Tory Spindle

• PhD
• Professor (Associate) at Johns Hopkins Medicine

Aim: To examine the acute pharmacokinetics (PK) and pharmacodynamics (PD) of a patented oral cannabinoid product containing a botanical hemp-derived "full-spectrum" extract with an approximate 1:1 ratio of cannabidiol (CBD) to cannabidiolic acid (CBDA) and delta-9-tetrahydrocannabinol (THC) to delta-9-tetrahydrocannabinolic acid (THCA). Methods: He...

Introduction Since their 2016 US debut, nicotine pouches, which are available in various flavours and strengths, have grown in popularity. Nicotine pouches may appeal to people who use tobacco, but there is also concern that they may appeal to youth and non-nicotine users. This study analysed nicotine pouch advertising trends from 2021 to 2023 to e...

Oral nicotine pouches (ONPs) are an emergent class of tobacco products that, unlike conventional oral smokeless tobacco products, contain a nicotine powder instead of tobacco leaves. This review synthesizes available data on ONPs in key research domains including survey studies, marketing/advertising studies, chemical characterization and in vitro...

Aim: To evaluate the label accuracy and content of various hemp-derived cannabidiol (CBD) products (cannabinoid products with ≤0.3% Δ9-tetrahydrocannabinol [THC]), as well as evaluate advertised claims on product labels. Methods: Hemp haircare, cosmetics, and food/drink products that were advertised to contain CBD were purchased from retail stores...

Background The concoction known as "lean" containing codeine and promethazine, holds a prominent cultural presence and is often referenced in mass media platforms (e.g., music and social media). Surprisingly, there’s a scarcity of national data characterizing the use of lean. Therefore, the current study investigated the use of lean using national...

Objectives: Despite widespread kratom use, there is a lack of knowledge regarding its effects on driving. We evaluated the self-reported driving behaviors of kratom consumers and assessed their simulated-driving performance after self-administering kratom products. Methods: We present results from: 1) a remote, national study of US adults who re...

Products containing cannabidiol (CBD) have proliferated after the 2018 Farm Bill legalized hemp (cannabis with ≤0.3% delta-9-tetrahydrocannabinol, Δ9-THC). CBD-containing topical products have surged in popularity but controlled clinical studies on them are limited. This study characterized the effects of five commercially available hemp-derived hi...

Introduction Oral nicotine pouches (ONPs) contain a crystalized nicotine powder instead of tobacco leaves. ONPs come in a variety of flavors and are often marketed as “tobacco-free,” but research on ONP use-motivations and related experiences is limited. Methods This cross-sectional web-based survey collected self-report data on ONP use-characteri...

Introduction: Research reports a robust association between combustible cigarette use and alcohol use frequency and severity. Extension to the emerging landscape of electronic nicotine delivery system (ENDS) use is needed to inform prevention and treatment strategies. Method: We evaluated data from the 2020 National Survey on Drug Use and Health...

Understanding cannabis-drug interactions is critical given regulatory changes that have increased access to and use of cannabis. Cannabidiol (CBD) and Δ-9-tetrahydrocannabinol (Δ9-THC), the most abundant phytocannabinoids, are in vitro reversible and time-dependent (CBD only) inhibitors of several cytochrome P450 (CYP) enzymes. Cannabis extracts we...

Importance: Controlled clinical laboratory studies have shown that cannabidiol (CBD) can sometimes attenuate or exacerbate the effects of Δ9-tetrahydrocannabinol (Δ9-THC). No studies have evaluated differences in pharmacokinetics (PK) of Δ9-THC and pharmacodynamics (PD) between orally administered cannabis extracts that vary with respect to Δ9-THC...

Background: Cannabis-infused products available for oral consumption include food and drink items (i.e., edibles) (e.g., baked goods, gummy-, chocolate-, and hard-candies, beverages/drinks) as well as non-food formulations (e.g., oils/tinctures, pills/capsules). This study characterized the motives, opinions, and subjective experiences associated...

The legalization of cannabis for medicinal and non-medicinal purposes, and the corresponding increase in diversity of cannabis products, has resulted an urgent need for cannabis regulatory science. Among the most pressing needs is research related to impairment due to cannabis exposure, especially on driving performance. The present project was des...

Purpose of Review With cannabis legalization expanding throughout the world, an unprecedented number of people now have access to legal cannabis. This expanded legalization has also created an extensive retail market that includes a litany of cannabis products, which vary on factors such as chemical profile (i.e., chemotype), formulation, and inten...

Importance: Products containing cannabinoids such as cannabidiol (CBD) have proliferated since 2018, when the Agriculture Improvement Act removed hemp (ie, cannabis containing <0.3% Δ9-tetrahydrocannabinol [THC]) from the US controlled substances list. Topical cannabinoid products can be purchased nationwide at retail stores and over the internet,...

Traditionally, smoking has been the predominant method for administering cannabis, but alternative routes of administration have become more prevalent. Additionally, research examining urinary cannabinoid excretion profiles has primarily focused on 11-nor-9-carboxy-∆9-tetrahydrocannabinol (Δ9-THC-COOH), a metabolite of Δ9-tetrahydrocannabinol (Δ9-T...

Delta-8-tetrahydrocannabinol (Δ8-THC) has emerged as a new retail cannabinoid product in the U.S. This study queried Δ8-THC users about product use characteristics and self-reported drug effects. Participants were recruited via a large online crowdsourcing platform (Amazon Mechanical Turk). Adults (N = 252) with past year Δ8-THC use (35% with at le...

There is limited data on the comparative pharmacokinetics of cannabidiol (CBD) across oral and vaporized formulations. This within-subject, double-blind, double-dummy, placebo-controlled laboratory study analyzed the pharmacokinetic profile of CBD, Δ9-tetrahydrocannabinol (∆9-THC) and related metabolites in blood and oral fluid (OF) after participa...

There has been growing interest in developing therapeutic agents and other consumer products derived from cannabis and its components. To date, the US Food and Drug Administration (FDA) has not approved cannabis as a safe and effective drug for any indication. With the progressive state legalization of cannabis for medical use, healthcare providers...

The market for products containing cannabidiol (CBD) is booming globally. However, the pharmacokinetics of CBD in different oral formulations and the impact of CBD use on urine drug testing outcomes for cannabis (e.g., 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (∆9-THCCOOH)) are understudied. This study characterized the urinary pharmacokinetics of C...

Background Cannabis legalization is expanding, but there are no established methods for detecting cannabis impairment. Aim Characterize the acute impairing effects of oral and vaporized cannabis using various performance tests. Methods Participants ( N = 20, 10 men/10 women) who were infrequent cannabis users ingested cannabis brownies (0, 10, an...

Objectives: Electronic cigarette (ECIG)-generated aerosol contains particulate matter with a diameter less than 2.5 microns (PM2.5). Particles of this size may be injurious to the health of those who inhale them. Few studies have assessed the relationship between ECIG aerosol PM2.5 and ECIG liquid ingredients or ECIG device power. Methods: Two s...

Cannabis effects are predominantly mediated by pharmacological actions on cannabinoid type 1 (CB1) receptors. Prior positron emission tomography (PET) studies in individuals who use cannabis included almost exclusively males. PET studies in females are needed because there are sex differences in cannabis effects, progression to cannabis use disorde...

Cannabis products available for retail purchase are often marketed based on purported plant species (e.g., "indica" or "sativa"). The cannabis industry frequently claims that indica versus sativa cannabis elicits unique effects and/or is useful for different therapeutic indications. Few studies have evaluated use patterns, beliefs, subjective exper...

Objective Many jurisdictions use per se limits to define cannabis-impaired driving. Previous studies, however, suggest that THC concentrations in biological matrices do not reliably reflect cannabis dose and are poorly correlated with magnitude of driving impairment. Here, we first review a range of concerns associated with per se limits for THC. W...

As cannabis policy changes, there is an urgent need to understand interactions between cannabis and alcohol couse. An online sample of 711 adult past-month cannabis and alcohol users completed both single-item hypothetical purchasing tasks for cannabis and alcohol and cross-commodity purchasing tasks assessing adjusting-price cannabis with concurre...

Policy changes have increased access to cannabis for individuals with little or no prior exposure. Few studies have examined sex differences in cannabis effects among individuals with sporadic cannabis use or for nonsmoked routes of cannabis administration. Data from four double-blind, placebo-controlled studies were pooled to compare the acute pha...

Purpose of Review Global policy changes have increased access to products containing cannabidiol (CBD), a primary constituent of hemp and cannabis. The CBD product industry has experienced tremendous growth, in part, because CBD is widely touted as an effective therapeutic for myriad health conditions. However, only 1 CBD product (Epidiolex®) has b...

Oral cannabis products (a.k.a. "edibles") have increased in popularity in recent years. Most prior controlled pharmacokinetic evaluations of cannabis have focused on smoked cannabis and included males who were frequent cannabis users. In this study, 17 healthy adults (8 females), with no cannabis use in at least the past two months, completed four...

Introduction The use and availability of oral and inhalable products containing cannabidiol (CBD) as the principal constituent has increased with expanded cannabis/hemp legalization. However, few controlled clinical laboratory studies have evaluated the pharmacodynamic effects of oral or vaporized CBD or CBD-dominant cannabis. Methods Eighteen hea...

Background Prior controlled cannabis research has mostly focused on smoked cannabis and predominantly included frequent cannabis users. Oral cannabis products (“edibles”) make up a large and growing segment of the retail cannabis market. This study sought to characterize the pharmacodynamic effects of oral cannabis among infrequent cannabis users....

E-cigarettes have dramatically increased in popularity among youth. Coincident with expanded legalization, young adults' use of cannabis (marijuana) has also steadily increased in recent years. Use of tobacco products can increase the chances of later cannabis initiation among youth. However, most longitudinal investigations of tobacco and cannabis...

Background The ability of an electronic cigarette (e-cigarette) to deliver nicotine effectively may be dependent on features of the device, the liquid and the user. Some of these features have been examined in previous work (eg, liquid nicotine concentration and puff topography), while others have not (eg, nicotine dependence and demographic charac...

Cannabis products in which cannabidiol (CBD) is the primary chemical constituent (CBD-dominant) are increasingly popular and widely available. The impact of CBD exposure on urine drug testing has not been well studied. This study characterized the urinary pharmacokinetic profile of 100-mg oral and vaporized CBD, vaporized CBD-dominant cannabis (100...

Purpose: Longitudinal studies indicate that e-cigarette use among youth and young adults is associated with cigarette smoking initiation. The purpose of this study was to identify reasons why nonsmoking young adults transition from e-cigarette use to cigarette smoking. Methods: The study used concept mapping (CM), a mixed-method participatory ap...

As cannabis has become more accessible, use of alternative methods for cannabis administration such as vaporizers has become more prevalent. Most prior controlled pharmacokinetic evaluations have examined smoked cannabis in frequent (often daily) cannabis users. This study characterized the urinary excretion profile of 11-nor-9-carboxy-Δ9-tetrahydr...

Laws regulating cannabis have changed radically in the U.S. and abroad. Historically, users smoked dried cannabis flowers that contained Δ9-tetrahydrocannabinol (THC), the primary psychoactive component of cannabis, as the principal product constituent. Coincident with cannabis legalization and increased interest in medicinal use of the plant, ther...

Currently, an unprecedented number of individuals can legally access cannabis. Vaporization is increasingly popular as a method to self-administer cannabis, partly due to perception of reduced harm compared with smoking. Few controlled laboratory studies of cannabis have used vaporization as a delivery method or evaluated the acute effects of canna...

Importance Vaporization is an increasingly popular method for cannabis administration, and policy changes have increased adult access to cannabis drastically. Controlled examinations of cannabis vaporization among adults with infrequent current cannabis use patterns (>30 days since last use) are needed. Objective To evaluate the acute dose effects...

Background: Electronic cigarettes (ECIGs) are a class of tobacco products that produce different effects (e.g., nicotine delivery), depending on the device, liquid, and behavioral factors. However, the influence of the two primary ECIG liquid solvents, propylene glycol (PG) and vegetable glycerin (VG), on ECIG acute effects is unknown. Methods:...

Introduction: The power output of e-cigarettes varies considerably, as does the composition of liquids used with these products. Most e-cigarette liquids contain two primary solvents: propylene glycol (PG) and vegetable glycerin (VG). The primary aim of this study was to examine the extent to which PG and VG composition and device power interact w...

Electronic cigarette (ECIG) nicotine delivery and other effects may depend on liquid nicotine concentration and user experience. This study is the first to systematically examine the influence of ECIG liquid nicotine concentration and user experience on nicotine delivery, heart rate, puff topography, and subjective effects. Thirty-three ECIG-experi...

Importance: The public health implications of e-cigarettes depend, in part, on whether e-cigarette use affects the risk of cigarette smoking. Objective: To perform a systematic review and meta-analysis of longitudinal studies that assessed initial use of e-cigarettes and subsequent cigarette smoking. Data sources: PubMed, EMBASE, Cochrane Libr...

Introduction: Electronic cigarette (e-cigarette) use prevalence is increasing among U.S. adolescents and adults but recent longitudinal data for college/university students are scarce. Furthermore, the extent that e-cigarette use is associated with the onset of cigarette smoking and the factors that lead to the uptake of e-cigarettes in college st...

Objective: Evaluating electronic cigarettes (ECIGs) in the clinical laboratory is critical to understanding their effects. However, laboratory evaluation of ECIGs can be challenging, as they are a novel, varied, and evolving class of products. The objective of this paper is to describe some methodological challenges to the clinical laboratory eval...

Introduction Electronic cigarettes (ECIGs) aerosolize a liquid solution often containing nicotine. ECIG nicotine delivery may be influenced by user puffing behaviors (“puff topography”). ECIG puff topography can be recorded using mouthpiece–based computerized systems. The present study sought to examine the extent to which these systems influence E...

Introduction Secondhand smoke (SHS) from combustible cigarettes causes numerous diseases. Policies have been developed to prevent SHS exposure from indoor cigarette use to reduce health risks to non-smokers. However, fewer policies have been implemented to deter electronic cigarette (ECIG) use indoors, and limited research has examined the impact o...

Introduction: Electronic cigarettes (ECIGs) heat a nicotine-containing solution; the resulting aerosol is inhaled by the user. Nicotine delivery may be affected by users' puffing behavior (puff topography), and little is known about the puff topography of ECIG users. Puff topography can be measured using mouthpiece-based computerized systems. Howe...

Electronic cigarettes (ECIGs), also referred to as electronic nicotine delivery systems or "e-cigarettes," generally consist of a power source (usually a battery) and heating element (commonly referred to as an atomizer) that vaporizes a solution (e-liquid). The user inhales the resulting vapor. Electronic cigarettes have been increasing in popular...

This clinical case conference discusses 3 cases of patients using electronic cigarettes. Electronic cigarettes, also referred to as electronic nicotine delivery systems or "e-cigarettes," generally consist of a power source (usually a battery) and a heating element (commonly referred to as an atomizer) that vaporize a solution (e-liquid). The user...

Verbal communication provides explicit cues about groups and individuals (Lambert, Hodgson, Gardner, & Fillenbaum, 1960). Accented speech reflects individuals’ characteristics such as race, biological sex, social class, and education and functions to categorize individuals according to group membership from which stereotyped evaluations may arise (...