Cannabinoid hyperemesis syndrome.

SummaryCannabis use is legalised in many countries. We present a patient in their 40s who complained of recurrent abdominal pain and associated nausea and vomiting. The patient was previously seen in various hospitals, treated symptomatically, and discharged with a diagnosis of non-specific abdominal pain. The patient had a chronic history of smoking cannabis and nicotine and drinking alcohol. Abdominal examination revealed no masses, and abdominal X-ray was normal. Blood tests and gastroduodenoscopy revealed no obvious aetiology. Intravenous fluids, together with antiemetics and proton pump inhibitors, were administered. The patient also received counselling and was advised to stop cannabis use. At discharge, the patient was well and asked to come back for review in 2 weeks, and, thereafter monthly for a period of 6 months after stopping cannabis use. The patient reported no recurrent symptoms despite continued cigarette and alcohol use. A suspected cannabinoid hyperemesis syndrome (CHS) became a consideration. Awareness of cannabis-related disorders such as CHS may assist in avoiding costly hospital workups.

Associations between smoking and pain in early recovery in residential substance use treatment-seekers.

INTRODUCTION: A growing literature indicates bidirectional associations between pain and tobacco use. Cigarette smokers are at increased risk for chronic pain, and observational and experimental studies indicate that pain increases motivation to smoke. Tobacco use disorder frequently co-occurs with other substance use disorders, which are also associated with chronic pain vulnerability. Despite evidence that pain significantly predicts smoking and relapse, associations between smoking history/trajectory and changes in pain over the course of treatment have not been characterized. The objective of the study was to determine the association between in-treatment smoking trajectory, pack-years (i.e., number of cigarette packs smoked per day multiplied by smoking duration), pain-related interference in daily activities, and pain intensity over the course of residential treatment. METHODS: In this study, 280 adult smokers in a residential SUD treatment center in North Central Florida completed questionnaires assessing cigarette use, pain intensity, and pain interference at treatment entry and discharge (Mean = 80.3 days, SD = 25.6). Most participants were diagnosed with alcohol use disorder (66.1 %). Opioid (27.9 %) and cannabis use disorders (29.6 %) were also common. Participants were grouped by whether their smoking increased (n = 36), decreased (n = 46), or stayed the same (n = 133) from entry to discharge. RESULTS: Analyses indicated a positive association between pack-years and pain intensity at both baseline (r = 0.185, p = 0.018) and discharge (r = 0.184, p = 0.019). Smoking trajectory was associated with pack-years, with those decreasing smoking having greater pack-years than those sustaining or increasing use [F(2,136) = 8.62, p < 0.01, η2p = 0.114]. Mixed general linear models indicated pain intensity [F(1,274) = 44.15, p < 0.0001, η2p = 0.138] and interference in day-to-day activities [F(1,276) = 31.79, p < 0.0001, η2p = 0.103] decreased significantly over time. However, there was no main effect of smoking trajectory on pain intensity [F(2,212) = 2.051, p = 0.131, η2p = 0.019] or of smoking trajectory by time interaction [F(2, 212) = 1.228, p = 0.295, η2p = 0.011]. CONCLUSIONS: Overall, findings provide evidence that smoking behavior influences pain within the context of residential substance use treatment. Given that pain is associated with urge to use substances and risk of return to use, more consistent and rigorous assessment of pain and proactive pain management is likely to enhance substance use treatment outcomes among people who smoke.

Association of Cannabis Use Disorder with Major Adverse Cardiac and Cerebrovascular Events in Older Non-Tobacco Users: A Population-Based Analysis.

BACKGROUND: Tobacco use disorder (TUD) adversely impacts older patients with established cardiovascular disease (CVD) risk. However, CVD risk in chronic habitual cannabis users without the confounding impact of TUD hasn't been explored. We aimed to determine the risk of major adverse cardiac and cerebrovascular events (MACCE) in older non-tobacco smokers with established CVD risk with vs. without cannabis use disorder (CUD). METHODS: We queried the 2019 National Inpatient Sample for hospitalized non-tobacco smokers with established traditional CVD risk factors aged ≥65 years. Relevant ICD-10 codes were used to identify patients with vs. without CUD. Using multivariable logistic regression, we evaluated the odds of MACCE in CUD cohorts compared to non-CUD cohorts. RESULTS: Prevalence of CUD in the sample was 0.3% (28,535/10,708,815, median age 69), predominantly male, black, and non-electively admitted from urban teaching hospitals. Of the older patients with CVD risk with CUD, 13.9% reported MACCE. The CUD cohort reported higher odds of MACCE (OR 1.20, 95% CI 1.11-1.29, p < 0.001) compared to the non-CUD cohort. Comorbidities such as hypertension (OR 1.9) and hyperlipidemia (OR 1.3) predicted a higher risk of MACCE in the CUD cohort. The CUD cohort also had higher unadjusted rates of acute myocardial infarction (7.6% vs. 6%) and stroke (5.2% vs. 4.8%). CONCLUSIONS: Among older non tobacco smokers with known CVD risk, chronic cannabis use had a 20% higher likelihood of MACCE compared to those who did not use cannabis.

Cannabis use Disorder and Complications After Anterior Cervical Diskectomy and Fusion.

OBJECTIVE: The aim of this study, a retrospective database analysis, was to assess the impact of baseline cannabis use disorder (CUD) on perioperative complication outcomes in patients undergoing primary 1- to 2-level anterior cervical diskectomy and fusion (ACDF) surgery. METHODS: The PearlDiver Database was queried from January 2010 to December 2021 for patients who underwent primary 1- to 2-level ACDF surgery for degenerative spine disease. Patients with CUD diagnosis 6 months before the index ACDF surgery (i.e., CUD) were propensity matched with patients without CUD (i.e., control in a ratio of 1:1, employing age, gender, and Charlson Comorbidity Index as matching covariates). Univariate and multivariable analysis models with adjustment of confounding variables were used to evaluate the risk of CUD on perioperative complications between the propensity-matched cohorts. RESULTS: The 1:1 matched cohort included 838 patients in each group. Following multivariate analysis, CUD was demonstrated to be associated with an increased incidence of hospital readmission at 90 days (odds ratio [OR] = 2.64, 95% confidence interval: [1.19 to 6.78], [P = 0.027]) and revision surgery at 1 year postoperative (OR = 3.36, 95% confidence interval: [1.17 to 14.18], [P = 0.049]). CUD was additionally associated with reduced risk of overall medical complications at both 6 months and 1 year postoperative (OR = 0.55, [P = 0.021], and OR = 0.54, [P = 0.015], respectively). CONCLUSIONS: These findings indicate that isolated baseline CUD is associated with an increased risk of hospital readmission at 90 days postoperative and cervical spine reoperation at 1 year after primary 1- to 2-level ACDF surgery with a decrease in overall medical complications, cardiac arrhythmias, and acute renal failure.

Prevalence and impact of cannabis use disorder on acute ischemic stroke and subsequent mortality in elderly peripheral vascular disease patients: A population-based analysis in the USA (2016 - 2019).

BACKGROUND: Given current evidence linking peripheral atherosclerotic disease, also known as cannabis arteritis, and acute ischemic stroke (AIS) in individuals with cannabis use disorder (CUD), we investigated the frequency and implications of CUD in relation to AIS risk and outcomes among elderly patients with peripheral vascular disease (PVD). METHODS: The National Inpatient Sample (2016-2019) was used to compare geriatric patients with PVD and cannabis use disorder CUD. CUD was correlated with AIS admissions. Adjusted multivariable regression models assessed in-hospital mortality rates. RESULTS: Of 5,115,824 geriatric admissions with PVD, 50.6 % were male and 77.5 % were white. 21,405 admissions had cardiovascular and CUD co-occurrence. 19.7 % of CUD patients had diabetes mellitus (DM), compared to 33.7 % of non-CUD patients. Smoking and HTN rates were comparable between groups. Patients with CUD used more recreational drugs concurrently than those without CUD. AIS prevalence was 5.2 % in CUD patients and 4.0 % in controls (p < 0.001). In the geriatric population with PVD, the presence of CUD was found to be associated with increased odds of hospitalizations due to AIS, with an adjusted odds ratio (aOR) of 1.34 (95 % confidence interval [CI] 1.18-1.52, p < 0.001). All-cause in-hospital mortality was not statistically significant, with an aOR of 0.71 (95 %CI 0.36-1.37, p = 0.302). In our study, older patients with PVD and hypertension (aOR 1.73) had a greater risk of AIS. Intriguingly, when we analyzed AIS predictors in elderly PVD patients with concurrent tobacco use disorder, we identified a counterintuitive protective effect (aOR 0.58, 95 % CI 0.42-0.79, p < 0.001). CONCLUSIONS: Our findings indicate that among geriatric patients with PVD and concurrent CUD, there is a notable 34 % risk of AIS. Importantly, this risk persists despite controlling for other CVD risk factors and substance use. Further investigations are warranted to elucidate and validate the intriguing phenomenon known as the smoker's paradox.

[Epidemiological and clinical profile of cannabis users at the Addiction Care and Prevention Centre of the Laquintinie Hospital in Douala, Cameroon]. / Profil épidémiologique et clinique des consommateurs de cannabis au centre de soins d'accompagnement et de prévention en addictologie de l'Hôpital Laquintinie de Douala, Cameroun.

Cannabis is the most widely used illicit drug in the world. It is consumed by age groups, the main ones being adolescents and young adults. Its consumption leads to somatic, psychiatric and social complications. Data in our context are scarce. The purpose of our work was to describe the epidemiological and clinical profile of patients with cannabis addiction at the Centre for Care, Support and Prevention of the Laquintinie Hospital in Douala. We conducted a retrospective cross-sectional study of patients followed from March 2021 to July 2022 for cannabis addiction at the Addiction Care, Support and Prevention Center of the Laquintinie Hospital in Douala. The diagnosis of use disorder was based on a dependency syndrome related to cannabis use (single event usage). Data entry and analysis were performed using SPSS version 7.1 software. Of the 45 cases of cannabis addiction, 44 (98%) were male patients with an average age of 21,97 years. The most affected age group was between 20 and 24 years (28/44 or 63%); 49% of consumers were students, 62% of mothers accompanying patient to the consultation. The age of cannabis use initiation was 16 years (31%), the most commonly used form of cannabis was herbal (100%) and 100% of patients used inhalation (smoking). The most common complication was amotivational syndrome (31%). Cannabis use initiation occurs at an early age. The most commonly used form of cannabis is herbal administered through inhalation (smoking). The most common complications are amotivational syndrome, cognitive disorders, sleep disorders and withdrawal syndrome.

Tobacco/nicotine dependence as a risk factor for substance use disorders and related mental health conditions among cancer patients.

BACKGROUND: Cancer patients often face multiple comorbidities and are at risk for various mental health conditions and substance use disorders. Tobacco/nicotine dependence (TND) is a known risk factor for poor health outcomes and has been associated with psychiatric disorders including substance use disorder. However, the specific relationship between TND and the risk of substance use disorder and mental health conditions among cancer patients remains underexplored. This study aimed to assess the association between TND and the risk of comorbid conditions among cancer patients. METHODS: Data were obtained from a database of electronic health records for patients from the University of California health system. The odds for every condition among cancer patients with TND were calculated and compared with those for cancer patients without TND. ORs were adjusted for gender, ethnicity, and race. RESULTS: Three thousand seven hundred and ninety-one cancer patients with TND had 252,619 total conditions, and 51,711 cancer patients without TND had 2,310,880 conditions. After adjusting for confounders, the condition for which TND most exacerbated risk was psychoactive substance-induced organic anxiety disorder (OR = 16.3, p < 0.001). This appeared consistent with the second, third, and fifth most-exacerbated conditions: stimulant use disorder (OR = 12.8, p < 0.001), cocaine induced mental disorder (OR = 11.0, p < 0.001), and cocaine use disorder (OR = 11.0, p < 0.001). Different conditions exacerbated by TND include acute alcoholic intoxication (OR = 11.4, p < 0.001), opioid use disorder (OR = 7.6, p < 0.001), schizoaffective disorder (OR = 7.4, p < 0.001), and cannabis use disorder (OR = 6.3, p < 0.001). CONCLUSIONS: Our findings reveal a strong association between TND and an increased risk of substance use disorder and mental health conditions among cancer patients. Specifically, cancer patients with TND were at an elevated risk for psychoactive substance-induced organic anxiety disorder, stimulant use disorder, and cocaine-related disorders. Additionally, TND was associated with an increased risk of acute alcoholic intoxication, opioid use disorder, schizoaffective disorder, and cannabis use disorder. These findings underscore the need for comprehensive screening and interventions to address TND and comorbid conditions among cancer patients.

Cannabis Use Disorder and Perioperative Complications.

Importance: Cannabis use is growing in the US and is increasingly perceived as harmless. However, the perioperative impact of cannabis use remains uncertain. Objective: To assess whether cannabis use disorder is associated with increased morbidity and mortality after major elective, inpatient, noncardiac surgery. Design, Setting, and Participants: This retrospective, population-based, matched cohort study used data from the National Inpatient Sample for adult patients aged 18 to 65 years who underwent major elective inpatient surgery (including cholecystectomy, colectomy, inguinal hernia repair, femoral hernia repair, mastectomy, lumpectomy, hip arthroplasty, knee arthroplasty, hysterectomy, spinal fusion, and vertebral discectomy) from January 2016 to December 2019. Data were analyzed from February to August 2022. Exposure: Cannabis use disorder, as defined by the presence of specific International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes. Main Outcome and Measures: The primary composite outcome was in-hospital mortality and 7 major perioperative complications (myocardial ischemia, acute kidney injury, stroke, respiratory failure, venous thromboembolism, hospital-acquired infection, and surgical procedure-related complications) based on ICD-10 discharge diagnosis codes. Propensity score matching was performed to create a 1:1 matched cohort that was well balanced with respect to covariates, which included patient comorbidities, sociodemographic factors, and procedure type. Results: Among 12 422 hospitalizations, a cohort of 6211 patients with cannabis use disorder (median age, 53 years [IQR, 44-59 years]; 3498 [56.32%] male) were matched with 6211 patients without cannabis use disorder for analysis. Cannabis use disorder was associated with an increased risk of perioperative morbidity and mortality compared with hospitalizations without cannabis use disorder in adjusted analysis (adjusted odds ratio, 1.19; 95% CI, 1.04-1.37; P = .01). The outcome occurred more frequently in the group with cannabis use disorder (480 [7.73%]) compared with the unexposed group (408 [6.57%]). Conclusions and Relevance: In this cohort study, cannabis use disorder was associated with a modest increased risk of perioperative morbidity and mortality after major elective, inpatient, noncardiac surgery. In the context of increasing cannabis use rates, our findings support preoperative screening for cannabis use disorder as a component of perioperative risk stratification. However, further research is needed to quantify the perioperative impact of cannabis use by route and dosage and to inform recommendations for preoperative cannabis cessation.

Associations of alcohol use disorder, cannabis use disorder, and nicotine dependence with concurrent opioid use disorder in U.S. adults.

Polysubstance use of alcohol, cannabis, and nicotine has been shown to be correlated with opioid use disorder (OUD). The goal of this study was to determine whether alcohol use disorder (AUD), cannabis use disorder (CUD), and/or nicotine dependence were associated with concurrent OUD. Data came from the 2015-2019 National Survey on Drug Use and Health (n = 282,768, 48.5% male). Weighted logistic regression was performed for experiencing OUD in the past year concurrent with AUD, CUD, nicotine dependence, all pairwise interactions, the three-way interaction, and demographic covariates. Compared to individuals with no substance use disorder (SUD), individuals with AUD had 5.24 times the odds (95% CI [4.25, 6.46]), individuals with CUD had 6.69 times the odds (95% CI [5.13, 8.72]), and individuals with nicotine dependence had 7.12 times the odds of experiencing OUD (95% CI [6.10, 8.32]). Individuals with either AUD and CUD or AUD and nicotine dependence had approximately 15 times the odds of having OUD than those with no SUD (95% CI [12.58, 19.53] and 95% CI [11.63, 18.19], respectively). Individuals with CUD and nicotine dependence had 27.35 times the odds of having OUD than those with no SUD (95% CI [21.88, 34.19]). Individuals with AUD, CUD, and nicotine dependence had 47.31 times the odds of having OUD compared to individuals with no SUD (95% CI [36.79, 60.83]). A multiplicative effect was present when two or more SUD occurred simultaneously and was greatest when all three occurred at once, which suggests that prevention programs or interventions aimed at OUD should focus on persons with multiple SUDs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Severe Cannabis use is Associated with Complications and Prolonged Length of Stay in Bariatric Surgery.

PURPOSE: In the United States, recreational and medicinal cannabis use has continually increased in recent years, including in patients undergoing bariatric surgery. However, the effects of cannabis use on morbidity and mortality after bariatric surgery are uncertain, and the literature is limited by a paucity of studies. This study intends to evaluate the effects of cannabis use disorder on outcomes in patients undergoing bariatric surgery. MATERIALS AND METHODS: The National Inpatient Sample 2016-2019 was queried for patients ≥ 18 years who underwent roux-en-y gastric bypass (RYGB), vertical sleeve gastrectomy (VSG), or adjustable gastric band (AGB) surgery. Cannabis use disorder was identified using ICD-10 coding. Three outcomes were evaluated: medical complications, in-hospital mortality, and length of stay. Logistic regression was used to evaluate effects of cannabis use disorder on medical complications and in-hospital mortality, and linear regression for length of stay. All models controlled for race, age, sex, income, procedure type, and various medical comorbidities. RESULTS: A total of 713,290 patients were included in this study, with 1,870 (0.26%) having cannabis use disorder. Cannabis use disorder was associated with medical complications (OR: 2.24; 95% CI: 1.31-3.82; P = 0.003) and longer lengths of stay (ß: 1.3; SE: 0.297; P < 0.001), but not in-hospital mortality (OR: 3.29; CI: 0.94-11.5); P = 0.062). CONCLUSIONS: Severe cannabis use was associated with higher risk for complications and extended length of stay. Future investigations are needed to better elucidate the relationship between cannabis use and bariatric surgery, including effects of dosage, chronicity, and method of ingestion.

Current (but not ex) cigarette smoking is associated with worse cognitive performances in schizophrenia: results from the FACE-SZ cohort.

BACKGROUND: Tobacco use is common in subjects with schizophrenia (SZ) and has sometimes been associated with better functioning in short-term studies. Only few studies embrace an extensive examination of tobacco influence on clinical, cognitive and therapeutic characteristics in stabilized SZ outpatients. The objective of the present study was to assess the association between cognitive performances and smoking status in SZ subjects. METHODS: In total, 1233 SZ participants (73.9% men, mean age 31.5) were included and tested with a comprehensive battery. Tobacco status was self-declared (never-, ex-, or current smokers). Multivariable analyses including principal component analyses (PCA) were used. RESULTS: In total, 53.7% were smokers with 33.7% of them nicotine-dependent. Multiple factor analysis revealed that current tobacco smoking was associated with impaired general intellectual ability and abstract reasoning (aOR 0.60, 95% IC 0.41-0.88, p = 0.01) and with a lifetime alcohol use disorder (p = 0.026) and a lifetime cannabis use disorder (p < 0.001). Ex- and never-smokers differed for age, mean outcome, cannabis history and medication [ex-smokers being older (p = 0.047), likely to have higher income (p = 0.026), a lifetime cannabis use disorder (p < 0.001) and higher CPZeq doses (p = 0.005)]. Premorbid IQ in the three groups significantly differed with, from higher to lower: ex-smokers, never-smoker, current smokers (all p < 0.001). CONCLUSIONS: This study is the largest to date providing strong evidence that chronic smoking is associated with cognitive impairment in SZ, arguing against the self-medication hypothesis as a contributor to the high prevalence of smoking in SZ. Ex-smokers may also represent a specific subgroup. Longitudinal studies are warranted to determine the developmental impact of tobacco on neurocognition.

Assessing cognitive behavioral therapy for insomnia in individuals with cannabis use disorder utilizing actigraphy and serum biomarkers: A pilot study.

OBJECTIVE/BACKGROUND: This pilot study aims to assess the effect of Cognitive Behavioral Therapy for insomnia (CBTi) in individuals with cannabis use disorder and insomnia. It also aims to investigate the effect of CBTi on levels of serum inflammatory markers in relation to insomnia symptoms. METHODS/PATIENTS: Individuals with cannabis use disorder and insomnia symptoms were recruited over 18 months. Data collected included demographics, self-reported sleep parameters, and cannabis use. Blood samples were drawn to measure IL-2, IL-6, CRP, and cortisol. Participants completed the Insomnia Severity Index questionnaire (ISI) and the Patient Health Questionnaire-4 (PHQ-4), and they were provided with an actigraphy (wrist) device for 1 week before CBTi and a subsequent week after completing the 4 CBTi sessions. RESULTS: Nineteen participants were enrolled in the study. The mean ISI score decreased from moderately severe insomnia at baseline to no clinically significant insomnia after CBTi with a sustained decrease at 3- and 6-months follow-up. Actigraphy showed a significant decrease in sleep onset latency (SOL) after CBTi. Three months after CBTi, 80% of participants reported a decrease in their cannabis use. There was also a significant and sustained decrease in mean PHQ-4 scores after CBTi. Although only trending towards significance, the levels of three out of four biomarkers (IL-2, IL-6, CRP) were decreased 6 months after CBTi. CONCLUSIONS: CBTi is effective as a short- and long-term treatment of insomnia and comorbid anxiety/depression in individuals who regularly use cannabis. A potential added benefit is a reduction in cannabis consumption and inflammatory serum biomarkers.

Hypertensive Crisis-Related Hospitalizations and Subsequent Major Adverse Cardiac Events in Young Adults with Cannabis Use Disorder: A Nationwide Analysis.

Background and Objectives: With the growing recreational cannabis use and recent reports linking it to hypertension, we sought to determine the risk of hypertensive crisis (HC) hospitalizations and major adverse cardiac and cerebrovascular events (MACCE) in young adults with cannabis use disorder (CUD+). Material and Methods: Young adult hospitalizations (18−44 years) with HC and CUD+ were identified from National Inpatient Sample (October 2015−December 2017). Primary outcomes included prevalence and odds of HC with CUD. Co-primary (in-hospital MACCE) and secondary outcomes (resource utilization) were compared between propensity-matched CUD+ and CUD- cohorts in HC admissions. Results: Young CUD+ had higher prevalence of HC (0.7%, n = 4675) than CUD- (0.5%, n = 92,755), with higher odds when adjusted for patient/hospital-characteristics, comorbidities, alcohol and tobacco use disorder, cocaine and stimulant use (aOR 1.15, 95%CI:1.06−1.24, p = 0.001). CUD+ had significantly increased adjusted odds of HC (for sociodemographic, hospital-level characteristics, comorbidities, tobacco use disorder, and alcohol abuse) (aOR 1.17, 95%CI:1.01−1.36, p = 0.034) among young with benign hypertension, but failed to reach significance when additionally adjusted for cocaine/stimulant use (aOR 1.12, p = 0.154). Propensity-matched CUD+ cohort (n = 4440, median age 36 years, 64.2% male, 64.4% blacks) showed higher rates of substance abuse, depression, psychosis, previous myocardial infarction, valvular heart disease, chronic pulmonary disease, pulmonary circulation disease, and liver disease. CUD+ had higher odds of all-cause mortality (aOR 5.74, 95%CI:2.55−12.91, p < 0.001), arrhythmia (aOR 1.73, 95%CI:1.38−2.17, p < 0.001) and stroke (aOR 1.46, 95%CI:1.02−2.10, p = 0.040). CUD+ cohort had fewer routine discharges with comparable in-hospital stay and cost. Conclusions: Young CUD+ cohort had higher rate and odds of HC admissions than CUD-, with prevalent disparities and higher subsequent risk of all-cause mortality, arrhythmia and stroke.

[Effects of cannabis use on attention and memory in adolescent population: a systematic review.] / Efectos del consumo de cannabis en la atención y la memoria en población adolescente: una revisión sistemática.

OBJECTIVE: Cannabis is an illegal drug whose use has increased in recent years, especially among adolescents. Despite its popularity, its use and abuse brings with it health consequences, being greater if consumption occurs in the adolescent stage, since the brain is in full development. The objective of this systematic review was to determine the effects of cannabis use on cognitive functions of attention and memory in adolescent population. METHODS: A systematic review of the literature was carried out in the main search portals (Pubmed, Web of Science, SciELO, Cochrane) referring to the last 10 years, following the PRISMA criteria. The systematic search strategy was carried out in the period from March to May 2021, applying the PICO method and the PEDro scale to guarantee the methodological quality of the included studies. RESULTS: Both attention and memory are affected by cannabis use; however, memory functions improve with abstinence, not being so for attention. Memory deficits are an indicator of therapeutic abandonment of addiction treatment. In relation to psychosocial interventions aimed at improving memory, the contingency management, educational interventions and motivational interviewing have not been shown to be effective on the effects of substances. Working memory training offers positive results, although not clinically significant. Finally, memory deficits are an indicator of therapeutic abandonment of pharmacological treatment for cannabis addiction. Therefore, research is needed aimed both at reducing the side effects of drugs on memory processes and at establishing to what extent memory deficits associated with cannabis use can facilitate therapeutic abandonment. CONCLUSIONS: More research is necessary, considering the dual consumption of cannabis-tobacco and the effects that both substances may have jointly and separately on attention and memory processes.

OBJETIVO: El cannabis es una droga ilegal cuyo consumo se ha visto incrementado en los últimos años, especialmente en población adolescente. A pesar de su popularidad, su uso y abuso trae consigo consecuencias para la salud, siendo mayores si el consumo se produce en la etapa adolescente, ya que el cerebro se encuentra en pleno desarrollo. El objetivo de esta revisión sistemática fue determinar los efectos del consumo de cannabis en las funciones cognitivas de atención y memoria en población adolescente. METODOS: Se llevó a cabo una revisión sistemática de la literatura en los principales portales de búsqueda (Pubmed, Web of Science, SciELO, Cochrane) referida a los últimos diez años, siguiendo los criterios PRISMA. La estrategia de búsqueda sistemática se realizó en el periodo de tiempo comprendido entre los meses de marzo a mayo de 2021, aplicándose el método PICO y la escala PEDro para garantizar la calidad metodológica de los estudios incluidos. RESULTADOS: Tanto la atención como la memoria se ven afectadas por el consumo de cannabis; sin embargo, la memoria mejora su funcionamiento con la abstinencia, no ocurriendo lo mismo con la atención. Los déficits de memoria son un indicador de abandono terapéutico del tratamiento para la adicción. En relación con las intervenciones psicosociales orientadas a la mejora de la memoria, tanto el manejo de contingencias como las intervenciones educativas y la entrevista motivacional no se han mostrado efectivas sobre los efectos de las sustancias. El entrenamiento en la memoria de trabajo ofrece resultados positivos, aunque clínicamente no significativos. Finalmente, los déficits de memoria son un indicador de abandono terapéutico del tratamiento farmacológico para la adicción al cannabis, por lo que se precisa investigación orientada tanto a reducir los efectos secundarios de los fármacos sobre los procesos mnésicos como a establecer en qué medida los déficits de memoria asociados al consumo de cannabis pueden facilitar el abandono terapéutico. CONCLUSIONES: Se precisa mayor investigación, considerando el consumo dual de cannabis-tabaco y los efectos que ambas sustancias pueden tener, conjuntamente y por separado, sobre los procesos de atención y memoria.

Levels of impulsivity in individuals with cannabis use disorder.

INTRODUCTION: Substance use disorder consists of the presence of cognitive, behavioral, and physiological symptoms, indicating continuous use of one or more substances by the individual. The literature points to the existence of a relationship between impulsive behavior, in which individuals tend to act thoughtlessly and with a lower level of planning, and consumption of substances including cannabis. OBJECTIVES: To examine the presence and severity of impulsivity in individuals with cannabis use disorder and investigate associations between sociodemographic and clinical characteristics and impulsivity. METHOD: Participants completed a sociodemographic data sheet and the Barratt Impulsiveness Scale (BIS-11). A total of 122 subjects with a diagnosis of cannabis use disorder participated, with a mean age of 34.46 years (standard deviation = 9.62). RESULTS: The prevalence of high levels of impulsivity in the sample ranged from 30 to 33%; the BIS-11 total score was significantly associated with cohabitation and alcohol use. The BIS-11 scores for motor impulsivity and attentional impulsivity were also associated with consumption of alcohol. No associations were found between impulsivity and the variables age, education, use of tobacco, or use of cocaine/crack. CONCLUSION: This study contributes to understanding of substance dependence, especially cannabis. It found presence of impulsive behavior among individuals with cannabis use disorder, which is corroborated by reports in the literature.

The Association of Cannabis Use Disorder with Acute Limb Ischemia and Critical Limb Ischemia.

OBJECTIVES: Heavy cannabis use has been associated with the development of acute myocardial infarction and stroke. The objective of this study was to determine if heavy, chronic cannabis use is associated with the development of acute limb ischemia (ALI) or critical limb ischemia (CLI). METHODS: We conducted a retrospective cohort study within the National Inpatient Sample (2006-2015). Patients without cannabis use disorder (CUD) were matched to patients with CUD in a 2:1 ratio using propensity scores. Our primary outcomes were incidence of ALI and CLI. Secondary outcomes included incidence of acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), frequency of open or endovascular interventions, length of stay, and total costs. Sensitivity analyses were performed with alternative models, including in the entire unmatched cohort with regression models utilizing survey weights to account for sampling methodology. RESULTS: We identified a cohort of 46,297 857 unmatched patients. Patients with CUD in the unmatched cohort were younger, with less cardiovascular risk factors, but higher rates of smoking and substance abuse. The matched cohort included 824,856 patients with CUD and 1,610,497 controls. Those with CUD had a higher incidence of ALI (OR 1.20 95% CI: 1.04-1.38 P=.016). Following multiple sensitivity analyses, there was no robust association between CLI and CUD. We observed no robust association of CUD with AMI, CMI, procedures performed, frequency of amputation, costs, or total length of stay. CONCLUSIONS: Cannabis use disorder was associated with a significantly higher incidence of admission for acute limb ischemia. CUD was not associated with an increased risk of critical limb ischemia following sensitivity analysis. Given CUD is often seen in younger, less co-morbid patients it provides an important target for intervention in this population.

Strategies for Prevention or Treatment of Tobacco and Cannabis Use Disorder.

Tobacco and cannabis use in pregnancy are associated with increased adverse perinatal and long-term offspring outcomes. Products for both have evolved with various forms available on the market, challenging accurate counseling of risks and quantification of tobacco and cannabis usage during the perinatal period. Health care providers are recommended to screen for any type of use, provide consistent messaging of harms of tobacco and cannabis use in pregnancy, and offer individualized interventions. The journey to cessation can be complicated by barriers and triggers, lack of social supports, and mental health challenges that should be addressed to prevent relapse and withdrawals.

Long-Term Cannabis Use and Cognitive Reserves and Hippocampal Volume in Midlife.

OBJECTIVE: Cannabis use is increasing among midlife and older adults. This study tested the hypotheses that long-term cannabis use is associated with cognitive deficits and smaller hippocampal volume in midlife, which is important because midlife cognitive deficits and smaller hippocampal volume are risk factors for dementia. METHODS: Participants are members of a representative cohort of 1,037 individuals born in Dunedin, New Zealand, in 1972-1973 and followed to age 45, with 94% retention. Cannabis use and dependence were assessed at ages 18, 21, 26, 32, 38, and 45. IQ was assessed at ages 7, 9, 11, and 45. Specific neuropsychological functions and hippocampal volume were assessed at age 45. RESULTS: Long-term cannabis users showed IQ decline from childhood to midlife (mean=-5.5 IQ points), poorer learning and processing speed relative to their childhood IQ, and informant-reported memory and attention problems. These deficits were specific to long-term cannabis users because they were either not present or were smaller among long-term tobacco users, long-term alcohol users, midlife recreational cannabis users, and cannabis quitters. Cognitive deficits among long-term cannabis users could not be explained by persistent tobacco, alcohol, or other illicit drug use, childhood socioeconomic status, low childhood self-control, or family history of substance dependence. Long-term cannabis users showed smaller hippocampal volume, but smaller hippocampal volume did not statistically mediate cannabis-related cognitive deficits. CONCLUSIONS: Long-term cannabis users showed cognitive deficits and smaller hippocampal volume in midlife. Research is needed to ascertain whether long-term cannabis users show elevated rates of dementia in later life.