Illicit Drug Use

Student-Athletes are at an Increased Risk for Binge Drinking and Substance Use

Title: Psychological correlates and binge drinking behaviours among Canadian youth- a cross-sectional analysis of the mental health pilot data from the COMPASS study

A recent study has examined data from the COMPASS program and found that student-athletes in Canada were more likely to engage in binge-drinking and illicit substance use. Researchers focussed on the measure of flourishing, defined as an overall healthy mental state and emotional connectedness, and how flourishing related to concerning drinking and substance use behavior. Student-athletes were found to be the most at risk for binge-drinking, defined as consuming 5 or more drinks in a single session, and those more likely to binge-drink were also more likely to co-use illicit substances. This research provides evidence for the formation of targeted prevention programs.

Cannabis use is banned among athletes by most sports organizations. Cannabis appeals to athletes considering the many different consumption methods, allowing discreet consumption and personalization with variable potential opportunities for relief. Cannabinoids are generally naturally occurring substances unless clearly manufactured, and have been shown to be beneficial for post-workout recovery, muscle soreness, anxiety, sleep, and relaxation. All of those symptoms, including the emotionally driven ones, are common among student-athletes who often feel an immense amount of pressure to perform in competition. As in most other areas of modern culture, Cannabidiol (CBD) finds itself in a grey area for most sports organizations’ substance regulations given that it is not intoxicating and readily available with a notable safety profile. Even if cannabis is not federally legal, CBD is so widely available that many athletes are embracing it, in lieu of more dangerous, or potentially addictive, medications.

Tweet: A recent study has examined data from the #COMPASS program and found that #studentathletes in Canada were more likely to engage in #binge-drinking and illicit substance use. Read this and other linked studies:

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Benjamin Caplan, MDStudent-Athletes are at an Increased Risk for Binge Drinking and Substance Use
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Volume of Brain (Lateral Orbitofrontal Cortex) Predicts Drug Use

Orbitofrontal cortex volume prospectively predicts cannabis and other substance use onset in adolescents

Researchers have recently unveiled that the volume of the lateral orbitofrontal cortex (OFC) is able to predict future substance use in adolescents. Individuals were followed for 13 years after undergoing magnetic functional resonance imaging and surveyed for cannabis and alcohol use. Interestingly, the authors chose to utilize those who had used cannabis, but in limited quantities, as a control group instead of including them in their cannabis users group. Similarly, the alcohol only group of participants also included those who used cannabis multiple times within the past year. Nevertheless, the authors conclude that the size of the lateral OFC is able to predict drug use in adolescents although not without admitting the need for replication and validity. 

This paper represents an important example of biased information within the medical community. Bias is inherent, there is no way around it. But, it is the duty of researchers to publish their findings while remaining as objective as possible, and to do so, transparently. The grouping decisions for the study groups here, and the choices the authors made regarding statistical analysis of this data are odd, considering their definitions and broad claims. This may be due to the views of the organization funding the research, or the bias of the research team members themselves, but the limitations of the study should be considered strongly. Even beyond the groupings, the fact that this research took place in a state where cannabis use is legal for recreational and medical use is a reason to consider other confounding variables. Scientists have an obligation to pursue the truth and not extrapolate their findings to fit a personal or professional agenda. Many articles cherry-pick statistics and extrapolate small findings of data, leaving readers and media outlets to polularize findings that do not represent a full picture. It falls on discerning readers to read mindfully and consider a study’s methodolgy and demographics, as carefully as possible. 

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Benjamin Caplan, MDVolume of Brain (Lateral Orbitofrontal Cortex) Predicts Drug Use
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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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Benjamin Caplan, MDStress Increases the Probability of Drug Abuse
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Cannabinoids have Opioid-Sparing Effects on Morphine Analgesia

Opioid-Sparing Effects of Cannabinoids on Morphine Analgesia- Participation of CB1 and CB2 Receptors

Researchers have recently provided evidence that synthetic cannabinoids are able to work synergistically with morphine to provide maximum pain relief while limiting opioid doses.

In an effort to control the current opioid epidemic researchers have been looking into the possible benefits of cannabinoids due to the interaction of the opioid and endocannabinoid systems. The results of this study showed that various synthetic cannabinoids (WIN and GP1a) were able to work synergistically with morphine in two separate pain models to maximize analgesic effects. Further evidence is still needed to validate these claims before patient use, but this paper provides further evidence that medical cannabis may help put an end to the opioid crisis. 

Highlighted in this paper is the lingering uncertainty of exact mechanisms within the endocannabinoid system. The authors of this article are left without definite answers as to whether or not the analgesic effect is mediated completely through cannabinoid receptor 1 (CB1) or if cannabinoid receptor 2 (CB2) is also involved. Research into cannabinoids is slow within the United States, as there are currently only privately funded studies. This severely limits the medical community from a full understanding. The better a system is understood, the more concrete answers can be found. Critics may never support the rescheduling of cannabis but without moving cannabis to a Schedule II or III, it remains impossible to back even their claims. 

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Benjamin Caplan, MDCannabinoids have Opioid-Sparing Effects on Morphine Analgesia
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Pediatric Oncology Center Justifies the Use of Medical Cannabis

Pediatric oncologists from Minnesota recently published an article justifying their use of medical cannabis as palliative care for their patients.

The majority of patients at the oncology center were approved for medical cannabis use during their first round of treatment, in order to immediately address the negative side effects of chemotherapy such as nausea, pain, and cancer cachexia. The data provided from the center described much higher chemotherapy compliance rates among patients, and that patients have a much better quality of life when utilizing cannabis.

This article highlights a few promising trends and issues with using medical cannabis; one promising trend is the hope for cannabis to provide antitumor effects. Cannabis has been a subject of exploration for antitumor effects and it has shown promising results. But, there are many limitations to the few studies that have been published, leading the authors to defer any definitive conclusions. The center in Minnesota noted that many of the patients diagnosed with brain tumors were especially hopeful that cannabis would aid in curing them of cancer, second to utilizing the drug for nausea. This is a promising trend because it means the greater public is showing interest in the therapeutic possibilities of cannabis and their support and call for research will aid the drive for the federal rescheduling of marijuana. 

Also highlighted in this article is that, of all the patients certified to use medical cannabis, a subset of 24% never actually registered through the state to receive it. The authors have no firm explanation for these circumstances but seem to suspect that the $200 annual certification fee, on top of the cost for each additional dispensed product may be limiting of patients abilities to afford cannabis. Without the backing of the federal government, insurance companies are unable to cover medical cannabis. As the depth and reach of cannabis research grow, there are good reasons for patients to feel optimistic about medical cannabis.

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Benjamin Caplan, MDPediatric Oncology Center Justifies the Use of Medical Cannabis
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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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Benjamin Caplan, MDAdolescent E-Cigarette Use Increased by 78%
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Sex differences in the anxiety effects of cannabinoids

In overarching trends, one pattern that is seen in the medical literature is a greater tendency for males to be more likely to develop drug abuse disorders than female counterparts, whilst females are more likely to develop anxiety disorders than male counterparts.

Of course, these trends are merely observational patterns in the current literature, which represents a biased perspective of biased subjects, and certainly not etched in stone. Further, many people do not conform to one pre-determined organization system as simple as gender to help educate whether they would be likely to develop drug dependence or anxiety, and even others don’t conform to a single gender. So, a sizeable grain of salt must be taken with what we understand from this literature.

That given, the relevant punch line here is what role might cannabis play in inducing or reducing anxiety across sexes, and how does cannabis might relate to addiction/dependence.

We are still at early stages of these important questions, but one recent study found, that female rats were significantly more likely than male rats to experience anxiety when given large doses of cannabis.

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Benjamin Caplan, MDSex differences in the anxiety effects of cannabinoids
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Vaping cannabis among adolescents: prevalence and associations with tobacco use from a cross-sectional study in the USA

Out of 2,835 high school students from North Carolina, 272 students (or 9.6%) reported ever vaping cannabis. Interestingly, the odds of ever vaping cannabis were significantly higher among males (11.0%) compared with females (8.2%), and significantly higher among non-Hispanic white students (11.3%) compared with non-Hispanic black students (5.0%).

It’s clear that white males are the most likely to have ever vaping cannabis. Why might minority students engage less with recreational drug use?

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Benjamin Caplan, MDVaping cannabis among adolescents: prevalence and associations with tobacco use from a cross-sectional study in the USA
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Profile of Dr Caplan, Dr Grinspoon, CED Clinic, and modern Medical Cannabis in Alcoholism & Drug Abuse Weekly

The esteemed medical periodical, Alcoholism & Drug Abuse Weekly, takes a closer look at modern medical cannabis with Dr Grinspoon and I. Our discussion brings an insider’s look at how the system operates, from clinic to dispensary, the dynamic changes we’ve already seen and highlights some of the changes to come. Included are The Role of Medicine, The Ethics of doctors in business, The Patient Experience, Physician’s Support, Growing the Plant, and a sit-down with a local dispensary.

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Benjamin Caplan, MDProfile of Dr Caplan, Dr Grinspoon, CED Clinic, and modern Medical Cannabis in Alcoholism & Drug Abuse Weekly
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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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