A descriptive study of older medical cannabis users in medical cannabis clinics

Introduction: There is a dearth of information on older users (65+ years) of medical cannabis, who may face unique challenges due to altered metabolism with aging, concurrent medication use, and risk of adverse effects. This observational study aimed to describe a large cohort of older medical cannabis users in Canada. Method(s): From Oct 2014 to Oct 2020, a commercial medical cannabis provider based in Canada collected anonymized data for research purposes from patient volunteers. Data included demographic, social, and health details (at intake) and cannabis products, self-perceived changes in symptoms and change in medications (at follow-up, variable duration). Cannabis products were categorized as cannabidiol (CBD) only, tetrahydocannabinol (THC) only or mixed CBD/THC. Of the mixed, formulations could be in 1:1 ratios (CBD+/THC+), predominantly CBD (CBD+/THC-) or predominantly THC (CBD-/THC+). Result(s): In total, 9766 subjects in the older cohort (65+ years old) completed the entire questionnaire (mean age (SD) = 73.6 (6.8) y, 60% female). They represented 23.1% of the total dataset (N = 42,267, mean (SD) =51.5 (16.8) y). The proportion of adults in the older cohort tended to increase over time (pre-2018: 17.6%;2018: 26.7%;2019: 31.2%;2020: 22.7%, when the overall intake decreased from 8869 to 5644). Among the older cohort, 15.5% were previous cannabis users and 67.7% were referred for chronic pain (mainly arthritis, chronic pain, lower back pain). Concomitant analgesic use was common (over-the-counter analgesics: 44.5%;opioids: 28.3%;NSAIDs: 24.5%). 7.9% of the sample (compared to 19.9% in the whole sample) were referred for psychiatric disorders, though 21.4% indicated antidepressant use and 12.3% indicated benzodiazepine use. Another 7% were referred for neurological disorders. Follow-up data were captured in visits (11,992) from 4698 older patients, averaging 2.5 visits per patient. The type of medical cannabis used changed over time, with increasing use of cannabis oil compared to herbal cannabis. In 2020, of 2478 visits, 78.9% use was cannabis oil and 6.7% was herbal forms (pre-2018: 57.6% vs 36.2%). The composition of cannabis oil demonstrated a preference for cannabinoid oil (CBD+) over tetrahydrocannabinol (THC+) in 6043 visits: 45.2% were using CBD+ preparations, only 3.2% were using THC+ preparations, and for CBD/THC combinations, CBD predominated (CBD+/THC-: 30.5%;CBD+/THC+: 16.8%;CBD-/THC+: 4.3%). Adverse-effects (7062 visits) included dry mouth (15.8%), drowsiness (8.6%), dizziness (4%) and hallucinations (0.6%). Patients reported improved pain, sleep and mood over time, though 15-20% reported no improvement or worsening. Medication use was mostly unchanged, though 40% of opioid users reported requiring reduced dosages. Conclusion(s): These data were drawn from a large convenience sample. The data suggest an increasing proportion of older users of medical cannabis, though COVID-19 may have affected recent use. Female users comprised a higher proportion, and cannabis oil containing CBD was preferred. Systematic studies of effectiveness and safety in older users of cannabinoids are needed given its increasing use. Funding(s): No funding was received for this work.Copyright © 2021

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.

Year 2022 in review - Chronic pain.

This article presents a selection of interesting basic research, clinical studies, new recommendations, new definitions of pain, a new type of nociplastic pain, and a completely new type of post-covid headache. Only foreign and relevant sources are discussed.Copyright © 2022, Czech Medical Association J.E. Purkyne. 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.

Factors Associated with Medical Cannabis Use After Certification: A Three-Month Longitudinal Study.

Background: Over the past decade, there has been increased utilization of medical cannabis (MC) in the United States. Few studies have described sociodemographic and clinical factors associated with MC use after certification and more specifically, factors associated with use of MC products with different cannabinoid profiles. Methods: We conducted a longitudinal cohort study of adults (N=225) with chronic or severe pain on opioids who were newly certified for MC in New York State and enrolled in the study between November 2018 and January 2022. We collected data over participants' first 3 months in the study, from web-based assessment of MC use every 2 weeks (unit of analysis). We used generalized estimating equation models to examine associations of sociodemographic and clinical factors with (1) MC use (vs. no MC use) and (2) use of MC products with different cannabinoid profiles. Results: On average, 29% of the participants used predominantly high delta-9-tetrahydrocannabinol (THC) MC products within the first 3 months of follow-up, 30% used other MC products, and 41% did not use MC products. Non-Hispanic White race, pain at multiple sites, and past 30-day sedative use were associated with a higher likelihood of MC use (vs. no MC use). Current tobacco use, unregulated cannabis use, and enrollment in the study during the COVID-19 pandemic were associated with a lower likelihood of MC use (vs. no MC use). Among participants reporting MC use, female gender and older age were associated with a lower likelihood of using predominantly high-THC MC products (vs. other MC products). Conclusion: White individuals were more likely to use MC after certification, which may be owing to access and cost issues. The findings that sedative use was associated with greater MC use, but tobacco and unregulated cannabis were associated with less MC use, may imply synergism and substitution that warrant further research. From the policy perspective, additional measures are needed to ensure equitable availability of and access to MC. Health practitioners should check patients' history and current use of sedative, tobacco, and unregulated cannabis before providing an MC recommendation and counsel patients on safe cannabis use. clinicaltrials.gov (NCT03268551).

Shifts in medical cannabis use in Canada during the COVID-19 pandemic. / Changements observés au Canada dans la consommation de cannabis à des fins médicales pendant la pandémie de COVID-19.

INTRODUCTION: The COVID-19 pandemic has had widespread secondary negative health impacts including loss of material security and exacerbation of mental illness in at-risk populations. While increases in the nonmedical use of certain substances, including cannabis, have been observed in samples of the Canadian population, no research has documented COVID-concurrent shifts in medical cannabis use in Canada. METHODS: Data were derived from the 2021 Canadian Cannabis Patient Survey, an online survey administered in May 2021 to people authorized to use medical cannabis recruited from one of two Canadian licensed medical cannabis producers. McNemar tests assessed for changes in past 3-month medical cannabis frequency from before to during the pandemic. We explored correlates of increasing frequency of cannabis use since before the pandemic in bivariable and multivariable logistic models. RESULTS: In total, 2697 respondents (49.1% women) completed the survey. Daily medical cannabis use increased slightly but significantly from before the pandemic (83.2%) to during the pandemic (90.3% at time of survey; p < 0.001). Factors significantly associated with increasing frequency of medical cannabis use included female gender, younger age, pandemic-related job loss, primary cannabis use to manage mental health, prescription drug use and nonmedical cannabis use (p < 0.05). CONCLUSION: There were slight shifts towards higher frequency of medical cannabis use after the onset of the COVID-19 pandemic. While short- and long-term impacts of cannabis use on pandemic-related mental distress are unknown, clinicians working with patients who use medical cannabis should be aware of possible changes in use patterns during the pandemic.

Analyzing the Perspectives of Health Professionals and Legal Cannabis Users on the Treatment of Chronic Pain With Cannabidiol: Protocol for a Scoping Review.

BACKGROUND: Medical cannabis is one of the most commonly reported treatments for chronic pain. The wide acceptance and research in alternative medicine have put medical cannabis in the limelight, where researchers are widely examining its therapeutic benefits, including treatment of chronic pain. OBJECTIVE: The purpose of this scoping review is to provide an overview of the perspectives on cannabidiol as an alternative treatment for chronic pain among health professionals and legal cannabis users. METHODS: The framework of Arksey and O'Malley guides the design of this scoping review, and the elements reported use the recommended guidelines of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A comprehensive literature search accessed the databases CINAHL Complete and MEDLINE via EBSCO, Australia/New Zealand Reference Centre, PsycINFO, Ovid Emcare, Wiley Online Library, Scopus, Informit New Zealand Collection, and Google Scholar for published literature, and then it was extended to include gray literature. Gray literature searches included searching the databases Australia/New Zealand Reference Centre, Informit New Zealand Collection, INNZ: Index New Zealand, ProQuest Dissertations & Theses Global, and AUT Tuwhera Research Repository, and the website nzresearch.org.nz. The studies included in this scoping review were assessed for eligibility for inclusion using the following criteria: published in English after 2000, conducted in New Zealand (NZ) or Australia, and aimed to investigate the perspectives of health professionals and medical cannabis users using interviews for data collection. Studies were screened for inclusion using Covidence, a software tool to filter search results, and the risk of bias was assessed using the Critical Appraisal Skills Programme tool. Although this is not a required step for scoping reviews, it added an element of strength to this scoping review. Data will be analyzed using thematic analysis guided by Braun and Clarke. The findings from the data analysis will be presented in a table, which will then inform the key themes for discussion. RESULTS: The database search started in October 2021 and was completed in December 2021. The total number of studies included in this review is 5 (n=5). Studies included were conducted in NZ or Australia and examined the perspectives using participant interviews. This scoping review is anticipated to be submitted for publication in December 2022. CONCLUSIONS: Using perspectives is a valuable tool to understand the challenges experienced by health professionals and medical cannabis users associated with medical cannabis treatment. Addressing these challenges through interventions that are highlighted through perspectives such as educating health professionals to increase access to medical cannabis in NZ may aid in policy reformulation for medical cannabis in the context of NZ. Thus, this scoping review highlights the importance of medical cannabis research and suggests recommendations to guide and inform medical cannabis policy in the context of NZ. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37697.

Selective Changes in Medical Cannabis Use Early in the COVID-19 Pandemic: Findings from a Web-Based Sample of Adults in the United States.

Background: The COVID-19 pandemic has had widespread impacts on mental health and substance use. While increases in nonmedical cannabis use during COVID-19 have been documented among people who use cannabis across a diversity of settings, changes in specific medical applications of cannabis during the COVID-19 pandemic have not been characterized. We sought to examine changes in the prevalence, frequency, and mode of use of medical cannabis for a range of commonly treated conditions and symptoms during COVID-19. Methods: Data were obtained from an online survey of a sample of adults in the United States who use cannabis (n=1886), administered in September 2020. This study was restricted to participants who self-reported past-year medical cannabis use (n=598). Using data reported in a retrospective (pre-COVID) and current assessment period, we examined changes in cannabis use prevalence, frequency, and inhalation as the primary mode of administration for 11 commonly treated conditions. Results: There were slight but statistically significant increases in weekly (from 21.4% to 23.4%) and daily (from 16.2% to 20.7%) self-reported medical cannabis use during COVID-19 (p<0.001). Anxiety was the only specific therapeutic purpose for which daily cannabis use increased statistically significantly during COVID-19 (18.5% to 25.4%; p=0.004). In multivariable logistic regression, the odds of increasing cannabis use for anxiety during COVID-19 were statistically significantly higher for women, respondents from Western states, and states with legal medical and nonmedical cannabis. Discussion: We detected slight shifts toward higher frequencies of medical cannabis use during COVID-19. Disaggregated by therapeutic indication, daily cannabis use to manage anxiety increased during the pandemic. There is a need to assess whether changes in cannabis use that coincided with the pandemic will be sustained over time, and how these changes are connected to mental health outcomes, particularly among women.

Cannabidiol as a personalized treatment for anxiety: clinical cases in Mexico.

Anxiety-related disorders are one of the most common mental health issues worldwide. Mexico has reported an increase in the prevalence of these ailments secondary to the confinement derived from the COVID-19 pandemic. Given the limitations of commonly used treatments for these disorders, a need arises to develop new pharmacological treatments for these patients. This paper has the primary objective of evaluating the efficacy and safety of cannabidiol isolate in drug compounding used as a personalized treatment in patients with anxiety disorders through the presentation of four clinical cases.

Healthcare practitioner perceptions on barriers impacting cannabis prescribing practices.

BACKGROUND: Canadians seeking medical cannabis (MC) may encounter difficulties in finding a healthcare provider (HCP) who authorizes their access to it. Barriers that HCPs face in authorizing MC are unclear. The objectives of this study were to evaluate HCP opinions, knowledge, comfort, and practice in MC prescribing and counseling on recreational cannabis use, and whether the COVID-19 pandemic affected MC prescribing practices. METHODS: Eligible participants included HCPs (e.g., attending physicians, nurses, pharmacists) in Canada. A questionnaire evaluating their knowledge, comfort, and practice in medical and recreational cannabis was designed based on instruments developed in previous studies. Between April 13th-December 13th 2021, ninety-one healthcare associations were asked to distribute the survey to their members, and an advertisement was placed in the online Canadian Medical Association Journal. Descriptive statistics were used to analyze the results. RESULTS: Twenty-four organizations agreed to disseminate the survey and 70 individuals completed it. Of respondents, 71% were attending physicians or medical residents, while the remainder were nurses, pharmacists or other HCPs. Almost none (6%) received training in MC in professional school but 60% did receive other training (e.g., workshops, conferences). Over half (57%) received more questions regarding MC since recreational cannabis was legalized, and 82% reported having patients who use MC. However, 56% felt uncomfortable or ambivalent regarding their knowledge of MC, and 27% were unfamiliar with the requirements for obtaining MC in Canada. The most common symptoms for recommending MC were pain and nausea, whereas the most common conditions for recommending it were cancer and intractable pain. The strongest barrier to authorizing MC was uncertainty in safe and effective dosage and routes of administration. The strongest barrier to recommending or authorizing MC was the lack of research evidence demonstrating its safety and efficacy. During the pandemic, many respondents reported that a greater number of their patients used cannabis to relieve anxiety and depression. CONCLUSIONS: Our results suggest that HCPs across Canada who responded to our survey are unfamiliar with topics related to MC. The strongest barriers appear to be lack of clinical research, and uncertainty in safe and effective MC administration. Increasing research, training, and knowledge may help HCPs feel more equipped to make informed treatment/prescribing decisions, which may help to improve access to MC.

Chronic pain: year in review

Chronic pain, defined as persistent or recurrent pain lasting more than three months, remains a significant health challenge, affecting more than 20% of the population in the USA, and carrying a huge social and economic burden. In last year, significant contributions have been published regarding the understanding of chronic pain syndromes, with regards to pathogenesis, clinical, psychological, and therapeutic aspects. In this review we aim to summarize some relevant - but not exhaustive-data that emerged during 2021. We will focus on new insights into the pathophysiology, related to genetics, microbiome and metabolomic strategies, neuro-imaging studies pouring light on mechanisms of exercise-induced hypoalgesia, the role of galanin in nociception, and the role of psychological comorbidities. We will also browse therapeutic issues (use of medical cannabis and its effect as opioid-sparing, emergence of compounds targeting Adenyl cyclase type 1 involved in signaling for chronic pain sensitization) as well as novel non-pharmacological modalities (use of virtual reality techniques) and the role of some nutrients in the management of chronic pain such as ginseng and ginsenosides. Last but not least, we will focus on an emerging population of chronic pain syndrome due to the long-term effects of COVID-19.

Israeli news media coverage of COVID-19 and use of cannabis and tobacco: A case study of inconsistent risk communication.

BACKGROUND: There is continued scientific debate regarding the link between risk of COVID-19 infection and increased disease severity and tobacco and cannabis use. The way this topic is presented in news media coverage may influence public attitudes and behavior and is thus an important topic of investigation. This study examines (1) the extent to which Israeli news media reported a positive (i.e., protective/therapeutic), negative (i.e., harmful), or inconclusive association between three types of substance use (tobacco, medical cannabis, recreational cannabis) and risk of COVID-19 infection and/or increased disease severity, and (2) the extent that this media coverage refers to scientific research. METHODS: A quantitative content analysis of news articles related to tobacco and cannabis use and COVID-19 (N = 113) from eleven of the highest circulation newspapers in Israel. RESULTS: News items were significantly more likely to mention increased COVID-19 risk for tobacco use, compared to cannabis use. All medical cannabis news items reported that medical cannabis use was associated with reduced COVID-19 risk. In contrast, news items about recreational cannabis use were more likely to describe a balanced or inconclusive risk for COVID-19, or increased risk. The majority of articles referred to scientific research. CONCLUSION: While Israeli news media reported a relatively consistent message about the increased risk of COVID-19 in relation to tobacco use, messages about cannabis use were less consistent in communicating risk information. Research should examine effects of media coverage of tobacco and cannabis use and COVID-19 on public perceptions and behaviors.

Medicinal cannabis in Europe-An overview

Plants have been used for medicinal purposes long before prehistoric period. Among these ancient medicinal herbs, Cannabis, a flowering plant of the family Cannabaceae, originating from Central and South Asia, was used due to its broad-spectrum applications over the centuries. Its uses ranged from ropes, clothing, paper to its psychoactive properties, making it a very appealing plant. From the 1900's onwards cannabis consumption was deemed illegal in several countries around the world due to its overuse consequences [1]. The lack of scientific information regarding the mechanism of action of its constituents was a direct consequence from the illegal status given in the 1900's. Recently, this has changed, cannabis pre-clinical studies have shown several medicinal properties which helped cannabis gained traction and legal status for its medicinal use in most of North and South America, and in some European countries, lifting some of the old prejudice. In Europe, medicinal cannabis usage is still growing. Several cannabinoid-containing medicinal products are already available in the market [2,3]. EXMceuticals Portugal is one of the European Pharmaceutical companies working with medicinal cannabis that is specialized in extraction and purification of cannabinoids and terpenes for pharmaceutical grade ingredients. Most recently, due to the COVID-pandemic our research efforts have been put to "BioBlock COVID", a project that focus on antiviral properties of terpenes from cannabis and other medicinal plants for inactivation o the virus SARS-CoV-2, and its applications in tissues, hand and surface disinfectants.

Mental health symptoms during the COVID-19 pandemic among cancer survivors who endorse cannabis: Results from the COVID-19 cannabis health study

Background: The use of medical cannabis represents an opportunity to improve access to equitable cancer treatment among minoritized populations who frequently face barriers to traditional palliative care options or mental health treatments. Poor mental health among cancer survivors is of concern as it reduces adherence to cancer survivorship treatment and can reduce overall survival. The COVID-19 pandemic has highlighted the importance of access to palliative care due to the increase of mental health symptoms among cancer survivors. Despite the potential benefits of medicinal cannabis, data describing the use of cannabis to manage mental health symptoms among cancer survivors is limited, particularly in the context of the COVID-19 pandemic. Objective: Our objective was to examine the prevalence of mental health symptoms and the behavioral impacts of the COVID-19 pandemic on cancer survivors who endorse cannabis use. Methods: Our participants included adults (≥18 years) who self-reported medicinal cannabis use and responded to our internet-based questionnaire (03/21/2020-03/24/2021). Overall, we received 3,594 responses. For this study, data included 158 participants including 79 cancer survivors (2.2%) along with age-matched medicinal cannabis users without a history of cancer (N = 79). Descriptive statistics were used to compare demographic characteristics, prevalence of generalized anxiety (GAD-7), and depression (CES-D-10), changes in behavior during the COVID-19 pandemic, and self-reported coping mechanisms by cancer survivorship status. Results: Overall, 61% and 48% of cancer survivors self-reported to use medicinal cannabis to manage their anxiety and depression, respectively. Additionally, 54% of cancer survivors reported cannabis use to manage their chronic pain. Probable clinical depression (CES-D-10 score ≥ 10) and anxiety (GAD-7 score ≥ 10) were identified in 50.7% and 38.9% of cancer survivors, respectively. Cancer survivors were more likely to report that their anxiety symptoms made it very or extremely difficult to work, take care of things at home, or get along with other people (23.0% vs. 11.8%, p = 0.015) than adults without a history of cancer. Pandemic-related coping mechanisms frequently reported by cancer survivors with anxiety or depression included more sleep (47.5%), practicing meditation/mindfulness (47.5%), physical activity (47.5%), talking to family and friends (42.5%), overeating or stress-eating (25.0%), and using more cannabis (25.0%). Cancer survivors with anxiety and depression reported to be more likely to fear giving COVID-19 to someone else (47.5% vs. 23.1%, p=0.023) and to fear being diagnosed with COVID-19 (77.5% vs. 38.5%, p<0.001) compared to cancer survivors without mental health conditions. Conclusion: Given the prevalence of anxiety and depression symptoms reported among cancer survivors and their use of cannabis, further research is recommended to evaluate its use as palliative care to improve mental health and quality of life among cancer survivors.

Educating minorities about marijuana for medical use and the consequences of unlawful use of marijuana

Objectives: Florida A&M University (FAMU) established the Medical Marijuana Education and Research Initiative (MMERI) to educate minorities about marijuana for medical use and the impact of the unlawful use of marijuana, pursuant to Sec. 381.986 F. S. This presentation provides an overview of how MMERI, has educated and engaged individuals throughout the State of Florida, using onsite classes, print and broadcast media, over myriad communications channels, including the MMERI website (mmeri.famu.edu), podcasts and videocasts. After the onset of the COVID-19 global pandemic, MMERI moved to online technologies, including an E-Newsletter and Conversations on Cannabis, a virtual forum broadcast over Zoom, to expand its education, communication and community engagement reach throughout Florida. In addition to the number of events, minorities and Floridians served, and percentage ethnically, the facilitator will reveal numerical findings and qualitative insight derived from pre/post assessments, as well as satisfaction surveys. Methods: This overview consists of descriptive statistics with comparative analyses using both quantitative and qualitative data to organize, summarize and report on selected education and outreach activities. The effectiveness of the education and outreach activities were measured by participant feedback on the pre/post assessment for the Basic Medical Marijuana Education course, as well as satisfaction surveys. Result: The number and types of activities and events and participants served, reveal MMERI's compliance with its legislative mandate to educate minorities. However, the invaluable data extracted from assessment and surveys, provided critical insight showing participants not only moved from one level of competency to a higher one in the cognitive domain: but in the affective domain as well. The responses illustrated participants viewed medical marijuana more favorable when compared to unlawful usage of marijuana, after viewing MMERI's presentations. The demographics revealing the ethnicity of Floridians served in descending order as: 55% Whites, 24% Hispanics;16% Blacks;3% Asians;and 2% Mixed/Others, exemplifies MMERI's commitment to diversity. Conclusion: FAMU's MMERI educated minorities about marijuana for medical use and the impact of the unlawful use of marijuana, pursuant to Sec. 381.986 F.S.

Fighting the storm: could novel anti-TNFα and anti-IL-6 C. sativa cultivars tame cytokine storm in COVID-19?

The main aspects of severe COVID-19 disease pathogenesis include hyper-induction of proinflammatory cytokines, also known as 'cytokine storm', that precedes acute respiratory distress syndrome (ARDS) and often leads to death. COVID-19 patients often suffer from lung fibrosis, a serious and untreatable condition. There remains no effective treatment for these complications. Out of all cytokines, TNFα and IL-6 play crucial roles in cytokine storm pathogenesis and are likely responsible for the escalation in disease severity. These cytokines also partake in the molecular pathogenesis of fibrosis. Therefore, new approaches are urgently needed, that can efficiently and swiftly downregulate TNFα, IL-6, and the inflammatory cytokine cascade, in order to curb inflammation and prevent fibrosis, and lead to disease remission. Cannabis sativa has been proposed to modulate gene expression and inflammation and is under investigation for several potential therapeutic applications against autoinflammatory diseases and cancer. Here, we hypothesized that the extracts of novel C. sativa cultivars may be used to downregulate the expression of pro-inflammatory cytokines and pathways involved in inflammation and fibrosis. Initially, to analyze the anti-inflammatory effects of novel C. sativa cultivars, we used a well-established full thickness human 3D skin artificial EpiDermFTTM tissue model, whereby tissues were exposed to UV to induce inflammation and then treated with extracts of seven new cannabis cultivars. We noted that out of seven studied extracts of novel C. sativa cultivars, three (#4, #8 and #14) were the most effective, causing profound and concerted down-regulation of COX2, TNFα, IL-6, CCL2, and other cytokines and pathways related to inflammation and fibrosis. These data were further confirmed in the WI-38 lung fibroblast cell line model. Most importantly, one of the tested extracts had no effect at all, and one exerted effect that may be deleterious, signifying that careful cannabis cultivar selection must be based on thorough pre-clinical studies. The observed pronounced inhibition of TNFα and IL-6 is the most important finding, because these molecules are currently considered to be the main targets in COVID-19 cytokine storm and ARDS pathogenesis. Novel anti-TNFα and anti-IL-6 cannabis extracts can be useful additions to the current anti-inflammatory regimens to treat COVID-19, as well as various rheumatological diseases and conditions, and 'inflammaging' - the inflammatory underpinning of aging and frailty.

In search of preventive strategies: novel high-CBD Cannabis sativa extracts modulate ACE2 expression in COVID-19 gateway tissues.

With the current COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there is an urgent need for new therapies and prevention strategies that can help curtail disease spread and reduce mortality. The inhibition of viral entry and thus spread is a plausible therapeutic avenue. SARS-CoV-2 uses receptor-mediated entry into a human host via the angiotensin-converting enzyme 2 (ACE2), which is expressed in lung tissue as well as the oral and nasal mucosa, kidney, testes and gastrointestinal tract. The modulation of ACE2 levels in these gateway tissues may be an effective strategy for decreasing disease susceptibility. Cannabis sativa, especially those high in the anti-inflammatory cannabinoid cannabidiol (CBD), has been found to alter gene expression and inflammation and harbour anti-cancer and anti-inflammatory properties. However, its effects on ACE2 expression remain unknown. Working under a Health Canada research license, we developed over 800 new C. sativa cultivars and hypothesized that high-CBD C. sativa extracts may be used to down-regulate ACE2 expression in target COVID-19 tissues. Using artificial 3D human models of oral, airway and intestinal tissues, we identified 13 high-CBD C. sativa extracts that decrease ACE2 protein levels. Some C. sativa extracts down-regulate serine protease TMPRSS2, another critical protein required for SARS-CoV-2 entry into host cells. While our most effective extracts require further large-scale validation, our study is important for future analyses of the effects of medical cannabis on COVID-19. The extracts of our most successful novel high-CBD C. sativa lines, pending further investigation, may become a useful and safe addition to the prevention/treatment of COVID-19 as an adjunct therapy.

Medication and substance use increases among people using cannabis medically during the COVID-19 pandemic.

BACKGROUND: The ongoing COVID-19 pandemic strains the medical system, limiting access to healthcare services. Many people use cannabis medically for chronic health conditions and as a substitute for other medications. As such, changes in cannabis access associated with COVID-19 may result in increased non-cannabis drug use. METHODS: We recruited N = 353 individuals through Amazon Mechanical Turk who reported current medical cannabis use in April and May of 2020. We assessed the effects of the COVID-19 pandemic on patterns of medication and substance use, as well as on cannabis use patterns. RESULTS: Over half of participants either started using or increased use of medications or substances because of the COVID-19 pandemic, most commonly alcohol and sleep aids. Over a third of participants increased cannabis use while 25% decreased cannabis use. Approximately 40% of participants who increased or started use of medications/substances (other than cannabis) reported doing so because of changed access to medical cannabis. CONCLUSION: The reported increase in drug use among people using medical cannabis is concerning. Because the pandemic will likely continue for months (or even years), having a better understanding of why this is occurring is critical for developing effective harm-reduction strategies in this population.