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Cannabis use disorder (CUD) and cannabis use (CU) are significant conditions frequently co-occurring with attention-deficit hyperactivity disorder (ADHD). A recent genome-wide association study (GWAS) has shed light on the genetic overlap between ADHD and these cannabis-related conditions. This article delves into the study’s findings, highlighting the genetic loci associated with these disorders and their implications for understanding the comorbidity of ADHD and CUD or CU.
Genetic Overlap Between ADHD and Cannabis Use Disorders: The GWAS identified 36 genome-wide significant loci that are concordant for both ADHD and CUD, and ten loci for ADHD and CU. One of the key risk genes identified for ADHD-CUD is DRD2. The study found that ADHD-CUD risk genes exhibited high expression levels across various brain tissues and developmental stages, a pattern not observed in ADHD-CU genes.
Genetic Correlations and Substance Use: ADHD-CUD and ADHD-CU demonstrated similar genetic correlations with substance use; however, they differed significantly when it came to substance-use disorders. This differentiation underscores the complexity of the genetic interplay between ADHD and cannabis-related disorders.
Polygenic Scores (PGS) and Psychiatric Disorders: Individuals with ADHD-CUD showed increased polygenic scores for psychiatric disorders compared to those with ADHD alone. Moreover, they also exhibited a higher burden of rare deleterious variants. These findings suggest that the genetic underpinnings of ADHD-CUD may contribute to a broader spectrum of psychiatric comorbidities.
Risk Stratification: The stratification of individuals with ADHD by their CUD PGS revealed stark differences in the risk of developing comorbid CUD. Those in the highest CUD-PGS bin faced an absolute risk of 22% for comorbid CUD, which is substantially higher than the 1.6% risk observed among control individuals without ADHD.
Implications: These findings provide critical insights into the genetic factors contributing to the co-occurrence of ADHD and cannabis use disorders. Understanding these genetic overlaps can inform targeted interventions and personalised treatment strategies for individuals at high risk of developing these comorbid conditions.
Source: Nature
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A recent population-based retrospective cohort study published in JAMA Internal Medicine has explored the associations between prenatal cannabis use and maternal health outcomes during pregnancy. The study analysed pregnancies in Northern California from January 2011 to December 2019 and evaluated whether in utero exposure to cannabis is linked to various adverse maternal health conditions.
Study Design and Participants
The study included pregnancies that lasted 20 weeks or longer and were screened for prenatal cannabis use. A total of 316,722 pregnancies from 250,221 unique individuals were examined. The demographic breakdown of the sample was as follows:
- Asian/Pacific Islander: 26.5% (84,039)
- Black: 6.3% (20,053)
- Hispanic: 26.3% (83,145)
- White: 37.4% (118,333)
- Mean Age: 30.6 years (Standard Deviation: 5.4 years)
Exposure Definition
Prenatal cannabis use was defined based on self-reported use during early pregnancy or positive toxicology test results from universal screening at the entrance to prenatal care (approximately 8-10 weeks’ gestation). The frequency of use was categorised as daily, weekly, monthly or less, never, or unknown. Specific data points included:
- Self-reported Use: 2.9%
- Positive Toxicology Testing: 5.3%
- Both Self-report and Toxicology: 1.8%
Frequency of cannabis use among the study participants was:
- Daily: 0.6% (1,930)
- Weekly: 0.7% (2,345)
- Monthly or Less: 1.5% (4,892)
- Unknown: 3.4% (10,886)
Main Outcomes and Measures
Electronic health record data were used to define the following maternal health outcomes:
- Gestational Hypertension
- Preeclampsia
- Eclampsia
- Gestational Diabetes
- Gestational Weight Gain Greater and Less than Guidelines
- Placenta Previa
- Placental Abruption
- Placenta Accreta
- Severe Maternal Morbidity
Adjusted risk ratios (aRRs) were calculated using a modified Poisson regression to determine the association between prenatal cannabis use and these health outcomes.
Results:
The study found significant associations between prenatal cannabis use and several adverse maternal health outcomes:
- Gestational Hypertension: aRR of 1.17 (95% CI, 1.13-1.21)
- Preeclampsia: aRR of 1.08 (95% CI, 1.01-1.15)
- Weight Gain Less than Guidelines: aRR of 1.05 (95% CI, 1.01-1.08)
- Weight Gain Greater than Guidelines: aRR of 1.09 (95% CI, 1.08-1.10)
- Placental Abruption: aRR of 1.19 (95% CI, 1.05-1.36)
The study noted that the pattern of results was similar when prenatal cannabis use was defined solely by self-report or toxicology testing. Additionally, the associations between the frequency of prenatal cannabis use and outcomes varied with the specific health outcome being measured.
Conclusions and Relevance: The findings suggest that prenatal cannabis use is associated with several adverse maternal health outcomes during pregnancy. Continued research is necessary to understand whether characteristics such as dose, mode, and timing of prenatal cannabis use moderate these associations. (Source: JAMA)
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Introduction: Cannabis use and cannabis use disorder (CUD) are associated with adverse psychosocial outcomes, but their impact on workplace absenteeism remains poorly understood. Moreover, few studies have examined the role of CUD severity. This study aims to address these gaps by examining the associations between cannabis use recency, frequency, CUD severity, and workplace absenteeism.
Methods: Cross-sectional data from a U.S. representative sample of full-time employed adults aged ≥18 from the 2021 to 2022 National Survey on Drug Use and Health (N=46,499) were analyzed. The associations between cannabis use recency, past-month cannabis use frequency, CUD severity, and workplace absenteeism (measured by self-reported number of missed days due to illness/injury and skipped work in the last 30 days) were evaluated using negative binomial regression, adjusting for sociodemographic characteristics and other substance use. Data were analyzed in 2023–2024.
Results: An estimated 15.9% of full-time employed adults used cannabis in the past month, with 6.5% meeting CUD criteria. Past-month cannabis use (compared to no lifetime use), more frequent past-month cannabis use (compared to no use in the past month), and each level of CUD (compared to no CUD) were associated with increased incidence of both missing work due to illness/injury and skipping work, with a dose-response relationship observed between CUD severity and skipping work (mild: adjusted incident rate ratio [aIRR]=1.60 [95% confidence interval [CI]=1.24, 2.08]; moderate: aIRR=1.98 [95% CI=1.50, 2.61]); severe (aIRR=2.87 [95% CI=2.12, 3.88]).
Conclusions: Individuals with recent and frequent cannabis use and CUD are disproportionately prone to workplace absenteeism. Results support the enforcement of workplace drug prevention and treatment policies.
(Source: https://www.sciencedirect.com/science/article/abs/pii/S0749379724002587)
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The placebo effect is a fascinating phenomenon where a person experiences real changes in their health after receiving a treatment that has no therapeutic value. This effect is particularly notable in pain management.
When a person believes they are receiving a pain-relieving treatment, their brain can release natural painkillers called endorphins. These chemicals interact with the brain’s pain pathways, reducing the perception of pain. This process is known as placebo analgesia.
Research has shown that the placebo effect can be as effective as actual pain medications in some cases. For instance, studies have found that patients receiving a placebo can experience pain relief comparable to those taking low doses of morphine. This effect is not just about positive thinking; it involves complex neurobiological reactions, including increased activity in brain regions associated with mood and self-awareness….
When it comes to cannabis, the problem is that we need to create the placebo effect whilst disconnecting the patient from the substance that may have many other negative side-effects beyond the pain issue, which cannabis most certainly has.
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Cannabis research has come a long way, shedding light on its potential therapeutic benefits and risks. Yet, despite advancements, the integration of biomarkers—a critical tool for precise and objective measurement—remains noticeably absent from much of this research. This raises several questions: Why haven’t biomarkers been used more extensively in cannabis research? Is there a deliberate effort to withhold data that could lead to definitive outcomes? Let’s delve into these questions to understand the complexities and potential reasons behind this gap.
Biomarkers and Their Importance
Biomarkers are measurable indicators of a biological state or condition, encompassing genetic, biochemical, and physiological parameters. They provide objective, quantifiable data, aiding in early detection, diagnosis, and monitoring of diseases. In the context of cannabis research, biomarkers could offer invaluable insights into how cannabis affects the brain and body at a molecular level, potentially leading to more targeted treatments and clearer understanding of risks.
Current State of Cannabis Research
Most cannabis research today revolves around cognitive outcomes and self-reported data. While these approaches are essential, they have limitations such as subjectivity, variability, and short-term focus. Cognitive tests and surveys often fail to capture the nuanced, long-term effects of cannabis use. Hence, the integration of biomarkers could fill these gaps, providing a more comprehensive understanding of cannabis’s impact.