If You Smoke Pot, Your Anesthesiologist Needs To Know

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DENVER — When Colorado legalized marijuana, it became a pioneer in creating new policies to deal with the drug.

Now the state’s surgeons, nurses and anesthesiologists are becoming pioneers of a different sort in understanding what weed may do to patients who go under the knife.

Their observations and initial research show that marijuana use may affect patients’ responses to anesthesia on the operating table — and, depending on the patient’s history of using the drug, either help or hinder their symptoms afterward in the recovery room.

Colorado makes for an interesting laboratory. Since the state legalized marijuana for medicine in 2000 and allowed for its recreational sale in 2014, more Coloradans are using it — and they may also be more willing to tell their doctors about it.

Roughly 17 percent of Coloradans said they used marijuana in the previous 30 days in 2017, according to the National Survey on Drug Use and Health, more than double the 8 percent who reported doing so in 2006. By comparison, just 9 percent of U.S. residents said they used marijuana in 2017.

“It has been destigmatized here in Colorado,” said Dr. Andrew Monte, an associate professor of emergency medicine and medical toxicology at the University of Colorado School of Medicine and UCHealth. “We’re ahead of the game in terms of our ability to talk to patients about it. We’re also ahead of the game in identifying complications associated with use.”

One small study of Colorado patients published in May found marijuana users required more than triple the amount of one common sedation medicine, propofol, as did nonusers.

Those findings and anecdotal reports are prompting additional questions from the study’s author, Dr. Mark Twardowski, and others in the state’s medical field: If pot users indeed need more anesthesia, are there increased risks for breathing problems during minor procedures? Are there higher costs with the use of more medication, if a second or third bottle of anesthesia must be routinely opened? And what does regular cannabis use mean for recovery post-surgery?

But much is still unknown about marijuana’s impact on patients because it remains illegal on the federal level, making studies difficult to fund or undertake.

It’s even difficult to quantify how many of the estimated 800,000 to 1 million anesthesia procedures that are performed in Colorado each year involve marijuana users, according to Dr. Joy Hawkins, a professor of anesthesiology at the University of Colorado School of Medicine and president of the Colorado Society of Anesthesiologists. The Colorado Hospital Association said it doesn’t track anesthesia needs or costs specific to marijuana users.

As more states legalize cannabis to varying degrees, discussions about the drug are happening elsewhere, too. On a national level, the American Association of Nurse Anesthetists recently updated its clinical guidelines to highlight potential risks for and needs of marijuana users. American Society of Anesthesiologists spokeswoman Theresa Hill said that the use of marijuana in managing pain is a topic under discussion but that more research is needed. This year, it endorsed a federal bill calling for fewer regulatory barriers on marijuana research.

Why Should Patients Disclose Marijuana Use? 

No matter where patients live, though, many nurses and doctors from around the country agree: Patients should disclose marijuana use before any surgery or procedure. Linda Stone, a certified registered nurse anesthetist in Raleigh, N.C., acknowledged that patients in states where marijuana is illegal might be more hesitant.

“We really don’t want patients to feel like there’s stigma. They really do need to divulge that information,” Stone said. “We are just trying to make sure that we provide the safest care.”

In Colorado, Hawkins said, anesthesiologists have noticed that patients who use marijuana are more tolerant of some common anesthesia drugs, such as propofol, which helps people fall asleep during general anesthesia or stay relaxed during conscious “twilight” sedation. But higher doses can increase potentially serious side effects such as low blood pressure and depressed heart function.

Limited airway flow is another issue for people who smoke marijuana. “It acts very much like cigarettes, so it makes your airway irritated,” she said.

To be sure, anesthesia must be adjusted to accommodate patients of all sorts, apart from cannabis use. Anesthesiologists are prepared to adapt and make procedures safe for all patients, Hawkins said. And in some emergency surgeries, patients might not be in a position to disclose their cannabis use ahead of time.

Even when they do, a big challenge for medical professionals is gauging the amounts of marijuana consumed, as the potency varies widely from one joint to the next or when ingested through marijuana edibles. And levels of THC, the chemical with psychoactive effects in marijuana, have been increasing in the past few decades.

“For marijuana, it’s a bit of the Wild West,” Hawkins said. “We just don’t know what’s in these products that they’re using.”

Marijuana’s Effects On Pain After Surgery

Colorado health providers are also observing how marijuana changes patients’ symptoms after they leave the operating suite — particularly relevant amid the ongoing opioid epidemic.

“We’ve been hearing reports about patients using cannabis, instead of opioids, to treat their postoperative pain,” said Dr. Mark Steven Wallace, chair of the pain medicine division in the anesthesiology department at the University of California-San Diego, in a state that also has legalized marijuana. “I have a lot of patients who say they prefer it.”

Matthew Sheahan, 25, of Denver, said he used marijuana to relieve pain after the removal of his wisdom teeth four years ago. After surgery, he smoked marijuana rather than using the ibuprofen prescribed but didn’t disclose this to his doctor because pot was illegal in Ohio, where he had the procedure. He said his doctor told him his swelling was greatly reduced. “I didn’t experience the pain that I thought I would,” Sheahan said.

In a study underway, Wallace is working with patients who’ve recently had surgery for joint replacement to see whether marijuana can be used to treat pain and reduce the need for opioids.

But this may be a Catch-22 for regular marijuana users. They reported feeling greater pain and consumed more opioids in the hospital after vehicle crash injuries compared with nonusers, according to a study published last year in the journal Patient Safety in Surgery.

“The hypothesis is that chronic marijuana users develop a tolerance to pain medications, and since they do not receive marijuana while in the hospital, they require a higher replacement dose of opioids,” said Dr. David Bar-Or, who directs trauma research at Swedish Medical Center in Englewood, Colo., and several other hospitals in Colorado, Texas, Missouri and Kansas. He is studying a synthetic form of THC called dronabinol as a potential substitute for opioids in the hospital.

Again, much more research is needed.

“We know very little about marijuana because we’ve not been allowed to study it in the way we study any other drug,” Hawkins said. “We’re all wishing we had a little more data to rely on.”

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

CBD: The next weapon in the war against opioid addiction?

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CBD, or cannabidiol, is everywhere, with word on the street saying that it can cure everything from a bad mood to cancer. However, most of these claims are not based on scientific evidence. Animal studies suggest that CBD might be beneficial for some health indications, such as pain, inflammation, arthritis and anxiety.

However, until recently, the only medical indication that CBD has been proven to treat in humans is seizures associated with pediatric epilepsy. Now, however, a recent study suggested that CBD curbed cravings in people with opioid dependence. This is one of the first double-blind controlled trials, the gold standard for drug research, to show benefit of using CBD outside epilepsy treatment. Thus, researchers can say with greater confidence that CBD may be helpful in fighting the war against opioid addiction.

While this study is very exciting, as scientists who study drugs and addiction, we want to stress that this study was very narrow and used specific, standardized amounts of CBD. Thus, the results do not suggest that buying a bottle or jar of over-the-counter CBD is going to help with opioid cravings – or any other medical conditions.

Addiction is a brain disease

In order to understand why CBD might be useful to treat opioid addiction, it is helpful to take a closer look at how addiction alters normal behavior. Addiction is broadly defined by the American Psychiatric Association as “a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence.” Addiction is classified as a disease because addiction hijacks and alters the way how the brain processes information.

Specifically, areas of the brain critical in controlling the perception of daily and pleasurable activities are susceptible to the influence of addictive drugs. Due to the rewiring of the brain under addiction, the individual often perceives the world in context to their drug of choice. The brain learns to associate drug paraphernalia or the physical location of drug partaking in the context of receiving a drug. These cues become integral reminders and reinforcers of drug use.

These events occur with most known drugs of abuse, such as cocaine, alcohol, nicotine, methamphetamines as well as opioids.

Addiction is often thought of in terms of the pursuit of the “high” associated with the use of a drug. However, most addicts continue to use, or relapse when trying to quit using their respective addictive drug. This difficulty, despite the desire and often pressure by friends, family and co-workers to quit, is often due to the negative effects of drug withdrawal.

Depending on the drug, the symptoms of drug withdrawal can vary and range from mild to severe intensity. In the case of opioid withdrawal, symptoms often include anxiety, nausea, vomiting, diarrhea, abdominal cramps and rapid heartbeat. An individual going through opioid withdrawal experiencing extreme conditions of anxiety is likely to take opioids to alleviate that anxiety. This sort of behavior can be repetitive, leading to a what is called a feed-forward loop of dependence on an abused drug.

A person is often referred to as “dependent” on a drug when the drug must be present for the individual to function normally. Importantly, anxiety and depression are correlated with opioid dependence.

For dependent individuals, ongoing use of a drug is not perceived as a conscious choice, but rather an evil necessity. Medication-assisted treatment with drugs like methadone or buprenorphine, allows for an individual to undergo recovery from an opioid use disorder. The use of medication assisted treatment significantly decreases the likelihood of an individual to relapse and fatally overdose due to withdrawal or dependence symptoms.

CBD and Epidiolex

CBD was tested in several clinical trials and was shown to work and to be safe in treating a rare form of epilepsy. A pharmaceutical grade CBD, Epidiolex, gained FDA approval in June 2018 for this specific usage.

CBD is currently only prescribed as the drug Epidiolex. That is because, up until now, CBD has only been shown to be safe and effective in the treatment of intractable pediatric epilepsy.

Importantly, CBD binds to different receptors than those that lead to opioid addiction.

CBD and opioid addiction

In experiments reported in 2009, rats were trained to press a lever to receive heroin. CBD did not decrease the amount of heroin that the rats self-administered, or the drug seeking behavior displayed by the rat while taking heroin. However, when rats were taken off heroin and given CBD, there was a decrease in drug-seeking behavior when the animals were exposed to a heroin-associated cue.

Initial studies of CBD in humans verified that CBD, when co-administered with fentanyl, is safe and well tolerated in healthy, non-opioid dependent individuals. A 2015 report of a small double-blind study conducted in opioid-dependent individuals found that a single administration of CBD, in comparison to a placebo, decreased cue-induced craving of opioids and feelings of anxiety. A double-blind, placebo-controlled study means that doctors and patients in the study do not know who is getting a real drug and who is getting a placebo. That is to guard against what is known as the placebo effect.

A double-blind placebo-controlled study published on May 21, 2019 adds to these findings by demonstrating that the Food and Drug Administration-approved Epidiolex can reduce cue-induced craving in individuals that had been former heroin users. Furthermore, in these individuals, Epidiolex reduced reports of anxiety, and blood levels of cortisol, a hormone known to increase under conditions of stress and anxiety.

Although further studies are needed, these studies strongly suggest that Epidiolex or CBD may hold promise as a critical weapon in fighting the opioid epidemic.

This could be a big deal.

Practical considerations

Before rushing out to purchase over-the-counter CBD to treat any medical condition, there are several practical considerations that should be considered.

Only Epidiolex is FDA-approved for a medical condition – pediatric seizures. All other forms of CBD aren’t regulated. There have been numerous consumer reports that show that the actual amount of CBD in over-the-counter products is significantly less than what is reported on the label. Also, some of these over-the-counter products contain enough THC to show up on drug tests.

Although Epidiolex was found to be safe in clinical trials, it can interact with other drugs prescribed for migraines and bipolar disorder. This could mean that taking CBD with certain drugs could diminish or enhance the effects of prescriptions, leading to problems controlling particular medical conditions that were once well-managed, or increase side effects of the other medications. For this reason, it is incredibly important to talk to your doctor or pharmacist about potential drug interactions before using CBD.The Conversation

Jenny Wilkerson is the assistant professor of Pharmacodynamics at the University of Florida. Lance McMahon is the professor and chair of Pharmacodynamics at the University of Florida.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

People Who Use Marijuana Tend to Weigh a Bit Less

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The finding runs contrary to the belief that marijuana users who get “the munchies” will ultimately gain more weight.

“Over a three-year period, all participants showed a weight increase, but interestingly, those who used marijuana had less of an increase compared to those that never used,” says Omayma Alshaarawy, assistant professor of family medicine at Michigan State University and lead author of the paper in the International Journal of Epidemiology. “Our study builds on mounting evidence that this opposite effect occurs.”

The results also suggest that new and persistent users are less likely to be overweight or obese, overall.

“We found that users, even those who just started, were more likely to be at a normal, healthier weight and stay at that weight,” Alshaarawy says. “Only 15 percent of persistent users were considered obese compared to 20 percent of non-users.”

TWO POUNDS

Researchers used National Epidemiologic Survey of Alcohol and Related Conditions data and looked at the Body Mass Index, or BMI, of 33,000 participants, ages 18 and older, then compared the numbers.

While the actual weight difference among users and non-users was modest, around two pounds for a 5-foot-7-inch participant weighing about 200 pounds at the start of the study, the variance was prevalent among the entire sample size.

“An average 2-pound difference doesn’t seem like much, but we found it in more than 30,000 people with all different kinds of behaviors and still got this result,” Alshaarawy says.

WHY?

So, what is it about marijuana that seems to affect weight? Alshaarawy indicated it’s still relatively unknown but points to several factors possible factors.

“It could be something that’s more behavioral like someone becoming more conscious of their food intake as they worry about the munchies after cannabis use and gaining weight,” she says. “Or it could be the cannabis use itself, which can modify how certain cells, or receptors, respond in the body and can ultimately affect weight gain. More research needs to be done.”

But, people shouldn’t use marijuana as a diet aid, Alshaarawy cautions.

“There’s too many health concerns around cannabis that far outweigh the potential positive, yet modest, effects it has on weight gain,” she says. “People shouldn’t consider it as a way to maintain or even lose weight.”

The National Institutes of Health funded the work.

This article was re-published under the Attribution 4.0 International license via Futurity.

Marijuana is a lot more than just THC

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Medical marijuana is legal in 33 states as of November 2018. Yet the federal government still insists marijuana has no legal use and is easy to abuse. In the meantime, medical marijuana dispensaries have an increasing array of products available for pain, anxiety, sex and more.

The glass counters and their jars of products in the dispensary resemble an 18th century pharmacy. Many strains for sale have evocative and magical names like Blue Dream, Bubba Kush and Chocolope. But what does it all mean? Are there really differences in the medical qualities of the various strains? Or, are the different strains with the fanciful names all just advertising gimmicks?

I am a professor in the University of Southern California School of Pharmacy. I have lived in California a long time and remember the Haight-Ashbury Summer of Love. While in graduate school, I worked with professor Alexander Shulgin, the father of designer drugs, who taught me the chemistry of medicinal plants. Afterwards, while a professor at USC, I learned Chumash healing from a Native American Chumash healer for 14 years from 1998 until 2012. She taught me how to make medicines from Californian plants, but not marijuana, which is not native to the U.S. Currently, I am teaching a course in medical marijuana to pharmacy students.

If there is one thing about marijuana that is certain: In small doses it can boost libido in men and women, leading to more sex. But can marijuana really be used for medical conditions?

What are cannabinoids?

New research is revealing that marijuana is more than just a source of cannabinoids, chemicals that may bind to cannabinoid receptors in our brains, which are used to get high. The most well-known is tetrahydrocannabinol (THC). Marijuana is a particularly rich source of medicinal compounds that we have only begun to explore. In order to harness the full potential of the compounds in this plant, society needs to overcome misconceptions about marijuana and look at what research clearly says about the medical value.

The FDA has already made some moves in this direction by approving prescription drugs that come from marijuana including dronabinol, nabilone, nabiximols and cannabidiol. Dronabinol and nabilone are cannabinoids that are used for nausea. Nabiximols – which contain THC, the compound most responsible for marijuana’s high and cannabidiol, which does not induce a high – are used to treat multiple sclerosis. Cannabidiol, or CBD, is also used to treat some types of epilepsy.

Marijuana, originally from the Altai Mountains in Central and East Asia, contains at least 85 cannabinoids and 27 terpenes, fragrant oils that are produced by many herbs and flowers that may be active, drug-like compounds. THC is the cannabinoid everyone wants in order to get high. It is produced from THC acid – which constitutes up to 25 percent of the plant’s dry weight – by smoking or baking any part of the marijuana plant.

THC mimics a naturally occurring neurotransmitter called anandamide that works as a signaling molecule in the brain. Anandamide attaches to proteins in the brain called cannabinoid receptors, which then send signals related to pleasure, memory, thinking, perception and coordination, to name a few. THC works by hijacking these natural cannabinoid receptors, triggering a profound high.

Tetrahydrocannabivarinic acid, another cannabinoid, can constitute up to 10 percent of the dry weight. It is converted to another compound that probably contributes to a high, tetrahydrocannabivarin, when smoked or ingested in baked goods. Potent varieties like Doug’s Varin and Tangie may contain even higher concentrations.

Medical properties of marijuana

But not all cannabinoids make you high. Cannabidiol, a cannabinoid similar to THC, and its acid are also present in marijuana, especially in certain varieties. But these do not cause euphoria. The cannabidiol molecule interacts with a variety of receptors – including cannabinoid and serotonin receptors and transient receptor potential cation channels (TRP) – to reduce seizures, combat anxiety and produce other effects.

Marijuana also contains several monoterpenoids – small, aromatic molecules – that have a wide range of activities including pain and anxiety relief and that work by inhibiting TRP channels.

Myrcene is the most abundant monoterpenoid, a type or terpene, in marijuana. It can relax muscles. Other terpenes such as pinene, linalool, limonene and the sesquiterpene, beta-caryophyllene are pain relievers, especially when applied directly to the skin as a liniment. Some of these terpenes may add to the high when marijuana is smoked.

What do all these varieties do?

Many different varieties of marijuana are on the market and are alleged to treat a range of diseases. The FDA has no oversight for these claims, since the FDA does not recognize marijuana as a legal product.

Strains of marijuana are grown that produce more THC than cannadidiol or vice versa. Other varieties have abundant monoterpenoids. How do you know that the strain you choose is legitimate with probable medical benefits? Each strain should have a certificate of analysis that shows you how much of each active compound is present in the product you buy. Many states have a bureau of cannabis control that verifies these certificates of analysis. However, many certificates of analysis do not show the monoterpenoids present in the marijuana. The analysis of monoterpenoids is difficult since they evaporate from the plant material. If you are looking for a strain high in myrcene or linalool, ask for proof.

Marijuana can improve several conditions, but it can also make others worse and can have nasty side effects.

As recreational use has become more widespread, marijuana hyperemesis syndrome is becoming more of a problem in our society. Some people vomit uncontrollably after smoking marijuana regularly. It can be treated by rubbing a cream made from capsaicin, from chili peppers, on the abdomen. Capsaicin cream is available in pharmacies.

Also, high THC varieties of marijuana, such as Royal Gorilla and Fat Banana, can cause anxiety and even psychosis in some people.

Researchers have also shown that anxiety can be effectively treated with strains that have more cannabidiol and linalool. It may be best to rub a cannabidiol balm or lotion on your cheeks to relieve anxiety.

Other conditions that studies have shown are improved by marijuana are: cancer induced nausea, Type 2 diabetes, two forms of epilepsy, HIV-induced weight gain, irritable bowel syndrome, migraines, multiple sclerosis, osteoarthritis, rheumatoid arthritis, pain, chronic pain, post-traumatic stress disorder, sleep disorders and traumatic brain injury.

For some of these conditions, studies show that eating or topically applying marijuana products rather than smoking is recommended.

Clearly, more research is needed from the scientific community to help guide the appropriate, safe use of marijuana. However, the FDA does not recognize the use of medical marijuana. This makes funding for research on marijuana difficult to find. Perhaps the cannabis industry should consider funding scientific research on marijuana. But conflicts of interest may become a concern as we have seen with drug company-sponsored studies.The Conversation

James David Adams, associate professor of pharmacology and pharmaceutical sciences, University of Southern California.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Cannabis use in teens not a gateway to conduct problems, study suggests

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With the legalization of cannabis for adults becoming increasingly widespread, more adolescents will be trying the drug. And parents will be wondering what the consequences will be for their teens should they try and continue to use marijuana.

A few decades ago, there was considerable concern that cannabis use was a gateway to more serious problems, such as socializing with drug-using peers and delinquent behavior. In fact, a study of a large cohort of youth in New Zealand in the 1990s suggested just such an outcome.

More recently, my research colleagues and I were able to ask whether this applied to teens today in the U.S. Our study involved following 364 adolescents living in Philadelphia over eight years, starting when they were between 10 and 12 years old. We conducted five annual surveys and a final follow-up survey when they turned 18 and 19. Using a more sensitive statistical methodology than had been used in the past, we were able to disentangle the effects of which came first: conduct problems or marijuana use. And we found some interesting patterns.

Our study showed that users of marijuana do not seek out other users. In addition, we found no evidence that use of cannabis led to greater problem behavior. Instead, we found that the teens who reported changes in their problem behavior were more likely to subsequently increase their use of cannabis. And they were also more likely to begin associating with peers who also used the drug.

This was different from other marijuana users who did not develop new friends who used marijuana. They were more likely to start using marijuana if their friends already used it, which was not a surprise. But there was no evidence that marijuana use led to the development of potentially deviant peer relationships with youth likely to engage in problem behavior.

Teens and cannabis use

The study tracked subjects’ use of cannabis as well as other drugs. In addition, the study asked them about whether they engaged in various types of problem behavior, such as stealing and skipping school. We also asked about their friends’ drug use, and at the final follow-up, we probed for symptoms of substance use disorder stemming from their use of cannabis and other drugs.

At the final follow-up, about 40 percent of the adolescents who continued to use marijuana reported having developed a mild cannabis use disorder, showing signs of two or three symptoms, such as craving the drug and feeling the need to use it. We were not surprised that the teens who had behavior problems were more likely to develop the disorder, and our cohort was more likely to include this high-risk group than nationally representative samples. Thus, the likelihood of acquiring even a mild disorder from marijuana use is probably much lower.

But even the teens without behavior problems were susceptible to developing the disorder.

Nevertheless, there was no evidence that use of cannabis led to the development of conduct disorder or to more serious use of other drugs; all of the evidence pointed to the reverse.

This suggests that the prior findings may have been due to the failure to examine the effects of problem behavior on cannabis use. It may also reflect changes in how the drug is used in today’s more accepting environment.

Cannabis not the risk some fear?

In one sense, these findings are reassuring. They suggest that greater access to cannabis need not have the deleterious effects once feared.

Yet cannabis is still a potentially addictive substance, just as alcohol and tobacco, the other drugs that many adolescents are likely to try. And despite the use of these popular drugs, there was very little evidence of gateway effects to harder drugs, such as heroin or other opioids. The gateway hypothesis regarding adolescent drug use has lost a lot of its credibility following more careful research on the effects of the drugs that adolescents are likely to try. Indeed, youth who use one drug are also likely to use others, as opposed to one leading to another. And as we found, substance use disorders tend to cluster across drugs.

As noted above, teens with friends who used cannabis were also more likely to start using the substance. This suggests that as the drug becomes more available, it is likely to spread through peer networks, just as alcohol does now despite it being restricted in sales to those over age 20.

And this further suggests that there will likely be more cases of substance use disorder attributed to cannabis. Based on our teenage cohort’s experience with alcohol, we estimate that less than 25 percent of youth who use alcohol consistently will develop a mild case of alcohol use disorder. It would not be surprising if the same thing happens as cannabis becomes more available.

Cannabis not harmless

Our findings suggest that cannabis is not a harmless drug, and policymakers and parents should proceed with this awareness as it becomes more available. Youth who are susceptible to psychosis are playing with fire when using strong doses of the drug. And parents may not know if their teen is susceptible.

Evidence to date in the states that have legalized marijuana for recreational use suggests that motor vehicle fatalities due to crashes do not increase post-legalization. However, there is some evidence that it may lead to more non-fatal crashes.

On the other hand, cannabis is increasingly recognized as an effective pain killer for many who suffer from chronic conditions, and the states that have legalized medical marijuana have experienced a decline in prescriptions for opioids.

But the connections between cannabis and opioid use are complex. There is some evidence that use of cannabis in adults can lead to greater use of opioids, but this too is older research which may not reflect the medical use of the drug. Determining the overall benefits of cannabis will continue to be a subject of research.

All of this evidence points to the increasing recognition that cannabis is incorrectly labeled as a Schedule 1 drug by the U.S. government, along with heroin, LSD and ecstasy. This classification designates cannabis as having “no currently accepted medical use and a high potential for abuse.” Considerable experience along with the growing consensus of the medical community suggests that this conclusion is no longer tenable.

Our study also suggests that fears about the drug’s potential gateway effects in causing harms for adolescents have been exaggerated. A sound policy going forward will require a balanced appraisal of both its benefits and harms.

The Conversation

Dan Romer, Research Director, Annenberg Public Policy Center, University of Pennsylvania

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How masculinity affects young men’s marijuana use

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Friendships and ideas about masculinity have a powerful effect on marijuana use among young minority men, report researchers.

Researchers discovered that strong social bonds between men may increase, rather than decrease, marijuana use, contrary to what was previously thought. They also found that men who believe in more traditional masculine gender roles—men are supposed to be strong, successful, and not complain or show worry—are more likely to not use marijuana.

While marijuana use among adolescents in low-income neighborhoods is a common target for study, the new research breaks new ground in the examination of minority men between the ages of 18 and 25, in between adolescence and adulthood, says lead author Tamara Taggart, a postdoctoral fellow at Yale University’s Center for Interdisciplinary Research on AIDS.

Marijuana is the most commonly used illegal drug in the United States. While its use is prevalent among emerging adults of all genders and races, black and Latino emerging adults who use marijuana are more likely to experience the drug’s negative consequences, including incarceration, interpersonal violence, injury, and dependence, as compared to their white peers.

The new study takes one step further than previous studies that determined that living in a disadvantaged neighborhood leads to escalated rates of marijuana use. Researchers looked at two crucial characteristics to determine a neighborhood’s impact on health: neighborhood problems, including abandoned buildings, litter, violence, and crime, which are known to cause daily stress that can hinder health and well-being; and social cohesion—defined by strong interpersonal bonds, shared values, and a lack of conflict between individuals and groups within a neighborhood, which can foster positive health outcomes.

Consistent with previous studies, the researchers found a positive association between neighborhood problems and marijuana use.

“This result suggests that neighborhoods can be a source of stress that may influence men to cope through using substances,” says Taggart.

There was also a positive association with social cohesion, previously thought to be a deterrent to substance use. This could be attributed, according to the research, to social norms that are more permissive of marijuana use, and strong social bonds between those that use marijuana.

Taggart used data from the Cell Phone Research to Enhance Wellness (CREW) study, that explores social networks, cellular phones, and health behavior. The study interviewed 119 minority emerging adult men from New Haven, CT.

Because not all young men in disadvantaged neighborhoods use marijuana, other factors that may deter them need to be considered to get a better understanding of how neighborhood environments can impact substance use. Taggart used masculinity as a further determinant of health behavior.

“These findings underscore the importance of understanding social cohesion and neighborhood contexts when trying to reduce the impact of substance use. Our findings imply that more socially connected men may view marijuana use as a way to enact their masculinity and establish a stable identity,” she says.

Next steps may include trying to get a deeper understanding of the role of these bonds in men’s substance use behaviors, and possible interventions that could reduce neighborhood problems overall through multilevel community-based interventions.

This article was originally published at Futurity and is republished here under the Creative Commons Attribution 4.0 International license.

If cannabis is getting stronger, why aren’t cases of schizophrenia rising?

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Most people who smoke pot enjoy it, but a smaller proportion experience psychotic-like symptoms, such as feeling suspicious or paranoid. The question that polarizes researchers is whether smoking cannabis is associated with a risk of developing psychotic problems, such as schizophrenia, in the long term.

Of course, cannabis use is common, while schizophrenia is relatively rare, affecting less than one per cent of the population. Even if cannabis use were to double the risk, over 98 percent of cannabis users would not develop schizophrenia. Researchers have to tread carefully in evaluating the evidence and avoiding scaremongering.

Although several studies suggest that cannabis users have a higher risk of developing schizophrenia, one key point remains hotly contested. Since the 1960s, cannabis potency and rates of use have risen in many Western countries with high-potency strains now dominating the market. If cannabis were a cause of psychosis, we would expect that, as this increased, rates of schizophrenia would increase alongside it. But this has not happened.

Still not settled

Although this topic was debated by two eminent British psychiatrists, David Nutt and Robin Murray, in The Guardian and by others in Nature, it remains contested whether a cause-and-effect relationship between smoking cannabis and schizophrenia truly exists.

Perhaps we lack sufficient records of schizophrenia cases to show a robust correlation. It has also been argued that not all effects follow causes. For example, although obesity in the West is increasing and is a known cause of heart disease, the risk of suffering fatal heart disease is going down. The reason for this is a third factor: treatments for heart disease have improved and are saving more lives. If cannabis potency is increasing and rates of schizophrenia are not, a similar third factor may explain this.

Perhaps the answer is in those brief experiences we have when we use cannabis. This week results from our online survey thecannabissurvey.com are published in Psychological Medicine.

We asked 1,231 cannabis users about their experiences when they used cannabis and calculated a “pleasurable experiences score” and a “psychotic-like experiences score”. We then asked the participants if they were continuing to use cannabis, or if they were thinking of quitting in the future.

Those who reported the most pleasurable experiences continued to use the drug and had no intention of quitting. Those with higher psychotic-like experiences had either stopped or were thinking of quitting in the future. The experience you have with the drug determines whether you continue to use it or not, regardless of your age, sex, mental health history or other drugs you have used.

Interestingly, this might mean that the people at highest risk are the very ones who are quitting. Other studies suggest that, compared with healthy controls, people with schizophrenia have more psychotic-like experiences when they use cannabis. And those at higher risk of schizophrenia – that is, people with genetic or psychological risk factors for the disease – tend to have more psychotic-like experiences. If these are the people who are stopping using cannabis, they may offset their risk of developing schizophrenia from cannabis use.

The cannabis discontinuation hypothesis

We could think of the experience as a warning sign to which they are responding. This could be the third factor that explains why the link between cannabis potency and schizophrenia rates is not direct. We call this the “cannabis discontinuation hypothesis” and propose it in more detail in our paper.

This hypothesis is more nuanced than simply being pro- or anti-cannabis. On the one hand, if you believe that cannabis causes psychosis, this may explain why the rates of cannabis and schizophrenia are not directly correlated. On the other hand, you could argue that since those at highest risk heed the body’s warning system, why does any of this matter. People who are at highest risk will stop in any case. Of course, it is likely that not everyone does, and we need to make sure that we offer the right support to that small group at highest risk who continue to use.

It is important to remember that, at this stage, this is a hypothesis, not a fact. The survey was taken at a single point in time and the online sample we had may be different from the average cannabis user. But this group were moderate to heavy users, drawn from activist sites and social media – those that we need to engage the most in this kind of work.

The ConversationThe best study to confirm the hypothesis would be a long-term study mapping cannabis experiences to schizophrenia risk, drawn from the general population, but this would be a long and expensive study to do. In the meantime, we are continuing to work at thecannabissurvey.com looking at what causes the different experiences we have. Improved knowledge of these factors will lead to more nuanced understanding in the future.

Musa Sami is a researcher and academic psychiatrist at King’s College London.

This article was originally published on The Conversation.

There’s a surprising link between coffee and cannabis

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New research shows coffee can affect our metabolism in dozens of ways—including our metabolism of steroids and the neurotransmitters typically linked to cannabis—beyond the caffeine boost we expect in the morning.

“These are entirely new pathways by which coffee might affect health.”

After drinking four to eight cups of coffee in a day, people’s neurotransmitters related to the endocannabinoid system—the same ones that cannabis affects—decreased. That’s the opposite of what occurs after someone uses cannabis.

Neurotransmitters are the chemicals that deliver messages between nerve cells and cannabinoids are the chemicals that give the cannabis plant its medical and recreational properties. Our body also naturally produces endocannabinoids, which mimic cannabinoid activity.

Further, certain metabolites related to the androsteroid system increased after drinking four to eight cups of coffee in a day, which suggests coffee might facilitate the excretion or elimination of steroids. Because the steroid pathway is a focus for certain diseases including cancers, coffee may have an effect on these diseases as well, researchers say.

“These are entirely new pathways by which coffee might affect health,” says lead author Marilyn Cornelis, assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine. “Now we want to delve deeper and study how these changes affect the body.”

Little is known about how coffee directly impacts health. In the new study, which appears in the Journal of Internal Medicine, scientists applied advanced technology that allowed them to measure hundreds of metabolites in human blood samples from a coffee trial for the first time.

For the study, 47 people in Finland didn’t drink coffee for one month, then consumed four cups a day for the second month, and then eight cups a day for the third month. Researchers used advanced profiling techniques to examine more than 800 metabolites in the blood collected after each stage of the study.

Blood metabolites of the endocannabinoid system decreased with coffee consumption, particularly with eight cups per day.

The endocannabinoid metabolic pathway is an important regulator of our stress response, Cornelis says, and some endocannabinoids decrease in the presence of chronic stress.

“The increased coffee consumption over the two-month span of the trial may have created enough stress to trigger a decrease in metabolites in this system,” Cornelis says. “It could be our bodies’ adaptation to try to get stress levels back to equilibrium.”

Sweet, low-calorie foods confuse our metabolism
The endocannabinoid system also regulates a wide range of functions: cognition, blood pressure, immunity, addiction, sleep, appetite, energy, and glucose metabolism.

“The endocannabinoid pathways might impact eating behaviors…the classic case being the link between cannabis use and the munchies.”

The brew also has been linked to aiding weight management and reducing risk of type 2 diabetes.

“This is often thought to be due to caffeine’s ability to boost fat metabolism or the glucose-regulating effects of polyphenols (plant-derived chemicals),” Cornelis says. “Our new findings linking coffee to endocannabinoids offer alternative explanations worthy of further study.”

The American Diabetes Association, the German Federal Ministry of Health, and other sources funded the work.

This article was originally published at northwestern.edu and republished here under the Creative Commons Attribution 4.0 International license.

The link between drugs and music, explained by science

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For centuries, musicians have used drugs to enhance creativity and listeners have used drugs to heighten the pleasure created by music. And the two riff off each other, endlessly. The relationship between drugs and music is also reflected in lyrics and in the way these lyrics were composed by musicians, some of whom were undoubtedly influenced by the copious amounts of heroin, cocaine and “reefer” they consumed, as their songs sometimes reveal.

Ella Fitzgerald’s paean to ‘wacky dust’.

Acid rock would never have happened without LSD, and house music, with its repetitive 4/4 beats, would have remained a niche musical taste if it wasn’t for the wide availability of MDMA (ecstasy, molly) in the 1980s and 1990s.

And don’t be fooled by country music’s wholesome name. Country songs make more references to drugs than any other genre of popular music, including hip hop.

Under the influence

As every toker knows, listening to music while high can make it sound better. Recent research, however, suggests that not all types of cannabis produce the desired effect. The balance between two key compounds in cannabis, tetrahydrocannabinol and cannabidiols, influence the desire for music and its pleasure. Cannabis users reported that they experienced greater pleasure from music when they used cannabis containing cannabidiols than when these compounds were absent.

Listening to music – without the influence of drugs – is rewarding, can reduce stress (depending upon the type of music listened to) and improve feelings of belonging to a social group. But research suggests that some drugs change the experience of listening to music.

Clinical studies that have administered LSD to human volunteers have found that the drug enhances music-evoked emotion, with volunteers more likely to report feelings of wonder, transcendence, power and tenderness. Brain imaging studies also suggest that taking LSD while listening to music, affects a part of the brain leading to an increase in musically inspired complex visual imagery.

Pairing music and drugs

Certain styles of music match the effects of certain drugs. Amphetamine, for example, is often matched with fast, repetitive music, as it provides stimulation, enabling people to dance quickly. MDMA’s (ecstasy) tendency to produce repetitive movement and feelings of pleasure through movement and dance is also well known.

Fujiya & Miyagi – Serotonin Rushes.

An ecstasy user describes the experience of being at a rave:

I understood why the stage lights were bright and flashing, and why trance music is repetitive; the music and the drug perfectly complemented one another. It was as if a veil had been lifted from my eyes and I could finally see what everyone else was seeing. It was wonderful.

There is a rich representation of drugs in popular music, and although studies have shown higher levels of drug use in listeners of some genres of music, the relationship is complex. Drug representations may serve to normalise use for some listeners, but drugs and music are powerful ways of strengthening social bonds. They both provide an identity and a sense of connection between people. Music and drugs can bring together people in a political way, too, as the response to attempts to close down illegal raves showed.

People tend to form peer groups with those who share their own cultural preferences, which may be symbolised through interlinked musical and substance choices. Although there are some obvious synergies between some music and specific drugs, such as electronic dance music and ecstasy, other links have developed in less obvious ways. Drugs are one, often minor, component of a broader identity and an important means of distinguishing the group from others.

The ConversationAlthough it is important not to assume causality and overstate the links between some musical genres and different types of drug use, information about preferences is useful in targeting and tailoring interventions, such as harm reduction initiatives, at music festivals.

Ian Hamilton, Lecturer in mental health and addiction, University of York; Harry Sumnall, Professor in Substance Use, Liverpool John Moores University, and Suzi Gage, Lecturer, University of Liverpool

This article was originally published on The Conversation. Read the original article.

Marijuana may keep HIV patients sharp, finds study

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Researchers have found that a chemical in marijuana, called tetrahydrocannabinol, or THC, could potentially slow the process of mental decline that affects up to 50 percent of HIV patients.

“It’s believed that cognitive function decreases in many of those with HIV partly due to chronic inflammation that occurs in the brain,” says Norbert Kaminski, director of the Institute for Integrative Toxicology at Michigan State University and lead author of the study, which appears in the journal AIDS.

“This happens because the immune system is constantly being stimulated to fight off disease,” Kaminski says.

Kaminski and his coauthor, Mike Rizzo, a graduate student in toxicology, discovered that the compounds in marijuana were able to act as anti-inflammatory agents, reducing the number of inflammatory white blood cells, called monocytes, and decreasing the proteins they release in the body.

“This decrease of cells could slow down, or maybe even stop, the inflammatory process, potentially helping patients maintain their cognitive function longer,” Rizzo says.

The two researchers took blood samples from 40 HIV patients who reported whether or not they used marijuana. Then, they isolated the white blood cells from each donor and studied inflammatory cell levels and the effect marijuana had on the cells.

“The patients who didn’t smoke marijuana had a very high level of inflammatory cells compared to those who did use,” Kaminski says. “In fact, those who used marijuana had levels pretty close to a healthy person not infected with HIV.”

Kaminski has studied the effects of marijuana on the immune system since 1990. His lab was the first to identify the proteins that can bind marijuana compounds on the surface of immune cells. Up until then, it was unclear how these compounds, also known as cannabinoids, affected the immune system.

HIV, which stands for human immunodeficiency virus, infects and can destroy or change the functions of immune cells that defend the body. With antiretroviral therapy—a standard form of treatment that includes a cocktail of drugs to ward off the virus—these cells have a better chance of staying intact.

Yet, even with this therapy, certain white blood cells can still be overly stimulated and eventually become inflammatory.

“We’ll continue investigating these cells and how they interact and cause inflammation specifically in the brain,” Rizzo says.

“What we learn from this could also have implications to other brain-related diseases like Alzheimer’s and Parkinson’s since the same inflammatory cells have been found to be involved,” he adds.

Knowing more about this interaction could ultimately lead to new therapeutic agents that could help HIV patients specifically maintain their mental function.

“It might not be people smoking marijuana,” Kaminski says. “It might be people taking a pill that has some of the key compounds found in the marijuana plant that could help.”

This article was originally published at Futurity and was republished here under the Creative Commons by 4.0 license.