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Kelly LE, Rieder MJ, Finkelstein Y. Medical cannabis for children: Evidence and recommendations. Paediatr Child Health 2024; 29:104-121. [PMID: 38586483 PMCID: PMC10996577 DOI: 10.1093/pch/pxad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/20/2023] [Indexed: 04/09/2024] Open
Abstract
Interest in using cannabis products for a medical purpose in children under the age of 18 years is increasing. There are many medical cannabis products available that can include cannabidiol (CBD) or delta-9-tetrahydrocannabinol (THC), or both. Despite many therapeutic claims, there are few rigorous studies to inform the dosing, safety, and efficacy of medical cannabis in paediatric clinical practice. This statement reviews the current evidence and provides recommendations for using medical cannabis in children. Longer-term (2-year) reports support the sustained tolerability and efficacy of cannabidiol therapy for patients with Lennox-Gastaut and Dravet syndromes. CBD-enriched cannabis extracts containing small amounts of THC have been evaluated in a small number of paediatric patients, and further research is needed to inform clinical practice guidelines. Given the widespread use of medical cannabis in Canada, paediatricians should be prepared to engage in open, ongoing discussions with families about its potential benefits and risks, and develop individualized plans that monitor efficacy, reduce harms, and mitigate drug-drug interactions.
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Affiliation(s)
- Lauren E Kelly
- Canadian Paediatric Society, Drug Therapy Committee, Ottawa, Ontario, Canada
| | - Michael J Rieder
- Canadian Paediatric Society, Drug Therapy Committee, Ottawa, Ontario, Canada
| | - Yaron Finkelstein
- Canadian Paediatric Society, Drug Therapy Committee, Ottawa, Ontario, Canada
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Puttharak P, Wangnai P, Puttharak J, Baisaeng N. Optimizing medicinal hemp production with synergistic light-enhanced technologies and organic biorefinery approaches. J Photochem Photobiol B 2024; 254:112890. [PMID: 38507943 DOI: 10.1016/j.jphotobiol.2024.112890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/02/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
This study explores the application of sustainable organic and biorefinery methods to increase the production of therapeutic hemp. Specifically, it focuses on Solodiol, Carmagnola, and Doctor Seedman strains. The study was carried out for 60 days in a highly controlled setting. It employed a unique combination of Murashige and Skoog (MS) media, supplemented with 2,4-D (0.5 mg/L) and kinetin (0.5 mg/L), and augmented with organic additions such as coconut water. This distinctive amalgamation facilitated extraordinary expansion across all varieties. The Solodiol strain demonstrated remarkable growth characteristics in terms of the number of branches, leaves, shoots, and height, whilst Carmagnola and Doctor Seedman indicated significant differences in diameter. Carmagnola, specifically, flourished in specific conditions: a strict 16-h period of light followed by 8 h of darkness, particularly when exposed to blue light. The Carmagnola strain, grown using MS feed (2StemMS), produced a hemp oil extract with a high concentration of 3.85%, compared to the Solodiol and Doctor Seedman strains, and also showcases their potential in promoting an environmentally friendly and therapeutically helpful medicinal hemp industry.
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Affiliation(s)
- Phopgao Puttharak
- Department of Biology, School of Science, University of Phayao, Phayao Province 56000, Thailand.
| | - Patthamaporn Wangnai
- Department of Biology, School of Science, University of Phayao, Phayao Province 56000, Thailand
| | - Jarucha Puttharak
- School of Dentistry, University of Phayao, Phayao Province 56000, Thailand
| | - Nuttakorn Baisaeng
- School of Pharmaceutical Sciences, University of Phayao, Phayao Province 56000, Thailand
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Balneaves LG, Brown A, Green M, Prosk E, Rapin L, Monahan-Ellison M, McMillan E, Zaid J, Dworkind M, Watling CZ. Canadians' use of cannabis for therapeutic purposes since legalization of recreational cannabis: a cross-sectional analysis by medical authorization status. BMC Med 2024; 22:150. [PMID: 38589855 PMCID: PMC11003000 DOI: 10.1186/s12916-024-03370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND There has been a precipitous decline in authorizations for medical cannabis since non-medical cannabis was legalized in Canada in 2018. This study examines the demographic and health- and medical cannabis-related factors associated with authorization as well as the differences in medical cannabis use, side effects, and sources of medical cannabis and information by authorization status. METHODS Individuals who were taking cannabis for therapeutic purposes completed an online survey in early 2022. Multivariable logistic regression was used to determine odds ratios (OR) and 95% confidence intervals (CI) of demographic and health- and medical cannabis-related variables associated with holding medical cannabis authorization. The differences in medical cannabis use, side effects, and sources of information by authorization status were determined via t-tests and chi-squared analysis. RESULTS A total of 5433 individuals who were currently taking cannabis for therapeutic purposes completed the study, of which 2941 (54.1%) currently held medical authorization. Individuals with authorization were more likely to be older (OR ≥ 70 years vs. < 30 years, 4.85 (95% CI, 3.49-6.76)), identify as a man (OR man vs. woman, 1.53 (1.34-1.74)), have a higher income (OR > $100,000/year vs. < $50,000 year, 1.55 (1.30-1.84)), and less likely to live in a small town (OR small town/rural vs. large city, 0.69 (0.59-0.81)). They were significantly more likely to report not experiencing any side effects (29.9% vs. 23.4%; p < 0.001), knowing the amount of cannabis they were taking (32.1% vs. 17.7%; p < 0.001), obtaining cannabis from regulated sources (74.1% vs. 47.5%; p < 0.001), and seeking information about medical cannabis from healthcare professionals (67.8% vs. 48.2%; p < 0.01) than individuals without authorization. CONCLUSIONS These findings offer insight into the possible issues regarding equitable access to medical cannabis and how authorization may support and influence individuals in a jurisdiction where recreational cannabis is legalized, highlighting the value of a formal medical cannabis authorization process.
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Affiliation(s)
- Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Ashleigh Brown
- SheCann Cannabis, Winnipeg, MB, Canada
- Medical Cannabis Canada, Toronto, ON, Canada
| | - Matthew Green
- Medical Cannabis Canada, Toronto, ON, Canada
- Department of Psychology, Brock University, St. Catharine's, ON, Canada
| | | | | | | | | | | | - Michael Dworkind
- Santé Cannabis, Montréal, QC, Canada
- Department of Medicine, McGill University, Montréal, QC, Canada
| | - Cody Z Watling
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Pomey MP, Jutras-Aswad D, Paquette J, Saadi K, Taguemout M, Ikene DL, Arbour N, Zertal A, Fréjeau N, Morin D, Ouellette JS, Alami Marrouni K, Duquette P. Perceptions and engagement of patients with chronic conditions on the use of medical cannabis: a scoping review. Eur J Med Res 2024; 29:211. [PMID: 38561859 PMCID: PMC10983766 DOI: 10.1186/s40001-024-01803-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
CONTEXT Studies generally focus on one type of chronic condition and the effect of medical cannabis (MC) on symptoms; little is known about the perceptions and engagement of patients living with chronic conditions regarding the use of MC. OBJECTIVES This scoping review aims to explore: (1) what are the dimensions addressed in studies on MC that deal with patients' perceptions of MC? and (2) how have patients been engaged in developing these studies and their methodologies? Through these objectives, we have identified areas for improving future research. METHODS We searched five databases and applied exclusion criteria to select relevant articles. A thematic analysis approach was used to identify the main themes: (1) reasons to use, to stop using or not to use MC, (2) effects of MC on patients themselves and empowerment, (3) perspective and knowledge about MC, and (4) discussion with relatives and healthcare professionals. RESULTS Of 53 articles, the main interest when assessing the perceptions of MC is to identify the reasons to use MC (n = 39), while few articles focused on the reasons leading to stop using MC (n = 13). The majority (85%) appraise the effects of MC as perceived by patients. Less than one third assessed patients' sense of empowerment. Articles determining the beliefs surrounding and knowledge of MC (n = 41) generally addressed the concerns about or the comfort level with respect to using MC. Only six articles assessed patients' stereotypes regarding cannabis. Concerns about stigma constituted the main topic while assessing relationships with relatives. Some articles included patients in the research, but none of them had co-created the data collection tool with patients. CONCLUSIONS Our review outlined that few studies considered chronic diseases as a whole and that few patients are involved in the co-construction of data collection tools as well. There is an evidence gap concerning the results in terms of methodological quality when engaging patients in their design. Future research should evaluate why cannabis' effectiveness varies between patients, and how access affects the decision to use or not to use MC, particularly regarding the relationship between patients and healthcare providers. Future research should consider age and gender while assessing perceptions and should take into consideration the legislation status of cannabis as these factors could in fact shape perception. To reduce stigma and stereotypes about MC users, better quality and accessible information on MC should be disseminated.
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Affiliation(s)
- Marie-Pascale Pomey
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada.
- School of Public Health, Department of Health Management, Evaluation of Policy, Université de Montréal, 7101 Du Parc Avenue 3rd Floor, Montréal, QC, H3N 1X9, Canada.
- Centre of Excellence on Partnership with Patients and the Public, Montréal, QC, Canada.
| | - Didier Jutras-Aswad
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, QC, Canada
| | - Jesseca Paquette
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
| | - Kamilla Saadi
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Anthropology, Université de Montréal, Montréal, QC, Canada
| | - Mélissa Taguemout
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Dina-Liza Ikene
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Nathalie Arbour
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Amel Zertal
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Nathalie Fréjeau
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
| | - Danielle Morin
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
| | - Jean-Sylvain Ouellette
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Multiple Sclerosis Society of Canada, Toronto, ON, Canada
| | - Kanza Alami Marrouni
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Pierre Duquette
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
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Dubois C, Fernandes H, Lin M, Martins KJB, Dyck JRB, Klarenbach SW, Richer L, Jess E, Hanlon JG, Hyshka E, Eurich DT. Benzodiazepine use in medical cannabis authorization adult patients from 2013 to 2021: Alberta, Canada. BMC Public Health 2024; 24:859. [PMID: 38504198 PMCID: PMC10953249 DOI: 10.1186/s12889-024-18356-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Benzodiazepines are a class of medications that are being frequently prescribed in Canada but carry significant risk of harm. There has been increasing clinical interest on the potential "sparing effects" of medical cannabis as one strategy to reduce benzodiazepine use. The objective of this study as to examine the association of medical cannabis authorization with benzodiazepine usage between 2013 and 2021 in Alberta, Canada. METHODS A propensity score matched cohort study with patients on regular benzodiazepine treatment authorized to use medical cannabis compared to controls who do not have authorization for medical cannabis. A total of 9690 medically authorized cannabis patients were matched to controls. To assess the effect of medical cannabis use on daily average diazepam equivalence (DDE), interrupted time series (ITS) analysis was used to assess the change in the trend of DDE in the 12 months before and 12 months after the authorization of medical cannabis. RESULTS Over the follow-up period after medical cannabis authorization, there was no overall change in the DDE use in authorized medical cannabis patients compared to matched controls (- 0.08 DDE, 95% CI: - 0.41 to 0.24). Likewise, the sensitivity analysis showed that, among patients consuming ≤5 mg baseline DDE, there was no change immediately after medical cannabis authorization compared to controls (level change, - 0.04 DDE, 95% CI: - 0.12 to 0.03) per patient as well as in the month-to-month trend change (0.002 DDE, 95% CI: - 0.009 to 0.12) per patient was noted. CONCLUSIONS This short-term study found that medical cannabis authorization had minimal effects on benzodiazepine use. Our findings may contribute ongoing evidence for clinicians regarding the potential impact of medical cannabis to reduce benzodiazepine use. HIGHLIGHTS • Medical cannabis authorization had little to no effect on benzodiazepine usage among patients prescribed regular benzodiazepine treatment in Alberta, Canada. • Further clinical research is needed to investigate the potential impact of medical cannabis as an alternative to benzodiazepine medication.
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Affiliation(s)
- Cerina Dubois
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy 11405 - 87 Ave Edmonton, AB, T6G 1C9 2E, Edmonton, AB, Canada
| | - Heidi Fernandes
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy 11405 - 87 Ave Edmonton, AB, T6G 1C9 2E, Edmonton, AB, Canada
| | - Mu Lin
- SPOR (Strategy for Patient Oriented Research) Data Platform, Alberta Health Services, Edmonton, Alberta, Canada
| | - Karen J B Martins
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Scott W Klarenbach
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Lawrence Richer
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ed Jess
- College of Physicians & Surgeons of Alberta, Edmonton, Alberta, Canada
| | - John G Hanlon
- St. Michael's Hospital Department of Anesthesia, University of Toronto, Ontario, Canada
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Ontario, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy 11405 - 87 Ave Edmonton, AB, T6G 1C9 2E, Edmonton, AB, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy 11405 - 87 Ave Edmonton, AB, T6G 1C9 2E, Edmonton, AB, Canada.
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Valente AC, Lopes LPN, Matheus ME. Medical cannabis use in oncology and associated outcomes: A scoping review. J Oncol Pharm Pract 2024:10781552241239006. [PMID: 38477532 DOI: 10.1177/10781552241239006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Natural and synthetic cannabinoids are being used worldwide to treat various symptoms in cancer patients. This study aims to map the therapeutic benefits and adverse effects associated with the use of cannabis-based drugs in these outcomes. METHODS Following Joanna Briggs Institute guidelines a scoping review was conducted. The study protocol was available in the Open Science Framework public repository. An extensive search strategy involving databases like Cochrane Library, Embase, CINAHL, Medline/PubMed, Lilacs, Google Scholar, and Open Gray for gray literature analysis was executed by a skilled librarian. The inclusion criteria were primary studies (observational and randomized) that evaluated the efficacy and safety of cannabinoids in cancer patients. The review encompassed studies of diverse designs, publication years, and types, as long as they addressed cannabinoids' impact in oncology. RESULTS Twenty-nine (82.86%) out of total of 35 were randomized and 6 (14.14%) were non-randomized. About 57.1% of studies utilized registered products as interventions, with THC being the most natural cannabinoid cited in variable doses and administration routes. Moreover, 62.85% of studies specified the cancer types (breast, lung, sarcomas, hematological and reproductive system), while only one study detailed cancer staging. The evaluated outcomes encompassed nausea and vomiting (77.14%), appetite (11.43%), pain (8.57%), and tumor regression (2.86%) across different proportions of studies. CONCLUSION Cannabinoids show promise in managing pain, emesis, and anorexia/cachexia linked to cancer progression. New randomized clinical trials with a larger number of participants and observational studies on long-term safety are crucial to affirm their medicinal utility for cancer patients unresponsive to conventional drugs.
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Affiliation(s)
| | | | - Maria Eline Matheus
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Denneler T, Mahling M, Hermann S, Stengel A, Zipfel S, Herrmann-Werner A, Festl-Wietek T. Medical students' attitudes and perceived competence regarding medical cannabis and its suggestibility. BMC Med Educ 2024; 24:149. [PMID: 38360743 PMCID: PMC10867999 DOI: 10.1186/s12909-024-05089-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION The global trend of legalizing medical cannabis (MC) is on the rise. In Germany, physicians have prescribed MC at the expense of health insurers since 2017. However, the teaching on MC has been scant in medical training. This study investigates medical students' attitudes and perceived competence regarding MC and evaluates how varying materials (videos/articles) impact their opinions. METHODS Fourth-year medical students were invited to participate in the cross-sectional study. During an online session, students viewed a video featuring a patient with somatoform pain discussing her medical history, plus one of four randomly assigned MC-related materials (each an article and a video depicting a positive or negative perspective on MC). Students' opinions were measured at the beginning [T0] and the end of the course [T1] using a standardized questionnaire with a five-point Likert scale. We assessed the influence of the material on the students' opinions using paired-sample t-tests. One-way analysis of variance and Tukey post-hoc tests were conducted to compare the four groups. Pearson correlations assessed correlations. RESULTS 150 students participated in the course, the response rate being 75.3% [T0] and 72.7% [T1]. At T0, students felt a little competent regarding MC therapy (M = 1.80 ± 0.82). At T1, students in groups 1 (positive video) and 3 (positive article) rated themselves as more capable in managing MC therapy [Formula: see text], and students in groups 3 (positive article) and 4 (negative article) felt more skilled in treating patients with chronic pain [Formula: see text]. Compared to the other groups, group 2 students (negative video) felt significantly less competent. They perceived cannabis as addictive, hazardous and unsuitable for medical prescription. DISCUSSION This study showed that medical students lack knowledge and perceived competence in MC therapy. Material influences their opinions in different ways, and they seek more training on MC. This underlines that integrating MC education into medical curricula is crucial to address this knowledge gap.
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Affiliation(s)
- Tatjana Denneler
- Deanery of Students' Affairs, Faculty of Medicine, University of Tuebingen, Tuebingen, Germany
| | - Moritz Mahling
- TIME- Tuebingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
- Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension, University Hospital Tuebingen, Tuebingen, Germany
| | - Sabine Hermann
- University Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapie, University Hospital of Tuebingen, Tuebingen, Germany
- German Center for Mental Health (DZPG), site Tuebingen, Tuebingen, Germany
- Center for Internal Medicine and Dermatology, Deparment of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapie, University Hospital of Tuebingen, Tuebingen, Germany
| | - Anne Herrmann-Werner
- TIME- Tuebingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
- Department of Psychosomatic Medicine and Psychotherapie, University Hospital of Tuebingen, Tuebingen, Germany
| | - Teresa Festl-Wietek
- TIME- Tuebingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany.
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Ghandour L, Slim A, Abbas N, El-Khoury J. Patterns of cannabis use, perception of harm, and perceived impact of legislative change in an online sample of young adults from Lebanon: insight on recreational users versus dual motive users. Harm Reduct J 2024; 21:41. [PMID: 38360652 PMCID: PMC10868015 DOI: 10.1186/s12954-024-00958-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Lebanon remains as one of the major sources of cannabis worldwide. In 2020, its government passed a legislation enabling the cultivation of local medicinal cannabis. This first study following the legislative change examines the overlapping use of cannabis for recreational/medicinal purposes and characteristics of the distinct cannabis user types. METHODS A total of 1230 young adults (18-24 years) filled an anonymous online survey in early 2020. RESULTS Young adults in the sample were distributed as follows: 33% 18-20 years; 60% males; 94% Lebanese; 75% students; and 89% living with family. The older young adults (21-24), males, those employed, living with non-family members, and who perceived themselves as being a little/lot richer than most were statistically significantly more present in the cannabis user subtypes (recreational only or recreational/medicinal) than non-cannabis users. When dual recreational/medicinal users are compared to recreational users only, the latter seemed to have a more conservative profile of behaviours, attitudes, and perceptions and acts of harm. The prevalence ratio comparing the prevalence of users supporting consuming cannabis "once or twice" in dual motive users vs. recreational users only was 1.13 for "once or twice", 1.25 for "occasionally", 1.64 for "regularly", and 2.4 for "daily". Any other illicit drug use was reported by 1% of the non-cannabis users, 36% of the recreational users only, and 58% of the recreational/medicinal users (p-value < 0.01). Similarly, any prescription drug use was reported by 3% of the non-cannabis users, 16% of the recreational users only, and 28% of both recreational/medicinal users (p-value < 0.01). CONCLUSION The interface between recreational and medicinal cannabis use is complex. Dual motive users may warrant special attention as a subpopulation of cannabis users. This is relevant to contexts experiencing medicinal cannabis legislation changes, such as Lebanon, as policymakers and implementers should be sensitized to the emerging evidence for more data-informed policy changes.
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Affiliation(s)
- Lilian Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, P.O. Box 11-0236, Beirut, Lebanon
| | - Andre Slim
- Department of Epidemiology and Population Health, Faculty of Health Sciences, P.O. Box 11-0236, Beirut, Lebanon
| | - Nada Abbas
- Department of Epidemiology and Population Health, Faculty of Health Sciences, P.O. Box 11-0236, Beirut, Lebanon
| | - Joseph El-Khoury
- Department of Psychiatry, The Valens Clinic, Business Bay, Dubai, United Arab Emirates.
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Kritikos AF, Johnson JK, Hodgkin D. Simultaneous Cannabis and Alcohol Use among Medical Cannabis Patients. Subst Use Misuse 2024; 59:847-857. [PMID: 38343069 DOI: 10.1080/10826084.2024.2305795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Background: During the past two decades of cannabis legalization, the prevalence of medical cannabis (MC) use has increased and there has also been an upward trend in alcohol consumption. As less restricted cannabis laws generate more adult cannabis users, there is concern that more individuals may be simultaneously using medical cannabis with alcohol. A few studies have examined simultaneous use of medical cannabis with alcohol, but none of those studies also assessed patients' current or previous non-medical cannabis use. This paper explores simultaneous alcohol and medical cannabis use among medical cannabis patients with a specific focus on previous history of cannabis use and current non-medical cannabis use. Methods: A retrospective cohort study of MC patients (N = 319) from four dispensaries located in New York. Bivariate chi-square tests and multivariable logistic regression are used to estimate the extent to which sociodemographic and other factors were associated with simultaneous use. Results: Approximately 29% of the sample engaged in simultaneous use and a large share of these users report previous (44%) or current (66%) use of cannabis for non-medical purposes. MC patients who either previously or currently use cannabis non-medicinally, men, and patients using MC to treat a pain-related condition, were significantly more likely to report simultaneous alcohol/MC use. Conclusions: Findings indicate that there may be differential risks related to alcohol/MC use, which should be considered by cannabis regulatory policies and prevention/treatment programs. If patients are using cannabis and/or alcohol to manage pain, clinicians should screen for both alcohol and cannabis use risk factors.
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Affiliation(s)
| | - Julie K Johnson
- Cannabis Control Commission, Commonweath of Massachusetts, Worcester, MA, USA
| | - Dominic Hodgkin
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
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Holt A, Nouhravesh N, Strange JE, Kinnberg Nielsen S, Schjerning AM, Vibe Rasmussen P, Torp-Pedersen C, Gislason GH, Schou M, McGettigan P, Lamberts M. Cannabis for chronic pain: cardiovascular safety in a nationwide Danish study. Eur Heart J 2024; 45:475-484. [PMID: 38200679 DOI: 10.1093/eurheartj/ehad834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND AND AIMS A rising number of countries allow physicians to treat chronic pain with medical cannabis. However, recreational cannabis use has been linked with cardiovascular side effects, necessitating investigations concerning the safety of prescribed medical cannabis. METHODS Using nationwide Danish registers, patients with chronic pain initiating first-time treatment with medical cannabis during 2018-21 were identified and matched 1:5 to corresponding control patients on age, sex, chronic pain diagnosis, and concomitant use of other pain medication. The absolute risks of first-time arrhythmia (atrial fibrillation/flutter, conduction disorders, paroxysmal tachycardias, and ventricular arrhythmias) and acute coronary syndrome were reported comparing medical cannabis use with no use. RESULTS Among 1.88 million patients with chronic pain (46% musculoskeletal, 11% cancer, 13% neurological, and 30% unspecified pain), 5391 patients claimed a prescription of medical cannabis [63.2% women, median age: 59 (inter-quartile range 48-70) years] and were compared with 26 941 control patients of equal sex- and age composition. Arrhythmia was observed in 42 and 107 individuals, respectively, within 180 days. Medical cannabis use was associated with an elevated risk of new-onset arrhythmia {180-day absolute risk: 0.8% [95% confidence interval (CI) 0.6%-1.1%]} compared with no use [180-day absolute risk: 0.4% (95% CI 0.3%-0.5%)]: a risk ratio of 2.07 (95% CI 1.34-2.80) and a 1-year risk ratio of 1.36 (95% CI 1.00-1.73). No significant association was found for acute coronary syndrome [180-day risk ratio: 1.20 (95% CI 0.35-2.04)]. CONCLUSIONS In patients with chronic pain, the use of prescribed medical cannabis was associated with an elevated risk of new-onset arrhythmia compared with no use-most pronounced in the 180 days following the initiation of treatment.
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Affiliation(s)
- Anders Holt
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 6, PO Box 635, DK-2900 Hellerup, Denmark
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, 85 Park Road, Grafton, Auckland 1142, New Zealand
| | - Nina Nouhravesh
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 6, PO Box 635, DK-2900 Hellerup, Denmark
| | - Jarl E Strange
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 6, PO Box 635, DK-2900 Hellerup, Denmark
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Sebastian Kinnberg Nielsen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 6, PO Box 635, DK-2900 Hellerup, Denmark
| | - Anne-Marie Schjerning
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, DK-4000 Roskilde, Denmark
- The Danish Heart Foundation, Department of Research, Vognmagergade 7, DK-1120 Copenhagen, Denmark
| | - Peter Vibe Rasmussen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 6, PO Box 635, DK-2900 Hellerup, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1353 Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 6, PO Box 635, DK-2900 Hellerup, Denmark
- The Danish Heart Foundation, Department of Research, Vognmagergade 7, DK-1120 Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1353 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 6, PO Box 635, DK-2900 Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen, Denmark
| | - Patricia McGettigan
- William Harvey Research Institute, Charterhouse Square Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Morten Lamberts
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 6, PO Box 635, DK-2900 Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen, Denmark
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11
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Dubois C, Lunghi C, Eurich DT, Dyck JRB, Hyshka E, Hanlon JG, Zongo A. Medical cannabis authorization and risk of emergency department visits and hospitalization due to psychotic disorders: A propensity score-matched cohort study. Schizophr Res 2024; 264:534-542. [PMID: 38330686 DOI: 10.1016/j.schres.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
Despite evidence showing that recreational cannabis use is associated with a higher risk of psychotic disorders, this risk has not been well characterized for patients using medical cannabis. Therefore, this study assessed the risk of emergency department (ED) visits and hospitalization for psychotic disorders (the study outcome) among adult patients authorized to use medical cannabis. We performed a retrospective cohort study on patients authorized to use medical cannabis in a group of Ontario cannabis clinics between 2014 and 2019. Using clinical and health administrative data, each patient was matched by propensity scores to up to 3 population-based controls. Conditional Cox proportional hazards regressions were used to assess the risk. Among 54,006 cannabis patients matched to 161,265 controls, 39 % were aged ≤50 years, and 54 % were female. Incidence rates for psychotic disorders were 3.00/1000 person-years (95%CI: 2.72-3.32) in the cannabis group and 1.88/1000 person-years (1.75-2.03) in the control group. A significant association was observed, with an adjusted hazard ratio of 1.38 (95%CI: 1.19-1.60) in the total sample and 1.63 (1.40-1.91) in patients without previous psychotic disorders. The results suggest that cannabis authorization should include a benefit-risk assessment of psychotic disorders to minimize the risk of events requiring emergency attention.
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Affiliation(s)
- Cerina Dubois
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Carlotta Lunghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec, Université Laval Research Centre, Quebec City, Quebec, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - John G Hanlon
- St. Michael's Hospital Department of Anesthesia, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada
| | - Arsene Zongo
- Population Health and Optimal Health Practices Research Unit, CHU de Québec, Université Laval Research Centre, Quebec City, Quebec, Canada; Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada.
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12
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Freitag EW, Zolotov Y, Annam J, Labins J, Yamada JM, Jillani SM, Arnsten JH, Slawek DE. Available but inaccessible: patient experiences during the first 2 years of a primary care-based medical cannabis program at an academic medical center. Harm Reduct J 2024; 21:1. [PMID: 38166921 PMCID: PMC10763347 DOI: 10.1186/s12954-023-00919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Medical cannabis use and public acceptance in the United States have increased over the past 25 years. However, access to medical cannabis remains limited, particularly for underserved populations. To understand how patients experience medical cannabis accessibility, we measured medical cannabis use and barriers to use after medical cannabis certification in an urban safety-net academic medical center. METHODS We conducted a retrospective cohort study among patients seen in Montefiore's Medical Cannabis Program (MMCP) from 2017 to 2019. Patient demographic and clinical characteristics, as well purchase history of medical cannabis, were extracted from electronic medical records. We also administered a phone questionnaire to a subset of patients to assess usage patterns, effectiveness, and barriers to medical cannabis use. RESULTS Among 562 patients who were newly certified for medical cannabis between 2017 and 2019, 45% purchased medical cannabis, while 55% did not. Patients who purchased medical cannabis were more likely to be white and have private insurance or Medicare. Unregulated cannabis use and current tobacco use were less common among those who purchased medical cannabis. In multivariable logistic regression analysis, unregulated cannabis use remained negatively associated with purchasing medical cannabis. Patients reported that affordability and dispensary accessibility were their main barriers to purchasing medical cannabis. CONCLUSION Among patients certified for medical cannabis use, fewer than half purchased medical cannabis after certification. Improving access to medical cannabis is crucial for ensuring equitable access to regulated cannabis, and to reducing unregulated cannabis use.
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Affiliation(s)
| | - Yuval Zolotov
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Jayabhargav Annam
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Jaqueline Labins
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Jaclyn M Yamada
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Syeda Masharab Jillani
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Julia H Arnsten
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Deepika E Slawek
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA.
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13
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Hirsch AG, Wright EA, Nordberg CM, DeWalle J, Stains EL, Kennalley AL, Zhang J, Tusing LD, Piper BJ. Dispensaries and Medical Marijuana Certifications and Indications: Unveiling the Geographic Connections in Pennsylvania, USA. Med Cannabis Cannabinoids 2024; 7:34-43. [PMID: 38487377 PMCID: PMC10939510 DOI: 10.1159/000537841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Pennsylvania opened its first medical marijuana (MMJ) dispensary in 2018. Qualifying conditions include six conditions determined to have no or insufficient evidence to support or refute MMJ effectiveness. We conducted a study to describe MMJ dispensary access in Pennsylvania and to determine whether dispensary proximity was associated with MMJ certifications and community demographics. Methods Using data from the Pennsylvania Department of Health, we geocoded MMJ dispensary locations and linked them to US Census Bureau data. We created dispensary access measures from the population-weighted centroid of Zip Code Tabulation Areas (ZCTAs): distance to nearest dispensary and density of dispensaries within a 15-min drive. We evaluated associations between dispensary access and the proportion of adults who received MMJ certification and the proportion of certifications for low evidence conditions (amyotrophic lateral sclerosis, epilepsy, glaucoma, Huntington's disease, opioid use disorder, and Parkinson's disease) using negative binomial modeling, adjusting for community features. To evaluate associations racial and ethnic composition of communities and distance to nearest dispensary, we used logistic regression to estimate the odds ratios (OR) and 95% confidence intervals (CI), adjusting for median income. Results Distance and density of MMJ dispensaries were associated with the proportion of the ZCTA population certified and the proportion of certifications for insufficient evidence conditions. Compared to ZCTAs with no dispensary within 15 min, the proportion of adults certified increased by up to 31% and the proportion of certifications for insufficient evidence decreased by up to 22% for ZCTAs with two dispensaries. From 2018 to 2021, the odds of being within five miles of a dispensary was up to 20 times higher in ZCTAs with the highest proportions of individuals who were not White (2019: OR: 20.14, CI: 10.7-37.8) and more than double in ZCTAs with the highest proportion of Hispanic individuals (2018: OR: 2.81, CI: 1.51-5.24), compared to ZCTAs with the lowest proportions. Conclusions Greater dispensary access was associated with the proportions of certified residents and certifications for low evidence conditions. Whether these patterns are due to differences in accessibility or demand is unknown. Associations between community demographics and dispensary proximity may indicate MMJ access differences.
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Affiliation(s)
| | - Eric A. Wright
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA
| | - Cara M. Nordberg
- Department of Population Health Sciences, Geisinger, Danville, PA, USA
| | - Joseph DeWalle
- Department of Population Health Sciences, Geisinger, Danville, PA, USA
| | - Elena L. Stains
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | | | - Joy Zhang
- Department of Health and Societies, University of Pennsylvania, Philadelphia, PA, USA
| | - Lorraine D. Tusing
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA
| | - Brian J. Piper
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
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14
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Gastmeier K, Gastmeier A, Schwab F, Herdegen T. The Use of Tetrahydrocannabinol Is Associated with an Increase in Survival Time in Palliative Cancer Patients: A Retrospective Multicenter Cohort Study. Med Cannabis Cannabinoids 2024; 7:59-67. [PMID: 38655402 PMCID: PMC11037891 DOI: 10.1159/000538311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/04/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Tetrahydrocannabinol (THC) is often prescribed for ambulatory palliative patients to improve sleep quality and appetite and to reduce anxiety, stress, and pain. However, it is not known if THC has also an effect on the mortality of these patients. Method The objective was the impact of THC on mortality of ambulatory palliative patients. For this purpose, data from the palliative treatment documentation from 5 ambulatory palliative care teams in Brandenburg, Germany were used for this analysis. Survival time was calculated for 3 groups of patients: (1) without THC; (2) with THC in a low dosage (≤4.7 mg per day); and (3) THC in higher doses (≥4.7 mg per day). The analysis was done for 2 cohorts of patients. Cohort 1: all patients with a survival time of at least 7 days after inclusion in specialized ambulatory palliative care (SAPC) and cohort 2: a subgroup of patients with a survival time between 7 and 100 days. Kaplan-Meier curves were created, and multivariate analysis was done to investigate the impact of THC on mortality. Results A total of 9,419 patients with a survival time of at least 7 days after inclusion in SAPC were included in the analysis (cohort 1). 7,085 among them had a survival time between 7 and 100 days (cohort 2). In both cohorts, survival time was significantly prolonged by THC, but only when the daily THC dose was above the median of 4.7 mg. Survival time was 15 days longer in cohort 2 (40 vs. 25 days), when more than 4.7 mg THC were prescribed per day. Conclusion Use of THC is associated with a significant increase in survival time in ambulatory palliative patients which survive longer than 7 days the initiation of THC prescription and which use of THC >4.7 mg/day.
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Affiliation(s)
- Knud Gastmeier
- Practice for Palliative Medicine Potsdam, Potsdam, Germany
| | - Anne Gastmeier
- Special Practice for Internal Medicine, Pneumology and General Medicine, Kleinmachnow, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Thomas Herdegen
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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15
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Lee C, Danielson EC, Beestrum M, Eurich DT, Knapp A, Jordan N. Medical Cannabis and Its Efficacy/Effectiveness for the Treatment of Low-Back Pain: a Systematic Review. Curr Pain Headache Rep 2023; 27:821-835. [PMID: 38041708 DOI: 10.1007/s11916-023-01189-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE OF REVIEW This systematic review aims to inform the current state of evidence about the efficacy and effectiveness of medical cannabis use for the treatment of LBP, specifically on pain levels and overall opioid use for LBP. Searches were conducted in MEDLINE (PubMed), Embase, and CINAHL. The search was limited to the past 10 years (2011-2021). Study inclusion was determined by the critical appraisal process using the Joanna Briggs Institute framework. Only English language articles were included. Participant demographics included all adult individuals with LBP who were prescribed medical cannabis for LBP and may be concurrently using opioids for their LBP. Study quality and the risk of bias were both evaluated. A narrative synthesis approach was used. RECENT FINDINGS A total of twelve studies were included in the synthesis: one randomized controlled trial (RCT), six observational studies (one prospective, four retrospective, and one cross-over), and five case studies. All study results, except for the RCT, indicated a decrease in LBP levels or opioid use over time after medical cannabis use. The RCT reported no statistically significant difference in LBP between cannabis and placebo groups. Low back pain (LBP) affects 568 million people worldwide. In the United States, LBP treatment represents more than half of regular opioid users. With the opioid epidemic, alternative methods, particularly medical cannabis, is now increasingly sought by practicing physicians and patients. Due to its infancy, there is minimal high-quality evidence to support medical cannabis use as a first line treatment for LBP.
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Affiliation(s)
- Cerina Lee
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Elizabeth C Danielson
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Molly Beestrum
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Ashley Knapp
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neil Jordan
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
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16
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Wang Y, Robinson KR, Fechtel H, Hartog A. Medical Cannabis Use and Its Impact on Health Among Older Adults: Recent Research Findings and Future Directions. Curr Addict Rep 2023; 10:837-843. [PMID: 38586531 PMCID: PMC10997349 DOI: 10.1007/s40429-023-00519-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 04/09/2024]
Abstract
Purpose of Review With the rapidly changing landscape of state level legalization of cannabis, older adults have become one of the fastest growing populations seeking medical cannabis (MC). However, research evidence on the risks and benefits of MC use in this population remains limited. This review aims to synthesize recent literature on the impacts of MC use in older adults and identify critical knowledge gaps to be addressed in future research. Recent Findings Recent literature showed that older adults often face financial and/or educational barriers and stigma associated with MC access. Emerging data showed that MC may have therapeutic effects on symptoms of conditions such as chronic pain, insomnia, anxiety/depression, dementia, nausea, and vomiting. However, available evidence is inconsistent and tends to rely on self-report and uncontrolled studies. While some adverse events associated with MC use were reported, it is generally well tolerated in older adults. Neurocognitive and psychological consequences and cardiovascular risks have been reported but again only in limited studies with inconsistent findings. Summary There is a need for more systematic and rigorous research on MC in older adults to determine its safety and efficacy. Research on dosing procedures and product characteristics, as well as how these may impact health outcomes, is crucial. More consistent evidence is needed to inform policy changes and patient/physician education to minimize potential risks and optimize benefits among older adults seeking MC as an alternative treatment.
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Affiliation(s)
- Yan Wang
- Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA
| | - Kendall R. Robinson
- Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA
| | - Hannah Fechtel
- Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA
| | - Alexis Hartog
- Department of Biology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA
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Graham M, Chiu V, Stjepanović D, Hall W. A provisional evaluation of Australia's medical cannabis program. Int J Drug Policy 2023; 122:104210. [PMID: 37813082 DOI: 10.1016/j.drugpo.2023.104210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/03/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023]
Abstract
In 2016, the Australian Government legislated to allow cannabis to be prescribed to patients as an unapproved medicine under the special access provisions of the Therapeutic Goods Act. This paper compares the Australian regulatory approach with other national approaches, outlines the main provisions of the Special Access Scheme for medical cannabis, describes how the program has evolved since 2017, includes an analysis of adverse events reported to the Therapeutic Goods Administration, and discusses the barriers that remain for patients who wish to access medical cannabis. It assesses how well the Australian program has addressed the challenges of providing patients with easier access to medical cannabis while ensuring that high-quality products are used safely and effectively under medical guidance.
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Affiliation(s)
- Myfanwy Graham
- Centre for Drug Repurposing & Medicines Research, School of Medicine and Public Health, The University of Newcastle, Australia; Schaeffer Center for Health Policy & Economics, The University of Southern California, United States.
| | - Vivian Chiu
- National Centre for Youth Substance Use Research, The University of Queensland, Australia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use Research, The University of Queensland, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Australia
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18
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Beckett Wilson H, Metcalf McGrath L. "It's a big added stress on top of being so ill": The challenges facing people prescribed cannabis in the UK. Int J Drug Policy 2023; 122:104220. [PMID: 37806073 DOI: 10.1016/j.drugpo.2023.104220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/05/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND This paper reports on the first qualitative study to interview people prescribed cannabis in the UK. Cannabis is a class B controlled substance under the 1971 Misuse of Drugs (MoD) Act, but a 2018 change to UK regulations provided for the prescription of cannabis for medical purposes. Relatively few people have been able to access a prescription, despite this policy change. This paper examines their experiences. METHODS Qualitative, semi-structured interviews were conducted with 24 people with a prescription for cannabis, or their carers. Data was analysed using a reflextive thematic analysis approach. The findings are discussed using a zemiology (social harms) perspective which provides a language for critical reflection on the current cannabis policy context. RESULTS All participants reported that cannabis had significantly improved their mental and/or physical health, across a broad range of conditions. Many had been able to reduce their use of conventional medicines and reported that cannabis had relatively few side effects. Despite the potentially life-enhancing benefits of cannabis medicine, patients in the UK face multiple barriers to access. These include a lack of funding streams, bureaucratic supply problems, and a lack of training for doctors and police. Even for the few people able to obtain a prescription, the ongoing criminalisation of cannabis in the UK contributed to their experiences of stigmatisation. This often made it difficult and anxiety-inducing to take their medicine in public spaces. CONCLUSION The UK government's lack of implementation of medical cannabis legalisation, combined with their ongoing prohibition position, is producing multiple harms to people who need cannabis medicine. The policy context is perpetuating stigmatising attitudes to cannabis which, as we demonstrate, contribute to social harms. We make recommendations on equality of patient access, and highlight the importance of education and policy change as means of combatting stigma.
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Jylkkä J, Hupli A, Nikolaeva A, Alanen S, Back AE, Lindqvist S, Krabbe A, Lavie-Ajayi M, Kantonen O. The holistic effects of medical cannabis compared to opioids on pain experience in Finnish patients with chronic pain. J Cannabis Res 2023; 5:38. [PMID: 37941019 PMCID: PMC10634036 DOI: 10.1186/s42238-023-00207-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Medical cannabis (MC) is increasingly used for chronic pain, but it is unclear how it aids in pain management. Previous literature suggests that MC could holistically alter the pain experience instead of only targeting pain intensity. However, this hypothesis has not been previously systematically tested. METHOD A retrospective internet survey was used in a sample of Finnish chronic pain patients (40 MC users and 161 opioid users). The patients evaluated statements describing positive and negative phenomenological effects of the medicine. The two groups were propensity score matched to control for possible confounding factors. RESULTS Exploratory factor analysis revealed three experience factors: Negative Side Effects, Positive Holistic Effects, and Positive Emotional Effects. The MC group (matched n = 39) received higher scores than the opioid group (matched n = 39) in Positive Emotional Effects with large effect size (Rank-Biserial Correlation RBC = .71, p < .001), and in Holistic Positive Effects with medium effect size (RBC = .47, p < .001), with no difference in Negative Side Effects (p = .13). MC and opioids were perceived as equally efficacious in reducing pain intensity. Ratings of individual statements were exploratively examined in a post hoc analysis. CONCLUSION MC and opioids were perceived to be equally efficacious in reducing pain intensity, but MC additionally positively affected broader pain-related factors such as emotion, functionality, and overall sense of wellbeing. This supports the hypothesis that MC alleviates pain through holistically altering the pain experience.
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Affiliation(s)
- Jussi Jylkkä
- Department of Psychology, Åbo Akademi University, Turku, Finland.
| | - Aleksi Hupli
- Emerging Technologies Lab, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Aleksandra Nikolaeva
- Turku Brain and Mind Center, Faculty of Medicine, University of Turku, Turku, Finland
| | - Sandra Alanen
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Anna Erika Back
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Sara Lindqvist
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Andreas Krabbe
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Maya Lavie-Ajayi
- Gender Studies Program, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Oskari Kantonen
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, University of Turku, Turku, Finland
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Lacroix C, Guilhaumou R, Micallef J, Bruneteau G, Desnuelle C, Blin O. Cannabis for the treatment of amyotrophic lateral sclerosis: What is the patients' view? Rev Neurol (Paris) 2023; 179:967-974. [PMID: 37460332 DOI: 10.1016/j.neurol.2023.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/19/2022] [Accepted: 03/13/2023] [Indexed: 11/12/2023]
Abstract
Cannabis may have therapeutic benefits to relieve symptoms of amyotrophic lateral sclerosis (ALS) thanks to its pleiotropic pharmacological activity. This study is the first to present a large questionnaire-based survey about the "real-life" situation regarding cannabis use in the medical context in ALS patients in France. There were 129 respondents and 28 reported the use of cannabis (21.7%) to relieve symptoms of ALS. Participants mostly reported the use of cannabidiol (CBD) oil and cannabis weed and declared benefits both on motor (rigidity, cramps, fasciculations) and non-motor (sleep quality, pain, emotional state, quality of life, depression) symptoms and only eight reported minor adverse reactions (drowsiness, euphoria and dry mouth). Even if cannabis is mostly used outside medical pathways and could expose patients to complications (street and uncontrolled drugs, drug-drug interactions, adverse effects…), most of the participants reported "rational" consumption (legal cannabinoids, with only few combustion and adverse reactions). Despite some limitations, this study highlights the need for further research on the potential benefits of cannabis use for the management of ALS motor and non-motor symptoms. Indeed, there is an urgent need and call for and from patients to know more about cannabis and secure its use in a medical context.
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Affiliation(s)
- C Lacroix
- Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Inserm, Inst Neurosci Syst, UMR 1106, Aix-Marseille University, University Hospital Federation DHUNE, 13005 Marseille, France.
| | - R Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Inserm, Inst Neurosci Syst, UMR 1106, Aix-Marseille University, University Hospital Federation DHUNE, 13005 Marseille, France
| | - J Micallef
- Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Inserm, Inst Neurosci Syst, UMR 1106, Aix-Marseille University, University Hospital Federation DHUNE, 13005 Marseille, France
| | - G Bruneteau
- Paris ALS expert center, Assistance publique-Hôpitaux de Paris, Sorbonne université, Pitié-Salpêtrière Hospital, 75013 Paris, France; Brain Institute, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - C Desnuelle
- Departement of Neurology, Charity Association ARSLA, Emeritus Professor University Côte d'Azur, Côte d'Azur, France
| | - O Blin
- Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Inserm, Inst Neurosci Syst, UMR 1106, Aix-Marseille University, University Hospital Federation DHUNE, 13005 Marseille, France
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Coelho SG, Rueda S, Costiniuk CT, Jenabian MA, Margolese S, Mandarino E, Shuper PA, Hendershot CS, Cunningham JA, Arbess G, Singer J, Wardell JD. Knowledge of Cannabinoid Content Among People Living with HIV Who Use Cannabis: a Daily Diary Study. Int J Behav Med 2023:10.1007/s12529-023-10221-x. [PMID: 37794278 DOI: 10.1007/s12529-023-10221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Many people living with HIV (PLWH) use cannabis for medicinal reasons. Patients' knowledge of the tetrahydrocannabinol (THC) and cannabidiol (CBD) concentrations of the cannabis products they use may be important in helping patients achieve symptom relief while guarding against potential risks of cannabis use. However, no studies have examined cannabinoid concentration knowledge among PLWH. METHOD PLWH (N = 29; 76% men, mean age 47 years) reporting cannabis use for both medicinal and nonmedicinal reasons completed daily surveys over 14 days assessing cannabis products used, knowledge of cannabinoid concentrations of cannabis products used, cannabis use motives (medicinal, nonmedicinal, both), and positive and negative cannabis-related consequences. Across the 361 cannabis use days captured on the daily surveys, at least some knowledge of cannabinoid concentrations was reported on an average of 43.1% (for THC) and 26.6% (for CBD) of the days. RESULTS Generalized linear mixed models revealed that participants were more likely to report knowing THC and CBD concentrations on days when they used non-flower forms of cannabis relative to days when they used cannabis flower only. Participants who used cannabis for medicinal reasons on a greater proportion of days had greater knowledge of cannabinoid concentration overall across days. Further, greater overall knowledge of cannabinoid concentrations was associated with fewer reported negative cannabis-related consequences. CONCLUSIONS Findings suggest that among PLWH, knowledge of cannabinoid concentrations may be higher when using non-flower cannabis products and among those reporting primarily medicinal cannabis use. Moreover, knowledge of cannabinoid concentration may protect against negative cannabis-related consequences in this population.
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Affiliation(s)
- Sophie G Coelho
- Department of Psychology, York University, 277 Behavioural Sciences Building, 4700 Keele St., Toronto, ON, Canada
| | - Sergio Rueda
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Cecilia T Costiniuk
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
- Chronic Viral Illness Service and Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Infection and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Mohammad-Ali Jenabian
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
- Department of Biological Sciences, Université du Québec á Montréal, Montreal, QC, Canada
| | | | | | - Paul A Shuper
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Christian S Hendershot
- Department of Psychiatry, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
- Bowles Centre for Alcohol Studies, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - John A Cunningham
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Addictions, Kings College London, London, UK
| | - Gordon Arbess
- Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Joel Singer
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey D Wardell
- Department of Psychology, York University, 277 Behavioural Sciences Building, 4700 Keele St., Toronto, ON, Canada.
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.
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Barré T, Venturino H, Di Beo V, Carrieri P, Pelissier-Alicot AL. French general practitioners and medical cannabis: A need for training. Encephale 2023; 49:537-539. [PMID: 37246101 DOI: 10.1016/j.encep.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Tangui Barré
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Hélène Venturino
- Aix-Marseille Université, Faculté de Médecine, Marseille, France.
| | - Vincent Di Beo
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Anne-Laure Pelissier-Alicot
- APHM, CHU La Timone, Service de Médecine légale, Aix-Marseille Université, Faculté de Médecine, Marseille, France.
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23
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Walsh Z, Mitchell I, Crosby K, St Pierre M, DeClerck D, Ong K, Lucas P. A small clinical trial of vaporized cannabis for PTSD: suggestive results and directions for future study. Trials 2023; 24:578. [PMID: 37689680 PMCID: PMC10493009 DOI: 10.1186/s13063-023-07543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/23/2023] [Indexed: 09/11/2023] Open
Abstract
The last few decades have seen increasing interest in the use of cannabis for post-traumatic stress disorder (PTSD). Recent attempts to evaluate the clinical efficacy of cannabis for PTSD were inconclusive and generalizability was limited by undesirable features of the study drug. The present clinical trial evaluated the effects of a commercially available chemovar that was delivered by vaporization. The study was designed as a randomized placebo-controlled cross-over study with three conditions; however, only five individuals completed the trial, and analysis of the placebo effect was not possible. Results identified positive changes consistent with medium-sized within-subject effects for cannabis in the treatment of PTSD. Positive trending results and high patient need mandate future studies of cannabis for the treatment of PTSD.
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Affiliation(s)
- Zach Walsh
- Department of Psychology, The University of British Columbia, Kelowna, BC, Canada.
| | - Ian Mitchell
- Department of Emergency Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Kim Crosby
- Department of Psychology, The University of British Columbia, Kelowna, BC, Canada
| | - Michelle St Pierre
- Department of Psychology, The University of British Columbia, Kelowna, BC, Canada
| | - Drew DeClerck
- Department of Psychology, The University of British Columbia, Kelowna, BC, Canada
| | - Kaye Ong
- , Tilray, Nanaimo, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| | - Philippe Lucas
- , Tilray, Nanaimo, BC, Canada
- Social Dimensions of Health, The University of Victoria, Victoria, BC, Canada
- SABI Mind, Calgary, AB, Canada
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Arkell TR, Abelev SV, Mills L, Suraev A, Arnold JC, Lintzeris N, McGregor IS. Driving-related behaviors, attitudes, and perceptions among Australian medical cannabis users: results from the CAMS 20 survey. J Cannabis Res 2023; 5:35. [PMID: 37674243 PMCID: PMC10481606 DOI: 10.1186/s42238-023-00202-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023] Open
Abstract
Road safety is an important concern amidst expanding worldwide access to legal cannabis. The present study reports on the driving-related subsection of the Cannabis as Medicine Survey 2020 (CAMS-20) which surveyed driving-related behaviors, attitudes, and perceptions among Australian medical cannabis (MC) users. Of the 1063 respondents who reported driving a motor vehicle in the past 12 months, 28% (297/1063) reported driving under the influence of cannabis (DUIC). Overall, 49-56% of respondents said they typically drive within 6 h of MC use, depending on the route of administration (oral or inhaled). Non-medical cannabis (NMC) was perceived to be more impairing for driving than MC. Binary logistic regression revealed associations between likelihood of DUIC and (1) inhaled routes of cannabis administration, (2) THC-dominant products, (3) illicit rather than prescribed use, (4) believing NMC does not impair driving, and (5) not being deterred by roadside drug testing. Overall, these findings suggest there is a relatively low perception of driving-related risk among MC users. Targeted education programs may be needed to highlight the potential risks associated with DUIC, and further research is needed to determine whether driving performance is differentially affected by MC and NMC.
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Affiliation(s)
- Thomas R Arkell
- Centre for Mental Health and Brain Science, Swinburne University of Technology, Melbourne, VIC, Australia.
| | - Sarah V Abelev
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Llewellyn Mills
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, NSW, Australia
- Department of Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Anastasia Suraev
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Jonathon C Arnold
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Discipline of Pharmacology, Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, NSW, Australia
- Department of Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
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Cook AC, Sirmans ET, Stype A. Medical cannabis laws lower individual market health insurance premiums. Int J Drug Policy 2023; 119:104143. [PMID: 37572391 DOI: 10.1016/j.drugpo.2023.104143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/10/2023] [Accepted: 07/15/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND To evaluate the impact of medical cannabis laws (MCLs) on health insurance premiums. We study whether cannabis legalization significantly impacts aggregate health insurer premiums in the individual market. Increases in utilization could have spillover effects to patients in the form of higher health insurance premiums. METHODS We use 2010-2021 state-level U.S. private health insurer financial data from the National Association of Insurance Commissioners. We examined changes to individual market health insurance premiums after the implementation of medical cannabis laws. We employed a robust difference-in-differences estimator that accounted for variation in policy timing to exploit temporal and geographic variation in state-level medical cannabis legalization. RESULTS Seven years after the implementation of Medical Cannabis laws, we observe lower health insurer premiums in the individual market. Starting seven years post-MCL implementation, we find a reduction of $-1662.7 (95% confidence interval [CI -2650.1, -605.7]) for states which implemented MCLs compared to the control group, a reduction of -$1541.8 (95% confidence interval [CI 2602.1, -481.4]) in year 8, and a reduction of $-1625.8, (95% confidence interval [CI -2694.2, -557.5]) in year 9. Due to the nature of insurance pooling and community rating, these savings are appreciated by cannabis users and non-users alike in states that have implemented MCLs. CONCLUSIONS The implementation of MCLs lowers individual-market health insurance premiums. Health insurance spending, including premiums, comprises between 16% and 34% of household budgets in the United States. As healthcare costs continue to rise, our findings suggest that households that obtain their health insurance on the individual (i.e., not employer sponsored) market in states with MCLs appreciate significantly lower premiums.
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Affiliation(s)
- Amanda C Cook
- 356C Schmidthorst College of Business, Department of Economics, Bowling Green State University, Bowling Green, OH 43403, United States.
| | - E Tice Sirmans
- Department of Finance, Insurance and Law, Illinois State University and Katie School of Insurance and Risk Management, United States
| | - Amanda Stype
- Department of Economics, Eastern Michigan University, United States
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Slawek DE, Althouse AD, Feldman R, Arnsten JH, Bulls HW, Liebschutz JM, Nugent SM, Orris SR, Rohac R, Starrels JL, Morasco BJ, Kansagara D, Merlin JS. Cannabis dispensary staff approaches to counseling on potential contraindications to cannabis use: insights from a national self-report survey. BMC Prim Care 2023; 24:145. [PMID: 37442944 PMCID: PMC10347704 DOI: 10.1186/s12875-023-02095-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Legal cannabis is available in more than half of the United States. Health care professionals (HCPs) rarely give recommendations on dosing or safety of cannabis due to limits imposed by policy and lack of knowledge. Customer-facing cannabis dispensary staff, including clinicians (pharmacists, nurses, physician's assistants), communicate these recommendations in the absence of HCP recommendations. Little is known about how dispensary staff approach individuals with complex medical and psychiatric comorbidities. Using responses from a national survey, we describe how cannabis dispensary staff counsel customers with medical and psychiatric comorbidities on cannabis use and examine whether state-specific cannabis policy is associated with advice given to customers. METHODS National, cross-sectional online survey study from February 13, 2020 to October 2, 2020 of dispensary staff at dispensaries that sell delta-9-tetrahydrocannabinol containing products. Measures include responses to survey questions about how they approach customers with medical and psychiatric comorbidities; state medicalization score (scale 0-100; higher score indicates more similarity to regulation of traditional pharmacies); legalized adult-use cannabis (yes/no). We conducted multiple mixed effects multivariable logistic regression analyses to understand relationships between state medicalization and dispensary employees' perspectives. RESULTS Of 434 eligible respondents, most were budtenders (40%) or managers (32%), and a minority were clinicians (18%). State medicalization score was not associated with responses to most survey questions. It was associated with increased odds of encouraging customers with medical comorbidities to inform their traditional HCP of cannabis use (Odds ratio [OR]=1.2, 95% confidence interval [CI] 1.0-1.4, p=0.03) and reduced odds of recommending cannabis for individuals with cannabis use disorder (CUD) (OR=0.8, 95% CI 0.7-1.0, p=0.04). Working in a state with legalized adult-use cannabis was associated with recommending traditional health care instead of cannabis in those with serious mental illness (OR 2.2, 95% CI 1.1-4.7, p=0.04). Less than half of respondents believed they had encountered CUD (49%), and over a quarter did not believe cannabis is addictive (26%). CONCLUSIONS When managing cannabis dosing and safety in customers with medical and psychiatric comorbidity, dispensary staff preferred involving individuals' traditional HCPs. Dispensary staff were skeptical of cannabis being addictive. While state regulations of dispensaries may impact the products individuals have access to, they were not associated with recommendations that dispensary staff gave to customers. Alternative explanations for dispensary recommendations may include regional or store-level variation not captured in this analysis.
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Affiliation(s)
- Deepika E Slawek
- Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA.
| | - Andrew D Althouse
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Feldman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julia H Arnsten
- Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Hailey W Bulls
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
- CHAllenges in Managing and Preventing Pain (CHAMPP) Clinical Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jane M Liebschutz
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shannon M Nugent
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Steven R Orris
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca Rohac
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joanna L Starrels
- Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Benjamin J Morasco
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Devan Kansagara
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Jessica S Merlin
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
- CHAllenges in Managing and Preventing Pain (CHAMPP) Clinical Research Center, University of Pittsburgh, Pittsburgh, PA, USA
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Costiniuk C, MacCallum CA, Boivin M, Rueda S, Lacasse G, Walsh Z, Daeninck PJ, Margolese S, Mandarino E, Deol JK, Sanchez T, Bell AD. Why a distinct medical stream is necessary to support patients using cannabis for medical purposes. J Cannabis Res 2023; 5:25. [PMID: 37403136 DOI: 10.1186/s42238-023-00195-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Since 2001, Canadians have been able to obtain cannabis for medical purposes, initially through the Access to Cannabis for Medical Purposes Regulations (ACMPR). The Cannabis Act (Bill C-45) came into force on October 17, 2018, replacing the ACMPR. The Cannabis Act enables Canadians to possess cannabis purchased from a licensed retailer without authorization for either medical or nonmedical purposes. The Cannabis Act is currently the guiding legislation which governs both medical and nonmedical access. The Cannabis Act contains some improvements for patients but is essentially the same as its previous legislation. Beginning in October 2022, the federal government is conducting a review of the Cannabis Act and is questioning whether a distinct medical cannabis stream is still required, given the ease of access to cannabis and cannabis products. Although there is overlap in the reasons for medical and recreational cannabis use, the distinct legislation of medical versus recreational use of cannabis in Canada may be under threat. MAIN BODY A large segment of the medical, academic, research, and lay communities agree that there is a need for distinct medical and recreational cannabis streams. Perhaps most importantly, separation of these streams is necessary to ensure that both medical cannabis patients and healthcare providers receive the required support needed to optimize benefits while minimizing risks associated with medical cannabis use. Preservation of distinct medical and recreational streams can help to ensure that needs of different stakeholders are met. For example, patients require guidance in the form of assessing the appropriateness of cannabis use, selection of appropriate products and dosage forms, dosing titration, screening for drug interactions, and safety monitoring. Healthcare providers require access to undergraduate and continuing health education as well as support from their professional organizations to ensure medical cannabis is appropriately prescribed. Although there are challenges in conducing research, as motives for cannabis use frequently straddle boundaries between medical versus recreational cannabis use, maintenance of a distinct medical stream is also necessary to ensure adequate supply of cannabis products appropriate for medical use, to reduce stigma associated with cannabis in both patients and providers, to help enable reimbursement for patients, to facilitate removal of taxation on cannabis used for medical purposes, and to promote research on all aspects of medical cannabis. CONCLUSION Cannabis products for medical and recreational purposes have different objectives and needs, requiring different methods of distribution, access, and monitoring. HCPs, patients, and the commercial cannabis industry would serve Canadians well to continue to advocate to policy makers to ensure the continued existence of two distinct streams and must strive to make ongoing improvements to the current programs.
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Affiliation(s)
- Cecilia Costiniuk
- Chronic Viral Illness Service/Division of Infectious Diseases, McGill University Health Centre, McGill Cannabis Research Centre and Research Institute of the McGill University Health Centre, Montreal, QC, H4A 3J1, Canada.
| | - Caroline A MacCallum
- Department of Medicine and Division of Palliative Care, University of British Columbia and Greenleaf Medical Clinic, Vancouver, BC, Canada
| | | | - Sergio Rueda
- Department of Psychiatry and Institute of Health Policy, Management and Evaluation, Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - Paul J Daeninck
- Department of Internal Medicine, CancerCare Manitoba, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Shari Margolese
- Canadian Institutes of Health Research (CIHR) Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Enrico Mandarino
- Canadian Institutes of Health Research (CIHR) Canadian HIV Trials Network, Vancouver, BC, Canada
- MJardin Canada, Toronto, ON, Canada
| | - Jagpaul Kaur Deol
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Tatiana Sanchez
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - Alan D Bell
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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N S Gendy M, Taisir R, Sousa S, Costello J, Rush B, Busse JW, Mackillop J. Prevalence of cannabis use disorder among individuals using medical cannabis at admission to inpatient treatment for substance use disorders. Addict Behav 2023; 142:107667. [PMID: 36893511 DOI: 10.1016/j.addbeh.2023.107667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/28/2022] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Cannabis is used for medical and recreational purposes and may result in cannabis use disorder (CUD). This study explored the prevalence of cannabis use disorder and other psychiatric comorbidities among inpatients undergoing treatment for substance use disorder who reported medical cannabis use at admission. METHODS We assessed CUD and other substance use disorders based on DSM-5 symptoms, anxiety with the Generalized Anxiety Disorder scale (GAD-7), depression with the Patient Health Questionnaire (PHQ-9), and post-traumatic stress disorder with the PTSD Checklist for DSM-5 (PCL-5). We compared the prevalence of CUD and other psychiatric comorbidities between inpatients who endorsed the use of cannabis for medical purposes only vs those endorsing use for medical and recreational purposes. RESULTS Among 125 inpatients, 42% reported medical use only, and 58% reported medical and recreational use (dual motives). For CUD, 28% of Medical-Only and 51% of Dual-Use motives patients met the diagnostic criteria for CUD (p = 0.016). High psychiatric comorbidities were present: 79% and 81% screened positive for an anxiety disorder, 60% and 61% screened positive for depression, and 66% and 57% screened positive for PTSD for the Medical-Only and Dual-Use inpatients, respectively. CONCLUSIONS Many treatment-seeking individuals with substance use disorder who report medical cannabis use meet criteria for CUD, particularly those reporting concurrent recreational use.
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Affiliation(s)
- Marie N S Gendy
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada; Homewood Research Institute, Guelph, ON, Canada
| | | | - Sarah Sousa
- Homewood Research Institute, Guelph, ON, Canada
| | | | - Brian Rush
- Homewood Research Institute, Guelph, ON, Canada; Center for Addiction and Mental Health, Toronto, ON, Canada
| | - Jason W Busse
- Department of Anesthesia, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, Canada
| | - James Mackillop
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada; Homewood Research Institute, Guelph, ON, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, Canada; Department of Psychology, Neuroscience, and Behavior, McMaster University, Hamilton, Canada.
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Lyu X, Illamola SM, Marino SE, Leppik IE, Dahmer S, Lehfeldt P, Conway JM, Remmel RP, Kingsley K, Birnbaum AK. Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends. Curr Ther Res Clin Exp 2023; 99:100709. [PMID: 37538850 PMCID: PMC10393751 DOI: 10.1016/j.curtheres.2023.100709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/02/2023] [Indexed: 08/05/2023]
Abstract
Background Little is known about the distribution of cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) to patients participating in state medical cannabis programs. The Minnesota cannabis program requires third-party testing of products with limited formulations of cannabis for distribution to patients. Objective To characterize the distribution of cannabis products, their CBD/THC content, and dosing among patients with qualifying conditions. Methods This is a retrospective analysis of ∼50% of registered users receiving medical cannabis in Minnesota (June 16, 2016, to November 15, 2019). Data included formulation, CBD/THC prescribed doses, and qualifying conditions. The primary end points were calculated using daily dose and duration of use. Comparisons were made for CBD and THC total daily dose dispensed, patient age, and approved product. Nonparametric statistical tests were used (significance was set at p < 0.05). Results A total of 11,520 patients were listed with 1 qualifying condition. The most common condition was intractable pain (60.0%). Median dispensation duration varied from 53 days (cancer) to 322 days (muscle spasms). Most (≥62.8%) patients across all qualifying conditions received both CBD and THC. Median THC dose was lower in older (≥65 years) compared with younger adults with intractable pain (p < 0.0001) and cancer patients (p = 0.0152), and the same pattern was found CBD dose with seizure (p = 0.0498) patients. For commercial products with Food and Drug Administration indications, the median CBD total daily dose was 86.9% lower than the recommended doses for patients with seizures (Epidiolex: Jazz Pharmaceuticals, Palo Alto CA) and median THC total daily dose was 65.3% (Syndros: Benuvia Manufacturing, Round Rock, TX) or 79.3% lower (Marinol: Banner Pharmacaps, Inc., High Point, NC) for cancer patients. Conclusions A majority of patients received products containing both CBD and THC. Dosages varied by age group and were lower than recommended for conditions with Food and Drug Administration-approved products. Complex pharmacokinetics of THC and CBD, possible age-related changes in physiology, unknown efficacy, and potential for drug interactions all increase the need for monitoring of patients receiving cannabis products. (Curr Ther Res Clin Exp. 2023; 84:XXX-XXX).
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Affiliation(s)
- Xintian Lyu
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Sílvia M. Illamola
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Susan E. Marino
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
- Center for Clinical and Cognitive Neuropharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Ilo E. Leppik
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
- Center for Clinical and Cognitive Neuropharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
- Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Stephen Dahmer
- Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Goodness Growth Holdings, Minneapolis, Minnesota
| | | | - Jeannine M. Conway
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Rory P. Remmel
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | | | - Angela K. Birnbaum
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
- Center for Clinical and Cognitive Neuropharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
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Capler NR, Balneaves LG, Buxton JA, Kerr T. Reasonable access: important characteristics and perceived quality of legal and illegal sources of cannabis for medical purposes in Canada. J Cannabis Res 2023; 5:18. [PMID: 37291647 DOI: 10.1186/s42238-023-00185-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/30/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Throughout the past two decades of legal medical cannabis in Canada, individuals have experienced challenges related to accessing legal sources of cannabis for medical purposes. The objective of our study was to examine the sources of cannabis accessed by individuals authorized to use medical cannabis and to identify possible reasons for their use of illegal sources. METHODS Individuals who participated in the Cannabis Access Regulations Study (CANARY), a national cross-sectional survey launched in 2014, and indicated they were currently authorized to use cannabis for medical purposes in Canada were included in this study. We assessed differences between participants accessing cannabis from only legal sources versus from illegal sources in relation to sociodemographic characteristics, health-related factors, and characteristics of medical cannabis they considered important. A secondary analysis assessed differences in satisfaction with various dimensions of cannabis products and services provided by legal versus illegal sources. RESULTS Half of the 237 study participants accessed cannabis from illegal sources. Individuals accessing cannabis from illegal sources were significantly more likely to value pesticide-free products, access to a variety of strains, ability to select strain and dosage, ability to observe and smell cannabis, availability in a dispensary, and availability in small quantities than did individuals accessing cannabis from only legal sources (all p < 0.05). Additionally, participants gave significantly higher satisfaction scores to illegal sources than to legal sources on service-related dimensions of cannabis access (all p < 0.05). CONCLUSION Our findings contribute to an understanding of reasonable access to medical cannabis from a patient perspective and how to assess whether it has been achieved. Characteristics of cannabis products and services valued by patients and appropriate to their needs should be incorporated into legal medical cannabis programs to promote the use of legal medical sources. While pertaining specifically to medical use of cannabis in Canada, the findings of this study may also be instructive for understanding the use of illegal cannabis sources for non-medical purposes in Canada and provide insight for other jurisdictions implementing cannabis regulations for both medical and non-medical purposes.
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Affiliation(s)
- N Rielle Capler
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Musqueam Traditional Territory, Vancouver, BC, V6T 1Z3, Canada.
| | - Lynda G Balneaves
- College of Nursing, University of Manitoba, Room 495, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | - Jane A Buxton
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Musqueam Traditional Territory, Vancouver, BC, V6T 1Z3, Canada
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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Bettstetter H, Schäfer A. [Tetrahydrocannabinol (THC) in patients with fibromyalgia syndrome (FMS) : A retrospective study of changes in pain, psychometric variables, and analgesic consumption during inpatient interdisciplinary multimodal pain therapy (IMPT)]. Schmerz 2023:10.1007/s00482-023-00727-4. [PMID: 37289246 DOI: 10.1007/s00482-023-00727-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/09/2023] [Accepted: 04/13/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Since March 1, 2017, medical cannabis (MC) can be prescribed nationwide in Germany. To date, there have been a number of qualitatively different studies on the effectiveness of MC in fibromyalgia syndrome (FMS). OBJECTIVE The aim of the study was to investigate the effectiveness of THC in the course of interdisciplinary multimodal pain therapy (IMPT) on pain and several psychometric variables. MATERIALS AND METHODS For the study, in the period 2017-2018, all patients in the pain ward of a clinic who were suffering from FMS and were treated in a multimodal interdisciplinary setting were selected based on inclusion criteria. The patients were examined separately according to groups with and without THC about pain intensity, various psychometric parameters and analgesic consumption during the stay. RESULTS Of the 120 FMS patients included in the study, 62 patients (51.7%) were treated with THC. In the parameters of pain intensity, depression, and quality of life, there was a significant improvement in the entire group during the stay (p < 0.001), which was significantly greater through the use of THC. In five of the seven analgesic groups examined, the dose was reduced or the drug discontinued significantly more often in the patients treated with THC. CONCLUSION The results provide indications that THC can be considered as a medical alternative in addition to the substances previously recommended in various guidelines.
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Affiliation(s)
- Horst Bettstetter
- Schmerzzentrum Inn-Salzach, Wackerstr. 7, 84489, Burghausen, Deutschland.
| | - Arne Schäfer
- Fachbereich Psychodiabetologie, Diabetes-Klinik Bad Mergentheim, Theodor-Klotzbücher-Str. 12, 97980, Bad Mergentheim, Deutschland
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, Haus A3, 97080, Würzburg, Deutschland
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Colby AM, Dilley JA, Pensky HM, Johnson JK. Medical Cannabis Program Sustainability in the Era of Recreational Cannabis. Clin Ther 2023; 45:578-588. [PMID: 37414508 DOI: 10.1016/j.clinthera.2023.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Since October 2022, a total of 21 states have enacted both medical-use and adult-use cannabis legalization, each with their own unique set of laws, regulations, implementation, structures, and enforcement ("policies"). Unlike adult-use programs, medical-use programs often represent a safer and affordable option for patients with diverse needs; however, current evidence suggests that medical-use program activity decreases after implementation of adult-use retail. The current study compares medical patient registration data and medical- and adult-use retail data from 3 distinct medical- and adult-use states (Colorado, Massachusetts, and Oregon) in the time after adult-use retail implementation in each state. METHODS To investigate changes in medical cannabis programs with simultaneous adult-use legalization, correlation and linear regression analyses were used to assess outcome measures: (1) medical-use retail sales; (2) adult-use retail sales; and (3) number of registered medical patients in all fiscal quarters after adult-use retail sales were implemented in each state to September 2022. FINDINGS Adult-use cannabis sales increased significantly over time in all 3 states. However, both medical-use sales and number of medical patients registered in the states increased only in Massachusetts. IMPLICATIONS Results indicate that states' preexisting medical-use programs may undergo critical changes after adult-use cannabis legalization is enacted and implemented. Key policy and program differences, such as regulatory differences in the implementation of adult-use retail sales, may have differential impacts on medical-use programs. For continued patient access, it is critical that future research assess the differences within and between states' medical-use and adult-use programs that permit sustainability of medical-use programs alongside adult-use legalization and implementation.
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Affiliation(s)
- Alexander M Colby
- Massachusetts Cannabis Control Commission, Worcester, Massachusetts, USA.
| | - Julia A Dilley
- Program Design and Evaluation Services, Multnomah County/Oregon Public Health Division, Portland, Oregon, USA
| | - Hailey M Pensky
- Massachusetts Cannabis Control Commission, Worcester, Massachusetts, USA
| | - Julie K Johnson
- Massachusetts Cannabis Control Commission, Worcester, Massachusetts, USA
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Coelho SG, Wardell JD. Characterizing heterogeneity among people who use cannabis for medicinal reasons: A latent class analysis of a nationally representative Canadian sample. Int J Drug Policy 2023; 117:104076. [PMID: 37247474 DOI: 10.1016/j.drugpo.2023.104076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Many individuals who use cannabis report doing so for medicinal reasons. Few studies have explored heterogeneity within this population, which may be important to inform targeted interventions. This study used latent class analysis to identify subgroups of people who use cannabis for medicinal reasons and their sociodemographic and cannabis-risk-related correlates. METHOD Data were drawn from the 2019 Canadian Alcohol and Drugs Survey, which is a representative survey of Canadians ages 15 years and older. Data from 814 individuals reporting past-year use of cannabis for medicinal or mixed medicinal and non-medicinal reasons were included. Latent class analysis was conducted with forms of cannabis used, cannabis use frequency, concurrent non-medicinal cannabis use, and the medical conditions and symptoms cannabis was used to manage as indicators. RESULTS Four distinct latent classes of medicinal cannabis use were identified: a non-daily cannabis flower for mental health and sleep class (39.56% of the sample), a non-daily cannabis flower for pain class (26.41% of the sample), a non-daily cannabis oil for physical health class (20.15% of the sample), and a daily multi-form cannabis for mental health and non-medical reasons class (13.88% of the sample). Sociodemographic factors and risk level for cannabis-related harms were associated with latent class membership. CONCLUSIONS Results of this study reveal considerable heterogeneity among people reporting medicinal cannabis use and suggest that the distinct patterns of cannabis use behaviors and motives observed may be important for understanding risk for cannabis-related harms in this population. Findings underscore a need for harm reduction interventions tailored toward specific patterns of medicinal cannabis use.
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Affiliation(s)
| | - Jeffrey D Wardell
- Department of Psychology, York University, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
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Syed SA, Singh J, Elkholy H, Rojnić Palavra I, Tomicevic M, Eric AP, Pinto da Costa M, Guloksuz S, Radhakrishnan R. Impact of personal beliefs about medical cannabis on physician recommendation practices: Results of an international survey. Asian J Psychiatr 2023; 85:103634. [PMID: 37257363 DOI: 10.1016/j.ajp.2023.103634] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023]
Affiliation(s)
| | - Jatinder Singh
- Department of Psychiatry, Penn State Milton S. Hershey Medical Center, PA, USA
| | - Hussien Elkholy
- Neurology and Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Marko Tomicevic
- University Hospital Dubrava, Department of Psychiatry, Zagreb, Croatia
| | - Anamarija Petek Eric
- Department of Psychiatry, Clinical Hospital Centre Osijek, Croatia; Faculty of Medicine Osijek, J.J. Strossmayer University Osijek, Croatia
| | - Mariana Pinto da Costa
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Sinan Guloksuz
- Department of Psychiatry, Yale School of Medicine, CT, USA; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
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Mansell H, Zaslawski Z, Mbabaali S, King PM, Kelly LE, Lougheed T, Anderson J, Huntsman RJ, Alcorn J. Medical cannabis in schools: The experiences of caregivers. Paediatr Child Health 2023; 28:102-106. [PMID: 37151922 PMCID: PMC10156934 DOI: 10.1093/pch/pxac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/22/2022] [Indexed: 05/09/2023] Open
Abstract
Objectives Implementing medical cannabis (MC) into a child's daily routine can be challenging and there is a lack of guidance for its therapeutic use in schools in Canada. Our objective was to learn about the experiences of caregivers of school-aged children who require MC. Methods Qualitative description was used and caregivers were interviewed about MC in schools and in general. The transcripts were entered into Dedoose software for qualitative analysis and content analysis was performed. Sentences and statements were ascribed line by line into meaning units and labelled with codes, and organized according to categories and subcategories. Results Twelve caregivers of school-aged children who take MC participated. The most common reasons for treatment were drug-resistant epilepsy (DRE), autism, or other developmental disorders. Approximately half of the participants' children (n = 6) took MC during the school day and most (5/6) perceived their experiences to be positive or neutral but reported a lack of knowledge about MC. While data saturation was not reached regarding MC in schools, rich dialogues were garnered about MC in general and three categories were identified: challenges (subcategories stigma, finding an authorizer, cost, dosing, and supply); parents as advocates (subcategories required knowledge, attitudes, skills, and sources of information); and caregiver relief for positive outcomes. Conclusions Caregivers demonstrate remarkable tenacity despite the many challenges associated with MC use. Education and practice change are needed to ensure that children using MC can benefit from or continue to experience its positive outcomes within the school environment and beyond.
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Affiliation(s)
- Holly Mansell
- Correspondence: Holly Mansell, College of Pharmacy and Nutrition, University of Saskatchewan, Office E3208, Health Sciences Building, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5, Canada. Telephone (306) 966-1512, e-mail
| | - Zina Zaslawski
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sophia Mbabaali
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia M King
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lauren E Kelly
- Departments of Pharmacology and Therapeutics and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Taylor Lougheed
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Section of Emergency Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Jennifer Anderson
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard J Huntsman
- Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jane Alcorn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Tait J, Erridge S, Holvey C, Coomber R, Usmani A, Sajad M, Hoare J, Khan S, Weatherall M, Rucker JJ, Platt M, Sodergren MH. Clinical outcome data of chronic pain patients treated with cannabis-based oils and dried flower from the UK Medical Cannabis Registry. Expert Rev Neurother 2023; 23:413-423. [PMID: 37021592 DOI: 10.1080/14737175.2023.2195551] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND The following study evaluated the clinical outcomes of patients enrolled in the UK Medical Cannabis Registry, who were treated with inhaled dried flower (Adven® EMT2, Curaleaf International, Guernsey), and sublingual/oral medium-chain triglyceride-based oils (Adven, Curaleaf International, Guernsey) for chronic pain. METHODS In this cohort study, the primary outcomes were changes in validated patient reported outcome measures (PROMs) at 1, 3, and 6 months compared to baseline, and adverse event analysis. Statistical significance was defined as p < 0.050. RESULTS Three hundred and forty-eight (45.7%), 36 (4.7%), and 377 (49.5%) patients were treated with oils, dried flower, or both, respectively. Patients treated with oils or combination therapy recorded improvements within health-related quality of life, pain, and sleep-specific PROMs at 1, 3, and 6 months (p < 0.050). Patients treated with combination therapy recorded improvements in anxiety-specific PROMs at 1, 3, and 6 months (p < 0.050). 1,273 (167.3%) adverse events were recorded, with previously cannabis naïve users, ex-cannabis users, and females more likely to experience adverse events (p < 0.050). CONCLUSIONS This study observed an association between initiation of CBMP treatment and improved outcomes for chronic pain patients. Prior cannabis use and gender were associated with adverse event incidence. Placebo-controlled trials are still necessary to establish the efficacy and safety of CBMPs for chronic pain.
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Affiliation(s)
- James Tait
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Simon Erridge
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Carl Holvey
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Ross Coomber
- Department of Medicine, Sapphire Medical Clinics, London, UK
- Department of Trauma and Orthopaedics, St. George's Hospital NHS Trust, London, UK
| | - Azfer Usmani
- Department of Medicine, Sapphire Medical Clinics, London, UK
- Department of Anaesthesia, Dartford and Gravesham NHS Trust, Kent, UK
| | - Mohammed Sajad
- Department of Medicine, Sapphire Medical Clinics, London, UK
- Department of Anaesthesia, Dudley Group of Hospitals NHS Trust, West Midlands, UK
| | - Jonathan Hoare
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Shaheen Khan
- Department of Medicine, Sapphire Medical Clinics, London, UK
- Department of Palliative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Mark Weatherall
- Department of Medicine, Sapphire Medical Clinics, London, UK
- Department of Neurology, Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - James J Rucker
- Department of Medicine, Sapphire Medical Clinics, London, UK
- Department of Psychological Medicine, King's College London, London, UK
- Centre for Affective Disorders, South London & Maudsley NHS Foundation Trust, London, UK
| | - Michael Platt
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Mikael H Sodergren
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Medicine, Sapphire Medical Clinics, London, UK
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Akiki G, Richa S, Kazour F. Medical and recreational cannabis: A cross-sectional survey assessing a sample of physicians' attitudes, knowledge and experience in a university hospital in Lebanon. Encephale 2023; 49:130-137. [PMID: 35016798 DOI: 10.1016/j.encep.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/03/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT A law legalizing the farming of medical cannabis for the international market was passed in Lebanese parliament in April 2020. Thus, this makes Lebanon the first Arab country to legalize medical cannabis, a law which can hold potential public health consequences. The advocates of legalization of medical cannabis in society and in the media influence the public opinion. A community of Lebanese physicians was the first to be asked about this subject. OBJECTIVE This study aims to assess a sample of physicians' opinions, knowledge and experiences with medical and non-medical cannabis. METHOD All physicians of every speciality working at the Hôtel Dieu de France-Beirut hospital (450) received by email a 33-question-online survey in French between November 2020 and December 2020. The survey was designed based on similar studies published outside of Lebanon. RESULTS Eighty-five Lebanese physicians responded to the survey and 80% of them supported the decriminalization of medical cannabis in Lebanon. But only 16% reported knowing the indications of medical cannabis, and only 24% stated that they have adequate knowledge of its secondary effects. Eighty-eight percent of them felt that they might be more comfortable discussing the option of medical cannabis if they had formal education on the subject. CONCLUSION Even though the majority of the sample who participated in this study seemed to approve the use of medical cannabis, they lacked the knowledge and confidence to do it. Therefore, this study highlights the need of physician training in the subject of medical cannabis. Future well-conducted university studies will produce evidence-based-guidelines for medical cannabis indications and side effects.
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Affiliation(s)
- G Akiki
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon; Hôtel Dieu de France Hospital, Beirut, Lebanon
| | - S Richa
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon; Hôtel Dieu de France Hospital, Beirut, Lebanon
| | - F Kazour
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon; Hôtel Dieu de France Hospital, Beirut, Lebanon; CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France.
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Zolotov Y, Lomba J, Ghiroli M, Masyukova M, Arnsten JH, Starrels JL, Ross J, Cunningham CO, Slawek DE. "It doesn't make any sense to even try": the disruptive impact of COVID-19's first wave on people with chronic pain using medical cannabis in New York. J Cannabis Res 2023; 5:10. [PMID: 36978185 PMCID: PMC10049907 DOI: 10.1186/s42238-023-00180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted health care but it is unknown how it impacted the lives of people using medical cannabis for chronic pain. OBJECTIVE To understand the experiences of individuals from the Bronx, NY, who had chronic pain and were certified to use medical cannabis during the first wave of the COVID-19 pandemic. METHODS We conducted 1:1 semi-structured qualitative telephone interviews from March through May 2020 with a convenience sample of 14 individuals enrolled in a longitudinal cohort study. We purposively recruited participants with both frequent and infrequent patterns of cannabis use. Interviews addressed the impact of the COVID-19 pandemic on daily life, symptoms, medical cannabis purchase, and use. We conducted a thematic analysis, with a codebook approach, to identify and describe prominent themes. RESULTS Participants' median age was 49 years, nine were female, four were Hispanic, four were non-Hispanic White, and four were non-Hispanic Black. We identified three themes: (1) disrupted access to health services, (2) disrupted access to medical cannabis due to the pandemic, and (3) mixed impact of chronic pain on social isolation and mental health. Due to increased barriers to health care in general and to medical cannabis specifically, participants reduced medical cannabis use, stopped use, or substituted medical cannabis with unregulated cannabis. Living with chronic pain both prepared participants for the pandemic and made the pandemic more difficult. CONCLUSION The COVID-19 pandemic amplified pre-existing challenges and barriers to care, including to medical cannabis, among people with chronic pain. Understanding pandemic-era barriers may inform policies in ongoing and future public health emergencies.
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Affiliation(s)
- Yuval Zolotov
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA.
| | - Jacinta Lomba
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
| | - Megan Ghiroli
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
| | - Mariya Masyukova
- Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Julia H Arnsten
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
| | - Joanna L Starrels
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
| | - Jonathan Ross
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
| | - Chinazo O Cunningham
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
| | - Deepika E Slawek
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
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Erridge S, Olsson F, Sodergren MH. Patient priorities for research: A focus group study of UK medical cannabis patients. Complement Ther Clin Pract 2023; 50:101693. [PMID: 36399996 DOI: 10.1016/j.ctcp.2022.101693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/06/2022] [Accepted: 11/06/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION There has yet to be an evaluation of medical cannabis patient preferences with respect to future research. As such, prioritisation of research agendas has been largely driven by academia and industry. The primary aim of this study was to elicit priorities for research from medical cannabis patients in the United Kingdom (UK). METHODS Patients undergoing active treatment for health conditions with medical cannabis in the UK were invited to take part in focus groups from December 2021 to February 2022. An inductive thematic analysis of responses was performed. Participants also completed a ranking exercise whereby they assigned ten counters (each equivalent to £1 million GBP) to competing research priorities. RESULTS 30 medical cannabis patients participated across 3 focus groups. The following themes were identified as research priorities: adverse events, comparison between cannabis-based medicinal products, health conditions, pharmacology of cannabis, types of study, healthcare professionals' attitudes, social environment, agriculture and manufacturing, and the cannabis plant. Participants assigned the highest proportion of research funding to 'assessment of effect on specific symptoms' (26 counters; 8.7%). CONCLUSIONS This study highlighted specific themes within which to focus future research on medical cannabis. Clinically, there was a directive towards ensuring that research is condition- or symptom-specific. Participants also emphasised themes on the social impact of medical cannabis, such as knowledge of medical cannabis among healthcare professionals, stigma, and effects on driving and in the workplace. These findings can guide both research funders and researchers into effectively conducting research which fits within a more patient-centric model.
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Affiliation(s)
- Simon Erridge
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK; Sapphire Medical Clinics, London, UK
| | - Fabian Olsson
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mikael H Sodergren
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK; Sapphire Medical Clinics, London, UK.
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Yana JL, Lee C, Eurich DT, Dyck JRB, Hanlon JG, Zongo A. Risk of depressive disorders associated with medical cannabis authorization: A propensity score matched cohort study. Psychiatry Res 2023; 320:115047. [PMID: 36638694 DOI: 10.1016/j.psychres.2022.115047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/22/2022] [Accepted: 12/31/2022] [Indexed: 01/03/2023]
Abstract
There is an increase in the medical use of cannabis. However, the safety of medical cannabis, particularly for mental health conditions, has not yet been clearly established. Thus, this study assessed the risk of emergency department (ED) visits and hospitalization for depressive disorders among medical cannabis users. We conducted a retrospective longitudinal cohort study of patients who received medical authorization to use cannabis from 2014 to 2019 in Ontario, matched (1:3 ratio) to population-based controls using propensity scores. Conditional Cox regressions were used to assess the association between cannabis authorization and the outcome. A total of 54,006 cannabis-authorized patients and 161,265 controls were analyzed. Approximately 39% were aged under 50 years, 54% were female, and 16% had a history of anxiety or mood disorders. The adjusted hazard ratio (aHR) for depressive disorders was 2.02 (95%CI: 1.83-2.22). The aHR was 2.23 (1.95-2.55) among subjects without prior mental health disorders. The interaction between sex (or age) and exposure was not significant. In conclusion, medical cannabis authorization was associated with an increased risk of depressive disorders. This finding highlights the need for a careful risk-benefit assessment when authorizing cannabis, particularly for patients who seek cannabis to treat a depressive condition.
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Rosenbæk F, Riisgaard H, Nielsen JB, Wehberg S, Waldorff FB, Pedersen LB, Søndergaard J. GPs' prescription patterns, experience, and attitudes towards medicinal cannabis-a nationwide survey at the early stage of the Danish test scheme. BMC Prim Care 2023; 24:17. [PMID: 36650442 PMCID: PMC9843989 DOI: 10.1186/s12875-023-01971-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND On 1 January 2018 a four-year test scheme concerning use of medicinal cannabis (MC) was enacted. It has recently been extended for four more years by the Danish Parliament permitting all Danish physicians to prescribe MC to their patients. Previous studies have shown that general practitioners (GPs) have varying prescription experience, little knowledge, and mixed attitudes about MC. However, the present evidence is still limited, and no studies exist about Danish GPs' prescription experience, knowledge, and attitudes towards MC. Therefore, our aim was to examine Danish GPs' prescription experience, knowledge, and attitudes towards MC. METHODS A national online survey-based study addressing Danish GPs was performed from September 2018 to July 2019. We performed separate multivariable logistic regression analyses including GPs' prescription experience, knowledge, and attitudes towards MC as outcome variables. RESULTS A total of 427 (38.4%) of 1112 GPs completed the questionnaire. Of these, 37 (8.7%) had experience in prescribing MC. The majority had little or no knowledge about MC (80.6%) as well as a negative view on prescription of MC (71.4%) to patients. Factors associated with prescribing MC to patients were: Single-handed practices (OR = 1.6, 95% CI 1.1;1.8) and perception of having quite some knowledge about MC (OR = 4.8, 95% CI 2.2;10.4). Factors associated with having quite some knowledge about MC were: having a positive attitude towards prescribing MC (OR = 5.2, 95% CI 1.9;14.0), being male (OR = 1.7, 95% CI 1.4;1.8), and being at least 60 years of age (OR = 2.8, 95% CI 1.3;6.0). Factors associated with having a positive attitude towards prescribing MC were: having quite some knowledge about MC (OR = 5.2, 95% CI 2.2;12.5) and GPs being male (OR = 1.7, 95% CI 1.1;1.9). CONCLUSION In this first study on prescription experience, knowledge, and attitudes about MC among Danish GPs, conducted one year after the Danish test scheme was enacted, we find a very low proportion of prescribers, little knowledge, and an overall negative attitude towards MC. Among the prescribing GPs, four in ten have little to no knowledge and a negative attitude towards MC. We stress that prescribing patterns, knowledge, and attitudes may change throughout the remaining time of the test scheme.
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Affiliation(s)
- F. Rosenbæk
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000 Denmark
| | - H. Riisgaard
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000 Denmark
| | - J. B. Nielsen
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000 Denmark
| | - S. Wehberg
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000 Denmark
| | - F. B. Waldorff
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000 Denmark ,grid.5254.60000 0001 0674 042XThe Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - L. B. Pedersen
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000 Denmark ,grid.10825.3e0000 0001 0728 0170Department of Public Health, DaCHE – Danish Centre for Health Economics, University of Southern Denmark, Winsløws Vej 9B, Odense C, 5000 Denmark
| | - J. Søndergaard
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000 Denmark
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Sajdeya R, Fechtel HJ, Spandau G, Goodin AJ, Brown JD, Jugl S, Smolinski NE, Winterstein AG, Cook RL, Wang Y. Protocol of a Combined Cohort and Cross-Sectional Study of Persons Receiving Medical Cannabis in Florida, USA: The Medical Marijuana and Me (M 3) Study. Med Cannabis Cannabinoids 2023; 6:46-57. [PMID: 37261066 PMCID: PMC10228286 DOI: 10.1159/000530052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/01/2023] [Indexed: 06/02/2023] Open
Abstract
Significant knowledge gaps regarding the effectiveness and safety of medical cannabis (MC) create clinical challenges for MC physicians, making treatment recommendations and patients choosing treatment among the growing number of options offered in dispensaries. Additionally, data describing the characteristics of people who use MC and the products and doses they receive are lacking. The Medical Marijuana and Me (M3) Study was designed to collect patient-centered data from MC users. We aim to describe preferred MC use patterns that patients report as "most effective" for specific health conditions and symptoms, identify user characteristics associated with such use patterns, characterize adverse effects, including cannabis use disorder, identify products and patient characteristics associated with adverse effects, describe concurrent prescription medication use, and identify concomitant medication use with potential drug-MC interaction risk. Among MC initiators, we also aim to quantify MC use persistence and identify reasons for discontinuation, assess MC utilization pattern trajectories over time, describe outcome trajectories of primary reasons for MC use and determine factors associated with different trajectories, track changes in concomitant substance and medication use after MC initiation, and identify factors associated with such changes. M3 is a combined study comprised of: (1) a prospective cohort of MC initiators completing surveys at enrollment, 3 months, and 9 months after MC initiation and (2) a cross-sectional study of current MC users. A multidisciplinary committee including researchers, physicians, pharmacists, patients, and dispensary personnel designed and planned study protocols, established study measures, and created survey questionnaires. M3 will recruit 1,000-1,200 participants aged ≥18 years, with ∼50% new and ∼50% current MC patients from MC clinics across Florida, USA. Study enrollment started in May 2022 and will continue until the target number of patients is achieved. Survey domains include sociodemographic characteristics, physical and mental health, cannabis use history, reasons for MC use and discontinuation, MC products and use patterns, concurrent use of prescription medications and other substances, and side effects. Data collected in the M3 Study will be available for interested researchers affiliated with the Consortium for Medical Marijuana Clinical Outcomes Research. The M3 Study and Databank will be the largest cohort of current and new MC users in Florida, USA, which will provide data to support MC-related health research necessary to inform policy and clinical practice and ultimately improve patient outcomes.
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Affiliation(s)
- Ruba Sajdeya
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
| | - Hannah J. Fechtel
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
| | - Gabriel Spandau
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
- Department of Agricultural Education and Communication, College of Agricultural and Life Sciences, University of Florida, Gainesville, Florida, USA
| | - Amie J. Goodin
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Joshua D. Brown
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Sebastian Jugl
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Nicole E. Smolinski
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Almut G. Winterstein
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
| | - Yan Wang
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
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de Gier C, Scharinger C, Stark RH, Steurer P, Klier CM. Tetrahydrocannabinol in Pediatrics: Room for Improvement? Med Cannabis Cannabinoids 2023; 6:125-129. [PMID: 37900897 PMCID: PMC10601896 DOI: 10.1159/000533607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/11/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction The use of medical cannabis in pediatrics is not common in clinical practice, and there is a lack of prospective studies, especially in pediatric subpopulations. This study aimed to provide data on the off-label administration of tetrahydrocannabinol (∆9-THC) in a pediatric tertiary center in Austria. Methods A retrospective data analysis was performed to assess the use of ∆9-THC at the Department of Pediatrics and Adolescent Medicine at the Comprehensive Center of Pediatrics (Medical University Vienna) from 2016 to 2018. The use of ∆9-THC in the Pediatric Department at the Medical University Vienna between 2016 and 2018 was analyzed using a retrospective design. Results The most common diagnoses of patients receiving ∆9-THC were brain cancer and genetic diseases, including inborn metabolic disorders. The 32 patients who had received ∆9-THC had an arithmetic mean of 9.42 diagnoses and were treated with an arithmetic mean of 13.52 other drugs. Eleven of the 32 patients died by the end of the study period, indicating palliative use. Conclusion The data shows that only severely ill patients were treated with ∆9-THC. A lack of information on the drug's indications, duration, and dosage was noticed in the files, which could represent problems for patient safety.
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Affiliation(s)
- Charlotte de Gier
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department for Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Christian Scharinger
- Department of Child and Adolescent Psychiatry, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Rosa H Stark
- Department of Child and Adolescent Psychiatry, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Philipp Steurer
- Clinical Division of Pediatric Psychosomatics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Claudia M Klier
- Clinical Division of Pediatric Psychosomatics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Tsampoula I, Zartaloudi A, Dousis E, Koutelekos I, Pavlatou N, Toulia G, Kalogianni A, Polikandrioti M. Quality of Life in Patients Receiving Medical Cannabis. Adv Exp Med Biol 2023; 1425:401-415. [PMID: 37581814 DOI: 10.1007/978-3-031-31986-0_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Medical cannabis has been used to relieve the symptoms of people with various chronic diseases. Despite of this, it has been stigmatized, even after its legalization in many countries. AIM The purpose of this study was to investigate the quality of life of patients receiving medical cannabis. MATERIAL AND METHOD One hundred patients receiving medical cannabis were given (a) a socio-demographic and clinical questionnaire, and (b) the SF-36 Health Survey scale for assessing quality of life. RESULTS The majority of our patients who received medical cannabis to treat their neurological disorders (58%) reported decrease in their symptoms (96%), better energy and vitality (68%), ability to perform their professional duties (88%), and an improvement in sleeping and appetite (79% and 71%, respectively) after receiving medical cannabis. Our participants exhibited very few restrictions in activities due to emotional difficulties, a moderate general health status as well as moderate vitality and energy. Participants, who reported a longer period of receiving medical cannabis, reported statistically significant more energy and vitality (p = 0.000), but also better mental (p = 0.000) and general health status (p = 0.001). Furthermore, the majority of patients have disclosed medical cannabis use to their family members (85%) and enjoyed their support (93%), but they haven't revealed their medication treatment to their social environment (81%). CONCLUSIONS Appropriate knowledge could significantly help health professionals in the field of planning and implementation of personalized nursing care in order to achieve optimal therapeutic outcomes.
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Affiliation(s)
- Iliana Tsampoula
- Department of Nursing, University of West Attica, Athens, Greece
| | | | - Evangelos Dousis
- Department of Nursing, University of West Attica, Athens, Greece
| | | | - Niki Pavlatou
- Department of Nursing, University of West Attica, Athens, Greece
| | - Georgia Toulia
- Department of Nursing, University of West Attica, Athens, Greece
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Kluwe L, Scholze C, Schmidberg LM, Wichmann JL, Gemkov M, Keller MJ, Farschtschi SC. Medical Cannabis Alleviates Chronic Neuropathic Pain Effectively and Sustainably without Severe Adverse Effect: A Retrospective Study on 99 Cases. Med Cannabis Cannabinoids 2023; 6:89-96. [PMID: 37900896 PMCID: PMC10601926 DOI: 10.1159/000531667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/17/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Medical cannabis may provide a treatment option for chronic neuropathic pain. However, empirical disease-specific data are scarce. Methods This is a retrospective observational study including 99 patients with chronic neuropathic pain. These patients received medical cannabis by means of inhaling dried flowers with tetrahydrocannabinol content of <12-22% at a maximal daily dose of 0.15-1 g. Up to six follow-ups were carried out at intervals of 4-6 weeks. Pain severity, sleep disturbance, general improvement, side effects, and therapy tolerance at the follow-up consultations were assessed in interviews and compared with the baseline data using non-parametric Wilcoxon signed-rank test. Results Within 6 weeks on the therapy, median of the pain scores decreased significantly from 7.5 to 4.0 (p < 0.001). The proportion of patients with severe pain (score >6) decreased from 96% to 16% (p < 0.001). Sleep disturbance was significantly improved with the median of the scores decreased from 8.0 to 2.0 (p < 0.001). These improvements were sustained over a period of up to 6 months. There were no severe adverse events reported. Mild side effects reported were dryness in mucous tissue (5.4%), fatigue (4.8%), and increased appetite (2.7%). Therapy tolerance was reported in 91% of the interviews. Conclusion Medical cannabis is safe and highly effective for treating neuropathic pain and concomitant sleep disturbance.
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Affiliation(s)
- Lan Kluwe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | - Martin Julian Keller
- Algea Care GmbH, Frankfurt, Germany
- Department of Global Development and Health, The University of Gothenburg, Gothenburg, Sweden
| | - Said C. Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Nicholas M, Erridge S, Bapir L, Pillai M, Dalavaye N, Holvey C, Coomber R, Rucker JJ, Weatherall MW, Sodergren MH. UK medical cannabis registry: assessment of clinical outcomes in patients with headache disorders. Expert Rev Neurother 2023; 23:85-96. [PMID: 36722292 DOI: 10.1080/14737175.2023.2174017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Headache disorders are a common cause of disability and reduced health-related quality of life globally. Growing evidence supports the use of cannabis-based medicinal products (CBMPs) for chronic pain; however, a paucity of research specifically focuses on CBMPs' efficacy and safety in headache disorders. This study aims to assess changes in validated patient-reported outcome measures (PROMs) in patients with headaches prescribed CBMPs and investigate the clinical safety in this population. METHODS A case series of the UK Medical Cannabis Registry was conducted. Primary outcomes were changes from baseline in PROMs (Headache Impact Test-6 (HIT-6), Migraine Disability Assessment (MIDAS), EQ-5D-5L, Generalized Anxiety Disorder-7 (GAD-7) questionnaire and Single-Item Sleep Quality Scale (SQS)) at 1-, 3-, and 6-months follow-up. P-values <0.050 were deemed statistically significant. RESULTS Ninety-seven patients were identified for inclusion. Improvements in HIT-6, MIDAS, EQ-5D-5L and SQS were observed at 1-, 3-, and 6-months (p < 0.005) follow-up. GAD-7 improved at 1- and 3-months (p < 0.050). Seventeen (17.5%) patients experienced a total of 113 (116.5%) adverse events. CONCLUSION Improvements in headache/migraine-specific PROMs and general health-related quality of life were associated with the initiation of CBMPs in patients with headache disorders. Cautious interpretation of results is necessary, and randomized control trials are required to ascertain causality.
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Affiliation(s)
- Martha Nicholas
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Simon Erridge
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Lara Bapir
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Manaswini Pillai
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nishaanth Dalavaye
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Carl Holvey
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Ross Coomber
- Department of Medicine, Sapphire Medical Clinics, London, UK.,Department of Trauma and Orthopaedics, St. George's Hospital NHS Trust, London, UK
| | - James J Rucker
- Department of Medicine, Sapphire Medical Clinics, London, UK.,Department of Psychological Medicine, Kings College London, London, UK.,Centre for Affective Disorders, South London & Maudsley NHS Foundation Trust, London, UK
| | - Mark W Weatherall
- Department of Medicine, Sapphire Medical Clinics, London, UK.,Department of Neurology, Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - Mikael H Sodergren
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medicine, Sapphire Medical Clinics, London, UK
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Clobes TA, Palmier LA, Gagnon M, Klaiman C, Arellano M. The impact of education on attitudes toward medical cannabis. PEC Innov 2022; 1:100009. [PMID: 37364019 PMCID: PMC10194214 DOI: 10.1016/j.pecinn.2021.100009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 06/28/2023]
Abstract
Objective This research explores the impact of patient education on reducing historical and current stigma. Methods Participants were recruited through social media, parenting with community organizations, and snowball sampling. A pretest posttest method was utilized. Participants viewed five balanced educational videos about medicinal cannabis. Attitudes toward medical cannabis were measured with a modified version of the medical component of the Recreational and Medical Cannabis Attitudes Scale (RMCAS). In total, 111 participants completed all requirements of the study. Results Results of a Wilcoxon Sign Rank Test demonstrated a significant increase in the modified medical component of the RMCAS (1.18, p = 0.029). Conclusion Health education is an effective intervention to reduce stigma associated with medical cannabis. Future health policies must take a balanced, education-focused, and proactive stance in reducing barriers to care that exist due to the negative stigma associated with cannabis use.Innovation: Historically, patient education has focused on areas such as tobacco, automobile safety, vaccinations, obesity, and the like. This research applied patient education to the area of medical cannabis to improve attitudes toward it and improve patient access.
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Affiliation(s)
- Thomas A. Clobes
- California State University, Channel Islands 1 University Dr., Camarillo, CA 93012, USA
| | - Lauren A. Palmier
- The University of Health Sciences and Pharmacy in St. Louis 1 Pharmacy, Pl, St. Louis, MO 63110, USA
| | - Matin Gagnon
- California State University, Channel Islands 1 University Dr., Camarillo, CA 93012, USA
| | - Colby Klaiman
- California State University, Channel Islands 1 University Dr., Camarillo, CA 93012, USA
| | - Mya Arellano
- California State University, Channel Islands 1 University Dr., Camarillo, CA 93012, USA
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Sznitman SR, Meiri D, Amit BH, Rosenberg D, Greene T. Posttraumatic stress disorder, sleep and medical cannabis treatment: A daily diary study. J Anxiety Disord 2022; 92:102632. [PMID: 36182689 DOI: 10.1016/j.janxdis.2022.102632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 06/19/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
Despite increasing use of Medical Cannabis (MC) among posttraumatic stress disorder (PTSD) patients, research is lacking on how MC treatment relates to PTSD symptomatology, in particular sleep disturbances. This study examines the time gap between MC use and sleep onset and its association with (1) number of awakenings throughout the night, (2) early awakenings, (3) nightmares. Each morning over a two week period, 77 licensed MC patients suffering from PTSD reported on the timing of previous night MC use and sleep disturbances. Within-person analyses found that shorter time gaps between previous night MC use and sleep start time was associated with lower likelihood of experiencing nightmares throughout the night, but it was not associated with nightly awakenings or waking up too early. Between-person analyses showed that individuals who used MC products with higher CBD concentrations reported fewer early awakenings. These preliminary results indicate that future research should test causal relations between MC use and sleep problems in PTSD patients. Future research is warranted in order to explore causal relationships between MC use, nightmares and insomnia in PTSD patients.
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Affiliation(s)
| | - David Meiri
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ben H Amit
- Reuth Rehabilitation Center, Faculty of Medicine, Tel Aviv University, Israel
| | | | - Talya Greene
- Department of Community Mental Health, University of Haifa, Israel
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Clobes TA, Gagnon M. Demographic factors that impact attitudes toward medical cannabis. PEC Innov 2022; 1:100085. [PMID: 37213732 PMCID: PMC10194315 DOI: 10.1016/j.pecinn.2022.100085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/03/2022] [Accepted: 09/13/2022] [Indexed: 05/23/2023]
Abstract
Objective This study aims to identify pertinent demographic characteristics that influence attitudes toward medical cannabis. Methods Survey respondents were recruited through social media posts, partnering with community organizations, and snowball sampling. Attitudes were measured with a modified version of the medical component of the Recreational and Medical Cannabis Attitudes Scale (MMCAS). Data were analyzed using a one-way ANOVA or one-way Welch ANOVA to determine differences within demographic characteristics. A Tukey-Kramer, or Games-Howell, post-hoc analysis was conducted to determine specific groups within the independent variables that significantly impacted medical cannabis attitudes. Results A total of 645 participants completed the survey. Significant variation in MMCAS was noted between groups based on race, political party affiliation, political view, religion, state legal status, and past/current cannabis use. There were no significant variations noted in MMCAS for apolitical factors. Conclusion Political, religious, and legal demographic factors impact attitudes toward medical cannabis. Innovation The use of health education targeted at the groups of people who continue to harbor antiquated attitudes toward medical cannabis will help to improve patient access and, thus, patient outcomes. Cannabis advocates can innovatively apply health education efforts to groups of people who are aligned with the demographic factors identified in this current work.
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HaGani N, Sznitman S, Dor M, Bar-Sela G, Oren D, Margolis-Dorfman L, Goor-Aryeh I, Green MS. Attitudes Toward the Use of Medical Cannabis and the Perceived Efficacy, Side-effects and Risks: A Survey of Patients, Nurses and Physicians. J Psychoactive Drugs 2022; 54:393-402. [PMID: 34893011 DOI: 10.1080/02791072.2021.2009598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Gaps between physician and patient perceptions may lead to misunderstandings and mismanage of treatment. There are sparse data about the differences in opinions toward medical cannabis (MC) between patients and health professionals. The aim of this study was to examine the attitudes toward MC, its perceived efficacy, side effects and risk of dependency, among patients, nurses and physicians. A cross-sectional study of samples of 430 patients, 65 nurses and 65 physicians in two large medical centers in Israel. Questionnaires were administered on attitudes, perceived efficacy, side-effects and perceived risks of dependency. Compared with nurses and physicians, patients who were using MC had the most positive attitudes toward MC (p < .001). Younger age, high school education, being Jewish and ever using MC, were associated with more positive attitudes toward MC among patients (p < .001). Among nurses and physicians, having an oncology specialty predicted more positive attitudes toward MC. Physicians had a less positive attitude toward MC compared to nurses (p < .01). Our study provides evidence that physicians are less positive in their views toward MC compared to nurses and patients. More information and awareness to MC may reduce the gap in perceptions between physicians and patients.
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Affiliation(s)
- Neta HaGani
- School of Public Heath, University of Haifa, Haifa, Israel.,Rambam Medical Center, Haifa, Israel
| | | | - Michael Dor
- Department of Health Systems Management, Ariel University, Ari'el, Israel
| | - Gil Bar-Sela
- Oncology and Hematology Division, Emek Medical Center, Afula, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - Dana Oren
- Pain Medicine Institute, Sheba Medical Center, Ramat Gan, Israel
| | | | - Itay Goor-Aryeh
- Pain Medicine Institute, Sheba Medical Center, Ramat Gan, Israel
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