This Week in the ASAM Weekly

The Association of Cannabis Potency with Adverse Psychiatric Effects of Cannabis

By David A. Gorelick, MD, PhD, DLFAPA, FASAM

Cannabis potency, the content of ∆⁹-tetrahydrocannabinol (THC), usually expressed as the percentage of dry weight, has increased substantially worldwide over the past four decades. This higher potency poses a risk of increased harms because of evidence of a positive association between cannabis potency and adverse psychiatric effects from long-term cannabis use. This article reviews the evidence for this association.

Read the full editorial here.

Lead

Recommendations for Reducing the Risk of Cannabis Use-Related Adverse Psychosis Outcomes: A Public Mental Health-Oriented Evidence Review 🔓

Journal of Dual Diagnosis

As legal controls liberalize around cannabis, the authors reviewed the literature about links between cannabis use and psychosis to make recommendations for consumers, health professionals, and policy makers to decrease risk of developing psychosis symptoms. The authors provide 11 recommendations and the level of evidence for each. Recommendations based on the most substantial evidence of linkage to psychosis include: 1) avoid use in adolescence (<16), 2) avoid cannabis with high tetrahydrocannabinol (THC) concentration, 3) limit frequency of use, 4) avoid use if experiencing psychosis symptoms or receiving treatment, and 5) avoid use if one has other risk factors for developing psychosis.

Research and Science

Running High: Cannabis Users' Subjective Experience of Exercise During Legal Market Cannabis Use Versus No Use in a Naturalistic Setting

Cannabis and Cannabinoid Research

This within-subjects crossover study compared participants' experiences of running after ad libitum use of legal market cannabis (cannabis run) to running without cannabis (non-cannabis run) in a real-world setting. Participants (n=49) were cannabis users between the ages of 21 and 49 years (mean=30.82). The majority of participants were male (61.5%) and non-Hispanic White (81.6%). Results suggest that acute cannabis use may be associated with a more positive exercise experience among regular cannabis users. Research using varied methodologies, a range of exercise modalities, and diverse populations is needed to establish the long-term harms and benefits associated with this behavior, as well as the generalizability of these findings to other populations and settings.

Alignment in local approaches to alcohol and cannabis control policy: A case study of California cities and counties 🔓

International Journal of Drug Policy

This study examined how local recreational cannabis policies mirror existing alcohol policies for nearly 250 cities and counties in California. Two scores were employed: local policy stringency (“stringency score”) as well as provisions that could be applied to both substances. Average alcohol stringency score was 7.7 (range: 0-26; maximum possible score: 46). Some 71% of local governments banned retail cannabis sales, but these same municipalities had less stringent policies for alcohol, indicating that existing alcohol controls are not adapted to regulate cannabis. These assessments are needed to assist governments in understanding the public health implications of legalizing cannabis.

A comparison of advertised versus actual cannabidiol (CBD) content of oils, aqueous tinctures, e-liquids and drinks purchased in the UK 🔓

Journal of Cannabis Research

This study, conducted in the UK, purchased 63 cannabidiol (CBD) products online and analyzed them for actual CBD content using high performance liquid chromatography or gas chromatography-mass spectroscopy. The products represented 40 brands and consisted of 13 aqueous tinctures, 29 oils, 10 e-liquids (for e-cigarettes), and 10 drinks. Most had CBD content less than advertised. The deviation of actual content from advertised content (in percent) were: -51%±41% for aqueous tinctures, -19%±15% for oils, -29%±10% for e-liquids, and -66%±37% for drinks. Only 8% of products had CBD concentrations within 10% of advertised.

Learn More

Cannabis-Involved Emergency Department Visits Among Persons Aged <25 Years Before and During the COVID-19 Pandemic — United States, 2019–2022 🔓

MMWR

To understand trends in U.S. cannabis-involved emergency department (ED) visits (i.e., those for which cannabis use was documented in the chief complaint or a discharge diagnosis) among young persons aged <25 years during the COVID-19 pandemic, CDC used National Syndromic Surveillance Program data to examine changes in ED visits during 2019–2022. Mean weekly cannabis-involved ED visits among all young persons were higher during the COVID-19 pandemic in 2020, 2021, and 2022, compared with corresponding periods in 2019. Large increases in cannabis-involved ED visits throughout the COVID-19 pandemic compared with prepandemic surveillance periods in 2019 were identified among persons aged ≤10 years. Improving clinicians’ awareness of rising cannabis-involved ED visits might aid in early diagnosis of cannabis intoxication among young persons.

Prenatal delta-9-tetrahydrocannabinol exposure is associated with changes in rhesus macaque DNA methylation enriched for autism genes 🔓

Clinical Epigenetics

The authors cite studies showing an association between maternal cannabis use and autism spectrum disorder (ASD), ADHD, and intellectual disability in the offspring. They also note that cannabis use to treat morning sickness in pregnancy has doubled over the past decade. This study exposed pregnant, non-human primates (rhesus macaques) to THC. DNA methylation was measured in 5 tissues at delivery. They found 29 genes, candidates for ASD, methylated in THC-exposed macaques greater than the controls in all 5 tissues. This increased methylation with prenatal THC exposures reflects alterations in the epigenome that could be the underlying mechanism for the association of prenatal cannabis exposure and ASD observed in humans.

Cannabis and Cannabinoids for Pain and Posttraumatic Stress Disorder in Military Personnel and Veterans

JAMA Psychiatry

While cannabis use in the military is low, with the expansion of legalization of marijuana, particularly for medical use, the authors review the current evidence for use of cannabis products for treatment of pain and post-traumatic stress disorders (PTSD). After review of meta-analysis, the authors found no benefit for pain with the use of cannabinoids; further, studies suggested any perceived benefits by patients were attributable to placebo effect. Similarly, across multiple studies, there did not appear to be any benefit from cannabinoids for treatment of PTSD. Based on current evidence, the authors state cannabinoid for treatment of PTSD or pain in military personnel or veterans is not supported.

Management of Posttraumatic Stress Disorder and Acute Stress Disorder 2023 🔓

VA/DoD Clinical Practice Guidelines

The guideline describes the critical decision points in the Management of Posttraumatic Stress Disorder and Acute Stress Disorder and provides clear and comprehensive evidence based recommendations incorporating current information and practices for practitioners throughout the Department of Defense and Veterans Affairs Health Care systems. The guideline is intended to improve patient outcomes and local management of patients with one of these diagnoses. The updated guidelines recommend against cannabis or cannabis derivatives for the treatment of PTSD

In The News