Archives: Research

This paper reports that incidences of pediatric cannabis exposure in Massachusetts increased following medical marijuana legalization. The study analyzed cannabis exposure cases amongst individuals aged 0-19 reported to the Regional Center for Poison Control between 2009 and 2016. Individuals who have cannabis in their homes either for medicinal or recreational purposes should take significant steps to ensure that children and/or teenagers do not ingest cannabis unintentionally or intentionally. Cannabis should be regarded similarly to any prescription drug kept in a home with children and be kept in a childproof container in a safe location. In addition, it is possible that the increase in cannabis related cases reported to the Regional Center of Poison Control reflect decreasing stigma towards cannabis use and increased willingness to contact help in situations of accidental or excessive ingestion.

The issue of JAMA published on August 09, 2019 includes an entire section on cannabis curated by Kevin Hill. Topics include cannabis use for medical purposes such as chronic pain and cancer treatment.

Currently, there is not enough significant data to conclude that THC or any other cannabinoid is harmful to a developing fetus. This study of 367,403 pregnancies among women in Northern California, reports that the relative rates of daily, weekly, and monthly cannabis use in the year before and during pregnancy increased from 2009 to 2017. Cannabis use in the year before pregnancy nearly doubled, increasing from 6.80% to 12.50% from 2009 to 2017. In addition, the study found that 96% of those who used cannabis during pregnancy also used the year before they were pregnant. This paper also reported that daily cannabis use increased the most rapidly, reaching 25% of women who used cannabis during the year before pregnancy and 21% among women who used during pregnancy in 2017. There needs to be a significant increase in educational and prevention efforts focused on reducing prenatal use in order to combat the dramatic increase in online resources/social media sites that provide incomplete information suggesting that cannabis is safe in treating pregnancy related symptoms. Future research should be focused on determining the toxicity, if any, of THC and other cannabinoids ingested before and during pregnancy.

Up to 7.5% of pregnant women in the United States use cannabis during their pregnancy. The concentration of THC in cannabis is increasing as is the number of pregnant women who use cannabis. It is critical that the developmental risk of THC and its main active metabolite, 11-OH-THC, be determined. Ethical reasons make it impossible to directly measure exposure to cannabinoids in a developing fetus. However, an understanding of the parameters that metabolize and eliminate THC would allow for a Physiologically Based Pharmacokinetic (PCPK) modeling system that can accurately predict fetal exposure to THC and 11-OH-THC. This paper reports the first set of drug dependent parameters that are necessary to predict maternal-fetal cannabinoid exposure through PBPK modeling. Researchers investigated liver enzymes and confirmed previous studies showing that that CYP2C9 is the major enzyme responsible for the elimination of THC and for the creation of 11-OH-THC. The paper also reports that 11-OH-THC is eliminated primarily by UGT enzymes in the liver. In order to accurately predict maternal-fetal exposure and therefore risk, future studies need to be conducted on placenta, intestine, and lung enzymes. Additionally, 11-OH-THC is one of forty metabolites that form after THC is metabolized. Future studies should also investigate the metabolic pathways of other THC metabolites to accurately assess the risks of maternal-fetal exposure.

Approximately 35% of Americans suffer from obesity and its related health effects. The activation of cannabinoid 1 receptor [CB1R] has been shown to increase body weight, appetite, insulin resistance, and fat cell production. Thus, overactivity of CB1R is associated with obesity and the side effects that come with it, such as type II diabetes. Previously, rimonabant, a CB1R antagonist was developed and approved for use in Europe to improve eating habits as well as metabolic outcomes of patients with obesity. However, rimonabant blocked the activation of CB1R in the brain, which resulted in undesirable and serious neuropsychiatric side effects. This paper describes a new peripheral CB1R antagonist, AJ5012, which displays a significantly lower brain penetrance than rimonabant while remaining effective in improving glycemic control, adipose tissue inflammation, and insulin sensitivity. Multiple experiments on obese mice showed that AJ5012 improved metabolic outcomes independent of weight loss. The results indicate that blocking CB1R outside of the brain can help limit the biochemical repercussions of obesity while also avoiding the negative side effects of brain-penetrant drugs. Although promising, future research should focus on determining the oral bioavailability of AJ5012 and in-depth investigation of other peripheral CB1R antagonists that can more effectively break the connection between adipose tissue inflammation and obesity-induced insulin resistance.

Adolescence is a critical period marked by complex neurological processes and is frequently associated with mood fluctuations and impulsivity. Consequently, understanding the effects of cannabis use during this developmental stage is essential in order to assess risks that may be associated with adolescent cannabis use. The present study aims to examine the association between recent cannabis use and anxious mood lability. Data from 466 adolescents were collected beginning in the spring quarter of the 8^th grade until the spring quarter of the 10^th grade.  The results showed that adolescents who reported cannabis use within the past 30 days experienced significantly higher instances of anxious rapid mood fluctuations when compared to adolescents who reported no cannabis use in the past 30 days. Although this finding lacks causative value, exploring whether young adults use cannabis to reduce mood fluctuations or whether their mood lability results from cannabis use is worthwhile as it could provide insights on how to address anxiety in adolescents.

Due to the increasing rates of tobacco and cannabis use co-occurrence among individuals seeking treatment for cannabis use disorder (CUD), appropriate timing of tobacco intervention (TI) initiation is important in maximizing the effects of both the CUD intervention and TI. The present study compared the difference in treatment outcomes among individuals with CUD who received TI and CUD intervention simultaneously or CUD intervention followed by TI. The results showed no significant difference in cannabis outcome between the two groups indicating that the addition of TI during CUD treatment had neither positive nor negative effects in CUD treatment outcome. Notably, 39% of individuals in the sequential group attempted to quit despite having not been exposed to the experiment’s tobacco intervention. This finding may allude to the utility of simultaneous treatment of CUD and tobacco dependence. Although some of the hypotheses of this study were unfounded, and treatment outcomes were poor in both groups, this study presents a good starting point in exploring the practicality of simultaneous treatment of both cannabis and tobacco use disorders.

Cannabis’ increasing popularity is paralleled by growing concerns about its habit-forming propensity along with other important public health concerns including but not limited to driving under the influence and availability to adolescents. This double-blind placebo-controlled study presents a novel pharmacological treatment for individuals suffering from cannabis use disorder. The study shows that daily oral treatment with an inhibitor of the anandamide-metabolizing enzyme, FAAH, significantly attenuates withdrawal symptoms in chronic cannabis users, compared to placebo. Anandamide is an endogenous cannabinoid transmitter. FAAH inhibition protects anandamide from degradation and enhances its signaling actions. If confirmed in larger studies, these findings could have profound utility in the treatment of cannabis use disorder

As the cannabis market expands, consumers face a wide variety of products with different methods of consumption such as vaporizing, smoking, edible formulations, etc., Thus, rigorous analyses of pharmacokinetics and pharmacodynamics for each route of consumption are warranted to provide meaningful guidelines and warnings to consumers. This study compared the acute effects of smoked and vaporized cannabis among infrequent adult users. The results showed that vaporized cannabis elicit greater effects than smoked cannabis despite controlling for THC concentration.