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Background: This study investigated community pharmacists' level of knowledge and attitude towards medical marijuana and its association with sociodemographic characteristics. Methods: A cross-sectional study was conducted from 21 February 2022 to 15 November 2022. Community pharmacists working in Klang Valley were given a self-administered questionnaire. This survey instrument facilitated the collection of information about their sociodemographic attributes, training background, and knowledge and attitude concerning medical marijuana. Through rigorous analysis of the accumulated data, discernible factors correlating with the levels of knowledge and attitudes surrounding medical marijuana were identified. Results: The majority (n=149, 53.8%) of participants had low knowledge of medical marijuana. Participants with lower knowledge of medical marijuana tend to have a negative attitude toward medical marijuana. Besides that, male participants showed higher knowledge of medical marijuana than female participants. Furthermore, it was found that atheists had the most negative attitude among other religions toward medical marijuana. Conclusion: Most community pharmacists in Malaysia lack sufficient knowledge about medical marijuana. This indicates that Malaysian pharmacists are not future-ready and need to equip themselves with adequate knowledge of the indications and adverse effects of medical marijuana if it is to be legalised one day. Thus, there is a need for improved training and education of pharmacists around cannabis-based medicines. [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]

Introduction: In recent years, multiple publications underscored many beneficial properties associated with medical marihuana. Its current applications encompass pain relief, multiple sclerosis, the treatment of anxiety disorders, Dravet syndrome and other. It can potentially extent to the treatment of patients with fibromyalgia or in people with diabetic complications. The expansive potential of medical cannabis in the prevention and treatment of many diseases is seen in its complex and multidirectional mechanisms of action. Medical marihuana has impact on cannabinoid receptors, and it exerts effects through many other molecular targets. Aim of the study: This review seeks present mechanisms of action of medical marihuana and explore its potential therapeutic targets. Materials and methods: A comprehensive review of literature available in the PubMed and Google Scholar databases was performed, using the following keywords: "medical marihuana", "medical cannabis", "medical marihuana mechanism of action", "therapeutic targets of medical marihuana", "endocannabinoid system", "medical marihuana in pain treatment", "medical marihuana amygdala body", "medical marihuana serotonin receptors". Conclusions: Medical marihuana emerges as a promising candidate in the treatment of many diseases and common condition. However, further research is imperative to ascertain the effects of the drug and transform it into an effective medication which maximizes benefits and minimalizes side effects. [ABSTRACT FROM AUTHOR]

Background: There has been a precipitous decline in authorizations for medical cannabis since non-medical cannabis was legalized in Canada in 2018. This study examines the demographic and health- and medical cannabis-related factors associated with authorization as well as the differences in medical cannabis use, side effects, and sources of medical cannabis and information by authorization status. Methods: Individuals who were taking cannabis for therapeutic purposes completed an online survey in early 2022. Multivariable logistic regression was used to determine odds ratios (OR) and 95% confidence intervals (CI) of demographic and health- and medical cannabis-related variables associated with holding medical cannabis authorization. The differences in medical cannabis use, side effects, and sources of information by authorization status were determined via t-tests and chi-squared analysis. Results: A total of 5433 individuals who were currently taking cannabis for therapeutic purposes completed the study, of which 2941 (54.1%) currently held medical authorization. Individuals with authorization were more likely to be older (OR ≥ 70 years vs. < 30 years, 4.85 (95% CI, 3.49–6.76)), identify as a man (OR man vs. woman, 1.53 (1.34–1.74)), have a higher income (OR > $100,000/year vs. < $50,000 year, 1.55 (1.30–1.84)), and less likely to live in a small town (OR small town/rural vs. large city, 0.69 (0.59–0.81)). They were significantly more likely to report not experiencing any side effects (29.9% vs. 23.4%; p < 0.001), knowing the amount of cannabis they were taking (32.1% vs. 17.7%; p < 0.001), obtaining cannabis from regulated sources (74.1% vs. 47.5%; p < 0.001), and seeking information about medical cannabis from healthcare professionals (67.8% vs. 48.2%; p < 0.01) than individuals without authorization. Conclusions: These findings offer insight into the possible issues regarding equitable access to medical cannabis and how authorization may support and influence individuals in a jurisdiction where recreational cannabis is legalized, highlighting the value of a formal medical cannabis authorization process. [ABSTRACT FROM AUTHOR]

Background: Medical cannabis, legalized in many countries, remains illegal in France. Despite an experiment in the medical use of cannabis that began in March 2021 in France, little is known about the factors associated with the use of cannabis for self-medication among adults. Methods: Data came from the French TEMPO cohort and were collected between December 2020 and May 2021. Overall, 345 participants aged 27–47 were included. Cannabis for self-medication was defined using the following questions: 'Why do you use cannabis?' and 'In what form do you use cannabis?'. The penalized regression method "Elastic net" was used to determine factors associated with the use of cannabis for self-medication, with the hypothesis that it is mainly used for pain in individuals who have already used cannabis. Results: More than half of the participants reported having ever used cannabis (58%). Only 10% used it for self-declared medical reasons (n = 36). All self-medication cannabis users, except one, were also using cannabis for recreational purposes. The main factors associated with cannabis use for self-medication vs. other reasons included cannabis use trajectories, the presence of musculoskeletal disorders, tobacco smoking, and parental divorce. Conclusions: Engaging in cannabis use during adolescence or early adulthood may increase the likelihood of resorting to self-medication in adulthood. Due to the propensity of individuals with cannabis use during adolescence to resort to uncontrolled products for self-medication, this population should be more systematically targeted and screened for symptoms and comorbidities that may be associated with cannabis use. [ABSTRACT FROM AUTHOR]

Early adversity, the loss of the inhibitory GABAergic interneuron parvalbumin, and elevated neuroinflammation are associated with depression. Individuals with a maltreatment history initiate medicinal cannabis use earlier in life than non-maltreated individuals, suggesting self-medication. Female rats underwent maternal separation (MS) between 2 and 20 days of age to model early adversity or served as colony controls. The prelimbic cortex and behavior were examined to determine whether MS alters the cannabinoid receptor 2 (CB2), which has anti-inflammatory properties. A reduction in the CB2-associated regulatory enzyme MARCH7 leading to increased NLRP3 was observed with Western immunoblots in MS females. Immunohistochemistry with stereology quantified numbers of parvalbumin-immunoreactive cells and CB2 at 25, 40, and 100 days of age, revealing that the CB2 receptor associated with PV neurons initially increases at P25 and subsequently decreases by P40 in MS animals, with no change in controls. Confocal and triple-label microscopy suggest colocalization of these CB2 receptors to microglia wrapped around the parvalbumin neuron. Depressive-like behavior in MS animals was elevated at P40 and reduced with the CB2 agonist HU-308 or a CB2-overexpressing lentivirus microinjected into the prelimbic cortex. These results suggest that increasing CB2 expression by P40 in the prelimbic cortex prevents depressive behavior in MS female rats. [ABSTRACT FROM AUTHOR]

Driving under the influence of cannabis (DUIC) is a major cause of preventable death and a growing public health concern. News media coverage of DUIC may influence public perceptions of causal factors for DUIC, risks of DUIC, and potential policy solutions. This study examines Israeli news media coverage of DUIC, and contrasts media coverage according to whether news items refer to cannabis use for medical vs. non-medical purposes. We conducted a quantitative content analysis of news articles related to driving accidents and cannabis use (N = 299) from eleven of the highest circulation newspapers in Israel between 2008 and 2020. We apply attribution theory to analyze media coverage of accidents that were linked to medical cannabis, use compared with non-medical use. News items describing DUIC in the context of non-medical (vs. medical) cannabis use were more likely to: (a) emphasize individual causes (vs. social and political); (b) describe drivers in negative terms (vs. neutral or positive); (c) refer to an increased accident risk due to cannabis use (vs. inconclusive or low risk); and (d) call for increased enforcement rather than education. Results show that Israeli news media coverage of cannabis-impaired driving varied significantly depending on whether it referred to cannabis use for medical purposes, or non-medical purposes. News media coverage may influence public perceptions of the risks of DUIC, the factors that are associated with this issue, and potential policy solutions that may reduce the prevalence of DUIC in Israel. [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]

Simple Summary: Symptom management is a key goal of palliative cancer care. There is growing interest in the use of cannabis-based medicines or products for the management of physical and psychosocial symptoms associated with cancer or cancer treatment, including pain, nausea and vomiting, insomnia, and mood disorders. However, research on medical uses of cannabis has been limited because of legal restrictions and stigma. The goal of this review is to explore the potential role of cannabis and cannabinoids in the management of cancer-related symptoms. Limited evidence suggests that cannabis may improve cancer-related pain, chemotherapy-induced nausea and vomiting, appetite and chemosensory changes, insomnia, and mood disorders; however, cannabis is associated with several neuropsychiatric and systemic adverse effects and drug interactions. In this review, we discuss the potential role of cannabis and cannabinoids in the management of cancer-related symptoms. There is limited evidence demonstrating the effectiveness of cannabis-based products in treating cancer-related pain and gastrointestinal symptoms such as nausea, vomiting, and loss of appetite. Regarding the role of cannabis-based products in the treatment of insomnia and mood disorders, most studies looked at these symptoms as secondary outcomes with mixed results. Cannabis-based products have adverse effects, ranging from neuropsychiatric to systemic effects to potential drug interactions. [ABSTRACT FROM AUTHOR]

Growing evidence on medical cannabis has moved its legislation forward in various countries, which has increased research on stakeholder reactions. While various studies looked at experts and users, research on public perceptions is scarce. This study aims to (1) examine the relationships between knowledge, perceptions, and behavioral intention toward medical cannabis, and (2) identify and profile key segments within the general public. An online survey was conducted among 656 respondents in Belgium. Findings showed that both subjective and objective knowledge are relatively poor, while risk/benefit perceptions and behavioral intention are much more positive. Subjective and objective knowledge as well as social trust have a positive influence on benefit perceptions and a negative influence on risk perceptions. In turn, risk and benefit perceptions are key determinants of behavioral intention, but in opposite directions. Furthermore, cluster analysis identified a cautious (23% of the sample), positive (50%), and enthusiastic cluster (27%). In terms of socio-demographic profile, older and highly educated people were significantly more represented in the latter two clusters. While our study demonstrated that cannabis is well accepted for medical purposes, research is needed to further validate the relationships between knowledge, perceptions, and (intended) behavior in different settings and policy contexts. [ABSTRACT FROM AUTHOR]

Medical cannabis use among U.S. Veterans has continued to rise. However, data on cannabis use by older Veterans is generally less available. This study aims to understand the characteristics of older Veterans who enrolled in the Medical Cannabis Patient Program in Illinois and analyze their health outcomes and co-use of cannabis and opioids using longitudinal survey data. Overall, participants reported positive outcomes for pain, sleep, and emotional problems because of cannabis use in two survey periods. Approximately, 62% and 85% respondents reported no change in memory and falls, respectively, with only 3% and 1% reporting a negative outcome for the conditions in both surveys. About 20.4% of those who indicated cannabis use only in the initial survey started to co-use opioids in the follow-up survey, while 44.1% of those who indicated the use of both substances in the initial survey reported no longer using opioids in the follow-up survey. However, these changes were not statistically significant ($$\alpha = 0.05).$$ α = 0.05). The logistic regression showed that both clinical and contextual factors affected co-use. In conclusion, older U.S. Veterans may be using cannabis to alleviate their pain and other chronic conditions. More research is needed to understand the effect of cannabis use on reducing or substituting opioids. [ABSTRACT FROM AUTHOR]

The authors discuss key data regarding licensed medical cannabis use in the United States, including changes in estimates of patients using medical cannabis overall, conditions for which patients obtain medical cannabis licenses, passage of new state-level medical cannabis laws, the number and type of clinicians authorizing medical cannabis use, and shifts in the number of patients based on the presence of nonmedical adult use laws. Visual Abstract. Trends in U.S. Medical Cannabis Registrations, Authorizing Clinicians, and Reasons for Use From 2020 to 2022: The authors discuss key data regarding licensed medical cannabis use in the United States, including changes in estimates of patients using medical cannabis overall, conditions for which patients obtain medical cannabis licenses, passage of new state-level medical cannabis laws, the number and type of clinicians authorizing medical cannabis use, and shifts in the number of patients based on the presence of nonmedical adult use laws. Background: As medical cannabis availability increases, up-to-date trends in medical cannabis licensure can inform clinical policy and care. Objective: To describe current trends in medical cannabis licensure in the United States. Design: Ecological study with repeated measures. Setting: Publicly available state registry data from 2020 to 2022. Participants: People with medical cannabis licenses and clinicians authorizing cannabis licenses in the United States. Measurements: Total patient volume and prevalence per 10 000 persons in the total population, symptoms or conditions qualifying patients for licensure (that is, patient-reported qualifying conditions), and number of authorizing clinicians. Results: In 2022, of 39 jurisdictions allowing medical cannabis use, 34 reported patient numbers, 19 reported patient-reported qualifying conditions, and 29 reported authorizing clinician numbers. Enrolled patients increased 33.3% from 2020 (3 099 096) to 2022 (4 132 098), with a corresponding 23.0% increase in the population prevalence of patients (175.0 per 10 000 in 2020 to 215.2 per 10 000 in 2022). However, 13 of 15 jurisdictions with nonmedical adult-use laws had decreased enrollment from 2020 to 2022. The proportion of patient-reported qualifying conditions with substantial or conclusive evidence of therapeutic value decreased from 70.4% (2020) to 53.8% (2022). Chronic pain was the most common patient-reported qualifying condition in 2022 (48.4%), followed by anxiety (14.2%) and posttraumatic stress disorder (13.0%). In 2022, the United States had 29 500 authorizing clinicians (7.7 per 1000 patients), 53.5% of whom were physicians. The most common specialties reported were internal or family medicine (63.4%), physical medicine and rehabilitation (9.1%), and anesthesia or pain (7.9%). Limitation: Missing data (for example, from California), descriptive analysis, lack of information on individual use patterns, and changing evidence base. Conclusion: Enrollment in medical cannabis programs increased overall but generally decreased in jurisdictions with nonmedical adult-use laws. Use for conditions or symptoms without a strong evidence basis continues to increase. Given these trends, more research is needed to better understand the risks and benefits of medical cannabis. Primary Funding Source: National Institute on Drug Abuse of the National Institutes of Health. [ABSTRACT FROM AUTHOR]

Using cross-sectional baseline measurements from a longitudinal cohort study, we evaluated the perceived impact of the Coronavirus Disease 2019 (COVID-19) pandemic on cannabis use and emotional well-being among college students meeting cannabis use disorder (CUD) criteria (N = 150). Compared to before the pandemic, participants retrospectively reported an increase in cannabis use during the first phase of the pandemic when stay-at-home orders occurred, which was correlated with a greater number of CUD symptoms and cannabis use-related consequences since the pandemic began. Reporting greater frequency of cannabis use during the pandemic was associated with greater frequency of using amphetamine-type drugs and consumption of cannabis by dabbing since the pandemic began. There were significant differences in cannabis use-related outcomes as a function of negative emotions (e.g., feeling lonely/stressed/anxious/depressed) experienced during the pandemic. The findings elucidate the impact of the pandemic on cannabis use among college students with CUD and can inform prevention/intervention efforts in this population. [ABSTRACT FROM AUTHOR]

Purpose: People with cancer who use medicinal cannabis do so despite risks associated with limited clinical evidence, legalities, and stigma. This study investigated how Australians with cancer rationalise their medicinal cannabis use despite its risks. Methods: Ten adults (5 males and 5 females; mean age of 53.3) who used cannabis medicinally for their cancer were interviewed in 2021–2022 about how they used and accessed the substance, attitudes and beliefs underpinning their use, and conversations with others about medicinal cannabis. Results: Participants had cancer of the bowel, skin, oesophagus, stomach, thyroid, breast, and Hodgkin lymphoma for which they were receiving treatment (n = 5) or under surveillance (n = 5), with most (n = 6) encountering metastatic disease. Cannabis was used to treat a variety of cancer-related symptoms such as pain, poor sleep, and low mood. Cannabis was perceived as natural and thus less risky than pharmaceuticals. Participants legitimised their medicinal cannabis use by emphasising its natural qualities and distancing themselves from problematic users or riskier substances. Cost barriers and a lack of healthcare professional communication impeded prescription access. Similarly, participants navigated medicinal cannabis use independently due to a lack of guidance from healthcare professionals. Conclusion: Findings highlight the need for robust data regarding the harms and efficacy of medicinal cannabis and dissemination of such information among healthcare professionals and to patients who choose to use the substance. Ensuring healthcare professionals are equipped to provide non-judgmental and evidence-based guidance may mitigate potential safety and legal risks. [ABSTRACT FROM AUTHOR]

Fungal contamination is an important problem in cannabis and medical cannabis production, as fungi can produce toxic compounds or reduce the quality and safety of the product. The aim of this study was to perform a bibliometric evaluation related to fungal contamination in cannabis, analyzing current trends in this field and providing future perspectives for research. For this purpose, an exhaustive search was carried out in the scientific literature in electronic databases such as Scopus and Web of Science (WOS), covering the period from 2000 to 2023. The results obtained were processed through bibliometrics and network analysis, using tools such as RStudio and Bibliometrix software. The results revealed that the main themes associated with fungal contamination in cannabis are focused on: diseases related to fungal contamination of the plant, use of fungi as an alternative biological control in cannabis cultivation, metabolites associated with cannabis and their potential in fungal control, as well as fungal diversity in cannabis cultivation and postharvest and the risk to consumer health. Finally, future research areas are proposed to address the challenge of fungal contamination in medicinal cannabis production, covering topics such as pest control, contamination, genetic resistance, active compounds, analysis methods, and the impact of fungi on cannabis. [ABSTRACT FROM AUTHOR]

Background and Objective: Cannabis use is increasing among older adults, with use primarily for medicinal purposes. Much of the evidence on perceptions of cannabis is derived from younger populations and current users of cannabis. The purpose of this study was to describe community-dwelling older Canadians' perceptions of cannabis effectiveness, safety and accessibility for medicinal purposes and to identify factors influencing cannabis perceptions. Methods: An online survey of older adults' perceptions, knowledge and experiences with cannabis was completed between February and September 2022. The survey was open to English-speaking and French-speaking Canadians aged 50 years and older regardless of their cannabis use history. Results: A total of 1615 Canadians completed the survey. Respondents identified primarily as men (49.7%) or women (48.5%) of Caucasian decent. The majority of participants viewed cannabis as a reasonable alternative (65.8%) and an effective (70.5%) treatment modality for symptom management in older adults. Few respondents (16.4%) felt that older adults compared to younger adults were at a higher risk of side effects and 34.5% felt that cannabis is safe to use with most medicines. Cannabis perceptions were influenced by gender, cannabis use history (prior use vs current use) and reasons for cannabis use (recreational purposes vs medicinal purposes vs both purposes). Conclusions: Older Canadians have a positive view of the role of cannabis in symptom management. The perceptions of cannabis safety and effectiveness were influenced by gender, cannabis use history and reasons for cannabis use. Healthcare professionals should leverage these perceptions when discussing cannabis with their older patient populations. [ABSTRACT FROM AUTHOR]

A limited number of studies have examined how drying conditions affect the cannabinoid and terpene content in cannabis inflorescences. In the present study, we evaluated the potential of controlled atmosphere drying chambers for drying medicinal cannabis inflorescence. Controlled atmosphere drying chambers were found to reduce the drying and curing time by at least 60% compared to traditional drying methods, while preserving the volatile terpene content. On the other hand, inflorescences subjected to traditional drying were highly infested by Alternaria alternata and also revealed low infestation of Botrytis cinerea. In the high-THC chemovar ("240"), controlled N2 and atm drying conditions preserved THCA concentration as compared to the initial time point (t0). On the other hand, in the hybrid chemovar ("Gen12") all of the employed drying conditions preserved THCA and CBDA content. The optimal drying conditions for preserving monoterpenes and sesquiterpenes in both chemovars were C5O5 (5% CO2, 5% O2, and 90% N2) and pure N2, respectively. The results of this study suggest that each chemovar may require tailored drying conditions in order to preserve specific terpenes and cannabinoids. Controlled atmosphere drying chambers could offer a cost-effective, fast, and efficient drying method for preserving cannabinoids and terpenes during the drying process while reducing the risk of mold growth. [ABSTRACT FROM AUTHOR]

The effort to maintain cannabinoid and terpene levels in harvested medicinal cannabis inflorescence is crucial, as many studies demonstrated a significant concentration decrease in these compounds during the drying, curing, and storage steps. These stages are critical for the preparation and preservation of medicinal cannabis for end-use, and any decline in cannabinoid and terpene content could potentially reduce the therapeutic efficacy of the product. Consequently, in the present study, we determined the efficacy of pre-harvest hexanoic acid treatment alongside four months of post-harvest vacuum storage in prolonging the shelf life of high THCA cannabis inflorescence. Our findings indicate that hexanoic acid treatment led to elevated concentrations of certain cannabinoids and terpenes on the day of harvest and subsequent to the drying and curing processes. Furthermore, the combination of hexanoic acid treatment and vacuum storage yielded the longest shelf life and the highest cannabinoid and mono-terpene content as compared to all other groups studied. Specifically, the major cannabinoid's—(-)-Δ9-trans-tetrahydrocannabinolic acid (THCA)—concentration decreased by 4–23% during the four months of storage with the lowest reduction observed following hexanoic acid pre-harvest treatment and post-harvest vacuum storage. Hexanoic acid spray application displayed a more pronounced impact on mono-terpene preservation than storage under vacuum without hexanoic acid treatment. Conversely, sesqui-terpenes were observed to be less prone to degradation than mono-terpenes over an extended storage duration. In summation, appropriate pre-harvest treatment coupled with optimized storage conditions can significantly extend the shelf life of cannabis inflorescence and preserve high active compound concentration over an extended time period. [ABSTRACT FROM AUTHOR]

Context: Studies generally focus on one type of chronic condition and the effect of medical cannabis (MC) on symptoms; little is known about the perceptions and engagement of patients living with chronic conditions regarding the use of MC. Objectives: This scoping review aims to explore: (1) what are the dimensions addressed in studies on MC that deal with patients' perceptions of MC? and (2) how have patients been engaged in developing these studies and their methodologies? Through these objectives, we have identified areas for improving future research. Methods: We searched five databases and applied exclusion criteria to select relevant articles. A thematic analysis approach was used to identify the main themes: (1) reasons to use, to stop using or not to use MC, (2) effects of MC on patients themselves and empowerment, (3) perspective and knowledge about MC, and (4) discussion with relatives and healthcare professionals. Results: Of 53 articles, the main interest when assessing the perceptions of MC is to identify the reasons to use MC (n = 39), while few articles focused on the reasons leading to stop using MC (n = 13). The majority (85%) appraise the effects of MC as perceived by patients. Less than one third assessed patients' sense of empowerment. Articles determining the beliefs surrounding and knowledge of MC (n = 41) generally addressed the concerns about or the comfort level with respect to using MC. Only six articles assessed patients' stereotypes regarding cannabis. Concerns about stigma constituted the main topic while assessing relationships with relatives. Some articles included patients in the research, but none of them had co-created the data collection tool with patients. Conclusions: Our review outlined that few studies considered chronic diseases as a whole and that few patients are involved in the co-construction of data collection tools as well. There is an evidence gap concerning the results in terms of methodological quality when engaging patients in their design. Future research should evaluate why cannabis' effectiveness varies between patients, and how access affects the decision to use or not to use MC, particularly regarding the relationship between patients and healthcare providers. Future research should consider age and gender while assessing perceptions and should take into consideration the legislation status of cannabis as these factors could in fact shape perception. To reduce stigma and stereotypes about MC users, better quality and accessible information on MC should be disseminated. [ABSTRACT FROM AUTHOR]

Background: When state governments impose quotas on commercial marijuana licenses, regulatory commissions use an application process to assess the feasibility of prospective businesses. Decisions on license applications are often met with formal appeals and legal challenges from rejected applicants. Although prior research has examined substate disparities in the availability of marijuana dispensaries, less attention has been given to the quality of license applications. The present study analyzed the relationship between neighborhood-level characteristics and the quality of prospective dispensary businesses. Methods: During Missouri's first applicant pool for medical marijuana dispensaries in 2019, a total of 606 census tracts contained the location site of at least one dispensary applicant. Using data from the Missouri Department of Health and Senior Services and the American Community Survey, fractional and binary logistic regression models were used to estimate the relationship between census-tract characteristics and application outcomes. Results: License applications received higher evaluation scores when proposed dispensary sites were in census tracts with greater population densities and no majority in racial/ethnic composition. Census tracts with poorer socioeconomic conditions attracted a disproportionate share of low-scoring applicants from the bottom quartile of scores. These effects were stronger for certain application subsections, particularly those assessing the quality of an applicant's business plan and on-site security. Conclusions: Some communities tend to attract prospective license holders who possess better quality resources, business practices, and industry experience. State disparities in commercial licensing requirements and application processes may lead to the inequities in legal product access found in some prior studies. [ABSTRACT FROM AUTHOR]

Cannabis, traditionally used for recreation due to psychoactive compounds in its leaves, flowers, and seeds, has not been thoroughly explored for potential therapeutic benefits. Δ9-trans-Tetrahydrocannabinol, a key cannabinoid in cannabis, causes hallucinogenic effects and delirium symptoms. In contrast, cannabidiol (CBD) does not induce hallucinations and has shown effectiveness in treating symptoms of various rare, incurable diseases. Cannabis exhibits neuroprotective, anti-inflammatory, anti-thrombotic, anti-bacterial, analgesic, and antiepileptic properties, recently attracting more attention. This review aims to summarize comprehensively the impact of cannabis on human health, focusing on endocannabinoids and their receptors. It also delves into recent CBD research advancements, highlighting the compound's potential medical applications. Overall, this paper provides valuable insights into the prospective development of medical cannabis, with a particular emphasis on CBD. [ABSTRACT FROM AUTHOR]

Over the past few decades, many current uses for cannabinoids have been described, ranging from controlling epilepsy to neuropathic pain and anxiety treatment. Medicines containing cannabinoids have been approved by both the FDA and the EMA for the control of specific diseases for which there are few alternatives. However, the molecular-level mechanism of action of cannabinoids is still poorly understood. Recently, cannabinoids have been shown to interact with autotaxin (ATX), a secreted lysophospholipase D enzyme responsible for catalyzing lysophosphatidylcholine (LPC) to lysophosphatidic acid (LPA), a pleiotropic growth factor that interacts with LPA receptors. In addition, a high-resolution structure of ATX in complex with THC has recently been published, accompanied by biochemical studies investigating this interaction. Due to their LPA-like structure, endocannabinoids have been shown to interact with ATX in a less potent manner. This finding opens new areas of research regarding cannabinoids and endocannabinoids, as it could establish the effect of these compounds at the molecular level, particularly in relation to inflammation, which cannot be explained by the interaction with CB1 and CB2 receptors alone. Further research is needed to elucidate the mechanism behind the interaction between cannabinoids and endocannabinoids in humans and to fully explore the therapeutic potential of such approaches. [ABSTRACT FROM AUTHOR]

Background: The Veterans Health Administration tracks urine drug tests (UDTs) among patients on long-term opioid therapy (LTOT) and recommends discussing the health effects of cannabis use. Objective: To determine the occurrence of cannabis-related discussions between providers and patients on LTOT during six months following UDT positive for cannabis, and examine factors associated with documenting cannabis use. Design: We identified patients prescribed LTOT with a UDT positive for cannabis in 2019. We developed a text-processing tool to extract discussions around cannabis use from their charts. Subjects: Twelve thousand seventy patients were included. Chart review was conducted on a random sample of 1,946 patients. Main measures: The presence of a cannabis term in the chart suggesting documented cannabis use or cannabis-related discussions. Content of those discussions was extracted in a subset of patients. Logistic regression was used to examine the association between patient factors, including state of residence legal status, with documentation of cannabis use. Key Results: Among the 12,070 patients, 65.8% (N = 7,948) had a cannabis term, whereas 34.1% (N = 4,122) of patients lacked a cannabis term, suggesting that no documentation of cannabis use or discussion between provider and patient took place. Among the subset of patients who had a discussion documented, 47% related to cannabis use for medical reasons, 35% related to a discussion of VA policy or legal issues, and 17% related to a discussion specific to medical risks or harm reduction strategies. In adjusted analyses, residents of states with legalized recreational cannabis were less likely to have any cannabis-related discussion compared to patients in non-legal states [OR 0.73, 95% CI 0.64–0.82]. Conclusions: One-third of LTOT patients did not have documentation of cannabis use in the chart in the 6 months following a positive UDT for cannabis. Discussions related to the medical risks of cannabis use or harm reduction strategies were uncommon. [ABSTRACT FROM AUTHOR]

To test the hypothesis that genetic and pharmacological modulation of the classical cannabinoid type 1 (CB1) and 2 (CB2) receptors attenuate cancer-induced bone pain, we searched Medline, Web of Science and Scopus for relevant skeletal and non-skeletal cancer studies from inception to July 28, 2022. We identified 29 animal and 35 human studies. In mice, a meta-analysis of pooled studies showed that treatment of osteolysis-bearing males with the endocannabinoids AEA and 2-AG (mean difference [MD] − 24.83, 95% confidence interval [95%CI] − 34.89, − 14.76, p < 0.00001) or the synthetic cannabinoid (CB) agonists ACPA, WIN55,212-2, CP55,940 (CB1/2-non-selective) and AM1241 (CB2-selective) (MD − 28.73, 95%CI − 45.43, − 12.02, p = 0.0008) are associated with significant reduction in paw withdrawal frequency. Consistently, the synthetic agonists AM1241 and JWH015 (CB2-selective) increased paw withdrawal threshold (MD 0.89, 95%CI 0.79, 0.99, p < 0.00001), and ACEA (CB1-selective), AM1241 and JWH015 (CB2-selective) reduced spontaneous flinches (MD − 4.85, 95%CI − 6.74, − 2.96, p < 0. 00001) in osteolysis-bearing male mice. In rats, significant increase in paw withdrawal threshold is associated with the administration of ACEA and WIN55,212-2 (CB1/2-non-selective), JWH015 and AM1241 (CB2-selective) in osteolysis-bearing females (MD 8.18, 95%CI 6.14, 10.21, p < 0.00001), and treatment with AM1241 (CB2-selective) increased paw withdrawal thermal latency in males (mean difference [MD]: 3.94, 95%CI 2.13, 5.75, p < 0.0001), confirming the analgesic capabilities of CB1/2 ligands in rodents. In human, treatment of cancer patients with medical cannabis (standardized MD − 0.19, 95%CI − 0.35, − 0.02, p = 0.03) and the plant-derived delta-9-THC (20 mg) (MD 3.29, CI 2.24, 4.33, p < 0.00001) or its synthetic derivative NIB (4 mg) (MD 2.55, 95%CI 1.58, 3.51, p < 0.00001) are associated with reduction in pain intensity. Bioinformatics validation of KEGG, GO and MPO pathway, function and process enrichment analysis of mouse, rat and human data revealed that CB1 and CB2 receptors are enriched in a cocktail of nociceptive and sensory perception, inflammatory, immune-modulatory, and cancer pathways. Thus, we cautiously conclude that pharmacological modulators of CB1/2 receptors show promise in the treatment of cancer-induced bone pain, however further assessment of their effects on bone pain in genetically engineered animal models and cancer patients is warranted. [ABSTRACT FROM AUTHOR]

Background: In Canada, cannabis legalization altered the way that the public can access cannabis for medical purposes. However, Canadians still struggle with finding healthcare professionals (HCPs) who are involved in medical cannabis counselling and authorization. This raises questions about the barriers that are causing this breakdown in care. Our study explored the perceptions of primary care providers regarding cannabis in their practice. Methods: Semi-structured interviews were conducted by Zoom with HCPs in Newfoundland and Labrador (NL) to discuss their experiences with medical and non-medical cannabis in practice. Family physicians and nurse practitioners who were practicing in primary care in NL were included. The interview guide and coding template were developed using the Theoretical Domains Framework (TDF). A thematic analysis across the TDF was then conducted. Results: Twelve participants with diverse demographic backgrounds and experience levels were interviewed. Five main themes emerged including, knowledge acquisition, internal influences, patient influences, external HCP influences, and systemic influences. The TDF domain resulting in the greatest representation of codes was environmental context and resources. Interpretation: The findings suggested that HCPs have significant knowledge gaps in authorizing medical cannabis, which limited their practice competence and confidence in this area. Referring patients to cannabis clinics, while enforcing harm-reduction strategies, was an interim option for patients to access cannabis for medical purposes. However, developing practice guidelines and educational resources were suggested as prominent facilitators to promote medical cannabis authorization within the healthcare system. [ABSTRACT FROM AUTHOR]

Background: Cannabis policies have changed drastically over the last few years with many states enacting medical cannabis laws, and some authorizing recreational use; all against federal laws. As a result, cannabis products are marketed in dispensaries in different forms, most abundantly as flowers intended for smoking and sometimes vaping. All samples used in this study were obtained directly from law enforcement. The sample collection process was facilitated and funded by the National Marijuana Initiative (NMI), part of the High-Intensity Drug Trafficking Area (HIDTA) program. This initial report focuses on cannabis flowers. Similar studies with other cannabis products will be the subject of a future report. Methods: A total of 107 Δ9-THC cannabis flower samples were collected by law enforcement from adult commercial use cannabis dispensaries, located in three different states (Colorado, Oregon, and California) and analyzed in this study for cannabinoid concentration. Samples were analyzed by GC-FID following our previously published procedure. Discussion: The label claims for total Δ9-THC content ranged from 12.04 to 58.20% w/w, while GC-FID results showed a concentration ranging from 12.95 to 36.55% w/w. Of the evaluated 107 products, only 32 samples have Δ9-THC content within ± 20% of the labeled content. However, the remaining 75 samples were found to be out of the ± 20% acceptance criteria. The degree of agreement for the tested samples using ± 20% tolerance with label claims was only 30%. The results of this study indicate that there is a need for more stringent regulations to ensure that product labeling is accurate, as 70% of the evaluated products did not meet the ± 20% acceptance criteria. This highlights the importance of healthcare professionals and patients being vigilant about the Δ9-THC content, as inaccurate labeling of cannabis products could potentially result in adverse health effects. Furthermore, there is a pressing need for more rigorous regulation of commercial cannabis products in the United States. [ABSTRACT FROM AUTHOR]

Background: Cannabis interest and use is increasing in the United States, yet research on its use among cancer patients is limited. Methods: Individuals with cancer completed an anonymous cross-sectional questionnaire. Multivariable logistic regressions estimated odds ratios (OR) between patients' demographic and clinical characteristics with cannabis-related interest, current use, and provider recommendation. Results: Participants (n = 943) were, on average, 61.7 years old. Older patients were less likely to use cannabis products (OR = 0.42, confidence interval [95% CI]: 0.26–0.69) and less likely to be interested in cannabis (OR = 0.60, 95% CI: 0.44–0.84) than younger patients. Those with higher education were less likely to be using cannabis (OR = 0.41, 95% CI: 0.25–0.67) and less likely to have received a provider recommendation of cannabis use than the least educated (OR = 0.38, 95% CI: 0.19–0.76). Cancer spread and type were significant correlates of provider recommendation of cannabis use. Conclusions: Additional research is warranted to better understand cancer patients' motivations for cannabis use and interest. [ABSTRACT FROM AUTHOR]

Background: Despite increasing medical cannabis use, research has yet to establish whether and to what extent products containing delta-9-tetrahydrocannabinol (THC) impact driving performance among patients. Stable doses of prescribed cannabinoid products during long-term treatment may alleviate clinical symptoms affecting cognitive and psychomotor performance. Aim: To examine the effects of open-label prescribed medical cannabis use on simulated driving performance among patients. Methods: In a semi-naturalistic laboratory study, 40 adults (55% male) aged between 23 and 80 years, consumed their own prescribed medical cannabis product. Driving performance outcomes including standard deviation of lateral position (SDLP), the standard deviation of speed (SDS), mean speed and steering variability were evaluated using the Forum8 driving simulator at baseline (pre-dosing), 2.5 h and 5 -h (post-dosing). Perceived driving effort (PDE) was self-reported after each drive. Oral fluid and whole blood samples were collected at multiple timepoints and analysed for THC via liquid chromatography-mass spectrometry. Results: A significant main effect of time was observed for mean speed (p = 0.014) and PDE (p = 0.020), with patients displaying modest stabilisation of vehicle control, increased adherence to speed limits and reductions in PDE post-dosing, relative to baseline. SDLP (p = 0.015) and PDE (p = 0.043) were elevated for those who consumed oil relative to flower-based products. Detectable THC concentrations were observed in oral fluid at 6-h post-dosing (range = 0–24 ng/mL). Conclusions: This semi-naturalistic study suggests that the consumption of medical cannabis containing THC (1.13–39.18 mg/dose) has a negligible impact on driving performance when used as prescribed. [ABSTRACT FROM AUTHOR]

Background There is a lack of studies on the course and effectiveness of medical cannabis in the treatment of major depressive disorder (MDD). Methods Retrospective longitudinal (18 weeks) study of n=59 outpatients with MDD, treated with medical cannabis via a telemedical platform. Previous treatment with antidepressant medication was required for inclusion into the study. Standardized data collection was carried out at entry and during monthly consultations. Severity of depression was measured on a 0–10 point rating scale. Side-effects were assessed by a checklist. Results Patients were 20–54 years old; 72.9% were male; one third reported times of regular cannabis consumption within the previous five years. Drop-out rate was 22% after 18 weeks. Mean severity of depression decreased from 6.9 points (SD 1.5) at entry to 3.8 points (2.7) at week 18 (baseline observation carried forward; 95% CI for the mean difference: 2.4 to 3.8; p<0.001). A treatment response (>50% reduction of the initial score) was seen in 50.8% at week 18. One third of patients complained about side effects, none was considered as severe. Concomitant antidepressant medication (31% of patients) was not associated with outcome. Conclusions Medical cannabis was well tolerated and dropout rate was comparable to those in clinical trials of antidepressant medication. Patients reported a clinically significant reduction of depression severity. Further research on the effectiveness of medical cannabis for MDD seems warranted. Risks of this medication, such as sustaining or inducing a cannabis use disorder, or side effects such as poor concentration, must be taken into consideration. [ABSTRACT FROM AUTHOR]

Background: In 2016, California transitioned from legalized medical cannabis use to adult-use. Little is known about how this policy change affected medicinal cannabis use among young adults. Objectives: To identify longitudinal groups of medicinal cannabis users and concurrent changes in health- and cannabis use-related characteristics among young adults in Los Angeles between 2014 and 2021. Methods: Cannabis users (210 patients and 156 non-patients; 34% female; ages 18–26 at baseline) were surveyed annually across six waves. Longitudinal latent class analysis derived groups from two factors – cannabis patient status and self-reported medicinal use. Trajectories of health symptoms, cannabis use motives, and cannabis use (daily/near daily use, concentrate use, and problematic use) were estimated across groups. Results: Three longitudinal latent classes emerged: Recreational Users (39.3%) – low self-reported medicinal use and low-to-decreasing patient status; Recreational Patients (40.4%) – low self-reported medicinal use and high-to-decreasing patient status; Medicinal Patients (20.3%) – high self-reported medicinal use and high-to-decreasing patient status. At baseline, Medicinal Patients had higher levels of physical health symptoms and motives than recreational groups (p <.05); both patient groups reported higher level of daily/near daily and concentrate use (p <.01). Over time, mental health symptoms increased in recreational groups (p <.05) and problematic cannabis use increased among Recreational Patients (p <.01). Conclusions: During the transition to legalized adult-use, patterns of medicinal cannabis use varied among young adults. Clinicians should monitor increases in mental health symptoms and cannabis-related problems among young adults who report recreational – but not medicinal – cannabis use. [ABSTRACT FROM AUTHOR]

Background: Research on cannabis‐based medicinal products (CBMPs) in anxiety remains inconclusive due to a paucity of high‐quality evidence. Studies indicate a bidirectional relationship between generalized anxiety disorder (GAD) and sleep disruption, but it is unclear how this affects CBMP treatment outcomes. This study aims to compare the patient‐reported outcome measures (PROMs) of patients prescribed CBMPs for GAD, with and without impaired sleep. Methods: Changes in PROMs were recorded from baseline to 1, 3, 6, and 12 months between those with impaired or unimpaired sleep. Multivariate logistic regression was applied to compare factors associated with a clinically significant improvement in GAD‐7 at 12 months. Secondary outcomes included adverse event incidence and frequency. Results: Of the 302 patients that fit the inclusion criteria, mean GAD‐7, single‐item sleep quality, and EQ‐5D‐5L index values improved at all time points (p < 0.001). A relationship between sleep impairment and clinically significant changes in GAD‐7 at 1 and 3 months was identified (p ≤ 0.01). On multivariate regression, only baseline GAD severity was associated with an increased likelihood of observing a clinically significant improvement in anxiety (p < 0.001). Seven hundred and seven (234%) adverse events were reported by 55 (18.21%) participants. Conclusions: This study observed an association between CBMP treatment and improvements in anxiety in patients with GAD. While patients with comorbid sleep disruption had greater improvements in anxiety, the differences were not maintained in a multivariate analysis. Baseline anxiety severity may be a predictor for CBMP treatment outcomes. [ABSTRACT FROM AUTHOR]

An increasing number of countries have started to decriminalize or legalize the consumption of cannabis for recreational and medical purposes. The active ingredients in cannabis, termed cannabinoids, affect multiple functions in the human body, including coordination, motor skills, memory, response time to external stimuli, and even judgment. Cannabinoids are a unique class of terpeno-phenolic compounds, with 120 molecules discovered so far. There are certain situations when people under the influence of cannabis may be a risk to themselves or the public safety. Over the past two decades, there has been a growing research interest in detecting cannabinoids from various biological matrices. There is a need to develop a rapid, accurate, and reliable method of detecting cannabinoids in oral fluid as it can reveal the recent intake in comparison with urine specimens, which only show a history of consumption. Significant improvements are continuously made in the analytical formats of various technologies, mainly concerning improving their sensitivity, miniaturization, and making them more user-friendly. Additionally, sample collection and pretreatment have been extensively studied, and specific devices for collecting oral fluid specimens have been perfected to allow rapid and effective sample collection. This review presents the recent findings regarding the use of oral fluid specimens as the preferred biological matrix for cannabinoid detection in a point-of-care biosensor diagnostic device. A critical review is presented, discussing the findings from a collection of review and research articles, as well as publicly available data from companies that manufacture oral fluid screening devices. Firstly, the various conventional methods used to detect cannabinoids in biological matrices are presented. Secondly, the detection of cannabinoids using point-of-care biosensors is discussed, emphasizing oral fluid specimens. This review presents the current pressing technological challenges and highlights the gaps where new technological solutions can be implemented. [ABSTRACT FROM AUTHOR]

PURPOSE: A growing body of scientific research indicates that oncology teams tend to offer individuals with cancer little clinical advice regarding medicinal cannabis (MC) and that individuals with cancer instead turn to cannabis dispensaries for MC guidance. Our objective was to investigate dispensary personnels backgrounds and trainings in MC advising. METHODS: The study design was semistructured interviews across 13 states with cannabis dispensary personnel in managerial or client-facing positions. Of 38 recruited, 26 (68%) completed interview. The primary outcome was training in MC advising. Researchers targeted thematic saturation and adhered to Consolidated Criteria for Reporting Qualitative Research. RESULTS: Of 26 participants, 54% were female, with an average age of 40 (range: 22-64) years. Half worked in client-facing roles; half worked in managerial ones. Study participants endorsed passionate commitment to their profession, often motivated by personal experience with MC therapeutics. Cannabis dispensaries often privileged sales skills over cannabis therapeutics knowledge when hiring, resulting in uneven baseline levels of cannabis therapeutics expertise among staff. Most participants reported workplace cannabis therapeutics training to be unstandardized and weak. They described dispensary personnel as resourceful in pursuing cannabis knowledge, self-financing learning in off-hours, sampling dispensary products, and exchanging knowledge. Nearly half the participants called for quality, standardized cannabis therapeutics training for dispensary personnel. CONCLUSION: The many oncology teams who defer to dispensary personnel regarding MC advising rely on a workforce who views themselves as unevenly trained. Further research should include a national survey of cannabis dispensary personnel to learn whether these findings hold true in a larger sample. If so, the oncology community must determine the best approach to clinically advising individuals with cancer about MC.

AimsThis study estimated the likelihoods of individuals transitioning to different cannabis use status following recreational cannabis legalization (RCL) in the United States.DesignSecondary analysis of a nationally representative longitudinal cohort in the United States. We used propensity score matching to balance individual characteristics between RCL and comparison states and generalized mixed regressions to estimate behavioral transitions in matched samples.ParticipantsA longitudinal cohort of 21 863 individuals (6925 youths and 14 938 adults) participating in the Population Assessment of Tobacco and Health waves 3 and 4.SettingFour RCL states that implemented RCL between waves 3 and 4 (California, Massachusetts, Nevada and Maine) and comparison states in the United States.MeasurementsTransitions in cannabis use over the two waves: (1) from non-users to users; (2) from non-users to weekly users; (3) from users to non-users. Individuals in RCL states were compared with matched individuals in (1) states with medical cannabis legalization (MCL), (2) states not legalizing cannabis (non-legalizing) and (3) MCL and non-legalizing states combined.FindingsAmong youths, the association between RCL and greater odds of transition from non-users to users was seen in comparison with non-legalizing states [odds ratio (OR) = 2.18, 95% confidence interval (CI) = 1.37-3.45] and combined states (OR = 1.73, 95% CI = 1.23-2.42). Evidence was lacking regarding the associations between RCL and transitions from non-users to weekly users and from users to non-users. Among adults, RCL was associated with greater odds of transitions from non-users to users and non-users to weekly users if RCL states were compared with non-legalizing states (OR = 1.68, 95% CI = 1.15-2.46; OR = 1.82, 95% CI = 1.00-3.31, respectively) or combined states (OR = 1.51, 95% CI = 1.11-2.07; OR = 2.09, 95% CI = 1.19-3.66, respectively). RCL was also associated with lower odds of transition from users to non-users if RCL states were compared with non-legalizing states (OR = 0.54, 95% CI = 0.35-0.81).ConclusionsThere appears to be some evidence that recreational cannabis legalization in the United States is associated with elevated odds of transition to cannabis use among both youths and adults.

An interview with poster contest winners Mehran Afshar, Alexander Barber, Lucy Buckley, Baljinder Randhawa, and Yonatan Hillinger is presented. They talk about their poster and their research on patients using medical cannabis as chronic pain treatment in the United Kingdom (UK). They explain how their study could benefit patients with pain and physical and mental health conditions. They discuss the various ways in which medical cannabis can be prescribed.