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1.
Subst Abuse Treat Prev Policy ; 17(1): 36, 2022 05 08.
Artículo en Inglés | MEDLINE | ID: mdl-35527269

RESUMEN

BACKGROUND: Approximately 3.8% of adults worldwide have used cannabis in the past year. Understanding how cannabis use is associated with other health conditions is crucial for healthcare providers seeking to understand the needs of their patients, and for health policymakers. This paper analyzes the relationship between documented cannabis use disorders (CUD), cannabis use (CU) and other health diagnoses among primary care patients during a time when medical use of marijuana was permitted by state law in California, United States of America. METHODS: The study utilized primary care electronic health record (EHR) data from an academic health system, using a case-control design to compare diagnoses among individuals with CUD/CU to those of matched controls, and those of individuals with CUD diagnoses with individuals who had CU otherwise documented. Associations of documented CU and CUD with general medical conditions and health conditions associated with cannabis use (both medical and behavioral) were analyzed using conditional logistic regression. RESULTS: Of 1,047,463 patients with ambulatory encounters from 2013-2017, 729 (0.06%) had CUD diagnoses and 3,731 (0.36%) had CU documented in their EHR. Patients with documented CUD and CU patients had significantly (p < 0.01) higher odds of most medical and behavioral diagnoses analyzed. Compared to matched controls, CUD-documented patients had highest odds of other substance use disorders (OR = 21.44: 95% CI 9.43-48.73), any mental health disorder (OR = 6.99; 95% CI 5.03-9.70) social anxiety disorder (OR = 13.03; 95% CI 2.18-77.94), HIV/AIDS (OR = 7.88: 95% CI 2.58-24.08), post-traumatic stress disorder (OR = 7.74: 95% CI 2.66-22.51); depression (OR = 7.01: 95% CI 4,79-10.27), and bipolar disorder (OR = 6.49: 95% CI 2.90-14.52). Compared to matched controls, CU-documented patients had highest odds of other substance use disorders (OR = 3.64; 95% CI 2.53-5.25) and post-traumatic stress disorder (OR = 3.41; 95% CI 2.53-5.25). CUD-documented patients were significantly more likely than CU-documented patients to have HIV/AIDS (OR = 6.70; 95% CI 2.10-21.39), other substance use disorder (OR = 5.88; 95% CI 2.42-14.22), depression (OR = 2.85; 95% CI 1.90-4.26), and anxiety (OR = 2.19: 95% CI 1.57-3.05) diagnoses. CONCLUSION: The prevalence of CUD and CU notation in EHR data from an academic health system was low, highlighting the need for improved screening in primary care. CUD and CU documentation were associated with increased risk for many health conditions, with the most elevated risk for behavioral health disorders and HIV/AIDS (among CUD-documented, but not CU-documented patients). Given the strong associations of CUD and CU documentation with health problems, it is important for healthcare providers to be prepared to identify CU and CUD, discuss the pros and cons of cannabis use with patients thoughtfully and empathically, and address cannabis-related comorbidities among these patients.


Asunto(s)
Cannabis , Infecciones por VIH , Abuso de Marihuana , Marihuana Medicinal , Trastornos Relacionados con Sustancias , Adulto , Estudios de Casos y Controles , Comorbilidad , Cobre , Registros Electrónicos de Salud , Infecciones por VIH/epidemiología , Humanos , Abuso de Marihuana/epidemiología , Marihuana Medicinal/uso terapéutico , Atención Primaria de Salud , Trastornos Relacionados con Sustancias/epidemiología , Estados Unidos
2.
Forensic Sci Int ; 335: 111309, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35462181

RESUMEN

Cannabis cultivation for medical purposes in Brazil has been increased in the last years. While cannabis crops are prohibited, hundreds patients have been granted with judicial authorizations and there is little information about the cultivation conditions, yields and chemical profiles of the plants. Cannabis plants contain hundreds of compounds, with cannabinoids and terpenes the main drivers of their toxicological and pharmacological properties. Besides the cannabinoids, terpene contents are useful for the chemotaxonomic classification of different varieties, and their role in forensic analyses should be further delineated. The present study monitored cannabis crops of fifteen participants who were granted special licenses by the Brazilian Courts in Rio de Janeiro and São Paulo. The cultivation conditions were monitored and five cannabinoids (tetrahydrocannabinol acid-THCA, tetrahydrocannabinol-THC, cannabidiolic acid-CBDA, cannabidiol-CBD and cannabinol-CBN) and nineteen terpenes were quantified in cannabis flowers. The total grow cycle of thirty-five cannabis plants ranged from 10 to 24 weeks. The dry flower yields ranged 22-90 g per plant. Most cannabis specimens were CBD-rich varieties (CBD levels from 1.6% to 16.7%, and THC levels from 0.0% to 2.6%, n = 22) used to treat epileptic patients. The THC-rich varieties contained CBD levels ranging from 0.03% to 0.8%, and THC levels from 0.7% to 20.1%, n = 11. Fewer of the samples contained THC:CBD ratios of approximately 1:1 (CBD levels of 3.3-3.8% and THC levels of 2.2-3.7%, n = 2). The most abundant terpenes in the cannabis flowers were beta-caryophyllene, alpha-humulene, guaiol and alpha-bisabolol. CBD-rich varieties showed significant higher levels of beta-caryophyllene and alpha-humulene in comparison with THC-rich varieties. Overall, the study herein provides data concerning medical cannabis crops grown in a region of Brazil that not only guide individual medical cannabis cultivation methods but also aid forensic analyses.


Asunto(s)
Cannabidiol , Cannabinoides , Cannabis , Alucinógenos , Marihuana Medicinal , Analgésicos , Brasil , Cannabinoides/análisis , Cannabinol/análisis , Cannabis/química , Dronabinol/análisis , Humanos , Terpenos
3.
Curr Rheumatol Rep ; 24(5): 119-131, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35486218

RESUMEN

PURPOSE OF REVIEW: Changing attitudes about marijuana have led to an increase in use of medicinal marijuana, especially for painful chronic conditions. Patients ask rheumatologists for guidance on this topic. This review provides up-to-date information on the safety and efficacy of medicinal cannabis for rheumatic disease pain. RECENT FINDINGS: The number of publications related to rheumatic disease and cannabis has increased, but recent literature skews heavily toward reviews vs primary research. Data supporting a role for cannabinoids in rheumatic disease continue to grow. Observational and survey studies show increased use of medicinal cannabis, both by people with rheumatic disease and the general population, and suggest that patients find these treatments beneficial. Prospective studies, however, including randomized controlled clinical trials, are rare and sorely needed. As medicinal cannabis use for rheumatic diseases rises, despite lack of evidence, we review the sparse data available and provide tips for conversations about medicinal cannabis for rheumatologists.


Asunto(s)
Cannabis , Dolor Crónico , Marihuana Medicinal , Dolor Musculoesquelético , Enfermedades Reumáticas , Analgésicos/uso terapéutico , Dolor Crónico/tratamiento farmacológico , Dolor Crónico/etiología , Humanos , Marihuana Medicinal/uso terapéutico , Estudios Prospectivos , Enfermedades Reumáticas/tratamiento farmacológico
4.
BMC Public Health ; 22(1): 671, 2022 04 06.
Artículo en Inglés | MEDLINE | ID: mdl-35387635

RESUMEN

BACKGROUND: Within the United States (US), because racial/ethnic disparities in cannabis arrests continue, and cannabis legalization is expanding, understanding disparities in availability of legal cannabis services is important. Few studies report mixed findings regarding disparities in availability of legal cannabis services; none examined New York. We examined disparities in availability of medical cannabis services in New York. We hypothesized that New York census tracts with few Black or Hispanic residents, high incomes, high education levels, and greater urbanicity would have more medical cannabis services. METHODS: In this cross-sectional study, we used data from the 2018 US Census Bureau 5-year American Community Survey and New York Medical Marijuana Program. Main exposures were census tract characteristics, including urban-rural classification, percentage of Black and Hispanic residents, percentage of residents with bachelor's degrees or higher, and median household income. Main outcomes were presence of at least one medical cannabis certifying provider and dispensary in each census tract. To compare census tracts' characteristics with (vs. without) certifying providers and dispensaries, we used chi-square tests and t-tests. To examine characteristics independently associated with (vs. without) certifying providers, we used multivariable logistic regression. RESULTS: Of 4858 New York census tracts, 1073 (22.1%) had medical cannabis certifying providers and 37 (0.8%) had dispensaries. Compared to urban census tracts, suburban census tracts were 62% less likely to have at least one certifying provider (aOR = 0.38; 95% CI = 0.25-0.57). For every 10% increase in the proportion of Black residents, a census tract was 5% less likely to have at least one certifying provider (aOR = 0.95; 95% CI = 0.92-0.99). For every 10% increase in the proportion of residents with bachelor's degrees or higher, a census tract was 30% more likely to have at least one certifying provider (aOR = 1.30; 95% CI = 1.21-1.38). Census tracts with (vs. without) dispensaries were more likely to have a higher percentage of residents with bachelor's degrees or higher (43.7% vs. 34.1%, p < 0.005). CONCLUSIONS: In New York, medical cannabis services are least available in neighborhoods with Black residents and most available in urban neighborhoods with highly educated residents. Benefits of legal cannabis must be shared by communities disproportionately harmed by illegal cannabis.


Asunto(s)
Cannabis , Marihuana Medicinal , Estudios Transversales , Humanos , Marihuana Medicinal/uso terapéutico , New York , Características de la Residencia , Estados Unidos
5.
Asian Pac J Cancer Prev ; 23(4): 1309-1314, 2022 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-35485690

RESUMEN

OBJECTIVE: Cannabis is therapeutic for numerous medical conditions. The demand for medical cannabis (MC) use in cancer patients is increasing, even with many patients lacking proper knowledge about MC. Therefore, this study aimed to describe the attitudes and beliefs of cancer patients demanding MC use in northern Thailand. METHODS: This cross-sectional study administered multistage random sampling to recruit 565 cancer patients who indicated that they demand MC use in northern Thailand. These patients responded to a self-administered structured questionnaire about their feelings on MC. We used descriptive statistics, including frequency and percentage, to describe categorical data, whereas we used mean and standard deviation for continuous data. RESULTS: Out of a total of 565 participants, 59.7% were female, 40.3% were male, and 46.4% were middle-aged adults, with a mean age of 58.3 ± 13.0 years. Of these participants who demanded the use of MC, the top three most common types of cancers were breast cancer (27.8%), colorectal cancer (21.4%), and lung cancer (10.6%). Most of the participants (51.2%) had early-stage cancer, and 46.5% received chemotherapy. We found that patients who demanded MC use had a generally positive attitude (53.3%). Among the patients who required MC use, 55.4% believed that it would help relieve side effects caused by modern treatments, cure cancer (38.8%), relieve suffering from cancer symptoms (30.6%), and cause one to live longer and to improve their health (16.3%). Most patients' decisions regarding MC use (45.3%) demanded MC use after receiving modern treatments, and 95.6% demanded MC use with modern treatment. Overall, these patients (65.3%) needed MC from the MC clinic in the Government Hospital. CONCLUSIONS: This study highlights the attitudes and beliefs towards MC use among cancer patients, their positive expectations of the outcome, and the need for MC use.


Asunto(s)
Cannabis , Marihuana Medicinal , Neoplasias , Adulto , Anciano , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Marihuana Medicinal/uso terapéutico , Persona de Mediana Edad , Neoplasias/tratamiento farmacológico , Tailandia
6.
MMW Fortschr Med ; 164(Suppl 6): 29-34, 2022 04.
Artículo en Alemán | MEDLINE | ID: mdl-35449489

RESUMEN

BACKGROUND: It is known from medical practise that patients and physicians can have positive experiences with little-researched and unapproved interventions. Under certain circumstances, effects even go beyond the placebo effect. METHOD: Based on casuistics of chronic pain patients, the question of whether self-medication in the context of a good doctor-patient relationship can optimize the efficacy of cannabinoids and reduce dose and undesirable side effects is investigated. Using medicinal cannabis as an example, a new view on self-medication and medical support is proposed. RESULTS: The casuistics show that daily requirements (average of approximately 75 mg) for Δ9tetrahydocannabinol (THC) doses can be reduced. An unaccompanied and risky self-medication can be transformed into an effective therapy with significantly less medical cannabis. The approach consists of tracing the self-medication that has taken place to date and picking up the patient where he has "discovered" something for himself. The specific mode of action of cannabis in chronic diseases can be explained by mechanisms in the endocannabinoid system. Cannabinoids relieve patients in the context of stress, anxiety and depression, which are always involved in chronic diseases. In their physical as well as psychological sensations, patients are strengthened and eventually guided into self-efficacy. CONCLUSIONS: If the patient has "discovered" cannabis as medicine for himself and can draw on positive experiences, something very powerful can emerge. In addition to the specific effects demonstrated by studies, there are non-specific effects or contextual factors at work that tend to be neglected in evidence-based medicine. These non-specific effects include, above all, those factors through which a patient gives a (subjective) meaning to a specific intervention. A new view on self-medication and medical support in chronic diseases is needed.


Asunto(s)
Cannabinoides , Cannabis , Epilepsia , Marihuana Medicinal , Analgésicos , Cannabinoides/uso terapéutico , Enfermedad Crónica , Epilepsia/inducido químicamente , Epilepsia/tratamiento farmacológico , Humanos , Masculino , Marihuana Medicinal/uso terapéutico , Relaciones Médico-Paciente
7.
MMW Fortschr Med ; 164(8): 64, 2022 04.
Artículo en Alemán | MEDLINE | ID: mdl-35449287
8.
MMW Fortschr Med ; 164(Suppl 1): 65, 2022 04.
Artículo en Alemán | MEDLINE | ID: mdl-35359296
9.
J Drugs Dermatol ; 21(4): 413-419, 2022 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-35389585

RESUMEN

BACKGROUND: Data to date supports the potential for targeting the cutaneous endocannabinoid system to treat eczematous dermatoses. However, our understanding of patient knowledge and utilization of cannabis/cannabis-derived products as treatments for eczema is limited, highlighting both a gap and opportunity to engage with the eczema community. METHODS: An online survey assessing the use, knowledge, and attitudes of a broad scope of cannabis product types was advertised by the National Eczema Association (NEA) via social media and NEA network dissemination. RESULTS: Of 76 respondents to the survey, 69 (90.79%) were individuals diagnosed with eczema, 7 (9.21%) were primary caregivers of a dependent diagnosed with eczema. Respondents most frequently used OTC products purchased without recommendation from a dermatologist (22 [36.07%], n=61) and least frequently used medical cannabis recommended by a dermatologist (2 [3.12%], n=64). All respondents supported medical cannabis use (50 [100%], n=50) and most respondents (47 [94%], n=50) would be comfortable seeing a dermatologist who recommended medical cannabis. 94% of respondents (47, n=50) would be interested in learning about using medical cannabis for treatment of eczema, but most had never discussed this topic with their healthcare provider (54 [93.10%], n=58). 46.67% of respondents (28, n=60) were unsure if OTC cannabis-derived products were regulated by the FDA. CONCLUSION: Eczema patients are open to learning about cannabinoids and many are already using OTC products. As both consumer interest/use and the cannabis industry continue to outpace medical research and guidelines, dermatologists need to be prepared to counsel patients on cannabinoid applications in dermatology. J Drugs Dermatol. 2022;21(4):413-419. doi:10.36849/JDD.6615.


Asunto(s)
Cannabinoides , Cannabis , Eccema , Marihuana Medicinal , Actitud , Cannabinoides/uso terapéutico , Eccema/tratamiento farmacológico , Humanos , Marihuana Medicinal/uso terapéutico , Medicamentos sin Prescripción/uso terapéutico
10.
Mult Scler Relat Disord ; 59: 103638, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35382939

RESUMEN

BACKGROUND: The extent of medical cannabis use by people with multiple sclerosis (MS) in Canada has not been evaluated for more than a decade since recreational cannabis was legalized. Legalization provided an avenue for those to whom legal cannabis was previously inaccessible to access it as an alternative therapy. Our objective was to evaluate the prevalence of medical cannabis use by Canadians with MS, the reasons it is used, adverse effects, as well as the context surrounding how it is obtained and where users learned about it. METHODS: An anonymous questionnaire was distributed to prospective participants through various channels. The questionnaire included questions about participant characteristics and quality of life, their MS, and their medical cannabis use. It also employed two validated patient-reported outcome measures, the PDDS and the MSQOL-54. RESULTS: Completed questionnaires were submitted by 344 individuals. Among respondents, 215/344 (64.5%) reported having used medical cannabis at least once, and 180 (52.3%) reported still currently using it. Based on disease and quality of life data, we found that respondents with more severe or progressive forms of MS were more likely to have tried medical cannabis. Medical cannabis was used most by current and former users to treat sleep problems (84.2%), pain (80.0%), and spasticity (68.4%), while the most reported adverse effects were drowsiness (57.2%), feeling quiet/subdued (48.8%), and difficulty concentrating (28.4%). Most current and former users obtained their cannabis from a legal, reliable source (76.1%) and many (74%) learned about medical cannabis from someone other than a healthcare provider. CONCLUSIONS: This study showed that nearly two-thirds of survey respondents, comprised of Canadians living with MS, have tried medical cannabis at least once and that those with a greater disease burden were more likely to have tried it. Users reported that cannabis is moderately to highly effective in treating several symptoms and that adverse effects are not generally severe, nor are they the main factor driving medical cannabis cessation. Our results support the need for more research examining medical cannabis use in MS and for evidence-based resources to be publicly available for those exploring it as a potential therapy.


Asunto(s)
Cannabis , Marihuana Medicinal , Esclerosis Múltiple , Canadá/epidemiología , Estudios Transversales , Humanos , Marihuana Medicinal/efectos adversos , Esclerosis Múltiple/tratamiento farmacológico , Esclerosis Múltiple/epidemiología , Estudios Prospectivos , Calidad de Vida
11.
JAMA Netw Open ; 5(3): e222106, 2022 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-35302633

RESUMEN

Importance: Despite the legalization and widespread use of cannabis products for a variety of medical concerns in the US, there is not yet a strong clinical literature to support such use. The risks and benefits of obtaining a medical marijuana card for common clinical outcomes are largely unknown. Objective: To evaluate the effect of obtaining a medical marijuana card on target clinical and cannabis use disorder (CUD) symptoms in adults with a chief concern of chronic pain, insomnia, or anxiety or depressive symptoms. Design, Setting, and Participants: This pragmatic, single-site, single-blind randomized clinical trial was conducted in the Greater Boston area from July 1, 2017, to July 31, 2020. Participants were adults aged 18 to 65 years with a chief concern of pain, insomnia, or anxiety or depressive symptoms. Participants were randomized 2:1 to either the immediate card acquisition group (n = 105) or the delayed card acquisition group (n = 81). Randomization was stratified by chief concern, age, and sex. The statistical analysis followed an evaluable population approach. Interventions: The immediate card acquisition group was allowed to obtain a medical marijuana card immediately after randomization. The delayed card acquisition group was asked to wait 12 weeks before obtaining a medical marijuana card. All participants could choose cannabis products from a dispensary, the dose, and the frequency of use. Participants could continue their usual medical or psychiatric care. Main Outcomes and Measures: Primary outcomes were changes in CUD symptoms, anxiety and depressive symptoms, pain severity, and insomnia symptoms during the trial. A logistic regression model was used to estimate the odds ratio (OR) for CUD diagnosis, and linear models were used for continuous outcomes to estimate the mean difference (MD) in symptom scores. Results: A total of 186 participants (mean [SD] age 37.2 [14.4] years; 122 women [65.6%]) were randomized and included in the analyses. Compared with the delayed card acquisition group, the immediate card acquisition group had more CUD symptoms (MD, 0.28; 95% CI, 0.15-0.40; P < .001); fewer self-rated insomnia symptoms (MD, -2.90; 95% CI, -4.31 to -1.51; P < .001); and reported no significant changes in pain severity or anxiety or depressive symptoms. Participants in the immediate card acquisition group also had a higher incidence of CUD during the intervention (17.1% [n = 18] in the immediate card acquisition group vs 8.6% [n = 7] in the delayed card acquisition group; adjusted odds ratio, 2.88; 95% CI, 1.17-7.07; P = .02), particularly those with a chief concern of anxiety or depressive symptoms. Conclusions and Relevance: This randomized clinical trial found that immediate acquisition of a medical marijuana card led to a higher incidence and severity of CUD; resulted in no significant improvement in pain, anxiety, or depressive symptoms; and improved self-rating of insomnia symptoms. Further investigation of the benefits of medical marijuana card ownership for insomnia and the risk of CUD are needed, particularly for individuals with anxiety or depressive symptoms. Trial Registration: ClinicalTrials.gov Identifier: NCT03224468.


Asunto(s)
Marihuana Medicinal , Trastornos del Inicio y del Mantenimiento del Sueño , Adolescente , Adulto , Anciano , Femenino , Humanos , Marihuana Medicinal/uso terapéutico , Persona de Mediana Edad , Trastornos del Humor , Propiedad , Dolor/tratamiento farmacológico , Método Simple Ciego , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológico , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Adulto Joven
12.
Int J Drug Policy ; 103: 103648, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35325638

RESUMEN

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.


Asunto(s)
COVID-19 , Cannabis , Alucinógenos , Marihuana Medicinal , COVID-19/epidemiología , Cannabis/efectos adversos , Comunicación , Humanos , Israel/epidemiología , Medios de Comunicación de Masas , Tabaco , Uso de Tabaco
13.
CMAJ Open ; 10(1): E196-E202, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35292477

RESUMEN

BACKGROUND: The use of cannabis for medical purposes by pediatric patients is expanding across Canada; however, supporting evidence, federal regulations and treatment guidelines are lacking. To understand factors affecting treatment decisions in this landscape, we sought to delineate clinician perspectives, ethics priorities and values for cannabis authorization. METHODS: We sampled participants purposefully through Canadian Childhood Cannabinoid Clinical Trials listservs, which include the majority of pediatric oncologists and palliative care physicians practising in Canada, among many other pediatric physicians and clinicians. Inclusion criteria were being a practising clinician in Canada, involvement in the care of children and willingness to be interviewed regardless of stance on medical cannabis. In November and December 2020, we conducted semistructured interviews focusing on principles, values and priorities, including medical, professional, regulatory, evidentiary and social considerations, for authorizing medical cannabis to children. Interviews were recorded, transcribed and analyzed by means of deductive and inductive thematic methods. RESULTS: We conducted 18 interviews with a diverse group of clinicians representing a range of specialties within pediatric care, including neurology, palliative care, oncology, family medicine and pharmacology. The interviews yielded 4 themes and 12 subthemes related to a priori (medical, professional, regulatory, evidentiary and social themes) and emergent themes. The 4 themes of access, relationships and relational autonomy (autonomy within relationships), medically appropriate use and research priorities were grounded in principles of harm reduction. Participants described problematic authorization procedures that negatively affect patient use. Principles associated with relational autonomy were highlighted as a feature of open clinical communication. Benefits of appropriate medical uses weighed positively over risks, even in the context of potential effects on neurodevelopment. Participants expressed that more research is essential to align medical cannabis with biomedical standards. INTERPRETATION: Clinicians reported pursuing ethical use of medical cannabis for pediatric patients and prioritizing their safety under principles of harm reduction. There is a need for evidence about neurodevelopmental risks, support for research, treatment guidelines and greater knowledge about stakeholder perspectives to alleviate burdens related to use of medical cannabis for pediatric patients in Canada.


Asunto(s)
Marihuana Medicinal , Médicos , Adolescente , Canadá/epidemiología , Niño , Comunicación , Humanos , Marihuana Medicinal/uso terapéutico , Investigación Cualitativa
14.
J Palliat Med ; 25(5): 802-806, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35319304

RESUMEN

Introduction: Our academic ambulatory palliative care program has counseled, monitored, and certified patients for cannabis as part of routine palliative care practice for six years. Objective: We describe the population certified for cannabis and policies, procedures, and medicolegal challenges in our palliative care clinic. Methods: We performed a retrospective review of patients, qualifying diagnoses for cannabis certification, reasons for referral, and number of annual certifications. Results: Between 2015 and 2021, we certified 1711 patients for cannabis. The most common indications were cancer (64%), pain (24%), and neuropathy (9%). Other three months in 2021, 28% of new referrals to our practice were certified for cannabis and 15% of patients were referred explicitly for cannabis certification. Conclusion: Despite legal and practical challenges to implementing a medical cannabis program, our palliative care program has fully integrated cannabis as part of our standard outpatient clinical practice.


Asunto(s)
Alucinógenos , Enfermería de Cuidados Paliativos al Final de la Vida , Marihuana Medicinal , Analgésicos , Humanos , Marihuana Medicinal/uso terapéutico , Cuidados Paliativos , Políticas , Derivación y Consulta
16.
Drug Alcohol Depend ; 234: 109388, 2022 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-35316689

RESUMEN

BACKGROUND: Mood, sleep and pain problems are common comorbidities among treatment-seeking cannabis-dependent patients. There is limited evidence suggesting treatment for cannabis dependence is associated with their improvement. This study explored the impact of cannabis dependence treatment on these comorbidities. METHODS: This is a secondary analysis from a 12-week double-blind placebo-controlled trial testing the efficacy of a cannabis agonist (nabiximols) against placebo in reducing illicit cannabis use in 128 cannabis-dependent participants. Outcome measurements including DASS-21 (Depression, Anxiety, and Stress subscales); Insomnia Severity Index (ISI); and Brief Pain Inventory (BPI), were performed at weeks 0, 4, 8, 12 and 24. Each was analysed as continuous outcomes and as binary cases based on validated clinical cut-offs. RESULTS: Among those whose DASS and ISI scores were in the moderate to severe range at baseline, after controlling for cannabis use, there was a gradual decrease in severity of symptoms over the course of the trial. BPI decreased significantly until week 12 and then rose again in the post-treatment period during weeks 12-24. Neither pharmacotherapy type (nabiximols vs placebo) nor number of counselling sessions contributed significant explanatory power to any of the models and were excluded from the final analyses for both continuous and categorical outcomes. CONCLUSIONS: Participants in this trial who qualified as cases at baseline had elevated comorbidity symptoms. There was no evidence that nabiximols treatment is a barrier to achieving reductions in the comorbid symptoms examined. Cannabis dependence treatment reduced illicit cannabis use and improved comorbidity symptoms, even when complete abstinence was not achieved.


Asunto(s)
Cannabis , Alucinógenos , Abuso de Marihuana , Marihuana Medicinal , Analgésicos/uso terapéutico , Cannabidiol , Agonistas de Receptores de Cannabinoides/uso terapéutico , Comorbilidad , Método Doble Ciego , Dronabinol , Combinación de Medicamentos , Alucinógenos/uso terapéutico , Humanos , Abuso de Marihuana/terapia , Marihuana Medicinal/uso terapéutico , Dolor/tratamiento farmacológico , Sueño , Resultado del Tratamiento
17.
J Addict Nurs ; 33(1): 45-50, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35230060

RESUMEN

ABSTRACT: The past 2 years has been a challenge as society made huge adaptations to keep people safe from COVID-19 and struggled to continue life on a day-to-day basis. Working with families, young adults, and adolescents, nurses are often faced with caring for individuals who recreationally use cannabis and believe use is harmless. Adolescents as a group tend to appraise information from a different lens than adults. In an evolving world, where cannabis is legalized for medicinal and recreational use, it is important to shift the paradigm of how we approach cannabis use in adolescents. This article will focus on COVID-19's impact on cannabis use in adolescents and apply the transtheoretical model of change to promote safer choices while supporting adolescent autonomy. In addition, we will incorporate behavioral health strategies to reduce risks of cannabis use by equipping adolescents with guidelines, boundaries, and tools.


Asunto(s)
COVID-19 , Cannabis , Marihuana Medicinal , Adolescente , Humanos , Conducta de Reducción del Riesgo , SARS-CoV-2 , Adulto Joven
18.
Subst Abus ; 43(1): 917-924, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35254218

RESUMEN

Background: Most states have legalized medical cannabis, yet little is known about how medical cannabis use is documented in patients' electronic health records (EHRs). We used natural language processing (NLP) to calculate the prevalence of clinician-documented medical cannabis use among adults in an integrated health system in Washington State where medical and recreational use are legal. Methods: We analyzed EHRs of patients ≥18 years old screened for past-year cannabis use (November 1, 2017-October 31, 2018), to identify clinician-documented medical cannabis use. We defined medical use as any documentation of cannabis that was recommended by a clinician or described by the clinician or patient as intended to manage health conditions or symptoms. We developed and applied an NLP system that included NLP-assisted manual review to identify such documentation in encounter notes. Results: Medical cannabis use was documented for 16,684 (5.6%) of 299,597 outpatient encounters with routine screening for cannabis use among 203,489 patients seeing 1,274 clinicians. The validated NLP system identified 54% of documentation and NLP-assisted manual review the remainder. Language documenting reasons for cannabis use included 125 terms indicating medical use, 28 terms indicating non-medical use and 41 ambiguous terms. Implicit documentation of medical use (e.g., "edible THC nightly for lumbar pain") was more common than explicit (e.g., "continues medical cannabis use"). Conclusions: Clinicians use diverse and often ambiguous language to document patients' reasons for cannabis use. Automating extraction of documentation about patients' cannabis use could facilitate clinical decision support and epidemiological investigation but will require large amounts of gold standard training data.


Asunto(s)
Marihuana Medicinal , Procesamiento de Lenguaje Natural , Adolescente , Adulto , Documentación , Humanos , Marihuana Medicinal/uso terapéutico , Medición de Resultados Informados por el Paciente , Atención Primaria de Salud
19.
Artículo en Inglés | MEDLINE | ID: mdl-35270462

RESUMEN

The rising popularity of medical marijuana and its potential therapeutic uses has resulted in passionate discussions that have mainly focused on its possible benefits and applications. Although the concept itself seems promising, the multitude of presented information has noticeable ramifications-terminological chaos being one. This work aimed to synthesize and critically analyze scientific evidence on the therapeutic uses of cannabinoids in the field of psychiatry. Emphasis was placed on the anxiolytic effects of cannabis constituents and their effects on post-traumatic stress disorder, anxiety disorders, schizophrenia spectrum, and other psychotic disorders. The review was carried out from an addictological perspective. A database search of interchangeably combined keywords resulted in the identification of subject-related records. The data were then analyzed in terms of relevance, contents, methodologies, and cited papers. The results were clear in supporting one common conclusion: while most findings provide support for beneficial applications of medical marijuana in psychiatry, no certain conclusions can be drawn until larger-scaled, more methodologically rigorous, and (preferably) controlled randomized trials verify these discoveries.


Asunto(s)
Cannabinoides , Cannabis , Marihuana Medicinal , Trastornos por Estrés Postraumático , Trastornos de Ansiedad/tratamiento farmacológico , Cannabinoides/uso terapéutico , Humanos , Marihuana Medicinal/uso terapéutico
20.
Eur Rev Med Pharmacol Sci ; 26(4): 1224-1234, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35253178

RESUMEN

OBJECTIVE: Chronic pain is one of the most common medical conditions in developed countries. The 2020 Italian National Report on Medicines shows how, in the last years, there was a light but constant increase in the prescription of pain medications. The purpose of our study was to assess the effects of long-term cannabis-based oil consumption on the distribution of patients with analgesics prescriptions for chronic pain in a Pain Medicine Unit in Northern Italy. PATIENTS AND METHODS: This is a retrospective, observational study in which patients treated with long-term medical cannabis-based oils, followed between June 2016 and July 2019, were enrolled. The effects of cannabis-based oil consumption on the distribution of patients with pain medications, before and after its long-term use, were evaluated with a Related Samples McNemar Test. Subgroups analyses were performed based on sex, age, comorbidity, duration of cannabis treatment, and condition driving cannabis prescription. RESULTS: A significant difference in opioid non-users after a long-term cannabis-based oil therapy was identified (from 32.1% to 55.4%, p = 0.0023), while no significant differences were found in the distribution of anticonvulsant, antidepressant, and benzodiazepine users. A high benzodiazepine use prevalence was revealed, while subgroup analyses showed increased antidepressant use in people over 65 years old (from 93.7% to 56.2%; p = 0.0313). CONCLUSIONS: Pain medication patterns of prescribing show how necessary it is to improve prescription practices among chronic pain patients. Opioid-sparing medications represent a crucial aspect of the pain treatment process, along with deprescribing protocols. Clinicians and clinical pharmacologists must cooperate to meet the need of a guide that can represent the most possible appropriate therapy for these patients.


Asunto(s)
Cannabis , Dolor Crónico , Marihuana Medicinal , Anciano , Analgésicos/uso terapéutico , Analgésicos Opioides/uso terapéutico , Benzodiazepinas/uso terapéutico , Agonistas de Receptores de Cannabinoides , Dolor Crónico/tratamiento farmacológico , Humanos , Marihuana Medicinal/uso terapéutico , Aceites/uso terapéutico
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