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BackgroundThe legal climate for cannabis use has dramatically changed with an increasing number of states passing legislation legalizing access for medical and recreational use. Among cancer patients, cannabis is often used to ameliorate adverse effects of cancer treatment. Data are limited on the extent and type of use among cancer patients during treatment and the perceived benefits and harms. This multicenter survey was conducted to assess the use of cannabis among cancer patients residing in states with varied legal access to cannabis.MethodsA total of 12 NCI-Designated Cancer Centers, across states with varied cannabis-access legal status, conducted surveys with a core questionnaire to assess cannabis use among recently diagnosed cancer patients. Data were collected between September 2021 and August 2023 and pooled across 12 cancer centers. Frequencies and 95% confidence intervals for core survey measures were calculated, and weighted estimates are presented for the 10 sites that drew probability samples.ResultsOverall reported cannabis use since cancer diagnosis among survey respondents was 32.9% (weighted), which varied slightly by state legalization status. The most common perceived benefits of use were for pain, sleep, stress and anxiety, and treatment side effects. Reported perceived risks were less common and included inability to drive, difficulty concentrating, lung damage, addiction, and impact on employment. A majority reported feeling comfortable speaking to health-care providers though, overall, only 21.5% reported having done so. Among those who used cannabis since diagnosis, the most common modes were eating in food, smoking, and pills or tinctures, and the most common reasons were for sleep disturbance, followed by pain and stress and anxiety with 60%-68% reporting improved symptoms with use.ConclusionThis geographically diverse survey demonstrates that patients use cannabis regardless of its legal status. Addressing knowledge gaps concerning benefits and harms of cannabis use during cancer treatment is critical to enhance patient-provider communication.

ABSTRACT Background Aim Methods Results Implications for Cannabis Nursing Patient or Public Contribution People with HIV have a higher risk of developing non‐AIDS‐defining cancers in older age, leading to a significant population living with two conditions, HIV and cancer. There is an increasing interest in cannabis use for symptom management in people with chronic conditions; in 2023, the American Nurses Association officially recognised cannabis nursing as a specialty nursing practice focusing on the care of individuals seeking education/guidance in the therapeutic use of cannabis, supporting the urgency of its research. However, the scientific literature lacks a synthesised review in the focused populations.To explore observational research on cannabis use for symptom management among people with HIV and/or cancer and identify gaps in current knowledge to inform future research and policy development.Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Scoping Reviews (PRISMA‐ScR) checklist, a literature search of relevant articles was conducted in the databases PubMed (n = 552), PsycInfo (n = 204), CINAHL (n = 164) and Embase (n = 976). Upon screening 1738 articles, 142 were identified for full‐text review and 51 were retained for data extraction.There were more studies evaluating cannabis use among people with cancer than with HIV and no studies among people living with comorbid HIV and cancer. Most studies were cross‐sectional with limited metrics on the perceived effectiveness and safety of cannabis use for symptom management and its dosing/mode of delivery for reducing symptoms. While studies focused on cannabis therapy under the provision of healthcare providers, individuals reported obtaining information about cannabis from friends/family/the Internet.This body of research could be strengthened by rigorous longitudinal study designs to build causal relationships on the therapeutic effects of cannabis use and the inclusion of reliable and valid symptom assessment measures over time, which facilitates developing clinical practice guidance and policymaking in cannabis nursing.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion An innovative New South Wales government funded statewide Cannabis Medicines Advisory Service (CMAS) operated between January 2018 and June 2022. The service provided comprehensive patient‐specific and evidence‐based information to support health professionals in prescribing and patient care decisions. This study aimed to describe real‐world data collected by CMAS.A sub‐set of de‐identified, patient‐specific enquiries collected between January 2021 and June 2022 (n = 123/567; 21.7%) were analyzed using R version 4.2.1. Diagnosis, indication, and comorbidities were coded using Medical Dictionary for Regulatory Activities (MedDRA) terminology.Most patient‐specific enquiries from medical practitioners were from general practitioners (n = 103/123; 83.7%). Female (n = 53/123; 43.1%) and male (n = 59/123; 48.0%) patients were similarly represented. Sex was not specified for 8.9% (n = 11/123) of patients. The mean age of patients was 52.1 years (range <10–90). The most common three diagnoses were osteoarthritis, anxiety, and chronic pain. Indications that were most frequently reported included chronic pain, anxiety, back pain, non‐neuropathic pain, and insomnia. Comedications were most commonly non‐opioid and opioid analgesics and antidepressants. Most practitioners were considering prescribing a cannabidiol (CBD) product for their patient. Cannabinoid composition selection guidance provided by CMAS was predominantly (delta‐9‐tetrahydrocannabinol) THC:CBD ~1:1, followed by CBD‐only products. CMAS was contacted by health professionals regarding the management of potential adverse events for five patients.The findings of this study shed light on the information medical practitioners were seeking to inform their clinical decision‐making about medical cannabis and can inform the development of clinical guidance resources. [ABSTRACT FROM AUTHOR]

With the partial legalization of high-THC Cannabis sativa across 23 states for recreational use and 38 states for medical purposes in the United States, the Cannabis industry is poised for significant growth. Projected to reach a sales volume of $50.7 billion by 2028, this growth is driven by the trend of lifting Cannabis prohibition. High-THC C. sativa cultivars, containing more than 0.3% delta-9 tetrahydrocannabinol (Δ9-THC) as defined by the 2018 US Farm Bill, are used for both medicinal and recreational purposes. Cannabis sativa is a short day, dioecious, annual plant, where female plants are favored for THC production, which requires seed feminization techniques to ensure an accurate female plant population. This involves using an ethylene inhibitor to induce sex reversal, leading to male flower development on female plants, allowing for self-pollination and the production of feminized seeds. However, challenges such as seed viability and the occurrence of male flowers in progeny have been noted. This review provides guidelines to enhance the production of viable feminized seeds in high-THC Cannabis cultivars. Literature findings indicate that Silver Thiosulfate (STS) is the most effective ethylene inhibitor for sex reversal and seed feminization in high-THC Cannabis cultivars. Specifically, a single dose of 3 mM STS should be applied during the vegetative stage via foliar spraying until runoff, followed by exposure to a short photoperiod of up to 12 hours to induce flowering and seed production. Progeny plants should be assessed for seed germination rate and compared for growth performance with the original parent plant to assess the declining effects of inbreeding. Adhering to these guidelines can improve the quality and viability of feminized seeds, meeting commercial market standards and industry demands for high-THC Cannabis cultivars. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionThis study explores how cannabis has been accommodated over the last 18 years in the social world of an online forum in Poland. It considers users who operate in the context of unhurried normalization and restrictive policy that has barely changed over the last two decades. Simultaneously, these users refer to global cannabis cultures and follow progressive policy developments worldwide.Cannabis-related threads were scrapped from the biggest Polish forum, posted in the years 2006–2023, and divided into three periods marked by minor relaxation of the punitive law in 2011 and the introduction of medical cannabis in 2019. The threads were thematically analyzed to track changes in the perceived access to cannabis and shifts in the reasons users praise it.The shifts indicate the interaction of the normalization processes on both sides of the cannabis social world in Poland: among users and in society. The praise becomes less unconditional, and nuanced goals, or reflexivity of use emerges.We have recognized a consensus among forum users that there are problems associated with use. Instead of harm being neutralized as it used to be when stigmatization mattered more, it is now discussed among users who are becoming better informed, reflexive, and likely to engage with bottom-up harm reduction efforts. [ABSTRACT FROM AUTHOR]

Purpose: Healthcare providers often hesitate to discuss medical cannabis (MC) due to limited understanding, risks and benefits, and misinformation. This reluctance is notable with older adult patients, despite MC's potential benefits. This study investigates whether primary care providers (PCPs) routinely inquire about MC when treating older adults and the frequency of such inquiries. Methods: A 23-question survey was emailed to 575 physicians, pharmacists, nurse practitioners, and physician assistants who completed a Pennsylvania Department of Health-approved MC course. The survey was conducted in 2022 to 2023, and the participants were drawn from a pool of individuals who completed the course between 2018 and 2022. PCPs need to be practicing in the Tri-state area and caring for older adults. Results were cross-tabulated to examine the relationship between healthcare practitioners' inquiries about MC and patients' questions about MC. McNemar and Chi-square tests were used for analysis. Results: Survey results revealed that PCPs were more likely to inquire about alcohol and tobacco use than cannabis with older adults (P <.0001). Patients were more likely to initiate conversations about MC use (P =.037). PCPs did not frequently inquire about cannabis use amongst their patients or consider it as a therapeutic option. Conclusion: This study underscores the prevalent reluctance among PCPs to initiate discussions about MC treatment with older adults. Further investigation is needed to identify how to improve communication regarding the risks and benefits of MC. [ABSTRACT FROM AUTHOR]

International consensus has emerged, which proposes that the measurement and standardization of the quantity of THC potency, or dose (mgTHC), is a requisite for identifying consistent relationships between patterns of cannabis use and the risk for negative health outcomes, especially critical given the increasing number of U.S. states and European countries considering legalizing cannabis for recreational use. Despite the lack of measurement approaches that provide accurate, real-time data on THC dosage, the number of states that have implemented legal adult use cannabis markets has coincided with the use of regulatory seed-to-sale or track-and-trace systems. Seed-to-sale tracking systems are designed to track the amount of cannabis cultivated, and typically leverage biochemical testing contractors to label the THC potencies and amounts on a diverse array of cannabis products. We propose leveraging seed-to-sale tracking systems to facilitate a more objective measure of THC potency. In the current review, we will: 1) summarize the complexities of accurately measuring the multidimensional aspects of cannabis use patterns; 2) review recent advancements in quantifying THC and the importance of standardizing THC dose in measuring cannabis use; and 3) discuss the potential value of future research efforts examining how state-level seed-to-sale tracking data can inform the standard THC dose. [ABSTRACT FROM AUTHOR]

Aim: Our objective was to systematically assess the prevalence and clinical features of adverse events related to interactions between cannabinoids and psychotropic drugs through a retrospective chart review. Methodology: 1586 adverse event reports were assessed. Cases included in the analysis showed a high probability of a causal relationships between cannabinoid-psychotropic drug interactions and adverse events. Data extracted included age, sex, psychotropic drug, cannabinoid products, other medications, and the clinical outcomes and mechanisms of these interactions. Results: Cannabinoids were involved in 8% of adverse events associated with the concomitant use of psychotropic drugs and other preparations. We identified 20 reports in which side effects presented a causal relationship with the use of psychotropic drugs and cannabinoids. Preparations containing 18% or more tetrahydrocannabinol (THC), presented significant side effects with the following antidepressants: mianserine (restless legs syndrome, urogenital pain, ventricular tachycardia), mirtazapine (pancreatitis, hyperhidrosis, arthralgia), quetiapine (myocarditis, renal failure, bradycardia, sialorrhea), haloperidol (ventricular arrhythmia, prolonged QTc), aripiprazole (prolonged QTc), ventricular tachycardia) and cariprazine (stomach pain, hepatotoxicity), sertraline (ataxia, hyperactivity, coma, hallucinations, anxiety, agitation, tachycardia, panic attacks, disorientation, headache, dizziness, blurry vision, severe emesis, xerostomia, dry eyes), trazodone (disorientation, memory impairment, sedation), fluvoxamine (tachycardia, tachypnoea, dysarthria, auditory hallucinations). Two out of 20 reports (10%) analyzed in our study was related with the simultaneous use of cannabidiol (CBD) oil and sertraline. Concomitant use of those substances was associated with the adverse events in form of diarrhea, emesis, fever and severe fatigue. Conclusion: Clinicians need to closely monitor adverse events resulting from the combined use of cannabinoids and psychotropic medications. The accumulation of side effects and pharmacokinetic interactions (including CYP and p-glycoprotein inhibition) between these drugs can lead to clinically significant adverse outcomes. [ABSTRACT FROM AUTHOR]

Cannabinoids, derived from the Cannabis sativa plant, have garnered increasing attention for their potential therapeutic applications in various diseases. The pharmacologically active compounds in Cannabis , such as delta-9-tetrahydrocannabinol and cannabidiol, exhibit diverse immunomodulatory properties. Although studies have explored the effects of cannabinoids on immune function, their specific interactions with the thymus, a primary immune organ critical for T-cell development and maturation, remain an intriguing area of investigation. As the thymus plays a fundamental role in shaping the immune repertoire, understanding the interplay between cannabinoids and thymic function may shed light on potential benefits or concerns associated with Cannabis -based therapies. This article aims to provide an overview of the current scientific knowledge regarding the impact of medicinal Cannabis on the thymus and its implications for disease treatment and immune health. [ABSTRACT FROM AUTHOR]

Background and Objectives: Legalization of medical marijuana has increased unintentional exposure to marijuana in young children. We aim to explore the sociodemographic disadvantage profile, prevalence, and clinical presentation of children diagnosed with unintentional exposure to marijuana. Methods: We conducted a retrospective chart abstraction of 121 children (aged 0–6) seen at the Emergency Department (ED) at a single tertiary hospital center in Dayton, Ohio between January 01, 2010 and January 09, 2022. Results: Majority were female (62.8%), white (50.4%), and with Medicaid as their primary insurance (84.3%). The median age at exposure was 1.8 years. There was a 14‐fold increase in unintentional marijuana cases pre‐2017 (7 cases) versus post‐2017 (114 cases), the year of legalization of medical marijuana in the state of Ohio. Majority of the patients were using public assistance (66.4%). 26.7% of the cases had a prior social work consultation and 38.1% had a prior children services consultation. 51.3% of the children had a social disadvantage index score of 3 or greater (range 0–5) with higher scores indicating greater disadvantage. Discussion and Conclusions: The number of patients presenting to the ED at the hospital has increased 14‐fold since the legalization of medical marijuana in Ohio. Half of the children displayed a higher sociodemographic disadvantage index score. Scientific Significance: Our study is the first study investigating the sociodemographic profile of children exposed to marijuana. The findings of this study may be utilized to inform policy for safely dispensing recreational and medicinal marijuana products and focus the efforts on families with sociodemographic disadvantage. [ABSTRACT FROM AUTHOR]

The article discusses lessons from edible packaging policies and child poisonings. Topics include cannabis-related policies that can impact both cannabis business practices and cannabis use-related risks, public health effects of cannabis edible packaging policy, and public health effects as cannabis policies evolve.

Objectives. To investigate characteristics of data reported in US medical cannabis registries across states. Methods. Data included 2021 medical cannabis registry reports from 34 states, Puerto Rico, and the District of Columbia (hereafter, states) with active medical cannabis programs. The data from the reports were manually coded into domains and subcategories, including information related to patients (e.g., number, demographics), authorizing clinicians, sales (e.g., content, revenue), license tracking, and health and safety outcomes. Results. Among 36 states, 97% reported total patient number and 75% reported number of authorizing clinicians. Least reported subcategories included patient race/ethnicity (8%), adverse events (11%), therapeutic benefits (6%), and product recalls (6%). States that recently legalized medical cannabis (2013–2018) reported a higher number of subcategories overall, with a median of 11 versus 8 for early adopting states (1996–2012). More medical-use states reported data on authorizing clinicians compared with nonmedical adult-use states but were otherwise similar. Conclusions. Medical cannabis state registries generally reported data on consumers, clinicians, and sales rather than health and safety outcomes. More comprehensive and uniform medical cannabis public health surveillance is needed. (Am J Public Health. 2024;114(S8):S685–S693. https://doi.org/10.2105/AJPH.2024.307728) [ABSTRACT FROM AUTHOR]

For public health protection, informed decision-making relies on having a robust foundation of evidence concerning risks and their prevention. Application of an evidence-based framework depends on the availability of pertinent, scientifically sound data generated by well-directed and valid research endeavors. In this essay, we address the current state of research in humans and the evidential base concerning high-concentration delta-9-tetrahydrocannabinol (delta-9-THC) products, which are readily available in the United States. Furthermore, we explore the intricate challenges faced in carrying out research on these products, which reflect the full range of study design issues: measurement of exposure and outcomes, confounding, selection bias, and the generalizability of findings. We offer recommendations to guide future research toward providing more informative evidence. By following these recommendations, researchers and funders on this emerging topic could move toward generating the valid and comprehensive evidence needed to effectively inform public health initiatives and guide policy decisions regarding high-concentration delta-9-THC products and their use. The urgency of generating such evidence cannot be overstated, given the widespread legalization and increasing availability and use of these products. (Am J Public Health. 2024;114(S8):S639–S644. https://doi.org/10.2105/AJPH.2024.307724) [ABSTRACT FROM AUTHOR]

Objectives. To estimate changes in medical cannabis patient activity after Canada's recreational cannabis legalization. Methods. I used linear regressions of interrupted times series models to analyze medical cannabis patient registrations per 10 000 residents, purchases per 100 registrations, and packages per purchase in Canada's 10 provinces between April 2017 and December 2022. I tested relationships between the recreational law's passage in June 2018, recreational sales starting in October 2018, and the arrival of edibles and vapes in December 2019. Results. Medical patient registrations initially increased; they slowed after the law passed and started decreasing after edibles became available. Medical purchasing frequencies initially decreased; they decreased further in proportion to recreational sales but stabilized after edibles became available. Medical purchase sizes were initially stable; they began increasing after edibles became available. Conclusions. Canada saw substantial decreases in medical cannabis patient registrations, but the remaining patients stabilized their purchasing frequencies and increased their purchase sizes. Public Health Implications. Other countries might see significant changes in patient usage of their medical cannabis systems after nationwide recreational cannabis legalization. (Am J Public Health. 2024;114(S8):S673–S680. https://doi.org/10.2105/AJPH.2024.307721) [ABSTRACT FROM AUTHOR]

Background and Aim: Since 1996, 38 US states have legalized access to cannabis (medical and/or adult‐use recreational). We aimed to estimate the effect of three dimensions of state cannabis policy design – pharmaceutical, permissive and fiscal – on levels of overall, alcohol‐impaired, occupant, light truck and pedestrian fatality rates. Design and setting: Observational study of US states' overall, alcohol‐impaired, occupant, light truck and pedestrian fatalities between 1994 and 2020. Cases: The unit of analysis was at the state level, consisting of 50 states and 27 years of time series data, resulting in a total of 1350 state‐year observations. Measurements Fatality rates associated with alcohol‐impaired, pedestrian, total occupant, passenger car and light truck fatality rates were obtained from the Fatality Analysis Reporting System of the National Highway Traffic Safety Administration and normalized per 10 billion vehicle miles traveled. State cannabis policies are measured in three bundles (scales): pharmaceutical, permissive and fiscal. Findings The pharmaceutical bundle was associated with increases in all fatality rates [β = 0.145; 95% confidence interval (CI) = 0.116–0.173; P < 0.000]. The permissive bundle was associated with lower overall fatality rates (β = −0.319; 95% CI = −0.361 to −0.277; P < 0.000). The fiscal bundle was generally associated with higher fatality rates (β = 0.062; 95% CI = 0.043–0.081; P < 0.000), occupant (β = 0.070; 95% CI = 0.042–0.098; P < 0.000), light trucks (β = 0.049; 95% CI = 0.026–0.072; P < 0.000). Conclusions: US state cannabis regulations influence traffic safety. Greater permissiveness in US state cannabis regulations does not appear to correlate with traffic fatality rate increases, but greater medicalization and fiscal operation does. [ABSTRACT FROM AUTHOR]

Purpose: Endometriosis is a chronic inflammatory disease that can cause various pain symptoms. Current therapy options do not always provide sufficient pain relief and often cause unpleasant side effects. Recent studies have shown that the endocannabinoid system is involved in the endometriosis pathophysiology, and using Cannabinoids may be a potential therapeutic option. We aimed to determine for the first time, the Cannabis use prevalence, self-rated effectiveness, and the possible reduction in medication in German-speaking countries. Methods: A cross-sectional online survey was distributed through endometriosis support and advocacy groups on social media. German-speaking endometriosis patients aged ≤ 18, residing in Germany, Austria, and Switzerland were eligible to participate. Results: Out of 912 participants who provided valid answers, 114 reported using cannabis for self-management. Cannabis was rated as the most effective self-management strategy to reduce symptom intensity (self-rated efficacy 7.6 out of 10). Additionally, ~ 90% of the participants were able to decrease their pain medication intake. The greatest improvement was observed in sleep (91%), menstrual pain (90%), and non-cyclic pain (80%). Apart from increased fatigue (17%), side effects were infrequent (≤ 5%). Conclusion: At the time of the study, Cannabis consumption was still illegal in Germany, Austria, and Switzerland, with medical cannabis being rarely prescribed due to complex requirements. Results suggest that Cannabis has become a popular self-management method for treating endometriosis-related symptoms, leading to substantial symptom improvement. Further studies are needed to investigate the best administration methods, dosage, THC/CBD ratio, potential side effects, and long-term effects to provide official recommendations to patients and healthcare providers. [ABSTRACT FROM AUTHOR]

Background: Phytocannabinoids inhibit the aggregation and neurotoxicity of the neurotoxic Alzheimer's disease protein β amyloid (Aβ). We characterised the capacity of five proprietary medical cannabis extracts, heated and non‐heated, with varying ratios of cannabidiol and Δ9‐tetrahydrocannabinol and their parent carboxylated compounds to protect against lipid peroxidation and Aβ‐evoked neurotoxicity in PC12 cells. Methods: Neuroprotection against lipid peroxidation and Aβ1–42‐induced cytotoxicity was assessed using the thiazolyl blue tetrazolium bromide (MTT) assay. Transmission electron microscopy was used to visualise phytocannabinoid effects on Aβ1–42 aggregation and fluorescence microscopy. Results: Tetrahydrocannabinol (THC)/tetrahydrocannabinolic acid (THCA)‐predominant cannabis extracts demonstrated the most significant overall neuroprotection against Aβ1–42‐induced loss of PC12 cell viability. These protective effects were still significant after heating of extracts, while none of the extracts provided significant neuroprotection to lipid peroxidation via tbhp exposure. Modest inhibition of Aβ1–42 aggregation was demonstrated only with the non‐heated BC‐401 cannabis extract, but overall, there was no clear correlation between effects on fibrils and conferral of neuroprotection. Conclusions: These findings highlight the variable neuroprotective activity of cannabis extracts containing major phytocannabinoids THC/THCA and cannabidiol (CBD)/cannabidiolic acid (CBDA) on Aβ‐evoked neurotoxicity and inhibition of amyloid β aggregation. This may inform the future use of medicinal cannabis formulations in the treatment of Alzheimer's disease and dementia. [ABSTRACT FROM AUTHOR]

Dramatic changes in state-level cannabis laws (CL) over the past 25 years have shifted societal beliefs throughout the United States, with unknown implications for youth. In the present study, we conducted an updated systematic review and meta-analysis examining estimated effects of medical cannabis legalization (MCL) and recreational cannabis legalization (RCL) on past-month cannabis use among US youth. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, followed by a subsequent meta-analysis investigating the associations between state-level cannabis laws (ie, MCL vs non-MCL, and RCL vs non-RCL) and past-month cannabis use prevalence among US adolescents and young adults. Supplemental analyses examined age-group effects and design-related factors. Our search identified 4,604 citations, 34 and 30 of which were included in qualitative and quantitative analyses, respectively. Meta-analysis of MCL studies identified no significant association between MCL and change in past-month youth cannabis use (odds ratio [OR] = 0.981, 95% CI = 0.960, 1.003). Meta-analysis of RCL studies showed significantly increased odds of past-month cannabis use (OR = 1.134, 95% CI = 1.116-1.153). Meta-analysis of more recent studies, however, showed a significantly increased odds of past-month cannabis use among both adolescents and young adults (OR = 1.089, 95% CI = 1.015,1.169, and OR = 1.221, 95% CI = 1.188,1.255, respectively). Cannabis legalization has complex and heterogenous effects on youth use that may differ across law types. Our meta-analytic results showed modest positive effects of RCL on past-month cannabis use (more so in young adults than in adolescents) and minimal effects of MCL on these outcomes in US youth. Given the shift toward recreational legalization, additional focus on RCL effects is warranted. Cannabis laws have changed dramatically throughout the United States over the past 25 years. It is important to determine if medical or recreational cannabis legalization are associated cannabis use in youth. The authors conducted a systematic review and meta-analysis to investigate the associations between state-level cannabis laws and past-month cannabis use in adolescents and young adults. The authors identified 64 articles and found that recreational cannabis laws were associated with a modest but significant higher odds of past-month cannabis use. In contrast, medical cannabis laws were not associated with past-month youth cannabis use. Analysis of more recent studies suggested a rise in cannabis use among youth. The authors conclude that further research is needed to better understand the impact of recreational cannabis legalization on youth. [ABSTRACT FROM AUTHOR]

Introduction: There is growing recognition of the potential of cannabis to treat various medical conditions and symptoms, such as chronic pain, spasticity, and epilepsy. However, one of the biggest challenges is the assurance of a standardized cannabis product that contains a consistent amount of its main psychoactive substances delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), and which is compliant with predetermined specifications for these compounds. This is crucial not only to ensure consistent cannabis quality and dosage for patients but also to effectively translate research findings into clinical practice. Methods: This systematic literature review provides an overview of the effects of standardized cannabis products from Bedrocan, a leading Dutch producer of pharmaceutical-quality standardized medicinal cannabis. Results: Cannabis administration to healthy volunteers induces dose-dependent acute effects, such as rapidly rising THC and CBD blood concentrations, the subjective experience of high and anxiety, slower reaction time and impaired attention, learning and working memory. Patient studies suggest that treatment with medicinal cannabis reduces pain intensity across a broad range of chronic pain-related medical conditions. Medicinal cannabis showed a mild safety profile, with minor and transient side effects, such as feeling high, coughing and mental confusion. The strength of acute effects, the experience of side effects and the drop-out rate in patient studies may depend on cannabis dose, cannabis composition (CBD:THC ratio), and cannabis use history of participants. Conclusion: Safety and efficacy of standardized medicinal cannabis products should be further investigated in randomized clinical trials with sufficient sample size, with particular focus on cannabis dose and composition, age and differences between males and females. [ABSTRACT FROM AUTHOR]

Background: The opening up of the laws to medicinal cannabis in recent years is a key factor in the growth of this therapy, but there is little information about what nurses know and think about it. The present paper seeks to analyze the knowledge, opinions, and experiences of nurses and nursing students in Portugal regarding the use of cannabis and to understand gender differences. Methods: A self-completion questionnaire was drawn up and published online. It received face and content validity and was approved by the Ethics Committee. The instrument includes socio-demographic data, questions about knowledge, opinions, experiences, and training in cannabis. The data was collected and processed by applying descriptive and inferential statistics using the chi-square test and Fisher's exact test on the SPSS platform. Results: The majority of the 610 participants were women. The therapeutic benefits of medical cannabis were appreciated by 79,6% of nurses and 84,3% of students. When asked about the functions of the endocannabinoid system, 71,7% of nurses and 79,5% of students had never heard of it. There is a statistically significant gender difference concerning personal experience of cannabis use to treat symptoms or illnesses. Conclusions: As the levels of knowledge were low and a minority had education on medical cannabis, there is a need for further education of nurses and for this emerging area to be included in the curricula. [ABSTRACT FROM AUTHOR]

Cannabis, often criticized, has active compounds that indicate multiple medical benefits. However, before the potential decriminalization and legalization of medical cannabis, pharmacists play a crucial role in the decision-making for personalized therapy and evidence-based medicine. This study investigates pharmacists’ perspectives on medical cannabis, covering medical use, societal impact, research, legality, and regulation. This study was conducted through semi-structured interviews with pharmacists from different sectors. Interviews were conducted with 16 pharmacists, with 4 from each sector: industry, academia, community, and hospital. There was a consensus on the need for streamlined research before potential decriminalization and legalization of cannabis, highlighting concerns about abuse and misuse despite its benefits. With that in mind, all participants agree that there is a need to update the current legislation and regulations to better control the use and distribution of medical cannabis. Several participants also called to attention that education plays an important role in the potential decriminalization of medical cannabis, with cannabis-related stigma being a potential deterrent for not only the public but also healthcare professionals. As medical cannabis is a new subject in Malaysia, this study could ignite further multidisciplinary human-related research with strict regulations which will ultimately result in evidence-based medicine. [ABSTRACT FROM AUTHOR]

Background and Objectives Methods Results Discussion and Conclusions Scientific Significance Limited evidence guides the efficacy and safety of cannabis for therapeutic purposes (CTP). Healthcare providers lack requisite knowledge to advise and support patients. This study aimed to describe and compare several aspects of initial CTP interactions across different provider types.Adult cannabis consumers (N = 507) from the United States completed an anonymous online survey about their initial CTP interaction with their healthcare provider. Providers were categorized into four groups (Mental Health [MH], Family Medicine [FM], Medical Clinics [MC], and Other Specialty [OS]). Analyses compared several aspects of the interaction (e.g., risk mitigation, recommendations, satisfaction/confidence) across groups.Less than half of the sample reported discussion of cannabis risks (44.0%) or follow‐ups at subsequent visits (46.7%). Recommendations (where to obtain, consumption method, dose, frequency, and authorization) were uncommon (9.7%–25.2%). While the MH group reported the highest rates of risk mitigation behaviors, regression models adjusted for sociodemographic and cannabis characteristics were largely nonsignificant. For recommendations, the MC group was more likely than the MH group to report receiving all recommendations (p < .05). Younger age and greater cannabis‐related problems increased likelihood of risk mitigation and recommendations.CTP interactions focused on risk but generally lacked comprehensive recommendations that could potentially promote safe use. Data from provider perspectives could support the need for CTP guidelines and develop training for healthcare providers to promote safe CTP practices.For the first time, this study explored several aspects of CTP interactions and compared experiences across a variety of providers. [ABSTRACT FROM AUTHOR]

This review provides an overview of cannabis-based phytocannabinoids, focusing on their mechanisms of action, therapeutic applications, and production processes, along with the environmental factors that affect their quality and efficacy. Phytocannabinoids such as THC (∆9-tetrahydrocannabinol), CBD (cannabidiol), CBG (cannabigerol), CBN (cannabinol), and CBC (cannabichromene) exhibit significant therapeutic potential in treating various physical and mental health conditions, including chronic pain, epilepsy, neurodegenerative diseases, skin disorders, and anxiety. The cultivation of cannabis plays a crucial role in determining cannabinoid profiles, with indoor cultivation offering more control and consistency than outdoor methods. Environmental factors such as light, water, temperature, humidity, nutrient management, CO2, and the drying method used are key to optimizing cannabinoid content in inflorescences. This review outlines the need for broader data transfer between the health industry and technological production, especially in terms of what concentration and cannabinoid ratios are effective in treatment. Such data transfer would provide cultivators with information on what environmental parameters should be manipulated to obtain the required final product. [ABSTRACT FROM AUTHOR]

AbstractChronic pain and mental health issues like depression and anxiety significantly contribute to disease burden in Western countries. While cannabinoids are suggested to have analgesic, anxiolytic and antidepressant properties, evidence, especially for long-term use, is inconclusive. This 12-month observational study evaluated the effects of prescribed medicinal cannabis for 96 patients suffering from pain, as well as sleep disturbances, depression and anxiety. Treatment outcomes for pain, depression, anxiety and sleep problems were assessed at 3, 6, and 12 months using validated instruments. Significant reductions were observed in pain scores and the interference of pain on daily functions, alongside improvements in mental health and sleep. Many patients reported notable improvements in pain severity and reduced use of pain medications in the first 6 months, with a decline at 12 months. Additionally, sustained improvements in depression, anxiety, stress and sleep were observed, with about half reporting substantial improvement. Adverse effects were common but mostly mild or moderate, most commonly dry mouth and sleepiness. These results show that prescribed medicinal cannabis treatment is associated with improvements in chronic pain and mental health symptoms, such as depression, anxiety and stress. However, findings also suggest reduced effectiveness with longer-term use, emphasizing the need for additional research. [ABSTRACT FROM AUTHOR]

Cannabis is a gateway drug that can lead to the engagement of other substances. Psychological dysfunctioning and dependence have been highlighted as primary components to substance misuse. The purpose of this study was to investigate what aspects of cannabis use and psychological dysfunctioning are associated with the engagement of other substances and impaired driving. Subject to screening, 200 active adult cannabis users completed an online survey. Existing data involving non-cannabis users (N = 833) were also implemented as comparative data. The comparisons suggested that cannabis users were far more likely to have used other drugs in the past 12 months, compared to non-cannabis users. Bivariate correlations and multiple regressions indicated that the degree of cannabis use and likely dependence, psycho-social motives for using cannabis, emotion dysregulation, and psychopathology were positively associated with the frequency of using and driving on other substances. Finally, an ANOVA demonstrated that outside of age, there were no apparent differences in substance use behaviours, motives for using cannabis, and psychological dysfunction, between medicinal and black-market cannabis users. These findings highlight the potential benefits of incorporating self-regulatory concepts into current road safety initiatives, which aim to reduce the interconnected issue of substance misuse and impaired driving behaviours. [ABSTRACT FROM AUTHOR]

Background: Studies investigating the association between cannabis use and physical activity have had mixed results. This study provided a population-based assessment while determining how the relationship is affected by variables such as cannabis legalization status and chronic medical conditions. Methods: Behavior Risk Factor Surveillance System (BRFSS) data were used to evaluate the association between cannabis use and physical activity among adults ages 18 years and older in several states and territories of the U.S. during 2016–2022. Adjusted odds ratios (ORs) measuring the relationship between physical activity in the past 30 days (yes vs. no) and cannabis use in the past 30 days (yes vs. no) based on legalization and health status were estimated using logistic regression. Results: Physical activity increased from 73.16% in 2016 to 75.72% in 2022 (3.5% increase) and current cannabis use increased from 7.48% in 2016 to 14.71% in 2022 (96.7% increase). Current cannabis use was 6.5% higher in areas of legalized recreational cannabis (vs. not legal) and 0.7% higher in areas of legalized medical cannabis (vs. not legal). For the combined years, the OR measuring the association between cannabis use and physical activity was 1.24 (95% CI 1.10–1.41), after adjusting for age, sex, race/ethnicity, marital status, employment status, education, smoking status, weight classification, legal status, and chronic medical condition. The adjusted OR was 1.47 (95% CI 1.34–1.62) in areas with legalized recreational and medical cannabis (vs. illegal) and 1.05 (95% CI 0.98–1.12) in areas with legalized medical cannabis only (vs. illegal). Having a medical condition was significantly associated with lower prevalence of physical activity in the adjusted models (overall adjusted OR = 0.79, 95% CI 0.73–0.85). However, this significantly lower odds ratio was insignificant for current cannabis users. Conclusions: Public policy and personal health behaviors may improve with the findings that legal medical cannabis promotes greater physical activity in those experiencing chronic medical conditions and legal recreational cannabis promotes (even more so) greater physical activity in those not experiencing chronic medical conditions. [ABSTRACT FROM AUTHOR]

AbstractThis cohort study aims to assess the outcomes of fibromyalgia patients enrolled in the UK Medical Cannabis Registry prescribed a homogenous selection of cannabis-based medicinal products (CBMPs). A cohort study of fibromyalgia patients treated with oils (Adven®, Curaleaf International, UK), dried flower (Adven®, Curaleaf International, UK) or both CBMPs was performed. Primary outcomes were changes from baseline at 1, 3, 6 and 12 months in validated patient-reported outcome measures. Secondary outcomes included descriptive analysis of adverse events. One hundred and forty-eight participants were treated with oils (n = 77; 52.03%), dried flower (n = 14; 9.46%) or both (n = 57; 38.51%). Improvements in the generalized anxiety disorder-7 questionnaire, single-item sleep quality scale, fibromyalgia symptom severity score and EQ-5D-5L Index values were observed at each follow up period compared to baseline (p < 0.050). Thirty-six (24.32%) patients experienced 648 adverse events. Improvements were observed across all primary outcomes with no differences observed across different formulations of CBMPs. Adverse events were reported by one-quarter of participants and were more likely to reported by cannabis naïve patients. This present work through focusing on a homogeneous group of CBMPs can help inform randomized controlled trials after observing signals of improvement associated with a specific cultivar of CBMPs. [ABSTRACT FROM AUTHOR]

This study discusses the dilemma of internal cannabis prohibition in the frame of Kompas TV. This dilemma was raised in Rosi's talk show about Cannabis Topics: Myths and Facts on February 6, 2020. The aim of this study is to know how the media construction of Kompas TV was about the issue of utilizing cannabis as a medical requirement. In studying this, the researcher used method analysis based on framing the analysis of Robert Entman. This study follows a paradigm of subjective interpretive with a qualitative approach to the presented text in Rosi's talk show. Analysis was done with the use of four substances based on framing the analysis of Robert Entman, namely, define problems (problem identification), diagnose causes (problem causes), make moral judgments (decision moral), and recommend treatment (settlement emphasize). Data collection techniques were used from video documentation of Rosi's talk show. Research results reveal that Kompas TV, through Rosi's talk show, shows a tendency to stick to the views that cannabis production is in the class of psychotropic group 1. This study showed the construction of Kompas TV, which is influenced by media ideology. [ABSTRACT FROM AUTHOR]

Objective: Previous cancer studies have indicated that medical marijuana addresses a significant unmet need, namely chronic pain treatment and conferring oncology supportive care. However, the clinical research evaluating medical marijuana is preliminary and requires further consideration. Data Sources: We conducted a PubMed search primarily comprising retrospective and prospective studies, systematic reviews, and randomized clinical trials (RCTs) from approximately 2020–2023. The search included specific terms that incorporated medical marijuana, cancer treatment, cancer-related symptoms, pain management, and side effects. Data Summary: A total of 40 studies were included in the review, many of which were either of acceptable or good quality. Select investigations indicated that medical marijuana was associated with decreased overall pain levels and improvements in nausea and vomiting. Alternatively, the results from RCTs have found that the benefits from a placebo were equivalent to medical marijuana in both the treatment of cancer-related pain and providing an opioid-sparing effect. Conclusions: Despite the potential cancer-related benefits derived from medical marijuana, the study design and results for many of the investigations on which the evidence is based, were neither uniform nor conducted via RCTs; hence, the efficacy and appropriateness of medical marijuana in treating cancer-related conditions remain indeterminate. [ABSTRACT FROM AUTHOR]

The article "Prescription of Cannabis Flowers" discusses the requirements for the prescription of cannabis for medical purposes according to the Social Code Book V. It is argued that a justified assessment by the treating physician is necessary to obtain approval. The Federal Social Court has ruled that the coding of a decubitus ulcer must be done as a pressure sore. The court's decision emphasizes the need for a strict interpretation of billing regulations. [Extracted from the article]

Italy legalized cannabis oil for specific medical conditions (neuropathic pain, refractory epilepsy and other established pathologies) in 2015, but mandates titration of principal cannabinoids before marketing each batch using iphenated techniques coupled with mass spectrometry. To assess reliability of laboratories from the Italian National Health Service in charge of titrating the batches, the Italian National Institute of Health set up an quality control program on determination of Δ9-tetrahydrocannabinol l (THC), cannabidiol (CBD), Δ9-tetrahydrocannabinolic acid A (THCA-A) and cannabidiolic acid (CBDA) in cannabis oil preparations. Two rounds of exercises have been carried out since 2019, involving sixteen Italian laboratories. Five different cannabis oil samples (19-1A and 19-1B for the first round and 22-1A, 22-1B and 22-1C for the second one were prepared and 1 mL amount of each sample was sent to the laboratories. The quantitative performance of each laboratory was assessed calculating the Z-score value, a statistical measurement for value's relationship to the mean of a group of values. In the first round, eight out of fourteen laboratories employed an LC-MS while the remaining six used GC-MS. Differently, in the second round, six out of eleven laboratories employed a GC-MS while the remaining five used LC-MS. In the first round, only 28.6 % laboratories achieved an acceptable performance (Z-score±2), and all of them used LC-MS as analytical method. In the second round, none of the laboratories achieved an acceptable performance. Satisfactory results, based on Z-scores, were generally low (0.0–75.0 %), with only one exception of 100 % for THCA-A determination in sample 22-1B. In the second round, three false negatives (two THC and one CBD by GC-MS determination) were reported while no false positives were described in the blank sample. The two rounds yielded a mean ERR% of 42 % approximately and a mean CV% around 70 % in GC-MS determination. When applying LC-MS determination, the two rounds yielded a mean ERR% of 36 % approximately and a mean CV% around 33 %. The obtained results underline the need for a clear and consistent protocol to be adopted by all laboratories intending to include the titration of oily cannabis-based products into their routinely analytical techniques. This emphasis on methodology standardization and participation to quality control schemes is essential for ensuring reliable and accurate measurements, ultimately enhancing the overall effectiveness and reliability of medical cannabis treatments. [ABSTRACT FROM AUTHOR]

Objective: The state of Illinois' Opioid Alternative Pilot Program (OAPP) is the first and only official harm-reduction program in the US to address the opioid crisis via facilitation of safe and legal access to medical cannabis. This study evaluates the association of medical cannabis use with pain level and frequency of opioid use in the first cohort of OAPP participants in 2019. Methods: A survey was sent OAPP enrollees between February and July 2019. Cannabis users (n = 626) were compared to non-users (n = 234) to determine whether there was an association between cannabis use and self-reported (a) pain level and (b) frequency of opioid use. Backward stepwise regression models were used. Results: A total of 860 participants was included in the analysis. Overall, 75% of the study sample reported pain as their primary medical symptom, and 67% of cannabis users reported having a disability. The mean difference in pain level between cannabis users and non-users was 4.5 units (on a 100-point scale) higher among cannabis users than non-users (p = 0.03); and cannabis use was statistically associated with pain level. High-frequency opioid users had lower odds of reporting cannabis use within the past year than low/no opioid users. Conclusions: Although there was a statistical association between cannabis use and pain, the difference of 4.5 points in pain level between users and non-users was too small to reflect a clinically meaningful relative difference. This study may provide useful information to providers and clinicians about how the OAPP and similar programs may reduce opioid use and improve health outcomes. [ABSTRACT FROM AUTHOR]

In recent years, cannabis use by people suffering from PTSD, as a means of alleviating their symptoms, has increased. Nonetheless, scant research has examined the lived experience of women who use cannabis to cope with PTSD. Eight semi-structured interviews with Israeli women who use cannabis to cope with PTSD were analyzed using interpretative phenomenological analysis (IPA). The results of this research highlight the utility of cannabis for women coping with symptoms of PTSD, and the advantages of cannabis over other medications. Nevertheless, the main challenge with cannabis use in the context of PTSD is the feeling of detachment that it engenders. This feeling of detachment helps women to manage symptoms when they become unbearable but can also reduce their ability to be fully present in their relationships and everyday life, and increase feelings of self-alienation and helplessness. [ABSTRACT FROM AUTHOR]

Peer recovery coaches (PRCs), direct service providers with lived experience in recovery, are a growing sector of the substance use workforce. As rates of cannabis use increase nationwide, including among treatment-seeking populations, many PRCs will work with clients who wish to use cannabis for medical or recreational purposes. This study explores how PRCs perceive the use of cannabis among clients in treatment or recovery services. Semi-structured phone interviews were completed with 28 PRCs in Michigan. Inductive thematic analysis was used to document PRCs' perceptions of client cannabis use, including overall trends, potential benefits, and concerns. While participants indicated a desire to support clients' autonomy, and many were able to identify potential benefits of cannabis use, they also expressed concerns about the quality of clients' recovery and difficulties managing personal biases. Findings highlight key areas for training and technical assistance to assist PRCs in their work with clients who use cannabis. [ABSTRACT FROM AUTHOR]

Background: Tourette syndrome (TS) is a neurodevelopmental disorder characterized by motor and phonic tics. It is a condition that affects between 0.3% and 0.7% of children, and its pathophysiology remains largely elusive. TS is associated with structural and functional alterations in corticostriatal circuits and neurochemical imbalances. Even though TS is currently incurable, there are established treatment options available, including behavioral therapy and neuroleptics. The use of cannabis-based medicine for tic management is an emerging therapeutic strategy, although its efficacy is still under investigation. It is hypothesized to interact with the endogenous cannabinoid system, but further research is required to ascertain its safety and effectiveness in TS. Aim: In our systematic review and meta-analysis, we aim to assess the effectiveness of cannabis-based medicine in the treatment of TS. Methods: We searched PubMed, Cochrane, Scopus, and Web of Sciences until February 2024. We included clinical trials and cohort studies investigating the efficacy of cannabis-based medicine in the treatment of TS. Data extraction focused on baseline characteristics of the included studies and efficacy outcomes, including scores on the Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS). We conducted the meta-analysis using Review Manager version 5.4. software. We compared the measurements before and after drug intake using mean difference (MD) and 95% confidence interval (CI). Results: In total, 357 articles were identified for screening, with nine studies included in the systematic review and 3 in the meta-analysis. These studies involved 401 adult patients with TS treated with cannabis. YGTSS revealed a significant reduction in total scores (MD = -23.71, 95% CI [-43.86 to -3.55], P = 0.02), PUTS revealed a significant decrease in scores (MD = -5.36, 95% CI [-8.46 to -2.27], P = 0.0007), and Y-BOCS revealed no significant difference in score reduction (MD = -6.22, 95% CI [-12.68 to 0.23], P = 0.06). Conclusion: The current study indicates promising and potentially effective outcomes with the use of cannabis-based medicine in mitigating the severity of tics and premonitory urges. However, there is a need for larger, placebo-controlled studies with more representative samples to validate these findings. [ABSTRACT FROM AUTHOR]

Interest in medical cannabis and cannabis-based medicinal products (CBMPs) has increased greatly in recent years. Two cannabinoids are of principal importance; delta-9-tetrahydrocannabinol (∆9-THC), the primary psychoactive component, and also cannabidiol (CBD), considered non-intoxicating. Each has distinct mechanisms of action and different therapeutic potentials. CBMPs differ in their ∆9-THC and CBD components; predominantly ∆9-THC, balanced formulations with equivalent ∆9-THC and CBD elements, and CBD-predominant products. In this narrative review, we evaluate the published evidence for the clinical benefits of CBMPs and overall benefits in well-being. We also review the overall safety profile and discuss the potential for dependence with CBMPs. Evidence can be drawn from a wide range of randomized and other controlled studies and from observational real-world studies. Most data from observational registry studies are supportive of ∆9-THC-based products (∆9-THC-predominant or balanced CBMPs) in the management of chronic neuropathic pain. Balanced products are also effective in reducing spasticity in multiple sclerosis. Most CBMPs show benefit in providing symptomatic benefits in reducing anxiety, nausea, and in improving sleep, but the place of specific products is more subtle, and choice guided by specific circumstances. Symptomatic improvements are accompanied by improved quality of life and well-being. Safety data indicate that CBMPs are generally well tolerated in most patients without specific contraindications. The majority of adverse effects are non-serious, and transient; most are principally associated with ∆9-THC and are dose-dependent. In contrast to recreational cannabis use, there is little evidence from clinical studies that CBMPs have any potential for dependence. [ABSTRACT FROM AUTHOR]

Many states have legalized medical and recreational marijuana use in the past decade, which has potential consequences for roadway safety. Using a state‐level panel of heavy truck crash statistics from 2005 to 2021 and a difference‐in‐difference estimation strategy, we test whether legalization has affected crash rates. Our results show that legalization does not increase crash rates on average; however, responses are heterogeneous across states, with Colorado, New Jersey, and Washington (state) showing crash reductions, while Connecticut and Virginia saw crashes increase. These results suggest that marijuana legalization does not have a straightforward relationship with heavy truck accidents, warranting continued research and policy scrutiny. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to describe nurses' experiences caring for patients who use medicinal cannabis. For the purpose of this study, the term 'medicinal cannabis' is used to describe cannabis‐based products that are sourced legally or illegally. Design: Qualitative study using thematic analysis. Methods: Eleven registered nurses explored their experiences caring for patients using medicinal cannabis in the Australian healthcare sector. Semistructured interviews were via telephone, Zoom or face to face. Transcribed interview data were analysed using the six phases of thematic analysis. Results: The nurses' experiences of caring for patients who use medicinal cannabis were described in three themes; 'Searching for predictable processes of regulation, access and use of medicinal cannabis', 'One conundrum after another' and 'There is a lot to learn'. Overall, nurses described feeling underprepared to care for patients who use or want to use medicinal cannabis in the Australian healthcare sector. Conclusion: The results indicate that nurses want to have meaningful discussions with patients about the use of medicinal cannabis, yet do not always have the confidence to do so. Nurses sought their own education on how to better support patients. All participants echoed the need for education. The nurse's role in caring for and supporting patients using medicinal cannabis could improve the patient experience. Implications for the Profession and/or Patient Care: Nurses play an essential role in improving the patient's experience and advocating for those using or wanting to discuss medicinal cannabis as a part of holistic care. Defining the nurse's role in effectively caring for patients can begin by providing evidence‐based education to nurses. Including nurses in policy development and beginning to understand the legal and regulatory implications for nurses are important. Impact: This is the first study presenting current issues for nurses who care for patients using medicinal cannabis in Australian healthcare systems. Reporting Method: COREQ guidelines were adhered to for this study. No Patient or Public Contribution: For this research project on the experiences of registered nurses caring for patients using medicinal cannabis, we did not engage members of the patient population or the general public. [ABSTRACT FROM AUTHOR]

Background: As cannabis legalization continues to spread across the United States, average Δ9-tetrahydrocannabinol concentrations in recreational products have significantly increased, and no prior study has evaluated effective treatments to reduce cannabis use among high potency cannabis users. Some research has found that the non-intoxicating cannabinoid cannabidiol reduces cannabis use and cannabis use disorder-related symptoms, such as affective disturbance and withdrawal. Results of these studies are promising but limited to synthetic or isolated forms of cannabidiol. Objective: Conduct a placebo-controlled randomized control trial comparing the effects of hemp-derived cannabidiol on reducing Δ9-tetrahydrocannabinol use in concentrate users with cannabis use disorder. Methods: Design. Double-blind, three-arm randomized placebo-controlled trial. Setting. University in the Denver-Boulder, CO, USA area. Study population. Community members who are heavy, stable cannabis concentrate users that meet criteria for at least moderate cannabis use disorder and are seeking to decrease or stop cannabis use. Data. Self-report demographics, substance use, and mental health characteristics, blood and urine based biomarkers and anthropometrics. Outcomes. Affective, physiological, and physical withdrawal symptoms, Δ9-tetrahydrocannabinol use. Analysis. Three-group ANOVAs and χ2 tests will be used to compare baseline variables between groups. Characteristics that differ between groups will be evaluated as potential covariates in subsequent analyses. A multilevel modeling framework will be used for primary outcome analysis to account for the repeated observations nested within participants over time. Pairwise post-hoc simple effects tests will be conducted to confirm patterns of differences. Trial registration: ClinicalTrials.gov NCT06107062. [ABSTRACT FROM AUTHOR]

Background and Objectives Methods Results Conclusion and Scientific Significance Despite marijuana's association with adverse pregnancy and birth outcomes, its use during pregnancy increased over the last two decades. During this period, medical marijuana has been legalized in 38 states and the District of Columbia. States with legalized medical marijuana have observed increased marketing of marijuana and related products. This study aims to examine the association between state‐level medical marijuana legalization and marijuana use during pregnancy in the United States.Using the 2015–2021 National Survey on Drug Use and Health, we evaluated the association between marijuana use in the past month among currently pregnant mothers (N = 4338) and legalized medical marijuana in their state of residence. Survey‐weighted descriptive, bivariate, and multivariable logistic regression analyzes were performed.About 5.7% of pregnant women reported using marijuana in the past month, and 59.0% lived in a state where medical marijuana was legalized across 2015–2021. Compared to those living in states without marijuana legalization, more pregnant women living in states with marijuana legalization reported using marijuana (4.6% vs. 6.5%). In the multivariable model, pregnant women residing in states with medical marijuana legalization were more likely to use marijuana than residents of states without legalization (adjusted Odds Ratio: 1.56; 95% Confidence Interval: 1.11–2.18).This is the first known study to find that pregnant women living in states where medical marijuana is legalized are more likely to use marijuana during pregnancy. Pregnant women should be informed of adverse pregnancy and birth outcomes linked to marijuana use during pregnancy. [ABSTRACT FROM AUTHOR]

AbstractAmid increasing awareness regarding opioid addiction, medical marijuana has emerged as a substitute to opioids for pain management. Concurrently, opioid manufacturers are putting significant research into making opioids safer yet effective. Interactions between these manufacturers and physicians are critical to advance existing pain management protocols. Direct payments from opioid manufacturers to physicians are established practices that often moderates such interactions. We study the effects of passage of a medical marijuana law (MML) on these direct payments to physicians. To draw causal conclusions, we develop a novel penalized synthetic control (SC) method that accommodates zero-payment related latent structures inherent in these payments. Under a truncated flexible additive mixture model, we show that the SC method has uncontrolled maximal risk without the penalty; by contrast, the proposed penalized method provides efficient estimates. Our analysis finds a significant decrease in direct payments from opioid manufacturers to pain medicine physicians as an effect of MML passage. We provide evidence that this decrease is due to medical marijuana becoming available as a substitute. Finally, our heterogeneity analyses indicate that the decrease in direct payments is comparatively higher for physicians practicing in localities with higher white populations, lower affluence, and a larger proportion of working-age residents. Supplementary materials for this article are available online, including a standardized description of the materials available for reproducing the work. [ABSTRACT FROM AUTHOR]

Background: The psychosocial impact of medical marijuana use is not yet known. This study evaluated short-term changes in health-related quality of life (HRQoL) over the first three months of medical marijuana use. Methods: This prospective, observational, longitudinal study followed adults newly recommended for medical marijuana by a physician for any of the more than 20 qualifying medical conditions in Pennsylvania. Participants (N = 438) provided their clinical status and demographic information, and completed semi-structured interviews prior to medical marijuana initiation (baseline) and at three months. HRQoL was assessed by the Short Form-36 (SF-36). Paired-samples t-tests evaluated changes in HRQoL over time. Results: Participants (M age = 46.4 years [15.6]; 66.4% female) were mostly commonly referred for medical marijuana to treat anxiety disorders (61.9%) or severe chronic or intractable pain (53.6%). Participants reported rapid and significant improvements in all of the domains of HRQoL from baseline to three months after initiating medical marijuana use (physical functioning, role limitations due to physical health problems, emotional well-being, role limitations due to emotional problems, bodily pain, social functioning, energy/fatigue and general health, P <.001 for all). Age was negatively predictive of level of improvement over time for the physical functioning (P <.0001), role limitations due to physical health problems (P <.001), and pain (P <.0001) domains after controlling for baseline, with older participants displaying less improvement than younger participants. Conclusions: Gains were observed in all HRQoL domains assessed after three months of medical marijuana use. In several domains, age was a significant predictor of degree of improvement. [ABSTRACT FROM AUTHOR]

Although marijuana is illegal at the federal level, many states have legalized it for medicinal and recreational purposes. Many hospitals do not allow cannabis in their facilities. This review aims to identify issues and concerns regarding the development of hospital policies to allow medicinal marijuana for patients. [ABSTRACT FROM AUTHOR]

The societal acceptance of cannabis in various regions of Thailand has greatly increased its legal use. In July 2021, the Thailand Government Gazette authorized the use of cannabis for medical, cosmetic, food and beverage, and smoking purposes. This development might lead to easier access to cannabis, especially among adolescents, resulting in higher prevalence. This survey research aimed to investigate and visualize the spatial distribution of cannabis establishments based on usage patterns in the Mueang District of Surat Thani Province, Thailand, using geographic information systems (GIS). The cannabis establishments were explored and analyzed using GIS to visualize their locations and buffer maps. The location map illustrated the distribution of cannabis establishments, categorized by patterns of cannabis use. Additionally, the buffer map visualized the radius of cannabis establishments around five educational institutions. Data collection was conducted between May and June 2024. The locations of the establishments and educational institutions provided in the researchers' data collection were used to generate coordinates on Google Maps and visit the places of establishments. These specifics were imported for analysis using ArcGIS version 10.5. The spatial distribution analysis indicated the presence of 61 cannabis establishments in the study area, which were categorized by the pattern of cannabis use, including 43 cannabis smoke establishments, 10 cannabis-contained beverage establishments, and 8 cannabis-contained food and beverage establishments, as depicted on the location map. Cannabis establishments were strategically situated in areas with higher population density, likely reflecting increased demand for use. Buffer maps were created within a 500 to 1000-meter radius around educational institutions to demonstrate the accessibility of cannabis, especially for adolescents. These findings have the potential to influence government policies and initiatives aimed at preventing and regulating adolescent access to cannabis. Specifically, regulations concerning the proximity of cannabis-selling establishments to educational institutions could be evaluated and implemented appropriately. [ABSTRACT FROM AUTHOR]

Introduction. The use of medical marijuana was legalized in Mexico in 2017. In June 2021, the Supreme Court authorized personal marijuana use, as well as its planting, cultivation, harvest, preparation, possession, and transportation for recreational purposes by persons aged 18 and over, decriminalizing its use. Objectives. 1) To determine which variables are associated with favorable opinions regarding medical use, recreational use, and the legalization of marijuana use; and 2) to determine whether there are differences in the variables that best predict support for medicinal and recreational use and legalization of marijuana among marijuana users and non-users. Method. Data are drawn from the 2016 National Survey on Drug, Alcohol, and Tobacco Use, administered to a nationally representative sample of Mexican households. A validated questionnaire was used with questions on demographic characteristics, marijuana use (including the number of times it has been used), respondents' opinions regarding the legalization of marijuana and recreational use, whether they have been offered marijuana without having to pay for it, perception of risk associated with marijuana use, and excessive alcohol consumption. Results. Being male and having a low perception of the risks of marijuana use are the variables mostly strongly associated with approving medical and recreational use and its legalization, irrespective of whether respondents used it. Other variables associated with approval are age, educational attainment, and income level. Discussion and Conclusion. Legislators and policy makers should consider the full range of public opinion concerning the use and legalization of marijuana and incorporate it into their proposals. [ABSTRACT FROM AUTHOR]

Study design: Prospective observational qualitative study. Objective: Cannabis is used by patients for the treatment of chronic pain, spasticity, sleep issues or mood disorders such as anxiety and depression. Since 2018, it has been authorised in the United Kingdom for medical use as an unlicensed medicine. This study aims to determine if patients are using cannabis for the management of symptoms related to spinal cord injury, and if so, whether they are using medical or illicit cannabis. Methods: Spinal cord injury patients from the Yorkshire Regional Spinal Injuries Centre and SPINE Community in the United Kingdom were surveyed. Participants were sent a 7-point electronic survey. All results were anonymous, and confidentiality was maintained throughout the process. Results: In total, 223 patients completed the survey. Not all patients answered every question. Of those who responded 65.35% (n = 132) were paraplegic and 34.65% (n = 70) were tetraplegic. Patients were suffering from chronic pain (longer than 3 months), spasticity, loss of/difficulty in sleeping or anxiety/depression. Almost 15% (14.93%, n = 33 out of 221) used cannabis to manage their symptoms, out of those the majority used street cannabis (79.41%, n = 27 out of 34) were using street cannabis. Conclusion: This study demonstrates that there are spinal cord injury patients in the UK using cannabis to treat their symptoms. A majority appear to be using illicit cannabis. Given that cannabis can interact with other medications, and that the quality and content of illicit cannabis can be highly variable and at times dangerous, it is important for physicians to discuss cannabis use with their patients. This can inform prescribing and allow them to educate patients on the dangers of medical cannabis and potential alternatives. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to measure NP students' knowledge and perception of medical marijuana (MM) and determine whether they need additional education on the topic. Methods: A cross-sectional, descriptive study was implemented. NP students were asked to complete a survey that assessed their knowledge of MM, including adverse reactions and medical indications. Perceptions of recreational marijuana and MM were assessed through a 5-point Likert-scale questionnaire. Results: Of the 230 NP students who completed all or part of the questionnaire, 115 met inclusion criteria and were included in results. Most students (94%) felt that MM should be legalized in all US states. Likewise, 97% felt that MM education should be included in NP program curricula; however, only 30% reported receiving in-depth education on the topic. Participants were asked to identify, among 18 provided medical conditions, those which were approved indications for MM use; accurate response rate was low, though cancer, pain, cachexia, nausea/vomiting, posttraumatic stress disorder, and epilepsy were identified correctly as indications by more than half of participants. Previous MM use and religious affiliation had an impact on knowledge and perceptions of MM. Conclusion: With an increasing number of states legalizing MM, NP programs must evaluate their current curricula and integrate content that addresses the gap in knowledge of MM mechanism of action, indications, and adverse reactions. [ABSTRACT FROM AUTHOR]

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]

Cannabis and its major constituents, Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), are being widely used to treat sleep disturbances. However, THC can cause acute cognitive and psychomotor impairment and there are concerns that driving and workplace safety might be compromised the day after evening use. Here, we examined possible 'next day' impairment following evening administration of a typical medicinal cannabis oil in adults with insomnia disorder, compared to matched placebo. This paper describes the secondary outcomes of a larger study investigating the effects of THC/CBD on insomnia disorder. Twenty adults [16 female; mean (SD) age, 46.1 (8.6) y] with physician-diagnosed insomnia who infrequently use cannabis completed two 24 h in-laboratory visits involving acute oral administration of combined 10 mg THC and 200 mg CBD ('THC/CBD') or placebo in a randomised, double-blind, crossover trial design. Outcome measures included 'next day' (≥9 h post-treatment) performance on cognitive and psychomotor function tasks, simulated driving performance, subjective drug effects, and mood. We found no differences in 'next day' performance on 27 out of 28 tests of cognitive and psychomotor function and simulated driving performance relative to placebo. THC/CBD produced a small decrease (-1.4%, p=.016, d=-0.6) in accuracy on the Stroop-Colour Task (easy/congruent) but not the Stroop-Word Task (hard/incongruent). THC/CBD also produced a small increase (+8.6, p=.042, d=0.3) in self-ratings of Sedated at 10 h post-treatment, but with no accompanying changes in subjective ratings of Alert or Sleepy (p's>0.05). In conclusion, we found a lack of notable 'next day' impairment to cognitive and psychomotor function and simulated driving performance following evening use of 10 mg oral THC, in combination with 200 mg CBD, in an insomnia population who infrequently use cannabis. [ABSTRACT FROM AUTHOR]