Current Evidence of Cannabidiol's Potential as an Anxiolytic Agent

This article will summarize the current knowledge and scientific evidence regarding cannabidiol as a possible pharmacological tool for anxiety disorders. Although the use of this substance in medical practice is gaining momentum, gaps can still be found in the current knowledge regarding its molecular targets, drug-to-drug interactions, efficacy in different populations, adequate dosage, duration of treatment, and correct formulation. Moreover, current evidence is still preliminary, lacking robust, blinded, and placebo-controlled clinical trials in many areas of investigation. After reading this article, readers should have a thorough understanding of the current scientific evidence regarding the use of CBD as an anxiolytic drug. [Psychiatr Ann. 2023;53(6):242–246.]

Facial ageing . . . and other stories

When high quality photographs of the faces of 2700 middle aged and older participants in a longitudinal study were assessed by a panel without knowledge of their chronological age and medical history, people whose perceived age was lower than their chronological age were less likely to have osteoporosis, chronic obstructive pulmonary disease, hearing loss, or cataracts. Energy expenditure and incident type 2 diabetes Data from 90 000 participants in the UK Biobank study who wore an accelerometer for seven days reveal a linear relation between the amount of energy expended during physical activity and the subsequent incidence of type 2 diabetes—even after adjusting for body mass index. A study using data for 1.5 million prescriptions of PPIs in UK general practice found an increased risk of diagnosis of an inflammatory bowel disease in the first two years after treatment started.

HPV+ Oropharyngeal Cancer in Waldenström Macroglobulinemia.

We present a case of squamous cell carcinoma (SCC) in the setting of Waldenström macroglobulinemia (WM). A 68-year-old male and daily marijuana smoker with recently diagnosed WM presented via telemedicine in 2020 for a progressively worsening sore throat and unintentional weight loss. Immunotherapy for WM was delayed due to the COVID-19 pandemic. In the clinic, examination revealed an indurated, tender midline mass at the base of the tongue, not limiting tongue mobility. The left level-II and right level-III lymph nodes were enlarged. The oropharyngeal lesion was biopsied, and pathology was consistent with human papillomavirus-positive (HPV+) SCC. Four cycles of concurrent chemotherapy and radiation for SCC were administered without delay, with an initial response. However, on surveillance, metastases to the brain and lungs were detected, and the patient was placed on palliative treatment as he did not meet eligibility for a clinical trial due to his WM. Concurrent WM and HPV+ SCC may have a worse prognosis, due to disease progression and reduced therapeutic options.

Retrospective Recall of Marijuana Use Patterns Following the COVID-19 Outbreak Vary as a Function of User Type Among Adolescents in Washington State.

Marijuana use in middle and late adolescence is a significant public health concern given that an earlier age of onset is prospectively associated with numerous marijuana misuse outcomes. The outbreak of COVID-19 resulted in stay-at-home orders and social distancing guidelines across the United States yet the impact of these orders on adolescent marijuana use is unknown in the U.S. The aims of this study were to examine adolescents' recall of changes in marijuana use patterns following the COVID-19 outbreak as a function of one's typical levels of use, and to qualitatively assess reasons for perceived change. A screening survey for a larger study was completed by 156 adolescents (ages 15-18, 78% male) after the stay-at-home order was put in place in Washington state in March 2020. The cross-sectional survey included self-reported demographic information, marijuana use, and retrospective recall of changes to marijuana use following the state's stay-at-home order. Initial findings did not reveal any pattern of change that described the entire sample, however adolescents' recall of changes in use significantly varied as a function of typical use such that moderate/heavy users had higher odds of reporting maintained (5.04 times higher) or increased use (3.07 times higher) compared to irregular/light marijuana users. Primary reasons for decreasing use included decreased availability and socialization. Primary reasons for increasing use included more free time and coping with stress and anxiety. The findings suggest that pandemic-related changes in marijuana use are not consistent across adolescents and that moderate and heavy users may be at increased risk of marijuana misuse under pandemic conditions.

COVID-19 Vaccine Uptake and Attitudes Within Two Cohorts of Younger Adult Cannabis Users

It is crucial to understand COVID-19 vaccine uptake and attitudes among young adult cannabis users given the lowest vaccination rates among young adults and negative association between cannabis use and willingness to get vaccinated. 18–21-year-old and 26–33-year-old cohorts of cannabis users, recruited in California, were surveyed about the COVID-19 vaccine uptake/attitudes between March-August 2021. Cannabis use/demographic differences were investigated by vaccination status. Vaccine attitudes data were categorized and presented descriptively. 44.4% of the older and 71.8% of the younger cohorts were vaccinated. Non-Hispanic Black/African American race/ethnicity, lack of health insurance, and medicinal orientation towards cannabis use were negatively associated with vaccine receipt within the older cohort. For both cohorts, top reasons for vaccine hesitancy and rejection were concerns about speed of development, potential side effects, natural immunity, and lack of trust of vaccines. Our results highlight greater vaccine hesitance/rejection and need for targeted interventions among mid-20's-early-30's cannabis users.

Impact of telehealth versus traditional visits on pain management patients utilizing medical cannabis during the COVID-19 pandemic

Alternatives to traditional office visits have become a necessity with the recent COVID-19 outbreak, resulting in an unmatched surge in telehealth adoption. The present study was an investigation of the impact of telehealth versus traditional office visits in medical cannabis clinics treating patients for chronic pain. With 50,000,000 American adults experiencing pain and over 750,000 overdoses attributed to opioid usage, collecting research-driven evidence to increase the availability of safe, effective, and nonopioid treatment options will create positive social change. The Donabedian model was applied to measure the quality of care, focusing on structure (cannabis clinics), process (telehealth vs. traditional office visits), and outcome (visual analog scale [VAS]). The study utilized a quasi-experimental, retrospective analysis of data using multiple linear regression comparing the impact of telemedicine visits versus traditional office visits on treating five pain types in a medical cannabis clinic during a pandemic. The main finding of this study indicated that telemedicine visits were as effective as traditional office visits in treating pain. However, there was not statistically significant data to suggest that cannabis-derived medicines resulted in improved outcomes in the five pain types studied (general, back, arthritic, cancer, and migraine). Across all pain types and subjects there was an overall decrease in pain from initial visit (7.44) to follow-up visit (6.29) a decrease of 15.4% on the VAS. Expanding healthcare service treatment options that are safe, effective, and accessible in caring for chronic pain will prevent disease, improve health outcomes, and improve quality of care all leading to positive social change. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Cannabis: Global Histories ed. by Lucas Richert and James H. Mills (review)

Peter Hynd replicates verbatim the language of excise reports in British India to narrate the colonial state's apparently successful fiscal measures to lower cannabis sales and maximize revenue. Besides misnaming Hemchunder Kerr as Dutt and misidentifying the Garhjat in Orissa as Gujarat sixteen hundred kilometers west, Hynd concludes that the infrastructure of cannabis revenue extraction by an oppressive colonial force is that reasonable but rare occasion where "modern governments stand to learn a thing or two from the example set by the British Raj.” Behind the story of the GW Pharmaceuticals product Sativex, Suzanne Taylor uncovers years of lobbying by middle-class citizen groups like the Multiple Sclerosis Society in the 1990s that pushed for controlled medical research on cannabis and gave it a respectable face. [...]the editors' invitation to a renewed research agenda around this assessment, tediously termed "globalization without globalizers,” is constrained by their neglect of the teeming scholarly assessments and critiques of the category "global” and the framework "globalization.” More importantly, in 2022, even as emerging mass spectrometry research on cannabinoid non-psychoactive acids at the Linus Pauling Institute suggest their potential to successfully bind Covid-19 spike proteins against human epithelial cells, states in the Global South continue to face restrictions from global narcotics control institutions on scientific studies of cannabis.

Pregnant individual's lived experience of cannabis use during the COVID-19 pandemic: a qualitative study.

Introduction: Quantitative studies indicate that the COVID-19 pandemic has contributed to increased rates of prenatal cannabis use. However, little is known about how the pandemic has impacted cannabis use from the perspective of pregnant individuals themselves. Our objective was to characterize COVID-19-related changes in cannabis use among pregnant individuals who used cannabis during the pandemic. Methods: We conducted 18 focus groups (from 11/17/2021 to 12/17/2021) with Black and White pregnant individuals aged 18+ who self-reported prenatal cannabis use during universal screening at entrance to prenatal care (at ~8 weeks gestation) in Kaiser Permanente Northern California. Virtual focus groups were transcribed and analyzed using thematic analysis. Results: The sample of 53 pregnant individuals (23 Black, 30 White) was 30.3 years old (SD = 5.2) on average, and most (70%) self-reported daily versus weekly or monthly prenatal cannabis use. Major themes regarding the impact of the pandemic on cannabis use included increases in use (resulting from depression, anxiety, stress, boredom), and changes in social use (less sharing of smoked cannabis products), modes of use (from smoking to other modes due to respiratory concerns) and source (from storefront retailers to delivery). Conclusion: Coping with mental health symptoms and stress were identified drivers of perceived pandemic-related increases in prenatal cannabis use in 2021. Pregnant individuals adapted their use in ways consistent with public health recommendations to decrease social contact and reduce or quit smoking to mitigate COVID-19 transmission and harms. Proactive, mental health outreach for pregnant individuals during future pandemic waves may reduce prenatal cannabis use.

The association between preconception cannabis use and depression and anxiety during pregnancy.

OBJECTIVE: Cannabis use among individuals of reproductive age has increased with cannabis legalization and heightened stress during the COVID-19 pandemic. Our study provides data on preconception cannabis use and cannabis use disorder (CUD) during the pandemic and models the association between preconception cannabis use and depression and anxiety during pregnancy. METHODS: Data on substance use and depression and anxiety symptoms were collected from questionnaires and the Structured Clinical Interview for DSM-5 (SCID-5) from pregnant individuals in Oregon in 2019-2022. Linear regression was used to model the association between the frequency of preconception cannabis use and scores on the Center for Epidemiological Studies of Depression-Revised (CESD-R) and Beck Anxiety Inventory (BAI). RESULTS: The prevalence of preconception cannabis use was 27.8% among 227 study participants. CUD was diagnosed in 19% of cannabis users, or 5.3% of the overall sample. Daily cannabis use, compared to rare/never use, was associated with increases in CESD-R (ß = 6.22, p 0.029) and BAI (ß = 4.71, p 0.045) scores. CONCLUSIONS: Cannabis use and CUD are common among individuals of reproductive age. Given the association between preconception cannabis use and depression and anxiety during pregnancy, more attention is needed on screening and counseling of cannabis use among people of reproductive age.

Trinidad and Tobago and money laundering control: a country committed to strengthening the link

PurposeIn 2008, the author wrote on the Concept of "Money Laundering Control: The Missing Link in Trinidad and Tobago. Now, approximately two years after that seminal assessment, the author has re-assessed the domestic anti-money laundering (AML) framework, with particular reference to the controls in place to address money laundering (ML) and the confiscation of the proceeds of crime. This paper aims to assess the efficiency and effectiveness of the newly implemented regime and considers whether it meets international standards.Design/methodology/approachThis analysis embraces a pluralist approach. Within this assessment, a case study method is used with contextual qualitative analysis. Empirical data is analyzed and causal connections are linked to the analysis.FindingsThis research highlights catalytic change and creativity in addressing deficiencies within the AML architecture in Trinidad and Tobago. Upon analysis, it is pellucid that a radically altered criminal justice landscape has emerged and a more aggressive and targeted approach to address ML and the confiscation of the proceeds of crime is apparent. The result is a shift in paradigm with tangible outcomes to suggest that the strategies have borne fruit and that the twin island Republic is indeed committed to strengthening the link.Research limitations/implicationsFindings are limited to Trinidad and Tobago and to the period ended April 2020.Originality/valueAs a country with a medium to high ML risk, the possible negative socio-economic effects of ML cannot be underscored. Disruption of ML and the confiscation of the proceeds of crime are, therefore, imperative. This paper considers the progress made in addressing these pertinent issues and assists in assessing the effects of the reformation efforts undertaken by Trinidad and Tobago.

The effects of the 4/20 cannabis holiday and adult-use cannabis legalization on medical cannabis sales and medical cannabis patient registration in Arizona.

BACKGROUND: This study examined whether the 4/20 cannabis holiday was associated with increases in medical cannabis sales from licensed dispensaries in Arizona from 2018-2021, and whether adult-use cannabis legalization (the vote in November 2020 and retail sales in January 2021) was associated with declines in medical cannabis sales and in the number of registered medical patients. METHODS: Data came from the Arizona Medical Marijuana Program monthly reports from January 2018-December 2021. The reports show daily sales from licensed medical cannabis dispensaries (i.e., the number of medical cannabis dispensary transactions and the amount of cannabis sold in pounds), which we averaged by week, and show the number of registered medical cannabis patients each month. Autoregressive integrated moving average models were used to test changes in these outcomes associated with the 4/20 cannabis holiday and with legalization of adult-use cannabis. RESULTS: During the week of the 4/20 cannabis holiday, medical cannabis dispensary transactions abruptly increased by an average of 2,319.4 transactions each day (95% CI: 1636.1, 3002.7), and the amount of medical cannabis sold increased by an average of 120.3 pounds each day (95% CI: 99.3-141.3). During the first week of adult-use cannabis sales in late January 2021, medical cannabis dispensary transactions abruptly decreased by an average of 5,073 transactions each day (95% CI: -5,929.5, -4216.7), and the amount of medical cannabis sold decreased by an average of 119.1 pounds each day (95% CI: -144.2, -94.0). Moreover, medical cannabis sales continued to gradually decline each week after the start of adult-use retail sales, with declines in sales preceding declines in registered patients. By December 2021, slightly over a year after the vote to legalize adult-use cannabis, the actual number of registered medical cannabis patients fell short of the forecasted number, had adult-use not been legalized, by 36.5%. Moreover, the number of medical dispensary transactions and the amount of medical cannabis sold fell short of expectations, had adult-use cannabis not been legalized, by 58% and 53%, respectively. CONCLUSIONS: Findings document the blurred boundary between medical and non-medical cannabis use and are consistent with the possibility that medical cannabis legalization contributes to increases in adult cannabis use and dependence.

Community-Based Prevention of Substance Use in Adolescents: Outcomes Before and During the COVID-19 Pandemic in Santiago, Chile.

A primary community prevention approach in Iceland was associated with strong reductions of substance use in adolescents. Two years into the implementation of this prevention model in Chile, the aim of this study was to assess changes in the prevalence of adolescent alcohol and cannabis use and to discuss the impact of the COVID-19 pandemic on the substance use outcomes. In 2018, six municipalities in Greater Santiago, Chile, implemented the Icelandic prevention model, including structured assessments of prevalence and risk factors of substance use in tenth grade high school students every 2 years. The survey allows municipalities and schools to work on prevention with prevalence data from their own community. The survey was modified from an on-site paper format in 2018 to an on-line digital format in a shortened version in 2020. Comparisons between the cross-sectional surveys in the years 2018 and 2020 were performed with multilevel logistic regressions. Totally, 7538 participants were surveyed in 2018 and 5528 in 2020, nested in 125 schools from the six municipalities. Lifetime alcohol use decreased from 79.8% in 2018 to 70.0% in 2020 (X2 = 139.3, p < 0.01), past-month alcohol use decreased from 45.5 to 33.4% (X2 = 171.2, p < 0.01), and lifetime cannabis use decrease from 27.9 to 18.8% (X2 = 127.4, p < 0.01). Several risk factors improved between 2018 and 2020: staying out of home after 10 p.m. (X2 = 105.6, p < 0.01), alcohol use in friends (X2 = 31.8, p < 0.01), drunkenness in friends (X2 = 251.4, p < 0.01), and cannabis use in friends (X2 = 217.7, p < 0.01). However, other factors deteriorated in 2020: perceived parenting (X2 = 63.8, p < 0.01), depression and anxiety symptoms (X2 = 23.5, p < 0.01), and low parental rejection of alcohol use (X2 = 24.9, p < 0.01). The interaction between alcohol use in friends and year was significant for lifetime alcohol use (ß = 0.29, p < 0.01) and past-month alcohol use (ß = 0.24, p < 0.01), and the interaction between depression and anxiety symptoms and year was significant for lifetime alcohol use (ß = 0.34, p < 0.01), past-month alcohol use (ß = 0.33, p < 0.01), and lifetime cannabis use (ß = 0.26, p = 0.016). The decrease of substance use prevalence in adolescents was attributable at least in part to a reduction of alcohol use in friends. This could be related to social distancing policies, curfews, and homeschooling during the pandemic in Chile that implied less physical interactions between adolescents. The increase of depression and anxiety symptoms may also be related to the COVID-19 pandemic. The factors rather attributable to the prevention intervention did not show substantial changes (i.e., sports activities, parenting, and extracurricular activities).

COVID-19 Vaccine Cardiac Complications: A Case Series on Implications of Marijuana in Adolescents With Myopericarditis.

We report on two critically ill pediatric patients, aged 16 and 18 years, presenting with acute myopericarditis at a tertiary-care center in New Jersey, United States. Both patients had their severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations, tested negative for SARS-CoV-2, and shared only significant history of asthma. Clinical presentations were similar to acute onset chest pain that worsened with deep inspiration. One patient reported a history of vaping and escalating marijuana use several hours preceding presentation. Both patients had elevated troponin on admission and had ST-segment elevation on electrocardiogram (EKG), thus prompting admission to the pediatric intensive care unit (PICU) for cardiac monitoring. Myopericarditis has multiple etiologies and is a newly described rare complication of the SARS-CoV-2 vaccine. It can also occur as a complication of vaping and frequent marijuana drug use. Our paper highlights the importance of a detailed social and drug history in adolescents presenting with chest pain. The clinical characterization is necessary to promote better case definitions and the design of targeted interventions for this vulnerable group.

Changing cannabis policies and social work: Implications for students, families, and schools

State laws governing recreational and medicinal cannabis use are trending toward legalization, which has implications for school social workers and the students, families, and communities they serve. The patchwork of policies and conflicting public opinion sends mixed messages to youth and families who may lack sufficient information regarding risks of adolescent cannabis use. This article will explore topics relevant to legalization of cannabis including medical versus recreational use, racial overtones in marijuana policy, effects on student cognitive development and mental health, child welfare involvement, disparities in school discipline, criminal record expungement, and school-based cannabis prevention programs. The article will conclude with a summary of recommendations for schools. This article is a product of the research conducted by the Health Education and Leadership Scholars planning team at the University of Illinois for a policy-practice conference that was cancelled due to COVID-19. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Missouri's Public Health at a Glance

According to the 2021 Behavioral Risk Factor Surveillance Survey, with an obesity prevalence rate of 37-2% in adults, Missouri continues to outpace the national average of 33-9%. The model described at https://wwwhealthiermo. org/-the Foundational Public Health Services (FPHS)-aims to assure six core public health programmatic areas are available through every public health agency: chronic disease prevention, communicable disease control, environmental public health,;injury prevention, maternal, child and family health, and linkages to medical, behavioral, and community resources. With funding from the Centers for Disease Control and Prevention (CDC), DHSS will lead an effort over the next four to five years to conduct a cost analysis for full implementation of the FPHS model statewide, as well as an accountability measure planning effort with a diverse group of stakeholders inclusive of county and state policymakers. DHSS Chief Medical Officer Heidi Miller, MD, MSMA member and an internal medicine physician with extensive experience with uninsured, Medicaid and underinsured populations, joined DHSS as the department's first Chief Medical Officer in January 2023- Dr. Miller will provide medical guidance and expertise to DHSS programs, serve as the liaison with medical associations and providers, be instrumental in program and protocol development, and continue to build and implement the vision of an integrated public health and healthcare system.

Cannabis use during the COVID-19 pandemic: Results from a longitudinal study of cannabis users

Background: The coronavirus (COVID-19) pandemic has shifted life in the United States. It is reasonable to expect the challenges of cannabis use in the U.S. are amplified given the vast shutdowns and economic insecurity. The purpose of the research is to examine changes in adult cannabis use during COVID-19. Methods: This one-group, longitudinal, cohort study reports results from an online survey and six-month follow-up. Both surveys examined cannabis use and additional questions regarding COVID-19 were added to the follow-up. Quantitative analysis (e.g., ANOVA) was conducted on the questionnaire and thematic analysis was performed on a text question. Results: A majority of the sample (65.7%) reported no significant change in cannabis use as a result of COVID-19. A one-way ANOVA of CUDIT-R scores showed statistical significance (p < .01) between age groups. Contrary to the quantitative analysis, thematic analysis revealed many changes in cannabis use as a response to COVID-19. Conclusions: Self-efficacy can be seen through the empowered behaviors to change cannabis products but those with an increase in CUDIT-R scores may need targeted assessments and education to promote healthier cannabis use. Additionally, this study calls for a larger examination of changes in cannabis use by age and working conditions. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Has COVID-19 Changed Marijuana Use in the United States?

Pandemic-related stress, depression, and anxiety might be important motivations for marijuana use. In this paper, we study the impact of the COVID-19 pandemic on the use of marijuana among people aged 12 and older in the United States. We use data from the National Survey on Drug Use and Health (NSDUH) and different econometric models to investigate this impact on national and state levels. We also consider the impact of the pandemic on the use of other illicit drugs such as heroin and methamphetamine. We find evidence that the COVID-19 pandemic has led to an increase in marijuana use at both state and national levels.

Changes in recreational cannabis use during home confinement in the COVID-19 pandemic

The aim of this article was to analyse the influence of population confinement on the experience of cannabis use and to identify the factors that modulate the pattern of cannabis use in a group of drug users living in the autonomous community of Aragón (Spain). For this purpose, a qualitative study was carried out based on sixteen semi-structured personal interviews with cannabis users according to a non-random snowball sampling. After analysing their discourse, changes were observed both in terms of an increase and a decrease in the experience of consumption, as well as a possible relationship between the changes in the consumption pattern of these users and the restrictions decreed by the government of this country. Thus, it was concluded that the population confinement generated changes in the consumption pattern of drug users, with an increase in consumption occurring in users with an increase in available free time and who had collected cannabis prior to asylum. Meanwhile, the reduction was related to the decrease in opportunities to consume cannabis, lack of knowledge of suppliers and longer working hours, mainly. © 2022 Asociacion Espanola de Estudio en Drogodependencias. All rights reserved.

Increases in cannabis use and negative emotions during covid-19 pandemic among college students with cannabis use disorder

ABSTRACT Using cross-sectional baseline measurements from a longitudinal cohort study, we evaluated the perceived impact of the Coronavirus Disease 2019 (COVID-19) pandemic on cannabis use and emotional well-being among college students meeting cannabis use disorder (CUD) criteria (N = 150). Compared to before the pandemic, participants retrospectively reported an increase in cannabis use during the first phase of the pandemic when stay-at-home orders occurred, which was correlated with a greater number of CUD symptoms and cannabis use-related consequences since the pandemic began. Reporting greater frequency of cannabis use during the pandemic was associated with greater frequency of using amphetamine-type drugs and consumption of cannabis by dabbing since the pandemic began. There were significant differences in cannabis use-related outcomes as a function of negative emotions (e.g., feeling lonely/stressed/anxious/depressed) experienced during the pandemic. The findings elucidate the impact of the pandemic on cannabis use among college students with CUD and can inform prevention/intervention efforts in this population. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

"It doesn't make any sense to even try": the disruptive impact of COVID-19's first wave on people with chronic pain using medical cannabis in New York.

BACKGROUND: The COVID-19 pandemic disrupted health care but it is unknown how it impacted the lives of people using medical cannabis for chronic pain. OBJECTIVE: To understand the experiences of individuals from the Bronx, NY, who had chronic pain and were certified to use medical cannabis during the first wave of the COVID-19 pandemic. METHODS: We conducted 1:1 semi-structured qualitative telephone interviews from March through May 2020 with a convenience sample of 14 individuals enrolled in a longitudinal cohort study. We purposively recruited participants with both frequent and infrequent patterns of cannabis use. Interviews addressed the impact of the COVID-19 pandemic on daily life, symptoms, medical cannabis purchase, and use. We conducted a thematic analysis, with a codebook approach, to identify and describe prominent themes. RESULTS: Participants' median age was 49 years, nine were female, four were Hispanic, four were non-Hispanic White, and four were non-Hispanic Black. We identified three themes: (1) disrupted access to health services, (2) disrupted access to medical cannabis due to the pandemic, and (3) mixed impact of chronic pain on social isolation and mental health. Due to increased barriers to health care in general and to medical cannabis specifically, participants reduced medical cannabis use, stopped use, or substituted medical cannabis with unregulated cannabis. Living with chronic pain both prepared participants for the pandemic and made the pandemic more difficult. CONCLUSION: The COVID-19 pandemic amplified pre-existing challenges and barriers to care, including to medical cannabis, among people with chronic pain. Understanding pandemic-era barriers may inform policies in ongoing and future public health emergencies.