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Who Are Medical Marijuana Patients? Population Characteristics from Nine California Assessment Clinics
Abstract
Marijuana is a currently illegal psychoactive drug that many physicians believe has substantial therapeutic uses. The medical literature contains a growing number of studies on cannabinoids as well as case studies and anecdotal reports suggesting therapeutic potential. Fifteen states have passed medical marijuana laws, but little is known about the growing population of patients who use marijuana medicinally. This article reports on a sample of 1,746 patients from a network of nine medical marijuana evaluation clinics in California. Patients completed a standardized medical history form; evaluating physicians completed standardized evaluation forms. From this data we describe patient characteristics, self-reported presenting symptoms, physician evaluations, other treatments tried, other drug use, and medical marijuana use practices. Pain, insomnia, and anxiety were the most common conditions for which evaluating physicians recommended medical marijuana. Shifts in the medical marijuana patient population over time, the need for further research, and the issue of diversion are discussed.
... This may explain our finding that in over half of the messages where a provider claimed they could not refer, prescribe [sic], or recommend medical marijuana, they followed up with assistance for the patient to access medical marijuana. Patients in our study primarily named pain, anxiety, and sleep as reasons for using or wanting to use medical marijuana, and these are the most commonly reported reasons for use in patients across the United States [10,45]. Providers may be more comfortable supporting use for reasons about which they are frequently approached [43,46]. ...
... A recent investigation found among patients with hypertension, diabetes, or both, younger patients were less likely to share clinical updates using secure messaging than older patients, while men were less likely to seek medical guidance than women [52]. At the same time, a study from California found that the population of medical marijuana users in the state is composed of a higher proportion of males and skewed younger than the general population [45]. While there may be many patients who are not disclosing their cannabis use [51], the patient portal platform may uniquely select patients who are more willing to disclose sensitive information. ...
Background
Patient portal secure messaging allows patients to describe health-related behaviors in ways that may not be sufficiently captured in standard electronic health record (EHR) documentation, but little is known about how cannabis is discussed on this platform.
Objective
This study aimed to identify patient and provider secure messages that discussed cannabis and contextualize these discussions over periods before and after its legalization for medical purposes in Pennsylvania.
Methods
We examined 382,982 secure messages sent by 15,340 patients and 6101 providers from an integrated health delivery system in Pennsylvania, United States, from January 2012 to June 2022. We used an unsupervised natural language processing approach to construct a lexicon that identified messages explicitly discussing cannabis. We then conducted a qualitative content analysis on a random sample of identified messages to understand the medical reasons behind patients’ use, the primary purposes of the cannabis-related discussions, and changes in these purposes over time.
Results
We identified 1782 messages sent by 1098 patients (7.2% of total patients in the study) and 800 messages sent by 430 providers (7% of total providers in the study) as explicitly discussing cannabis. The most common medical reasons for use stated by patients in 190 sampled messages included pain or a pain-related condition (50.5% of messages), anxiety (13.7% of messages), and sleep (11.1% of messages). We coded 56 different purposes behind the mentions of cannabis in patient messages and 33 purposes in 100 sampled provider messages. In years before the legalization (2012-2016), patient and provider messages (n=20 for both) were primarily driven by discussions about cannabis screening results (38.9% and 76.5% of messages, respectively). In the years following legalization (2017-2022), patient messages (n=170) primarily involved seeking assistance to facilitate medical use (35.2% of messages) and reporting current use (25.3% of messages). Provider messages (n=80) were driven by giving assistance with medical marijuana access (27.5% of messages) and stating that they were unable to refer, prescribe or recommend medical marijuana (26.3% of messages).
Conclusions
Patients showed a willingness to discuss cannabis use over patient portal secure messages and expressed interest in use after the legalization of medical marijuana. Some providers responded to patient inquiries with assistance in obtaining access to medical marijuana, while others cautioned patients on the risks of use. Insight into cannabis-related discussions through secure messages can help health systems determine opportunities to improve care processes around patients’ cannabis use, and providers should be supported to communicate accurate and consistent information.
... Concernant le cannabis à usage thérapeutique, dès les années 2000 en Amérique du Nord, des programmes permettaient l'accès au cannabis thérapeutique à certains patients via des dispensaires sur autorisation d'un médecin (P. G. Lucas, 2008 ;Reiman, 2006 ;Reinarman et al., 2011). En France, suite à l'expérimentation de la distribution du cannabis médical menée par l'Agence Nationale de la Sécurité du Médicament (ANSM) de 2021 à 2024, un cadre légal d'accès au cannabis médical devrait prochainement entrer en vigueur. ...
... De nombreux individus en France utilisent le cannabis pour ses bénéfices autothérapeutiques (Bastien et al., 2023 ;Reynaud-Maurupt, 2009). Indépendamment de la réglementation du cannabis, les bénéfices thérapeutiques de l'usage du cannabis les plus souvent rapportés par les personnes utilisatrices sont la gestion des douleurs, la réduction des symptômes anxieux et dépressifs, ainsi que la régulation du sommeil et de l'appétit (Ogborne et al., 2000 ;Park & Wu, 2017;Reinarman et al., 2011). Au vu des niveaux de consommation du cannabis dans la population et des débats autour de son usage thérapeutique, il apparaît important de documenter les stratégies mises en place par les personnes utilisatrices de cannabis pour gérer leurs consommations et leur santé. ...
Le cannabis est la substance psychoactive illicite la plus consommée en France, et de nombreuses personnes l’utilisent de manière thérapeutique en dehors d’un cadre de prescription. Une enquête collaborative par questionnaire en ligne a été menée en France afin d’explorer l’utilisation du cannabis dans le but de maîtriser, réduire ou arrêter les consommations d’autres substances psychoactives, légales, illégales ou prescrites médicalement. Nous décrivons les profils des participants, ainsi que les pratiques et perceptions liées à cette utilisation du cannabis, suggérant qu’elle s’intégrerait dans une diversité de parcours de consommation et de parcours de soin chez les personnes concernées. Face à de possibles difficultés dans l’accès ou le maintien des soins pour certaines personnes utilisatrices de substances ou ayant une prescription médicamenteuse, nous interprétons cette utilisation du cannabis comme une stratégie d’appropriation de ses consommations et ainsi de sa santé.
... Policy makers and clinicians have questioned whether MC users are different from non-medical users. Preliminary studies suggest that there is significant overlap between these groups, with many individuals using cannabis for both purposes (Furler et al., 2004), and some MC users having had significant experience as former non-medical users (Ogborne et al., 2000;Reinarman et al., 2011;Ware et al., 2005). Conversely, recent evidence suggests that there are important differences between those who use cannabis medically versus non-medically. ...
... This study drew on a population that was predominantly White, with all other race/ethnicity categories representing only a small proportion of the sample. This is consistent with previous studies that also had underrepresentation of Latino, Asian American (Reinarman et al., 2011),, and Black cohorts which was attributed to lower prevalence of cannabis use (SAMHSA, 2018). To rectify this limitation, weights were added to ensure that estimates were representative of the sample. ...
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.
... Irrespective of the legal status of cannabis for medical use, many users report selfmedication, even without physician recommendations (Hazekamp et al. 2013;Ogborne et al. 2000;Osborn et al. 2015;Sexton et al. 2016;Walsh et al. 2013). Besides the conditions cited above, therapeutic users report consuming cannabis to relieve anxiety and depression symptoms, sleeping disorders, headaches, craving for other drugs, and to improve appetite, energy and concentration (Hazekamp et al. 2013;Kosiba, Maisto, and Ditre 2019;Osborn et al. 2015;Reinarman et al. 2011). With respect to pain, cannabis selfmedication has been reported as an alternative or a complement to classic pharmaceutical prescriptions (Sexton et al. 2016), and the medical use of cannabis has been associated with a reduction in prescribed opioid dosages (Okusanya et al. 2020). ...
... Opioids are widely prescribed for chronic pain, and evidence suggests that cannabis could be used as a complement or a substitute for them in this context (Desroches and Beaulieu 2010; Lucas 2012). Despite the controversy as to whether cannabis is a suitable treatment for psychiatric comorbidities (Sarris et al. 2020), in countries where therapeutic cannabis is legal, some physicians prescribe it to treat anxiety and depressive symptoms (Reinarman et al. 2011). Cannabis seems to have an immediate perceived effect on depressive symptoms (Li et al. 2020) but its long-term impact on mental illness progression is unclear (Botsford, Yang, and George 2020). ...
Many cannabis users report therapeutic benefits from cannabis consumption, even when not recommended by a physician. To date, few data on therapeutic users of cannabis in France are available. Using a cross-sectional survey held in 2020, we collected sociodemographic, health and substance use data from 4150 daily cannabis users in France. We used multivariable logistic regression to assess factors associated with exclusive therapeutic use of cannabis. Approximately 10% (n = 453) of the participants reported using cannabis exclusively for therapeutic purposes. Exclusive therapeutic users of cannabis differed from non-exclusive (i.e. recreational and mixed) users, especially regarding age (aOR [95%CI] = 1.01 [1.00-1.02]), employment (aOR = 0.61 [0.47-0.79]), urban area of residence (aOR = 0.75 [0.60-0.94]), physical (aOR = 2.95 [2.34-3.70]) and mental health condition (aOR = 2.63 [1.99-3.49]), mode of cannabis administration (non-smoked, aOR = 1.89 [1.22-2.95); smoked with little tobacco, aOR = 1.39 [1.09-1.76]), frequency of cannabis use (aOR = 1.04 [1.01-1.06]), home cultivation (aOR = 1.56 [1.13-2.15]), at-ridsk alcohol use (aOR = 0.68 [0.54-0.84]), and previous-month opiate use (aOR = 1.67 [1.22-2.30]). A greater understanding of the distinct profiles of regular cannabis users could inform harm reduction strategies and care access for this population. Further studies are needed to better understand the boundaries between therapeutic and recreational use.
... The CEEQ-M contains 21 Likert-type items scored from 1 to 10, where numerical scores are indicated on the questionnaire to correspond to the following ordered categories: 1 and 2, strongly disagree; 3 and 4, disagree; 5 and 6, neutral; 7 and 8, agree; 9 and 10, strongly agree. The items of the CEEQ-M were largely selected from Reinarman et al. (2011), which queried 1,746 patients in nine medical cannabis clinics about their reasons for use. The complete, 21-item version of the CEEQ-M was administered to participants during the screening and postrandomization baseline visits, as well as at the following visit timepoints following randomization: 1 month, 3 months, 6 months, and 1 year (intervals correspond to time after randomization). ...
... In particular, the expectancies in this questionnaire are not inclusive of all possible expectancies, especially negative expectancies such as those related to side effects of cannabis use for health concerns. We undertook a pragmatic approach to item development, which drew on previously described motives for use (Reinarman et al., 2011), to meet the needs of the parent trial. Thus, the items of the CEEQ-M did not undergo a systematic development process. ...
The use of cannabis for medical symptoms is increasing despite limited evidence for its efficacy. Expectancies-prior beliefs about a substance or medicine-can modulate use patterns and effects of medicines on target symptoms. To our knowledge, cannabis expectancies have not been studied for their predictive value for symptom relief. The 21-item Cannabis Effects Expectancy Questionnaire-Medical (CEEQ-M) is the first longitudinally validated measure of expectancies for cannabis used for medical symptoms. The questionnaire was developed for a randomized clinical trial of the effect of state cannabis registration (SCR) card ownership on symptoms of pain, insomnia, anxiety, and depression in adults (N = 269 across six questionnaire administrations). Item-level analyses (n = 188) demonstrated between-person stability of expectancies and no aggregate, within-person expectancy changes 3 months after individuals gained access to SCR cards. Exploratory factor analysis (n = 269) indicated a two-factor structure. Confirmatory factor analysis at a later timepoint (n = 193) demonstrated good fit and scalar invariance of the measurement model. Cross-lagged panel models across 3 and 12 months (n = 187 and 161, respectively) indicated that CEEQ-M-measured expectancies did not predict changes in self-reported cannabis use; symptoms of pain, insomnia, anxiety, and depression; and well-being. However, greater baseline cannabis use predicted more positive expectancy changes. The findings suggest that the CEEQ-M is psychometrically sound. Future work should clarify at what timescales cannabis expectancies have predictive value and how cannabis expectancies for medical symptoms are maintained and diverge from other substance use expectancies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
... We did not find same day improvements in pain or depressive symptoms, which is consistent with our prior work looking at 12-week changes in health symptoms from in-person monthly assessments (i.e., non-daily diary) in adults randomized to receive a medical cannabis card (Gilman et al., 2021). Among health concerns, chronic pain is one of the most common complaints leading to an interest in cannabis use (Reinarman et al., 2011) and while some preclinical models suggest cannabinoids may regulate pain (Woodhams et al., 2015), clinical results have been inconclusive (Haroutounian et al., 2021;Mücke et al., 2018;National Academies of Sciences, Medicine, 2017). The current project did not find substantial evidence of cannabis improving same day pain symptoms. ...
... Depressive symptoms are also associated with increased cannabis use in epidemiological samples (Degenhardt et al., 2003;Onaemo et al., 2020) and are frequently cited as a reason to pursue medical cannabis (Reinarman et al., 2011). The current project however did not find substantive improvement in self-reported depressive symptoms, which is largely consistent with existing evidence (Abrams, 2018). ...
Background:
Real world patterns of cannabis use for health concerns are highly variable and rarely overseen by a physician. Pragmatic effectiveness studies with electronic daily diaries that capture person-specific patterns of cannabis use and health symptoms may help clarify risks and benefits.
Methods:
As part of a larger, randomized trial (NCT03224468), adults (N = 181) seeking cannabis for insomnia, pain, or anxiety or depressive symptoms were randomized to obtain a medical cannabis card immediately (MCC) or a waitlist control (WLC) and completed 12-weeks of daily web-based surveys on cannabis use and sleep, pain, and depressive symptoms.
Results:
Completion rates of daily surveys were moderate to high (median completed: 72 out of 90 days). Daily reports of cannabis use were consistent with monthly interview assessments and urinalysis. The MCC group increased cannabis use frequency in the 12 weeks following randomization, while WLC did not. Among the MCC group, self-reported sleep quality was significantly higher on cannabis use days, compared to nonuse days. The MCC group displayed long-term sleep improvements, consistent with increasing cannabis frequency. No improvements were found for pain or depressive symptoms.
Conclusion:
Cannabis use is associated with same day improvements in self-reported sleep quality, but not pain or depressive symptoms, although sleep improvements occurred in the context of increased frequency of cannabis use, raising the risk for cannabis use disorder. Daily web-based assessments of cannabis appear valid and feasible in adults seeking cannabis for health concerns, providing a flexible, complementary method for future real-world effectiveness studies with expanded and objective measures.
... As of May 2021, 36 US states, along with the District of Columbia, Puerto Rico, North Mariana Islands, and Guam had approved medical cannabis laws, with an estimated 5.461 million state-legal patients (Marijuana Policy Project, 2020). Self-report studies of medical cannabis patients have shown it being used to treat a variety of conditions including gastrointestinal problems, insomnia, mental health disorders, and most commonly, chronic pain (Boehnke et al., 2016;Bonn-Miller et al., 2014;Kosiba et al., 2019;Reinarman et al., 2011;Salazar et al., 2019;Schlienz et al., 2021;Sexton et al., 2016;Troutt & DiDonato, 2015). ...
... The overall patient demographics were expected as they reflect the population with the greatest access to and likelihood of using the 2015 Florida Compassionate Medical Cannabis Act, which constituted 1.13% of the population at the time of the study (Mahabir et al., 2020;Marijuana Policy Project, 2020). The demographics, ailments reported, and habits of use reported by our respondents were like previous studies (Bonn -Miller et al., 2014;Lucas et al., 2021;Mahabir et al., 2020;Reinarman et al., 2011;Salazar et al., 2019;Schlienz et al., 2021;Sexton et al., 2016;Troutt & DiDonato, 2015). Almost half (47.92%) of patients reported both pain and mental health diagnoses, while 28.86% of patients reported one or more mental health concerns and 9.07% reported one or more pain diagnosis only. ...
Purpose: Opioid use rates have dropped as North American patients gain access to medical cannabis, indicating a harm reduction role, yet health outcomes remain mostly unexplored. This study presents self-reported medical cannabis use, perceptions of health functioning, and changes in opioid pain medication use in Florida medical cannabis patients.
Methods: Patients (n = 2,183) recruited from medical dispensaries across Florida completed a 66-item cross-sectional survey that included demographic, health, and medication usage items, along with items from the Medical Outcomes Survey (SF-36) to assess health functioning before and after cannabis initiation.
Results: Most participants were between the ages of 20 and 70 years of age (95%), over 54% were female, 47% were employed, and most (85%) were white. Commonly reported ailment groups were Pain and Mental Health combined (47.92%), Mental Health (28.86%) or Pain (9.07%). Health domains of bodily pain, physical functioning, and social functioning improved while limitations due to physical and emotional problems were unchanged. Most patients rated medical cannabis as being important to their quality of life. Many (60.98%) reported using pain medications prior to medical cannabis, 93.36% of these reported a change in pain medication after medical cannabis. The majority of participants (79%) reported either cessation or reduction in pain medication use following initiation of medical cannabis and 11.47% described improved functioning.
Conclusions: The findings suggest that some medical cannabis patients decreased opioid use without harming quality of life or health functioning, soon after the legalization of medical cannabis. The public health implications of medical cannabis as an alternative pain medication are discussed.
... We contribute to this underexamined literature by using a synthetic control approach to examine the impact of legalized recreational use of marijuana on state-level obesity rates. We focus on recreational use specifically because it encompasses a larger and comparatively more representative sample of the population using marijuana than those who use it for medicinal reasons (Reinarman et al., 2011). We examine the effects of legalizing recreational marijuana on obesity rates in Washington State, which legalized recreational marijuana use in 2012 and allowed dispensaries to open in 2014. ...
... They also use synthetic controls as a robustness check due to noted limitations of their difference-in-difference approach (p. 19). 9 Further, patients using marijuana for medical reasons often differ considerably from the typical marijuana user (Reinarman et al., 2011). For example, Sznitman (2017) finds recreational marijuana users use marijuana more frequently, are likely to have full-time employment, are more likely to consume edibles, and spend more time under the influence than medicinal users. ...
Obesity in the US arguably constitutes the most significant health epidemic over the past century. Recent legislative changes allowing for recreational marijuana use further create a need to better understand the relationship between marijuana use and health choices, leading to obesity. We examine this relationship by using a synthetic control approach to examine the impact of legalized recreational marijuana access on obesity rates by comparing Washington State to a synthetically constructed counterfactual. We find that recreational marijuana's introduction did not lead to increased obesity rates and may have led to decreases in obesity.
... Despite the burgeoning availability and use of MM, relatively little is known about the characteristics, healthrelated quality of life (HRQoL), and psychosocial functioning of MM patients. Studies of patients in Florida [8] and California [9] reported chronic pain, anxiety, stress, and insomnia to be the most common complaints or conditions prompting referrals for MM. Among chronic pain patients in Ohio considering MM, 67.6% wanted to reduce their use of opioid medications, and 93.6% were amenable to following physician recommendations regarding the use of opioids and MM concurrently [10]. ...
... Several findings are noteworthy. First, the most common referral conditions of participants in the sample were chronic pain and anxiety, which is consistent with findings from previous studies in this area [8,9]. Collectively, our findings suggest that patients with chronic pain or anxiety may pursue alternative therapies for symptom relief beyond prescription medications or psychotherapy. ...
Introduction:
Despite the rising availability and use of medical marijuana (MM) in the USA, little is known about the demographics, clinical characteristics, or quality of life of MM patients. This study describes the demographic characteristics and health-related quality of life (HRQoL) of MM patients who are initiating treatment in Pennsylvania.
Methods:
Two-hundred adults naive to MM and referred for any of the 23 state-approved qualifying conditions were recruited at three MM dispensaries in Pennsylvania between September 2020 and March 2021. All participants consented to the study; completed semi-structured interviews that included demographic questionnaires, the Short Form-36 (SF-36), and Generalized Anxiety Disorder-7 (GAD-7); provided height and weight measurements; and allowed access their dispensary medical records.
Results:
Participants had a mean age of 48.5 ± 15.6 years, predominantly identified as female (67.5%), and were most commonly referred for chronic pain (63.5%) and/or anxiety (58.5%). Additionally, 46.0% were living with obesity as determined by BMI. Relative to a normative sample, participants reported diminished HRQoL in several domains, most notably in role limitations due to physical health (M = 46.0 ± 42.0), role limitations due to emotional problems (M = 52.5 ± 42.3), energy and fatigue (M = 39.8 ± 20.2), and pain (M = 49.4 ± 26.0).
Discussion/conclusion:
Patients initiating MM treatment experienced low HRQoL in multiple domains. Future studies could evaluate the relationship between HRQoL and patients' decisions to pursue MM treatment, as well as changes in HRQoL with MM use over time.
... 4 It has been argued that cannabis can be used as an effective substitute for opioids and benzodiazepines to manage chronic pain, anxiety, or sleep problems without the risk of fatal poisoning. [6][7][8][9] In this sense, increasing the availability of cannabis through laws that allow legal access to medical and recreational cannabis may lead to large enough individuallevel substitution to produce population-level changes in overdose rates. 10,11 All this is in a context in which the number of states legalizing recreational cannabis has increased rapidly, from two states in 2012, up to 19 states and the District of Columbia as of 2021. ...
Mandatory prescription drug monitoring programs and cannabis legalization have been hypothesized to reduce overdose deaths. We examined associations between prescription monitoring programs with access mandates (must-query PDMPs), legalization of medical and recreational cannabis supply, and opioid overdose deaths in United States counties in 2013-2020. Using data on overdose deaths from the National Vital Statistics System, we fit Bayesian spatiotemporal models to estimate risk differences and 95% credible intervals (CrIs) in county-level opioid overdose deaths associated with enactment of these state policies. Must-query PDMPs were independently associated with on average 0.8 (95% CrI, 0.5-1.0) additional opioid-involved overdose deaths per 100 000 person-years. Legal cannabis supply was not independently associated with opioid overdose deaths in this time period. Must-query PDMPs enacted in the presence of legal (medical or recreational) cannabis supply were associated with 0.7 (95% CrI, 0.4-0.9) more opioid-involved deaths relative to must-query PDMPs without any legal cannabis supply. In a time when overdoses are driven mostly by nonprescribed opioids, stricter opioid prescribing policies and more expansive cannabis legalization were not associated with reduced overdose death rates.
This article is part of a Special Collection on Mental Health.
... The similarity in AHDECC effects on antinociception (tail flick latency) between male and female rats observed in our study aligns with findings in rats after THC vapor administration (Moore et al., 2021). Pain relief is one of the most commonly cited reasons for medical cannabis use (Reinarman et al., 2011). The periaqueductal gray, a brain region that contains CB1R-expressing somatodendritic structures and presynaptic terminals, is implicated in pain modulation Wilson-Poe et al., 2012) and may play a role in the decreased pain sensitivity that we observed after AHDECC. ...
The consumption of D9-tetrahydrocannabinol (THC)- or cannabis-containing edibles has increased in recent years; however, the behavioral and neural circuit effects of such consumption remain unknown, especially in the context of ingestion of higher doses resulting in cannabis intoxication. We examined the neural and behavioral effects of acute high-dose edible cannabis consumption (AHDECC). Sprague-Dawley rats (6 males, 7 females) were implanted with electrodes in the prefrontal cortex (PFC), dorsal hippocampus (dHipp), cingulate cortex (Cg), and nucleus accumbens (NAc). Rats were provided access to a mixture of Nutella (6 g/kg) and THC-containing cannabis oil (20 mg/kg) for 10 minutes, during which they voluntarily consumed all of the provided Nutella and THC mixture. Cannabis tetrad and neural oscillations were examined 2, 4, 8, and 24-h after exposure. In another cohort (16 males, 15 females), we examined the effects of AHDECC on learning and prepulse inhibition, and serum and brain THC and 11-hydroxy-THC concentrations. AHDECC resulted in higher brain and serum THC and 11-hydroxy-THC levels in female rats over 24 h. AHDECC also produced: 1) Cg, dHipp, and NAc gamma power suppression, with the suppression being greater in female rats, in a time-dependent manner; 2) hypolocomotion, hypothermia, and anti-nociception in a time-dependent manner; and 3) learning and prepulse inhibition impairments. Additionally, most neural activity and behavior changes appear 2 h post-ingestion, suggesting that interventions around this time might be effective in reversing/reducing the effects of AHDECC. Significance Statement The effects of high-dose edible cannabis on behaviour and neural circuitry are poorly understood. We found that the effects of acute high-dose edible cannabis consumption, which include decreased gamma power, hypothermia, hypolocomotion, analgesia, and learning and information processing impairments, are time- and sex-dependent. Moreover, these effects begin 2 h after AHDECC and last for at least 24 h, suggesting that treatments should target this time window in order to be effective.
... These questions were posed during the last wave of the study, which took place from December 2020 to May 2021. Based on the scientific literature (Haug et al. 2017;Reinarman et al. 2011;Ogborne et al. 2000), 12 reasons and four forms were selected to define use of cannabis for mental or physical health reasons (Additional file 1). Thus, individuals who selected at least one of these items were considered to be using cannabis for self-medication purposes, even if they also had so-called recreational use ("cannabis use for selfmedication" vs. "cannabis use for other reasons"). ...
Background
Medical cannabis, legalized in many countries, remains illegal in France. Despite an experiment in the medical use of cannabis that began in March 2021 in France, little is known about the factors associated with the use of cannabis for self-medication among adults.
Methods
Data came from the French TEMPO cohort and were collected between December 2020 and May 2021. Overall, 345 participants aged 27–47 were included. Cannabis for self-medication was defined using the following questions: ‘Why do you use cannabis?’ and ‘In what form do you use cannabis?’. The penalized regression method “Elastic net” was used to determine factors associated with the use of cannabis for self-medication, with the hypothesis that it is mainly used for pain in individuals who have already used cannabis.
Results
More than half of the participants reported having ever used cannabis (58%). Only 10% used it for self-declared medical reasons (n = 36). All self-medication cannabis users, except one, were also using cannabis for recreational purposes. The main factors associated with cannabis use for self-medication vs. other reasons included cannabis use trajectories, the presence of musculoskeletal disorders, tobacco smoking, and parental divorce.
Conclusions
Engaging in cannabis use during adolescence or early adulthood may increase the likelihood of resorting to self-medication in adulthood. Due to the propensity of individuals with cannabis use during adolescence to resort to uncontrolled products for self-medication, this population should be more systematically targeted and screened for symptoms and comorbidities that may be associated with cannabis use.
Supplementary Information
The online version contains supplementary material available at 10.1186/s42238-024-00230-2.
... Conversely, cannabis -now legal in some form in over 70% of U.S. states and territories -has attracted interest due to its ability to alleviate symptoms of both conditions with minimal, nonserious side effects such as drowsiness, dry mouth, tachycardia, and short-term impairment of memory, concentration, and motor performance (Prashad & Filbey, 2017;Stith et al., 2018;Wang et al., 2008). Surveys of medical cannabis users across the country have shown that relief from symptoms of anxiety and depression are among the most commonly cited reasons for using medical cannabis (Rosenthal & Pipitone, 2021;Reinarman et al., 2011). Likewise, Corroon et al. (2017) found that the odds of reporting substituting cannabis for prescription drugs were more than one and a half times greater among those reporting the use of cannabis to manage anxiety and depression. ...
Objective
Recent scientific attention has focused on the therapeutic effectiveness of cannabis use on a variety of physical and mental ailments. The present study uses smartphone technology to assess self-reported experiences of Florida cannabis users to understand how cannabis may impact anxiety and depression symptomatology.
Method
Several hundred Releaf App™ users from the state of Florida provided anonymous, real-time reports of their symptoms of anxiety and/or depression immediately before and after cannabis use sessions. Linear mixed-effects modeling was used to analyze the data at the symptom and user level.
Results
Results showed that for the majority of users, cannabis use was associated with a significant decrease in depression and anxiety symptomatology. While symptom type, doses per session, consumption method, and CBD levels were significant predictors of relief change, their effect sizes were small and should be interpreted with caution. At the user level, those who had positive relief outcomes in anxiety reported more doses and sessions, and those in the depression group reported more sessions.
Conclusions
Our results generally support the therapeutic effectiveness of cannabis against depression/anxiety symptomatology. Future work should include standardized statistics and effect size estimates for a better understanding of each variable's practical contribution to this area of study.
... This is the first large study exploring the effectiveness and tolerability of different cannabis strains prescribed by physicians in Germany. Previous studies demonstrated conflicting results [2,3,5,7,[9][10][11][12][13][14], but also differed in many ways with respect to the country studied, legality, access, costs, number and kind of available MC strains, standardization, characterization, and labeling of strains as well as the inclusion of patients using recreational cannabis as self-medication [2,3,15]. ...
Background Up to now, it is unclear whether different medicinal cannabis (MC) strains are differently efficacious across different medical conditions. In this study, the effectiveness of different MC strains was compared depending on the disease to be treated.
Methods This was an online survey conducted in Germany between June 2020 and August 2020. Patients were allowed to participate only if they received a cannabis-based treatment from pharmacies in the form of cannabis flowers prescribed by a physician.
Results The survey was completed by n=1,028 participants. Most participants (58%) have used MC for more than 1 year, on average, 5.9 different strains. Bedrocan (pure tetrahydrocannabinol to pure cannabidiol [THC:CBD]=22:<1) was the most frequently prescribed strain, followed by Bakerstreet (THC:CBD=19:<1) and Pedanios 22/1 (THC:CBD=22:1). The most frequent conditions MC was prescribed for were different pain disorders, psychiatric and neurological diseases, and gastrointestinal symptoms. Overall, the mean patient-reported effectiveness was 80.1% (range, 0–100%). A regression model revealed no association between the patient-reported effectiveness and the variety. Furthermore, no influence of the disease on the choice of the MC strain was detected. On average, 2.1 side effects were reported (most commonly dry mouth (19.5%), increased appetite (17.1%), and tiredness (13.0%)). However, 29% of participants did not report any side effects. Only 398 participants (38.7%) indicated that costs for MC were covered by their health insurance.
Conclusions Patients self-reported very good efficacy and tolerability of MC. There was no evidence suggesting that specific MC strains are superior depending on the disease to be treated.
... Participants were recruited via the national media, patient organisations, in selected doctors' offices and hospitals, at the illegal open drug market, christiania, and through various cannabis related sites on social media. the survey was inspired by previous surveys on use of caM in other countries (Grotenhermen & schnelle, 2003;hazekamp et al., 2013;Reiman et al., 2017;Reinarman et al., 2011;sexton et al., 2016;Ware et al., 2005;Webb & Webb, 2014). the survey consisted of 42 structured questions and 21 possible follow-up questions, answered in a yes/no format, multiple-choice response, and rating scales. ...
Background: Low-THC cannabis products have become popular worldwide and are used as
self-treatment for a variety of medical conditions despite limited high-quality evidence on efficacy
or long-term side-effects.
Method: We compare the experiences of CBD-oil-only users to that of users, who indicated use of
cannabis products conventionally higher in THC (high-THC cannabis) with respect to number of
symptoms relieved, overall perceived effect on symptoms, effect on pain level and sleep duration,
and perceived side-effects. A self-selected convenience sample of Danish cannabis users were
recruited to an anonymous online survey. Inclusion criteria were 18 years or older and use of
cannabis as medicine (CaM) (prescribed or non-prescribed).
Results: The final sample included 2.642 users of CaM, of which 992 were CBD-oil-only users and
1650 used high-THC products. Compared to respondents who used high-THC cannabis, CBD-oil-only
users reported fewer symptoms relieved by cannabis, a slightly lower overall symptom reduction, as
well as comparable pain reduction and sleep improvement. CBD-oil-only users reported fewer
side-effects and were more likely to report no side-effects of cannabis.
Conclusion: CBD-oils may produce less intense effects compared to high-THC cannabis products,
while also producing fewer side-effects. Regulation of the legal low-THC cannabis market is needed.
... This finding aligns with other studies which revealed that most medical cannabis patients are non-Hispanic White. 43,44 Over the years, non-Hispanic Blacks have been disproportionately arrested for non-violent possession of cannabis, which is still a Schedule 1 drug in the United States 45 The trauma from these experiences or sheer fear of arrest may account for their lack of interest in cannabis for medical use. In addition, our study revealed that survivors in support of cannabis legislation were more likely to be aware of and interested in cannabis use for cancer management. ...
Background
We examined the awareness, interest, and information sources relating to cannabis use for cancer management (including management of cancer symptoms and treatment‐related side effects) and determined factors associated with cancer survivors' awareness and interest in learning about cannabis use for cancer management.
Methods
This was a cross‐sectional study of adult cancer survivors ( N = 1886) receiving treatment at a comprehensive cancer center. Weighted prevalence and multivariable logistic regression analyses were conducted.
Results
Among cancer survivors, 88% were aware and 60% were interested in learning about cannabis use for cancer management. Common sources of information to learn about cannabis use for cancer management were cancer doctors/nurses (82%), other patients with cancer (27%), websites/blogs (26%), marijuana stores (20%), and family/friends (18%). The odds of being aware of cannabis use for cancer management was lower among male compared to female survivors (adjusted odds ratio [AOR]: 0.61; 95% confidence interval [CI]: 0.41–0.90), non‐Hispanic Blacks compared to non‐Hispanic Whites (AOR: 0.36; 95% CI: 0.21–0.62), and survivors who do not support the legalization of cannabis for medical use compared to those who do (AOR: 0.10; 95% CI: 0.04–0.23). On the other hand, the odds of being interested in cannabis use for cancer management was higher among non‐Hispanic Blacks compared to non‐Hispanic Whites (AOR: 1.65; 95% CI: 1.04–2.62), and among cancer survivors actively undergoing cancer treatment compared to patients on non‐active treatment (AOR: 2.25; 95% CI: 1.74–2.91).
Conclusion
Awareness of cannabis use for cancer management is high within the cancer survivor population. Results indicated health care providers are leading information source and should receive continued medical education on cannabis‐specific guidelines. Similarly, tailored educational interventions are needed to guide survivors on the benefits and risks of cannabis use for cancer management.
... The need for privacy may be due to individual differences and preferences, but it may also be due to their need to hide a stigmatized identity and avoid discrimination (Khachatryan et al., 2022). For others, a chronic health condition may require the treatment of a stigmatized drug, such as marijuana (e.g., Reinarman et al., 2011), and organizations may take away religious freedoms, including indigenous workers' drug usage for spiritual reasons (e.g., Farris & Lorence, 1995). Political beliefs and affiliation can be censured by organizations (e.g., Zilber, 2022), and legal cases such as Barbulescu v. Romania demonstrate how far organizations will go when encroaching on workers' personal, private lives overall (e.g, Jervis, 2018). ...
... A total of 37 patients (69.8%) reported depression in our sample, much higher than the estimated lifetime prevalence in community samples [71]. A history of depression has been found to be an important indicator of long-term symptoms following a TBI, which could explain the high proportion of patients who have experienced depression seeking alternative treatments [43,72]. Alternately, only 28 patients (52.8%) reported specifically using medical cannabis to help with their depression symptoms, which is similar to the prevalence in other medical cannabis studies [11,44,48]. ...
Aim: Traumatic brain injury (TBI) is a common neurological condition, which can present with a wide range of neuropsychological symptoms. Treating this broad spectrum of symptoms represents a significant medical challenge. In part because of this, there is growing interest in the use of medical cannabis to treat the sequelae of TBI, as medical cannabis has been used to treat multiple associated conditions, such as pain. However, medical cannabis represents a heterogeneous collection of therapies, and relatively little is known about their effectiveness in treating TBI symptoms. The aim of the present study was therefore to assess medical cannabis use in patients with TBI. Methods: In the present study, a retrospective chart review was conducted of patterns of cannabis use and TBI symptoms in individuals who used medical cannabis to treat TBI-related symptoms. All subjects were recruited from a medical cannabis clinic, where cannabis was authorized by physicians, using licensed cannabis products. A total of 53 subjects provided written consent to have their charts reviewed. Results: Neuropsychiatric conditions, including depression, pain, and anxiety were frequent in this group. The most common forms of medical cannabis consumption at intake included smoking, vaping, and oral ingestion. Patients used a combination of high tetrahydrocannabinol (THC)/low cannabidiol (CBD) and low THC/high CBD products, typically 1–3 times per day. Medical cannabis appeared to be relatively well-tolerated in subjects, with few serious side effects. At follow-up, subjects self-reported improvements in TBI symptoms, although these were not statistically significant when assessed using validated questionnaires. Conclusions: Overall findings indicate modest potential benefits of medical cannabis for TBI, but further research will be required to validate these results.
... The similarity in effects of THC on anti-nociception (tail flick latency) in males and females observed in our study was also reported in rats following THC vapor administration [39]. One of the most cited reasons for medical cannabis use is pain relief [73,74]. The periaqueductal gray, a brain region that contains CB1R-expressing somatodendritic structures and presynaptic terminals [75][76][77], is involved in pain modulation [78], and may play a role in the decreased pain sensitivity we observed following edible cannabis-induced poisoning. ...
Accidental exposure to Δ ⁹ -tetrahydrocannabinol (THC)-containing edible cannabis, leading to cannabis poisoning, is common in children and pets; however, the neural mechanisms underlying these poisonings remain unknown. Therefore, we examined the effects of acute edible cannabis-induced poisoning on neural activity and behavior. Adult Sprague-Dawley rats (6 males, 7 females) were implanted with electrodes in the prefrontal cortex (PFC), dorsal hippocampus (dHipp), cingulate cortex (Cg), and nucleus accumbens (NAc). Cannabis poisoning was then induced by exposure to a mixture of Nutella (6 g/kg) and THC-containing cannabis oil (20 mg/kg). Subsequently, cannabis tetrad and neural oscillations were examined 2, 4, 8, and 24 h after THC exposure. In another cohort (16 males, 15 females), we examined the effects of cannabis poisoning on learning and prepulse inhibition, and the serum and brain THC and 11-hydroxy-THC concentrations. Cannabis poisoning resulted in sex differences in brain and serum THC and 11-hydroxy-THC levels over a 24-h period. It also caused gamma power suppression in the Cg, dHipp, and NAc in a sex- and time-dependent manner. Cannabis poisoning also resulted in hypolocomotion, hypothermia, and anti-nociception in a time-dependent manner and impairments in learning and prepulse inhibition. Our results suggest that the impairments in learning and information processing may be due to the decreased gamma power in the dHipp and PFC. Additionally, most of the changes in neural activity and behavior appear 2 hours after ingestion, suggesting that interventions at or before this time might be effective in reversing or reducing the effects of cannabis poisoning.
... Estos dos usos médicos diferentes que se realizaron de la planta de Cannabis tuvieron un gran impacto en la medicina occidental, sobre todo debido a la escasez de opciones terapéuticas para enfermedades como tétanos, cólera, rabia, neuralgia, dismenorrea, convulsiones, asma, y reumatismo (Grinspoon, 1971 (Reinarman et. al, 2011). Las indicaciones médicas del Cannabis quedan resumidas en 1924 en -Sajous Analytic Cyclopedia of Practical Medicine‖ en tres áreas como sedante e hipnótico, analgésico y otros (Zuardi, 2006). Se estima que hasta finales del siglo XIX, los medicamentos a base de Cannabis eran unos de los más recetados en los EE.UU. (Gazmuri, 2014). Asim ...
... 3,4,[6][7][8][9] In 2011, researchers in California examined reasons for which patients utilized medical cannabis and found that pain, followed by insomnia and anxiety, were the top conditions that physicians recommended medical cannabis use. 10 A study conducted Florida found a reduction in the use of opioids and other pain-relieving medications while concomitantly using medical cannabis to treat their condition. 11 Researchers in other states have conducted exploratory and/or needs-based assessments specific to patients in their respective geographic locations, although the participants in these studies were not specifically certified medical cannabis patients 12,13 However, the results of these studies may not be representative of Pennsylvania patients as qualifying conditions are diverse and differ from other states. ...
Introduction/objectives:
Medical cannabis programs across the country vary and differ in their qualifying conditions for medical cannabis use. This has led to a gap in knowledge regarding the specific needs of cannabis patients, including the most common reason patients seek medical cannabis. The purpose of this study was to examine the current needs of medical cannabis patients in order to better inform future research, and to evaluate potential needs in policy changes in states with more restrictive qualifying conditions for medical cannabis use.
Methods:
A cross-sectional survey study was administered (n = 207) at a Laurel Harvest Labs dispensary in Pennsylvania. Participants were qualified medical cannabis users and were recruited as a convenience sample when entering the dispensary. The survey asked questions regarding participant demographics, medical cannabis qualifying conditions, usage, methods of administration, adverse effects, tolerance, and impact of medical cannabis on medication, alcohol, and tobacco use. Chi-squared or Fisher's exact tests were conducted for analyses involving categorical data.
Results:
The mean age of respondents was 36.7 years (SD = 12.8), and the majority were male (61.4%) and white (84.7%). Respondents self-reported that anxiety disorder was the most common qualifying medical condition and the most common comorbid condition (50.1%; 69.3%) for medical cannabis use. Additionally, approximately 95% of users reported having no adverse effects from using medical cannabis, and 90% of users preferred inhalation through vaporization as the preferred method of consumption. More than 50% of participants reported an improvement in their symptoms where only 20% of users reported being tolerant to their current dose. More than 70% of respondents reported that obtaining medical cannabis was "easy" and 54% of users reported that the cost of medical cannabis was not a barrier to access.
Conclusions:
Anxiety disorder is a prevalent condition for which medical cannabis is used; however, many states do not recognize anxiety disorder as a qualifying condition for medical cannabis. Further research on medical cannabis use for anxiety disorders is needed to evaluate proper dosing and responses to treatment.
... 5 Documentation of patients' medical cannabis use in the electronic health record (EHR) can support patient-clinician discussions of the risks of cannabis use and exploration of treatment alternatives. Patients use cannabis for a variety of health conditions, [6][7][8][9][10] and although evidence suggests potential benefit for neuropathic pain, appetite, nausea and vomiting, spasticity, and shortterm sleep outcomes, most health conditions for which patients use cannabis have insufficient or nonexistent evidence of benefit, potential contraindications, and more effective first-line treatment options. [11][12][13] Moreover, cannabis use has known risks, including increased risk of cannabis and other substance use disorders, mental health disorders, acute care utilization, and withdrawal. ...
Importance:
Patients who use cannabis for medical reasons may benefit from discussions with clinicians about health risks of cannabis and evidence-based treatment alternatives. However, little is known about the prevalence of medical cannabis use in primary care and how often it is documented in patient electronic health records (EHR).
Objective:
To estimate the primary care prevalence of medical cannabis use according to confidential patient survey and to compare the prevalence of medical cannabis use documented in the EHR with patient report.
Design, setting, and participants:
This study is a cross-sectional survey performed in a large health system that conducts routine cannabis screening in Washington state where medical and nonmedical cannabis use are legal. Among 108 950 patients who completed routine cannabis screening (between March 28, 2019, and September 12, 2019), 5000 were randomly selected for a confidential survey about cannabis use, using stratified random sampling for frequency of past-year use and patient race and ethnicity. Data were analyzed from November 2020 to December 2021.
Exposures:
Survey measures of patient-reported past-year cannabis use, medical cannabis use (ie, explicit medical use), and any health reason(s) for use (ie, implicit medical use).
Main outcomes and measures:
Survey data were linked to EHR data in the year before screening. EHR measures included documentation of explicit and/or implicit medical cannabis use. Analyses estimated the primary care prevalence of cannabis use and compared EHR-documented with patient-reported medical cannabis use, accounting for stratified sampling and nonresponse.
Results:
Overall, 1688 patients responded to the survey (34% response rate; mean [SD] age, 50.7 [17.5] years; 861 female [56%], 1184 White [74%], 1514 non-Hispanic [97%], and 1059 commercially insured [65%]). The primary care prevalence of any past-year patient-reported cannabis use on the survey was 38.8% (95% CI, 31.9%-46.1%), whereas the prevalence of explicit and implicit medical use were 26.5% (95% CI, 21.6%-31.3%) and 35.1% (95% CI, 29.3%-40.8%), respectively. The prevalence of EHR-documented medical cannabis use was 4.8% (95% CI, 3.45%-6.2%). Compared with patient-reported explicit medical use, the sensitivity and specificity of EHR-documented medical cannabis use were 10.0% (95% CI, 4.4%-15.6%) and 97.1% (95% CI, 94.4%-99.8%), respectively.
Conclusions and relevance:
These findings suggest that medical cannabis use is common among primary care patients in a state with legal use, and most use is not documented in the EHR. Patient report of health reasons for cannabis use identifies more medical use compared with explicit questions about medical use.
... In addition, our study is the first to examine medical cannabis services in New York, which has one of the most stringent medical cannabis policies in the US. In the only study that we are aware of that examined disparities in medical cannabis certification, only 14% of patients assessed for certification at nine medical cannabis clinics in California were Hispanic, while 32% of Californians were Hispanic [32]. Our study did not find a relationship between the percentage of Hispanic residents in a census tract and the availability of cannabis services. ...
Background
Within the United States (US), because racial/ethnic disparities in cannabis arrests continue, and cannabis legalization is expanding, understanding disparities in availability of legal cannabis services is important. Few studies report mixed findings regarding disparities in availability of legal cannabis services; none examined New York. We examined disparities in availability of medical cannabis services in New York. We hypothesized that New York census tracts with few Black or Hispanic residents, high incomes, high education levels, and greater urbanicity would have more medical cannabis services.
Methods
In this cross-sectional study, we used data from the 2018 US Census Bureau 5-year American Community Survey and New York Medical Marijuana Program. Main exposures were census tract characteristics, including urban–rural classification, percentage of Black and Hispanic residents, percentage of residents with bachelor’s degrees or higher, and median household income. Main outcomes were presence of at least one medical cannabis certifying provider and dispensary in each census tract. To compare census tracts’ characteristics with (vs. without) certifying providers and dispensaries, we used chi-square tests and t-tests. To examine characteristics independently associated with (vs. without) certifying providers, we used multivariable logistic regression.
Results
Of 4858 New York census tracts, 1073 (22.1%) had medical cannabis certifying providers and 37 (0.8%) had dispensaries. Compared to urban census tracts, suburban census tracts were 62% less likely to have at least one certifying provider (aOR = 0.38; 95% CI = 0.25–0.57). For every 10% increase in the proportion of Black residents, a census tract was 5% less likely to have at least one certifying provider (aOR = 0.95; 95% CI = 0.92–0.99). For every 10% increase in the proportion of residents with bachelor’s degrees or higher, a census tract was 30% more likely to have at least one certifying provider (aOR = 1.30; 95% CI = 1.21–1.38). Census tracts with (vs. without) dispensaries were more likely to have a higher percentage of residents with bachelor’s degrees or higher (43.7% vs. 34.1%, p < 0.005).
Conclusions
In New York, medical cannabis services are least available in neighborhoods with Black residents and most available in urban neighborhoods with highly educated residents. Benefits of legal cannabis must be shared by communities disproportionately harmed by illegal cannabis.
The need for nonaddictive and effective treatments for chronic pain are at an all-time high. Historical precedence, and now clinical evidence, supports the use of cannabis for alleviating chronic pain. A plethora of research on delta-9-tetrahydrocannabinol exists, yet cannabis is comprised of a multitude of constituents, some of which possess analgesic potential, that have not been systematically investigated, including the terpene myrcene. Myrcene attenuates pain hypersensitivity in preclinical models and is one of the most abundant terpenes found in cannabis. Despite these findings, it remains unclear how myrcene elicits these effects on nociceptive systems. The present study uses a male and female mouse model of neuropathic pain as well as in vitro experiments with HEK293T cells to explore these questions. We first demonstrate myrcene (1-200 mg/kg i.p.) dose-dependently increases mechanical nociceptive thresholds, where potency was greater in female compared with male pain mice. Testing canonical tetrad outcomes, mice were tested for hypolocomotion and hypothermia after myrcene administration. Myrcene did not alter locomotion or temperature, but female pain mice showed a conditioned place aversion to myrcene. A cannabinoid receptor 1 (CB1) antagonist inhibited myrcene's anti-allodynia. By contrast, in vitro cell culture experiments using a TRUPATH assay revealed myrcene does not directly activate CB1 receptors nor alter CB1 receptor activity elicited by CB1 agonist (CP 55,940) or endocannabinoids (anandamide or 2-arachidonoylglycerol). Understanding engagement of CB1 receptors in pain modulation and myrcene's mechanism of action warrants further study to understand the diversity of cannabis pharmacology and to further the frontier of pain research.
Background: Research suggests that individuals who experience four or more adverse childhood experiences (ACEs) have increased rates of cannabis use. However, most prior research does not separate recreational and medical usage. Medical cannabis is used legally in many states to treat a variety of health conditions, many of which are also associated with ACEs. Objectives: Therefore, we explore the extent to which medical cannabis users differ from recreational cannabis users and whether medical use is associated with ACEs, poor health, or disability. Accordingly, we ask the following questions: Are ACEs associated with any cannabis use when controlling for measures of poor health and disability? Are ACEs associated with medical cannabis use? Are associations between ACEs and medical cannabis use explained by poor health and/or disability? Results: Using 2019 BRFSS data, we find that ACEs are significantly associated with cannabis use, but that disability and poor health fully account for the effect of ACEs on medical cannabis use. Conclusions: We conclude that practitioners screen for ACEs and disability status when prescribing medical cannabis.
This research study sought to explore the impact that cannabis use has on mental
health, by providing insights into these two variables from the perspective of health
and social care professionals. The research highlights both positive and negative
effects that cannabis has on people’s mental health. It also shines a light on how
legalising recreational cannabis in Malta impacted the perceptions of Maltese citizens,
promoting a normalisation and a mistakenly favourable view of cannabis use for
recreational purposes.
Seven semi-structured interviews were conducted with health and social care
professionals selected through purposive sampling, who specialised in the field of
cannabis and mental health. The collected data was analysed through thematic
analysis. The study found that the negative impact of cannabis by far outweighs the
positive effects on people’s mental health and raised the alarm that legalising
recreational cannabis has normalised Maltese people’s perception of the recreational
use of cannabis, promoting the misconception of the harmless nature of cannabis
consumptions. These findings indicate the pressing need of making people more
aware of the negative consequences that cannabis has on mental health.
Furthermore, on a relatively new phenomenon- Maltese people’s changed perception
of cannabis use induced by legalisation of recreational cannabis use- is also important
for professionals working in the sector as it can help increase their knowledge and
understanding of the subject. This research showed that it is crucial to implement more
policies in place as the current legalisation is not being enforced well and not enough
awareness of the dangers posed by driving under the influence of cannabis use is
being raised. Such policies could include more educational campaigns to raise
awareness of the negative effects that cannabis use can produce.
Background
Although death is a primary motivator of behavior, it is not widely studied in marketing.
Focus of the Article
Through case analysis, integration of literature, and in-depth interviews of terminally ill patients, we explore the factors that change the consumption of medical treatment and the social issues that arise between themselves and other key stakeholders.
Research Question
What variables impact the decision-making process of terminally ill patients who choose to use an illegal treatment option?
Program Design/Approach
We explore the factors influencing consumption practices at the end of life through case analysis, literature integration, and in-depth interviews of terminally ill patients.
Importance to Social Marketing Field
This research gives social marketers a rare glimpse into the mind of the consumer at a pivotal moment of consumption end-of-life. Our exploration shows that when the conventional medical system fails, medical consumers engage in creative consumption patterns. Understanding these patterns allows social marketers to better understand and engage with terminally or chronically ill consumers.
Methods
This is a qualitative study using in-depth interviews.
Results
This study found that having an intimate relationship with mortality eliminates or weakens the constraints of cultural institutions and social groups as a part of the decision-making process.
Background: Although research suggests that early-life adversity (ELA) and cannabis use are linked, researchers have not established factors that mediate or modify this relationship. Identifying such factors could help in developing targeted interventions. We explored chronic pain as a potential mediator or moderator of this relationship. Methods: Using an online study, we collected cross-sectional data about ELA, cannabis use, and chronic pain to test whether ELA (adverse childhood experiences total score) is associated with cannabis use, and to examine pain as a potential mediator or moderator. Cannabis use was examined two ways: times used per day, and categorized as non-, some, or regular use. Chronic pain was measured as present/absent and as the number of painful body locations (0-8). Analyses used linear and multinomial regression. Results: ELA, chronic pain, and cannabis use were common among respondents. ELA was strongly associated with both measures of cannabis use. The number of painful body locations modestly mediated the association of ELA with cannabis use, reducing the magnitude of regression coefficients by about 1/7. The number of painful body locations modified the association between ELA and cannabis use (p≤0.006), while chronic pain presence/absence (a less-informative measure) had only a nonsignificant modification effect (p≥0.10). When either ELA or pain was high, the other was not associated with cannabis use; when either ELA or pain was low, more painful locations or higher ELA (respectively) was associated with more intense cannabis use. Conclusion: These exploratory findings suggest the importance of ELA and chronic pain as factors contributing to cannabis use, and of accounting for these factors in developing treatment and prevention strategies addressing cannabis use.
This systematic review and meta-analysis aimed to comprehensively evaluate the effectiveness of electroacupuncture (EA) for patients with anxiety. Randomized controlled trials (RCTs) on the treatment of anxiety by EA up to November 2022 were searched and collected from nine databases. Hamilton Anxiety Rating Scale (HAMA), self-rating anxiety scale (SAS), and adverse reactions were used as outcome indicators. The quality of relevant articles was evaluated using the Cochrane Collaboration’s risk of bias tool. The quality of evidence for each outcome was classified as “low risk,” “unclear risk,” or “high risk.” RevMan 5.0 was used for data analysis. A total of 633 articles were identified from nine electronic databases; 37 RCTs were included, which measured anxiety changes by using EA alone compared to the control group. For the main outcome, EA significantly reduced the HAMA score [Mean difference (MD):−1.13 (95% CI:−2.55–0.29), I²:80%], and the quality of evidence was moderate. EA significantly reduced the SAS score (MD:−3.47 (95% CI,−6.57−−0.36), I²:88%), and the quality of evidence was moderate. Our meta-analysis shows that EA reduces HAMA and SAS. This study suggests that EA can relieve anxiety. For various uses, additional research is needed on its effect when combined with other treatments.
Systematic review registration
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=345658, identifier (CRD42022345658).
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.
In recent years there has been an increase in cannabis use among adults in the U.S., which corresponds with changes in state-level laws making cannabis available for medical/recreational use. While cannabis became available for medical use in Florida in 2014, it was not until a ban on smoking cannabis was lifted in 2019 that the number of patients began to increase. The data for the current study are the Florida Young Adult Cannabis Study and focus on 415 medical cannabis patients (MCP). We identified several significant differences between male and female MCP. Female MCP initiated regular cannabis use at a younger age and reported more frequent cannabis use. Female MCP were more likely to endorse self-treatment motives while male MCP were more likely to endorse recreational motives. As Florida is one of the largest and most diverse states in the U.S., research on MCP is needed to inform policy.
Background:
Patients suffering from arthritis have limited treatment options for nonoperative management. In search of pain relief, patients have been taking over-the-counter cannabinoids. Cannabidiol (CBD) and cannabichromene (CBC) are minor cannabinoids with reported analgesic and anti-inflammatory properties and have been implicated as potential therapeutics for arthritis-related pain. To this end, we utilized a murine model to investigate the effectiveness of and mechanism by which CBC alone, CBD alone, or CBD and CBC in combination may provide a reduction in arthritis-associated inflammation.
Methods:
Forty-eight mice were included in the study, which were separated into 4 groups: control group (n = 12), treatment with CBD alone (n = 12), treatment with CBC alone (n = 12), and treatment with CBD + CBC (n = 12). We induced inflammation in each mouse utilizing the collagen-induced arthritis model. At scheduled timepoints, mice were clinically assessed for weight gain, swelling, and arthritis severity. In addition, inflammation-associated serum cytokine levels were analyzed for each animal.
Results:
Thirty-five of 48 mice survived the duration of the study resulting in the following group numbers: control group (n = 8), treatment with CBD alone (n = 9), treatment with CBC alone (n = 9), and treatment with CBD + CBC (n = 9). Animals treated with CBC and CBD + CBC showed significant weight gain between 3 and 5 weeks. Irrespective of treatment, regression analysis comparing all cytokine measurement and physical outcomes found a significant positive correlation between levels of 5 individual cytokines and both arthritis scores and swelling. Animals treated with CBD + CBC showed a significant decrease in swelling between 3 and 5 weeks compared with the control group. Cannabinoid treatment selectively affected the gene expression of eotaxin and lipopolysaccharide-induced CXC chemokine with combined treatment of CBC + CBD.
Conclusion:
Treatment with cannabinoids resulted in decreased clinical markers of inflammation. Further, the anti-inflammatory effect of CBC and CBD in conjunction was associated with a greater anti-inflammatory effect than either minor cannabinoid alone. Future work will elucidate the possibility of synergistic or entourage effects of minor cannabinoids used in combination for the treatment of arthritis-related pain and inflammation.
An updated third edition of this award-winning book provides a comprehensive overview of the complex associations between cannabis and mental illness. Organised into easy to navigate sections, the book has been fully revised to feature eight entirely new chapters covering important novel aspects. Marijuana and Madness incorporates new research findings on the potential use of cannabinoids, and synthetic cannabinoids, in an array of mental illnesses, balanced against the potential adverse effects. The associations between cannabis and psychosis, developing putative models of 'cannabis induced' psychosis and pathways to schizophrenia are all covered. The book importantly discusses the impact of exposure to cannabis at various stages of neurodevelopment (in utero, in childhood, and during adolescence) and it thoroughly reviews the treatments for cannabis dependence and health policy implications of the availability of increasingly high potency cannabis. This book will quickly become an essential resource for all members of the mental health team.
Drug treatment courts are challenged by the ongoing trend of marijuana legalization. In states where it is legal for adult citizens to consume marijuana for medical and recreational purposes, treatment courts need to determine whether participants should be allowed to consume or possess marijuana. By analyzing the written policies of treatment courts in states that have legalized recreational and medical marijuana, this study explores how treatment courts address such challenges. The review shows a large percentage of drug treatment courts have yet to clearly communicate their marijuana policies with the participants in writing. However, among the drug treatment courts that have established marijuana-specific policies, the vast majority of courts continue to ban the use of marijuana while a few courts allow medical marijuana use on an individual basis.
Background:
Cannabis legalization for medical and recreational purposes has been suggested as an effective strategy to reduce opioid and benzodiazepine use and deaths. We examined the county-level association between medical and recreational cannabis laws and poisoning deaths involving opioids and benzodiazepines in the US in 2002-2020.
Methods:
Our ecologic county-level, spatiotemporal study comprised 49 states. Exposures were state-level implementation of medical and recreational cannabis laws and state-level initiation of cannabis dispensary sales. Our main outcomes were poisoning deaths involving any opioid, any benzodiazepine, and opioids with benzodiazepines. Secondary analyses included overdoses involving natural and semi-synthetic opioids, synthetic opioids, and heroin.
Results:
Implementation of medical cannabis laws was associated with increased deaths involving opioids (rate ratio [RR]=1.14; 95% credible interval [CrI]: 1.11, 1.18), benzodiazepines (RR=1.19; 95%CrI: 1.12, 1.26), and opioids+benzodiazepines (RR=1.22; 95%CrI: 1.15, 1.30). Medical cannabis legalizations allowing dispensaries was associated with fewer deaths involving opioids (RR=0.88; 95%CrI: 0.85, 0.91) but not benzodiazepine deaths; results for recreational cannabis implementation and opioid deaths were similar (RR=0.81, 95%CrI: 0.75, 0.88). Recreational cannabis laws allowing dispensary sales was associated with consistent reductions in opioid- (RR=0.83; 95%CrI: 0.76, 0.91), benzodiazepine- (RR=0.79; 95%CrI: 0.68, 0.92), and opioid+benzodiazepine-related poisonings (RR=0.83; 95%CrI: 0.70, 0.98).
Conclusions:
Implementation of medical cannabis laws was associated with higher rates of opioid- and benzodiazepine-related deaths, while laws permitting broader cannabis access, including implementation of recreational cannabis laws and medical and recreational dispensaries, were associated with lower rates. Estimated effects of expanded availability of cannabis seem dependent on the type of law implemented and its provisions.
Driving under the influence of cannabis (DUIC) is a major cause of preventable death and a growing public health concern. News media coverage of DUIC may influence public perceptions of causal factors for DUIC, risks of DUIC, and potential policy solutions. This study examines Israeli news media coverage of DUIC, and contrasts media coverage according to whether news items refer to cannabis use for medical vs. non-medical purposes. We conducted a quantitative content analysis of news articles related to driving accidents and cannabis use (N = 299) from eleven of the highest circulation newspapers in Israel between 2008 and 2020. We apply attribution theory to analyze media coverage of accidents that were linked to medical cannabis, use compared with non-medical use. News items describing DUIC in the context of non-medical (vs. medical) cannabis use were more likely to: (a) emphasize individual causes (vs. social and political); (b) describe drivers in negative terms (vs. neutral or positive); (c) refer to an increased accident risk due to cannabis use (vs. inconclusive or low risk); and (d) call for increased enforcement rather than education. Results show that Israeli news media coverage of cannabis-impaired driving varied significantly depending on whether it referred to cannabis use for medical purposes, or non-medical purposes. News media coverage may influence public perceptions of the risks of DUIC, the factors that are associated with this issue, and potential policy solutions that may reduce the prevalence of DUIC in Israel.
Background
Evidence for long-term effectiveness of commercial cannabis products used to treat medical symptoms is inconsistent, despite increasingly widespread use.
Objective
To prospectively evaluate the effects of using cannabis on self-reported symptoms of pain, insomnia, anxiety, depression, and cannabis use disorder (CUD) after 12 months of use.
Methods
This observational cohort study describes outcomes over 9 months following a 12-week randomized, waitlist-controlled trial (RCT: NCT03224468) in which adults (N = 163) who wished to use cannabis to alleviate insomnia, pain, depression, or anxiety symptoms were randomly assigned to obtain a medical marijuana card immediately (immediate card acquisition group) or to delay obtaining a card for 12 weeks delay (delayed card acquisition group). During the 9-month post-randomization period, all participants could use cannabis as they wished and choose their cannabis products, doses, and frequency of use. Insomnia, pain, depression, anxiety, and CUD symptoms were assessed over the 9-month post-randomization period.
Results
After 12 months of using cannabis for medical symptoms, 11.7% of all participants (n = 19), and 17.1% of those using cannabis daily or near-daily (n = 6) developed CUD. Frequency of cannabis use was positively correlated with pain severity and number of CUD symptoms, but not significantly associated with severity of self-reported insomnia, depression, or anxiety symptoms. Depression scores improved throughout the 9 months in all participants, regardless of cannabis use frequency.
Conclusions
Frequency of cannabis use was not associated with improved pain, anxiety, or depression symptoms but was associated with new-onset cannabis use disorder in a significant minority of participants. Daily or near-daily cannabis use appears to have little benefit for these symptoms after 12 months of use.
This was a retrospective study of patients utilizing medical cannabis who received their medical cannabis documentation and allotment from a Harvest Medicine clinic in Canada to determine the impact of medical cannabis on anxiety and depression outcomes. Patients included in the study were at least 18 years of age with completed validated questionnaires for anxiety (GAD-7) and depression (PHQ-9) at their initial evaluation and at least one follow-up visit. There were 7,362 patients included in the sample, of which the average age was 49.8 years, and 53.1% were female. There were statistically significant improvements between baseline and follow-up scores for both the GAD-7 and PHQ-9, with larger improvements seen for patients who were actively seeking medical cannabis to treat anxiety or depression. From 12 months on, those reporting anxiety had an average decrease in GAD-7 scores that was greater than the minimum clinically important difference of 4, and the same was seen for patients reporting depression from 18 months on, with the average decrease in PHQ-9 scores more than the MCID minimum clinically important difference of 5. This study provides some evidence to support the effectiveness of medical cannabis as a treatment for anxiety and depression.
Given the rapid change in legal status and rise in cannabis use within the United States (U.S.), pharmacists will increasingly require competence in issues related to cannabis, especially for medical use. Pharmacy students and professionals in other health fields report low levels of cannabis knowledge, and medical cannabis users report that their knowledge is mostly from their own experiences and the internet. Several pharmacy organizations have advocated for pharmacists' education on therapeutic and legal issues related to medical cannabis. To determine the extent to which cannabis and its medical use are covered in the educational curricula of U.S. schools and colleges of pharmacy, plans for future coverage of medical cannabis, and differences by the state‐level legal status of cannabis. Pharmacy schools and colleges located within the U.S. were identified via the Accreditation Council for Pharmacy Education website. A 19‐item survey was developed by researchers with experience in curriculum development and pharmaceutical issues related to cannabis. One individual from each school provided detailed information on the inclusion of medical cannabis/marijuana topics in their Doctor of Pharmacy program. Two‐thirds (67%) of programs responded to the survey. Most programs (85.4%) had content on medical cannabis available in their curriculum, 53.1% in their required curriculum, 65.6% in their elective curriculum, and 33.0% in both their required and elective curricula. A small proportion (16.7%) had a stand‐alone medical cannabis elective course. Stand‐alone electives had the most comprehensive coverage of cannabis topics. General required and elective courses had minor differences in comprehensiveness. Results demonstrate a moderately rapid expansion in cannabis coverage in pharmacy curricula, although coverage of cannabis topics is rarely comprehensive. Additional efforts are needed to integrate cannabis into coursework and experiential learning experiences.
Objectives: To examine the proportion of individuals using cannabis for medical purposes who reported nonmedical use of cannabis after it became legal to do so. Materials and Methods: We acquired data from the Population Assessment for Tomorrow's Health, the Cannabis Legalization Surveillance Study on a subpopulation of participants residing in Hamilton, Ontario, Canada, who reported using cannabis for medical purposes. Specifically, we acquired data 6 months before, and again 6 months after, legalization of cannabis for nonmedical purposes. We constructed a logistic regression model to explore the association between potential explanatory factors and endorsing exclusively nonmedical use after legalization and reported associations as odds ratios and 95% confidence intervals. Results: Our sample included 254 respondents (mean age 33±13; 61% female), of which 208 (82%) reported both medical and nonmedical use of cannabis (dual motives) before legalization for nonmedical purposes, and 46 (18%) reported cannabis use exclusively for medical purposes. Twenty-five percent (n=63) indicated they had medical authorization to use medical cannabis, of which 37 (59%) also endorsed nonmedical use. After legalization of nonmedical cannabis, ∼1 in 4 previously exclusive cannabis users for medical purposes declared dual use (medical and nonmedical), and ∼1 in 4 previously dual users declared exclusively nonmedical use of cannabis. No individual with medical authorization reported a change to exclusively nonmedical use after legalization. Our adjusted regression analysis found that younger age, male sex, and lacking authorization for cannabis use were associated with declaring exclusively nonmedical use of cannabis after legalization. Anxiety, depression, impaired sleep, pain, and headaches were among the most common complaints for which respondents used cannabis therapeutically. Most respondents reported using cannabis as a substitute for prescription medication at least some of the time, and approximately half reported using cannabis as a substitute for alcohol at least some of the time. Conclusions: In a community sample of Canadian adults reporting use of cannabis for medical purposes, legalization of nonmedical cannabis was associated with a substantial proportion changing to either dual use (using cannabis for both medical and nonmedical purposes) or exclusively nonmedical use. Younger men without medical authorization for cannabis use were more likely to declare exclusively nonmedical use after legalization.
Importance:
Despite the legalization and widespread use of cannabis products for a variety of medical concerns in the US, there is not yet a strong clinical literature to support such use. The risks and benefits of obtaining a medical marijuana card for common clinical outcomes are largely unknown.
Objective:
To evaluate the effect of obtaining a medical marijuana card on target clinical and cannabis use disorder (CUD) symptoms in adults with a chief concern of chronic pain, insomnia, or anxiety or depressive symptoms.
Design, setting, and participants:
This pragmatic, single-site, single-blind randomized clinical trial was conducted in the Greater Boston area from July 1, 2017, to July 31, 2020. Participants were adults aged 18 to 65 years with a chief concern of pain, insomnia, or anxiety or depressive symptoms. Participants were randomized 2:1 to either the immediate card acquisition group (n = 105) or the delayed card acquisition group (n = 81). Randomization was stratified by chief concern, age, and sex. The statistical analysis followed an evaluable population approach.
Interventions:
The immediate card acquisition group was allowed to obtain a medical marijuana card immediately after randomization. The delayed card acquisition group was asked to wait 12 weeks before obtaining a medical marijuana card. All participants could choose cannabis products from a dispensary, the dose, and the frequency of use. Participants could continue their usual medical or psychiatric care.
Main outcomes and measures:
Primary outcomes were changes in CUD symptoms, anxiety and depressive symptoms, pain severity, and insomnia symptoms during the trial. A logistic regression model was used to estimate the odds ratio (OR) for CUD diagnosis, and linear models were used for continuous outcomes to estimate the mean difference (MD) in symptom scores.
Results:
A total of 186 participants (mean [SD] age 37.2 [14.4] years; 122 women [65.6%]) were randomized and included in the analyses. Compared with the delayed card acquisition group, the immediate card acquisition group had more CUD symptoms (MD, 0.28; 95% CI, 0.15-0.40; P < .001); fewer self-rated insomnia symptoms (MD, -2.90; 95% CI, -4.31 to -1.51; P < .001); and reported no significant changes in pain severity or anxiety or depressive symptoms. Participants in the immediate card acquisition group also had a higher incidence of CUD during the intervention (17.1% [n = 18] in the immediate card acquisition group vs 8.6% [n = 7] in the delayed card acquisition group; adjusted odds ratio, 2.88; 95% CI, 1.17-7.07; P = .02), particularly those with a chief concern of anxiety or depressive symptoms.
Conclusions and relevance:
This randomized clinical trial found that immediate acquisition of a medical marijuana card led to a higher incidence and severity of CUD; resulted in no significant improvement in pain, anxiety, or depressive symptoms; and improved self-rating of insomnia symptoms. Further investigation of the benefits of medical marijuana card ownership for insomnia and the risk of CUD are needed, particularly for individuals with anxiety or depressive symptoms.
Trial registration:
ClinicalTrials.gov Identifier: NCT03224468.
Rationale
Adolescent cannabinoid exposure has been shown to alter cognitive, reward-related, and motor behaviors as well as mesocorticolimbic dopamine (DA) function in adult animals. Pain is also influenced by mesocorticolimbic DA function, but it is not known whether pain or cannabinoid analgesia in adults is altered by early exposure to cannabinoids.
Objective
To determine whether adolescent Δ⁹-tetrahydrocannabinol (THC) exposure alters pain-related behaviors before and after induction of persistent inflammatory pain, and whether it influences antinociceptive of THC, in adult rats, and to compare the impact of adolescent THC exposure on pain to its effects on known DA-dependent behaviors such as exploration and consumption of a sweet solution.
Methods
Vehicle or THC (2.5 to 10 mg/kg s.c.) was administered daily to male and female rats on post-natal day (PND) 30–43. In adulthood (PND 80–88), sensitivity to mechanical and thermal stimuli before and after intraplantar injection of complete Freund’s adjuvant (CFA) was determined. Antinociceptive, exploratory, and consummatory effects of 2.0 mg/kg THC were then examined.
Results
Adolescent THC exposure did not significantly alter adult sensitivity to non-noxious or noxious stimuli either before or after CFA injection, nor did it alter the antinociceptive effect of THC. In contrast, adolescent THC exposure altered adult exploratory and consummatory behaviors in a sex-dependent manner: when tested as adults, adolescent THC-treated males showed less hedonic drinking than adolescent vehicle-treated males, and females but not males that had been THC-exposed as adolescents showed reduced sensitivity to THC-induced suppression of activity and THC-induced hedonic drinking as adults.
Conclusions
Adolescent THC exposure that altered both exploratory and consummatory behaviors in adults did not alter pain-related behaviors either before or after induction of inflammatory pain, suggesting that cannabinoid exposure during adolescence is not likely to substantially alter pain or cannabinoid analgesia in adulthood.
The possible medicinal uses of cannabis are growing, yet research on how patients use medical cannabis facility services remains scarce. This article reports on the Cannabis Care Study, in which 130 medical cannabis patients at seven facilities in the San Francisco Bay Area were surveyed to gather information about demographics, personal health practices, health outcomes, service use, and satisfaction with medical cannabis facilities. The study was modeled after Andersen's Behavioral Model of Health Services Use. Results show that patients tend to be males older than 35, identify with multiple ethnicities, and report variable symptom duration and current health status. Nearly half the sample reported substituting cannabis for alcohol and illegal drugs; 74% reported substituting it for prescription drugs. Satisfaction did not differ across study sites and was significantly higher than nationally reported satisfaction with health care. Implications for the medical cannabis community and the greater system of health and social care are discussed.
Our aim was to determine the combined and independent effects of tobacco and marijuana smoking on respiratory symptoms and chronic obstructive pulmonary disease (COPD) in the general population.
We surveyed a random sample of 878 people aged 40 years or older living in Vancouver, Canada, about their respiratory history and their history of tobacco and marijuana smoking. We performed spirometric testing before and after administration of 200 microg of salbutamol. We examined the association between tobacco and marijuana smoking and COPD.
The prevalence of a history of smoking in this sample was 45.5% (95% confidence interval [CI] 42.2%-48.8%) for marijuana use and 53.1% (95% CI 49.8%-56.4%) for tobacco use. The prevalence of current smoking (in the past 12 months) was 14% for marijuana use and 14% for tobacco use. Compared with nonsmokers, participants who reported smoking only tobacco, but not those who reported smoking only marijuana, experienced more frequent respiratory symptoms (odds ratio [OR] 1.50, 95% CI 1.05-2.14) and were more likely to have COPD (OR 2.74, 95% CI 1.66-4.52). Concurrent use of marijuana and tobacco was associated with increased risk (adjusted for age, asthma and comorbidities) of respiratory symptoms (OR 2.39, 95% CI 1.58-3.62) and COPD (OR 2.90, 95% CI 1.53-5.51) if the lifetime dose of marijuana exceeded 50 marijuana cigarettes. The risks of respiratory symptoms and of COPD were related to a synergistic interaction between marijuana and tobacco.
Smoking both tobacco and marijuana synergistically increased the risk of respiratory symptoms and COPD. Smoking only marijuana was not associated with an increased risk of respiratory symptoms or COPD.
A random-sample, anonymous survey of the members of the American Society of Clinical Oncology (ASCO) was conducted in spring 1990 measuring the attitudes and experiences of American oncologists concerning the antiemetic use of marijuana in cancer chemotherapy patients. The survey was mailed to about one third (N = 2,430) of all United States-based ASCO members and yielded a response rate of 43% (1,035). More than 44% of the respondents report recommending the (illegal) use of marijuana for the control of emesis to at least one cancer chemotherapy patient. Almost one half (48%) would prescribe marijuana to some of their patients if it were legal. As a group, respondents considered smoked marijuana to be somewhat more effective than the legally available oral synthetic dronabinol ([THC] Marinol; Unimed, Somerville, NJ) and roughly as safe. Of the respondents who expressed an opinion, a majority (54%) thought marijuana should be available by prescription. These results bear on the question of whether marijuana has a "currently accepted medical use," at issue in an ongoing administrative and legal dispute concerning whether marijuana in smoked form should be available by prescription along with synthetic THC in oral form. This survey demonstrates that oncologists' experience with the medical use of marijuana is more extensive, and their opinions of it are more favorable, than the regulatory authorities appear to have believed.
Cannabinoid use could potentially alter HIV RNA levels by two mechanisms: immune modulation or cannabinoid-protease inhibitor interactions (because both share cytochrome P-450 metabolic pathways).
To determine the short-term effects of smoked marijuana on the viral load in HIV-infected patients.
Randomized, placebo-controlled, 21-day intervention trial.
The inpatient General Clinical Research Center at the San Francisco General Hospital, San Francisco, California.
67 patients with HIV-1 infection.
Participants were randomly assigned to a 3.95%-tetrahydrocannabinol marijuana cigarette, a 2.5-mg dronabinol (delta-9-tetrahydrocannabinol) capsule, or a placebo capsule three times daily before meals.
HIV RNA levels, CD4+ and CD8+ cell subsets, and pharmacokinetic analyses of the protease inhibitors.
62 study participants were eligible for the primary end point (marijuana group, 20 patients; dronabinol group, 22 patients; and placebo group, 20 patients). Baseline HIV RNA level was less than 50 copies/mL for 36 participants (58%), and the median CD4+ cell count was 340 x 109 cells/L. When adjusted for baseline variables, the estimated average effect versus placebo on change in log10 viral load from baseline to day 21 was -0.07 (95% CI, -0.30 to 0.13) for marijuana and -0.04 (CI, -0.20 to 0.14) for dronabinol. The adjusted average changes in viral load in marijuana and dronabinol relative to placebo were -15% (CI, -50% to 34%) and -8% (CI, -37% to 37%), respectively. Neither CD4+ nor CD8+ cell counts appeared to be adversely affected by the cannabinoids.
Smoked and oral cannabinoids did not seem to be unsafe in people with HIV infection with respect to HIV RNA levels, CD4+ and CD8+ cell counts, or protease inhibitor levels over a 21-day treatment.
Surveys of physicians' attitudes regarding the therapeutic value of marijuana are rare. Drawing on a national sample of family physicians, general internists, obstetrician-gynecologists, psychiatrists, and addiction specialists, 960 (adjusted response rate 66%) offered opinions about the legal prescription of marijuana as medical therapy. Thirty-six percent believed prescribed marijuana should be legal and 26% were neutral to the proposition. Non-moralistic attitudes toward substance use were significantly associated with support for physician prescription, as was internal medicine and obstetrics-gynecology specialization. Physicians are, in general, less supportive than the general American public regarding the use of medical marijuana.
Cannabis (marijuana) had been used for medicinal purposes for millennia. Cannabinoid agonists are now attracting growing interest and there is also evidence that botanical cannabis is being used as self-medication for stress and anxiety as well as adjunctive therapy by the seriously ill and by patients with terminal illnesses. California became the first state to authorize medicinal use of cannabis in 1996, and it was recently estimated that between 250,000 and 350,000 Californians may now possess the physician's recommendation required to use it medically. More limited medical use has also been approved in 12 additional states and new initiatives are being considered in others. Despite that evidence of increasing public acceptance of "medical" use, a definitional problem remains and all use for any purpose is still prohibited by federal law.
California's 1996 initiative allowed cannabis to be recommended, not only for serious illnesses, but also "for any other illness for which marijuana provides relief," thus maximally broadening the range of allowable indications. In effect, the range of conditions now being treated with federally illegal cannabis, the modes in which it is being used, and the demographics of the population using it became potentially discoverable through the required screening of applicants. This report examines the demographic profiles and other selected characteristics of 4117 California marijuana users (62% from the Greater Bay Area) who applied for medical recommendations between late 2001 and mid 2007.
This study yielded a somewhat unexpected profile of a hitherto hidden population of users of America's most popular illegal drug. It also raises questions about some of the basic assumptions held by both proponents and opponents of current policy.
In an effort to examine and possibly utilise the community-based, bottom-up service design of medical cannabis facilities in the San Francisco Bay area of California, 130 adults who had received medical cannabis recommendations from a physician were surveyed at seven facilities to describe the social service aspects of these unique, community-based programmes. This study used an unselected consecutive sample and cross-sectional survey design that included primary data collection at the medical cannabis facilities themselves. In this exploratory study, individual level data were collected on patient demographics and reported patient satisfaction as gathered by the Patient Satisfaction Questionnaire III. Surveys were filled out on site. In the case of a refusal, the next person was asked. The refusal rate varied depending on the study site and ranged between 25% and 60%, depending on the facility and the day of sampling. Organisational-level data, such as operating characteristics and products offered, created a backdrop for further examination into the social services offered by these facilities and the attempts made by this largely unregulated healthcare system to create a community-based environment of social support for chronically ill people. Informal assessment suggests that chronic pain is the most common malady for which medical cannabis is used. Descriptive statistics were generated to examine sample- and site-related differences. Results show that medical cannabis patients have created a system of dispensing medical cannabis that also includes services such as counselling, entertainment and support groups - all important components of coping with chronic illness. Furthermore, patients tend to be male, over 35, identify with more than one ethnicity, and earn less than US$20 000 annually. Levels of satisfaction with facility care were fairly high, and higher than nationally reported satisfaction with health care in the USA. Facilities tended to follow a social model of cannabis care, including allowing patients to use medicine on site and offering social services. This approach has implications for the creation and maintenance of a continuum of care among bottom-up social and health services agencies.
Back and neck problems are among the symptoms most commonly encountered in clinical practice. However, few studies have examined national trends in expenditures for back and neck problems or related these trends to health status measures.
To estimate inpatient, outpatient, emergency department, and pharmacy expenditures related to back and neck problems in the United States from 1997 through 2005 and to examine associated trends in health status.
Age- and sex-adjusted analysis of the nationally representative Medical Expenditure Panel Survey (MEPS) from 1997 to 2005 using complex survey regression methods. The MEPS is a household survey of medical expenditures weighted to represent national estimates. Respondents were US adults (> 17 years) who self-reported back and neck problems (referred to as "spine problems" based on MEPS descriptions and International Classification of Diseases, Ninth Revision, Clinical Modification definitions).
Spine-related expenditures for health services (inflation-adjusted); annual surveys of self-reported health status.
National estimates were based on annual samples of survey respondents with and without self-reported spine problems from 1997 through 2005. A total of 23 045 respondents were sampled in 1997, including 3139 who reported spine problems. In 2005, the sample included 22 258 respondents, including 3187 who reported spine problems. In 1997, the mean age- and sex-adjusted medical costs for respondents with spine problems was 4181-2731 (95% CI, 2904) among those without spine problems (inflation-adjusted to 2005 dollars). In 2005, the mean age- and sex- adjusted medical expenditure among respondents with spine problems was 5670-3516 (95% CI, 3765) among those without spine problems. Total estimated expenditures among respondents with spine problems increased 65% (adjusted for inflation) from 1997 to 2005, more rapidly than overall health expenditures. The estimated proportion of persons with back or neck problems who self-reported physical functioning limitations increased from 20.7% (95% CI, 19.9%-21.4%) to 24.7% (95% CI, 23.7%-25.6%) from 1997 to 2005. Age- and sex-adjusted self-reported measures of mental health, physical functioning, work or school limitations, and social limitations among adults with spine problems were worse in 2005 than in 1997.
In this survey population, self-reported back and neck problems accounted for a large proportion of health care expenditures. These spine-related expenditures have increased substantially from 1997 to 2005, without evidence of corresponding improvement in self-assessed health status.
The author first describes the history of medical use of cannabis and its revival in the 1990s. He then provides an overview of the legal situation and how this affects doctors and patients if cannabis is prescribed or recommended as treatment. Subsequently, the state of the art of cannabis medication research is described and analyzed. Finally, the public and political discourse that arose in reaction to legal and political efforts to legalize cannabis for medical purposes is described.
Using the conflict over medical marijuana as a timely case study, this Article explores the overlooked and underappreciated power of states to legalize conduct Congress bans. Though Congress has banned marijuana outright, and though that ban has survived constitutional scrutiny, state laws legalizing medical use of marijuana constitute the de facto governing law in thirteen states. This Article argues that these state laws and (most) related regulations have not been, and, more interestingly, cannot be preempted by Congress, given constraints imposed on Congress's preemption power by the anti-commandeering rule, properly understood. Just as importantly, these state laws matter, in a practical sense; by legalizing medical use of marijuana under state law, states have removed the most significant barriers inhibiting the practice, including not only state legal sanctions, but also the personal, moral, and social disapproval that once discouraged medicinal uses of the drug. As a result, medical use of marijuana has survived and indeed, thrived in the shadow of the federal ban. The war over medical marijuana may be largely over, as commentators suggest, but contrary to conventional wisdom, it is the states, and not the federal government, that have emerged the victors in this struggle. Although the Article focuses on medical marijuana, the framework developed herein could be applied to conflicts pitting permissive state laws against harsh federal bans across a wide range of issues, including certain abortion procedures, possession of various types of firearms, and many other activities.
Cannabis has been advocated as a treatment for nausea, vomiting, wasting, pain and muscle spasm in cancer, HIV/AIDS, and neurological disorders. Such uses are prohibited by law; cannabinoid drugs are not registered for medical use in Australia and a smoked plant product is unlikely to be registered. A New South Wales Working Party has recommended granting exemption from prosecution to patients who are medically certified to have specified medical conditions. This proposal deserves to be considered by other State and Territory governments.
Transient lower esophageal sphincter relaxations (TLESRs) are the major cause of gastroesophageal acid reflux, and are triggered by postprandial gastric distention. Stimulation of GABA(B) receptors potently inhibits triggering of TLESR by gastric loads. The functional similarity between GABA(B) and cannabinoid receptors (CBRs) prompted us to study the role of CBRs on mechanisms of gastric distention-induced TLESRs.
Gastric nutrient infusion and air insufflation was performed during gastroesophageal manometry in conscious dogs. The effects of the CBR agonist WIN 55,212-2 were assessed alone and in combination with the CBR1 antagonist SR141716A or the CBR2 antagonist SR144528. The effects of WIN 55,212-2 were also studied on firing of gastric vagal mechanosensitive afferents in an isolated preparation of ferret stomach.
WIN 55,212-2 (57 nmol/kg) inhibited the occurrence of TLESR after gastric loads by 80% (P < 0.01). The latency to the first TLESR after the load was prolonged (P < 0.001), and the occurrence of swallowing was reduced (P < 0.05). The CBR1 antagonist SR141716A reversed the effects of WIN 55,212-2, whereas the CBR2 antagonist SR144528 did not. The CBR1 antagonist alone increased occurrence of TLESR (P < 0.05). The responses of gastric vagal mechanoreceptors to distention were unaffected by WIN 55,212-2 at a concentration of 3 micromol/L.
Exogenous and endogenous activation of the CBR1 receptor inhibits TLESRs. The effects of CBR1 are not mediated peripherally on gastric vagal afferents, and therefore are most likely in the brain stem.
The investigation of endocannabinoids leading to discovery of a new signalling system in the brain, depolarization-induced suppression of inhibition (DSI), for treatment related to brain and other medical problems is discussed. DSI, enables individual neurons to disconnect briefly from their neighbors and encode information. The results indicate that endocannabinoids are important in extinguishing the bad feelings and pain triggered by reminders of past experiences. It is suggested that abnormally low numbers of cannabinoid receptors are involved in post-traumatic stress syndrome, phobias and certain forms of chronic pains.
The use of cannabis for medical purposes is a controversial but an important topic of public and scientific interest. We report on the results of a self-administered questionnaire study conducted in the United Kingdom between 1998 and 2002. The questionnaire consisted of 34 items and included demographic data, disease and medication use patterns and cannabis use profiles. Subjects were self-selected; 3663 questionnaires were distributed and 2969 were returned [1805 (60.9%) women, mean age 52.7 years (SD 12.7)]. Medicinal cannabis use was reported by patients with chronic pain (25%), multiple sclerosis and depression (22% each), arthritis (21%) and neuropathy (19%). Medicinal cannabis use was associated with younger age, male gender and previous recreational use (p < 0.001). While caution must be exercised in interpreting these data, they point to the need for clinical studies of cannabis and cannabinoids with standardised and quality-controlled products.
Despite the major benefits of antiretroviral therapy on survival during HIV infection, there is an increasing need to manage symptoms and side effects during long-term drug therapy. Cannabis has been reported anecdotally as being beneficial for a number of common symptoms and complications in HIV infections, for example, poor appetite and neuropathy. This study aimed to investigate symptom management with cannabis. Following Ethics Committee approval, HIV-positive individuals attending a large clinic were recruited into an anonymous cross-sectional questionnaire study. Up to one-third (27%, 143/523) reported using cannabis for treating symptoms. Patients reported improved appetite (97%), muscle pain (94%), nausea (93%), anxiety (93%), nerve pain (90%), depression (86%), and paresthesia (85%). Many cannabis users (47%) reported associated memory deterioration. Symptom control using cannabis is widespread in HIV outpatients. A large number of patients reported that cannabis improved symptom control.
The use of cannabis for medical purposes remains controversial. Since support from general practitioners would be needed for the successful operation of a legalised prescription regime, New South Wales Northern Rivers general practitioners were surveyed on their attitudes to and knowledge of medicinal cannabis. A representative random sample of general practitioners, stratified by age and gender, was derived and interviewed. Results indicated generally high levels of knowledge of cannabis's medical uses. The mean number of patients seen in 2004 with medicinal cannabis-treatable conditions was 66.8, with chronic pain patients accounting for 36.7. Overwhelming majorities of respondents reported they would prescribe medicinal cannabis if it were legal, professionally supported and backed by research and that they would approve of clinical trials and a legalised regulatory scheme under such conditions. These results suggest the need to conduct a Statewide general practitioners' survey to confirm or refute the present findings.
Despite several lines of evidence suggesting the biological plausibility of marijuana being carcinogenic, epidemiologic findings are inconsistent. We conducted a population-based case-control study of the association between marijuana use and the risk of lung and upper aerodigestive tract cancers in Los Angeles.
Our study included 1,212 incident cancer cases and 1,040 cancer-free controls matched to cases on age, gender, and neighborhood. Subjects were interviewed with a standardized questionnaire. The cumulative use of marijuana was expressed in joint-years, where 1 joint-year is equivalent to smoking one joint per day for 1 year.
Although using marijuana for > or =30 joint-years was positively associated in the crude analyses with each cancer type (except pharyngeal cancer), no positive associations were observed when adjusting for several confounders including cigarette smoking. The adjusted odds ratio estimate (and 95% confidence limits) for > or =60 versus 0 joint-years was 1.1 (0.56, 2.1) for oral cancer, 0.84 (0.28, 2.5) for laryngeal cancer, and 0.62 (0.32, 1.2) for lung cancer; the adjusted odds ratio estimate for > or =30 versus 0 joint-years was 0.57 (0.20, 1.6) for pharyngeal cancer, and 0.53 (0.22, 1.3) for esophageal cancer. No association was consistently monotonic across exposure categories, and restriction to subjects who never smoked cigarettes yielded similar findings.
Our results may have been affected by selection bias or error in measuring lifetime exposure and confounder histories; but they suggest that the association of these cancers with marijuana, even long-term or heavy use, is not strong and may be below practically detectable limits.
The purpose of this study was to determine whether racial disparities in cancer therapy had diminished since the time they were initially documented in the early 1990s.
The authors identified a cohort of patients in the SEER-Medicare linked database who were ages 66 to 85 years and who had a primary diagnosis of colorectal, breast, lung, or prostate cancer during 1992 through 2002. The authors identified 7 stage-specific processes of cancer therapy by using Medicare claims. Candidate covariates in multivariate logistic regression included year, clinical, and sociodemographic characteristics, and physician access before cancer diagnosis.
During the full study period, black patients were significantly less likely than white patients to receive therapy for cancers of the lung (surgical resection of early stage, 64.0% vs 78.5% for blacks and whites, respectively), breast (radiation after lumpectomy, 77.8% vs 85.8%), colon (adjuvant therapy for stage III, 52.1% vs 64.1%), and prostate (definitive therapy for early stage, 72.4% vs 77.2%, respectively). For both black and white patients, there was little or no improvement in the proportion of patients receiving therapy for most cancer therapies studied, and there was no decrease in the magnitude of any of these racial disparities between 1992 and 2002. Racial disparities persisted even after restricting the analysis to patients who had physician access before their diagnosis.
There has been little improvement in either the overall proportion of Medicare beneficiaries receiving cancer therapies or the magnitude of racial disparity. Efforts in the last decade to mitigate cancer therapy disparities appear to have been unsuccessful.
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