All posts tagged: cannabis

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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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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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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Everything You Need to Know About Current Cannabis Laws and Challenges

Regulatory and legislative disparities with cannabis present challenges to P&T committees and health care providers

In summary

An article has recently been published that gives a summary of current federal and state cannabis laws and highlights the arising regulatory and legislative challenges. Cannabis is still considered a Schedule I drug at the federal level under the Controlled Substances Act but the FDA approval of Edioplex, a cannabidiol (CBD)-based epilepsy medication, has caused CBD to be ruled as a Schedule V drug by the Drug Enforcement Agency. The piece explains the implications of CBD approval, including the Farm Bill passed in 2018 and discusses the intricacies of maneuvering between federal and state drug regulations. Current laws, even at the federal level, show a shift towards the approval of cannabis products but there is still a long way to go. 

The article also highlights and attempts to explain the difficulties that physicians, budtenders,  and pharmacists in prescribing, licensing, and providing cannabis. Some states, not including Massachusetts, require that pharmacists provide cannabis so that they can properly advise patients about the risks and benefits of cannabis use. Massachusetts (MA), like many other states who have legalized medical cannabis, do not require budtenders at dispensaries to possess any prior medical knowledge, meaning that their advice on which strain or product a patient should try can be extremely under-informed and subjective. Patients in states like MA should take care to speak with their licensing physician or nurse practitioner about which cannabinoids or products would likely be best for them.

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Benjamin Caplan, MDEverything You Need to Know About Current Cannabis Laws and Challenges
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Cannabis Legalization in Canada will Minimally Impact Emergency Departments

Planning capacity for mental health and addiction services in the emergency department- a discrete-event simulation approach

In summary

A study published in June of 2019 has revealed the forecast for emergency department visits based on the current opioid crisis in Canada and the legalization of cannabis. Researchers observed an increase in the number of emergency department visits at hospitals in Canada, specifically for mental health addiction complaints. It was determined that the opioid crisis will continue to cause issues for emergency departments but that the legalization of cannabis will cause a minimal amount of issues due to the low-risk of addiction. While forecasting the effects of addiction-related emergencies researchers determined that there would be increased waiting times and the length of stay will deteriorate. It is recommended that Psychiatric Emergency Service Units increase their number of beds and that programs aimed at preventing alcohol and opioid addiction will be especially helpful for managing the future influx of patients. 

The opioid crisis is ravaging more than just the emergency rooms in Canada, extending all over North America. Opioids are incredibly dangerous considering their high risk of addiction, often leading to people illegally obtaining opioids or other illicit drugs like heroin. Opioids most commonly act on µ-opioid receptors which affect the reward pathway in the central nervous system, preventing pain and convincing the body that opioids are a great substance. Some doctors are all too willing to overprescribe opioids for chronic pain or during recovery periods leading many to begin their lifelong addiction. Considering the economic cost of dealing with addicts, the emotional cost to families and caretakers, and the promise of cannabis as an anti-nociceptive, the federal government should seriously consider rescheduling cannabis so that it can be more seriously considered as an adjunct or replacement therapy for pain.

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Benjamin Caplan, MDCannabis Legalization in Canada will Minimally Impact Emergency Departments
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Sunk Cost Bias seen in Frequent Cannabis Users

Persisting on the Past- Cross-sectional and Prospective Associations Between Sunk Cost Propensity and Cannabis Use

Researchers have recently found that those diagnosed with cannabis use disorder are also likely to display sunk cost bias. Sunk cost bias is the overgeneralized tendency to persist based on past investment, in other words, the tendency to focus heavily on the past and perseverate more than their counterparts. In a two-part study, it was found that frequent cannabis use was positively associated with sunk cost bias and that sunk cost bias was able to predict frequent cannabis use in a separate cohort. This correlation may prove useful when developing a possible examination or screening test to determine the benefit of medical cannabis for individuals looking into cannabis-based treatments. 

Cannabis use may not be for everyone as cannabinoids can affect people differently depending on their general demeanor or perhaps some mechanism that has yet to be defined. The most abundant, and perhaps well studied, psychoactive cannabinoid in cannabis is ∆-9-tetrahydrocannabinol (THC), which can affect people with anxiety very differently. Occasionally, especially when patients are hesitant to use cannabis already, THC can actually exacerbate symptoms of anxiety and therefore may not serve as the most efficient treatment for some patients. The development of a screening technique to determine how cannabinoids will affect patients before they try cannabis is desperately needed to ensure the benefit of the consumer. 

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Benjamin Caplan, MDSunk Cost Bias seen in Frequent Cannabis Users
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Another Glance at the Effect of Cannabis on Sperm

Paternal THC exposure in rats causes long-lasting neurobehavioral effects in the offspring

In summary

A recent study has exposed the negative effects of paternal exposure to ∆-9-tetrahydrocannabinol (THC) on attentional capabilities of offspring. The data provides evidence that a moderate dose of THC modulates the methylation of sperm in rats which was found to have long-term effects on offspring during the operant attention task. THC exposure did not affect the clinical health of the litter, the number of offspring, sex ratio, birth weight, survival rates, or growth although there was a reported increase in habituation of locomotor activity in adult offspring. As the study provides evidence that paternal exposure to THC can cause deleterious behavioral effects in the offspring this study should be repeated in humans or males who self-report cannabis use and conceive a child should be observed for the health of the next generation. 

The effect of prenatal exposure to cannabis on birth rates, birth outcomes, and the health of the mother is rather uncertain. Studies focussing on cannabis use during pregnancy are limited and what little has been reported is inconsistent. The featured article now brings to light that both parents may need to be cautious when attempting to conceive or when having unprotected sex as cannabis may affect both germ cells. Currently, governing bodies of obstetricians advise that pregnant mothers cease any cannabis use so if someone who needs cannabis for a medical purpose that improves their quality of life becomes pregnant they need to seek out alternative methods of treatment. Research is needed so that pregnant women can safely continue their medication or so that alternatives can be found so that women do not need to suffer for the duration of their pregnancy and possible breastfeeding period. 

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Benjamin Caplan, MDAnother Glance at the Effect of Cannabis on Sperm
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The Effectiveness of Cannabidiol as an Anti-Epileptic

Parasitic pharmacology- A plausible mechanism of action for cannabidiol

In summary

A recent editorial questions the efficacy of utilizing cannabidiol (CBD) as an anti-epileptic and proposes a plausible mechanism of action for previously seen anti-epileptic effects. While discussing the issues within the two randomized-placebo controlled studies published in the New England Journal of Medicine (NEJM) that led to the eventual FDA approval of Edioplex for the treatment of seizures, the author raises concerns about the quality of content published by the NEJM. The author claims that the two studies claiming that CBD was a novel therapy for Dravets Syndrome and Lennox-Gastaut Syndrome did not examine or publish the pharmacokinetic properties of CBD within their study and that all benefits found were actually due to the drug-drug interaction between CBD and clobazam, a known anti-epileptic. As this hypothesis was only examined as a simulation further testing is needed.

Cannabinoids, like all drugs, should continue to be questioned and retested for efficiency. Cannabis is not omnipotent and just because it holds promise for a myriad of ailments and disorders does not mean it may be the most efficient or ethical treatment available. Cannabinoids and terpenes deserve to be examined based on their potential as the medical community continues to search for novel cancer treatment, anti-emetics, appetite modulating drugs, and more which can then be fully developed for maximum pharmacological efficiency and compared to the current treatment. It seems irresponsible to not compare or develop cannabis-based medicine considering the promise seen in countless studies.

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Benjamin Caplan, MDThe Effectiveness of Cannabidiol as an Anti-Epileptic
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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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A Balanced Diet and Excercise Promotes Health via the Endocannabinoid System

Diet, endocannabinoids, and health

In summary

 It has recently been revealed that the endocannabinoid system plays a crucial role in the maintenance of health while aging. Researchers found that a aerobic exercise promotes endocannabinoid levels in the blood and the increased levels are positively associated with general well-being. The collected data shows that the endocannabinoid system is especially important for controlling appetite, improving systemic metabolism, and reducing obesity and diabetes. Diet and exercise both affect the overall function of the endocannabinoid system, highlighting the importance of maintaining a healthy lifestyle in order to promote health while aging. Further research should examine how cannabis-based supplements affect health while aging. 

The endocannabinoid system affects the function of various systems and organs within the body, emphasizing its potential as a therapeutic target. Even without the use of readily available cannabis, synthetic cannabinoids are being produced that aim to address a myriad of treatment-resistant disorders. Recent research has shown that cannabinoids provide benefits for more than just inflammation and pain or other disorders centered around the central nervous system and that their possible effects extend throughout the human body. Research into cannabinoids, synthetic or otherwise, as well as terpenes and flavonoids, should be highlighted in the near future to address cancer, anorexia nervosa, and other ailments that are notoriously difficult to treat.

The study is available for review or download here

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Benjamin Caplan, MDA Balanced Diet and Excercise Promotes Health via the Endocannabinoid System
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