require continued investigation. The purpose of this article is to provide a general review of the mechanism of medical cannabis and a scoping review of the current evidence for its efficacy, safety, and potential applicability in hand and upper extremity conditions. [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]

The use of medical cannabis has rapidly increased among cancer patients worldwide. Cannabis is often administered concomitantly with cancer medications, including immune checkpoint inhibitors (ICIs). As the cannabinoid receptors are abundantly expressed and modulate immune cells, it has been hypothesised that cannabis may attenuate the activity of ICIs. We aimed to assess the effect of cannabis on ICIs' efficiency in patients having non-small cell lung cancer (NSCLC). The murine model of CT26 tumour-bearing mice treated with an anti-PD-1 antibody and Δ9-tetrahydrocannabinol (THC) was used to evaluate the interaction between THC and ICIs in vivo. Correlation between use of medical cannabis and clinical outcome was evaluated in a cohort of 201 consecutive metastatic NSCLC patients treated with monotherapy pembrolizumab as a first-line treatment. Median overall survival (OS) of the mice receiving a control vehicle, THC, anti-PD-1 antibody or their combination was 21, 24, 31 and 54 days, respectively (p < 0.05 for the combination treatment compared to a control vehicle), indicating that THC did not reduce the efficacy of anti-PD-1 therapy. Of 201 NSCLC patients treated with first-line monotherapy pembrolizumab for metastatic disease, 102 (50.7%) patients received licence for cannabis within the first month of treatment. Cannabis-treated patients were younger compared to the cannabis naïve patients (median age 68 versus 74, p = 0.003), with female predominance (62, 60.8% versus 34, 34.3%, p = 0.002) and with more prevailing brain metastasis (15.7% versus 5%, p = 0.013). Similar distribution of histology, smoking status, ECOG (Eastern Cooperative Oncology Group) and programmed death-ligand 1 expression was noted between the groups. Liver metastases were marginally significant (19.6% versus 10.1%, p = 0.058). The most common indication for cannabis was pain (71%) followed by loss of appetite (34.3%). Time to tumour progression was similar for cannabis-naive and cannabis-treated patients (6.1 versus 5.6 months, respectively, 95% confidence interval, 0.82 to 1.38, p = 0.386), while OS was numerically higher in the cannabis-naive group (54.9 versus 23.6 months) but did not reach statistical significance (95% confidence interval 0.99 to 2.51, p = 0.08). In multivariate analyses, we did not identify cannabis use as an independent predictor factor for mortality. Preclinical and clinical data suggest no deleterious effect of cannabis on the activity of pembrolizumab as first-line monotherapy for advanced NSCLC. The differences in OS can most likely be attributed to higher disease burden and more symptomatic disease in the cannabis-treated group. These data provide reassurance regarding the absence of a deleterious effect of cannabis in this clinical setting. • Cannabis might alter tumour's microenvironment and, hence, reduce the immune checkpoint inhibitors efficacy. • We investigate this theory in murine models and real-world data. • We found no determinantal effect of this combination in clinic or laboratory. • This conclusion has a great reassuring impact on our patients having non-small cell lung cancer. [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]

Acute coronary syndrome (ACS) is the usual clinical entry point for coronary heart disease. France is the European country with the highest prevalence of cannabis use and an increase in serious cardiovascular complications, including infarction, related to cannabis. The main objective was to compare the clinical and cardiological profile of patients with ACS according to exposure to cannabis use. We conducted a retrospective, single-centre, exposure-non-exposure cohort study of all adult patients (> 18 years) admitted for ACS in the ICU between January 1, 2012 and December 31, 2021 at the Centre Hospitalier de Troyes, with mention of cannabis use in the medical record. A matching was performed so that each patient identified in the exposed group was associated with a comparable unexposed patient on age, sex, period of hospitalisation and cardiovascular event typology (type of ACS and topography for ST+). 2745 patients admitted to the ICU and the coronary angiography room presented an ST+ or ST− ACS from 01/01/2012 to 31/12/2021 at the CHT. For 31 patients of them (1.1%), we noted cannabis consumption, which concern 7,9% of SCA ST+ aged under 50. The link between cannabis use and ACS is established, but studies concerning the place of cannabis in the ACS pathway of an ICU are few in France. Our results show the interest of developing a specific pathway focused on the needs of patients and their specificities in post ACS management. [ABSTRACT FROM AUTHOR]

Context: Palliative care aims to improve the quality of life in patients with incurable illness. Medicinal cannabis (MC) has been used in the palliative care setting to address multiple symptoms in patients.Objectives: To evaluate the full scope of available literature investigating the effects and potential harms of MC on symptom management and quality of life in palliative care.Methods: PubMed, Embase, The Cochrane Library and clinicaltrials.gov were searched for eligible articles, published between 1960 and September 9, 2021. Quality of the evidence was assessed in accordance with Grading of Recommendations, Assessment, Development and Evaluations. Risk of bias was assessed using the RoB 2 tool for randomised controlled trials and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for non-randomized trials.Results: Fifty-two studies (20 randomised; 32 non-randomised) with 4786 participants diagnosed with cancer (n = 4491), dementia (n = 43), AIDS (n = 235), spasticity (n = 16), NORSE syndrome (n = 1) were included. The quality of evidence was 'very low' or 'low' for all studies, and low for only two randomised controlled trials. Positive treatment effects (statistical significance with P < 0.05) were seen for some MC products in pain, nausea and vomiting, appetite, sleep, fatigue, chemosensory perception and paraneoplastic night sweats in patients with cancer, appetite and agitation in patients with dementia and appetite, nausea and vomiting in patients with AIDS. Meta-analysis was unable to be performed due to the wide range of cannabis products used and the heterogeneity of the study outcomes.Conclusion: While positive treatment effects have been reported for some MC products in the palliative care setting, further high quality evidence is needed to support recommendations for its use in clinical practice. [ABSTRACT FROM AUTHOR]

• First study on distribution of cannabis policies using an intersectional approach. • Black residents in privileged areas were most likely to live where retail was allowed. • Equity provisions were rare but most common for Black residents in privileged areas. • Strict ad policies were most common for Latinx and Black residents in poorer areas. • The impact of cannabis policy disparities on public health remains uncertain. Policies governing legal cannabis commerce can vary widely within a U.S. state when local control exists. Disproportionate distribution of policies allowing retail sale, protecting public health, or promoting equity in licensing may contribute to differences in health and economic outcomes between sociodemographic subgroups. This cross-sectional study jointly examined racial, ethnic, and neighborhood socioeconomic characteristics of Californians subject to specific local cannabis policies to identify such disparities. Local laws in effect January 1, 2020, governing retail cannabis sales (bans, expanding buffers from youth-serving sites, restricting advertising, promoting equity in licensing, and capping outlets) were determined for California's 539 jurisdictions. The number of Asian, Black, Latinx, and white residents in socioeconomic advantaged versus disadvantaged neighborhoods (Census block groups) was determined using 2015–2019 American Community Survey data. We estimated proportions of the sociodemographic subpopulations covered by specific policies based on the block group's jurisdiction. To ascertain disparities in coverage proportions were compared across subgroups using Z-tests with the Bonferroni correction. Residents of socioeconomically advantaged neighborhoods were more likely to live in jurisdictions allowing retail cannabis commerce than those in disadvantaged neighborhoods (61.7 % versus 54.8 %). Black residents in advantaged neighborhoods were most likely to live where retailing was allowed (69 %), and white residents in disadvantaged neighborhoods least likely (49 %). Latinx and Black populations from disadvantaged neighborhoods were most likely to live in jurisdictions with stronger advertising restrictions (66 %). Equity in licensing policy was more prevalent for Black residents living in advantaged neighborhoods (57 %) than disadvantaged neighborhoods (49 %). Local cannabis policies potentially protecting public health and social equity are unequally distributed across race, ethnicity, and socioeconomic characteristics in California. Research examining whether differential policy exposure reduces, creates, or perpetuates cannabis-related health and socioeconomic disparities is needed. [ABSTRACT FROM AUTHOR]

• Medical cannabis (MC) use is increasing in older adults. • MC was associated with decreases in pain, negative affect, trauma, and nausea. • Negative reinforcement on psychiatric symptoms predicted CUD symptoms. • Negative reinforcement on physical symptoms predicted use problems but not CUD. Older adults are increasingly using medical cannabis (MC). It is unclear if therapeutic effects increase problematic use patterns. The current study addresses this issue by examining symptom trajectories across the day and using trajectories to predict problematic use. One-hundred six older adults (age range 55–74) who endorsed medical conditions approved for treatment using MC were recruited online. Participants received six text messages/day to assess momentary symptoms for 15 days. Participants provided 5,156 momentary assessments across 1,106 use days. Symptom trajectories were examined across the day. There was a decline in all symptoms following use. Negative affect, pain, and nausea evinced momentary negative reinforcement associations with cannabis intoxication. Momentary negative reinforcement was associated with adverse cannabis outcomes. Declines in post-use trauma symptoms and momentary negative reinforcement effects for negative affect were both associated with cannabis use disorder symptoms. These data suggest that MC may be effective in reducing common symptom clusters. However, the negative reinforcing effect (i.e., the link between use and symptom relief at the event level) may complicate the therapeutic nature (i.e., symptom reduction). Identifying interventions to maximize benefits while minimizing costs may increase the efficacy and safety of MC in older adults. [ABSTRACT FROM AUTHOR]

As many states have passed laws increasing the availability of legal marijuana, a growing body of research has explored the consequences of these trends on youths' marijuana-related perceptions and behaviors. However, prior work has been mixed on the effects of county-level variation in marijuana accessibility stemming from ordinances governing dispensary operations, and previous studies have not investigated whether the robust protective effects of attachment to parents on adolescent outcomes are moderated by these contextual factors. We use individual-level data from the 2022 Florida Youth Substance Abuse Survey (N = 47,572) merged with information on Florida counties to examine the direct and interactive effects of the presence/number of marijuana dispensaries and adolescents' attachment to parents on their use of marijuana, beliefs about its perceived wrongfulness, perceived parental approval of marijuana use, and perceived harmlessness of marijuana use. Although attachment to parents was inversely associated with all four outcomes, little evidence of independent or cross-level interaction effects of marijuana dispensaries emerged. Within a state that permits medical marijuana, county-level differences in marijuana access are likely not a salient risk factor for adolescents' marijuana use, beliefs, and perceptions. Effective parenting represents a consistent protective influence across these contexts. • Attachment to parents was inversely associated with all four marijuana outcomes. • Marijuana dispensaries were not associated with any of the four marijuana outcomes. • County-level dispensaries did not moderate the effects of attachment to parents. [ABSTRACT FROM AUTHOR]

The National Institutes of Health (NIH) support of cannabinoid and cannabis research has increased over the past few years. Several NIH Institutes, Centers, and Offices (ICOs) have a growing interest in the therapeutic potential of cannabis, cannabinoids, and related compounds as well as their adverse effects on health and society. The National Center on Complementary (NCCIH) and Integrative Health (NCCIH) has become a focal point for research on the therapeutic potential of the heretofore understudied minor cannabinoids and terpenes found in cannabis for the management of pain. Also, NCCIH has become more actively involved in coordinating activities to stimulate new research programs and coordinating various cannabis-related activities across the NIH. This presentation will provide an update on the broad landscape of cannabis-related research at the NIH, summarize new areas of research interest and investment, including those of NCCIH, and describe a new multi-NIH ICO extramural program coordinating group to foster collaboration, share information, and expand and coordinate NIH cannabis and cannabinoid research activities. [ABSTRACT FROM AUTHOR]

Introduction: On the basis of both scientific progress and popular lore, there is growing optimism in the therapeutic potential of cannabis (marijuana) and cannabinoid-based chemicals for movement disorders. There is also notable skepticism regarding the scientific basis for this therapeutic optimism and significant concerns regarding the safety and regulation of cannabinoid products, particularly those available without prescription.Methods: In recognition of the high interest and controversial nature of this subject, the meeting committee of the International Parkinson and Movement Disorders Society arranged for a talk on cannabis at the 2019 annual meeting's Controversies in Movement Disorders plenary session. This paper summarizes the highlights of this session.Results: The endocannabinoid system is strongly tied to motor function and dysfunction, with basic research suggesting several promising therapeutic targets related to cannabinoids for movement disorders. Clinical research on cannabinoids for motor and nonmotor symptoms in Parkinson's disease, Huntington's disease, Tourette's syndrome, dystonia, and other movement disorders to date are promising at best and inconclusive or negative at worst. Research in other populations suggest efficacy for common symptoms like pain. While social campaigns against recreational cannabinoid use focus on cognitive changes in adolescents, the long-term sequelae of regulated medical use in older adults with movement disorders is unknown. The overall risks of cannabinoids may be similar to other commonly used medications and include falls and apathy.Conclusion: Further research is greatly needed to better understand the actual clinical benefits and long-term side effects of medical cannabis products for movement disorders indications and populations. [ABSTRACT FROM AUTHOR]

Background: Treatment with medical cannabis (MC) in the United States tends to be patient-driven in nature despite evidence that suggests that patients have remarkably poor knowledge on the medical use of this treatment modality.Objective: To develop and pilot a collaborative, fee-for-service (FFS), office-based, pharmacist-directed MC therapy management (MCTM) service for patients suffering chronic pain.Practice Description: A collaborative, FFS, office-based, pharmacist-directed MCTM service where patients are seen after a physician deems them suitable for treatment with MC. The pharmacist designs the initial treatment regimen by selecting a formulation, dose, route, and frequency of administration and then manages ongoing therapy by making regimen changes based on the patient's response, adverse effects, and financial concerns.Practice Innovation: The creation of a specialized service where a registered MC pharmacist is positioned in a collaborating provider's office and sees patients face-to-face for the provision of MCTM services.Evaluation Methods: Patient retention, revenue generated, and ability to replicate the service were evaluated. Patient satisfaction was assessed by collecting subjective feedback on the service.Results: The pilot site that developed the service has seen 133 patients from 2016 to 2021 and has retained 89% of patients after 5 years of quarterly appointments. Patients appear willing to pay out of pocket for the service, and the revenue generated covers the pharmacist's and collaborating physician's time as well as additional overhead. The service has been replicated at 2 additional sites, and patient feedback has been positive.Conclusions: MCTM is another useful pharmacist service that patients are willing to pay for. MCTM services decrease the collaborating provider's workload while still allowing them to offer their patients personalized treatment with MC. In our experience, the service retains patients, generates enough revenue to cover costs, can be replicated, and is well received by patients. [ABSTRACT FROM AUTHOR]

• We aimed to develop a preliminary scale for identifying problematic use of medicinal cannabis. • 390 American participants filled out a list of items related to problematic use. • Additional questionnaires were also filled out to determine predictive validity. • A final eight-item list presented excellent reliability (Cronbach's alpha = 0.929). • The Medicinal Cannabis Negative Consequences Scale is a preliminary brief and reliable measure. The use of Medicinal Cannabis (MC) for treating chronic pain is increasing, globally, yet the definition of problematic MC use remains unclear. Defining problematic use of cannabis in medical and non-medical contexts may be fundamentally different since individuals prescribed MC often experience physical dependence, which do not necessarily imply pathology. We aimed to conceptualize problematic use of MC and develop a brief questionnaire for identifying and quantifying problematic MC use. Content validation used a broad definition of problematic substance use, adapting and compiling an initial list of 36 items from various sources: (a) screening tools for assessing problematic prescription opioid medication use; (b) screening tools for problematic recreational cannabis use and (c) qualitative interviews with MC patients. 390 American self-identified chronic pain patients holding a MC card rated each item from the initial list on a 5-point frequency scale and filled out questionnaires assessing various clinical outcomes. Following initial item titration, a multi‐group measurement invariance comparison strategy, using two external indicators: alcohol-related problems and depression, resulted a final eight-item list that met fit quality in a baseline model, presented excellent internal consistency reliability (α = 0.929), and significantly correlated with anxiety and low quality of life. Items in the final list related predominantly to negative consequences of MC use. Problematic use of MC is characterized by negative physiological, social, emotional and functional consequences. The final eight-item list was named the Medicinal Cannabis Negative Consequences Scale (MCNCS), emerging as a brief measure for problematic MC use and demonstrating preliminary reliability and validity, which could aid clinicians and researchers. [ABSTRACT FROM AUTHOR]

• Recreational/medical cannabis policies are only associated with youth blunt use absent a smoke-free policy. • Denormalization from smoke-free policies may extend to blunt use by reducing visibility of smoking. • Smoke-free policies may be a cost-effective way to mitigate effects of changing cannabis policies. Co-use of tobacco and cannabis has long been an issue for prevention and intervention efforts targeting these substances. Blunt use—cannabis inside a cigar wrapper—has been a consistent mode of cannabis consumption since the 1990s. Since then, both tobacco control and cannabis policies have changed considerably. This paper examines the influence of tobacco taxes and smoke-free policies as well as medical and recreational cannabis policies on blunt use among young people. Combining state-level tobacco control and cannabis policy data with the restricted-access youth cohort of the Population Assessment of Tobacco and Health (PATH) study, we use multilevel logistic regression models to examine the impact of these policies on past-year blunt use. While we found a main effect whereby both legal medical and recreational cannabis policies are associated with higher odds of blunt use among youth, interaction effects demonstrate that this association only emerges in states lacking a comprehensive tobacco smoke-free policy. In states with smoke-free policies, we found no significant associations between cannabis policy and odds of blunt use. Denormalization through smoke-free policies may mitigate the effects of recreational and medical cannabis policies on blunt use. Smoke-free policies represent a possible cost-effective mechanism to curb the co-use of tobacco and cannabis in the form of blunts. States with medical and recreational cannabis policies may benefit from greater prevention efforts for young people specifically focused on blunt use, especially in states that do not have strong tobacco control. [ABSTRACT FROM AUTHOR]

Anacardium occidentale (cashew) tree gum is being used in several sectors, including the pharmaceutical sector. This gum has been explored more in the medical field by many previous researchers, but there is a big research gap regarding its thermal and mechanical properties. Therefore, this research is intended to reveal the thermal, chemical, and mechanical characteristics of Anacardium occidentale tree gum. The results obtained in this regard are then compared with certain properties of artificial resins. Thermal analysis is carried out using a thermogravimetric analyzer, and differential scanning calorimeter, elemental analysis is carried out using a scanning electron microscope and a micro-X-ray fluorescence analyzer; and mechanical tests are carried out using a nano-indentation tester and a universal testing machine. The pH of 4.76 shows that the gum is acidic in nature, and the peaks obtained from thermal analysis demonstrate that it doesn't have a melting point. The microhardness value, tensile strength, flexural strength, and compressive strength of cashew gum are 218.39 MPa, 1.667 MPa, 3.64 MPa, and 2.667 MPa, respectively. The obtained results show that, Anacardium occidentale tree gum has comparable thermal properties to those of artificial resins and other natural gums. • Cashew gum doesn't have a melting point according to STA analysis. • Micro X-ray Fluorescence Test can be considered as a complementary test for SEM/EDX. • Electrical resistivity and viscosity of cashew gum reduce with increasing temperature. • Cashew gum can be used in many applications due to its valuable mechanical properties. [ABSTRACT FROM AUTHOR]

Post-traumatic stress disorder (PTSD) refers to a chronic impairing psychiatric disorder occurring after exposure to the severe traumatic event. Studies have demonstrated that medicinal cannabis oil plays an important role in neuroprotection, but the mechanism by which it exerts anti-PTSD effects remains unclear. The chronic complex stress (CCS) simulating the conditions of long voyage stress for 4 weeks was used to establish the PTSD mice model. After that, behavioral tests were used to evaluate PTSD-like behaviors in mice. Mouse brain tissue index was detected and hematoxylin-eosin staining was used to assess pathological changes in the hippocampus. The indicators of cell apoptosis and the BDNF/TRPC6 signaling activation in the mice hippocampus were detected by western blotting or real-time quantitative reverse transcription PCR experiments. We established the PTSD mice model induced by CCS, which exhibited significant PTSD-like phenotypes, including increased anxiety-like and depression-like behaviors. Medicinal cannabis oil treatment significantly ameliorated PTSD-like behaviors and improved brain histomorphological abnormalities in CCS mice. Mechanistically, medicinal cannabis oil reduced CCS-induced cell apoptosis and enhanced the activation of BDNF/TRPC6 signaling pathway. We constructed a PTSD model with CCS and medicinal cannabis oil that significantly improved anxiety-like and depressive-like behaviors in CCS mice, which may play an anti-PTSD role by stimulating the BDNF/TRPC6 signaling pathway. [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]

• We used discrete choice experiment to examine impacts of cannabis edible packaging. • Participants prefer branded packages to plain packages. • Participants prefer health claims to no health claims. • Participants using cannabis prefer youth-appealing packages to branded packages. • Package style and health claim are the most important package attributes. Cannabis edibles recently gained considerable market share in the United States. The tobacco and food literatures consistently suggest that product packaging regulations are crucial to substance control, but little is known about how product packaging may impact cannabis edible use. This study aims to estimate the impacts of packaging on individual preferences for cannabis edibles and explore heterogeneities in preferences by cannabis use status and use purposes. 1578 adults were recruited, who lived in 18 states and Washington D.C. in the United States that legalized recreational cannabis by the time of data collection in August and September of 2022. An online discrete choice experiment was conducted to elicit individual choices between cannabis edibles with variations in five packaging attributes: package style, health claim, potency indicator, warning label position, and warning label text. Mixed logit regressions were used to assess associations between package attributes and package choices. Subsample analysis was conducted by cannabis use status (users vs. nonusers) and use purposes (medical-only, recreational-only, and dual-purpose) to detect heterogeneities. Almost all subsamples prefer branded packages to plain packages, any health claim to no health claim, and any potency indicator to no potency indicator. Cannabis users, particularly recreational-only users and dual-purpose users, also prefer youth-appealing packages to branded packages. Warning label position and text have limited impacts on choices. Overall, package style is perceived to be the most important attribute among the five (relative importance 33.2–50.8%), followed by health claim (relative importance 22.6–30.5%). In the United States, adults' preferences for cannabis edibles are associated with packaging features. Policies requiring plain package and prohibiting youth-appealing package and unsubstantiated health claims may be effective methods of cannabis control. [ABSTRACT FROM AUTHOR]

Medical cannabis is increasingly considered for palliation of pain, nausea/vomiting, anorexia, and other symptoms. We aimed to determine whether training in hospice and palliative medicine (HPM) adequately prepares fellows to counsel patients about medical cannabis. A previously validated questionnaire was adapted for HPM fellows. Domains included fellows' practices recommending cannabis and their knowledge of its effectiveness and risks compared with standard treatments. U.S. HPM fellowships were sent surveys in 2022 and 2023. Forty six programs participated, 123 fellows responded (response rate of 42%) including 69% female; 55% White, and 28% Asian. Of respondents, 65% reported receiving formal training regarding medical cannabis; 57% reported discussing medical cannabis with over five patients; 23% recommended medical cannabis to more than five patients in the preceding year. Only 19%, however, felt sufficiently informed to issue cannabis-related recommendations. HPM fellows with prior training were not more likely to feel sufficiently informed to discuss cannabis (RR: 1.17; 95% CI: 0.82–1.66) or to recommend cannabis to patients (RR: 2.05, 95% CI: 0.89–4.71). Fellows rate cannabis as equally or more effective than conventional treatments for the following symptoms: anorexia/cachexia (63%), nausea/vomiting (43%), pain (25%), and neuropathic pain (21%). Most HPM fellows report formal training in the use of medical cannabis. Over half of trainees reported discussing medical cannabis with patients, but few considered themselves sufficiently informed to make cannabis-related clinical recommendations. These results suggest both a need for expanded high-quality evidence for medical cannabis in palliative care and for improved formal education for HPM fellows. [ABSTRACT FROM AUTHOR]

• There is insufficient evidence to determine whether medicinal cannabis might have a role in supporting the mental health of people with cancer. • Medicinal cannabis might improve and maintain appetite. • High-dose tetrahydrocannabinol (THC) might increase the incidence of side-effects, including anxiety. • No studies had mental health as the primary outcome or therapeutic target. • Confidence in findings was limited by risk of bias and imprecise pooled estimates. Medicinal cannabis might have a role in supporting the mental health of people with cancer. This systematic review and meta-analysis examined the efficacy and safety of medicinal cannabis, compared with any control, as an intervention for depression, anxiety, and stress symptoms in people living with cancer. A secondary aim was to examine the effect of low versus high Δ9-tetrahydrocannabinol (THC) dose on these outcomes. Five databases were systematically searched, and complemented with a snowball search from inception to May 2023, for any type of interventional study that included humans of any age with any cancer type. Primary outcomes were incidence and severity of depression, anxiety, and stress symptoms. Secondary outcomes were mood, cognition, quality of life, appetite, nutrition status, gastrointestinal symptoms, and adverse events. Data were pooled using Review Manager. Evidence was appraised using Cochrane risk of bias tools. Confidence in the estimated effect of pooled outcomes was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Fifteen studies (n = 11 randomized trials, n = 4 non-randomized trials) of 18 interventions (N = 1898 total participants; 100 % ≥18 years of age) were included. Ten studies examined THC (70 % synthetic), two synthetic cannabidiol with or without THC, and six whole-plant extracts. No clinically significant effects of medicinal cannabis were found on primary outcomes. The likelihood of anxiety events increased with higher-dose synthetic THC compared with a lower dose (OR: 2.0; 95 % CI: 1.4, 2.9; p < 0.001; Confidence: very low). Medicinal cannabis (THC, cannabidiol, and whole-plant extract) increased the likelihood of improved appetite (OR: 12.3; 95 % CI: 3.5, 45.5; p < 0.001; n = 3 interventions; Confidence: moderate) and reduced severity of appetite loss (SMD: −0.4; 95 % CI: −0.8, −0.1; p = 0.009; Confidence: very low). There was very low confidence that higher doses of synthetic THC increased the likelihood of any adverse event (OR: 0.5; 95 % CI: 0.3, 0.7; p < 0.001). Medicinal cannabis had no effect on emotional functioning, mood changes, confusion, disorientation, quality of life, and gastrointestinal symptoms. Confidence in findings was limited by some studies having high or unclear risk of bias and imprecise pooled estimates. There was insufficient evidence to determine the efficacy and safety of medicinal cannabis as a therapeutic intervention for depression, anxiety, or stress in people with active cancer. Further research should explore whether medicinal cannabis might improve and maintain appetite and if high-dose synthetic THC might increase the incidence of side-effects, including anxiety. To inform clinical practice, well-powered and rigorously designed trials are warranted that evaluate the effects of medicinal cannabis prescribed to target anxiety, depression, and stress. [ABSTRACT FROM AUTHOR]

In vivo solid-phase microextraction (SPME) is a minimally invasive, non-exhaustive sample-preparation technique that facilitates the direct isolation of low molecular weight compounds from biological matrices in living systems. This technique is especially useful for the analysis of phytocannabinoids (PCs) in plant material, both for forensic purposes and for monitoring the PC content in growing Cannabis spp. plants. In contrast to traditional extraction techniques, in vivo SPME enables continuous tracking of the changes in the level of PCs during plant growth without the need for plant material collection. In this study, in vivo SPME utilizing biocompatible C18 probes and liquid-chromatography coupled to quadrupole time-of flight mass spectrometry (LC-Q-TOF-MS) is proposed as a novel strategy for the extraction and analysis of the acidic forms of five PCs in growing medicinal cannabis plants. The SPME method was optimized by testing various parameters, including the extraction phase (coating), extraction and desorption times, and the extraction temperature. The proposed method was validated with satisfactory analytical performance regarding linearity (10–3000 ng/mL), limits of quantification, and precision (relative standard deviations below 5.5 %). The proposed method was then successfully applied for the isolation of five acidic forms of PCs, which are main components of growing medicinal cannabis plants. As a proof-of-concept, SPME probes were statically inserted into the inflorescences of two varieties of Cannabis spp. plants (i.e., CBD-dominant and Δ9-THC-dominant) cultivated under controlled conditions for 30 min extraction of tetrahydrocannabinolic acid (Δ9-THCA), cannabidiolic acid (CBDA), cannabigerolic acid (CBGA), cannabiviarinic acid (CBVA), and tetrahydrocannabivarinic acid (THCVA). The results confirmed that the developed SPME-LC-Q-TOF-MS method is a precise and efficient tool that enables direct and rapid isolation and analysis of PCs under in vivo conditions. The proposed methodology is highly appealing option for monitoring the metabolic pathways and compositions of multiple PCs in medicinal cannabis at different stages of plant growth. [Display omitted] • An analytical method to determine phytocannabinoids in Cannabis spp. is presented. • In vivo SPME allows direct isolation of acidic forms of phytocannabinoids from growing plants. • Precise tool for analysis of the composition of phytocannabinoids in in vivo conditions. • SPME-LC-Q-TOF-MS protocol for resolution and analysis of acidic forms of phytocannabinoids. • Monitoring of multiple phytocannabinoids at different stages of medicinal cannabis plant growth. [ABSTRACT FROM AUTHOR]

Conventional cannabis drying is time-consuming and energy intensive. A quick and dependable drying of cannabis is essential to ensure high-quality products to meet increasing demands. This study explored a combined microwave and infrared (MI) drying on cannabis comparing with control environmental (CE) drying. MI was very efficient with a short drying time of 16–200 min, high moisture diffusivity of 7.95×10−09-8.70×10−08 m2/s, and low energy consumption of 390.49–1611.42 kJ. The Page and Modified Page drying models fitted well to describe and predict the MI drying characteristics of cannabis. Microstructural images identified shrinkage in glandular trichomes of cannabis, whereas colorimetric assessment resulted in alteration of color attributes due to MI drying. It also facilitated the conversion of acidic cannabinoids to their neutral forms by decreasing tetrahydrocannabinolic acid (THCA) in g/g of dry matter from 20.15% to 7.57% and increasing tetrahydrocannabinol (THC) from 6.31% to 16.65% that insignificantly (p ≥0.05) affected the total THC level. MI drying resulted in a total terpenes concentration (%g/g of dry matters) of 0.541–0.730, insignificantly lower than CE drying (0.768). Overall, the study highlights MI as a rapid and energy-efficient drying for obtaining high quality cannabis, particularly for medicinal applications. [Display omitted] • The effects of microwave-infrared drying on medicinal cannabis were investigated. • Microwave-infrared drying was quite faster and saved 95.54–98.92% energy. • Scanning electron microscopy shows shrinkage and damage of cannabis trichomes. • Tetrahydrocannabinol content increased from 6.31% to 16.65%. • Total terpenes of dried samples were statistically similar but lower than fresh. [ABSTRACT FROM AUTHOR]

The prevalence of cannabis use disorders (CUDs) in people who use cannabis recreationally has been estimated at 22%, yet there is a dearth of literature exploring CUDs among people who use medicinal cannabis. We aimed to systematically review the prevalence of CUDs in people who use medicinal cannabis. In our systematic review and meta-analysis, we followed PRISMA guidelines and searched three databases (PsychInfo, Embase and PubMed) to identify studies examining the prevalence of CUDs in people who use medicinal cannabis. Meta-analyses were calculated on the prevalence of CUDs. Prevalence estimates were pooled across different prevalence periods using the DSM-IV and DSM-5. We conducted a systematic review of 14 eligible publications, assessing the prevalence of CUDs, providing data for 3681 participants from five different countries. The systematic review demonstrated that demographic factors, mental health disorders and the management of chronic pain with medicinal cannabis were associated with an elevated risk of CUDs. Meta-analyses were conducted on the prevalence of CUDs. For individuals using medicinal cannabis in the past 6–12 months, the prevalence of CUDs was 29% (95% CI: 21-38%) as per DSM-5 criteria. Similar prevalence was observed using DSM-IV (24%, CI: 14–38%) for the same period. When including all prevalence periods and using the DSM-5, the prevalence of CUDs in people who use medicinal cannabis was estimated at 25% (CI: 18-33%). The prevalence of CUDs in people who use medicinal cannabis is substantial and comparable to people who use cannabis for recreational reasons, emphasizing the need for ongoing research to monitor the prevalence of CUDs in people who use medicinal cannabis. • The prevalence of cannabis use disorders in people who use medicinal cannabis is estimated at 25% (CI: 18-33%). • People with chronic non-cancer pain, mental health or substance use disorders may have a higher risk of cannabis use disorder. • The study highlights the need to carefully consider the risk of cannabis use disorder when prescribing medicinal cannabis. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about the possible impacts of recreational marijuana legalization on alcohol and marijuana co-use among underage youth. This study examines the association between recreational marijuana legalization in California in 2016 and alcohol and marijuana co-use among adolescents. Additional analyses investigate the associations between recreational marijuana legalization and co-use among past 30-day drinkers and marijuana users and the frequency of alcohol and marijuana use among co-users.Methods: This study used annual cross-sectional data from 7th, 9th, and 11th graders (N=3,319,329) who participated in the California Healthy Kids Survey from 2010-2011 to 2018-2019. Measures included past 30-day alcohol and marijuana use and student demographic characteristics, survey year, pre-post recreational marijuana legalization, and urbanicity. Multilevel regression analyses were conducted in 2021.Results: Recreational marijuana legalization was associated with greater odds of past 30-day alcohol and marijuana co-use in the total sample (OR=1.06, 95% CI=1.05, 1.07). Recreational marijuana legalization was more strongly associated with co-use among adolescents who reported past 30-day alcohol use (OR=1.58, 95% CI=1.52, 1.62) and heavy drinking (OR=1.25, 95% CI=1.21, 1.29) but was inversely related to co-use among past 30-day marijuana users (OR=0.76, 95% CI=0.74, 0.78). Among past 30-day co-users, there was a positive association with the frequency of marijuana use (β=0.36, SE=0.07).Conclusions: Recreational marijuana legalization may increase the risk of alcohol and marijuana co-use among adolescents. Greater restrictions on the numbers of alcohol and marijuana retail outlets and hours of operation and advertising and higher taxes on alcohol and marijuana products may help reduce the availability of these substances to adolescents. [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]

This paper analyzes the historical stock returns of 10 medicinal cannabis companies for the period between 2015 and 2020, when the legalization of recreational cannabis was debated in Canada. The results of our analysis indicate that the industry was responsive to the announcements of regulatory change that led towards legalization. Furthermore, we compare the performance of cannabis companies to that of similar businesses. The results of the comparative analysis indicate that the performance of the matched pairs is largely correlated over time. Additionally, the pre-legalization performance of cannabis companies was better than their post-legalization performance. Given that cannabis companies did not outperform their matched pair, we can confirm that legalization did not have a significantly positive effect on the industry. We can also infer that, from a stock market perspective, the legalization of recreational cannabis has been unsuccessful thus far. [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]