Abuse

The Current Research on Cannabis-Alcohol Interactions and Risk Factors for Using Them Together

Title: Cannabis and Alcohol- From Basic Science to Public Policy

This new analysis summarizes the most recent preclinical trials and epidemiological studies concerning the interactions between cannabis and alcohol, as well as possible risk factors for co-use. Specific risk factors, such as frequency of use or belonging to particular groups, were found to be significant within studies (but not across separate studies.) The compiled data reveals that previous research is inconsistent and emphasizes the need for further research to elucidate at-risk populations.  


This article highlights a few secondary findings which all focus on the gaps in our knowledge concerning cannabis, of which there are many. There may be potential concerns with the integration of cannabis into modern culture, which has essentially normalized alcohol consumption. Future research will undoubtedly evaluate these concerns, and highlight potential advantages that cannabis consumption may offer as an alternative option.

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Benjamin Caplan, MDThe Current Research on Cannabis-Alcohol Interactions and Risk Factors for Using Them Together
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More Research Needed to Determine Impacts of Cannabis Use During Pregnancy

Cannabis Use in Pregnancy

With rates of cannabis use during pregnancy more than doubling between 2002 and 2017, a need for more studies, over longer periods of time, which investigate prenatal cannabis use has emerged. Existing data ranges from reporting an increased risk for preterm birth and low birth weight to cannabis reducing the risk of preeclampsia and gestational diabetes during pregnancy. Concerns are historically informed by preliminary alcohol and cocaine studies that falsely suggested no gestational harm, despite the eventual recognition that these substances ultimately carry significant risk. Pregnant women should exercise caution in their cannabis use until more definitive conclusions are found, regarding maternal cannabis use.

The decision of where, if anywhere, cannabis fits in relationship to pregnancy is populated with more questions than answers. There are a handful of good quality, long-term studies, to date, that show a pattern that informs some degree of generalization: by and large, the less frequently consumed, and the later during the pregnancy the consumption, the less potential risk. But, for the sake of any pregnant woman and her baby, this type of decision should always be made in direct consultation with the obstetrician supporting the pregnancy.

Additional Point: A lack of high-quality studies relating to cannabis use and gestational risk has resulted in conflicting evidence surrounding prenatal cannabis use. However, historical context involving prenatal alcohol and cocaine use studies informs the need to exercise caution before definitive conclusions are made

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Benjamin Caplan, MDMore Research Needed to Determine Impacts of Cannabis Use During Pregnancy
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Current Numbers for Cannabis Use Among Pregnant Women in the United State

Self-reported Medical and Nonmedical Cannabis Use Among Pregnant Women in the United States 

An observational study has revealed that the prevalence and frequency of cannabis use in pregnant women have increased over the past two decades.

No trends were seen although except a slight decrease in fetal growth in women who frequently used during the first two trimesters. The data concerning fetal growth, such as length and weight, were not statistically significant and would require further studies to appropriately indicate a correlation between cannabis use and decreased fetal growth.

The authors acknowledge that cannabis use may suffer from recall bias as women may underestimate the amount of cannabis they consumed or purposely withheld some information due to stigma, although some of the surveyed women were using recommended medical cannabis.  

This article highlights the large issue surrounding women consuming cannabis while expecting. Cannabinoids are able to cross the placenta and therefore affect the fetus during development. The American College of Obstetrics and Gynecologists recommend the cessation of any cannabis consumption while pregnant although there has been limited data discussing the actual effects on fetal development. A previously featured article on this blog stated that cannabis use had no effect on birth outcomes but also noted uncertainty in the possible effect on fetal growth. Considering this uncertainty, physicians should push for more research so that women who take medical cannabis can accurately discern whether or not to cease consumption while pregnant. 

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Benjamin Caplan, MDCurrent Numbers for Cannabis Use Among Pregnant Women in the United State
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Stress Increases the Probability of Drug Abuse

The Effects of Trait Emotional Intelligence on Adolescent Substance Use- Findings From a Hungarian Representative Survey

A recent study has revealed that teenagers who have a difficult time managing stress and appear to lack empathy were more likely to abuse tobacco, alcohol, and cannabis.

The studies initial goal was to determine if emotional intelligence could predict future drug abuse, but found that those with more empathy and interpersonal competencies were less likely to engage in substance abuse. This study provides data that may help to develop targeted drug prevention programs in order to lessen adolescent drug abuse or the development of any future substance abuse disorders. 

Highlighted in this study was the possible inaccuracy of the conclusions as the results may have been skewed by teenagers merely providing what they thought was a socially acceptable answer. Despite the fact that the majority of states have legalized the use of medical marijuana a stigma against cannabis use remains.

Stigma has and continues to stand in the way of medical research. If the consumption of cannabis were less frowned upon then perhaps more observational studies, studies that relied on self-reporting use, or even appropriate medical treatment, would be improved. The more information that can be gathered, the more accurate the research that can be conducted. In order to fully understand all the benefits and limitations of cannabinoids, although this also applies to tobacco and alcohol consumption, the uninformed stigma must also be eroded.

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This paper is also stored here:   http://bit.ly/2YB4dgE      inside the CED Foundation Archive

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Benjamin Caplan, MDStress Increases the Probability of Drug Abuse
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Adolescent E-Cigarette Use Increased by 78%

Characteristics of Daily E-Cigarette Use and Acquisition Means Among a National Sample of Adolescents

From 2017 to 2018 the amount of middle school and high school electronic cigarette (e-cigarette) users increased by 48% and 78% respectively. One of the first studies examining the association between e-cigarette characteristics and daily use among US adolescents is calling for comprehensive tobacco control efforts to reduce e-cigarette and nicotine addiction among adolescents. 38% of adolescent users report using their e-cigarette devices for cannabis which can be hazardous due to the lack of regulation. The potential risks associated with nicotine use and the dangerous misuse of these devices for other substances is putting youth’s health at risk.

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This paper is also stored here:    http://bit.ly/2Ff733m     inside the CED Foundation Archive

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Benjamin Caplan, MDAdolescent E-Cigarette Use Increased by 78%
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The Relationship between Cannabis and Schizophrenia

Cannabis and Psychosis: Are We any Closer to Understanding the Relationship?

Despite the constant technological gains in medicine, there is still insufficient information and knowledge about who is at risk of developing cannabis psychosis prior to an individual’s exposure to cannabis. Controlled research is limited due to the legal status of cannabis but the growing number of states legalizing medicinal and recreational use of cannabis will likely provide a naturalistic experiment that will produce a prevention strategy for the condition. Current schizophrenia research is limited to western male populations and an overemphasis on the biological model; future research should extend to a more diverse population and sociocultural factors that may lead to schizophrenia.

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Benjamin Caplan, MDThe Relationship between Cannabis and Schizophrenia
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Medical vs Rec

Many think medical marijuana laws will ultimately lead to adult-use, but this is not necessarily true, and for good reason. The medical industry recognizes that cannabis is a powerful medication and prioritizes its safety and health benefits, while so-called “recreational” or “adult use” cannabis seems to focus more on making money and supporting the pleasurable aspects of the plant.

Interestingly, at CED Clinic, we’re seeing more and more patients come in from the “adult-use.” Whether it’s a desire for comprehensive education (anything we put into our bodies has effects), personalizing a medical plan that considers short-term and long-term impact, or simply having a knowledgeable person to support individual choices and empowerment on an individual journey, we find that our patients enjoy learning and riding the cutting edge of the science of cannabis! http://bit.ly/2INDGY7

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Benjamin Caplan, MDMedical vs Rec
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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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Cannabinoid Hyperemesis Syndrome is Frequently Misdiagnosed as Cyclic Vomiting Syndrome

Association of Marijuana Use and Cyclic Vomiting Syndrome

A recent study has found that a subset of patients diagnosed with Cyclic Vomiting Syndrome actually suffers from Cannabinoid Hyperemesis Syndrome. Cannabinoid Hyperemesis Syndrome is a rare condition that primarily occurs in daily, long-term users of cannabis, more common among males than females. Chronic cannabis consumers should inform their physicians of any illicit drug use, as well as any cannabis consumption, during routine check-ups and/or emergency room visits, to ensure accurate diagnoses can be made.

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This paper is also stored here:   http://bit.ly/2F9YS8u      inside the CED Foundation Archive

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Benjamin Caplan, MDCannabinoid Hyperemesis Syndrome is Frequently Misdiagnosed as Cyclic Vomiting Syndrome
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How to prevent inappropriate teen use?

Especially in Colorado and Washington, people are taking note of teens’ use and access to potent marijuana, and many are concerned that there are not enough measures in place to prevent this. Newly legalized states should look into this before it becomes a national issue. https://wapo.st/2Fgmto9

Benjamin Caplan, MDHow to prevent inappropriate teen use?
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