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Published: 07 June 2022

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This is the madness you get when the largely unregulated #marijuana marketing monster is permitted to promote non-clinically trialled products with unsubstantiated claims of care and cure! 

But that’s exactly what you get in a ‘vote for medicine’ framework. The short-term and intergenerational harms of this #madness is all but guaranteed. It is disturbing enough when the ‘grown ups’ want to self-destruct, but when their actions condemn children to often irreversible harms, it’s beyond outrageous.

Ah! but the ‘intoxicated’ don’t care – except that whatever immediate ‘felt need’ is assuaged. Such is the inevitable trap of substance use.

Association of Comorbid Behavioral and Medical Conditions With Cannabis Use Disorder in Pregnancy

Considerable growth was observed in the prevalence of CUD diagnoses among individuals hospitalized prenatally and in the prevalence of depression, anxiety, nausea, and other conditions in individuals with CUD at hospitalization. This study highlights the need for more screening, prevention, and treatment, particularly in populations with co-occurring CUD and psychiatric disorders. Research on the determinants and outcomes associated with CUD during pregnancy is needed to guide clinicians, policy makers, and patients in making informed decisions.

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Published: 02 June 2022

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 Published Online:19 Apr 2022

Abstract

Introduction: Over-the-counter cannabidiol (CBD) products have seen unprecedented recent growth in the United Kingdom. However, analysis of these predominantly unregulated products from other countries tells us that they are often mislabeled or contain unlabeled and potentially dangerous chemicals. Thus, the aim of the present study was to analyze CBD oils available in the United Kingdom.

Materials and Methods: Phytocannabinoids, residual solvent, and heavy metals were measured blinded in 29 widely available CBD products by an independent testing facility using high-performance liquid chromatography with diode-array detection for cannabinoids, Headspace-gas chromatography-flame ionization detector and gas chromatography–mass spectrometry for residual solvents, and inductively coupled plasma–mass spectrometry for heavy metals.

Results: The mean advertised CBD content was 4.5%, and the actual mean measured CBD content of products was 3.2% (p=0.053, Mann–Whitney test). Only 11/29 (38%) products were within 10% of the advertised CBD content. Fifty five percent of products had measurable levels of the controlled substances Δ⁹-tetrahydrocannabinol (mean content 0.04%) or cannabinol (mean content 0.01%), as well as most other phytocannabinoid compounds including cannabidiolic acid (CBDA), cannabidivarin (CBDV), and cannabidivarin acid (CBDVA). Detectable levels of N-pentane, ethanol, isopropanol, heptane, lead, and arsenic were found in many of the CBD products, but these were within acceptable levels.

Conclusions: As demonstrated in other countries, the quality of over-the-counter CBD products in the United Kingdom can be substandard, particularly with regard to CBD content, and often contains levels of controlled substances. We recommend that these products be more strictly regulated for consumer welfare.

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Published: 01 June 2022

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Cannabis is the second-most common psychoactive substance (after alcohol) used during pregnancy.

• Elements of cannabis can pass through the placenta and affect the fetus’s development. Frequent cannabis use during pregnancy is associated with low birth weight and is part of a cluster of risk factors related to other adverse birth outcomes.
• There are also effects on behaviour in children and young adults, including attention deficits, emotional disturbances, increased hyperactivity and impulsivity, sleep disorders, and increased likelihood of substance use.
• Growing evidence from human and animal studies shows that paternal cannabis use can also negatively affect children’s neurodevelopment.
• Elements of cannabis can pass into breastmilk during lactation, which the infant absorbs and metabolizes.
• The effects of cannabidiol (CBD) use during pregnancy or breastfeeding are unknown. Both clinical and preclinical studies are urgently needed to evaluate the safety of CBD use during pregnancy.
• Information on the effects of cannabis use during pregnancy is essential to help healthcare providers advise patients about the effect of cannabis use and improve the health and well-being of patients and their children.

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Published: 24 May 2022

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Key points

• Activation of cannabinoid receptor 1 (CB1R) by endocannabinoids or synthetic ligands mediates acute haemodynamic effects and might contribute to pathology in cardiovascular disease; activation of cannabinoid receptor 2 (CB2R) exerts anti-inflammatory effects
• The psychoactive constituent of marijuana, Δ9‑tetrahydrocannabinol (THC), exerts its cardiovascular effects via CB1R activation; at low doses it might have beneficial properties via partial activation of CB1R and CB2R, and unrelated mechanisms
• The composition of marijuana (THC–cannabidiol ratio, terpenoids) can influence its therapeutic and cardiovascular adverse effects, with marijuana smoke being as harmful as tobacco smoke
• Most synthetic cannabinoids used for recreational use are full agonists of CB1R (THC is a partial agonist) with up to several hundred-fold higher potency and efficacy than THC, causing more dangerous adverse effects
• In parallel with a tenfold increase in the THC content of marijuana and the widespread availability of synthetic cannabinoids for recreational use, the number of serious cardiovascular adverse effects reported has markedly increased
• Clinicians should be vigilant to recognizing potential cardiovascular effects of marijuana and synthetic cannabinoids; controlled clinical trials should determine the long-term consequences of the use of medical marijuana on cardiovascular morbidity and mortality (Also see Handbook of Cannabis and Related Pathologies – 1st Edition (elsevier.com)

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