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Velayudhan L, Dugonjic M, Pisani S, Harborow L, Aarsland D, Bassett P, Bhattacharyya S. Cannabidiol for behavior symptoms in Alzheimer's disease (CANBiS-AD): a randomized, double-blind, placebo-controlled trial. Int Psychogeriatr 2024:1-3. [PMID: 38584388 DOI: 10.1017/s1041610224000516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Latha Velayudhan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, UK
| | - Marta Dugonjic
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sara Pisani
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, UK
| | | | - Sagnik Bhattacharyya
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, UK
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De Genna NM, Jacobsen E, Ganguli M. Marijuana use among community-dwelling older adults: A population-based study. Int J Geriatr Psychiatry 2024; 39:e6086. [PMID: 38613138 PMCID: PMC11112682 DOI: 10.1002/gps.6086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/01/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES There is a paucity of population-level data on marijuana use and mental health and functioning in older adults. METHODS We analyzed cross-sectional data (n = 910) from a well-characterized cohort, the Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study. MYHAT is an age-stratified random sample of the population age 65 years and older from a small-town in the USA. Half the sample was female and half were over 75 (Mean age = 77). Most participants were non-Hispanic White. Marijuana use was assessed by self-report and symptoms of mood disorders were screened using the modified Centers for Epidemiological Studies-Depression Scale and the Generalized Anxiety Disorder screener. Cognition was assessed by the Mini-Mental State Examination and a neuropsychological test battery; functioning using the OARS Activities of Daily Living and Instrumental Activities of Daily Living; and overall assessment using the Clinical Dementia Rating (CDR®). RESULTS One in five MYHAT participants had a history of marijuana use and 5% reported recent use, primarily for pain (41%) and recreation/relaxation (37%). Recent use was associated with cigarette and alcohol use, symptoms of depression or anxiety, and impairments in attention. CONCLUSIONS Twenty-percent of community-dwelling older adults living in a US state where recreational marijuana use is illegal had a history of marijuana use. Recent marijuana use was less common but, consistent with prior research, associated with other substance use and poorer mental health.
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Affiliation(s)
- Natacha M. De Genna
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Erin Jacobsen
- Department of Psychiatry, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - Mary Ganguli
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Departments of Psychiatry and Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Pagano S, Valenti C, Negri P, Billi M, Di Michele A, Bruscoli S, Febo M, Coniglio M, Marinucci L. Acute and chronic cannabidiol treatment: In vitro toxicological aspects on human oral cells. Food Chem Toxicol 2024; 185:114513. [PMID: 38342230 DOI: 10.1016/j.fct.2024.114513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024]
Abstract
Cannabidiol is gaining increasing interest for its potential anti-inflammatory, immunomodulatory, and antineoplastic effects. The purpose of this study is to investigate the biological effects of acute and chronic CBD administration on gingival fibroblasts and oral keratinocytes. Viability, morphology, migration, apoptosis and cell cycle, and expression of related genes (p53, BCL2, p21, and BAX) and of endocannabinoid system receptors (CB1, CB2 and GPR55) with real-time PCR and DNA damage with phospho-γ-H2AX immunofluorescence detection were analyzed. Concentrations between 100 μM and 0.001 μM were used: 50 μM (toxic dose), 25 μM (viability promoter), and 1 μM (nontoxic), were selected for subsequent chronic analysis. Acute treatment reveals significant effects than chronic, in particular in fibroblasts: concentrations ≥50 μM are highly cytotoxic, with increased apoptosis and reduced migration. Cell death correlates with increased p53 and BAX, followed by arrest in G0/G1 phase, with elevated p21 levels, suggesting a time- and dose-dependent damage. An increase in H2AX phosphorylation was observed with 25 μM and 50 μM, while 1 μM was biocompatible. Keratinocytes showed less cytotoxic effect than fibroblasts. Induced cell damage was dose- and time-related, with less damage after chronic treatment. Further investigations are needed with longer time frames to evaluate CBD dose- and time-dependent effects to identify an effective therapeutic dose.
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Affiliation(s)
- Stefano Pagano
- Department of Medicine and Surgery, Faculty of Dentistry, University of Perugia, S. Andrea delle Fratte, 06156, Perugia, Italy.
| | - Chiara Valenti
- Department of Medicine and Surgery, Faculty of Dentistry, University of Perugia, S. Andrea delle Fratte, 06156, Perugia, Italy; CISAS "Giuseppe Colombo", University of Padua, Via Venezia, 15, 35131, Padua, Italy.
| | - Paolo Negri
- Department of Medicine and Surgery, Faculty of Dentistry, University of Perugia, S. Andrea delle Fratte, 06156, Perugia, Italy.
| | - Monia Billi
- Department of Medicine and Surgery, Section of General Pathology, University of Perugia, S. Andrea delle Fratte, 06156, Perugia, Italy.
| | - Alessandro Di Michele
- Department of Physics and Geology, University of Perugia, Via Pascoli, 06123, Perugia, Italy.
| | - Stefano Bruscoli
- Department of Medicine and Surgery, Section of Pharmacology, University of Perugia, S. Andrea delle Fratte, 06156, Perugia, Italy.
| | - Marta Febo
- Department of Medicine and Surgery, Section of Pharmacology, University of Perugia, S. Andrea delle Fratte, 06156, Perugia, Italy.
| | - Maddalena Coniglio
- Department of Medicine and Surgery, Faculty of Dentistry, University of Perugia, S. Andrea delle Fratte, 06156, Perugia, Italy.
| | - Lorella Marinucci
- Department of Medicine and Surgery, Section of Biosciences and Medical Embryology, University of Perugia, S. Andrea delle Fratte, 06156, Perugia, Italy.
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Fernandez AC, Coughlin L, Solway ES, Singer DC, Kullgren JT, Kirch M, Malani PN. Prevalence and Frequency of Cannabis Use Among Adults Ages 50-80 in the United States. Cannabis Cannabinoid Res 2024; 9:59-64. [PMID: 38010715 PMCID: PMC10874828 DOI: 10.1089/can.2023.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Introduction: Legal access to and attitudes toward cannabis are changing rapidly. Most of the United States and territories allow adults to use medical and/or recreational cannabis. Recent trends demonstrate increasing cannabis use among older U.S. adults. However, little research has examined cannabis use among older adults since 2019, when the COVID-19 pandemic caused major changes in patterns of substance use. Methods: The National Poll on Healthy Aging is a nationally cross-sectional survey that asked U.S. adults ages 50-80 in January 2021 about their cannabis use in the past year. Multivariable logistic regression was used to identify demographic and health characteristics associated with cannabis use. Results: Among 2023 participants aged 50-80 (52.7% female), 12.1% reported cannabis use in the past year. Among those who reported cannabis use, 34.2% reported using cannabis products 4 or more days per week. In multivariable logistic regression, cannabis use was less likely among people who identified as Hispanic ethnicity or as "other" races compared with non-Hispanic white respondents. Cannabis use was more likely among unmarried/unpartnered and unemployed respondents. Those who consumed alcohol were more likely to use cannabis. Conclusions: More than one in 10 U.S. adults aged 50-80 used cannabis in the 1st year of the COVID-19 pandemic, and many used cannabis frequently. As access to and use of cannabis continue to increase nationally, clinicians and policymakers should monitor and address the potential risks among older adults.
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Affiliation(s)
- Anne C. Fernandez
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Lara Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Erica S. Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Dianne C. Singer
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey T. Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Preeti N. Malani
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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O’Neill V, Karanikas N, Sav A, Murphy P. Medicinal Cannabis and Implications for Workplace Health and Safety: Scoping Review of Systematic Reviews. Workplace Health Saf 2023; 71:400-410. [PMID: 37077169 PMCID: PMC10467002 DOI: 10.1177/21650799231157086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
PURPOSE Although medicinal cannabis is prescribed for conditions such as pain, epilepsy, nausea and vomiting during cancer treatment, evidence about associated adverse side effects is still evolving. Because adverse events (AEs) might impact the performance of workers, it is important to consider their implications on workplace health and safety (WHS). This study aimed to map the types and prevalence of the AEs associated with medical cannabis and articulate how those events could impact WHS. METHODS A scoping review of systematic reviews and/or meta-analyses published between 2015 and March 2021 was performed to identify the AEs of medicinal cannabis in adults. Publications in English and full text available online were collected from Embase, MEDLINE, PsychINFO, PubMed, Scopus, and Web of Science. RESULTS Of 1,326 papers identified from the initial search, 31 met the inclusion criteria and were analyzed. The studies reported various AEs with the most predominant being sedation, nausea/vomiting, dizziness, and euphoria. Acute and chronic pain was the most prevalent disorder under review. CONCLUSIONS Adverse events associated with the use of medicinal cannabis could increase workplace risks, including decreased alertness and reaction times, increased absenteeism, reduced ability to safely drive or operate machinery and an increased probability of falling. Focused research into the risk to workers and workplaces from the use of medical cannabis and related human performance impairment is urgently warranted.
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Affiliation(s)
| | | | - Adem Sav
- Queensland University of Technology
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Lachance SL, Zucker DM, Hutchins JM. Adult Cannabis Use: An Exploratory Case Study. J Gerontol Nurs 2023; 49:19-26. [PMID: 37523334 DOI: 10.3928/00989134-20230707-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Cannabis use is on the rise among adults and older adults managing chronic health conditions in the United States. There is limited understanding of this trend and the factors influencing cannabis use in the health care community. The current study explores the perceptions and experiences of adults and older adults with chronic health conditions who use cannabis regularly. Case study data were gathered through interviews guided by the Biopsychosocial Model. Biological, psychological, and social reasons for cannabis use emerged in the interviews. Despite reporting adverse events, cannabis was reported as an effective treatment for participants' chronic health issues, and participants were more comfortable with its use compared to prescription medications. A feeling of autonomy contributed to cannabis use being perceived as positive. Cannabis use is rising in the United States. Primary care providers must regularly screen older adults to identify appropriate and inappropriate use patterns. [Journal of Gerontological Nursing, 49(8), 19-26.].
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McClure EA, Walters KJ, Tomko RL, Dahne J, Hill EG, McRae-Clark AL. Cannabis use prevalence, patterns, and reasons for use among patients with cancer and survivors in a state without legal cannabis access. Support Care Cancer 2023; 31:429. [PMID: 37382737 DOI: 10.1007/s00520-023-07881-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE Cannabis use among patients with cancer is common, yet data are limited regarding use patterns, reasons for use, and degree of benefit, which represents an unmet need in cancer care delivery. This need is salient in states without legal cannabis programs, where perceptions and behavior among providers and patients may be affected. METHODS A cross-sectional survey of patients with cancer and survivors at the Hollings Cancer Center at the Medical University of South Carolina (no legal cannabis marketplace in SC) was completed as part of the NCI Cannabis Supplement. Patients (ages 18 +) were recruited using probability sampling from patient lists (N = 7749 sampled; N = 1036 completers). Weight-adjusted Chi-square tests compared demographics and cancer details among patients using cannabis since diagnosis versus those not using cannabis, while weighted descriptives are presented for cannabis use prevalence, consumption, symptom management, and legalization beliefs. RESULTS Weighted prevalence of cannabis use since diagnosis was 26%, while current cannabis use was 15%. The most common reasons for cannabis use after diagnosis were difficulty sleeping (50%), pain (46%), and mood changes and stress, anxiety, or depression (45%). Symptom improvement was endorsed for pain (57%), stress/anxiety/depression (64%), difficulty sleeping (64%), and loss of appetite (40%). CONCLUSIONS Among patients with cancer and survivors at a NCI-designated cancer center within SC, a state without legal access to medical cannabis, prevalence rates, and reasons for cannabis use are consistent with emerging literature in oncology populations. These findings have implications for care delivery, and work is needed to inform recommendations for providers and patients.
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Affiliation(s)
- Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
| | - Kyle J Walters
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth G Hill
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Aimee L McRae-Clark
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Banner A, Wieser S, Madersbacher S. Resource use in the last year of life of prostate cancer patients-A register-based analysis. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00685-z. [PMID: 37380803 DOI: 10.1038/s41391-023-00685-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/11/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Given the paucity of data on the end of life (EOL) of prostate-cancer (PC) patients, we investigated medication prescription patterns and hospitalizations during their final year of life. METHODS The data base of the Österreichische Gesundheitskasse Vienna (ÖGK-W) was used to identify all men who died with the diagnosis PC between 1.1.2015 and 31.12.2021 and who were under androgen deprivation and/or new hormonal therapies. Patient age, prescription patterns and hospitalizations during the last year of life were recorded, odds ratios for age groups were analyzed. RESULTS A total of 1.109 patients were included. ADT was given in 86.7% (n = 962) and NHT in 62.8% (n = 696). Overall, prescription of analgesics increased from 41% (n = 455) during the first to 65.1% (n = 722) in the last quarter of the final year of life. Prescription of NSAIDs was almost consistent (18-20%) whereas the number of patients receiving other non-opioids (paracetamol, metamizole) more than doubled (18 to 39%). Older men had lower prescription rates for NSAID (OR: 0.47, 95% CI: 0.35-0.64), non-opioids (OR: 0.43, 95% CI: 0.32-0.57), opioids (OR: 0.45, 95% CI: 0.34-0.6) and adjuvant analgesics (OR: 0.42, 95% CI: 0.28-0.65). Approximately 2/3 of patients (n = 733) died in the hospital with a median of four hospitalizations in the final year of life. The overall cumulative length of admission was less than 50d in 61.9%, 51-100d in 30.6% and >100d in 7.6%. Younger patients (<70 yrs) were more likely to die in the hospital (OR: 1.66, 95% CI: 1.15-2.39), had a higher median rate of hospitalizations (n = 6) and longer cumulative duration of admissions. CONCLUSIONS Resource use increased during the last year life of PC patients with highest rates in younger men. Hospitalization rates were high and 2/3 died in the hospital, both showed clear age dependency with higher rates, duration and death in the hospital for younger men.
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Affiliation(s)
- Andreas Banner
- Department of Urology, Klinik Favoriten, Vienna, Austria
| | - Sabine Wieser
- Österreichische Gesundheitskasse für Wien (ÖGK-W), Vienna, Austria
| | - Stephan Madersbacher
- Department of Urology, Klinik Favoriten, Vienna, Austria.
- Sigmund-Freud Privat Universität, Vienna, Austria.
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Moussa MK, Hall MAK, Akwe J. Cannabis-Induced Acute Encephalopathy in a 94-Year-Old Woman Due to Family Administration of Cannabidiol (CBD) Products: A Case Report. Cureus 2023; 15:e37927. [PMID: 37223146 PMCID: PMC10202677 DOI: 10.7759/cureus.37927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
In the United States, cannabis use is rising, including among older adults, as is unintentional ingestion. We describe the case of a 94-year-old woman admitted with altered mental status, diarrhea, and hallucinations. She lived with her family, who had noticed recent confusion with weakness, poor oral intake, and loose bowel movements. In the emergency room, her vital signs revealed mild tachycardia and hypotension. She was lethargic, disoriented, confused, and anxious but could answer simple questions. The attending hospitalist administered the Mini-Cog dementia screening and found that the patient was oriented to herself only and was unable to perform word recall tests or complete a clock drawing. The rest of her physical exam was within normal limits for her age. Despite a workup including urine culture, chest X-ray, and computed tomography scan of her head, no organic source for her mental change was found. After five days of admission, a close relative confessed that they had given the patient cannabis oil (marketed as "pure CBD," i.e., cannabidiol, a nonpsychoactive cannabis derivative widely touted as a remedy for pain, anxiety, and anorexia) in the form of edible brownies to help her with her persistent back pain and poor appetite. We performed a urine drug screen for tetrahydrocannabinol (THC), the psychoactive component of cannabis, which verified cannabis use, as well as exposure to THC. The patient recovered to baseline with supportive care. Currently, there is no governing body or framework for the regulation of cannabis products in the United States. Nonprescription CBD products are not regulated by the US Food and Drug Administration, and these products are not tested for safety, efficacy, or quality. Some producers voluntarily conduct such testing, but there is no regulatory oversight, and consumers may be unaware of the need for testing and/or which testing bodies are credible. Given the rapidly increasing proportion of older adults who are cannabis users, physicians should inquire about outpatient use of cannabis in general and CBD in particular during discussions with patients, even the most elderly.
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Affiliation(s)
- Mohamad K Moussa
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, USA
- Hospital Medicine, Emory Johns Creek Hospital, Johns Creek, USA
| | | | - Joyce Akwe
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, USA
- Hospital Medicine, Atlanta Veterans Affairs Medical Center, Atlanta, USA
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To J, Davis M, Sbrana A, Alderman B, Hui D, Mukhopadhyay S, Bouleuc C, Case AA, Amano K, Crawford GB, de Feo G, Tanco K, Garsed J. MASCC guideline: cannabis for cancer-related pain and risk of harms and adverse events. Support Care Cancer 2023; 31:202. [PMID: 36872397 DOI: 10.1007/s00520-023-07662-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Approximately 18% of patients with cancer use cannabis at one time as palliation or treatment for their cancer. We performed a systematic review of randomized cannabis cancer trials to establish a guideline for its use in pain and to summarize the risk of harm and adverse events when used for any indication in cancer patients. METHODS A systematic review of randomized trials with or without meta-analysis was carried out from MEDLINE, CCTR, Embase, and PsychINFO. The search involved randomized trials of cannabis in cancer patients. The search ended on November 12, 2021. The Jadad grading system was used for grading quality. Inclusion criteria for articles were randomized trials or systematic reviews of randomized trials of cannabinoids versus either placebo or active comparator explicitly in adult patients with cancer. RESULTS Thirty-four systematic reviews and randomized trials met the eligibility criteria for cancer pain. Seven were randomized trials involving patients with cancer pain. Two trials had positive primary endpoints, which could not be reproduced in similarly designed trials. High-quality systematic reviews with meta-analyses found little evidence that cannabinoids are an effective adjuvant or analgesic to cancer pain. Seven systematic reviews and randomized trials related to harms and adverse events were included. There was inconsistent evidence about the types and levels of harm patients may experience when using cannabinoids. CONCLUSION The MASCC panel recommends against the use of cannabinoids as an adjuvant analgesic for cancer pain and suggests that the potential risk of harm and adverse events be carefully considered for all cancer patients, particularly with treatment with a checkpoint inhibitor.
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Affiliation(s)
- Josephine To
- Division of Aged Care, Rehabilitation and Palliative Care, Northern Adelaide Local Health Network, Adelaide, Australia
| | - Mellar Davis
- Palliative Care Department, Geisinger Medical System, Danville, USA.
| | | | | | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Carole Bouleuc
- Department of Supportive and Palliative Care, P.S.L. University, Institut Curie, Paris, France
| | - Amy A Case
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Division of Geriatrics and Palliative Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Gregory B Crawford
- Northern Adelaide Local Health Network, South Australia, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | | | - Kimberson Tanco
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Arnstein P, Shade M, Herr KA, Young HM, Fishman SM. Managing Older Adults' Chronic Pain: Lower-Risk Interventions. Am J Nurs 2023; 123:46-52. [PMID: 36698362 DOI: 10.1097/01.naj.0000919740.00088.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
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Affiliation(s)
- Paul Arnstein
- Paul Arnstein is a professor in the School of Nursing at the MGH Institute of Health Professions in Boston. Marcia Shade is an assistant professor in the College of Nursing at the University of Nebraska Medical Center in Omaha. Keela A. Herr is the Kelting Professor in Nursing, associate dean for faculty, and codirector of the Csomay Center for Gerontological Excellence in the College of Nursing at the University of Iowa in Iowa City. Heather M. Young is a professor and founding dean emerita in the Betty Irene Moore School of Nursing at the University of California Davis in Sacramento, and national director of the Betty Irene Moore Fellowship for Nurse Leaders and Innovators. Scott M. Fishman is a professor, the Fullerton Endowed Chair in Pain Medicine, and executive vice chair in the Department of Anesthesiology and Pain Medicine at the University of California Davis School of Medicine in Sacramento, where he is also director of the Center for Advancing Pain Relief. This work was funded by the Mayday Fund and the Ralph C. Wilson, Jr. Foundation. Contact author: Paul Arnstein, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Hasbi A, Madras BK, George SR. Daily THC and withdrawal increase dopamine D1-D2 receptor heteromer to mediate anhedonia and anxiogenic-like behavior through a dynorphin and kappa opioid receptor mechanism. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022. [PMID: 37519471 PMCID: PMC10382712 DOI: 10.1016/j.bpsgos.2022.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Background Frequent cannabis use is associated with a higher risk of developing cannabis use disorder and other adverse consequences. However, rodent models studying the underlying mechanisms of the reinforcing and withdrawal effects of the primary constituent of cannabis, Δ9-tetrahydrocannabinol (THC), have been limited. Methods This study investigated the effects of daily THC (1 mg/kg, intraperitoneal, 9 days) and spontaneous withdrawal (7 days) on hedonic and aversion-like behaviors in male rats. In parallel, underlying neuroadaptive changes in dopaminergic, opioidergic, and cannabinoid signaling in the nucleus accumbens were evaluated, along with a candidate peptide designed to reverse altered signaling. Results Chronic THC administration induced anhedonic- and anxiogenic-like behaviors not attributable to altered locomotor activity. These effects persisted after drug cessation. In the nucleus accumbens, THC treatment and withdrawal catalyzed increased cannabinoid CB1 receptor activity without modifying receptor expression. Dopamine D1-D2 receptor heteromer expression rose steeply with THC, accompanied by increased calcium-linked signaling, activation of BDNF/TrkB (brain-derived neurotrophic factor/tropomyosin receptor kinase B) pathway, dynorphin expression, and kappa opioid receptor signaling. Disruption of the D1-D2 heteromer by an interfering peptide during withdrawal reversed the anxiogenic-like and anhedonic-like behaviors as well as the neurochemical changes. Conclusions Chronic THC increases nucleus accumbens dopamine D1-D2 receptor heteromer expression and function, which results in increased dynorphin expression and kappa opioid receptor activation. These changes plausibly reduce dopamine release to trigger anxiogenic- and anhedonic-like behaviors after daily THC administration that persist for at least 7 days after drug cessation. These findings conceivably provide a therapeutic strategy to alleviate negative symptoms associated with cannabis use and withdrawal.
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Gay L, Sheth S, Horstman MJ. Things We Do for No Reason™: Prescribing appetite stimulants to hospitalized older adults with unintentional weight loss. J Hosp Med 2022; 17:389-392. [PMID: 35585691 DOI: 10.12788/jhm.3652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Lindsey Gay
- Michael E DeBakey VA Medical Center, Houston, Texas
- Section of General Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Shaila Sheth
- Michael E DeBakey VA Medical Center, Houston, Texas
- Section of General Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Molly J Horstman
- Michael E DeBakey VA Medical Center, Houston, Texas
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E DeBakey VA Medical Center, Houston, Texas
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Worth H, O'Hara D, Agarwal N, Collister D, Brennan F, Smyth B. Cannabinoids for Symptom Management in Patients with Kidney Failure. Clin J Am Soc Nephrol 2022; 17:911-921. [PMID: 34987023 PMCID: PMC9269669 DOI: 10.2215/cjn.11560821] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
People with kidney failure can experience a range of symptoms that lead to suffering and poor quality of life. Available therapies are limited, and evidence for new treatment options is sparse, often resulting in incomplete relief of symptoms. There is growing interest in the potential for cannabinoids, including cannabidiol and tetrahydrocannabinol, to treat symptoms across a wide range of chronic diseases. As legal prohibitions are withdrawn or minimized in many jurisdictions, patients are increasingly able to access these agents. Cannabinoid receptors, CB1 and CB2, are widely expressed in the body, including within the nervous and immune systems, and exogenous cannabinoids can have anxiolytic, anti-emetic, analgesic and anti-inflammatory effects. Considering their known physiological actions and successful studies in other patient populations, cannabinoids may be viewed as potential therapies for a variety of common symptoms affecting those with kidney failure, including pruritus, nausea, insomnia, chronic neuropathic pain, anorexia, and restless legs syndrome. In this review, we summarize the pharmacology and pharmacokinetics of cannabinoids, along with what is known about the use of cannabinoids for symptom relief in those with kidney disease, and the evidence available concerning their role in management of common symptoms. Presently, while these agents show varying efficacy with a reasonable safety profile in other patient populations, evidence-based prescribing of cannabinoids for people with symptomatic kidney failure is not possible. Given the symptom burden experienced by individuals with kidney failure, there is an urgent need to understand the tolerability and safety of these agents in this population, which must ultimately be followed by robust, randomized controlled trials to determine if they are effective for symptom relief.
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Affiliation(s)
- Hayley Worth
- H Worth, Department of Palliative Medicine, St George Hospital, Kogarah, Australia
| | - Daniel O'Hara
- D O'Hara, NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Neeru Agarwal
- N Agarwal, NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - David Collister
- D Collister, Section of Nephrology, University of Alberta Department of Medicine, Edmonton, Canada
| | - Frank Brennan
- F Brennan, Department of Renal Medicine, St George Hospital, Kogarah, Australia
| | - Brendan Smyth
- B Smyth, NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
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15
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Workman CD, Sosnoff JJ, Rudroff T. Disparity between Perceptual Fall Risk and Physiological Fall Risk in Older Cannabis Users: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010109. [PMID: 35010369 PMCID: PMC8750873 DOI: 10.3390/ijerph19010109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 01/22/2023]
Abstract
Aging is associated with cognitive decline and increased fall risk. Cognitive impairment is associated with cannabis use, which is increasing among older adults. Perceptual and physiological fall risk are discordant in some older adults, but whether cannabis use influences this association is unknown. The purpose of this study was to investigate possible disparities between perceptual and physiological fall risk in older cannabis users. Eight older medical cannabis users and eight sex- and age-matched non-users provided data on perceptual and physiological fall risk. Group differences were assessed, and perceptual fall risk was correlated with physiological fall risk. Perceptual risk and most of the physiological fall risk variables were equivalent between the groups. However, cannabis users performed significantly worse on unipedal stance than non-users. In addition, perceptual fall risk had weak correlations with physiological fall risk in the users (Spearman’s rho = 0.17–0.41) and moderate-strong correlations in non-users (rho = −0.18–0.67). Cannabis users might have a discrepancy between perceptual and physiological fall risk. Because both concepts play a role in quality of life, identifying strategies to improve them may have significant benefits. Future studies investigating additional perceptual (e.g., cognition, fear of falling, depression, anxiety), physiological (e.g., more challenging static and dynamic balance conditions), and general fall risk are warranted.
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Affiliation(s)
- Craig D. Workman
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA;
| | - Jacob J. Sosnoff
- Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA;
- Department of Neurology, University of Iowa Health Clinics, Iowa City, IA 52242, USA
- Correspondence: ; Tel.: +1-319-467-0363
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16
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Cabañero D, Martín-García E, Maldonado R. The CB2 cannabinoid receptor as a therapeutic target in the central nervous system. Expert Opin Ther Targets 2021; 25:659-676. [PMID: 34424117 DOI: 10.1080/14728222.2021.1971196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Targeting CB2 cannabinoid receptor (CB2r) represents a promising approach for the treatment of central nervous system disorders. These receptors were identified in peripheral tissues, but also in neurons in the central nervous system. New findings have highlighted the interest to target these central receptors to obtain therapeutic effects devoid of the classical cannabinoid side-effects. AREAS COVERED In this review, we searched PubMed (January 1991-May 2021), ClinicalTrials.gov and Cochrane Library databases for articles, reviews and clinical trials. We first introduce the relevance of CB2r as a key component of the endocannabinoid system. We discuss CB2r interest as a possible novel target in the treatment of pain. This receptor has raised interest as a potential target for neurodegenerative disorders treatment, as we then discussed. Finally, we underline studies revealing a novel potential CB2r interest in mental disorders treatment. EXPERT OPINION In spite of the interest of targeting CB2r for pain, clinical trials evaluating CB2r agonist analgesic efficacy have currently failed. The preferential involvement of CB2r in preventing the development of chronic pain could influence the failure of clinical trials designed for the treatment of already established pain syndromes. Specific trials should be designed to target the prevention of chronic pain development.
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Affiliation(s)
- David Cabañero
- Institute of Research, Development and Innovation in Healthcare Biotechnology of Elche (IDiBE), Universidad Miguel Hernández. Elche, Alicante, Spain
| | - Elena Martín-García
- Neuropharmacology Laboratory, Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain.,IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain
| | - Rafael Maldonado
- Neuropharmacology Laboratory, Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain.,IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain
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17
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Brown JD, Rivera Rivera KJ, Hernandez LYC, Doenges MR, Auchey I, Pham T, Goodin AJ. Natural and Synthetic Cannabinoids: Pharmacology, Uses, Adverse Drug Events, and Drug Interactions. J Clin Pharmacol 2021; 61 Suppl 2:S37-S52. [PMID: 34396558 DOI: 10.1002/jcph.1871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/01/2021] [Indexed: 01/15/2023]
Abstract
The purpose of this narrative review is to describe the current use environment of both natural and synthetic cannabinoids while providing context for cannabinoid chemistry and pharmacology. In addition to a long history of recreational and nonmedical use, natural cannabinoids are increasingly used as prescription products, through medical cannabis programs, and as consumer health products. Despite anecdotal safety evidence, cannabis and cannabinoids are pharmacologically complex and pose risks for adverse drug events and drug-drug interactions. Synthetic cannabinoids, particularly agonists of cannabinoid receptors, are more potent than natural cannabinoids and can lead to more severe reactions and medical emergencies. This review provides a summary of approved uses and an overview of mechanisms of action for adverse drug events with natural and synthetic cannabinoids. Clinical considerations for special populations that may be at heightened risk for drug-drug interactions and adverse drug events while using natural or synthetic cannabinoids are examined, and recommendations are provided.
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Affiliation(s)
- Joshua D Brown
- Center for Drug Evaluation & Safety, University of Florida, Gainesville, Florida, USA.,Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA.,Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | | | | | - Matthew R Doenges
- University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - India Auchey
- University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Thanh Pham
- University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Amie J Goodin
- Center for Drug Evaluation & Safety, University of Florida, Gainesville, Florida, USA.,Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA.,Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
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18
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Porter B, St. Marie B, Milavetz G, Herr K. Cannabidiol (CBD) Use by Older Adults for Acute and Chronic Pain. J Gerontol Nurs 2021; 47:6-15. [PMID: 34191653 PMCID: PMC8344100 DOI: 10.3928/00989134-20210610-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Legalization of cannabidiol (CBD) products has ignited interest in clinical practice and research. One desired indication includes possible pain-relieving effects of CBD. The purposes of the current article are to (1) clarify terminology relevant to cannabinoids; (2) explain and understand the pharmacotherapeutics of CBD; (3) examine research of the current use of CBD by older adults for treating pain; (4) discuss safety considerations with using CBD products; and (5) provide best practice recommendations for clinicians as they advise their older adult patients. A review of the literature demonstrated mixed results on the efficacy of CBD in relieving pain in older adults. There is inconsistency in the labeling of over-the-counter CBD products that can result in safety issues and will require more federal quality control. Likewise, gaps in knowledge regarding safety and efficacy of CBD use in older adults are vast and require further research. [Journal of Gerontological Nursing, 47(7), 6-15.].
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Affiliation(s)
- Donna M Fick
- Penn State College of Nursing, University Park, Pennsylvania
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