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)

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.

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.

"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.

No Legal Recreational Marijuana in Missouri: We Have Enough Problems with Addiction!

The Missouri recreational marijuana referendum is financed by a despicable conglomerate of entities ranging from George Soros, to the Mexican drug cartels, to mainline businesses such as the alcohol industry which considers 95% THC (the high/ euphoria producing chemical of cannabis products) the next 'logical' adult beverage to accompany beer, wine, and liquor. 1,2,3 Collectively, I refer to this unsavory and unwholesome alliance as "Big Weed." After a decade of effort, tens of millions of dollars of advertising, promotion, and half-hearted, ineffectual opposition by the healthcare professions, no opposition by the Missouri Hospital Association and support by the Kansas City Star and St. Louis Post-Dispatch newspapers, sham medical pot was passed into constitutional law in 2018.1 That ship has sailed and, for better or for worse (my bet the latter), we will have to live with the consequences. Anecdotal reports from Missouri suburban hospitals and emergency rooms published in Missouri Medicine already indicate easy access medical marijuana is resulting in increased cannabis related ER visits and hospitalizations.5 Missouri Medicine has published more scientific and perspective articles on the unscientific nature of the studies of medical marijuana and the deleterious effects of moving from legal sham medical marijuana to legal recreational marijuana than any other state medical journal.

Medicinal Marijuana, Stress, Anxiety, and Depression: Primum non nocere

Higher levels of stress are associated with an increased risk of substance use disorders (SUDs) and other mental health conditions like depression. Short and long term changes in mood, depression, and suicidality can begin during adolescence and exacerbate by teen marijuana use according to a recent study.4 This longitudinal cohort study of over 30 years found that cannabis use during adolescence is not a medicine, but is associated with both depression and suicidality in adult life. [...]they are vulnerable to adverse cannabis outcomes, including continued opioid use and the development of additional substance use disorders.5 Public "medicinal" opinions on hydroxychloroquine and actual FDA- quality studies of safety and efficacy in SARS COVID 196 or voting marijuana a medicine is quite different than proving in a prospective, random assignment, placebo-controlled double-blind studies. Learning to inhale drug vapors may be the gateway event worth additional study.13 Most of the public health attention has been focused on vaping THC and death or severe toxic effects on lung and pulmonary function.

An Overview of Legal Issues and Regulations Affecting CBD-Based Franchise Systems

[...]in Oregon and Florida, consumers can purchase CBD in their coffee.2 Following declassification of hemp as a Schedule I drug, a recent Gallup poll found that one in seven Americans use hemp-derived CBD products (although CBD derived from marijuana is still illegal under federal law and will not be addressed here). "3 CBD products are available at a variety of mainstream retailers including CVS, Walgreens, GNC, Kroger, Ulta Beauty, Abercrombie & Fitch, and American Eagle Outfitters.4 Industry research firms estimate that by 2024, CBD sales will exceed twenty billion dollars in the United States.5 Another study projects a twenty-five percent compound annual growth rate in the CBD edible market between 2020 and 2027.6 Many consumers rely on CBD to treat anxiety, pain, and insomnia.7 Other common usages include over-the-counter treatment for depression, muscle contractions, skin conditions, and digestive concerns.8 A third of pet owners have purchased CBD-infused treats, food, or other items for their cats and dogs, and purchases of CBD pet products are rapidly increasing as pet owners begin to return to the office following the nationwide lifting of COVID-19 restrictions.9 Considering this clear market demand and the likelihood that states will continue to ease restrictions on sale of CBD and other hemp-derived related products, franchisors may find entering the CBD market an irresistible opportunity-either through creating a new franchised system that primarily sells CBD products or by adding them as a new or additional product line in an existing system. [...]Section IV addresses many of the unique challenges associated with franchises selling CBD and proposes best practices for both franchisors and franchisees. "25 Guy believed a cannabis product with low levels of THC but high levels of CBD would be appealing for these users.26 By the late 1990s, several Northern California cannabis growers were cultivating high CBD/low THC strains and distributing both the seeds and their research about its effects at marijuana shops and fairs on the West Coast.27 In 2010, a group of medical marijuana researchers and cannabis growers founded Project CBD, a nonprofit corporation with the goal of collecting and promoting medical research regarding the benefits of CBD.28 In August 2013, CNN aired Dr. Sanjay Gupta's documentary Weed, which contained a segment describing the successful use of a CBD oil developed by the Stanley Brothers, called "Charlotte's Web," to reduce seizures in fiveyear old Charlotte Figi.29 After the segment, the wait list for the oil grew to 15,000 people, families moved to Colorado with the hope of using the oil, and the Food and Drug Administration fast-tracked trials of GW Pharmaceutical's CBD-based medication, Epidiolex.30 Popular culture acceptance and demand for CBD has continued to increase in the last decade.

Cultural, Social and Psychological Factors of the Conservative Consumer towards Legal Cannabis Use—A Review since 2013

Cannabis consumption has become the center of much debate globally. The positive public perception of the medicinal benefits of cannabis and the rise of recreational usage of cannabis necessitate dramatic changes in cannabis reform policy. As a consequence, there is an increase in cannabis legalization around the globe, although it is still facing many rejections. It is crucial to understand the factors affecting public acceptance of cannabis use to support the contextualization and success of cannabis legalization. This review aims to address consumer cultural, social and psychological factors regarding the legal use of cannabis. Based on this review, cultures influence the endorsement or rejection of cannabis use depending on political views, religious sentiments and affiliated subcultures (adult, youth and adolescent subcultures). Regarding the social factors, socioeconomic status, measured by income, education level and occupation, is a key determinant of cannabis use. The beliefs opposing cannabis legalization are due to the negative stigma surrounding cannabis use. Nevertheless, growing awareness about the pharmaceutical and therapeutic effects of cannabis has led to an increase in positive attitudes towards cannabis legalization. Thus, dissemination of cannabis use benefits reaffirmed by scientific evidence could be a strategic way to alleviate the public’s negative feedback on cannabis legalization.

Seven days in medicine: 22-28 June 2022

Alcohol pricing Policies could significantly cut health harms, says WHO European countries could significantly reduce health harms from alcohol consumption by introducing minimum pricing for alcoholic beverages, said the World Health Organization. (Full story doi:10.1136/bmj.o1542) Valproate UK regulator looks into possible transgenerational effects The Medicines and Healthcare Products Regulatory Agency is examining animal data showing that the epilepsy drug sodium valproate could trigger genetic changes that are passed on to future generations. Austerity Local spending cuts link to poor health Local government spending cuts are associated with worse multimorbidity and health related quality of life, concluded a longitudinal study of 147 English local authorities published in the Lancet Regional Health—Europe.2 After controlling for other spending a 1% cut in public health expenditure was associated with a 0.15% increase in the prevalence of two or more chronic conditions.

In age of misinformation, cancer care community seeks new strategies to improve communication

Healio ;HemOnc Today spoke with oncologists and leading communication experts in science and medicine about the prevalence of cancer misinformation on social media, important research into the issue, and possible strategies to improve communication platforms and disseminate trustworthy information more effectively. A problem 'across multiple health topics' Skyler B. Johnson, MD, physicianscientist at Huntsman Cancer Institute and assistant professor of radiation oncology at The University of Utah, discovered the scale and scope of cancer misinformation when his wife was diagnosed with cancer. In July, Johnson and colleagues published results of a study in Journal of the National Cancer Institute that showed one-third of the most popular cancer treatment articles on social media included inaccurate information. The researchers found that: * online search volume for cannabis and cancer increased at 10 times the rate of standard therapies (more in states where recreational or medical cannabis was legal);* cannabis as a cancer cure represented the largest category of social media content (23%) on alternative cancer treatments;* of the 40 high-impact new stories on social media referencing cannabis and cancer, 32 (80%) were false news that proposed cannabis as a cancer cure and only one (2.5%) was an accurate news story that debunked that claim;and * the top false news story claiming cannabis as a cancer cure generated 4.26 million engagements on social media;meanwhile, the top news story debunking this false news only received 36,000 engagements.