Beneficio clínico del tratamiento con cannabinoides para el dolor crónico no oncológico

Introducción: los cannabinoides pueden ser una opción válida para el tratamiento del dolor crónico no oncológico de acuerdo a los estudios publicados hasta el momento y a nuestra experiencia clínica. Objetivo: valorar el beneficio clínico de preparados de cannabis medicinal (CM) para dolor crónico no oncológico en pacientes que consultaron en la Clínica de Endocannabinología del Uruguay (CEDU). Material y método: estudio descriptivo, observacional, longitudinal, de una población atendida en un centro privado de salud. Se trata de una cohorte de 438 pacientes que consultaron espontáneamente en CEDU desde septiembre de 2016 a marzo de 2020. El motivo de consulta fue dolor crónico no oncológico que no respondió al tratamiento estándar. Resultados: en la cohorte estudiada predominaron las mujeres (74%), promedio 69 años, que se asisten en el sistema privado de salud en el 95% de los casos, en su mayoría con instrucción secundaria. El tipo de dolor más frecuente fue el dolor osteoarticular. El quimiotipo de CM más usado fue cannabidiol (CBD) al 5%, con buena respuesta al tratamiento en el descenso del nivel del dolor y suspensión o disminución de uso de opioides (y derivados) y antiinflamatorios no esteroideos (AINES). Se observaron escasos y leves efectos adversos (EA) en la gran mayoría de los pacientes. Abandonaron el tratamiento 12 pacientes (menos del 3%). Conclusiones: esta investigación retrospectiva mostró una caída del nivel del dolor de 3,14 (valor p ≤ 0,0001), indicando que el CM puede ser una opción para el tratamiento del dolor crónico no oncológico. Se requieren más estudios para demostrar la efectividad y seguridad de los cannabinoides. Esto depende de muchos factores (leyes que faciliten la accesibilidad a variedad de productos de CM de grado médico, incentivos a la ciencia e investigación). De todas formas, podemos afirmar que los resultados presentados son prometedores en relación con su potencial terapéutico.

Introduction: Cannabinoids can be a valid option for the treatment of chronic non-cancer pain, according to the studies published to date and our clinical experience. Objectives: To evaluate the clinical benefit of medicinal cannabis preparations (MCPs) for chronic non-cancer pain in patients seen at the Endocannabinology Clinic of Uruguay (CEDU). Method: Descriptive, observational, longitudinal study of a population treated at a private healthcare center. This involves a cohort of 438 patients who spontaneously consulted at CEDU from September 2016 to March 2020. The reason for consultation was chronic non-cancer pain that did not respond to standard treatment. Results: in the studied cohort, women prevailed and accounted for 74% of patients. Average age was 69 years old and 95% of them sought care within the private healthcare system. Most women had completed secondary school education. The most frequent type of pain was osteoarticular pain. The most used chemovar of Medicinal Cannabis (MC) was 5% cannabidiol (CBD), showing a favorable treatment response in reducing pain levels and the discontinuation or reduction of opioid and non-steroidal anti-inflammatory drug (NSAID) usage. Few and mild adverse effects (AE) were observed in the vast majority of patients. Twelve patients (less than 3%) discontinued the treatment. Conclusions: This retrospective study demonstrated a reduction in pain level of 3.14 (p-value ≤ 0.0001) indicating that MC could be an option for the treatment of non-oncological chronic pain. Further studies are needed to demonstrate the effectiveness and safety of cannabinoids. This depends on many factors (laws facilitating accessibility to a variety of medical-grade MC products, incentives for science and research). Nevertheless, we can assert that the presented results are promising in consideration of their therapeutic potential.

Introdução: os canabinoides podem ser uma opção válida para o tratamento da dor crônica não oncológica de acordo com estudos publicados até o momento e nossa experiência clínica. Objetivos: avaliar o benefício clínico das preparações de Cannabis Medicinal (CM) para dor crônica não oncológica em pacientes que consultaram a Clínica de Endocanabinologia do Uruguai (CEDU). Método: estudo descritivo, observacional, longitudinal de uma população atendida em um centro de saúde privado. Esta é uma coorte de 438 pacientes que consultaram espontaneamente no CEDU no período setembro de 2016 - março de 2020. O motivo da consulta foi dor crônica não oncológica que não respondeu ao tratamento padrão. Resultados: na coorte estudada, 74% eram mulheres, a idade média foi 69 anos, 95% frequentam a rede privada de saúde e a maioria com ensino médio. O tipo de dor mais frequente foi a osteoarticular. O quimiotipo de MC mais utilizado foi o Canabidiol 5% (CBD), com boa resposta ao tratamento em termos de redução do nível de dor e suspensão ou redução do uso de opioides (e derivados) e anti-inflamatórios não esteroides (AINEs). A grande maioria dos pacientes apresentou poucos e leves efeitos adversos (EAs). Menos de 3% dos 12 pacientes abandonou o tratamento. Conclusões: Esta investigação retrospectiva mostrou uma queda no nível de dor de 3,14 (valor de p ≤ 0,0001), indicando que o MC pode ser uma opção para o tratamento da dor crônica não oncológica. São necessários mais estudos para demonstrar a eficácia e segurança dos canabinoides. Isso depende de muitos fatores (leis que facilitem o acesso a uma variedade de produtos CM de grau médico, incentivos para ciência e pesquisa). De qualquer forma, podemos afirmar que os resultados apresentados são promissores em relação ao seu potencial terapêutico.

Cannabis: Drug of Abuse and Therapeutic Agent, Two Sides of the Same Coin

ABSTRACT The consumption of Cannabis sativa plant, known as marijuana in the Western world, for different purposes (therapeutic, intoxicating, and spiritual) due to its psychoactive effects, can be traced back to ancient times. Cannabis is the most used illicit drug worldwide; however, its legal status is changing rapidly. Cannabis regulation will allow a better understanding of its effects as a misused drug, including new challenges, such as the availability of highly potent Cannabis extracts. Furthermore, scientific research is making significant efforts to take advantage of the potential therapeutic uses of Cannabis active compounds. The science of Cannabis derivatives started with the identification of the phytocannabinoids Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD), allowing the formal study of the complex set of effects triggered by Cannabis consumption and the deciphering of its pharmacology. Δ9-THC is recognized as the compound responsible for the psychoactive and intoxicating effects of Cannabis. Its study led to the discovery of the endocannabinoid system, a neuromodulatory system widespread in the human body. CBD does not induce intoxication and for that reason, it is the focus of the search for cannabinoid potential clinical applications. This review examines the current state of knowledge about contrasting perspectives on the effects of Cannabis, Δ9-THC, and CBD: their abuse liability and potential therapeutic use; two sides of the same coin.

Utilización medicinal de cannabis en pacientes oncológicos de San Carlos de Bariloche: Estudio basado en una encuesta / Medicinal use of cannabis in cancer patients in San Carlos de Bariloche: a survey-based study

RESUMEN INTRODUCCIÓN El uso medicinal del cannabis en pacientes oncológicos se ha popularizado en los últimos años. Para poder brindar asesoramiento que redunde en un uso más eficaz y seguro, es necesario conocer la experiencia y expectativas de los usuarios. El objetivo fue conocer los motivos y la experiencia del uso medicinal de cannabis en adultos con enfermedades oncológicas en San Carlos de Bariloche (Río Negro). MÉTODOS Se realizó un estudio basado en una encuesta en línea autoadministrada sobre uso de cannabis, tiempo y motivo de uso, grado de satisfacción, asesoramiento profesional, vía de administración y efectos adversos. RESULTADOS Participaron 201 pacientes. Un 19% utilizaba cannabis, y el 31% lo había utilizado antes. La principal forma de uso fue el aceite. Los principales motivos fueron tratar el dolor, dormir mejor y sentirse mejor. Las experiencias fueron satisfactorias o muy satisfactorias para más del 50%, y las más favorables fueron para tratar el dolor, mejorar el ánimo, tolerar la quimioterapia y dormir mejor. Entre las razones para dejar de usarlo se mencionó falta de utilidad, efectos adversos, dudas sobre dosis, tiempo de uso y calidad del producto adquirido. Menos del 50% de los pacientes habían recibido asesoramiento profesional sobre uso de cannabis. DISCUSIÓN El 50% de los participantes utilizó cannabis. Este relevamiento ofrece un diagnóstico útil para promover políticas que reflejen las necesidades frente al uso de cannabis.

ABSTRACT INTRODUCTION The medicinal use of cannabis in cancer patients has become popular in recent years. In order to provide advice that results in a more effective and safe use, it is necessary to know the experience and expectations of users. The objective was to know the reasons and experience of the medicinal use of cannabis in adults with oncological diseases in San Carlos de Bariloche (Río Negro province). METHODS The study was based on a self-administered online survey on cannabis use, time and reason for use, degree of satisfaction, professional advice, route of administration and adverse effects. RESULTS A total of 201 patients participated, of which 19% used cannabis and 31% had previously used it. The main form of use was oil. The main reasons for use were to treat pain, sleep better and feel better. The experiences were satisfactory or very satisfactory for more than 50%, and the most favorable ones were to treat pain, improve mood, tolerate chemotherapy, and sleep better. Lack of usefulness, adverse effects, doubts about the dose, time of use and quality of the product purchased were mentioned among the reasons for the decision to stop using it. Less than 50% of the patients had received professional advice on the use of cannabis. DISCUSSION Half of the participants used cannabis. This survey provides a useful diagnosis to foster policies that reflect the needs regarding the use of cannabis.

Influence of Drug Abuse Prevention Education and Experience of Staying Abroad on Perceptions of Recreational Cannabis: A Pilot Study / 社会薬学

In this study, we aim to clarify the impact of drug abuse prevention education and the experiences of people who have stayed in countries that are tolerate marijuana use for recreational purposes on their beliefs regarding the relaxation of the Cannabis Control Law. On May 12-13th, 2022, a web-based questionnaire survey was presented to Japanese nationals aged 18-41 years who had spent at least 5 days in a marijuana-tolerant country. Univariate and multiple logistic regression analyses were conducted with “Views on the Relaxation of the Cannabis Control Law” as the objective variable. A total of 160 respondents (45.6% male) responded, of whom 33.8% supported relaxing the law for the consumption of recreational cannabis in the form of food, drink, or smoke. Additionally, 27.5% of the respondents had encountered recreational cannabis through some channel during their stay. Multiple logistic regression analysis revealed a significant positive association between idea of supporting the relaxation of the law and the tolerance of the image of the physical and mental effects of recreational cannabis and the social effects of its distribution. Neither knowledge of marijuana and drug abuse nor the experience of being encouraged to use it during their stay were significantly associated. The study suggested that in order to deter marijuana use during stays in such countries, it is necessary not only to improve knowledge, but also to foster imagination and the ability to think and predict the physical and social effects of its use.

Understanding cannabis use in Singapore: profile of users and drug progression

INTRODUCTION@#Cannabis has consistently been the third most commonly abused drug among drug arrestees in Singapore over the past few years. Accordingly, this study aimed to understand the profile of cannabis users in Singapore and explore the effects of cannabis use on drug progression.@*METHODS@#A total of 450 participants who had used cannabis at least once in their lifetime were recruited from the National Addictions Management Service, prisons, the Community Rehabilitation Centre and halfway houses from August 2017 to May 2018. A face-to-face questionnaire was administered and descriptive analyses were conducted.@*RESULTS@#The mean participant age was 40.9 ± 14.51 years, and 93.1% of them were male. The participants generally initiated cannabis use during adolescence, at a mean onset age of 16.5 ± 4.46 years. Most (89.6%) were introduced to cannabis by peers. Approximately half of them (46.9%) had used cannabis before other illicit drugs and 42.1% of them had used heroin as the succeeding drug.@*CONCLUSION@#In Singapore, cannabis use is often initiated during adolescence, largely under peer influence. Cannabis users may progress to other illicit drugs, particularly heroin, later in life.

High COVID-19 morbidity and mortality risk among smoked drug users in Brazil

Abstract In much of the West, including Brazil, drug use has increased since social distancing began in response to the pandemic. Use of smoked and modified drugs, and their impacts on health, may contribute to aggravate the effects of the pandemic. However, studies on the relationship between use of smoked drugs and the new coronavirus are still scarce and have not received enough attention in global health recommendations. This paper aims to briefly review the relationship between use of smoked drugs and acute respiratory syndrome coronavirus 2 [SARS-CoV-2]. Recent studies also suggest that drug consumption increases the risk of contamination by SARS-CoV-2 and leads to worse prognosis, particularly consumption of drugs that affect lung function. Use of smoked drugs, especially tobacco, is strongly associated with lung diseases that are risk factors for contamination by SARS-CoV-2. It is essential to develop strategies based on specific characteristics of drug users and for mental health professionals to be included in strategic teams. It is also necessary to invest in information campaigns regarding risks and prevention of harm caused by smoked drugs as well as to design strategies that facilitate access to psychosocial treatment during the pandemic.

Pacientes neuropsiquiátricos e os benefícios do tratamento com fitocanabinóides / Neuropsychiatric patients and the benefits of phytocannabinoid treatment / Pacientes neuropsiquiátricos y los beneficios del tratamiento con fitochanabinoides

presente revisão visa sumarizar os estudos que abordam o uso de fitocanabinóides em pacientes com doenças neuropsiquiátricas, abordando os benefícios e possíveis efeitos adversos que podem ser observados. Foi realizada uma revisão integrativa de literatura com descritores MeSH: Cannabis, Medical Marijuana, Neurology, Neuropsychiatry e as bases de dados: PubMed, MEDLINE, CINAHL, SCOPUS, Web of Science e SciELO. Selecionou-se artigos entre 2015 a 2021 utilizando como critérios de inclusão, artigos que abordassem sobre o uso de fitocanabinoides em pacientes com doenças neurológicas e/ou psiquiátricas, disponíveis integralmente nos bancos de dados sem restrição de idioma. Após análise, foram encontrados 15 artigos, que evidenciaram benefícios como: propriedades ansiolíticas, antiepilépticas, antiparkinsonianas, antipsicóticas, de estabilização de humor, além de ser benéfico na regulação do sono, na Síndrome de Tourette, na demência, dores crônicas, amenização de sintomas eméticos dos tratamentos oncológicos e da espasticidade na esclerose múltipla, no TEPT e no autismo. Além disso, os fitocanabinoides parecem ter propriedades anti-inflamatórias e de neuroproteção. Entretanto, efeitos colaterais também foram observados, sendo os principais: piora no desempenho em testes cognitivos, sintomas gastrointestinais, sonolência, agitação, piora de alguns transtornos psiquiátricos, diminuição da concentração, aumento da ansiedade social, bem como boca e olhos secos. Conclui-se portanto que os fitocanabinóides podem apresentar ação terapêutica benéfica no tratamento de condições neuropsiquiátricas, tratamento de doenças neurodegenerativas, propriedades anti-inflamatórias e neuroprotetoras e tratamento de dores crônicas, entretanto devem ser considerados e monitorados os efeitos adversos em cada paciente.

This review aims to summarize the studies that address the use of phytocannabinoids in patients with neuropsychiatric diseases, addressing the benefits and possible adverse effects that can be observed. An integrative literature review was conducted with MeSH descriptors: Cannabis, Medical Marijuana, Neurology, Neuropsychiatry and the databases: PubMed, MEDLINE, CINAHL, SCOPUS, Web of Science and SciELO. Articles were selected between 2015 and 2021 using as inclusion criteria articles that addressed the use of phytocannabinoids in patients with neurological and/or psychiatric diseases, available in full in the databases without language restriction. After analysis, 15 articles were found, which showed benefits such as: anxiolytic, antiepileptic, antiparkinsonian, antipsychotic, mood stabilization properties, besides being beneficial in sleep regulation, Tourette's syndrome, dementia, chronic pain, mitigation of emetic symptoms of cancer treatments and spasticity in multiple sclerosis, PTSD and autism. In addition, phytocannabinoids appear to have anti-inflammatory and neuroprotective properties. However, side effects have also been observed, the main ones being: worsening performance in cognitive tests, gastrointestinal symptoms, drowsiness, agitation, worsening of some psychiatric disorders, decreased concentration, increased social anxiety, as well as dry mouth and eyes. Therefore, it is concluded that phytocannabinoids may present beneficial therapeutic action in the treatment of neuropsychiatric conditions, treatment of neurodegenerative diseases, anti-inflammatory and neuroprotective properties and treatment of chronic pain, however, the adverse effects in each patient should be considered and monitored.

Esta revisión tiene como objetivo resumir los estudios que abordan el uso de fitocanabinoides en pacientes con enfermedades neuropsiquiátricas, abordando los beneficios y posibles efectos adversos que pueden observarse. Se realizó una revisión integral de la literatura con los descriptores de MeSH: Cannabis, Medical Marijuana, Neurology, Neuropsychiatry y las bases de datos: PubMed, MEDLINE, CINAHL, SCOPUS, Web of Science y SciELO. Se seleccionaron artículos entre 2015 y 2021, utilizando como criterios de inclusión artículos que abordaban el uso de fitocanabinoides en pacientes con enfermedades neurológicas y/o psiquiátricas, disponibles enteramente en las bases de datos sin restricción lingüística. Después del análisis se encontraron 15 artículos que mostraron beneficios tales como: propiedades ansiolíticas, antiepilépticas, antiparkinsonianas, antipsicóticas, estabilizadoras del estado de ánimo, además de ser beneficiosos para regular el sueño, en el síndrome de Tourette, en demencia, dolor crónico, alivio de los síntomas eméticos de los tratamientos contra el cáncer y de la espasticidad en esclerosis múltiple, TEPT y autismo. Además, los fitobarabinoides parecen tener propiedades antiinflamatorias y neuroprotectoras. Sin embargo, también se observaron efectos adversos, siendo los principales: empeoramiento del desempeño en las pruebas cognitivas, síntomas gastrointestinales, somnolencia, agitación, empeoramiento de algunos trastornos psiquiátricos, disminución de la concentración, aumento de la ansiedad social, así como sequedad de boca y ojos. Por lo tanto, se concluye que los fitocanabinoides pueden tener una acción terapéutica beneficiosa en el tratamiento de las afecciones neuropsiquiátricas, el tratamiento de las enfermedades neurodegenerativas, las propiedades antiinflamatorias y neuroprotectoras y el tratamiento del dolor crónico, sin embargo, se deben considerar y monitorizar los efectos adversos en cada paciente.

Current legislation on medical cannabis. History, movements, trends and counter-tendencies, in the Brazilian territory / Legislação atual sobre cannabis medicinal. Histórico, movimentos, tendências e contratendências no território brasileiro

ABSTRACT BACKGROUND AND OBJECTIVES: Cannabis sativa is a plant that has been used by humankind for many years and is in the media spotlight due to its pharmacological features, being considered the great therapeutic option of the century. With the advent of the Drug Law (Lei de Drogas - Law No. 11,343/2006) there was a starting point for the situation of cannabis in Brazil. Thus, the objective of this narrative review was to discuss information about legal issues regarding cannabis in the Brazilian territory. CONTENTS: The Collegiate Directorate Resolution (Resolução da Diretoria Colegiada - RDC) No. 327 of December 2019, published by Brazilian Health Surveillance Agency (Agência Nacional de Vigilância Sanitária - ANVISA), provides on the procedures for granting health authorization for manufacturing and importation, as well as establishes requirements for marketing, prescription, storage, monitoring and surveillance of cannabis products for medicinal purposes to human use. The Bill of Law (Projeto de Lei - PL) No. 399/2015, proposed to amend article 2 of Law No. 11,343, of August 23, 2006, to enable planting and marketing of drugs containing extracts, substrates or parts of the cannabis plant. CONCLUSION: Cannabis cultivation in Brazil would make a great contribution not only to the pharmaceutical industry, but also to the agricultural industry, generating jobs and reducing raw material costs for drugs. However, the slow pace of Brazilian politics would be an obstacle. There is a need for more consolidated and specific legislation to regulate cannabis.

RESUMO JUSTIFICATIVA E OBJETIVOS: A Cannabis sativa é uma planta utilizada pela humanidade há muitos anos e está em evidência nas mídias devido ao seu caráter farmacológico, sendo considerada a grande opção terapêutica do século. Com o advento da Lei de Drogas (Lei nº 11.343/2006) houve um ponto de partida para a situação da cannabis no Brasil. Dessa forma, o objetivo desta revisão narrativa foi discorrer sobre informações acerca de questões legais quanto à cannabis no território brasileiro. CONTEÚDO: A Resolução da Diretoria Colegiada (RDC) nº 327, de dezembro de 2019, publicada pela Agência Nacional de Vigilância Sanitária (ANVISA), dispõe sobre os procedimentos para a concessão da autorização sanitária para a fabricação e a importação, bem como estabelece requisitos para a comercialização, prescrição, dispensação, monitoramento e a fiscalização de produtos de cannabis para fins medicinais de uso humano. O Projeto de Lei (PL) nº 399/2015, propôs alterar o artigo 2º da Lei nº 11.343, de 23 de agosto de 2006, para viabilizar o plantio e a comercialização de fármacos que contenham extratos, substratos ou partes da planta cannabis. CONCLUSÃO: O cultivo da cannabis no Brasil traria uma grande contribuição não só para a indústria farmacêutica, como também para a indústria agrícola, na geração de empregos e na redução dos custos da matéria-prima de fármacos. No entanto, a morosidade da política brasileira seria um empecilho. Há necessidade de uma legislação mais consolidada e específica para regulamentação da cannabis.

Genetic testing for cannabinoid use / Testes genéticos para uso de canabinoides

ABSTRACT BACKGROUND AND OBJECTIVES: Cannabis is the most popular and consumed illicit drug in the world, it has about 540 bioactive phytocannabinoids, including tetrahydrocarbinol (THC) and cannabidiol (CBD). The therapeutic potential of phytocannabinoids has been the subject of many studies in recent decades for many medical situations, including the management of chronic pain. The advent of pharmacogenetics currently allows the indication of the Cannabis dose to be evaluated individually. The objective of this work was to carry out a survey of the literature on the medicinal use of Cannabis and the application of pharmacogenetics in this therapy. CONTENTS: THC and CBD phytocannabinoids are the most abundant and researched. In the endocannabinoid system there are compounds similar to phytocannabinoids, cell receptors and metabolism enzymes. All these molecules are secreted from genes, which may have individual genetic polymorphisms that determine the modulation of the endocannabinoid system, and consequently impact the patients' therapeutic response. CONCLUSION: The existence of genetic tests for the prior assessment of the patients genetic profile in order to avoid side effects and to have more assertiveness in the indication of the cannabis product is an important tool to increase adherence to cannabis treatment.

RESUMO JUSTIFICATIVA E OBJETIVOS: A cannabis é a droga ilícita mais popular e consumida no mundo, possuindo cerca de 540 fitocanabinoides bioativos, entre eles o tetra-hidrocarbinol (THC) e o canabidiol (CBD). O potencial terapêutico dos fitocanabinoides tem sido alvo de muitos estudos nas últimas décadas para muitas situações médicas, incluindo o manejo da dor crônica. O advento da farmacogenética permite que atualmente a indicação da dose de cannabis seja avaliada individualmente. O objetivo deste estudo foi realizar um levantamento da literatura sobre o uso medicinal da cannabis e a aplicação da farmacogenética nessa terapia. CONTEÚDO: Os fitocanabinoides THC e CBD são os mais abundantes e pesquisados. No sistema endocanabinoide, existem compostos similares aos fitocanabinoides, receptores celulares e enzimas de metabolismo. Todas essas moléculas são secretadas a partir de genes que podem possuir polimorfismos genéticos individuais determinantes para a modulação do sistema endocanabinoide e, consequentemente, impactam a resposta terapêutica do paciente. CONCLUSÃO: A existência de testes genéticos para avaliação prévia do perfil genético do paciente a fim de evitar efeitos colaterais e ter mais assertividade na indicação do produto de cannabis é uma importante ferramenta para aumentar a aderência ao tratamento com cannabis.

Phytocannabinoids and the individualization of treatment. Why is there no level of evidence? / Fitocanabinoides e a individualização do tratamento. Por que não há nível de evidências?

ABSTRACT BACKGROUND AND OBJECTIVES: The individualization of treatment has been recognized as essential in medical practice, especially due to the demand for different therapeutic approaches for similar situations. However, the complex and variable nature of the phytocannabinoids present in the cannabis plant presents challenges for the application of traditional models for testing the efficacy and safety of new drugs. The objective of the present study was to highlight the particularities of cannabis, including genetic variety, cultivation and production, which make it difficult to comply with traditional drug registration protocols, and the importance of individualizing treatment in the use of cannabis for the control of pain. CONTENTS: Traditional models for testing the efficacy and safety of new drugs are based on a rigid methodology, divided into development and post-market phases. However, the complexity of the cannabis plant, with hundreds of actives that can vary according to the genetic variety, cultivation and production process, makes the application of these models difficult. In addition, international rules do not allow the registration of patents on cannabis products, due to the consideration that they are natural products and the extraction methods are already used in the industry for other plant actives. The individualization of treatment is fundamental in the use of cannabis for pain control, given the complexity of the plant and the limitations of traditional models of testing and drug registration. CONCLUSION: The particularities of cannabis, such as genetic variability and the impossibility of registering patents, make compliance with current protocols difficult. However, the individualization of treatment allows adapting therapies to the needs of each patient, considering effectiveness and tolerance of side effects. Therefore, there is a need to rethink research and registry models to allow for a more flexible and personalized approach in the field of cannabis medicines.

RESUMO JUSTIFICATIVA E OBJETIVOS: A individualização do tratamento tem sido reconhecida como essencial na prática médica, especialmente devido à demanda por diferentes abordagens terapêuticas para situações semelhantes. No entanto, a natureza complexa e variável dos fitocanabinoides presentes na cannabis apresenta desafios para a aplicação dos modelos tradicionais de testes de eficácia e segurança de novos fármacos. O objetivo deste estudo foi destacar as particularidades da cannabis, incluindo a variedade genética, o cultivo e a produção, que dificultam a conformidade com os protocolos tradicionais de registro de medicamentos, e bem como a importância da individualização do tratamento na utilização da cannabis para o controle da dor. CONTEÚDO: Os modelos tradicionais de testes de eficácia e segurança de novos fármacos são baseados em uma metodologia rígida, dividida em fases de desenvolvimento e pós-mercado. No entanto, a complexidade da planta de cannabis, com centenas de ativos que podem variar de acordo com a variedade genética, o cultivo e o processo de produção, torna difícil a aplicação desses modelos. Além disso, as regras internacionais não permitem o registro de patentes de produtos canábicos, devido à consideração de que são produtos naturais e os métodos de extração já são utilizados na indústria para outros ativos vegetais. A individualização do tratamento é fundamental na utilização da cannabis para o controle da dor, dada a complexidade da planta e as limitações dos modelos tradicionais de testes e registro de fármacos. CONCLUSÃO: As particularidades da cannabis, como a variabilidade genética e a impossibilidade de registro de patentes, dificultam a conformidade com os protocolos atuais. No entanto, a individualização do tratamento permite adaptar as terapias às necessidades de cada paciente, considerando a efetividade e a tolerância aos efeitos colaterais. Portanto, é necessário repensar os modelos de pesquisa e registro para permitir uma abordagem mais flexível e personalizada no campo dos fármacos canábicos.

Chronic headache and cannabinoids use: myths and truths / Cefaleia crônica e uso de canabinoides: mitos e verdades

ABSTRACT BACKGROUND AND OBJECTIVES: The use of cannabis for medical purposes is known since ancient times. The endocannabinoid system is present throughout central and peripheral nervous system and plays a role in many important regulatory physiological processes like immune function, synaptic plasticity, pain and regulation of stress and emotion, among others. Due to its wide distribution and according to researches, cannabis can be indicated for symptoms management in different disorders such as chronic pain, headache, epilepsy, anxiety and other psychiatric disorders. The primary cannabinoids studied to date include delta-9-tetrahydrocannabinol (THC), cannabinol (CBN), cannabigerol (CBG), and tetrahydrocannabivarin (THCV). The active ingredients in cannabis include flavonoids, terpenes, delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD) and they are able to act within the endocannabinoid system and decrease nociception and also the frequency of the symptoms. The purpose of the article is to document the validity of how medical cannabis can be utilized as an alternative therapy for chronic headache management and enlighten about false beliefs regarding its use. CONTENTS: Sixty-four relevant articles were selected after a thorough screening process using PubMed and Google Scholar databases. The following keywords were used: "Cannabis", "Medical Marijuana", "Headache", "Migraine", "Cannabis and Migraine", "Cannabis and Headache". This literature study demonstrates that medical cannabis use decreases migraine duration and frequency and headaches of unknown origin. CONCLUSION: Patients suffering from migraines and related conditions may benefit from medical cannabis therapy due to its convenience and efficacy.

RESUMO JUSTIFICATIVA E OBJETIVOS: O uso da cannabis medicinal é conhecido desde a antiguidade. O sistema endocanabinoide está distribuído no sistema nervoso central e periférico e atua como importante regulador em processos fisiológicos como função imune, plasticidade sináptica, regulação da dor e das emoções/estresse, entre outros. Devido à sua ampla distribuição e, de acordo com pesquisas, a cannabis pode ser indicada no manejo de sintomas em diferentes condições, como dor crônica, cefaleias, epilepsia, ansiedade e outras doenças psiquiátricas. Os canabinoides primários estudados são o 9-tetrahydrocannabinol (THC), cannabinol (CBN), canabigeral (CBG), e a tetrahidrocannabivarina (THCV). Os ingredientes ativos da cannabis incluem flavonoides, terpenos, delta-9- tetrahydrocannabinol (THC), canabidiol (CBD), e eles são capazes de agir dentro do sistema endocanabinoide e diminuir a nocicepção e a frequência dos sintomas. O objetivo deste estudo foi documentar a validade de como a cannabis medicinal pode ser utilizada como terapia alternativa para o manejo da cefaleia crônica, além de esclarecer sobre falsas crenças ligadas a seu uso. CONTEÚDO: Sessenta e quatro artigos foram selecionados por meio de pesquisa nas bases de dados Pubmed e Google Scholar. As seguintes palavras-chave foram usadas: "Cannabis", "Maconha Medicinal", "Cefaleia", "Enxaqueca", "Cannabis e Enxaqueca", "Cannabis e Cefaleia". A literatura mostra que o uso da cannabis medicinal reduz a duração e a frequência da enxaqueca e das cefaleias de origens não conhecidas. CONCLUSÃO: Pacientes sofrendo com enxaqueca e condições relacionadas podem se beneficiar da terapia com cannabis devido à sua conveniência e eficácia.

Current legislation on medical cannabis in the European Union: historical background, movements, trends, and counter-trends lessons for Brazil / Legislação atual sobre cannabis medicinal na União Europeia: históricos, movimentos, tendências e contratendências. Lições para o Brasil

ABSTRACT BACKGROUND AND OBJECTIVES: The growing interest in the medical use of cannabis and phytocannabinoids has led European Union (EU) countries to regulate the production and access to cannabis products for their citizens. This regulation is based on international conventions, the European Medicines Agency (EMA) guidelines and legal loopholes that grant autonomy to EU member countries to authorize the production and marketing of cannabis-based drugs and foods. This summary aims to present the current status of medical cannabis legislation in the EU, highlighting the authorization of drugs, regulatory processes and the autonomy of member states in the production of magistral formulas. CONTENTS: Most EU countries allow, in some form, the legal use of cannabis and its derivatives as a drug. Since 2019, three drugs containing nabiximols, dronabinol or nabilone have been authorized on the markets of EU member states. In addition to the EMA centralized procedure for marketing authorization, cannabinoid-based products can also be authorized through regional or national processes in EU countries. This autonomy extends to the production of magistral formulas in compounding pharmacies, allowing pharmacists to prepare formulas containing cannabis for use according to a specific medical prescription and, in some situations, at scale. CONCLUSION: While it is not possible to conclude which is the ideal approach to the regulation of medical cannabis that all countries should adopt, the experience of the EU provides valuable lessons. The autonomy granted to the member states allows the expansion of the medical use of cannabis through the authorization of drugs and the production of magistral formulas. These experiences can be used as a basis for reformulations in Brazilian regulations, aiming to expand access and medical use of cannabis in the country.

RESUMO JUSTIFICATIVA E OBJETIVOS: O crescente interesse no uso medicinal da cannabis e fitocanabinoides tem levado os países da União Europeia (UE) a regulamentarem a produção e acesso a produtos canábicos para seus cidadãos. Esta regulamentação se baseia em convenções internacionais, orientações da Agência Europeia de Medicamentos (EMA) e brechas legais que concedem autonomia aos países-membros da UE para autorizar a produção e comercialização de fármacos e alimentos à base de cannabis. Este estudo teve o objetivo de apresentar a situação atual da legislação sobre cannabis medicinal na UE, destacando a autorização de fármacos, os processos de regulamentação e a autonomia dos estados-membros na produção de fórmulas magistrais. CONTEÚDO: A maioria dos países da UE permite, de alguma forma, o uso legal da cannabis e seus derivados como fármaco. Desde 2019, três fármacos contendo nabiximols, dronabinol ou nabilona foram autorizados nos mercados dos estados-membros da UE. Além do procedimento centralizado da EMA para a autorização de comercialização, os produtos à base de canabinoides também podem ser autorizados por meio de processos regionais ou nacionais dos países da UE. Essa autonomia se estende à produção de fórmulas magistrais em farmácias de manipulação, permitindo que os farmacêuticos preparem fórmulas contendo cannabis para uso de acordo com prescrição médica específica e, em algumas situações, em escala. CONCLUSÃO: Embora não seja possível concluir qual é a abordagem ideal para a regulamentação da cannabis medicinal que deve ser adotada por todos os países, a experiência da UE fornece lições valiosas. A autonomia concedida aos estados-membros permite a ampliação do uso medicinal da cannabis por meio da autorização de fármacos e da produção de fórmulas magistrais. Essas experiências podem ser utilizadas como base para reformulações na regulamentação brasileira, visando ampliar o acesso e uso medicinal da cannabis no país.

Efficacy and analgesic potency of cannabinoids considering current available data / A eficácia e o poder analgésico dos canabinoides à luz dos dados atuais disponíveis

ABSTRACT BACKGROUND AND OBJECTIVES: Several studies have shown the growing interest and consumption of cannabinoids and medical cannabis (MC), with management of chronic pain being one of its main therapeutic recommendations. The objective of this study was to review and analyze the results of the most recent preclinical and clinical research on the application of MC and cannabinoids to understand their analgesic efficacy. CONTENTS: A literature review was performed in Pubmed. Preclinical research has shown the role of the endocannabinoid system in pain pathways through the identification of its action sites and pain modulation mechanisms. Numerous clinical studies have endeavored to demonstrate the efficacy of CM and cannabinoids in the management of various pain syndromes. Some international guidelines have already incorporated the use of MC and cannabinoids, but as third or fourth-line treatment and, in most cases, with weak recommendation. CONCLUSION: Despite the growing production of scientific knowledge, the data currently available still lack high-quality evidence to define the efficacy and analgesic potency of cannabinoids. Larger preclinical and clinical research are needed to understand the status of cannabinoids in pain management, as well as to generate high-quality evidence to include or not the use of MC and cannabinoids in guidelines for the management of the various pain syndromes.

RESUMO JUSTIFICATIVA E OBJETIVOS: Diversos trabalhos têm constatado o crescente interesse e o consumo de canabinoides e cannabis medicinal (CM), sendo o auxílio no manejo da dor crônica uma de suas principais indicações terapêuticas na atualidade. O objetivo deste estudo foi revisar e analisar os resultados das mais recentes pesquisas pré-clínicas e clínicas da aplicação da CM e dos canabinoides para compreensão de sua eficácia analgésica. CONTEÚDO: Foi realizada uma revisão de literatura no sistema de busca Pubmed. Pesquisas pré-clínicas têm evidenciado o papel do sistema endocanabinoides nas vias da dor, através da identificação de seus locais de atuação e mecanismos de modulação da dor. Inúmeros estudos clínicos têm mostrado eficácia da CM e dos canabinoides para manejo de diversas síndromes dolorosas. Algumas diretrizes internacionais já incorporaram o uso de CM e canabinoides, mas como tratamento de terceira ou quarta linha e, na maioria dos casos, com poucas recomendações. CONCLUSÃO: Apesar da crescente produção de conhecimento científico, os dados atualmente disponíveis ainda carecem de evidências de alta qualidade para definição da eficácia e poder analgésico dos canabinoides. São necessários maiores estudos pré-clínicos e clínicos para que se possa compreender melhor o status dos canabinoides no manejo da dor, assim como gerar evidências de alta qualidade para incluir ou não o uso da CM e dos canabinoides nos guidelines de manejo das diversas síndromes dolorosas.

Adverse effects of cannabinoid use: what is the safety paradigm? / Efeitos adversos do uso dos canabinoides: qual o paradigma de segurança?

ABSTRACT BACKGROUND AND OBJECTIVES: Interest in the use of marijuana (Cannabis sativa) for medicinal purposes has increased exponentially in recent decades, and the plant and its derivatives are becoming more frequently found in prescriptions for patients with chronic pain. All prescription drugs and illicit substances have adverse effects, even those from plants, fruits, and flowers, as has been well established with the use of tobacco, alcohol, and opium. Marijuana is no exception. The purpose of this study was to review and synthesize the evidence related to the adverse effects promoted by plant-derived cannabinoids, and the implications for the safety of using these substances in pain patients. CONTENTS: A narrative review was conducted based on articles published in scientific journals indexed in Pubmed and Scielo between the years 2000 and 2022. CONCLUSION: The evidence is still contradictory and weak on many aspects of adverse effects and clearly there is a need for further research and advances towards a more detailed elucidation of these effects for both non-medical and medical cannabis use. Screening and monitoring of such use, identifying situations of vulnerability to mental illness and dependence, with careful surveillance for adverse effects, is critical.

RESUMO JUSTIFICATIVA E OBJETIVOS: O interesse na utilização da maconha (Cannabis sativa) com fins medicinais aumentou de forma exponencial nas últimas décadas e a planta e seus derivados vêm se tornando mais frequentemente encontrados nas prescrições médicas de pacientes com dor crônica. Todos os fármacos prescritos e substâncias ilícitas têm efeitos adversos, mesmo aquelas provenientes de plantas, frutas e flores, como já ficou bem estabelecido com o uso do tabaco, álcool e ópio. A maconha não é exceção. O objetivo deste estudo foi revisar e sintetizar as evidências relacionadas aos efeitos adversos promovidos pelos canabinoides derivados da planta, e às implicações sobre a segurança do uso destas substâncias em pacientes com dor. CONTEÚDO: Foi realizada uma revisão narrativa baseada em artigos publicados em revistas científicas indexadas no Pubmed e Scielo, entre os anos de 2000 e 2022. CONCLUSÃO: As evidências ainda são contraditórias e frágeis em relação a muitos aspectos dos efeitos adversos e claramente há a necessidade de mais pesquisas e avanços para uma elucidação mais detalhada destes efeitos tanto para o uso não medicinal quanto médico de cannabis. É fundamental uma triagem e monitoramento desse uso, identificando situações de vulnerabilidade a doenças mentais e dependência, com cuidadosa vigilância de efeitos adversos.

Percepción de riesgo asociada al consumo de alcohol, tabaco y marihuana en estudiantes universitarios: diferencias en función del consumo y del sexo / Perceived risk associated with the consumption of alcohol, tobacco and marijuana: differences according to use and gender

Resumen El consumo de alcohol, tabaco y marihuana presenta una alta prevalencia entre adultos emergentes universitarios. Una variable que incide en el consumo de estas tres sustancias psicoactivas es la percepción de riesgo asociada a dicha conducta. Este estudio examinó -en adultos emergentes universitarios argentinos- la relación bi o multivariada, entre el riesgo percibido de consumir alcohol, tabaco y marihuana, y el consumo propiamente dicho de estas sustancias. Se analizaron también variaciones en la percepción de riesgo en función del sexo y del tipo de consumo (con y sin consumo episódico excesivo de alcohol [CEEA], con y sin consumo de tabaco o marihuana). La muestra final, no probabilística y de carácter accidental, estuvo compuesta por 279 estudiantes universitarios (75.6% mujeres; M edad = 23.02; DE = 3.36) que completaron un cuestionario online. Se encontraron diferencias significativas en la percepción de riesgo (global y para indicadores individuales) en función del sexo y del tipo de consumo. A su vez, el sexo (i.e., ser hombre) y la mayor frecuencia de CEEA, de consumo de tabaco y marihuana se asociaron a la percepción de un menor riesgo atribuido al consumo de cada sustancia. Los hallazgos sugieren que las conductas de consumo frecuente e intensivo podrían ser el foco de intervenciones para corregir posibles sesgos en la interpretación o valoración del riesgo percibido.

Abstract Alcohol, tobacco, and marijuana consumption is highly prevalent among emerging adult college students. One of the variables influencing the consumption of these three psychoactive substances is the perception of risk associated with such behavior. This work examined bivariate and multivariate relationships between risk perception of alcohol, tobacco and marijuana use, and the use of those substances, in Argentinian emerging adults that attend college. Additionally, we analyzed differences in risk perception in regards of gender. A sample of 279 college students (75.6% women; M age = 23.02; SD = 3.36) completed an online survey. We used a non-probabilistic and accidental sampling. We found significant differences in risk perception as a function of gender and type of consumption (i.e., with/without heavy episodic drinking [HED], with or without tobacco/marijuana use). Being men and exhibiting a higher frequency of HED, tobacco or marijuana consumption were significantly associated to the perception of a lower risk attributed to each substance. These findings suggests that frequent and intensive substance use behaviors could be the focus for interventions to correct risk perceptions.

Prevalencia y factores asociados al consumo de marihuana en adolescentes escolarizados de Colombia, en el 2016 / Prevalence and factors associated with marijuana use in school adolescents in Colombia, in 2016

Resumen Introducción: La marihuana es concebida como una droga de bajo riesgo, considerada ilegal en Colombia, si bien es la más consumida por los adolescentes. Objetivo: Describir la prevalencia y examinar los factores asociados al consumo de marihuana durante los últimos 30 días por adolescentes escolarizados de Colombia. Método: Estudio transversal analítico. Muestra constituida por 80.018 adolescentes escolarizados entre 12 y 18 años. Se considera "adolescente consumidor de marihuana", a aquél que declaró haberla consumido durante los últimos treinta días. Se tuvieron en cuenta variables de interés, el sexo, la edad, el tipo de colegio, los episodios de ideación suicida y autolesión deliberada, la existencia de problemas de rendimiento académico y disciplinarios. Se realizó una descripción de la prevalencia de marihuana por cada una de las variables de interés. Se estimaron asociaciones por medio de modelos lineales generalizados, todos los análisis fueron ajustados por el factor de expansión. Resultados: La prevalencia de consumo de marihuana en los últimos 30 días fue del 4,3 % (IC 95 % 4,1 %- 4,6 %). Las mayores prevalencias de consumo se registraron en adolescentes que habían reportado 3 o más veces de ideación suicida en los últimos 12 meses, y en aquellos que acusaron 3 o más veces de autolesión deliberada en los últimos 12 meses (10,4 % y 10,0 %, respectivamente). Se encontró una asociación con todas las variables estudiadas. Conclusiones: Se evidenció una fuerte asociación entre el consumo de marihuana y presencia de episodios de autolesiones deliberadas y episodios de ideación suicida en adolescentes escolarizados.

Summary Introduction: Marijuana is conceived as a low-risk drug, considered illegal in Colombia, and the most consumed by adolescents. Objective: To describe the prevalence and examine the factors associated with marijuana use during the last 30 days by adolescents in school in Colombia. Method: Cross-sectional analytical study. Sample is 80,018 adolescents in school between 12 and 18 years of age. An "adolescent user of marijuana" is one who declared having used it during the last thirty days. Variables of interest were considered: sex, age, type of school, episodes of suicidal ideation and deliberate self-harm, the existence of academic and disciplinary performance problems. A description of the prevalence of marijuana was made for each of the variables of interest. Associations were estimated using generalized linear models, all analyzes were adjusted for the expansion factor. Results: The prevalence of marijuana use in the last 30 days was 4.3% (95% CI 4.1%-4.6%). The highest prevalence of consumption was recorded in adolescents who had reported 3 or more times of suicidal ideation in the last 12 months, and in those who accused 3 or more times of deliberate self-harm in the last 12 months (10.4% and 10. 0%, respectively). An association was found with all the variables studied. Conclusions: A strong association was found between marijuana use and the presence of episodes of deliberate self-harm and episodes of suicidal ideation in school adolescents.

Buerger's disease with cerebral involvement in a middle-aged woman with diabetes mellitus. a case report

Introduction: Buerger's disease (BD) generally affects men, young people, and smokers, but it can also affect women. Its incidence is rare in Latin America. Case report: A 40-year-old Colombian woman, active smoker and user of psychoactive substances, attended the emergency department of a tertiary care center due to symptoms of 3 days consisting of retraction of the corner of the mouth, drooling, and involuntary tongue movements. The patient, who had a history of uncontrolled diabetes and recent acute ischemia of the right upper limb due to acute thrombosis, required surgical management and subsequent use of oral anticoagulation. She later developed necrotic changes in the distal phalanges of the right hand that required ablative therapy. Since age, sex and limb involvement were not typical for BD, collagenosis, vasculitis or thrombophilia were ruled out, but after excluding these disorders, BD with atypical features was considered. The patient was discharged with oral anticoagulation, aspirin, combined analgesia, physiotherapy, and recommendation for smoking cessation. Conclusions: Age, sex, smoking and comorbidities such as diabetes are risk factors for BD. Imaging and histopathology are the gold standard for the definitive diagnosis of this entity. Multidisciplinary management, lifestyle changes, smoking cessation, pain control, good wound healing and social support are key aspects for better clinical outcomes in patients with BD.

Introducción. La enfermedad de Buerger (EB) afecta generalmente a hombres, jóvenes y fumadores, y aunque también puede afectar a mujeres, su incidencia es rara en Latinoamérica. Presentación del caso. Mujer colombiana de 40 años, fumadora activa y consumidora de sustancias psicoactivas, quien acudió al servicio de urgencias de una institución de tercer nivel por síntomas de 3 días de evolución consistentes en retracción de la comisura bucal, babeo y movimientos involuntarios de la lengua. La paciente, que tenía antecedente de diabetes no controlada y reciente isquemia aguda de miembro superior derecho por trombosis aguda, requirió manejo intervencionista y subsecuente uso de anticoagulación oral. Posteriormente, desarrolló cambios necróticos en falanges distales de mano derecha y requirió terapia ablativa. Dado que la edad, el género y la afectación de las extremidades no eran típicos para EB, se procedió a descartar colagenosis, vasculitis o trombofilia, pero tras excluir estas patologías se consideró EB con características atípicas. La paciente fue dada de alta con anticoagulación oral, aspirina, analgesia combinada, fisioterapia y recomendación de suspender el consumo de tabaco. Conclusiones. La edad, el género, el tabaquismo y las comorbilidades como diabetes son factores de riesgo para EB. La imagenología e histopatología son estándar de oro en el diagnóstico definitivo de esta entidad. El manejo multidisciplinario, los cambios en el estilo de vida, la cesación del tabaquismo, el control del dolor, la buena cicatrización de heridas y el apoyo social son aspectos importantes para obtener mejores resultados clínicos en pacientes con EB.

Prevalencia y factores asociados al consumo de marihuana en universitarios de Colombia en el año 2016

Introducción: El consumo de marihuana toma un singular interés en el contexto de la universidad y en los universitarios, pues su uso podría ser parte de las relaciones sociales con sus pares. Objetivo: Describir la prevalencia y examinar los factores asociados al consumo de marihuana durante los últimos treinta días en estudiantes universitarios de Colombia durante 2016. Método: Estudio transversal analítico. Se realizó un análisis con 9555 universitarios colombianos. Fue considerado como consumidor de marihuana el universitario que manifestó haberla consumido durante los últimos treinta días. Se tomaron como variables de interés el sexo, la edad, la percepción de la situación económica, los problemas académicos y disciplinarios en la secundaria y las características de control parental. Para el análisis se reportó la prevalencia de la marihuana por cada una de las características estudiadas. Las asociaciones fueron estimadas a través de modelos lineales generalizados, tales análisis se ajustaron por el factor de expansión. Resultados: Se halló que el 9,7 % (IC 95 % 9,1 %- 10,4 %) había consumido marihuana en los últimos treinta días; los hombres (OR 2,23 IC95 % 1,92 - 2,59), aquellos que acusaron no tener control parental sobre los amigos (OR 2,32 IC95 % 1,58- 3,41) y que confesaron haber tenido problemas disciplinarios en la secundaria (OR 3,35 IC95 % 2,67-4,19), mostraron asociación con el consumo de marihuana. Conclusiones: La prevalencia de consumo de marihuana en estudiantes universitarios es elevada con respecto a otros países de la región. Destacan características como la presencia de problemas académicos o disciplinarios en la secundaria, así como un pobre control parental; ellas mostraron que tenían mayor relación con el consumo de marihuana entre los universitarios indagados.

Introduction: The consumption of marijuana takes on a singular interest in the context of the university and university students, because its use could be a part of relationships with their peers. Objective: To describe the prevalence and examine the factors associated with marijuana use during the last thirty days, in university students in Colombia, during the year 2016. Method: Cross-sectional analytical study. An analysis was carried out with 9555 Colombian university students. The university student who stated that he had used it during the last thirty (30) days was considered a marijuana user. The studied variables were sex, age, perception of the economic situation, academic and disciplinary problems in high school, and the characteristics of parental control. For analysis, the prevalence of marijuana was reported for each of the characteristics studied. The associations were estimated through generalized linear models; all analyzes were adjusted by the expansion factor. Results: It was found that 9.7% (95% CI 9.1%-10.4%) had used marijuana in the last thirty days; men (OR 2.23 CI95% 1.92 - 2.59), those who reported not having parental control over friends (OR 2.32 CI95% 1.58-3.41) and who confessed to having had disciplinary problems in high school (OR 3.35 CI95% 2.67-4.19) were associated with marijuana use. Conclusions: The prevalence of marijuana use in university students is high, compared to other countries in the region. They highlight characteristics such as the presence of academic or disciplinary problems in high school, as well as poor parental control; they showed that they had a greater relationship with the use of marijuana among the university students surveyed.

Factores que diferencian el consumo frecuente y esporádico de marihuana en estudiantes universitarios / Factors differentiating frequent and sporadic marijuana use in college students

Resumen Aunque el consumo de marihuana es altamente prevalente entre universitarios de Argentina, poco se sabe respecto a los factores que permiten distinguir a los consumidores frecuentes de marihuana de quienes consumen esporádicamente. Por esta razón, en el presente trabajo se indagó sobre las posibles variaciones en los contextos de consumo, motivos de consumo, normas percibidas y estrategias conductuales de protección entre universitarios con consumo frecuente o esporádico de marihuana, y se analizó la utilidad de este conjunto de variables para distinguir entre estos los tipos de consumidores mencionados. Para ello, se contó con una muestra de 1083 estudiantes universitarios argentinos que completó una encuesta en línea sobre el consumo de sustancias. En particular, este trabajo se realizó con la submuestra que reportó consumir marihuana en los últimos 30 días (n = 158; 51.3 % mujeres). Dicha encuesta interrogaba sobre el consumo de marihuana y las consecuencias negativas asociadas, así como por motivos de consumo, normas sociales percibidas y estrategias conductuales de protección. Como resultado, los consumidores frecuentes presentaron mayor cantidad de consecuencias negativas (M = 4.92) que los consumidores esporádicos (M = 1.82; p < .05), y se halló un perfil distintivo en un conjunto de variables. A nivel multivariado, los motivos de animación (OR = 1.230; p < .05), las estrategias conductuales de protección (OR = .941; p < .05), el consumo en solitario (OR = 2.024; p < .05) y el consumo en fiestas universitarias (OR = 2.669; p < .05) discriminaron significativamente entre ambas clases de consumidores. En general, los hallazgos revelaron subpoblaciones heterogéneas de consumidores de marihuana que difieren no solo en el consumo y sus consecuencias, sino también en los contextos de consumo y en un conjunto de variables relevantes. Estas subpoblaciones distintivas requieren de intervenciones diferentes y específicas.

Abstract Although marijuana use is highly prevalent among university students in Argentina, little is known about the factors that distinguish frequent marijuana users from sporadic users. For this reason, the present study investigated the possible variations in the contexts of consumption, motives for consumption, perceived norms, and protective behavioral strategies among university students with frequent or sporadic marijuana use, and analyzed the usefulness of this set of variables to distinguish between these two types of users. For this purpose, a sample of 1083 Argentine university students completed an online survey on substance use. In particular, this work was conducted with the subsample that reported using marijuana in the last 30 days (n = 158; 51.3 % female). The survey asked about marijuana use and associated negative consequences, as well as motives for use, perceived social norms, and protective behavioral strategies. As a result, frequent users had a higher number of negative consequences (M = 4.92) than sporadic users (M = 1.82; p < .05), and a distinctive profile was found on a set of variables. At the multivariate level, cheerleading motives (OR = 1.230; p < .05), protective behavioral strategies (OR = .941; p < .05), solo use (OR = 2.024; p < .05), and college party use (OR = 2.669; p < .05) discriminated significantly between the two classes of users. Overall, the findings revealed heterogeneous subpopulations of marijuana users that differ not only in use and its consequences, but also in contexts of use and in a set of relevant variables. These distinct subpopulations require different and specific interventions.

Implications of Cannabis and Cannabinoid Use in COVID-19: Scoping Review / Implicaciones del uso de Cannabis y cannabinoides en el COVID-19: revisión de alcance / Implicações do uso da Cannabis e canabinoides na COVID-19: revisão de escopo

ABSTRACT Objective: to identify and synthesize studies on the effects of cannabis use and its relation with SARS-CoV-2, as well as the therapeutic possibilities of using cannabinoids in the prevention and treatment of COVID-19. Methods: scoping review, in the BVS, PubMed, SCIELO, CINAHL, SCOPUS, Web of Science, MedNar, CAPES and ProQuest databases, with no language restriction and year limitation. Narrative synthesis was performed. Results: cannabis use causes changes in the respiratory and vascular system, it reduces the production of cytokines, which affects the users' immune system, increasing the susceptibility to infection and progression of COVID-19. However, studies have suggested the use of cannabinoids in the prophylaxis and treatment of COVID-19, due to their anti-inflammatory effect. Conclusions: the use of inhaled cannabis increases the progression and severity of the infection. On the other hand, the benefits of cannabinoids seem promising to modulate the immune system, but it needs further studies.

RESUMEN Objetivo: identificar y sintetizar los estudios sobre los efectos del uso de cannabis y su relación con el SARS-CoV-2, así como las posibilidades terapéuticas de los cannabinoides para la prevención y el tratamiento del COVID-19. Métodos: revisión de alcance, sin límite de lenguaje y año, planteada en las bases BVS, PubMed, SCIELO, CINAHL, SCOPUS, Web of Science, MedNar, CAPES y ProQuest y desarrollada como síntesis narrativa. Resultados: el consumo de cannabis provoca alteraciones en los sistemas respiratorio y cardiovascular; reduce la producción de citosinas, lo que afecta el sistema inmunológico de los usuarios, aumentando la susceptibilidad a la infección y a la progresión del COVID-19. Sin embargo, algunos estudios sugieren el uso de cannabinoides en la profilaxis y en el tratamiento del COVID-19, debido a su efecto antiinflamatorio. Conclusiones: el uso de cannabis inhalado aumenta la progresión y la gravedad de la infección. Por otra parte, los beneficios de los cannabinoides parecen prometedores para modular el sistema inmunitario, aunque se necesitan más estudios sobre el tema.

RESUMO Objetivo: identificar e sintetizar os estudos sobre os efeitos do uso da cannabis e sua relação com o SARS-CoV-2, bem como as possibilidades terapêuticas da utilização de canabinoides na prevenção e no tratamento da COVID-19. Métodos: revisão de escopo, sem limitação de linguagem e ano, nas bases BVS, PubMed, SCIELO, CINAHL, SCOPUS, Web of Science, MedNar, CAPES e ProQuest. Foi realizada síntese narrativa. Resultados: o consumo de cannabis provoca alterações no sistema respiratório e vascular; reduz a produção de citocinas, o que afeta o sistema imunológico dos usuários, aumentando a susceptibilidade à infecção e a progressão da COVID-19. No entanto, estudos sugeriram o uso de canabinoides na profilaxia e no tratamento da COVID-19, devido ao seu efeito anti-inflamatório. Conclusões: o uso de cannabis inalada aumenta a progressão e a severidade da infecção. Por outro lado, os benefícios dos canabinoides parecem promissores para modular o sistema imunológico, mas necessita de mais estudos.