Promoting healthy choices: the importance of differentiating between ordinary and high risk cannabis use among high-school students

Sex Differences in the Association Between Cannabis Use and Diabetes Mellitus among U.S. Adults: The National Health and Nutritional Examination Survey, 2013-2018

Background: Diabetes mellitus is an important public health problem in the United States, accounting for 87,647 deaths in 2019. This study aimed to assess the association between cannabis use and diabetes mellitus by sex among U.S. adults. Methods: Data were abstracted from the National Health and Nutrition Examination Survey (NHANES) from 2013 through 2018. Cannabis use was estimated using exposure status and frequency of use. Diabetes mellitus was assessed based on physician diagnosis or laboratory results, per the American Diabetes Association guidelines. A multivariable survey logistic regression model was fitted to estimate adjusted odds ratios (aOR) and confidence intervals (95% CIs). Results: A total of 15,062 participants were included in this study. The majority were female (n=7845; 51.1%), >40 years of age (n=8564; 56.3%), non-Hispanic white (n=4873; 61.5%), with at least a college-level education (n=8239; 62.5%). Female participants who used cannabis heavily were less likely to be diagnosed with diabetes mellitus than female noncannabis users (aOR=0.49; 95% CI: 0.30-0.81; aOR=0.51; 95% CI: 0.31-0.84). However, no significant association was found for female adults who engaged in light use of cannabis (aOR=0.98; 95% CI: 0.55-1.75; aOR=1.01; 95% CI: 0.57-1.79). Among male adults, cannabis use, irrespective of the degree of exposure, was not significantly associated with diabetes mellitus (heavy users: aOR=0.89; 95% CI=0.56-1.41; light users: aOR=0.53; 95% CI=0.22-1.29). Conclusions: Heavy cannabis use is inversely associated with diabetes mellitus in females but not males. Further studies are needed to explore the sex-based heterogeneity-and individual and contextual factors responsible-in the association between cannabis use and diabetes mellitus.

Lasting effects of prenatal exposure to Cannabis in the retina of the offspring: an experimental study in mice

Background

Prenatal exposure to Cannabis is a worldwide growing problem. Although retina is part of the central nervous system, the impact of maternal Cannabis use on the retinal development and its postnatal consequences remains unknown. As the prenatal period is potentially sensitive in the normal development of the retina, we hypothesized that recreational use of Cannabis during pregnancy may alter retina structure in the offspring. To test this, we developed a murine model that mimics human exposure in terms of dose and use.

Methods

Pregnant BalbC mice were exposed daily for 5 min to Cannabis smoke (0.2 g of Cannabis) or filtered air, from gestational day 5 to 18 (N = 10/group). After weaning period, pups were separated and examined weekly. On days 60, 120, 200, and 360 after birth, 10 pups from each group were randomly selected for Spectral Domain Optical Coherence Tomography (SD-OCT) analysis of the retina. All retina layers were measured and inner, outer, and total retina thickness were calculated. Other 37 mice from both groups were sacrificed on days 20, 60, and 360 for retinal stereology (total volume of the retina and volume fraction of each retinal layer) and light microscopy. Means and standard deviations were calculated and MANOVA was performed.

Results

The retina of animals which mother was exposed to Cannabis during gestation was 17% thinner on day 120 (young adult) than controls (P = 0.003) due to 21% thinning of the outer retina (P = 0.001). The offspring of mice from the exposed group presented thickening of the IS/OS in comparison to controls on day 200 (P < 0.001). In the volumetric analyzes by retinal stereology, the exposed mice presented transitory increase of the IS/OS total volume and volume fraction on day 60 (young adult) compared to controls (P = 0.008 and P = 0.035, respectively). On light microscopy, exposed mice presented thickening of the IS/OS on day 360 (adult) compared to controls (P = 0.03).

Conclusion

Gestational exposure to Cannabis smoke may cause structural changes in the retina of the offspring that return to normal on mice adulthood. These experimental evidences suggest that children and young adults whose mothers smoked Cannabis during pregnancy may require earlier and more frequent clinical care than the non-exposed population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40942-021-00314-8.

Factors Associated With Truancy

Although truancy has been studied extensively, less attention has been given to the actual voices of the truants themselves. The current study helps fill that gap by examining recollections from a sample of 34 emerging adults (ages 18-25) who experienced various levels of high school truancy across different geographical settings. A qualitative approach using semi-structured interviews was used to explore how former truants spent their time while being truant. The findings highlight factors in the contexts of the individual, home, and school that can impact the decision to be truant from school.

Considering gender in cannabinoid research: a step towards personalized treatment of marijuana addicts

Addiction is a complex disorder with interacting factors, including environmental factors, drug-induced neurobiological changes, comorbidity, personality traits and stress responsivity. Numerous genetic variants that affect these factors may work in concert to affect vulnerability and severity of addiction. Traditionally, abuse of illicit drugs, including cannabis, was considered to be primarily a problem specific to men but the recent focus on drug addiction in women has brought attention to numerous sex differences in the central effects of these drugs, epidemiology of abuse-related disorders, etiologic considerations and psychiatric comorbidity. Gender is now recognised as a major factor in the modulation of the pharmacological effects of drugs of abuse, and sex differences have been reported in various phases of the addiction cycle in both humans and animals. Recently, important gender-dependent differences have been detected in the rates of initiation of marijuana smoking and in the frequency of use. Several animal studies, and in particular self-administration studies, confirmed the crucial role played by sex and gonadal hormones in determining higher sensitivity to marijuana's rewarding properties and vulnerability to cannabis addiction in females than in males. In general, women also show higher rate of relapse to drug use than men, likely due to divergent withdrawal experiences and increased reactivity to internal (emotional) and external (drug-associated) cues. According with this, craving for marijuana smoking and propensity to re-use cannabis after abstinence may also develop differently between the sexes and require distinct treatment approaches, thus highlighting the urgent need for gender-tailored prevention strategies and detoxification treatments.

How important are sex differences in cannabinoid action?

In humans as in animals, males and females are dissimilar in their genetic and hormonally driven behaviour; they process information differently, perceive experience and emotions in different ways, display diverse attitudes, language and social skills, and show sex-related differences in the brain anatomy and organization. Drug addiction is a widespread relapsing illness that affects both men and women. Sex-dependent differences have been frequently observed in the biological and behavioural effects of substances of abuse, including cannabis. Beside sex differences observed in the cannabinoid-induced effects related to cannabis abuse and dependence, cannabinoids have been shown to exert sex-dependent effects also in other physiological and behavioural aspects, such as food intake and energy balance (more evident in males), or anxiety and depression (more evident in females). Research has just begun to identify factors which could provide a neurobiological basis for gender-based differences in cannabinoid effects, among which, gonadal hormones seem to play a crucial role. Yet, cannabinoid pharmacodynamic and pharmacokinetic may also be important, as sex differences in cannabinoid effects might be due, at least in part, to differences in muscle mass and fat tissue distribution between males and females. Here, we will review both clinical and laboratory-based research evidence revealing important sex-related differences in cannabinoid effects, and put forward some suggestions for future studies to fill the gap in our knowledge of gender-specific bias in cannabinoid pharmacology.

The great cannabis classification debacle: what are the likely consequences for policing cannabis possession offences in England and Wales?

The British government downgraded cannabis from a Class B to a Class C drug in 2004; but in 2008 it reversed this decision,and cannabis is due to be reclassified back to Class B in January 2009. In this Harm Reduction Digest, Paul Turnbull assesses the impact of reclassification to Class B focusing on policing and the legitimacy of drug law. The government cited the availability of stronger strains of cannabis and a large rise in the number of UK-based "cannabis farms" as the reasons for this decision.This is set against a backdrop of a trend of declining levels of use in the UK and a number of jurisdictions throughout the world adopting civil rather than criminal procedures to deal with cannabis possession offences. It concludes that tougher penalties for cannabis possession will have little deterrent effect on use and that the focus of law enforcement is likely to continue to fall disproportionately on young men from black and minority ethnic groups. Turnbull concludes that a better approach would be to use targeted public health approaches to reduce cannabis use and harm.

Gender differences in the correlates of adolescents' cannabis use

Adolescents' gender-specific cannabis use rates and their correlates were examined. Data were obtained via a cross-sectional survey conducted in 2004 in British Columbia, Canada, funded by the Canadian Institutes of Health Research. School districts were invited to participate, and schools within consenting districts were recruited. In total, 8,225 students (50% male) from Grades 7 to 12 participated. About 73% were "White," and 47% had used cannabis in their lifetime. Cannabis users were grouped according to their frequency of use: "never users," "frequent users," or "heavy users." Male heavy cannabis users (14.3% of boys) were more likely to be in Grade 9 or higher; be Aboriginal; report poorer economic status; never feel like an outsider; frequently use alcohol and tobacco; and have lower satisfaction with family, friends, and school compared with boys that never used. Female heavy users (8.7% of girls) were more likely to be in a higher grade; report poorer economic status, mental health, and academic performance; frequently use alcohol and tobacco; and have lower satisfaction with their school compared with female never users. Three important gender differences in the multivariate analysis of the correlates of cannabis use were noted: school grade (for boys only), Aboriginal status (for boys only), and mental health (for girls only). Despite the limitations of relying on self-reports, a subset of youth appears to be at risk for excessive cannabis use that may impair life opportunities and health. The gender differences may be important in the design and implementation of prevention or treatment programs for adolescents.