All posts tagged: Adolescents

The Possible Effects of Cannabis Use in Adolescent Females

What Every Pediatric Gynecologist Should Know About Marijuana Use in Adolescents

In summary

A recent article has called for pediatric gynecologists to ward against the use of cannabis in adolescent females. By pointing out the inconsistent conclusions from multiple papers discussing the effect of cannabis use on neural development and fertility the author hopes to reduce the number of adolescent females utilizing cannabis. It is also pointed out that very little is known about the association between cannabis and mental health problems such as various forms of psychosis, anxiety, and depression. Considering how little conclusive evidence has been agreed upon by overarching associations of medical professions it does seem appropriate to warn against the risks of recreational cannabis but not without also acknowledging the possible benefits of medical cannabis. 

While there are many inconsistencies surrounding cannabis research some of the inconsistent conclusions can be heavily biased by funding parties. Biased articles are difficult to get around because they require fully delving into the material listed analyzed in the paper and looking into the studies that were included and left out of the meta-analysis to determine the validity of their findings. It is extremely frustrating to have articles presented to the public that are so heavily biased they cherry-pick data just to prove their side of a politically controversial therapy. Not all cannabis use is beneficial and is not well understood, but posting articles like this one give fodder to people attempting to prevent the rescheduling of cannabis so that specific chemicals can be harnessed for novel therapies to treat ailments we have no effective treatment for, such as Alzheimer’s, specific cancer types, and a slew of psychiatric disorders. Scientists have a responsibility to remain objective and this type of biased research is disappointing to come across.

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Benjamin Caplan, MDThe Possible Effects of Cannabis Use in Adolescent Females
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More Research on Adolescent Cannabis Use and Mental Disorders

The persistence of the association between adolescent cannabis use and common mental disorders into young adulthood

In summary

Further examination of chronic cannabis use in adolescents correlates with a higher prevalence of anxiety. Research discussing adolescent cannabis use and mental disorders has been inconsistent, mainly debating whether or not some mental disorders are caused by cannabis use. The featured article found no evidence of causation but did notice a positive correlation between chronic (described here as daily) adolescent cannabis use and the development of anxiety. The development of major depressive disorders was not positively correlated with cannabis use, even in regular users. Causation, especially for psychosis, should continue to be looked into in order to determine the full safety profile of cannabis-based medications. 

Adolescent cannabis use does seem risky when considering that cannabis directly affects the brain while the brain is still developing and very few researchers have published well recognized and accepted data discussing the effect of cannabis on neural development. It seems interesting that chronic cannabis use is positively correlated to the development of anxiety when the most abundant non-psychoactive cannabinoid and multiple terpenes are praised for their anxiolytic effects. Research into the effect of each chemical component of cannabis should be researched to fully elucidate which cannabinoid or combinations of cannabinoids, terpenes, etc., cause alternations in neurodevelopment and other effects. 

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Benjamin Caplan, MDMore Research on Adolescent Cannabis Use and Mental Disorders
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Adolescent Use is not Increased by Cannabis Legalization

Does liberalization of cannabis policy influence levels of use in adolescents and young adults_ A systematic review and meta-analysis

In summary

A recent meta-analysis and systematic review has shown that the liberalization of cannabis use has not increased the amount of reported cannabis use in adolescents. There appeared to be a slight increase in adult cannabis use post-recreational cannabis legalization but not a significant amount to clearly report that trend. These reports may be skewed due to the social stigma that continues to surround cannabis use and therefore prevents participants from accurately reporting their history, but further research in an area where cannabis legalization is likely to occur but hasn’t yet would provide an interesting opportunity to confirm these findings. 

Medical cannabis use has been legalized in 33 states at the time of this blog and legalized for recreational use in 11 states, highlighting the importance of looking into current demographics and legal activity. Some studies have suggested a decrease in adolescent cannabis use as illicit dealers are replaced by state-regulated dispensaries implying that legalization and regulation may actually provide a safer environment for cannabis use and allow better prevention practices for adolescents. Further research would be needed to confirm these hypotheses and previous findings but prove promising for future legalization.  

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Benjamin Caplan, MDAdolescent Use is not Increased by Cannabis Legalization
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Adolescent Female Cannabis-Users are Less Likely to Engage in Sexual Intercourse

Daily co-occurrences of marijuana use, alcohol use, and sexual intercourse among at-risk, truant adolescent girls

In summary

A recent study conducted by Brown University found that adolescent female cannabis users were less likely than their peers to engage in sexual intercourse. It remains uncertain whether cannabis is reducing participants’ desire to engage in sexual intercourse or if there is a second common factor that wards them away from intercourse. Within the same population, it was found that the participants who consumed alcohol were far more likely to engage in sexual intercourse that day than controls or cannabis users. This knowledge may aid in the development of prevention programs, specifically for those consuming alcohol underage and then engaging in sexual intercourse, defined as a high-risk behavior in this study. 

Adolescent cannabis use is a hot topic of conversation as state governments continue to legalize medical and recreational cannabis. At-home cultivators and those who maintain a large amount of cannabis at their homes need to ensure proper storage and restriction methods to ensure the safety of their children. Too little is known about the long-term effects of cannabis to allow adolescents to have unsupervised access to cannabis. There should also be more studies conducted addressing the effect of cannabis-based medications in adolescents so it can be deemed safe to give children for various disorders or if it affects neural development.

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Benjamin Caplan, MDAdolescent Female Cannabis-Users are Less Likely to Engage in Sexual Intercourse
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Drug Resilience is Age-Dependent

Behavioral effects of chronic WIN 55,212-2 administration during adolescence and adulthood in mice

In summary

 A recent study has revealed that adolescents appear resilient to some effects of cannabis yet early use leads to increased impulsivity later on in life. Researchers administered 3.0 of a cannabis receptor 1 (CB1) agonist, WIN55,212-2, per day for 21 days to one group of mice in adolescence and another in adulthood before testing their impulsivity, judgment, and learning abilities. Adolescent mice who had been given cannabis performed as well as controls at the learning activity while the adult group experienced a serious delay, suggesting an age-dependent difference in the cannabinoid system. Adolescent mice who had been given cannabis and then tested later as adults demonstrated increased impulsivity suggesting that exposure to cannabis during development does have a lasting effect on processes. Further research will need to validate these findings in non-human primates or be examined in naturalistic observation studies. 

When considering the implications of a study like this one it is important to note the varying accuracy of cannabis research conducted in murine models. While rats and mice are convenient physiological models due to their availability and economic value they do not always provide the most accurate representation of specific biological systems in humans. The endocannabinoid system of rats has been shown in previous featured studies to act differently than the human or primate endocannabinoid system meaning that any scientific evidence for cannabis-based medicine found from murine studies cannot be conclusive without further validation.

The study is available for review or download here
https://drive.google.com/open?id=12Yzwxy5Vd1MXmyBjeGCIcHOmHIiO6VIg

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Benjamin Caplan, MDDrug Resilience is Age-Dependent
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The Motivative for Abusing Cannabis as an Adolescent

Motives for cannabis use in high-risk adolescent users

In Summary

A recent article has revealed some of the motives behind adolescent cannabis abuse. Researchers found that cannabis is misused as a coping mechanism in individual adolescents who internalized behavioral problems which then leads to the development of a number of cannabis dependence symptoms. Participants who reported cannabis use for enhancement, social, and conformity purposes did not report similar issues with dependency. The gathered data suggests that the motivation behind cannabis use should be considered when addressing an individual’s use and that targeted intervention tools should focus on the motivation of drug abuse to better educate at-risk youth. 

This article emphasizes the need to educate adolescents on the medical benefits and proper use of cannabis before it can be abused. If at-risk youth are using cannabis to mitigate feelings of anxiety they may be worsening their symptoms as tetrahydrocannabinol (THC), the most abundant psychoactive component of cannabis, is known to exacerbate anxiety. If they knew about cannabidiol (CBD), which is a non-psychoactive cannabinoid, which is readily available in most states within the United States and has been beneficial for most people dealing with anxiety. Cannabinoids, terpenes, and flavonoids provide a myriad of medical benefits but a lack of education may allow teenagers to misuse those substances, including legal products, and worsen their symptoms, leading to continued misuse and may prevent them from seeking medical help for their ailments. 

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Benjamin Caplan, MDThe Motivative for Abusing Cannabis as an Adolescent
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Brief Interventions by Pediatricians can Reduce Adolescent Alcohol and Drug Abuse

Understanding Which Teenagers Benefit Most From a Brief Primary Care Substance Use Intervention

In Summary

A recent study has revealed that brief interventions given by primary care physicians can reduce alcohol and drug abuse among at-risk adolescents. This study aimed to address only alcohol and cannabis use disorders in teenagers who already reported the misuse of such substances. Participants were randomly assigned to receive an intervention from their physician or assigned as controls and then asked about their substance use habits 12 months later. Those who received an intervention reported a marked decrease in substance use through self-reporting and chemical screening. This research suggests that pediatricians and other general practitioners should speak candidly about the risks of substance use disorders with their patients. 

Pieces like the featured article highlight the importance of responsible cannabis use. Cannabis is becoming more socially acceptable as states continue to put forth policies that legalize medical and recreational use. Like alcohol and other drugs, cannabis should remain a semi-controlled substance whose availability is restricted by age or other factors so that at-risk youth are unable or less likely to abuse its benefits. State laws currently decide who has access to cannabis but as at-home cultivators become more prominent it will be necessary to ensure the security of those plants to prevent adolescents from misusing plants grown by family or friends. 

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Benjamin Caplan, MDBrief Interventions by Pediatricians can Reduce Adolescent Alcohol and Drug Abuse
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An Analysis of Sudden Cardiac Death Exposes the Danger of Tobacco and Cocaine

Sudden cardiac death associated to substances of abuse and psychotropic drugs consumed by young people- A population study based on forensic autopsies

In Summary:

A recent study out of Spain has revealed alarming trends among cases of sudden cardiac death associated with substances of abuse consumed by young people. Half of the 15-36-year-olds who suffered sudden cardiac death were found with illicit substances in their bodies, primarily cannabis, tobacco, and cocaine. Researchers found that although cannabis was the most common substance found in the deceased systems, cocaine and tobacco are known to have a stronger impact on the cardiovascular system and lead to ischemic heart disease, which is often the more acute causes of sudden death. It was also mentioned here that the duration of cannabis is far longer in the body than that of either tobacco or cocaine, and this duration may easily confuse people to associate it as a trigger for sudden death.

However, on the other hand, there are several tragic cases of young, otherwise heart-healthy individuals who have died with cannabis as the only substance discovered. Fortunately, these cases are extraordinarily rare, but unfortunately, no reproducible association has been established, so the mysterious concerns are not easily relieved or forgotten.

Dr. Caplan and the #MDTake:

While the return of medical cannabis to modern medical care seems to bring with it a return of appreciation for more naturalistic care, it is critical for us all to recognize that we still have much to learn. The tools and high standards of scientific evaluation have only recently been applied to cannabis, and there are reasonable arguments that the usual tools may not actually apply (for example, some are suggesting that the placebo effect, a cornerstone of randomized control trials may be a facet of effects related to the endocannabinoid system.)

For these, and a great many other unknowns, it is important for the discerning consumer to consult with trusted resources, including friends, family, scientists, and where possible, doctors, to ensure the appropriateness of use on an individual basis.




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Benjamin Caplan, MDAn Analysis of Sudden Cardiac Death Exposes the Danger of Tobacco and Cocaine
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Participants in Cannabis for Chronic Pain Study Describe Life-Changing Results

Restored Self: A Phenomenological Study of Pain Relief by Cannabis

In Summary:

In an Israeli qualitative study investigating the impact of cannabis use on chronic pain patients, all but one of the nineteen study participants experienced pain relief after cannabis use. Participants explained how cannabis allowed them to not just discontinue medications treating their pain, but also medications treating secondary outcomes of their pain, such as poor sleep and anxiety. Patients described feeling “a sigh of relief,” being “reborn” or being saved by cannabis use after years of debilitating pain and medication side effects.

Dr. Caplan and the #MDTake:

The pathway through which cannabis works to combat pain is different from the usual pathways doctors have used for the last 90 years. Prior to the 1930s, cannabis was used routinely, just about everywhere, but political and social agendas kidnapped the medicine and hid it away from most of the mainstream and from routine medical education.

Patients often describe typical pain relievers as adjusting the impact of the pain. Reducing or quieting the pain, softening discomfort, allowing the sufferer to perform previously typical tasks without debilitation or dysfunction. Cannabis, on the other hand, is sometimes described as “taking the sufferer away from the pain,” rather than the other way around. The effects that cannabis can have on the reduction of inflammation, attention, memory, and relaxation, provide a new type of opportunity for relief.

Still, other patients describe the effects of cannabis through a lens of mental focus. Whereas in daily use we typically open a standard set of drawers, some have said, the use of cannabis allows the consumer to open up a different set of draws, and through this adjusted lens, to see discomfort from a different perspective.

For those suffering with chronic pain, years upon years of discomfort, suffering that, when paired with modern medicines, has only met frustration and further discomfort, cannabis is frequently seen as a welcome “sigh of relief.”

different types of  pain
Discussion  from text of research  doc
Sample of text discussing lack of adverse  side effects of cannabis

This paper is also stored here:     http://bit.ly/32FZkUU    inside the CED Foundation Archive

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Benjamin Caplan, MDParticipants in Cannabis for Chronic Pain Study Describe Life-Changing Results
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Pre- and Post-natal Tobacco and Cannabis Exposure Impacts Children in a Sex-Specific Manner

Pre- and postnatal tobacco and cannabis exposure and child behavior problems: Bidirectional associations, joint effects, and sex differences

Summary Info:

Prenatal maternal cannabis and tobacco use is predictive of behavioral problems among toddlers. Resulting differences from control groups include anxiety, depression, and attention problems. Female children of mom’s consuming substances, in particular, seem to be more susceptible to problems relating to internalization, attention, and sleep. Additionally, the behavioral problems induced by prenatal cannabis and tobacco consumption often lead to further maternal substance consumption, which frequently exacerbates existing behavioral problems. 

Highlights of study of mother's prenatal and postnatal consumption of  cannabis
Highlights of interplay of mother's prenatal and postnatal consumption of  cannabis with children
Highlights of interplay of mother's prenatal and postnatal consumption of  cannabis with toddlers

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Benjamin Caplan, MDPre- and Post-natal Tobacco and Cannabis Exposure Impacts Children in a Sex-Specific Manner
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