All posts tagged: Cannabis Use Disorder (CUD)

Health Risks Associated with Co-Use of Cannabis and Nicotine

Types of cannabis and tobacco_nicotine co-use and associated outcomes in young adulthood

In summary

A recent survey has revealed the increased health risks and behavioral issues of those who use both cannabis and nicotine. After separating survey respondents into five categories based on use patterns (single-product use; concurrent use only; sequential use only; coadministration only; and both sequential use and coadministration) researchers examined the psychological and physical health of respondents finding that those who co-used cannabis and nicotine on the same occasion reported increased use and greater behavioral problems. Those who reported sequential use, so using one product directly before the other, were observed to have worse physical and mental health compared to those who only used one substance. This research may aid in the development of prevention programs by informing program developers about the associated risks of co-use. 

Understanding drug interactions is imperative for the health of the consumers, including those who use tobacco products. Very little research has been conducted that addresses drug interactions with cannabis and although some pharmacies are equipped with lists of theoretical information or previous incidents very little of it is certain. For those who need common medications like blood thinners, muscle relaxants, etc., drug interactions can be dangerous, even fatal, emphasizing the importance of understanding how cannabis interacts with other medications at the cellular level. Pharmacists and physicians need more knowledge to be able to thoroughly inform patients consuming marijuana of the potential risks. Future research should be conducted, as well as chemical modeling studies, to ensure the safety of cannabis users. 

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Benjamin Caplan, MDHealth Risks Associated with Co-Use of Cannabis and Nicotine
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The Relation Between Conduct Disorder and Cannabis

Conduct disorder-related hospitalization and substance use disorders in American teens

In summary

Cannabis use was found to highly correlate with inpatients diagnosed with conduct disorder amongst teenagers. Although some cannabis use was self-reported by patients dealing with other psychiatric disorders, it was seen most significantly in those with conduct disorder (CD), suggesting a higher risk of comorbidity between CD and substance use disorders. Although cannabis use was the most common substance reported by patients it was closely followed by tobacco and alcohol use. The demographics of patients using cannabis varied although those suffering from CD and substance use disorder were primarily male and black. Further research should be conducted to develop efficient prevention strategies. 

Looking into the substance use frequency and patterns of stigmatized or marginalized groups is not often done leaving many populations without specialized treatment or prevention programs. If members of the male black population are at a higher risk of developing substance use disorders then our prevention efforts should address that population first and foremost. People begin using substances for different reasons although some motivations are common among certain populations. By examining the underlying motivation for substance use frequency members of the healthcare community may be able to develop custom prevention or treatment methods by utilizing psychology or another science to drastically decrease the frequency of substance use disorders in all populations. 

The study is available for review or download here

View more studies like this in the CED Foundation Archive 

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Benjamin Caplan, MDThe Relation Between Conduct Disorder and Cannabis
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Reducing Cannabis Use Equally Effective as Abstinence in Treating Cannabis Use Disorder

Reduction in Cannabis Use and Functional Status in Physical Health, Mental Health, and Cognition

In a survey of 111 cannabis use disorder (CUD) patients with abstinent, low use, or heavy use of cannabis, similar benefits were experienced by patients who reduced their use to zero or low use. Both groups exhibited significantly better outcomes than the heavy use group with respect to overall health, appetite, and depression. According to the study, CUD patients “who used cannabis at a low level did not differ from the abstinent individuals in any of the functional outcome measures.” With a relatively small subject population, it is challenging to know if this is applicable to broader audiences, but regardless, It is likely to open up some new treatment option for CUD patients.

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This paper is also stored here:   http://bit.ly/2MTBOAm      inside the CED Foundation Archive

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Benjamin Caplan, MDReducing Cannabis Use Equally Effective as Abstinence in Treating Cannabis Use Disorder
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Natural & Cannabinoid Changes in Dopamine: A key to the psychosis question?

Comparing dopaminergic dynamics in the dorsolateral striatum between adolescent and adult rats- Effect of an acute dose of WIN55212-2

Brief summary:

A recent study has exposed an age-dependent mechanism within the dopaminergic system that relies on cannabinoid receptor 1 (CB1). Adult and adolescent dopamine levels were examined in the presence of a CB1 agonist and increased levels of extracellular dopamine were found in adolescents. This study reveals the different effects cannabis-based medicine has depended on the age of the patient and warrants future research to ensure cannabis has the desired therapeutic effect on patients.   

Dr Caplan Discussion Points:

This adds a helpful layer of insight to the way an animal model of dopamine changes over time, as well as its interaction with exogenous cannabinoids. This sheds light on the natural evolution of the dopamine control system (irrespective of how it interacts with endocannabinoids), and it also points to how cannabinoids may be involved.

This helps to educate the discussion about how psychosis and cannabis use may interact. There is a long-held understanding that dopamine abnormalities in the specific parts of the brain (mesolimbic and prefrontal brain regions) exist in schizophrenia. More recently, research has also strongly suggested that other neurotransmitters, including glutamate, GABA, acetylcholine, and serotonin are also involved in schizophrenia (and, coincidentally, there is also interaction with these other neurotransmitters from various components of cannabis). Nonetheless, this study simply suggests that, by nature, basal dopamine levels increase during adolescence. Also, the study points out that some cannabinoids boost basal levels too. It seems logical to suggest that excessive dopamine may create a problematic force of additional tipping toward illness, within individuals for whom a congenital predisposition toward illness exists.

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This paper is also stored here:    http://bit.ly/2HpWqM5     inside the CED Foundation Archive

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Benjamin Caplan, MDNatural & Cannabinoid Changes in Dopamine: A key to the psychosis question?
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Supplementing Antipsychotics with CBD Enhances Psychotic Symptom Treatment

Cannabidiol (CBD) as an Adjunctive Therapy in Schizophrenia: A Multicenter Randomized Controlled Trial

Most schizophrenia medications function by blocking the action of the dopamine D2 receptor and effectively treat positive psychotic symptoms, such as delusions or hallucinations, but fail to treat negative psychotic symptoms, such as lack of motivation or the lack of an ability to feel pleasure. Anecdotal evidence has pointed toward the potential for CBD to attenuate psychotic symptoms in conjunction with normally prescribed antipsychotics; additionally, CBD is not hypothesized to act on the D2 receptor, suggesting that it may afford unique advantages over anti-psychotics.

Researchers interested in further exploring this conducted the first known placebo-controlled CBD trial among schizophrenia patients. Although results did not suggest a potential for CBD to treat negative psychotic symptoms, in conjunction with antipsychotics, the CBD group experienced marked lower levels of positive psychotic symptoms. Both the placebo and CBD groups experienced equal levels of treatment-induced adverse events, suggesting that CBD is well-tolerated.

These results suggest that CBD may be effective in treating not only schizophrenia but also psychotic symptoms associated with Parkinson’s disease and THC-induced psychosis.

Additional Point: CBD has shown to act in a neuroprotective manner and reduce the psychoactive effects of THC, making it a viable option for patients who have experienced negative side effects with THC.

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This paper is also stored here:    http://bit.ly/2WztI04     inside the CED Foundation Archive

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Benjamin Caplan, MDSupplementing Antipsychotics with CBD Enhances Psychotic Symptom Treatment
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Benin Republic Hemp Improves Male Fertility

Cannabinoid-deficient Benin republic hemp (Cannabis sativa L.) improves semen parameters by reducing prolactin and enhancing antioxidant status

Cannabis sativa, specifically Nigerian hemp, has been found to have adverse effects on male fertility. It’s use has been linked to a decrease in semen parameters, germ cell proliferation, and reproductive organ weight. It can induce hyperprolactinemia, a condition causing infertility in 11% of men with low sperm count.

Data from the National Drug Law Enforcement Agency in Nigeria has suggested users preferentially obtaining hemp from the Benin Republic. In a recent study investigating the composition of Benin republic hemp, a lack of THC and lower levels of cannabinol were observed. Additionally, an ethanol extract of Benin republic hemp increased sperm count, morphology, and viability.   

Additional Point: Certain phytocannabinoids found in cannabis have demonstrated a detrimental effect on male fertility. However, analysis of hemp from the Benin republic shows a low to no levels of these toxic cannabinoids and evidence points to this particular hemp enhancing male fertility.

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This paper is also stored here:    http://bit.ly/2Yzc26y     inside the CED Foundation Archive

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Benjamin Caplan, MDBenin Republic Hemp Improves Male Fertility
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Looking for a genetic explanation for “Cannabis Use Disorder”

Genome-wide association study implicates CHRNA2 in Cannabis Use Disorder

Roughly 9% of cannabis users become dependent. In a recent study, scientists identified a significant association between CHRNA2 gene expression and a diagnosis of Cannabis Use Disorder. In other words, genetics might help to explain why some people may find themselves more dependent upon cannabis than others.

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This paper is also stored here:    http://bit.ly/2IVZJvJ     inside the CED Foundation Archive

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Benjamin Caplan, MDLooking for a genetic explanation for “Cannabis Use Disorder”
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Case Studies Expose Under Recognition of Cannabis Hyperemesis Syndrome

“Cannabis hyperemesis syndrome: still under-recognized after all these years

After two years of chronic vomiting and pain and dozens of trips to emergency rooms a 23-year-old woman was found to have cannabis hyperemesis syndrome (CHS). Physicians are still unable to recognize the early symptoms of CHS as cannabis use is still in a legal gray area in much of the country. A lack of research, recognition, and trust often prevents a quick diagnosis when an illness is related to cannabis, leading to multiple referrals and invasive tests.

CHS was first described 15 years ago yet it is not frequently recognized in patients. The case study featured in this blog post highlights patients and physicians’ outcry for tolerance and support so that cannabis-related illnesses can be efficiently and effectively engaged.

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This paper is also stored here:    http://bit.ly/2IxMxNx     inside the CED Foundation Archive

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Benjamin Caplan, MDCase Studies Expose Under Recognition of Cannabis Hyperemesis Syndrome
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Capsaicin Cream Treats Cannabinoid Hyperemesis Syndrome in Adolescents

Capsaicin Cream for Treatment of CHS adolescent

Researchers have found that capsaicin cream is an effective and safe method of treating cannabinoid hyperemesis syndrome (CHS) in adolescents. Capsaicin cream has previously been shown to be effective at treating CHS in adults but adolescents have previously been treated with haloperidol, a drug known to have serious side effects. Capsaicin cream offers a much safer and more cost-effective method of treatment for adolescents.

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This paper is also stored here:   http://bit.ly/2F8Gtcc      inside the CED Foundation Archive

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Benjamin Caplan, MDCapsaicin Cream Treats Cannabinoid Hyperemesis Syndrome in Adolescents
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“Liver toxicity” of mice force-fed with unreasonable amounts CBD

Here, an excellent example of how valuable it is for scientific literature to be read critically and thoughtfully. When reporters read, or extract, or convey only partial conclusions, it is all-too-easy for consumers to absorb an incomplete, undigested message. As consumers of journalism, the public deserves a more knowledgeable understanding. Here (http://bit.ly/2KV0jeG), Forbes (Mike Adams) conveys an unfortunate lack of deep consideration in the reporting. Thankfully, a brief quote is conveyed by Dr. Koturbash, who “was quick to point out that the CBD products coming to market may not pose this particular risk” – but this stone-throw of even-handedness falls short to appropriately balance an article already dripping with misgivings and incomplete evaluation of the material at hand.

For a more layered view of the science, the word “gavage,” as was applied to the mice in the study, describes force-feeding animals with a tube down their throats, often taped to mouths which are then kept gaping open. This is meant to simulate the biological processes of eating (different from giving meds IV, for example.) There is no regard to the stress that this process causes the animals, as they are treated as though they are biological CBD-processing machines. In the days where many people are taking 10mg pills of CBD per day, the amounts of CBD that were force-fed to these animals in this study, if translated to humans, would be 4,305mg, 12,915mg, and 43,050mg over 10 days, or 17,220mg, 51,660mg, and 172,200mg in one-shot doses.) For reference, these days, most dispensaries sell CBD in doses of 10mg, 20mg, up to 2-300mg.)

In the study, the authors suggest that they allow animals to eat “ad libitum,” as if to convey that they are treated with a buffet. And yet, the animals being stuffed with 43,050mg (human equivalent) of CBD still lost weight, while others (given 172,200mg (human equivalent) had uneven weight distribution.) To any reader considering these values critically, it must seem absurd to make conclusions about the actions of CBD as what is causing these effects, as if the fact of over-stuffing itself has no impact at all.

An analogy to this study: If you add 17,000 cars (or 172,000!) to a tunnel on the way to the airport, and stuff each car full of way too many people, there might be problematic levels of concern inside that tunnel.

Let’s hope to see more even-handed consideration and reporting from Forbes, in the future.

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This paper is also stored here:    http://bit.ly/2WWNOGA     inside the CED Foundation Archive

Here, another study that shows very different results. Instead of overstuffing mice w/ unrealistic amounts, if one administers CBD at sensible doses in the same population of mice, it turns out that CBD could directly reduce alcohol drinking, improve healthy processes in the liver, and alcohol-related brain damage…

“CBD reduces alcohol-related steatosis & fibrosis in the liver by reducing lipid accumulation, stimulating autophagy, modulating inflammation, reducing oxidative stress, & by inducing death of activated hepatic stellate cells” This new study:

This paper is also stored here: http://bit.ly/2IAvzOz  inside the CED Foundation Archive

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Benjamin Caplan, MD“Liver toxicity” of mice force-fed with unreasonable amounts CBD
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