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Objective: The objective of this study was to evaluate the safety and efficacy of medications commonly used in autism spectrum disorder (ASD) and compare this to what current research has shown regarding medical cannabis use in this population. Methods: Searches were performed to collect information surrounding currently used medications and their safety and efficacy profiles, biologic plausibility of cannabis use for symptoms of ASD, and studies detailing cannabis' safety and efficacy profile for use in the ASD population. Results were used to compare medications to cannabis as a proposed treatment. Results: The heterogeneity of ASD produces great difficulties in finding appropriate treatment, leading to many medication changes or treatment trials throughout a patient's life. Commonly prescribed medications display varying levels of efficacy, safety, and tolerability between patients and symptoms targeted. Some of the most common side effects cited are also considered the most troubling symptoms associated with ASD; aggression, anxiety, irritability, and a negative effect on cognition, leading many patients to discontinue use as the side effects outweigh benefits. Recent case reports and retrospective studies have displayed the potential efficacy, safety, and tolerability of cannabidiol (CBD)-rich medical cannabis use for treating both core symptoms of ASD and many comorbid symptoms such as irritability and sleep problems. Studies have also identified circulating endocannabinoids as a possible biomarker for ASD, providing another possible method of diagnosis. Conclusions: Currently, there are no approved medications for the core symptoms of ASD and only two medications Food and Drug Administration approved for associated irritability. Prescribed medications for symptoms associated with ASD display varying levels of efficacy, safety, and tolerability among the heterogeneous ASD population. At the time of this study there are no published placebo-controlled trials of medical cannabis for ASD and the observational studies have limitations. CBD-rich medical cannabis seems to be an effective, tolerable, and relatively safe option for many symptoms associated with ASD, however, the long-term safety is unknown at this time.

Patterns of cannabis consumption among regular users within a legalized environment have not been explored in detail. We aimed to conduct a survey among regular cannabis users to collect detailed information on frequency of use, methods of use, amounts consumed, and adverse health effects experienced. Data was collected via the Cannabis Users Survey on Health, a self-administered, anonymous online survey. Participants were adults (age 21+), residing in Colorado, who used cannabis at least once in the past month. Survey administration occurred June through October 2016. Of 1297 participant responses, 65.1% used cannabis at least once daily and smoking was the most common method of use (83.1%). Cannabis flower was the product most frequently purchased (n = 1006) and in the largest average amount per month (10 g). Adverse health effects were experienced by ~ 40%; most prevalent was paranoia (20.8%). The Cannabis Users Survey on Health provided data needed to inform public health on patterns of cannabis use in Colorado. Surveillance of adverse effects is needed to assess severity. High prevalence of daily use and smoking are concerning for long-term health effects. Continued data collection will allow public health to better assess the effects of increased cannabis availability on use patterns and health.

A versatile and scalable strategy is reported for the rapid generation of block copolymer libraries spanning a wide range of compositions starting from a single parent copolymer. This strategy employs automated and operationally simple chromatographic separation that is demonstrated to be applicable to a variety of block copolymer chemistries on multigram scales with excellent mass recovery. The corresponding phase diagrams exhibit increased compositional resolution compared to those traditionally constructed via multiple, individual block copolymer syntheses. Increased uniformity and lower dispersity of the chromatographic libraries lead to differences in the location of order-order transitions and observable morphologies, highlighting the influence of dispersity on the self-assembly of block copolymers. Significantly, this separation technique greatly simplifies the exploration of block copolymer phase space across a range of compositions, monomer pairs, and molecular weights (up to 50000 amu), producing materials with increased control and homogeneity when compared to conventional strategies.

With legalization of retail marijuana in Colorado, and the opening of dispensaries in January 2014, two key questions were how legalization would impact marijuana use and whether there would be an increase in adverse health events. Legalization did not noticeably impact marijuana use rates among adolescents or young adults. Past-30-day use among adolescents remained steady for more than ten years, pre- and post-legalization. Use among 18–25-year-olds has gradually increased for over ten years, with no change in the trend around legalization. However, healthcare encounters with mention of marijuana have increased after legalization. Poison center calls among 9–17-year-olds have markedly increased, while calls for 18–25-year-olds saw a modest increase. Meanwhile, the portion of hospitalizations with a marijuana code increased modestly among 9–17-year-olds but tripled among 18–25-year-olds, reaching 8.1% in 2014–2015. Healthcare encounters with mention of marijuana are rare among 0–8-year-olds, but have increased. Several future efforts are important. These include: 1) detailed analysis of use patterns, especially among individuals who use marijuana frequently 2) further research and improved data on healthcare encounters with mention of marijuana, to clarify their nature, cause, and severity and 3) research on long-term health effects of marijuana use with particular focus on the effects of greater frequency and quantity of use.

BACKGROUND Cannabis legalization in Colorado resulted in increased cannabis-associated health care utilization. Our objective was to examine cooccurrence of cannabis and mental health diagnostic coding in Colorado emergency department (ED) discharges and replicate the study in a subpopulation of ED visits where cannabis involvement and psychiatric diagnosis were confirmed through medical review. METHODS We collected statewide ED International Classification of Diseases, 9th Revision, Clinical Modification diagnoses from the Colorado Hospital Association and a subpopulation of ED visits from a large, academic hospital from 2012 to 2014. Diagnosis codes identified visits associated with mental health and cannabis. Codes for mental health conditions and cannabis were confirmed by manual records review in the academic hospital subpopulation. Prevalence ratios (PRs) of mental health ED discharges were calculated to compare cannabis-associated visits to those without cannabis. Rates of mental health and cannabis-associated ED discharges were examined over time. RESULTS Statewide data demonstrated a fivefold higher prevalence of mental health diagnoses in cannabis-associated ED visits (PR = 5.35, 95% confidence interval [CI], 5.27-5.43) compared to visits without cannabis. The hospital subpopulation supported this finding with a fourfold higher prevalence of psychiatric complaints in cannabis attributable ED visits (PR = 4.87, 95% CI = 4.36-5.44) compared to visits not attributable to cannabis. Statewide rates of ED visits associated with both cannabis and mental health significantly increased from 2012 to 2014 from 224.5 to 268.4 per 100,000 (p

In November 2012 Colorado voters approved legalized recreational marijuana. On January 1, 2014 Colorado became the first state to allow legal sales of non-medical marijuana for adults over the age of 21. Since that time, the state has been monitoring potential impacts on population health. In this paper we present lessons learned in the first three years following legal sales of recreational marijuana. These lessons pertain to health behaviors and health outcomes, as well as to health policy issues. Our intent is to share these lessons with other states as they face the prospect of recreational marijuana legalization.

The study objective was to use a preliminary risk based framework to evaluate the sufficiency of existing air data to answer an important public health question in Colorado: Do volatile organic compounds (VOCs) emitted into the air from oil and gas (OG) operations result in exposures to Coloradoans living at or greater than current state setback distances (500 feet) from OG operations at levels that may be harmful to their health? We identified 56 VOCs emitted from OG operations in Colorado and compiled 47 existing air monitoring datasets that measured these VOCs in 34 locations across OG regions. From these data, we estimated acute and chronic exposures and compared these exposures to health guideline levels using maximum and mean air concentrations. Acute and chronic non-cancer hazard quotients were below one for all individual VOCs. Hazard indices combining exposures for all VOCs were slightly above one. Lifetime excess cancer risk estimates for benzene were between 1.0 &times, 10&minus, 5&ndash, 3.6 &times, 5 and ethylbenzene was 7.3 &times, 6. This evaluation identified a small sub-set of VOCs, including benzene and n-nonane, which should be prioritized for additional exposure characterization in site-specific studies that collect comprehensive time-series measurements of community scale exposures to better assess community exposures.

OBJECTIVETo determine the relative risk of invasive methicillin-resistantStaphylococcus aureus(MRSA) infection among non-colonized (NC) patients, intermittently colonized (IC) patients, and persistently colonized (PC) patients.DESIGNObservational cohort study of patient data collected longitudinally over a 41-month period.SETTINGDepartment of Veterans Affairs Eastern Colorado Healthcare System, a tertiary care medical center.PATIENTSAny patient who received ≥5 MRSA nasal swab tests between February 20, 2010, and July 26, 2013. In total, 3,872 patients met these criteria, 0 were excluded, 95% were male, 71% were white, and the mean age was 62.9 years on the date of study entry.METHODSPatients were divided into cohorts based on MRSA colonization status. Physicians reviewed medical records to identify invasive infection and were blinded to colonization status. Cox and Kaplan-Meier analyses were used to assess the relationship between colonization status and invasive infection.RESULTSIn total, 102 patients developed invasive MRSA infections, 16.3% of these were PC patients, 11.2% of these were IC patients, and 0.5% of these were NC patients. PC patients were at higher risk of invasive infection than NC patients (hazard ratio [HR] 36.8; 95% CI, 18.4–73.6;PPP=.084). Alternate analysis methods confirmed these results.CONCLUSIONSThe risk of invasive MRSA infection is much higher among PC and IC patients, supporting routine clinical testing for colonization. However, this risk is similar among PC and IC patients, suggesting that distinguishing between the 2 colonization states may not be clinically important.Infect. Control Hosp. Epidemiol.2015;36(11):1292–1297

Over 22 million Americans are current users of marijuana; half of US states allow medical marijuana, and several allow recreational marijuana. The objective of this study was to evaluate the impact marijuana has on hospitalizations, emergency department (ED) visits, and regional poison center (RPC) calls in Colorado, a medical and recreational marijuana state. This is a retrospective review using Colorado Hospital Association hospitalizations and ED visits with marijuana-related billing codes, and RPC marijuana exposure calls. Legalization of marijuana in Colorado has been associated with an increase in hospitalizations, ED visits, and RPC calls linked with marijuana exposure. From 2000 to 2015, hospitalization rates with marijuana-related billing codes increased from 274 to 593 per 100,000 hospitalizations in 2015. Overall, the prevalence of mental illness among ED visits with marijuana-related codes was five-fold higher (5.07, 95% CI: 5.0, 5.1) than the prevalence of mental illness without marijuana-related codes. RPC calls remained constant from 2000 through 2009. However, in 2010, after local medical marijuana policy liberalization, the number of marijuana exposure calls significantly increased from 42 to 93; in 2014, after recreational legalization, calls significantly increased by 79.7%, from 123 to 221 (p

A systematic method was used to review the existing epidemiologic literature and determine the state of the scientific evidence for potential adverse health outcomes in populations living near oil and natural gas (ONG) operations in the United States. The review utilized adapted systematic review frameworks from the medical and environmental health fields, such as Grading of Recommendations, Assessment, Development and Evaluations (GRADE), the Navigation Guide, and guidance from the National Toxicology Program’s Office of Health Assessment and Translation (OHAT). The review included 20 epidemiologic studies, with 32 different health outcomes. Studies of populations living near ONG operations provide limited evidence (modest scientific findings that support the outcome, but with significant limitations) of harmful health effects including asthma exacerbations and various self-reported symptoms. Study quality has improved over time and the highest rated studies within this assessment have primarily focused on birth outcomes. Additional high-quality studies are needed to confirm or dispute these correlations.

To review current practices regarding prescribing controlled substances at an academic medical center and describe possible advantages of electronic prescribing of controlled substances (EPCS). A 10-question multiple choice survey was sent electronically to all house staff at an academic medical center. Aggregated data was analyzed for trends. 193 surveys (18.8 %) were completed. Of all respondents, 46.6 % were not able to write their own prescriptions. 70.0 % have used another provider's prescription pad to write prescriptions. 53.4 % have had prescriptions rejected or not filled by a pharmacy for being written incorrectly. 59.6 % kept a patient as an inpatient for a longer period of time due to the inability to obtain a prescription, costing an estimated $3.28 million per year. 58.0 % needed to have a patient return to the hospital to pick up prescriptions for an estimated 1583 return trips to the hospital yearly. 35.1 % had a patient return to the emergency department due to uncontrolled pain, estimated at $139,000 in yearly emergency department patient charges. The authors' survey highlights some of the financial, legal, efficiency, and satisfaction disadvantages due to the inability to use EPCS. Implementing EPCS and making it ubiquitous may limit some inefficiencies in academic hospital systems.