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Rates of cannabis initiation among teenagers and young adults are increasing. Further, the use of various forms of cannabis (smoked or vaped) with nicotine (dual use) is increasingly common among young people. The health effects of dual use are lesser known, particularly in the context of high-potency cannabis products and across different routes of administration, which is ominous in terms of predicting future health outcomes. There is a long history of cannabis use being associated with decreased activity and increased snacking, both of which could portend an increased risk of metabolic and cardiovascular disease, particularly when these habits begin during formative years. However, modern forms of cannabis may not have these same effects. Here, we assess whether cannabis use alone and dual use of cannabis with nicotine impact dietary and exercise habits in young people. An anonymous, social media-based survey was designed based on the UC San Diego Inhalant Questionnaire and published diet and exercise questionnaires. A total of 457 surveys were completed. Young sole cannabis users represented 29% of responders, 16% were dual users of cannabis and nicotine, and 55% were non-users of either drug. Although the sole use of cannabis was not associated with dietary or activity differences relative to non-users, dual users of cannabis and nicotine reported higher consumption of unhealthy sugars. This novel finding of dual use being associated with increased sugar intake in young people raises concerns for an increased risk of metabolic syndrome and cardiovascular disease in this population.

Background: Cannabis-based medicinal products (CBMPs) are increasingly demonstrating effectiveness in treating a wide range of conditions, with a relatively high safety profile in clinical usage compared to other prescription pain medications and few contraindications. Consultation and other prescription-related costs are, at present, higher for CBMPs than for some other treatment options, leading to some concern around wider prescribing. Research design and Methods: An early cost-effectiveness model was developed to estimate the impact of prescribing CBMPs alone and/or in addition to analgesics, physiotherapy, and cognitive behavioral therapy for chronic pain in the UK for 1 year. Results: Due to their comparative effectiveness, CBMPs were found to be cost saving. Various scenarios were model tested; in all scenarios where CBMPs decrease pain-level states, less resource use is required. Increased efficacy of 5% was conservatively assumed based on current Real-World Evidence. In this scenario, CBMPs were significantly more cost-effective, and as costs relating to the prescribing of these continue to fall, relative savings are predicted to increase. Conclusion: These findings highlight the substantial cost saving that CBMPs may represent for the treatment of chronic pain patients, and the benefits for healthcare providers as a treatment for this often hard-to-treat population. [ABSTRACT FROM AUTHOR]

Increased cases of canine tetrahydrocannabinol (THC) toxicosis have been reported in North America in recent years. Cases are often evaluated on an emergency basis and treatment has relied upon supportive care which can be costly and prohibitive for some pet owners. The purpose of this report is to describe the clinical findings and outcomes in dogs with non-medical, presumptive THC toxicosis treated by administration of a cannibidiol (CBD)-infused transmucosal dissolving sheet. Medical records of six cases of non-medical, presumptive THC toxicosis from a private primary care practice and a private after-hours emergency practice were reviewed and summarized. Five of six cases were treated exclusively with transmucosal CBD (0.4–2.6 mg/kg); one case also received injectable anti-emetic therapy. Lethargy and ataxia noticeably improved and all additional clinical signs resolved within 45 min of treatment in five of six cases. No further follow-up measures for THC toxicosis were required in any case; one case required additional follow-up for presumably unrelated gastrointestinal distress. This is the first report of treatment of canine THC toxicosis by administration of CBD. The use of transmucosal CBD-infused dissolving sheets resulted in expedient resolution of clinical signs in a minimally invasive manner that is accessible to both clients and veterinary practitioners. [ABSTRACT FROM AUTHOR]

Background: Cannabis is increasingly used and debates about the legalisation of the recreational use of cannabis are ongoing. In this prospective, placebo-controlled study in healthy volunteers not regularly consuming cannabis, subjective psychotropic and somatic effects after a single dose of intravenous THC were assessed and quantified over 48 h. Methods: Twenty-five healthy volunteers received a single IV bolus of THC and 6 received normal saline. Psychotropic and somatic effects of THC were assessed by two questionnaires that were completed at up to 14 timepoints from shortly before drug administration to 48 h later. Results: Demographic data did not differ between groups. Differences between THC and placebo for all assessed effects, except for euphoria, irritation and headache, were clearly discernible. Subdimensions related to positive mood were less and those related to negative mood were more pronounced in the THC group. Peak plasma concentrations were observed at 1 to 5 min after THC administration while peak effects occurred between 45 and 60 min. Differences between THC and placebo were pronounced and seen for up to 90 to 120 min for most effects, except for "sleepiness" and "deactivation", where the effect of THC was discernible for up to 5 h. At 24 and 48 h, there were no statistically significant difference between THC and placebo group. Conclusions: THC triggers a large range of psychotropic and somatic effects with peak effects at 45 to 60 min after IV administration of THC, much later than plasma peak levels. Most effects are short-lasting with a duration of up to 2 h, but some effects like sleepiness and deactivation can be longer-lasting and persist for 5 h or longer in cannabis-naïve or cannabis-abstinent individuals. Since effects of THC demonstrate a time course that differs from the time course of plasma concentrations it might be important to base the judgment of a possible impairment related to THC consumption on clinical or behavioral tests in addition to THC plasma levels. Trial registration: www.isrctn.com; registration number ISRCTN53019164. [ABSTRACT FROM AUTHOR]

Simple Summary: Cannabis (THC) and ethanol (EtOH) are widely used for their anti-inflammatory and analgesic properties. Whether both drugs have deleterious effects on skeletal muscle needs further investigations, particularly looking at mitochondria, the energy producers of the cells. We determined the effects of EtOH, alone and associated with THC, on skeletal muscle mitochondrial respiration, on predominantly glycolytic gastrocnemius muscles (less mitochondria) and oxidative soleus (many mitochondria) muscles in young and middle-aged rats (12 and 49 weeks). Considering the gastrocnemius, EtOH impaired mitochondrial respiration in a similar manner in young- and middle-aged muscles (−34.97 ± 2.97% vs. −37.50 ± 6.03%). Interestingly, concomitant THC aggravated EtOH-related mitochondrial impairment in young gastrocnemius muscles (−49.92 ± 1.69%, vs. −34.97 ± 2.97). Concerning the soleus, EtOH alone mainly decreased young muscle mitochondrial respiration (−42.39 ± 2.42% vs. −17.09 ± 7.61%, at 12 and 49 weeks). The soleus was less impaired at 12 weeks by THC and EtOH association than the gastrocnemius. In conclusion, EtOH, alone and associated with THC, significantly impairs skeletal muscle mitochondrial respiration and THC aggravates EtOH-induced alterations in young glycolytic muscle. Caution is therefore warranted if using THC or EtOH alone, and even more caution is needed if both drugs are concomitantly used. The anti-inflammatory and analgesic properties of cannabis might be useful to treat muscle diseases, including those linked or not to alcohol. Nevertheless, delta 9 tetrahydrocannabinol (THC) and ethanol (EtOH), often used concomitantly, can have deleterious effects on cardiac mitochondria. We therefore determined whether EtOH, alone and associated with THC, impairs skeletal muscle mitochondrial respiration. Further, we investigated potential modulation by metabolic phenotype and age by analyzing predominantly glycolytic gastrocnemius and oxidative soleus muscles in young and middle-aged rats (12 and 49 weeks). Considering the gastrocnemius, EtOH impaired mitochondrial respiration in a similar manner in young- and middle-aged muscles (−34.97 ± 2.97% vs. −37.50 ± 6.03% at 2.1 × 10−5 M; p < 0.05). Interestingly, concomitant THC aggravated EtOH-related mitochondrial impairment in young gastrocnemius (−49.92 ± 1.69%, vs. −34.97 ± 2.97 p < 0.05). Concerning the soleus, EtOH alone mainly decreased young muscle mitochondrial respiration (−42.39 ± 2.42% vs. −17.09 ± 7.61% at 2.1 × 10−5 M, p < 0.001, at 12 and 49 weeks). The soleus was less impaired at 12 weeks by THC and EtOH association than the gastrocnemius (−49.92 ±1.69 vs. −27.22 ± 8.96% in gastrocnemius and soleus, respectively, p < 0.05). In conclusion, EtOH, alone and associated with THC, significantly impairs skeletal muscle mitochondrial respiration and THC aggravates EtOH-induced effects on young glycolytic muscle. Age and metabolic phenotypes modulate these deleterious effects, with the glycolytic muscles of young rats being more prone to impairments than oxidative muscles. [ABSTRACT FROM AUTHOR]

Point‐of‐collection testing (POCT) devices are widely used in roadside and workplace drug testing to identify recent cannabis use by measuring the presence of Δ9‐tetrahydrocannabinol (THC) in oral fluid (OF). However, the performance of POCT devices with oral medicinal cannabis products remains poorly described. In a randomised, double‐blinded, crossover trial, adults with insomnia disorder (n = 20) received a single (2 mL) oral dose of oil containing 10 mg THC + 200 mg cannabidiol, or placebo, prior to sleep. Participants were tested with the Securetec DrugWipe® 5S (10 ng/mL THC cut‐off) and Dräger DrugTest® 5000 (25 ng/mL THC cut‐off) POCT devices at baseline (pre‐treatment) and then at 0.5, 10, and 18 h post‐treatment. An OF sample, taken at each time point, was also analysed using liquid chromatography–tandem mass spectrometry. Large individual variability in OF THC concentrations was observed 0.5 h post‐treatment (range: 0–425 ng/mL; mean (SD) 48.7 (107.5) ng/mL). Both the Securetec DrugWipe® 5S and DrugTest® 5000 demonstrated poor sensitivity to THC at 0.5 h post‐treatment (25% and 50%, respectively). At 10 and 18 h post‐treatment, all participant OF THC concentrations were below screening cut‐offs, and all test results were negative. These findings highlight the relatively poor sensitivity of both devices in detecting recent use of an oral medicinal cannabis product. They also suggest a low probability of obtaining a positive THC result the morning after ('one‐off') use. Further research is required to establish the probability of obtaining a positive THC result with regular medicinal cannabis use. [ABSTRACT FROM AUTHOR]

In this paper, an improved 100 CMM regenerative thermal oxidizer (RTO) is implemented for low-emission combustion. The existing RTO system is a cylindrical drum structure that cyclically introduces and discharges VOC gas into and from the rotating disk, and which achieves excellent energy efficiency with a heat recovery rate of more than 95%. However, the drive shaft designed under the RTO combustion chamber increases wear around the rotating shaft due to the load of the combustion chamber and there is a problem that the untreated gas is simultaneously released through the outlet due to the channeling phenomenon of the combustion chamber and the drive shaft. In addition, the combustion chamber, used at a high temperature of 800 °C, may cause serious problems such as rotation stop or explosion due to pollutants, dust accumulation, and thermal expansion in the chamber. Particularly when treating VOCs harmful gasses, RTO performance may be degraded due to the burner's non-uniform temperature control and unstable combustion function. To solve this problem, first, the design of the combustion chamber rotating plate driving device is improved. Second, when treating high concentration VOC gas, the design of combustion chamber considers a temperature increase of up to 920 °C or more. For this, the diameter of the gas burner is 125 mm and the outlet dimension is set to 650 mm × 650 mm to effectively discharge high-temperature waste heat. Third, the heat storage material in the combustion chamber is composed of a ceramic block with a thickness of 250 mm, and the outer diameter and height of the combustion chamber are set to, 2530 mm and 1875 mm, respectively, to optimize gas residence time and heat insulation thickness. Fourth, we supplement safe operation by applying the trip control algorithm of the programmable logic controller (PLC) panel for failure prediction of RTO and the Edge-IoT-based intelligent algorithm for this. Finally, we evaluate the economic performance of 100 CMM RTO by conducting empirical experiments to analyze changes in VOCs removal efficiency, nitrogen oxide emission concentration, and total hydrocarbon (THC) concentration through 10 CMM design and implementation. [ABSTRACT FROM AUTHOR]

Background/Objectives: Pregnant women have limited information on the impact of prenatal cannabis exposure (PCE) alone. Our aim was to determine if PCE, without alcohol, tobacco, or illicit drug use, is associated with altered birth outcome measures in obstetrically low-risk women. Methods: In this observational cohort study, pregnant women were recruited between 2019 and 2022 from communities in Washington and Oregon, USA, and enrolled following their first trimester. PCE eligibility required a minimum of three days/week of cannabis use during the first trimester with no required minimum use thereafter. For all participants, illicit drug, nicotine, or alcohol use was exclusionary throughout pregnancy and monitored via urine toxicology at multiple time points. Cannabis use was quantified into delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) mg/day using product weight and potency. Outcome measures included gestational age, weight, length, head circumference, and Apgar scores. Results: Study participants included 37 people in the PCE cohort and 35 controls. Average cannabis use for the PCE cohort was 198.0 mg of THC (SD = 221.2 mg)/day and 3.5 mg of CBD (SD = 4.3)/day. PCE newborns weighed less (38th vs. 52nd percentile, p = 0.04) and were shorter (40th vs. 55th percentile, p = 0.03) for their gestational age than controls. Female PCE newborns had smaller head circumference for gestational age (28th percentile; SD = 23), compared to male PCE newborns (55th percentile; SD = 32; p = 0.02). Conclusions: PCE is associated with reduced birth weight and shorter length for gestational age. The effect of PCE on brain growth may be sexually dimorphic. Future PCE studies should include sex as a biological variable and longitudinally evaluate long-term developmental and physiological outcomes. [ABSTRACT FROM AUTHOR]

The study highlights the need for quality control in evaluating medicinal plant products, especially CBD oils, before market release. Due to varying regulatory requirements, product labeling can sometimes be misleading, especially regarding cannabinoid concentrations such as CBD and THC. This research focused on developing a validated high-performance liquid chromatography (HPLC) method for accurately identifying and quantifying key cannabinoids in Commercial Veterinary CBD Oil. The main compounds identified included Cannabidivarin (CBDV), Cannabidiolic Acid (CBD-A), Cannabigerolic Acid (CBG-A), Cannabigerol (CBG), Cannabidiol (CBD), Tetrahydrocannabivarin (THCV), Cannabinol (CBN), ∆9-Tetrahydrocannabinol (d9-THC) ∆8-Tetrahydrocannabinol (d8-THC), Cannabicyclol (CBL), Cannabichromene (CBC), and Tetrahydrocannabinolic Acid (THCA), determined in line with the International Conference on Harmonization's (ICH) guidelines. The method was validated for linearity, accuracy, precision, limit of detection (LOD), and limit of quantitation (LOQ). It was determined to be linear, with a correlation coefficient (R²) > 0.999. The LOD and LOQ values calculated from the calibration curve ranged from 0.05 to 0.13 and 0.50 to 0.61 µg/mL, respectively. The method also exhibited acceptable precision, with relative standard deviation values lower than or equal to 2%. The method's accuracy was assessed through recovery percentages and fell within an acceptable range of 98–102 if the RSD was 2%. This study's rigorous methodology and comprehensive findings significantly contribute to cannabinoid analysis. This validated protocol was used to analyze cannabinoids in 14 commercial veterinary CBD oil products from the Republic of North Macedonia. The performance parameters demonstrated that the method is reliable for quantitatively measuring cannabinoids in CBD oil. The analysis showed that the cannabinoid levels in the products were consistent with the manufacturers' declared specifications, with no significant discrepancies in labeling. [ABSTRACT FROM AUTHOR]

ObjectivesMethodsResultsConclusionsClinical ImplicationsTo examine older adults’ cannabidiol (CBD) use and its associations with cannabis use and physical/mental health and other substance use problems.Using the 2022 National Survey on Drug Use and Health (N = 10,516 respondents age 50+), we fitted generalized linear models (GLM) with Poisson and log link using CBD as the dependent variable in the 50–64 and the 65+ age groups.In the 50–64 age group, 18.3% and 18.0% reported past-year CBD and cannabis, respectively, use. In the 65+ age group, the percentages were 14.3% and 8.0%. GLM results showed significant positive associations with both medical and non-medical cannabis use in both age groups. CBD use was positively associated with physical/mental health and illicit drug use problems in the 50–64 age group and with disordered psychotherapeutic drug use in the 65+ age group. Minoritized older adults had a lower likelihood of CBD use.CBD use is common, more so than cannabis especially in the 65+ age group and positively correlated with both medical and nonmedical cannabis use.Research is needed to examine therapeutic benefits and negative effects of CBD use in late life. Public health education is needed for growing numbers of older-adult CBD users. [ABSTRACT FROM AUTHOR]

Simple Summary: Industrial hemp biomass, the low Δ9-tetrahydrocannabinol variety of Cannabis sativa, has been identified as a potential feed for ruminants. To be a viable option for ruminants involved in the food chain, industrial hemp biomass needs to be suitable for both the animal and consumer. Studies have found industrial hemp biomass to be a nutritionally suitable feed for sheep; however, Δ9-tetrahydrocannabinol residues were identified in various tissues post feeding, persisting for up to 140 d in some sheep. Currently, there is zero tolerance for Δ9-tetrahydrocannabinol to be present in foods of animal origin (meat, milk, eggs), as no 'maximum' level has been set by Food Standards Australia and New Zealand, due to a lack of testing and available data. Consequently, the aim of this study was to investigate how ruminants process Δ9-tetrahydrocannabinol and elucidate why Δ9-tetrahydrocannabinol persists in animal tissues for an extended period of time. Results from this study support the prolonged residues previously identified in sheep, having implications for the potential utilisation of industrial hemp biomass as a feed for ruminants involved in the human food chain. The pharmacokinetics of Δ9-tetrahydrocannabinol (Δ9-THC) has not been established in ruminants. Pharmacokinetic knowledge is important given feeding industrial hemp biomass has been shown to result in tissue residues post feeding in sheep. Due to a lack of testing and available data, a 'maximum' concentration of Δ9-THC has not been currently set for foods of animal origin. Consequently, this study was designed to gain a better understanding of how ruminants process Δ9-THC. Eight Merino ewes were administered with two per os (PO) doses of 88.5 mg Δ9-THC/kg bodyweight (BW) 12 h apart. Blood samples were collected periodically post dosing to determine the pharmacokinetics of Δ9-THC and subcutaneous fat biopsies were taken to investigate the deposition and elimination of Δ9-THC from sheep. An elimination half-life of 31.40 ± 13.87 h was identified, with residues persisting in the subcutaneous fat for 28 d in five of the eight sheep, before decreasing below the limit of detection in all sheep by 91 d. These results support the prolonged presence of Δ9-THC residues previously identified. Thus, imposing a practical withholding period for ruminants involved in the food chain may not be possible, with further research required to investigate how iHemp biomass may be safely fed to ruminants. [ABSTRACT FROM AUTHOR]

Δ9-Tetrahydrocannabinol (THC) is the primary psychoactive component of cannabis which is being increasingly consumed by pregnant people. In humans, THC is sequentially metabolized in the liver to its circulating metabolites 11-hydroxy-THC (11-OH-THC, psychoactive) and 11-nor-9-carboxy-THC (THC-COOH, non-psychoactive). Human and macaque data show that fetal exposure to THC is considerably lower than the corresponding maternal exposure. Through perfused human placenta studies, we showed that this is due to the active efflux of THC (fetal-to-maternal) by a placental transporter(s) other than P-glycoprotein or breast cancer resistance protein. The identity of this placental transporter(s) as well as whether THC or its metabolites are substrates or inhibitors of hepatic solute carrier transporters is unknown. Therefore, we investigated whether 5 μM THC, 0.3 μM 11-OH-THC, and 2.5 μM THC-COOH are substrates and/or inhibitors of placental or hepatic solute carrier transporters at their pharmacologically relevant concentrations. Using HEK cells overexpressing human OATP1B1, OATP1B3, OATP2B1, OCT1, OCT3, OAT2, OAT4, or NTCP, and prototypic substrates/inhibitors of these transporters, we found that THC and THC-COOH were substrates but not inhibitors of OCT1. THC-COOH was a weak substrate of OCT3 and a weak inhibitor of OAT4. THC, 11-OH-THC, and THC-COOH were found not to be substrates/inhibitors of the remaining transporters investigated. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion Conclusion Chronic pain (CP) affects 35.0%–51.3% of the UK population, with 67%–88% reporting sleep disturbances. Cannabis‐based medicinal products (CBMPs) have shown therapeutic potential in managing CP. Evidence suggests poor sleep worsens pain perception; therefore, this study aimed to assess patient‐reported outcome measures (PROMs) following CBMP treatment in CP patients with and without co‐morbid sleep impairment.A prospective cohort study of CP patients from the UK Medical Cannabis Registry was conducted. Participants were separated by baseline single‐item sleep quality scale (SQS) score into sleep impaired (SQS ≤3) and unimpaired (SQS ≥4) cohorts. The primary outcome assessed changes in PROMs from baseline to 1‐, 3‐, 6‐, and 12‐months. Participants completed the following: SQS, General Anxiety Disorder‐7, EQ‐5D‐5L, Brief Pain Inventory (BPI), and Short‐Form McGill Pain Questionnaire‐2. Significance was defined as p < 0.050.1139 participants met the inclusion criteria (sleep impaired: n = 517, 45.4%; sleep unimpaired: n = 622, 54.61%). The sleep impaired cohort showed improvements in all PROMs at each follow‐up (p < 0.010). The sleep unimpaired cohort showed similar results (p < 0.050), except in SQS and ED‐5Q‐5L: self‐care and anxiety/depression scores (p > 0.050). However, the sleep impaired cohort observed greater improvements in BPI pain severity (p < 0.050) and SQS (p < 0.001) than the sleep unimpaired cohort at all follow‐ups. 2817 adverse events were self‐reported between both cohorts (p = 0.197).These findings align with literature that shows associated improvements in pain outcomes following CBMP administration. Sleep impaired individuals were more likely to experience greater pain severity improvements. However, this was not confirmed on multivariate logistic regression analysis and instead may be confounded by baseline pain severity.Whilst these results show promise for the effects of CBMPs on CP, they must be examined within the limitations of the study design. These findings provide further evidence to support the design of subsequent randomized controlled trials to verify causality between CBMPs and pain outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Cannabis, commonly known for both therapeutic and intoxicating effects, is gaining accessibility on legal markets and traction as a potential alternative therapy for pain mediation, particularly in those suffering from chronic low back pain. However, the effectiveness in this population of legal market forms of cannabis, particularly commonly used edibles, is unknown. Methods: Therefore, this study utilized a naturalistic prospective design where participants with chronic low back pain with intentions to initiate cannabis use for treatment were recruited and self-selected edible cannabis products containing varying amounts of delta- 9 tetrahydrocannabinol (THC) and cannabidiol (CBD). Products were categorized as CBD-dominant, THC-dominant, or combined THC and CBD (THC + CBD). Results: 249 participants [140 female (56.62%), mean (SD) age of 46.30 (16.02), 90% White] were tracked over 2 weeks of ad libitum use and assessed during a naturalistic acute cannabis administration session on changes in pain, mood, and subjective drug effects. During acute administration, a significant correlation between THC dose and short-term pain relief was found, suggesting that higher THC doses were associated with greater pain reduction (p <.05). In addition, THC was associated with higher levels of subjective cannabis drug effects (p <.001), regardless of whether CBD was also in the edible product. Acute CBD dose was primarily associated with short-term tension relief (p <.05); however, there were no associations between CBD dose and acute pain. Over the 2-week ad libitum administration period results suggested pain reductions across participants using all forms of cannabis. However, trends suggested that more frequent use of CBD-dominant edible cannabis may be associated with greater reductions in perceived pain over the 2-week observation period (p =.07). Discussion: These findings support the short-term analgesic effects of THC and anxiolytic effects of CBD and further suggest that orally-administered THC and CBD should continue to be evaluated for the potential to provide both acute and extended relief from chronic low back pain. Clinical Trial Registration: https://clinicaltrials.gov/study/NCT03522324?locStr=Boulder,%20CO&country=United%20States&state=Colorado&city=Boulder&cond=chronic%20low%20back%20pain&intr=Cannabis&rank=1, identifier NCT03522324. [ABSTRACT FROM AUTHOR]

Aim: Our objective was to systematically assess the prevalence and clinical features of adverse events related to interactions between cannabinoids and psychotropic drugs through a retrospective chart review. Methodology: 1586 adverse event reports were assessed. Cases included in the analysis showed a high probability of a causal relationships between cannabinoid-psychotropic drug interactions and adverse events. Data extracted included age, sex, psychotropic drug, cannabinoid products, other medications, and the clinical outcomes and mechanisms of these interactions. Results: Cannabinoids were involved in 8% of adverse events associated with the concomitant use of psychotropic drugs and other preparations. We identified 20 reports in which side effects presented a causal relationship with the use of psychotropic drugs and cannabinoids. Preparations containing 18% or more tetrahydrocannabinol (THC), presented significant side effects with the following antidepressants: mianserine (restless legs syndrome, urogenital pain, ventricular tachycardia), mirtazapine (pancreatitis, hyperhidrosis, arthralgia), quetiapine (myocarditis, renal failure, bradycardia, sialorrhea), haloperidol (ventricular arrhythmia, prolonged QTc), aripiprazole (prolonged QTc), ventricular tachycardia) and cariprazine (stomach pain, hepatotoxicity), sertraline (ataxia, hyperactivity, coma, hallucinations, anxiety, agitation, tachycardia, panic attacks, disorientation, headache, dizziness, blurry vision, severe emesis, xerostomia, dry eyes), trazodone (disorientation, memory impairment, sedation), fluvoxamine (tachycardia, tachypnoea, dysarthria, auditory hallucinations). Two out of 20 reports (10%) analyzed in our study was related with the simultaneous use of cannabidiol (CBD) oil and sertraline. Concomitant use of those substances was associated with the adverse events in form of diarrhea, emesis, fever and severe fatigue. Conclusion: Clinicians need to closely monitor adverse events resulting from the combined use of cannabinoids and psychotropic medications. The accumulation of side effects and pharmacokinetic interactions (including CYP and p-glycoprotein inhibition) between these drugs can lead to clinically significant adverse outcomes. [ABSTRACT FROM AUTHOR]

Objective: To quantify and characterize plasma cannabinoid concentrations in cases of suspected cannabis toxicity in dogs, identify potential correlations between clinical signs and plasma concentrations, and assess the specificity of cannabis toxicity diagnosis based on clinical signs alone. Design: Observational study. Setting: Veterinary teaching hospital. Animals: Thirty‐eight client‐owned animals. Interventions: Blood was collected from dogs presenting to the emergency room for suspected cannabinoid intoxication based on history or physical examination findings. Samples were analyzed using a validated liquid chromatography–tandem mass spectrometry method for the cannabinoids Δ9‐tetrahydrocannabinol (THC), cannabidiol (CBD), and their active metabolites. Measurements and Main Results: The most common abnormality observed was ataxia (35/38 dogs), with urinary incontinence, lethargy, and hyperesthesia also commonly noted. Cannabinoids were quantifiable in 37 of 38 plasma samples (97.4%), with THC the predominant cannabinoid (range: 1.99–2748 ng/mL). Lower concentrations of CBD (up to 115.3 ng/mL) and cannabinoid metabolites were detected. Of the clinical signs recorded, only abnormal reflexes were statistically correlated with the THC concentration at the time of sampling (P = 0.01). Conclusions: A diagnosis of suspected cannabinoid toxicity based on case history and clinical presentation was confirmed via quantifiable plasma concentrations in nearly all cases. Although the range of plasma cannabinoid concentrations was broad, the clinical signs observed were generally similar. Other than the presence of abnormal reflexes, clinical signs were not associated with plasma THC concentrations. Subsequent confirmation of cannabinoids in plasma indicates that cannabis toxicity in dogs can be diagnosed with high specificity by veterinarians based only on history and clinical abnormalities. [ABSTRACT FROM AUTHOR]

Background: The surge in the popularity of cannabis has led to an increase in the number of companies producing hemp-derived consumable cannabinoid products. Despite extensive exploration of cannabinoid efficacy, safety remains underreported. Any contaminants that are not deemed analytes of interest are ignored, leaving their identities and safety profiles a mystery. The unregulated nature of the cannabinoid market places the onus on reputable companies to set industry standards for product cleanliness. Objective: This study aimed to address this gap by assessing high and low potency forms of three popular hemp-derived cannabinoids – Delta 8-tetrahydrocannabinol (Δ8-THC), Hexahydrocannabinol (HHC), and Delta 9-tetrahydrocannabiphorol (Δ9-THCP). Methods: After identifying contaminants, the products were evaluated for toxicity in vitro using one liver and two lung cell lines in an effort to simulate the effects of oral consumption and inhalation. Results: Our study revealed that none of the compounds exhibited toxicity in the liver cell line, while all of the compounds exhibited toxicity in both of the lung cell lines – with the exception of one high-potency HHC sample. Conclusion: These findings highlight the critical need for stringent quality control in the cannabinoid industry, emphasizing the importance for both companies and consumers to prioritize clean, well-tested products to ensure safety in an increasingly unregulated market. [ABSTRACT FROM AUTHOR]

Objective: This study aims to describe patterns, sources, and reasons for cannabis use among cancer patients during active treatment (+CDTX) compared to no‐use during active treatment (−CDTX). Methods: Data are from 385 surveys collected via REDCap during phase I of an ongoing study among adult cancer patients seen at an NCI‐designated comprehensive cancer center within the last 5 years of treatment. A harmonized survey was created with 11 other NCI centers to assess cannabis use patterns, sources, and reasons for use. Sociodemographics and cancer details were also collected via self‐report. Descriptive statistics were calculated and stratified by +/−CDTX. Chi‐squared tests were conducted to compare proportions between groups. Results: Among the sample [49.5 years (SD 15.9); 53.0% male; and 41.6% Hispanic/Latino], 41.0% + CDTX and 59.0% −CDTX. A majority (71.8%) of +CDTX initiated use before diagnosis versus 44.1% in −CDTX (p < 0.0001); patients diagnosed with stage 4 cancer had a statistically significant higher prevalence of +CDTX (60.0%; p = 0.003); 53.3% in radiation reported +CDTX compared to 42.8% in chemotherapy, and 36.4% in immunotherapy. Dispensaries and local dealers were the top sources of cannabis in both groups. Among +CDTX, 44.3% consumed cannabis at least once a day DTX, dominant cannabinoids used were CBD (35.2%), Delta‐8‐THC (18.3%), and CBD + THC ratio (14.1%); 12.7% were unsure what they consumed. Joints were the most common inhalation method (61.5%), and store‐bought candy was the most common edible (39.2%). Depression/mood, pain, and enjoyment were the top three reasons for +CDTX compared to enjoyment, depression/mood, and nausea/upset stomach in −CDTX (p = 0.02). Conclusions: Patterns, sources, and reasons for cannabis use varied between +CDTX and ‐CDTX. Future studies should examine the impacts of cannabis and specific cannabinoids on cancer treatment, drug interactions, survival outcomes, and quality of life. [ABSTRACT FROM AUTHOR]

Background: Limited research considers the quantity and potency of cannabis products along with social context on the subjective effects of real-world cannabis use. Aims: This study examined the subjective effects of acute use as a function of Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) doses and social context during cannabis use episodes. Method: Ninety-six participants (43.75% male, M age = 35.73) reporting weekly cannabis use completed a baseline self-report battery assessing cannabis use. Then, THC and CBD potency and quantity of the cannabis product, social context, and subjective experience were assessed through self-initiated surveys after cannabis use episodes during a 14-day ecological momentary assessment (EMA). Results: Greater feeling high and liking were significantly associated with a higher THC dose than one's average (b = 0.03, p < 0.001; b = 0.02, p < 0.001) and social use (b = 0.38, p < 0.001; b = 0.20, p = 0.01). A higher CBD dose than one's average (b = 0.01, p = 0.04) was significantly associated with greater liking. A significant interaction effect of THC dose and social context (b = 0.01, p = 0.02) was observed such that solitary use had a negative association between THC dose and disliking (b = −0.01, p = 0.04), and social use had a null association (b = 0.003, p = 0.25). Individuals with greater cannabis problems reported lower liking (b = −0.18, p = 0.03) and higher disliking (b = 0.08, p = 0.02), but not feeling high, on average, across the EMA protocol. Conclusion: Social context plays an important role in the subjective experience of cannabis use. Interventions targeting cannabis problems could highlight the evidence that individuals with greater cannabis problems might experience less liking but more disliking in general across use episodes to effectively challenge expectancies/motives of use. [ABSTRACT FROM AUTHOR]

Purpose of Review: This document critically examines the role of cannabinoids in cancer care during an era marked by rapid advancements in oncology and changing perceptions on cannabis. It traces the historical context of cannabis in medicinal use, navigating its journey from widespread acceptance, subsequent criminalization, to its resurgence in modern therapeutic applications, particularly within the framework of Evidence-Based Medicine (EBM). Recent Findings: Anchored in EBM principles, this study synthesizes current research from clinical trials, systematic reviews, and meta-analyses to evaluate the efficacy and safety of cannabinoids in oncology. The focus is on their palliative effects, considering the nuances of effectiveness, risk assessment, and challenges inherent in translating these findings into clinical guidelines. Summary: The study seeks to bridge the gap between scientific research and clinical practice, offering insights to inform future oncological therapies and symptom management strategies involving cannabinoids. The potential benefits and risks of cannabinoid use in cancer treatment are assessed to guide clinicians and researchers in developing comprehensive, evidence-based approaches to patient care. [ABSTRACT FROM AUTHOR]

Given the increasing use of cannabis in the US, there is an urgent need to better understand the drug's effects on central signaling mechanisms. Extracellular vesicles (EVs) have been identified as intercellular signaling mediators that contain a variety of cargo, including proteins. Here, we examined whether the main psychoactive component in cannabis, Δ9-tetrahydrocannabinol (THC), alters EV protein signaling dynamics in the brain. We first conducted in vitro studies, which found that THC activates signaling in choroid plexus epithelial cells, resulting in transcriptional upregulation of the cannabinoid 1 receptor and immediate early gene c-fos, in addition to the release of EVs containing RNA cargo. Next, male and female rats were examined for the effects of either acute or chronic exposure to aerosolized ('vaped') THC on circulating brain EVs. Cerebrospinal fluid was extracted from the brain, and EVs were isolated and processed with label-free quantitative proteomic analyses via high-resolution tandem mass spectrometry. Interestingly, circulating EV-localized proteins were differentially expressed based on acute or chronic THC exposure in a sex-specific manner. Taken together, these findings reveal that THC acts in the brain to modulate circulating EV signaling, thereby providing a novel understanding of how exogenous factors can regulate intercellular communication in the brain.

There are known health concerns linked to prenatal tobacco and cannabis exposures. This study aims to objectively determine the level of exposure to tobacco and cannabis in pregnant individuals from six race/ethnicity groups (Black, Hispanic, Asian Indian, Native American, Vietnamese, and White) in the first three years following legalization of recreational marijuana use in 2018 in California. We used a cross-sectional sample of prenatal screening program participants (2018-2020) from southern and central California (N = 925). Exposures were estimated by a lab analysis of cotinine (tobacco) and 11-hydroxy-Δ9-tetrahydrocannabinol (OH-THC, cannabis) in banked serum. Disparities in tobacco exposure were evident, with Black subjects experiencing the highest smoking rate (16%) followed by Native American (10%) and White (8%) subjects, and ≤2% among Hispanic, Asian Indian, and Vietnamese subjects. Environmental tobacco exposure generally showed a similar pattern of exposure to tobacco smoking across race/ethnicity groups. Cannabis detection ranged from 5% among Hispanic subjects to 12% and 13% among White and Black subjects, respectively, and was higher among tobacco users and those exposed to environmental tobacco smoke than those with no cotinine detected. Tobacco and cannabis exposure were generally greatest in younger subjects and those with indices of a lower economic status; however, among Black subjects, cannabis exposure was greatest in older subjects and those with a higher socioeconomic status. Race/ethnicity, age, and socioeconomic factors can inform targeting of high-exposure groups for intervention.

Background and aims Design, setting and participants Measurements Findings Conclusions Young adult cannabis use is common; while cannabis is often marketed as a product that can improve sleep, evidence supporting these claims is limited, and effects may differ for individuals with underlying mental health issues. This study measured the association between cannabis use and sleep problems among young adults and determined whether associations differ by mental health status.Using two waves of a young adult cohort study (baseline: March–September 2020; follow‐up: January–June 2021), we measured the association of cannabis use frequency with subsequent sleep problems overall and stratified by baseline sleep quality and mental health status in separate moderation analyses. This study was conducted in Southern California, USA, and included 1926 participants aged 20–23 years (mean age = 21; 61% female, 46% Hispanic).Exposure was baseline cannabis use frequency (never use, prior use, 1–5 days/month, 6–19 days/month, ≥ 20 days/month). The outcome was sleep problems at follow‐up (range = 4–24, higher score indicating worse sleep). Models were adjusted for socio‐demographic factors, baseline sleep problems, mental health symptoms (depression and/or anxiety versus neither) and past 30‐day nicotine or alcohol use. In moderation analyses, models were additionally stratified by mental health symptoms and baseline sleep quality (excellent versus imperfect sleep).Among the young adult sample, 11% used cannabis ≥ 20 days/month at baseline. For participants without baseline anxiety or depression symptoms, using cannabis ≥ 20 days/month (versus never use) was associated with greater sleep problems at follow‐up [mean difference (MD) = 1.66, 95% confidence interval (CI) = 0.59–2.74]. Among participants with anxiety and/or depression and pre‐existing sleep problems at baseline, using cannabis ≥ 20 days/month (versus never use) was associated with fewer sleep problems at follow‐up (MD = –1.42, 95% CI = –2.81 to –0.02).The effects of cannabis use on sleep appear to differ by underlying mental health symptoms. Frequent cannabis use may improve sleep for young adults with depression and/or anxiety who have pre‐existing sleep problems, but worsen sleep for young adults without depression and/or anxiety. [ABSTRACT FROM AUTHOR]

Cannabinoids represent a highly researched group of plant-derived ingredients. The substantial investment of funds from state and commercial sources has facilitated a significant increase in knowledge about these ingredients. Cannabinoids can be classified into three principal categories: plant-derived phytocannabinoids, synthetic cannabinoids and endogenous cannabinoids, along with the enzymes responsible for their synthesis and degradation. All of these compounds interact biologically with type 1 (CB1) and/or type 2 (CB2) cannabinoid receptors. A substantial body of evidence from in vitro and in vivo studies has demonstrated that cannabinoids and inhibitors of endocannabinoid degradation possess anti-inflammatory, antioxidant, antitumour and antifibrotic properties with beneficial effects. This review, which spans the period from 1940 to 2024, offers an overview of the potential therapeutic applications of natural and synthetic cannabinoids. The development of these substances is essential for the global market of do-it-yourself drugs to fully exploit the promising therapeutic properties of cannabinoids. [ABSTRACT FROM AUTHOR]

Cannabinoid hyperemesis syndrome (CHS) is a (probably) rare syndrome that occurs in frequent and chronic cannabis users. It is characterised by cyclical vomiting and gastrointestinal symptoms. CHS is frequently misdiagnosed resulting in extensive investigations and delayed diagnosis and treatment. Standard anti‐emetic treatments are typically not effective, and no standardised treatment protocol exists for CHS. Bathing or showering in hot water is often reported to relieve symptoms. Little is known of the aetiology of CHS as the literature is predominantly informed by case reports and chart reviews. Similarly, little is known of the demographics and cannabis use patterns of those who develop CHS. The number of CHS cases globally appears to have risen following liberalisation of cannabis regulation and access in some countries, underscoring the need for wider recognition of CHS in emergency care and by the wider public. [ABSTRACT FROM AUTHOR]

During adolescence, cannabis experimentation is common, and its association with interindividual variations in brain maturation well studied. Cellular and molecular underpinnings of these system-level relationships are, however, unclear. We thus conducted a three-step study. First, we exposed adolescent male mice to Δ-9-tetrahydrocannabinol (THC) or a synthetic cannabinoid WIN 55,212-2 (WIN) and assessed differentially expressed genes (DEGs), spine numbers, and dendritic complexity in their frontal cortex. Second, in human (male) adolescents, we examined group differences in cortical thickness in 34 brain regions, using magnetic resonance imaging, between those who experimented with cannabis before age 16 (n = 140) and those who did not (n = 327). Finally, we correlated spatially these group differences with gene expression of human homologs of mouse-identified DEGs. The spatial expression of 13 THC-related human homologs of DEGs correlated with cannabis-related variations in cortical thickness, and virtual histology revealed coexpression patterns of these 13 genes with cell-specific markers of astrocytes, microglia, and a type of pyramidal cells enriched in dendrite-regulating genes. Similarly, the spatial expression of 18 WIN-related human homologs of DEGs correlated with group differences in cortical thickness and showed coexpression patterns with the same three cell types. Gene ontology analysis indicated that 37 THC-related human homologs are enriched in neuron projection development, while 33 WIN-related homologs are enriched in processes associated with learning and memory. In mice, we observed spine loss and lower dendritic complexity in pyramidal cells of THC-exposed animals (vs controls). Experimentation with cannabis during adolescence may influence cortical thickness by impacting glutamatergic synapses and dendritic arborization. [ABSTRACT FROM AUTHOR]

Recently, the anti-tumor effects of cannabis extract on various cancers have attracted the attention of researchers. Here, we report a nanoemulsion (NE) composition designed to enhance the delivery of two active components in cannabis extracts (∆9-Tetrahydrocannabinol (THC) and Cannabidiol (CBD)) in an animal model of glioblastoma. The efficacy of the NE containing the two drugs (NED) was compared with the bulk drugs and carrier (NE without the drugs) using the C6 tumor model in rats. Hemocompatibility factors (RBC, MCV, MCH, MCHC, RDW, PPP, PT and PTT) were studied to determine the potential in vivo toxicity of NED. The optimized NED with mean ± SD diameter 29 ± 6 nm was obtained. It was shown that by administering the drugs in the form of NED, the hemocompatibility increased. Cytotoxicity studies indicated that the NE without the active components (i.e. mixture of surfactants and oil) was the most cytotoxic group, while the bulk group had no toxicity. From the in vivo MRI and survival studies, the NED group had maximum efficacy (with ~4 times smaller tumor volume on day 7 of treatment, compared with the control. Also, survival time of the control, bulk drug, NE and NED were 9, 4, 12.5 and 51 days, respectively) with no important adverse effects. In conclusion, the NE containing cannabis extract could be introduced as an effective treatment in reducing brain glioblastoma tumor progression. [ABSTRACT FROM AUTHOR]

Cannabis, a diverse compounded plant with a rich cultural and scientific history, has garnered significant attention due to its therapeutic and medicinal potential. The plant's main active compounds, phytocannabinoids, notably A9-tetrahydrocannabinol (THC) and cannabidiol (CBD), play important roles in its effects. Cannabis formulations range from traditional herbal preparations to modern innovations like edibles, sprays, topicals and vaporizable products. Achieving consistent potency, controlled release, and desirable pharmacokinetics remain a challenge. The article delves into its diverse formulations obtained along with its routes of administration. The article provides an overview of cannabinoids-based formulations, highlighting their significance in the context of emerging therapeutic and commercial opportunities, while acknowledging the need for further research to optimize formulations and maximize benefits. [ABSTRACT FROM AUTHOR]

The public is increasingly reporting using cannabis for anxiety relief. Both cannabis use and the endocannabinoid system have been connected with anxiety relief/anxiolytic properties, but these relationships are complex, and the underlying mechanisms for them are unclear. Background/Objectives: Work is needed to understand how the endocannabinoid system, including the endocannabinoids anandamide (AEA) and 2-arachidonoylglycerol (2-AG), may be impacted by the main constituents of cannabis, Δ9-tetrahydrocannabinol (THC), and cannabidiol (CBD). Methods: The current study examined how the ab libitum use of products differing in THC and CBD affected AEA and 2-AG among 292 individuals randomly assigned to THC-dominant use (N = 92), CBD-dominant use (N = 97), THC + CBD use (N = 74), or non-use (N = 29). Results: The findings suggest that AEA levels do not change differently based on 4 weeks of cannabis use or by cannabinoid content, as AEA similarly increased across all conditions from study weeks 2 to 4. In contrast, AEA decreased at an acute administration session with product conditions containing any THC having greater AEA levels on average than the non-use condition. With regard to 2-AG, its levels appeared to primarily be affected by THC-dominant use, both acutely and over 4 weeks, when controlling for baseline cannabis use and examining study product use frequency among use conditions. Conclusions: Overall, the results continue to shed light on the complicated relationship between cannabinoid content and endocannabinoid production, and highlight the need for continued research on their interplay in human subjects. [ABSTRACT FROM AUTHOR]

Abstract and ARP Position Statement: Based on the available body of scientific evidence and with the goals of promoting safety of combat sports athletes and striving for the advancement of clean sport, the Association of Ringside Physicians recommends the following regarding cannabis: • Use of marijuana or synthetic cannabinoids by combat sports athletes is discouraged due to unproven benefits and many known adverse effects. Acute use can impair cognition and complex motor function, which likely leads to reduced performance in combat sports. Chronic use can increase risk for heart and lung disease, several cancers, schizophrenia, and can reduce testosterone in men and impair fertility. Benefits from cannabis in most contexts, including athletic performance, have not been proven. • Use of topical purified CBD is neither encouraged nor discouraged. • Since acute cannabis intoxication can impair complex cognitive and motor function, any athlete suspected of acute intoxication at the time of competition – based on clinical judgment – should be banned from that competition. • Wide-scale regulation of cannabis based on quantitative testing has limited usefulness in combat sports, for the following reasons: ∘ Cannabis is not ergogenic and is likely ergolytic. ∘ Concentrations in body fluids correlate poorly with clinical effects and timing of use. ∘ Access to testing resources varies widely across sporting organizations. [ABSTRACT FROM AUTHOR]

As cannabidiol (CBD) is not considered to be a drug and because of its potential health claims, it is an interesting compound that is often found in cosmetics. However, the safety of CBD, as well as the presence of trace amounts of other phytocannabinoids, including the psychoactive substance ∆9‐tetrahydrocannabinol (THC), is still being debated. A robust analytical technique capable of analysing cosmetic products and determining their phytocannabinoid content will be crucial in assessing the safety of these products. This systematic review aims to highlight the current analytical tools that could be used to analyse phytocannabinoids in cosmetics. The ideal method would be able to analyse high levels of CBD in combination with trace levels of THC and their acids. The method should provide good recoveries and accuracies in a variety of matrices while providing information on up‐coming phytocannabinoids such as cannabichromene (CBC), cannabigerol (CBG) and cannabinol (CBN). The systematic review approach was based on the Preferred Reporting Items for Systematic review and Meta‐Analyses method. The research focused on studies published from January 2010 to December 2022 in PubMed and Scopus. A total of 15 datasets met the inclusion and exclusion criteria and were tabulated to allow easy comparison. Although some of the reviewed methods can handle multiple matrices and provide satisfactory recoveries, this review process did not identify an ideal method. The most suitable methods either could not quantify phytocannabinoid acids or were not sensitive enough to quantify trace levels of psychoactive phytocannabinoids. [ABSTRACT FROM AUTHOR]

Electronic cigarettes (e-cigs), originally intended to be used as cigarette substitutes, have evolved into discreet devices for consuming drugs other than nicotine (DOTNs). Presented are the results of an exploratory survey in which information regarding demographics, e-cig device type, DOTN use, frequency and context of use was collected. The average reported age of respondents was 27.4 years of age (SD = 12.0), and respondents predominantly identified as male (73%). Vape pens (disposable or refillable) were the most reported device across all DOTN classes. Cannabinoids were the most reported class of DOTN used, for both lifetime and past 30-day use. Other DOTNs reported included herbal supplements, amphetamines, caffeine, kratom, vitamins, opiates, DMT, fentanyl, and ketamine. Combinations of DOTNs used in e-cigs and trends in poly-substance use were reported. The most commonly reported context was vaping alone, followed by with friends, at home, and at social events; less commonly reported contexts included when driving, at work, and at school. Results from this study are useful for developing future national surveys to consider a comprehensive substance use-focused strategy that includes vaping, building awareness of DOTN e-cig use, and highlighting public safety issues in driving impairment, crime scene investigations, and death investigations. [ABSTRACT FROM AUTHOR]

Background and aims: High‐potency cannabis has been associated with increased risk of psychosis, but a lack of prospective data hinders understanding of causality in this relationship. This study aimed to combine prospective report of cannabis use with retrospective report of potency to infer the potency of cannabis used in adolescence and explore whether use of cannabis, and the use of high‐potency cannabis, in adolescence is associated with incident psychotic experiences. Design: Population‐based birth cohort study. Setting: United Kingdom. Participants: n = 5570 participants who reported on any cannabis use (yes/no) age 16 and 18 years, and n = 1560 participants from this group who also retrospectively reported on cannabis potency. Measurements In questionnaires at ages 16 and 18, individuals self‐reported lifetime cannabis use, and at age 24, participants reported the type of cannabis they most commonly used in the whole time since first using cannabis. Psychotic experiences were assessed at age 24 years using the semi‐structured Psychosis‐Like Symptom Interview, with incident defined as new‐onset occurring between ages 19 and 24 years. Findings Use of high‐potency cannabis at age 16 or 18 was associated with twice the likelihood of experiencing incident psychotic experiences from age 19–24 (Odds Ratio 2.15, 95% Confidence Intervals 1.13–4.06). There was less evidence for an effect of any cannabis use on incident psychotic experiences (Odds Ratio 1.45, 95% Confidence Intervals 0.94–2.12). Conclusions: Use of high‐potency cannabis appears to be associated with increased likelihood of psychotic experiences. [ABSTRACT FROM AUTHOR]

The chemistry of phytocannabinoids has witnessed renewed interest these last decades as a consequence of reduced restrictions, research on the endocannabinoid system and the development of approved therapeutic treatments based on cannabinoids. The medicinal cannabinoid market constitutes a prolific scenario in current medicine. Most studies, however, have focused on only two major components of Cannabis sativa L., namely, cannabidiol (CBD, 2) and (-)-Δ9-trans-tetrahydrocannabinol (Δ9-trans-THC, 6a), the latter being the main psychoactive compound of this plant. The cis-diastereoisomer of Δ9-trans-THC, Δ9-cis-THC, although also present in the same plant, has been less investigated in terms of biological, medicinal and synthetic perspectives. Interestingly, the cis-fused tetrahydrobenzo [c]chromene motif present in Δ9- cis-THC is embedded in many other natural products which also exhibit interesting biological activities such as anticancer, antifungal, and antiparasitic. This review discloses synthetic approaches that have been established towards the cis-fused tetrahydroisochromene system of Δ9-cis-THC. [ABSTRACT FROM AUTHOR]

Cannabinoid use, particularly for recreational purposes, is increasing exponentially across all age groups, especially in younger populations, due to its perceived low risk and legalization. While cannabinoids may be largely considered as safe, there is mounting evidence of increased risk of systemic and neurological complications through their interaction with the poorly understood endocannabinoid receptor network within the central nervous system and other organ systems. Acute cannabinoid exposure can cause neuropsychiatric symptoms in addition to altering cerebral blood flow, leading to cerebrovascular complications such as ischemic stroke, subarachnoid hemorrhage, and reversible cerebral vasoconstriction syndrome (RCVS). Chronic use, particularly among adolescents, may be associated with increased risk of long-term cognitive deficits, schizophrenia, and other neuropsychiatric effects. Synthetic cannabinoids have increased potency, with reports of causing profound neurological complications including coma, seizures, posterior reversible encephalopathy syndrome, and RCVS. Despite increasing evidence, the quality of literature describing neurologic complications with cannabinoids remains limited to case series and retrospective cohort studies, with significant confounding factors such as concomitant use of other illicit drugs, limiting interpretation. In this review, we summarize the effect of cannabinoids on the neurologic system and associated neurological complications. [ABSTRACT FROM AUTHOR]

The purpose of this study was to conduct a scoping review to describe the evidence on the efficacy and safety of using cannabis-based medicines for osteoarthritis. The review was conducted following the framework proposed by Arksey and O'Malley and reported following PRISMA extension for scoping reviews guidelines. We conducted a comprehensive search across various databases including MEDLINE, Embase, Cochrane Library, CINAHL, Scopus, and Proquest, spanning from inception of each database to March 2023. We retrieved 2533 citations, and after deduplication, title and abstract screening, and full-text screening, 10 articles were included for analysis. These studies were composed of randomized-controlled trials (n = 4/10), cross-sectional surveys (n = 3/10), case studies (n = 2/10), and a cohort study (n = 1/10). Evidence for using cannabis-based medicines was mixed, with just 60% (n = 6/10) of included studies reporting statistically significant improvements in pain. Studies with larger samples sizes and longer durations of exposure did not find significant benefits for pain. The few adverse effects reported were generally mild and affected a minority of participants. Several studies also discovered that cannabis-based medicines were associated with a reduction in opioid use. Currently available data on the use of cannabis-based medicines in osteoarthritis is insufficient to make recommendations. Future research should address concerns regarding small sample sizes and short treatment durations to provide a more robust evidence base. Key Points • Current evidence remains mixed; studies that found a positive benefit with using cannabis-based medicines had limitations with small sample sizes and short durations of exposure • The use of cannabis-based medicines in osteoarthritis appears to be generally well tolerated, adverse effects are mild and experienced by a minority of participants • Cannabis-based medicines may decrease the use of opioids in patients with osteoarthritis • Future research should address the gaps in long-term efficacy and safety data [ABSTRACT FROM AUTHOR]

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Increased cases of canine tetrahydrocannabinol (THC) toxicosis have been reported in North America in recent years. Cases are often evaluated on an emergency basis and treatment has relied upon supportive care which can be costly and prohibitive for some pet owners. The purpose of this report is to describe the clinical findings and outcomes in dogs with non-medical, presumptive THC toxicosis treated by administration of a cannibidiol (CBD)-infused transmucosal dissolving sheet. Medical records of six cases of non-medical, presumptive THC toxicosis from a private primary care practice and a private after-hours emergency practice were reviewed and summarized. Five of six cases were treated exclusively with transmucosal CBD (0.4–2.6 mg/kg); one case also received injectable anti-emetic therapy. Lethargy and ataxia noticeably improved and all additional clinical signs resolved within 45 min of treatment in five of six cases. No further follow-up measures for THC toxicosis were required in any case; one case required additional follow-up for presumably unrelated gastrointestinal distress. This is the first report of treatment of canine THC toxicosis by administration of CBD. The use of transmucosal CBD-infused dissolving sheets resulted in expedient resolution of clinical signs in a minimally invasive manner that is accessible to both clients and veterinary practitioners.

Background: Delta 9-tetrahydrocannabinol (THC) concentrations in oral fluid (OF) at different time points after cannabis administration and factors related to these concentrations have not been previously described in a meta-analysis. This information is critical for better understanding of these tests for detection of prior cannabis use and cannabis impairment. Objectives: 1: To describe the summary statistics of THC concentrations at different time points after cannabis administration. 2: To describe the relationship between the variables of dose of THC, frequency of using cannabis, route of administration (i.e., inhaled or ingested), OF collection device and sex, with THC concentrations in OF, based on bivariate analyses. 3: To describe the independent contribution of each of the variables in Objective 2, based on a multivariate analysis of THC concentrations. Methods: A meta-analysis of studies from two databases (PubMed and Scopus) was conducted. Our inclusion criteria included published empirical articles that administered natural cannabis to subjects in a controlled setting, with OF drug tests showing the exact THC concentrations in OF for each subject (i.e., raw data) for at least two time points after cannabis administration using confirmatory methods. Seven studies of tests with published raw data for OF THC after cannabis administration met these criteria (n observations = 1157). Results: Summary statistics showed OF THC concentrations by time after use were highly dispersed at every time point, positively skewed, and declined over time. Many positive OF THC concentrations were found after 24-h in one study, but most studies did not conduct observations past 24 h. In a multivariate analysis, we found that increased dose, increased frequency of cannabis use, and inhaled (versus ingested) cannabis were statistically related to higher OF THC concentrations. OF collection with the intercept DOA device was significantly higher than expectorant (i.e. saliva) and being male (versus female) were only significant in a bivariate analysis. Too little data existed to reliably analyze the possible influence of other variables of age, race and body mass index (BMI) on OF THC concentrations. Discussion: False negatives exist when the tests are used to detect prior use. OF test results are related to confounders of frequency of cannabis use and inhaled (versus ingested) cannabis. OF tests can produce positives at a cut-off 1.0 ng/mL well beyond 24 h. The tests are not valid to detect cannabis impairment. More information is needed on the influence of potential confounders for OF concentrations. We do not have a good idea of the degree to which the subjects in these studies are representative of persons who use cannabis. Overall, more research is needed for these tests to be used in workplace settings.

Abstract Since its discovery as one of the main components of cannabis and its affinity towards the cannabinoid receptor CB1, serving as a means to exert its psychoactivity, Δ9-tetrahydrocannabinol (Δ9-THC) has inspired medicinal chemists throughout history to create more potent derivatives. Initially, the goal was to synthesize chemical probes for investigating the molecular mechanisms behind the pharmacology of Δ9-THC and finding potential medical applications. The unintended consequence of this noble intent has been the proliferation of these compounds for recreational use. This review comprehensively covers the most exhaustive number of THC-like cannabinoids circulating on the recreational market. It provides information on the chemistry, synthesis, pharmacology, analytical assessment, and experiences related to the psychoactive effects reported by recreational users on online forums. Some of these compounds can be found in natural cannabis, albeit in trace amounts, while others are entirely artificial. Moreover, to circumvent legal issues, many manufacturers resort to semi-synthetic processes starting from legal products extracted from hemp, such as cannabidiol (CBD). Despite the aim to encompass all known THC-like molecules, new species emerge on the drug users’ pipeline each month. Beyond posing a significantly high public health risk due to unpredictable and unknown side effects, scientific research consistently lags behind the rapidly evolving recreational market.

This article explores the neurobiological changes associated with agitation in Alzheimer's disease (AD) and potential interventions. Agitation is a complex behavior that affects many AD patients, but its exact cause is unclear. The article suggests that neuroinflammation, imbalances in brain neurotransmitters, and reduced CB1 receptor functionality may contribute to agitation. The therapeutic effects of THC and melatonin, which target these factors, are discussed. While studies have shown promising results, more research is needed to determine the efficacy of combining THC and melatonin. A recent pilot study found no serious adverse events or deaths, but larger studies are necessary to understand the long-term effects. The article concludes that therapeutic agents containing THC and melatonin may be effective in treating agitation in AD patients, but further trials are required. The study was supported by IGC Pharma LLC, and the authors' views do not necessarily represent those of their affiliated organizations or the publisher. [Extracted from the article]