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Objectives: Little is known about cannabis use in hunter-gatherers. Therefore, we investigated cannabis use in the Aka, a population of foragers of the Congo Basin. Because cannabis contains anthelminthic compounds, and the Aka have a high prevalence of helminthiasis, we also tested the hypothesis that cannabis use might be an unconscious form of self-medication against helminths., Methods: We collected self- and peer-reports of cannabis use from all adult Aka in the Lobaye district of the Central African Republic (n = 379). Because female cannabis use was low, we restricted sample collection to men. Using an immunoassay for Δ9-tetrahydrocannabinol-11-oic acid (THCA), a urinary biomarker of recent cannabis consumption, we validated cannabis use in men currently residing in camps near a logging road (n = 62). We also collected stool samples to assay worm burden. A longitudinal reinfection study was conducted among a subsample of the male participants (n = 23) who had been treated with a commercial anthelmintic 1 year ago., Results: The prevalence of self- and peer-reported cannabis use was 70.9% among men and 6.1% among women, for a total prevalence of 38.6%. Using a 50 ng/ml threshold for THCA, 67.7% of men used cannabis. Cannabis users were significantly younger and had less material wealth than the non-cannabis users. There were significant negative associations between THCA levels and worm burden, and reinfection with helminths 1 year after treatment with a commercial anthelmintic., Conclusions: The prevalence of cannabis use among adult Aka men was high when compared to most global populations. THCA levels were negatively correlated with parasite infection and reinfection, supporting the self-medication hypothesis., (© 2015 Wiley Periodicals, Inc.)

We tested a novel hypothesis that recreational use of neurotoxic plants helps defend against parasites. Specifically, we investigated the relationship between smoking and helminthiasis among the Aka, a remote population of Central African foragers who are avid tobacco smokers, suffer high rates of helminthiasis, and have little-to-no access to commercial anthelmintics. Two hundred and six healthy Aka men provided saliva and stool samples. Saliva samples were assayed for cotinine, a nicotine metabolite; a subsample was genotyped for the CYP2A6 enzyme, which metabolizes nicotine. Stool samples were assayed for intestinal helminth eggs as an index of worm burden. After 1 year, a subsample of participants was located and provided additional saliva and stool samples. We found (1) an exceptionally high prevalence of tobacco use, (2) a significant negative correlation between cotinine (a nicotine metabolite) and worm burden, (3) that treating helminths with albendazole, a commercial anthelmintic, reduced cotinine concentration two weeks later, compared to placebo controls, (4) among treated participants, higher cotinine concentrations in year 1 predicted less reinfection by year 2, and (5) younger and older participants with slow nicotine-metabolizing CYP2A6 alleles had lower worm burdens compared to those with extensive metabolizing alleles. These results provide the first evidence of a link between helminthiasis and smoking. They also suggest that, in populations where intestinal helminths are endemic, tobacco use might protect against helminth infection and reduce worm burden among infected individuals, and that individuals modulate nicotine exposure in response to infection. The results thus support the hypothesis that substance use helps defend against parasites. [ABSTRACT FROM AUTHOR]