In Summary

 A recent study has exposed the complexity of cannabis extracts as antitumor agents depending on the exact cannabinoid composition and cancer cell line. Researchers utilized whole cannabis extracts, meaning that the extract contains various amounts of cannabinoids, terpenes, and flavonoids produced by the cannabis plant, and found that each extract had various effects depending on cannabinoid composition. It was also found that the antitumor effects were not completely due to ∆-9-tetrahydrocannabinol (THC) as pure THC extracts did not provide the same effects as a whole plant extract. Some extracts were found to have antitumor effects on specific cancer cell lines but further research is needed to specify which ratio of cannabinoid and other chemicals provides the most benefits for each cell line. 
Considering the difficulty of treating cannabis and the horrible side-effects associated with chemotherapy it seems shocking that cannabis-based medications are not more widely accepted for cancer treatments. As cannabis is still classified as a Schedule I under the Controlled Substances Act the federal government can not provide any support for cannabis research which means that current research relies almost entirely on private funding. When examing the emotional and economic toll of cancer patients it seems irresponsible to not fully examine the possible benefits of cannabis-based medications to finally determine if they can provide more benefits than easing the side-effects of chemotherapy such as cachexia, chronic pain, and nausea. 

View more studies like this in the CED Foundation Archive:  http://bit.ly/drcaplan ​

Regulatory and legislative disparities with cannabis present challenges to P&T committees and health care providers ​

In Summary

​An article has recently been published that gives a summary of current federal and state cannabis laws and highlights the arising regulatory and legislative challenges. Cannabis is still considered a Schedule I drug at the federal level under the Controlled Substances Act but the FDA approval of Edioplex, a cannabidiol (CBD)-based epilepsy medication, has caused CBD to be ruled as a Schedule V drug by the Drug Enforcement Agency. The piece explains the implications of CBD approval, including the Farm Bill passed in 2018 and discusses the intricacies of maneuvering between federal and state drug regulations. Current laws, even at the federal level, show a shift towards the approval of cannabis products but there is still a long way to go. 
The article also highlights and attempts to explain the difficulties that physicians, budtenders,  and pharmacists in prescribing, licensing, and providing cannabis. Some states, not including Massachusetts, require that pharmacists provide cannabis so that they can properly advise patients about the risks and benefits of cannabis use. Massachusetts (MA), like many other states who have legalized medical cannabis, do not require budtenders at dispensaries to possess any prior medical knowledge, meaning that their advice on which strain or product a patient should try can be extremely under-informed and subjective. Patients in states like MA should take care to speak with their licensing physician or nurse practitioner about which cannabinoids or products would likely be best for them. 

View more studies like this in the CED Foundation Archive:  http://bit.ly/drcaplan 

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In Summary

​A study published in June of 2019 has revealed the forecast for emergency department visits based on the current opioid crisis in Canada and the legalization of cannabis. Researchers observed an increase in the number of emergency department visits at hospitals in Canada, specifically for mental health addiction complaints. It was determined that the opioid crisis will continue to cause issues for emergency departments but that the legalization of cannabis will cause a minimal amount of issues due to the low-risk of addiction. While forecasting the effects of addiction-related emergencies researchers determined that there would be increased waiting times and the length of stay will deteriorate. It is recommended that Psychiatric Emergency Service Units increase their number of beds and that programs aimed at preventing alcohol and opioid addiction will be especially helpful for managing the future influx of patients. 
The opioid crisis is ravaging more than just the emergency rooms in Canada, extending all over North America. Opioids are incredibly dangerous considering their high risk of addiction, often leading to people illegally obtaining opioids or other illicit drugs like heroin. Opioids most commonly act on µ-opioid receptors which affect the reward pathway in the central nervous system, preventing pain and convincing the body that opioids are a great substance. Some doctors are all too willing to overprescribe opioids for chronic pain or during recovery periods leading many to begin their lifelong addiction. Considering the economic cost of dealing with addicts, the emotional cost to families and caretakers, and the promise of cannabis as an anti-nociceptive, the federal government should seriously consider rescheduling cannabis so that it can be more seriously considered as an adjunct or replacement therapy for pain.

In Summary

Researchers have recently found that those diagnosed with cannabis use disorder are also likely to display sunk cost bias. Sunk cost bias is the overgeneralized tendency to persist based on past investment, in other words, the tendency to focus heavily on the past and perseverate more than their counterparts. In a two-part study, it was found that frequent cannabis use was positively associated with sunk cost bias and that sunk cost bias was able to predict frequent cannabis use in a separate cohort. This correlation may prove useful when developing a possible examination or screening test to determine the benefit of medical cannabis for individuals looking into cannabis-based treatments. 
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Cannabis use may not be for everyone as cannabinoids can affect people differently depending on their general demeanor or perhaps some mechanism that has yet to be defined. The most abundant, and perhaps well studied, psychoactive cannabinoid in cannabis is ∆-9-tetrahydrocannabinol (THC), which can affect people with anxiety very differently. Occasionally, especially when patients are hesitant to use cannabis already, THC can actually exacerbate symptoms of anxiety and therefore may not serve as the most efficient treatment for some patients. The development of a screening technique to determine how cannabinoids will affect patients before they try cannabis is desperately needed to ensure the benefit of the consumer. 

View more studies like this in the CED Foundation Archive:  http://bit.ly/drcaplan ​

In Summary

A recent study has exposed the negative effects of paternal exposure to ∆-9-tetrahydrocannabinol (THC) on attentional capabilities of offspring. The data provides evidence that a moderate dose of THC modulates the methylation of sperm in rats which was found to have long-term effects on offspring during the operant attention task. THC exposure did not affect the clinical health of the litter, the number of offspring, sex ratio, birth weight, survival rates, or growth although there was a reported increase in habituation of locomotor activity in adult offspring. As the study provides evidence that paternal exposure to THC can cause deleterious behavioral effects in the offspring this study should be repeated in humans or males who self-report cannabis use and conceive a child should be observed for the health of the next generation. 
The effect of prenatal exposure to cannabis on birth rates, birth outcomes, and the health of the mother is rather uncertain. Studies focussing on cannabis use during pregnancy are limited and what little has been reported is inconsistent. The featured article now brings to light that both parents may need to be cautious when attempting to conceive or when having unprotected sex as cannabis may affect both germ cells. Currently, governing bodies of obstetricians advise that pregnant mothers cease any cannabis use so if someone who needs cannabis for a medical purpose that improves their quality of life becomes pregnant they need to seek out alternative methods of treatment. Research is needed so that pregnant women can safely continue their medication or so that alternatives can be found so that women do not need to suffer for the duration of their pregnancy and possible breastfeeding period. 

In Summary

A recent meta-analysis and systematic review has shown that the liberalization of cannabis use has not increased the amount of reported cannabis use in adolescents. There appeared to be a slight increase in adult cannabis use post-recreational cannabis legalization but not a significant amount to clearly report that trend. These reports may be skewed due to the social stigma that continues to surround cannabis use and therefore prevents participants from accurately reporting their history, but further research in an area where cannabis legalization is likely to occur but hasn't yet would provide an interesting opportunity to confirm these findings. 

​Medical cannabis use has been legalized in 33 states at the time of this blog and legalized for recreational use in 11 states, highlighting the importance of looking into current demographics and legal activity. Some studies have suggested a decrease in adolescent cannabis use as illicit dealers are replaced by state-regulated dispensaries implying that legalization and regulation may actually provide a safer environment for cannabis use and allow better prevention practices for adolescents. Further research would be needed to confirm these hypotheses and previous findings but prove promising for future legalization.

In Summary

A recent study conducted by Brown University found that adolescent female cannabis users were less likely than their peers to engage in sexual intercourse. It remains uncertain whether cannabis is reducing participants' desire to engage in sexual intercourse or if there is a second common factor that wards them away from intercourse. Within the same population, it was found that the participants who consumed alcohol were far more likely to engage in sexual intercourse that day than controls or cannabis users. This knowledge may aid in the development of prevention programs, specifically for those consuming alcohol underage and then engaging in sexual intercourse, defined as a high-risk behavior in this study. 
Adolescent cannabis use is a hot topic of conversation as state governments continue to legalize medical and recreational cannabis. At-home cultivators and those who maintain a large amount of cannabis at their homes need to ensure proper storage and restriction methods to ensure the safety of their children. Too little is known about the long-term effects of cannabis to allow adolescents to have unsupervised access to cannabis. There should also be more studies conducted addressing the effect of cannabis-based medications in adolescents so it can be deemed safe to give children for various disorders or if it affects neural development. 

In Summary

Cannabis use was found to highly correlate with inpatients diagnosed with conduct disorder amongst teenagers. Although some cannabis use was self-reported by patients dealing with other psychiatric disorders, it was seen most significantly in those with conduct disorder (CD), suggesting a higher risk of comorbidity between CD and substance use disorders. Although cannabis use was the most common substance reported by patients it was closely followed by tobacco and alcohol use. The demographics of patients using cannabis varied although those suffering from CD and substance use disorder were primarily male and black. Further research should be conducted to develop efficient prevention strategies. 
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Looking into the substance use frequency and patterns of stigmatized or marginalized groups is not often done leaving many populations without specialized treatment or prevention programs. If members of the male black population are at a higher risk of developing substance use disorders then our prevention efforts should address that population first and foremost. People begin using substances for different reasons although some motivations are common among certain populations. By examining the underlying motivation for substance use frequency members of the healthcare community may be able to develop custom prevention or treatment methods by utilizing psychology or another science to drastically decrease the frequency of substance use disorders in all populations. 

In Summary

An article was recently published discussing how cooling the temperature of the environment a plant is growing in effects the overall growth pattern. Researchers specifically found that root–shoot biomass allocation and whole-plant growth rate varied ontogenetically in contrasting species in response to cooling. These variations in growth rates were seen in various strains of grass and flowering plants. The authors conclude that the findings of this study highlight the importance of measuring temporal growth dynamics rather than “snapshot” comparison, like height. Further research should expand to other species of plants beyond grasses and generic flowering plants found in most garden stores. 

Mass-produced cannabis plants tend to be grown in hydroponic set-ups like the plants in this study and are known to be sensitive to changes in growth factors. As the cannabis industry continues to grow the number of growers needed is increasing, stimulating the job market, but the number of at-home cultivators is also growing. For growers at home, it is important to note that the cannabinoids produced in a strain can vary depending on growth factors such as temperature, the mineral content of the soil, etc. They can purchase seeds of their favored strain grown in Colorado and grow an entirely different plant at their home in California. Consumers should be sure to consume a small dose or perfectly replicate growing conditions to ensure safe and effective consumption. 

In Summary