My work focuses on epidemiology, marketing, and policy issues in tobacco control, particularly in regards to the contentious debate over the use of tobacco products (e.g., snus, electronic cigarettes) for harm reduction. I have also maintained an ongoing interest in the epidemiology of the co-use of tobacco and cannabis, mainly in the form of blunt smoking. More recently, this interest has extended to the retail availability of tobacco products that are used with cannabis (e.g., cigarillos), as well as the promotion of non-tobacco alternatives (e.g., hemp wraps).
Category: Science & Medicine
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Why Are We Still Policing Cannabis?
The nation-wide movement to defund the police has given voice to advocates urging for the elimination of police departments or suggesting ways to replace policing with different responders. But how do we do that? For starters, we need to take a closer look at the way we identify and solve problems. When you define all your problems as nails, you end up with hammers. When your only tool is a hammer, your default solution is to hit everything. Read the full article at theHill.com.
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Effect of Inhaled Cannabis for Pain in Adults With Sickle Cell Disease A Randomized Clinical Trial
Sickle cell disease affects approximately 100,000 Americans. It is a genetic disease characterized by chronic pain and extremely painful episodes, which usually require treatment with large doses of opioids for extended periods of time. Opioids have a long list of side effects including respiratory depression and the risk of addiction. Cannabis has shown promise in treating pain but few controlled human trials have investigated the therapeutic uses of cannabis in a rigorous way. This study evaluated the effects of an approximately 1:1 ratio of THC and CBD in vaporized cannabis, compared to a placebo control that contained no active drug. The participants were 23 persons with sickle cell disease who experienced chronic pain. Each participant completed treatment with both the THC and CBD containing vapor as well as the placebo vapor. Patients used opioids similarly throughout both legs of the trial (cannabis and placebo) and there were no adverse side effects reported with the cannabis treatment. The trial concluded that vaporized cannabis did not significantly reduce pain and associated symptoms in comparison to placebo. The only statistically significant finding was that the cannabis treatment resulted in a decreased interference of sickle cell symptoms with mood. Shortcomings of this study include its small sample size (23) and its short duration of treatment (5 days). Further investigations should be conducted to assess the utility of cannabis as a treatment for chronic pain, particularly since this work found no significant adverse effects with this drug. Better understanding how cannabis can and cannot effectively treat pain may help curb the ongoing opioid epidemic and may aid in safely managing chronic pain.
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Acute and residual effects of smoked cannabis: Impact on driving speed and lateral control, heart rate and self-reported drug effects
With increasing availability of cannabis products and its decriminalized status in many states, understanding its acute and residual effects on driving is important in promoting public health and in guiding law enforcement with implementations of legal limits. In this study, 96 participants were randomly assigned to placebo, low tetrahydrocannabinol (THC) or high THC groups. Measures including speed, lane control, heart rate, and subjective drug effects were obtained at 30 minutes, 24-, and 48hours after exposure to cannabis. Results showed group differences in speed 30 minutes after exposure but not at 24 or 48 hours. More specifically, individuals in the high THC group drove significantly slower than those in the placebo group but the low THC group did not vary from either the high THC group or the placebo group while completing the single task driving test. Interestingly, when distraction is added such as counting backwards while driving (dual task driving test) individuals in both high and low THC group significantly drove slower than those in the placebo group. On analyzing the results of lateral control (tendency to swerve) a significant group difference was observed at 48 hours but not at 24 hours or 30 minutes. The combined results of this study indicate that the acute effects of smoked marijuana correlates with driving slowly especially when a distraction is present. Although the results relating to swerving was inconclusive, it may be beneficial to investigate as to why lane control is difficult to achieve at 48 hours after use but not acutely or 24 hours post exposure.
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Association Between Self-reported Prenatal Cannabis Use and Maternal, Perinatal, and Neonatal Outcomes.
Cannabis has shown promise in treating several medical conditions but its effects on pregnant women and developing fetuses is unknown. This study aimed to investigate the association of self-reported cannabis use by pregnant women and unfavorable maternal and perinatal outcomes. The main outcome the researchers investigated was early preterm births amongst a cohort of 661,617 women. 6.1% of women who did not use cannabis experienced preterm births before 37 weeks in comparison to 12.0% of women who used cannabis during their pregnancy. The results indicate that pregnant women should not use cannabis during the weeks of their pregnancy or leading up to pregnancy. Nevertheless, future studies should be conducted to investigate the impact of cannabis on pregnant mothers and developing fetuses with respect to cannabis ingestion at different gestational stages. Further, the study reports that cannabis use amongst pregnant mothers is increasing. However, it is entirely possible that increases in self-reported cannabis use correlate more-so with cannabis decriminalization and reducing social stigma rather than an empirical increase in cannabis use amongst pregnant women.
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A Review on Studies of Marijuana for Alzheimer’s Disease – Focusing on CBD, THC
This review article analyzed nine peer-reviewed studies focused on the effects of cannabinoids on Alzheimer’s disease and dementia. Due to the increasing life expectancy in society aging related Alzheimer’s disease onset has continued to increase since 1995. Thus, it is important that we investigate cannabis and its cannabinoids as potential pharmacotherapies for Alzheimer’s disease. The review of studies on CBD indicate that CBD can protect certain neuronal cells from pathological mechanisms present in Alzheimer’s disease. They also showed that CBD can promote neuronal cell growth in the hippocampus of the brain. Additionally, reviewed studies showed that the combination of CBD and THC appear to by more useful than CBD or THC alone in suppressing causal factors of Alzheimer’s disease. There should be continued research into CBD, THC, and other cannabinoids present in cannabis in order to determine their efficacy in preventing and treating Alzheimer’s disease.
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Polymorphism in Genes Coding for Cannabinoid Receptor 2 and Fatty Acid Amide Hydrolase
Cannabidiol’s anxiolytic effects have been demonstrated in several studies. However, the mechanism for this effect remains to be elucidated. The present paper offers additional data that may aid in future research in understanding endocannabinoids’ role in anxious behaviors. Over 900 participants were recruited to take part in the genetic analysis of cannabinoid receptor two (CB2) in chromosome one. A polymorphism leading to an amino acid change from arginine to glycine (R63Q) was identified. Interestingly, individuals who maintained the genes coding for arginine scored higher in depression and anxiety scales. In addition, a single amino acid change from cysteine to alanine (C385A) was noted in the gene coding for fatty acid amide hydrolase (FAAH) which is an enzyme that degrades the endocannabinoid anandamide. Of note, individuals who have the R allele in CB2 and A allele in FAAH were found to have the highest scores on the psychometric scales that were used to determine depressive and anxious phenotypes. The genetic associations found in this study provides further justification for the need for more robust genetic studies in order to understand the endocannabinoid system’s role in psychiatric disorders.
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Reduction of Benzodiazepine Use in Patients Prescribed Medical Cannabis
Benzodiazepines (BDs) like Xanax, are a class of medications used for anxiety, seizures, insomnia, and a variety of other neurological/psychiatric conditions. The adverse side effects of BDs are well documented and include dependence, addiction, withdrawal, and overdose. This study was performed on 146 medical cannabis patients who were using BDs at the initiation of cannabis therapy and was focused on investigating the reduction of BD use in patients who were prescribed medical cannabis. Following three clinical visits, 45.2% of the patients involved in the study had completely discontinued their use of BDs. In addition, following three clinical visits there was a significant reduction in the percentage of patients who reported that their medical conditions which ranged from neurologic pathology to chronic pain affected their life “all the time.” This study illuminates the need for continued research of medical cannabis and its potential as a legitimate treatment option for certain conditions. Further, more research should be conducted into the mechanism by which cannabis and cannabinoids can result in a reduction of benzodiazepine use.