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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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The Endocannabinoid System and Post-Traumatic Stress Disorder

Genetic susceptibility to posttraumatic stress disorder: analyses of the oxytocin receptor, retinoic acid receptor-related orphan receptor A and cannabinoid receptor 1 genes

In summary

A recent study has found that the dysregulation of cannabinoid receptor 1 (CB1) does not increase the likelihood of developing post-traumatic stress disorder (PTSD). Researchers analyzed genetics to determine if there was any correlation between single nucleotide polymorphisms within the oxytocin receptor (OXTR) gene, the RAR-related orphan receptor A (RORA) gene, and the cannabinoid receptor 1 (CB1) gene and PTSD. It was found that only a genetic variance concerning OXTR was correlated with an increased likelihood of developing PTSD when exposed to shocking traumatic events. Further research may allow for the development of targeted therapies to better prevent PTSD in those at high risk of developing the disorder like soldiers sent out for active duty. 

Although the dysregulation of the endocannabinoid system was not found to be correlated with an increased likelihood of developing PTSD cannabis is sometimes recommended to treat PTSD. Cannabis can be relaxing for many users and minimize the feelings of anxiety for those suffering from any psychiatric disorder characterized by anxiety but it is important to note that some cannabinoids can exacerbate anxiety. Specifically, tetrahydrocannabinol (THCO, the most abundant psychoactive cannabinoid in cannabis plants, can cause some people’s anxiety to worsen, highlighting the importance of developing a standard screening technique to warn those away from THC and towards a non-psychoactive cannabinoid to manage their symptoms, such as cannabidiol (CBD). 

The study is available for review or download here

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Benjamin Caplan, MDThe Endocannabinoid System and Post-Traumatic Stress Disorder
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The Legal Issues Concerning State Medical Cannabis Programs

Emerging public health law and policy issues concerning state medical cannabis programs

In summary

As the medical cannabis industry grows and local governments continue to legalize medical cannabis use state programs are forced to set standards without the aid of the federal government. State governments are now facing the challenge of attempting to regulate medical cannabis while maintaining the safety of patients and the general public. States now have to regulate labeling with universal warning symbols, child-resistant packaging, advertising restrictions, and pesticide use while also addressing members of the public’s concern about the safety of medical cannabis. If cannabis is ever rescheduled in the future so that the federal government can standardize the regulation of cannabis practices across the nation it will be interesting to see how local practices change in accordance. 

Despite multiple petitions and new research, the federal government has refused to reschedule cannabis. Cannabis used to be an accepted medication before a few politicians, namely Harry Anslinger began a propaganda campaign, highlighted by the film Reefer Madness (1936), turning the public opinion away from medical cannabis. This was largely thought to be a move to further ostracize minorities, further segregating races as Anslinger connected marijuana to violence to immigrants from Mexico. Cannabis never became medically dangerous in the early 1900s, merely a tool used by politicians to induce public fear and reinforce racist tendencies. In the featured article it was stated that 9 out of 10 Americans support the use of medical marijuana yet cannabis still has yet to be rescheduled and the reasons behind it are unclear but may lead back to the original push to have cannabis outlawed in the first place.

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Benjamin Caplan, MDThe Legal Issues Concerning State Medical Cannabis Programs
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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.

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

The study is available for review or download here

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Benjamin Caplan, MDAdolescent Female Cannabis-Users are Less Likely to Engage in Sexual Intercourse
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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

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Benjamin Caplan, MDThe Relation Between Conduct Disorder and Cannabis
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The Effect of Cooling Temperature on Growth Rates

Clothing the emperor- dynamic root–shoot allocation trajectories in relation to whole-plant growth rate and in response to temperature

In Summary

An article was recently published discussing how cooling the temperature of the environment a plant is growing in effects the overall growth pattern. Researchers specifically found that root–shoot biomass allocation and whole-plant growth rate varied ontogenetically in contrasting species in response to cooling. These variations in growth rates were seen in various strains of grass and flowering plants. The authors conclude that the findings of this study highlight the importance of measuring temporal growth dynamics rather than “snapshot” comparison, like height. Further research should expand to other species of plants beyond grasses and generic flowering plants found in most garden stores. 

Mass-produced cannabis plants tend to be grown in hydroponic set-ups like the plants in this study and are known to be sensitive to changes in growth factors. As the cannabis industry continues to grow the number of growers needed is increasing, stimulating the job market, but the number of at-home cultivators is also growing. For growers at home, it is important to note that the cannabinoids produced in a strain can vary depending on growth factors such as temperature, the mineral content of the soil, etc. They can purchase seeds of their favored strain grown in Colorado and grow an entirely different plant at their home in California. Consumers should be sure to consume a small dose or perfectly replicate growing conditions to ensure safe and effective consumption. 

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Benjamin Caplan, MDThe Effect of Cooling Temperature on Growth Rates
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Factors that Predict Cessation of Cannabis Use

Cessation of cannabis use- A retrospective cohort study

In summary

A retrospective cohort study conducted in Germany recently found that cessation of cannabis use can be predicted by a range of factors. Among those factors was older current age, being female, nonmigrant status, less sensation seeking, using psychological treatment, more peer cannabis use during youth and a more negative first experience with cannabis. Researchers also found that if survey-responders did not increase their frequency of use over the course of three years they were more likely to cease cannabis use. All of these factors are easy to determine early on and may lead to better prevention methods for those at a high risk of abuse.
As recreational and medical use continues to grow it seems that identifying risk factors for those who may abuse the benefits of cannabis increases in importance. If certain people are at risk of misusing cannabis and causing harm to their daily lives, for example by consuming psychoactive compounds and being unable to operate functionally within their environment, then their cannabis intake should be regulated and proper prevention methods should be put in place. Medical dispensaries are good for those just starting with cannabis because they have the freedom to experiment and figure out their ideal consumption methods and cannabinoid profile but it also allows patients the freedom to consume cannabis products that may not be very beneficial for them. It will be interesting to watch the changes in standardization as the prevalence of cannabis continues to grow.

The study is available for review or download here

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Benjamin Caplan, MDFactors that Predict Cessation of Cannabis Use
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Birth Defects Rose in Colorado Post-Cannabis Legalization

Cannabis teratology explains current patterns of Coloradan congenital defects- the contribution of increased cannabinoid exposure to rising teratological trends

In summary

Researchers have recently found that the frequency of major birth defects has increased in Colorado since the legalization of cannabis. It has been hypothesized that prenatal exposure to cannabis has caused these birth defects as the reported use of pain relievers, cocaine, alcohol, and tobacco did not increase. The specific birth defects that increased in frequency were atrial septal defect, spina bifida, microcephalus, Down’s syndrome, ventricular septal defect, and patent ductus arteriosus, but further research needs to be conducted to determine any causation. 

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. Currently, governing bodies of obstetricians advise that pregnant mothers cease any cannabis use. 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, even if they are using cannabis because they are resistant to more common treatment methods. 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. 

The study is available for review or download here

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Benjamin Caplan, MDBirth Defects Rose in Colorado Post-Cannabis Legalization
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