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Conflicting forces in the implementation of medicinal cannabis regulation in Uruguay. 在乌拉圭实施药用大麻管制方面的冲突力量。
Pub Date : 2023-07-12 DOI: 10.1186/s42238-023-00189-6
Eliana Alvarez, Rosario Queirolo, Belen Sotto

Background: Uruguay is widely known as a pioneer country regarding cannabis regulation policies, as it was the first state to regulate the cannabis market for both recreational and medicinal purposes in 2013. However, not all aspects of the regulation have moved forward at the same speed. Medicinal uses keep facing several challenges that undermine patients' effective access to treatments and products. What are those persistent challenges for the medicinal cannabis policy in Uruguay? This paper aims to describe and understand the current state of medicinal cannabis in the country and identify the most critical challenges and conflicting forces for its proper implementation.

Methods: To do so, we conduct twelve in-depth interviews with key informants, including governments officials, activists, entrepreneurs, researchers, and doctors. These interviews are complemented with information from the congressional committees' public records and other documentary sources.

Results: This research shows that the legal framework was thought to assure quality products over access. The main challenges of medicinal cannabis in Uruguay are related to three issues: (i) the timid development of the industry, (ii) a limited and expensive supply, and (iii) the emergence of an informal productive sector.

Conclusions: The political decisions regarding medicinal cannabis made in the last seven years have derived from a halfway policy that fails to guarantee patient access or promote the growth of a vibrant national industry. Positively, the several actors involved are aware of the extent of these challenges and new decisions have been made to overcome them, meaning that monitoring the future of the policy is very much needed.

背景:乌拉圭是众所周知的大麻监管政策的先驱国家,因为它是2013年第一个对娱乐和药用大麻市场进行监管的国家。然而,监管的各个方面并没有以同样的速度推进。医药用途一直面临着一些挑战,这些挑战破坏了患者有效获得治疗和产品的机会。乌拉圭医用大麻政策面临的持续挑战是什么?本文旨在描述和了解该国药用大麻的现状,并确定其适当实施的最关键挑战和冲突力量。方法:为此,我们对包括政府官员、活动家、企业家、研究人员和医生在内的关键线人进行了12次深度访谈。这些采访还补充了国会委员会的公共记录和其他文件来源的信息。结果:本研究表明,法律框架被认为是保证高质量的产品超过访问。乌拉圭医用大麻面临的主要挑战与三个问题有关:(i)工业发展缓慢;(ii)供应有限且价格昂贵;(iii)非正式生产部门的出现。结论:在过去七年中,有关医用大麻的政治决定源于一项中途政策,未能保证患者获得或促进一个充满活力的民族产业的增长。积极的方面是,有关的几个行动者认识到这些挑战的程度,并作出了克服这些挑战的新决定,这意味着非常需要监测政策的未来。
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引用次数: 0
Cannabis sativa demonstrates anti-hepatocellular carcinoma potentials in animal model: in silico and in vivo studies of the involvement of Akt. 大麻在动物模型中显示出抗肝细胞癌的潜力:关于 Akt 参与的硅学和体内研究。
Pub Date : 2023-07-12 DOI: 10.1186/s42238-023-00190-z
Dorcas I Akinloye, Damilohun S Metibemu, Mujidat T Shittu, Mariam A Lawal, Faith O Olatunji, Muideen A Oyediran, Oluseyi A Akinloye

Background: Targeting protein kinase B (Akt) and its downstream signaling proteins are promising options in designing novel and potent drug candidates against hepatocellular carcinoma (HCC). The present study explores the anti-HCC potentials of Cannabis sativa (C. sativa) extract via the involvement of Akt using both in silico and in vivo animal models of HCC approaches.

Methods: Phytoconstituents of C. sativa extract obtained from Gas Chromatography Mass-spectrometry (GCSM) were docked into the catalytic domain of Akt-2. The Diethylnitrosamine (DEN) model of HCC was treated with C. sativa extract. The effects of C. sativa extract treatments on DEN model of hepatocellular carcinoma were assessed by One-way analysis of variance (ANOVA) of the treated and untreated groups RESULT: The lead phytoconstituents of C. sativa extract, Δ-9-tetrahydrocannabinol (Δ-9-THC) and cannabidiol form stable hydrophobic and hydrogen bond interactions within the catalytic domain of Akt-2. C. sativa extract (15 mg/kg and 30 mg/kg) respectively gives a 3-fold decrease in the activities of liver function enzymes when compared with the positive control (group 2). It also gives a 1.5-fold decrease in hepatic lipid peroxidation and elevates serum antioxidant enzymes' activities by 1-fold in HCC treated Wistar rats when compared with the positive control (group 2). In an animal model of hepatocellular carcinoma, C. sativa extract significantly downregulated Akt and HIF mRNAs in groups 3, 4, and 5 with 2, 1.5, 2.5-fold decrease relative to group 2. VEGF mRNA was downregulated by 1.5-fold decrease in groups 3-5 when compared to group 2. The expression of XIAP mRNA was downregulated by 1.5, 2, and 1.25-folds in groups 3, 4, and 5 respectively, in comparison with group 2. In comparison to group 2, COX-2 mRNA levels were downregulated by 1.5, 1, and 1-folds in groups 3-5. In groups 3-5, CRP mRNA was downregulated by 2-fold in comparison with group 2. In groups 3-5, p21 mRNA was upregulated by 2, 2.5, and 3-folds, respectively when compared with group 2. It upregulated p53 mRNA by 2.5, 3.5, and 2.5-folds in groups 3-5 in comparison with group 2. It downregulated AFP mRNA by 3.5, 2.5, .2.5-folds in groups 3, 4, and 5 respectively when compared with group 2. Histologic analysis showed that C. sativa extract reduced necrosis and inflammation in HCC.

Conclusion: C. sativa demonstrates anti-hepatocellular carcinoma potentials in an animal model of HCC and with the involvement of Akt. Its anticancer potential is mediated through antiangiogenic, proapoptotic, cycle arrest, and anti-inflammatory mechanisms. In future studies, the mechanisms of anti-HCC effects of Δ-9-tetrahydrocannabinol (Δ-9- THC) and cannabidiol via the PI3K-Akt signaling pathways should be explored.

背景:靶向蛋白激酶 B(Akt)及其下游信号蛋白是设计新型高效抗肝细胞癌(HCC)候选药物的可行方案。本研究通过使用硅学和 HCC 体内动物模型方法,通过 Akt 的参与探索大麻(C. sativa)提取物的抗 HCC 潜力:方法:通过气相色谱-质谱联用技术(GCSM)获得的大麻提取物的植物成分与 Akt-2 的催化结构域对接。用荠菜提取物处理二乙基亚硝胺(DEN)HCC模型。结果:荠菜提取物的主要植物成分Δ-9-四氢大麻酚(Δ-9-THC)和大麻二酚在Akt-2的催化结构域内形成稳定的疏水和氢键相互作用。与阳性对照组(第 2 组)相比,大麻酚提取物(15 毫克/千克和 30 毫克/千克)可使肝功能酶的活性降低 3 倍。与阳性对照组(第 2 组)相比,荠菜提取物还能使接受 HCC 治疗的 Wistar 大鼠的肝脏脂质过氧化反应降低 1.5 倍,血清抗氧化酶活性提高 1 倍。在肝细胞癌动物模型中,荠菜提取物可显著下调第 3、4 和 5 组的 Akt 和 HIF mRNA,与第 2 组相比,分别下降了 2、1.5 和 2.5 倍。与第 2 组相比,第 3、4 和 5 组的 VEGF mRNA 下调了 1.5 倍;与第 2 组相比,第 3、4 和 5 组的 XIAP mRNA 表达分别下调了 1.5、2 和 1.25 倍。 与第 2 组相比,第 3-5 组的 COX-2 mRNA 水平分别下调了 1.5、1 和 1 倍。与第 2 组相比,第 3-5 组的 CRP mRNA 下调了 2 倍。与第 2 组相比,第 3-5 组的 p21 mRNA 分别上调了 2、2.5 和 3 倍。组织学分析表明,荠菜提取物可减少 HCC 的坏死和炎症:结论:在 HCC 动物模型中,荠菜具有抗肝细胞癌的潜力,Akt 参与其中。其抗癌潜力是通过抗血管生成、促凋亡、周期停滞和抗炎机制介导的。在今后的研究中,应探讨Δ-9-四氢大麻酚(Δ-9- THC)和大麻二酚通过 PI3K-Akt 信号通路发挥抗 HCC 作用的机制。
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引用次数: 0
Why a distinct medical stream is necessary to support patients using cannabis for medical purposes. 为什么需要一个独特的医疗流程来支持出于医疗目的使用大麻的患者。
Pub Date : 2023-07-04 DOI: 10.1186/s42238-023-00195-8
Cecilia Costiniuk, Caroline A MacCallum, Michael Boivin, Sergio Rueda, Gary Lacasse, Zach Walsh, Paul J Daeninck, Shari Margolese, Enrico Mandarino, Jagpaul Kaur Deol, Tatiana Sanchez, Alan D Bell

Background: Since 2001, Canadians have been able to obtain cannabis for medical purposes, initially through the Access to Cannabis for Medical Purposes Regulations (ACMPR). The Cannabis Act (Bill C-45) came into force on October 17, 2018, replacing the ACMPR. The Cannabis Act enables Canadians to possess cannabis purchased from a licensed retailer without authorization for either medical or nonmedical purposes. The Cannabis Act is currently the guiding legislation which governs both medical and nonmedical access. The Cannabis Act contains some improvements for patients but is essentially the same as its previous legislation. Beginning in October 2022, the federal government is conducting a review of the Cannabis Act and is questioning whether a distinct medical cannabis stream is still required, given the ease of access to cannabis and cannabis products. Although there is overlap in the reasons for medical and recreational cannabis use, the distinct legislation of medical versus recreational use of cannabis in Canada may be under threat.

Main body: A large segment of the medical, academic, research, and lay communities agree that there is a need for distinct medical and recreational cannabis streams. Perhaps most importantly, separation of these streams is necessary to ensure that both medical cannabis patients and healthcare providers receive the required support needed to optimize benefits while minimizing risks associated with medical cannabis use. Preservation of distinct medical and recreational streams can help to ensure that needs of different stakeholders are met. For example, patients require guidance in the form of assessing the appropriateness of cannabis use, selection of appropriate products and dosage forms, dosing titration, screening for drug interactions, and safety monitoring. Healthcare providers require access to undergraduate and continuing health education as well as support from their professional organizations to ensure medical cannabis is appropriately prescribed. Although there are challenges in conducing research, as motives for cannabis use frequently straddle boundaries between medical versus recreational cannabis use, maintenance of a distinct medical stream is also necessary to ensure adequate supply of cannabis products appropriate for medical use, to reduce stigma associated with cannabis in both patients and providers, to help enable reimbursement for patients, to facilitate removal of taxation on cannabis used for medical purposes, and to promote research on all aspects of medical cannabis.

Conclusion: Cannabis products for medical and recreational purposes have different objectives and needs, requiring different methods of distribution, access, and monitoring. HCPs, patients, and the commercial cannabis industry would serve Canadians well to continue to advocate to policy makers to ensure the continued existence of two distinct streams and must s

背景:自2001年以来,加拿大人已经能够获得用于医疗目的的大麻,最初是通过《为医疗目的获取大麻条例》。《大麻法案》(C-45法案)于2018年10月17日生效,取代了《ACMPR》。《大麻法》规定,加拿大人可以在未经授权的情况下拥有从持牌零售商处购买的大麻,用于医疗或非医疗目的。《大麻法》目前是管理医疗和非医疗获取的指导性立法。《大麻法案》对患者有一些改进,但本质上与之前的立法相同。从2022年10月开始,联邦政府正在对《大麻法》进行审查,考虑到大麻和大麻产品很容易获得,联邦政府正在质疑是否仍然需要一种独特的医用大麻流。虽然医用和娱乐用大麻的原因有重叠之处,但加拿大关于医用和娱乐用大麻的不同立法可能受到威胁。主体:医疗、学术、研究和非专业社区的很大一部分人都同意,有必要区分医用和娱乐用大麻。也许最重要的是,有必要将这些流分开,以确保医用大麻患者和保健提供者都能获得所需的支持,以最大限度地提高效益,同时尽量减少与医用大麻使用有关的风险。保留独特的医疗和娱乐流有助于确保满足不同利益攸关方的需求。例如,患者需要以评估大麻使用的适当性、选择适当的产品和剂型、剂量滴定、药物相互作用筛选和安全监测等形式获得指导。医疗保健提供者需要获得本科和继续健康教育以及其专业组织的支持,以确保医用大麻得到适当的处方。尽管在开展研究方面存在挑战,因为使用大麻的动机经常跨越医疗和娱乐大麻的界限,但也有必要维持一个独特的医疗流,以确保适当用于医疗用途的大麻产品供应充足,减少患者和提供者对大麻的污名,帮助报销患者,促进取消对用于医疗目的的大麻征税,并促进对医用大麻各方面的研究。结论:用于医疗和娱乐目的的大麻产品具有不同的目的和需求,需要不同的分销、获取和监测方法。医疗保健提供者、患者和商业大麻产业将继续向政策制定者倡导确保两种不同的大麻流继续存在,并必须努力不断改进目前的方案,这对加拿大人很有好处。
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引用次数: 0
Propylene glycol and Kolliphor as solvents for systemic delivery of cannabinoids via intraperitoneal and subcutaneous routes in preclinical studies: a comparative technical note. 丙二醇和Kolliphor作为溶剂在临床前研究中通过腹腔和皮下途径给药大麻素:一个比较的技术说明。
Pub Date : 2023-06-20 DOI: 10.1186/s42238-023-00194-9
Kaveh Momenzadeh, Diana Yeritsyan, Nadim Kheir, Rosalyn M Nazarian, Ara Nazarian

Background: Substance administration to laboratory animals necessitates careful consideration and planning in order to enhance agent distribution while reducing any harmful effects from the technique. There are numerous methods for administering cannabinoids; however, several parameters must be considered, including delivery frequency, volume of administration, vehicle, and the level of competence required for staff to use these routes properly. There is a scarcity of information about the appropriate delivery method for cannabinoids in animal research, particularly those that need the least amount of animal manipulation during the course of the investigation. This study aims to assess the feasibility and potential side effects of intraperitoneal and subcutaneous injection of CBD and THC using propylene glycol or Kolliphor in animal models. By evaluating the ease of use and histopathological side effects of these solvents, this study intends to help researchers better understand an accessible long-term delivery route of administration in animal experiments while minimizing the potential confounding effects of the delivery method on the animal.

Methods: Intraperitoneal and subcutaneous methods of systemic cannabis administration were tested in rat models. Subcutaneous delivery via needle injection and continuous osmotic pump release were evaluated using propylene glycol or Kolliphor solvents. In addition, the use of a needle injection and a propylene glycol solvent for intraperitoneal (IP) administration was investigated. Skin histopathological changes were evaluated following a trial of subcutaneous injections of cannabinoids utilizing propylene glycol solvent.

Discussion: Although IP delivery of cannabinoids with propylene glycol as solvent is a viable method and is preferable to oral treatment in order to reduce gastrointestinal tract degradation, it has substantial feasibility limitations. We conclude that subcutaneous delivery utilizing osmotic pumps with Kolliphor as a solvent provides viable and consistent route of administration for long-term systemic cannabinoid delivery in the preclinical context.

背景:实验动物的物质管理需要仔细考虑和规划,以加强药物分布,同时减少技术的任何有害影响。有许多方法可以管理大麻素;但是,必须考虑几个参数,包括交付频率、管理数量、车辆和工作人员正确使用这些路线所需的能力水平。关于大麻素在动物研究中的适当递送方法的信息缺乏,特别是那些在调查过程中需要最少动物操作的信息。本研究旨在评估丙二醇或Kolliphor在动物模型上腹腔和皮下注射CBD和THC的可行性和潜在的副作用。通过评估这些溶剂的易用性和组织病理学副作用,本研究旨在帮助研究人员更好地了解动物实验中可行的长期给药途径,同时最大限度地减少给药方法对动物的潜在混淆效应。方法:采用大鼠腹腔注射和皮下注射两种给药方法。使用丙二醇或Kolliphor溶剂评估针注射皮下给药和连续渗透泵释放。此外,还研究了针注射和丙二醇溶剂用于腹腔(IP)给药的使用。皮肤组织病理学变化评估后皮下注射大麻素利用丙二醇溶剂的试验。讨论:虽然以丙二醇为溶剂的大麻素IP递送是一种可行的方法,并且比口服治疗更可取,以减少胃肠道降解,但它具有实质性的可行性局限性。我们得出的结论是,在临床前背景下,利用渗透泵与Kolliphor作为溶剂的皮下递送为长期系统性大麻素递送提供了可行和一致的管理途径。
{"title":"Propylene glycol and Kolliphor as solvents for systemic delivery of cannabinoids via intraperitoneal and subcutaneous routes in preclinical studies: a comparative technical note.","authors":"Kaveh Momenzadeh,&nbsp;Diana Yeritsyan,&nbsp;Nadim Kheir,&nbsp;Rosalyn M Nazarian,&nbsp;Ara Nazarian","doi":"10.1186/s42238-023-00194-9","DOIUrl":"https://doi.org/10.1186/s42238-023-00194-9","url":null,"abstract":"<p><strong>Background: </strong>Substance administration to laboratory animals necessitates careful consideration and planning in order to enhance agent distribution while reducing any harmful effects from the technique. There are numerous methods for administering cannabinoids; however, several parameters must be considered, including delivery frequency, volume of administration, vehicle, and the level of competence required for staff to use these routes properly. There is a scarcity of information about the appropriate delivery method for cannabinoids in animal research, particularly those that need the least amount of animal manipulation during the course of the investigation. This study aims to assess the feasibility and potential side effects of intraperitoneal and subcutaneous injection of CBD and THC using propylene glycol or Kolliphor in animal models. By evaluating the ease of use and histopathological side effects of these solvents, this study intends to help researchers better understand an accessible long-term delivery route of administration in animal experiments while minimizing the potential confounding effects of the delivery method on the animal.</p><p><strong>Methods: </strong>Intraperitoneal and subcutaneous methods of systemic cannabis administration were tested in rat models. Subcutaneous delivery via needle injection and continuous osmotic pump release were evaluated using propylene glycol or Kolliphor solvents. In addition, the use of a needle injection and a propylene glycol solvent for intraperitoneal (IP) administration was investigated. Skin histopathological changes were evaluated following a trial of subcutaneous injections of cannabinoids utilizing propylene glycol solvent.</p><p><strong>Discussion: </strong>Although IP delivery of cannabinoids with propylene glycol as solvent is a viable method and is preferable to oral treatment in order to reduce gastrointestinal tract degradation, it has substantial feasibility limitations. We conclude that subcutaneous delivery utilizing osmotic pumps with Kolliphor as a solvent provides viable and consistent route of administration for long-term systemic cannabinoid delivery in the preclinical context.</p>","PeriodicalId":15172,"journal":{"name":"Journal of Cannabis Research","volume":"5 1","pages":"24"},"PeriodicalIF":0.0,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10280893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9709951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
No difference in COVID-19 treatment outcomes among current methamphetamine, cannabis and alcohol users. 目前甲基苯丙胺、大麻和酒精使用者之间的COVID-19治疗结果无差异。
Pub Date : 2023-06-19 DOI: 10.1186/s42238-023-00193-w
Ann Rydberg, Christopher A Dodoo, Terry D Schneekloth, Osama A Abulseoud

Background: Poor outcomes of COVID-19 have been reported in older males with medical comorbidities including substance use disorder. However, it is unknown whether there is a difference in COVID-19 treatment outcomes between patients who are current cannabis users, excessive alcohol drinkers and those who use a known hazardous stimulant such as methamphetamine (METH).

Methods: Electronic medical records (EMR) of COVID-19 patients with current METH (n = 32), cannabis (n = 46), and heavy alcohol use (n = 44) were reviewed. COVID-19 infection was confirmed by positive SARS-CoV-2 PCR test, current drug use was confirmed by positive urine drug testing, and alcohol use was identified by a blood alcohol concentration greater than 11 mg/dl. Multivariate linear regression models as well as the firth logistic regression models were used to examine the effect of substance use group (METH, cannabis, or alcohol) on treatment outcome measures.

Results: A total of 122 patients were included in this analysis. There were no significant differences found between drug groups in regards to key SARS-CoV-2 outcomes of interest including ICU admission, length of stay, interval between SARS-CoV-2 positive test and hospital discharge, delirium, intubation and mortality after adjusting for covariates. About one-fifth (21.9% in METH users, 15.2% in cannabis users, and 20.5% in alcohol users) of all patients required ICU admission. As many as 37.5% of METH users, 23.9% of cannabis users, and 29.5% of alcohol users developed delirium (P = 0.4). There were no significant differences between drug groups in COVID-19 specific medication requirements. Eight patients in total died within 10 months of positive SARS-CoV-2 PCR test. Two patients from the METH group (6.3%), two patients from the cannabis group (4.3%), and four patients from the alcohol group (9.1%) died.

Discussion: The study outcomes may have been affected by several limitations. These included the methodology of its retrospective design, relatively small sample size, and the absence of a COVID-19 negative control group. In addition, there was no quantification of substance use and many covariates relied on clinical documentation or patient self-report. Finally, it was difficult to control for all potential confounders particularly given the small sample size.

Conclusion: Despite these limitations, our results show that current METH, cannabis, and heavy alcohol users in this study have similar treatment outcomes and suffer from high morbidity including in-hospital delirium and high mortality rates within the first-year post COVID-19. The extent to which co-morbid tobacco smoking contributed to the negative outcomes in METH, cannabis, and alcohol users remains to be investigated.

背景:据报道,在患有药物使用障碍等医学合并症的老年男性中,COVID-19的预后较差。然而,目前尚不清楚当前大麻使用者、过度饮酒者和使用甲基苯丙胺(冰毒)等已知危险兴奋剂的患者在COVID-19治疗结果方面是否存在差异。方法:回顾性分析当前使用冰毒(n = 32)、大麻(n = 46)和重度酒精(n = 44)的COVID-19患者的电子病历(EMR)。通过SARS-CoV-2 PCR检测阳性确认COVID-19感染,通过尿液药物检测阳性确认当前用药,通过血液酒精浓度大于11 mg/dl确定是否饮酒。使用多元线性回归模型和第五逻辑回归模型来检验物质使用组(冰毒、大麻或酒精)对治疗结果测量的影响。结果:本分析共纳入122例患者。在ICU入院、住院时间、SARS-CoV-2阳性检测到出院的时间间隔、谵妄、插管和死亡率等关键的SARS-CoV-2结局方面,两组药物间无显著差异。约五分之一的患者(冰毒使用者21.9%,大麻使用者15.2%,酒精使用者20.5%)需要进入ICU。多达37.5%的冰毒使用者、23.9%的大麻使用者和29.5%的酒精使用者出现谵妄(P = 0.4)。药物组之间在COVID-19特异性药物需求方面无显著差异。SARS-CoV-2 PCR检测阳性10个月内死亡8例。冰毒组两名患者(6.3%),大麻组两名患者(4.3%),酒精组四名患者(9.1%)死亡。讨论:研究结果可能受到一些限制的影响。其中包括回顾性设计的方法、相对较小的样本量以及缺乏COVID-19阴性对照组。此外,没有物质使用的量化,许多协变量依赖于临床文件或患者自我报告。最后,很难控制所有潜在的混杂因素,特别是考虑到小样本量。结论:尽管存在这些局限性,我们的研究结果表明,在本研究中,目前的甲基安非他明、大麻和重度酒精使用者具有相似的治疗结果,并且在COVID-19后的一年内患有高发病率,包括院内谵妄和高死亡率。在甲基苯丙胺、大麻和酒精使用者中,共病吸烟对负面结果的影响程度仍有待调查。
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引用次数: 0
Cannabis for morning sickness: areas for intervention to decrease cannabis consumption during pregnancy. 大麻治疗孕吐:减少怀孕期间大麻消费的干预领域。
Pub Date : 2023-06-17 DOI: 10.1186/s42238-023-00184-x
Karli Swenson

Background: Cannabis use during pregnancy is increasing, with 19-22% of patients testing positive at delivery in Colorado and California. Patients report using cannabis to alleviate their nausea and vomiting, anxiety, and pain. However, preclinical and clinical data highlight harmful effects to offspring physiology and behavior following fetal cannabis exposure. This narrative review identifies potential areas for intervention to decrease cannabis consumption during pregnancy.

Methods: A combination of keywords, including "cannabis", "cannabis", "weed", "pregnancy", "morning sickness", "child protective services", and "budtender" were searched in databases such as PubMed and Google Scholar, as well as in social media forums, governmental webpages, and other publicly available sources.

Results: The literature search identified several areas for intervention to reduce cannabis use during pregnancy, including physician and pharmacist training, engagement with pregnant patients, regulation of dispensary workers, and the role of child protective services.

Discussion: This comprehensive review identifies multiple areas for improvement to benefit pregnant patients. Recommendations are independent and can be implemented simultaneously by the identified groups. Limitations of this research includes the relatively limited availability of data focused specifically on cannabis consumption during pregnancy and the complexity of the sociopolitical field of substance use during pregnancy.

Conclusions: Cannabis consumption during pregnancy is increasing and causes harm to the developing fetus. To educate pregnant patients about these risks, we must address the gaps in education from multiple contact points.

背景:怀孕期间大麻的使用正在增加,在科罗拉多州和加利福尼亚州,19-22%的患者在分娩时检测呈阳性。患者报告说,使用大麻可以缓解恶心、呕吐、焦虑和疼痛。然而,临床前和临床数据强调胎儿大麻暴露对后代生理和行为的有害影响。这篇叙述性综述确定了减少怀孕期间大麻消费的潜在干预领域。方法:在PubMed、Google Scholar等数据库以及社交媒体论坛、政府网页和其他公开来源中搜索“大麻”、“大麻”、“大麻”、“大麻”、“怀孕”、“孕吐”、“儿童保护服务”、“budtender”等关键词。结果:文献检索确定了几个干预领域,以减少怀孕期间的大麻使用,包括医生和药剂师培训,与怀孕患者的接触,药房工作人员的监管,以及儿童保护服务的作用。讨论:这项全面的综述确定了多个需要改进的领域,以使孕妇受益。建议是独立的,可以由确定的小组同时实施。这项研究的局限性包括,专门针对怀孕期间大麻消费的数据的可用性相对有限,以及怀孕期间物质使用的社会政治领域的复杂性。结论:妊娠期大麻消费量增加,对胎儿发育有危害。为了让孕妇了解这些风险,我们必须从多个接触点解决教育方面的差距。
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引用次数: 0
The therapeutic potential of purified cannabidiol. 纯化大麻二酚的治疗潜力。
Pub Date : 2023-06-13 DOI: 10.1186/s42238-023-00186-9
Saoirse Elizabeth O'Sullivan, Sanne Skov Jensen, Gitte Nykjaer Nikolajsen, Heidi Ziegler Bruun, Rhenu Bhuller, Julia Hoeng

The use of cannabidiol (CBD) for therapeutic purposes is receiving considerable attention, with speculation that CBD can be useful in a wide range of conditions. Only one product, a purified form of plant-derived CBD in solution (Epidiolex), is approved for the treatment of seizures in patients with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex. Appraisal of the therapeutic evidence base for CBD is complicated by the fact that CBD products sometimes have additional phytochemicals (like tetrahydrocannabinol (THC)) present, which can make the identification of the active pharmaceutical ingredient (API) in positive studies difficult. The aim of the present review is to critically review clinical studies using purified CBD products only, in order to establish the upcoming indications for which purified CBD might be beneficial. The areas in which there is the most clinical evidence to support the use of CBD are in the treatment of anxiety (positive data in 7 uncontrolled studies and 17 randomised controlled trials (RCTs)), psychosis and schizophrenia (positive data in 1 uncontrolled study and 8 RCTs), PTSD (positive data in 2 uncontrolled studies and 4 RCTs) and substance abuse (positive data in 2 uncontrolled studies and 3 RCTs). Seven uncontrolled studies support the use of CBD to improve sleep quality, but this has only been verified in one small RCT. Limited evidence supports the use of CBD for the treatment of Parkinson's (3 positive uncontrolled studies and 2 positive RCTs), autism (3 positive RCTs), smoking cessation (2 positive RCTs), graft-versus-host disease and intestinal permeability (1 positive RCT each). Current RCT evidence does not support the use of purified oral CBD in pain (at least as an acute analgesic) or for the treatment of COVID symptoms, cancer, Huntington's or type 2 diabetes. In conclusion, published clinical evidence does support the use of purified CBD in multiple indications beyond epilepsy. However, the evidence base is limited by the number of trials only investigating the acute effects of CBD, testing CBD in healthy volunteers, or in very small patient numbers. Large confirmatory phase 3 trials are required in all indications.

大麻二酚(CBD)用于治疗目的正在受到相当大的关注,人们猜测CBD在各种情况下都是有用的。只有一种产品,纯化形式的植物源性CBD溶液(Epidiolex),被批准用于治疗lenox - gastaut综合征,Dravet综合征或结节性硬化症患者的癫痫发作。CBD产品有时含有额外的植物化学物质(如四氢大麻酚(THC)),这使得阳性研究中活性药物成分(API)的鉴定变得困难,因此对CBD治疗证据基础的评估变得复杂。本综述的目的是严格审查仅使用纯化CBD产品的临床研究,以便确定纯化CBD可能有益的适应症。支持使用CBD的临床证据最多的领域是治疗焦虑症(7项非对照研究和17项随机对照试验的阳性数据)、精神病和精神分裂症(1项非对照研究和8项随机对照试验的阳性数据)、创伤后应激障碍(2项非对照研究和4项随机对照试验的阳性数据)和药物滥用(2项非对照研究和3项随机对照试验的阳性数据)。七项不受控制的研究支持使用CBD改善睡眠质量,但这只在一项小型随机对照试验中得到了验证。有限的证据支持使用CBD治疗帕金森病(3项阳性对照研究和2项阳性随机对照试验)、自闭症(3项阳性随机对照试验)、戒烟(2项阳性随机对照试验)、移植物抗宿主病和肠通透性(各1项阳性随机对照试验)。目前的随机对照试验证据不支持将纯化的口服CBD用于疼痛(至少作为急性镇痛药)或治疗COVID症状、癌症、亨廷顿舞蹈症或2型糖尿病。总之,已发表的临床证据确实支持在癫痫以外的多种适应症中使用纯化CBD。然而,证据基础受到试验数量的限制,这些试验只调查CBD的急性效应,在健康志愿者中测试CBD,或者在非常小的患者数量中测试CBD。所有适应症都需要大规模的验证性3期试验。
{"title":"The therapeutic potential of purified cannabidiol.","authors":"Saoirse Elizabeth O'Sullivan,&nbsp;Sanne Skov Jensen,&nbsp;Gitte Nykjaer Nikolajsen,&nbsp;Heidi Ziegler Bruun,&nbsp;Rhenu Bhuller,&nbsp;Julia Hoeng","doi":"10.1186/s42238-023-00186-9","DOIUrl":"https://doi.org/10.1186/s42238-023-00186-9","url":null,"abstract":"<p><p>The use of cannabidiol (CBD) for therapeutic purposes is receiving considerable attention, with speculation that CBD can be useful in a wide range of conditions. Only one product, a purified form of plant-derived CBD in solution (Epidiolex), is approved for the treatment of seizures in patients with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex. Appraisal of the therapeutic evidence base for CBD is complicated by the fact that CBD products sometimes have additional phytochemicals (like tetrahydrocannabinol (THC)) present, which can make the identification of the active pharmaceutical ingredient (API) in positive studies difficult. The aim of the present review is to critically review clinical studies using purified CBD products only, in order to establish the upcoming indications for which purified CBD might be beneficial. The areas in which there is the most clinical evidence to support the use of CBD are in the treatment of anxiety (positive data in 7 uncontrolled studies and 17 randomised controlled trials (RCTs)), psychosis and schizophrenia (positive data in 1 uncontrolled study and 8 RCTs), PTSD (positive data in 2 uncontrolled studies and 4 RCTs) and substance abuse (positive data in 2 uncontrolled studies and 3 RCTs). Seven uncontrolled studies support the use of CBD to improve sleep quality, but this has only been verified in one small RCT. Limited evidence supports the use of CBD for the treatment of Parkinson's (3 positive uncontrolled studies and 2 positive RCTs), autism (3 positive RCTs), smoking cessation (2 positive RCTs), graft-versus-host disease and intestinal permeability (1 positive RCT each). Current RCT evidence does not support the use of purified oral CBD in pain (at least as an acute analgesic) or for the treatment of COVID symptoms, cancer, Huntington's or type 2 diabetes. In conclusion, published clinical evidence does support the use of purified CBD in multiple indications beyond epilepsy. However, the evidence base is limited by the number of trials only investigating the acute effects of CBD, testing CBD in healthy volunteers, or in very small patient numbers. Large confirmatory phase 3 trials are required in all indications.</p>","PeriodicalId":15172,"journal":{"name":"Journal of Cannabis Research","volume":"5 1","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2023-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10262148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9692462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Naturalistic examination of the anxiolytic effects of medical cannabis and associated gender and age differences in a Canadian cohort. 加拿大队列中医用大麻的抗焦虑作用及其相关的性别和年龄差异的自然检查。
Pub Date : 2023-06-09 DOI: 10.1186/s42238-023-00192-x
Meenu Minhas, Stephanie E Lunn

Background: The aim of the current study was to examine patterns of medical cannabis use in those using it to treat anxiety and to investigate if the anxiolytic effects of cannabis were impacted by gender and/or age.

Methods: Patient-reported data (n = 184 participants, 61% female, 34.7 ± 8.0 years) was collected through the Strainprint® app. Tracked sessions were included if the method of administration was inhalation, treatment was for anxiety and the product used was dried flower. The final analyzed dataset encompassed three of the most commonly utilized dried flower products in anxiety sessions. Independent sample t-tests were used. The core analysis examined within subject changes overtime (pre-medication to post-medication) and interactions between time with two candidate moderators [gender (male, female) and age (18-29, 30-39, and 40 + years old)] by using analysis of variance (ANOVA). For significant main effects of interactions, post hoc tests were conducted using a Bonferroni correction. A secondary analysis examined differences in proportion of emotives endorsed as a function of gender or age using chi-square test of independence.

Results: Cannabis consumption resulted in a significant decrease in anxiety scores among both males and females (average efficacy of 50%) and efficacy was similar across the three cultivars. However, gender differences in efficacy were identified in two of the cultivars. All age groups experienced significant reductions in their anxiety post cannabis consumption; however, the 40 + year old group had significantly less efficacy than the other groups. The overall optimal dosing for the entire cohort was 9-11 inhalations for males and 5-7 inhalations for females, with some variation in dosing across the different cultivars, genders and age groups.

Conclusions: We found all three cultivars had significant anxiolytic effects and were well-tolerated. Some limitations of the study are the moderate sample size, self-reported diagnosis of anxiety, unknown comorbidities and experience with cannabis, whether other drugs or cannabis products were used, and restriction to solely inhaled administration. We suggest that the gender and age differences in optimal dosing could support both healthcare practitioners and patients initiate medical cannabis treatment for anxiety.

背景:当前研究的目的是检查那些使用医用大麻治疗焦虑的人使用大麻的模式,并调查大麻的抗焦虑作用是否受到性别和/或年龄的影响。方法:通过Strainprint®应用程序收集患者报告的数据(n = 184名参与者,61%为女性,34.7±8.0岁)。如果给药方法为吸入,治疗焦虑,使用的产品为干花,则纳入跟踪疗程。最后分析的数据集包括三种最常用的干花产品在焦虑会议。采用独立样本t检验。核心分析通过方差分析(ANOVA)检验了受试者随时间(服药前至服药后)的变化,以及时间与两个候选调节因子[性别(男性、女性)和年龄(18-29岁、30-39岁和40岁以上)]之间的相互作用。对于相互作用的显著主效应,采用Bonferroni校正进行事后检验。第二项分析使用卡方独立性检验检验了被认可为性别或年龄函数的情绪比例的差异。结果:大麻消费导致男性和女性的焦虑评分显著下降(平均功效为50%),三种品种的功效相似。然而,两个品种在功效上存在性别差异。所有年龄组的人在吸食大麻后的焦虑都显著减少;然而,40岁以上组的疗效明显低于其他组。整个队列的总体最佳剂量为男性9-11次吸入,女性5-7次吸入,不同品种、性别和年龄组的剂量有所不同。结论:我们发现这三个品种都有显著的抗焦虑作用,并且耐受性良好。该研究的一些局限性是样本量适中,自我报告的焦虑诊断,未知的合并症和大麻使用经历,是否使用其他药物或大麻产品,以及仅限于吸入给药。我们建议,最佳剂量的性别和年龄差异可以支持医疗从业人员和患者启动医用大麻治疗焦虑。
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引用次数: 0
The Desert Whale: the boom and bust of hemp in Arizona. 沙漠鲸鱼:亚利桑那州大麻的繁荣与萧条。
Pub Date : 2023-06-09 DOI: 10.1186/s42238-023-00187-8
Anastasia K Stats, Ken G Sweat, Robert N Masson, Kendra D Conrow, Amy E Frazier, Maxwell C K Leung

Background: This paper examines the factors that led to the collapse of hemp grown for cannabidiol (CBD) in Arizona, the United States of America (USA), and particularly in Yuma County, which is a well-established agricultural area in the state.

Methods: This research uses a combination of mapping analysis along with a survey of hemp farmers to assess the reasons why the hemp industry collapsed as well as to foster solutions to these problems.

Results: In 2019, 5430 acres were sown with hemp seed in Arizona with 3890 acres inspected by the state to determine if they could be harvested. By 2021, there were only 156 acres planted, and only 128 of those acres were inspected by the state for compliance. (Crop mortality accounts for the difference between acres sown and acres inspected.) CONCLUSIONS: A lack of knowledge about the hemp life cycle greatly contributed to the failure of high CBD hemp crops in Arizona. Other problems included noncompliance with tetrahydrocannabinol limits, poor sources for seeds and inconsistent genetics of the hemp varieties sold to farmers, and diseases that hemp plants were susceptible to such as Pythium crown and root rot and beet curly top virus. Addressing these factors will go far in making hemp a profitable and widespread crop in Arizona. Additionally, hemp grown for other traditional uses (e.g., fiber or seed oil) as well as new applications (e.g., microgreens, hempcrete, and phytoremediation) offers other pathways for successful hemp agriculture in this state.

背景:本文探讨了导致大麻种植的大麻二酚(CBD)在亚利桑那州,美利坚合众国(美国),特别是在尤马县,这是一个完善的农业区在国家崩溃的因素。方法:本研究采用地图分析结合麻农的调查来评估麻产业崩溃的原因,并促进解决这些问题。结果:2019年,亚利桑那州种植了5430英亩的大麻种子,该州检查了3890英亩的大麻种子,以确定是否可以收获。到2021年,只有156英亩的土地被种植,其中只有128英亩的土地得到了州政府的合规检查。(作物死亡率反映了播种面积和检查面积之间的差异。)结论:缺乏对大麻生命周期的了解是导致亚利桑那州高CBD大麻作物失败的主要原因。其他问题包括不符合四氢大麻酚的限制,种子来源差,出售给农民的大麻品种的遗传不一致,以及大麻植物容易感染的疾病,如皮腐病和根腐病以及甜菜卷顶病毒。解决这些因素将使大麻在亚利桑那州成为有利可图和广泛种植的作物。此外,大麻种植用于其他传统用途(例如,纤维或种子油)以及新应用(例如,微绿色,大麻混凝土和植物修复)为该州成功的大麻农业提供了其他途径。
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引用次数: 0
Reasonable access: important characteristics and perceived quality of legal and illegal sources of cannabis for medical purposes in Canada. 合理获取:加拿大医用大麻合法和非法来源的重要特征和质量。
Pub Date : 2023-06-09 DOI: 10.1186/s42238-023-00185-w
N Rielle Capler, Lynda G Balneaves, Jane A Buxton, Thomas Kerr

Background: Throughout the past two decades of legal medical cannabis in Canada, individuals have experienced challenges related to accessing legal sources of cannabis for medical purposes. The objective of our study was to examine the sources of cannabis accessed by individuals authorized to use medical cannabis and to identify possible reasons for their use of illegal sources.

Methods: Individuals who participated in the Cannabis Access Regulations Study (CANARY), a national cross-sectional survey launched in 2014, and indicated they were currently authorized to use cannabis for medical purposes in Canada were included in this study. We assessed differences between participants accessing cannabis from only legal sources versus from illegal sources in relation to sociodemographic characteristics, health-related factors, and characteristics of medical cannabis they considered important. A secondary analysis assessed differences in satisfaction with various dimensions of cannabis products and services provided by legal versus illegal sources.

Results: Half of the 237 study participants accessed cannabis from illegal sources. Individuals accessing cannabis from illegal sources were significantly more likely to value pesticide-free products, access to a variety of strains, ability to select strain and dosage, ability to observe and smell cannabis, availability in a dispensary, and availability in small quantities than did individuals accessing cannabis from only legal sources (all p < 0.05). Additionally, participants gave significantly higher satisfaction scores to illegal sources than to legal sources on service-related dimensions of cannabis access (all p < 0.05).

Conclusion: Our findings contribute to an understanding of reasonable access to medical cannabis from a patient perspective and how to assess whether it has been achieved. Characteristics of cannabis products and services valued by patients and appropriate to their needs should be incorporated into legal medical cannabis programs to promote the use of legal medical sources. While pertaining specifically to medical use of cannabis in Canada, the findings of this study may also be instructive for understanding the use of illegal cannabis sources for non-medical purposes in Canada and provide insight for other jurisdictions implementing cannabis regulations for both medical and non-medical purposes.

背景:在加拿大合法医用大麻的过去二十年中,个人在获取用于医疗目的的合法大麻来源方面遇到了挑战。我们研究的目的是审查被授权使用医用大麻的个人获得的大麻来源,并确定他们使用非法来源的可能原因。方法:参与2014年启动的全国性横断面调查“大麻获取条例研究”(CANARY)的个人,并表示他们目前被授权在加拿大用于医疗目的使用大麻,纳入本研究。我们评估了仅从合法来源获取大麻与从非法来源获取大麻之间的差异,包括社会人口学特征、健康相关因素以及他们认为重要的医用大麻特征。第二项分析评估了对合法来源与非法来源提供的大麻产品和服务的各个方面的满意度差异。结果:237名研究参与者中有一半从非法来源获得大麻。与仅从合法来源获取大麻的个人相比,从非法来源获取大麻的个人更有可能重视无农药产品、获得各种品种、选择品种和剂量的能力、观察和闻到大麻的能力、在药房的可获得性以及少量的可获得性(均p < 0.05)。此外,参与者在大麻获取服务相关维度上对非法来源的满意度得分明显高于合法来源(均p < 0.05)。结论:我们的研究结果有助于从患者的角度理解合理获得医用大麻以及如何评估是否已经实现。应将患者重视并适合其需要的大麻产品和服务的特点纳入合法医用大麻方案,以促进合法医疗来源的使用。虽然这项研究的结果专门与加拿大大麻的医疗用途有关,但它也可能有助于了解加拿大为非医疗目的使用非法大麻来源的情况,并为为医疗和非医疗目的实施大麻条例的其他司法管辖区提供见解。
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引用次数: 0
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Journal of Cannabis Research
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