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Taking medical cannabis for chronic pain linked to increased risk of arrhythmia
People taking medical cannabis for chronic pain have a slightly increased risk of arrhythmia, according to research published in the European Heart Journal today (Thursday). Arrhythmia is when the heart beats too slowly, too quickly or irregularly. It includes conditions like atrial fibrillation.
Recreational use of cannabis has been linked to cardiovascular disease but there has been very little research on the side effects of medical cannabis. (In most cases it’s simply the same ‘recreational’ product with the word ‘medical’ in front of it! And this is science?)
Researchers say the new study is important as a growing number of countries now permit medical cannabis as a treatment for chronic pain.
The data showed that patients receiving medical cannabis had a 0.8% risk of being diagnosed with arrhythmia that required monitoring and possible treatment within 180 days of receiving cannabis. This risk was more than twice the risk for patients with chronic pain who were not taking cannabis.
Medical cannabis is now allowed as a treatment for chronic pain in 38 US states as well as several countries in Europe – such as Spain, Portugal, the Netherlands and the UK – and elsewhere around the world. This means more and more doctors will find themselves prescribing cannabis, despite a lack of evidence on its side effects.
I don't think this research should make patients with chronic pain refrain from trying medical cannabis if other treatment has been inadequate. However, these results do suggest some improved monitoring may be advisable initially, especially in patients who are already at increased risk of cardiovascular disease."
Dr. Anders Holt from Copenhagen University Hospital – Herlev and Gentofte in Denmark
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By UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE JANUARY 1, 2024
A research review in the New England Journal of Medicine highlights the growing concern over cannabis use disorder, exacerbated by increased cannabis potency and usage. This disorder, affecting a significant portion of Americans, particularly young adults, is often accompanied by other psychiatric conditions. Credit: SciTechDaily.com
Review article published in the New England Journal of Medicine finds 16 million Americans have cannabis use disorder.
The widespread use of cannabis (marijuana) and its increased potency are associated with a rise in cannabis-related psychiatric conditions, according to a new University of Maryland School of Medicine (UMSOM) review article that was recently published in the New England Journal of Medicine. It highlights the urgent need for doctors to screen for and treat patients who are experiencing symptoms of cannabis use disorder, which means they are experiencing significant problems from their use of the drug.
Nearly one in five Americans ages 12 and older used cannabis in 2021, according to the article, and more than 16 million met the criteria for cannabis use disorder as outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Health Disorders (DSM-5-TR). Young adults ages 18 to 25 are disproportionately affected. The review found more than 14 percent of those in this age group had cannabis use disorder.
Misconceptions and Risks of Cannabis Use
“There is a lot of misinformation in the public sphere about cannabis and its effects on psychological health with many assuming that this drug is safe to use with no side effects,” said David A. Gorelick, MD, PhD, Professor of Psychiatry at UMSOM who wrote the review article. “It is important for physicians and the public to understand that cannabis can have addictive effects and to recognize signs and symptoms in order to get properly diagnosed and treated.”
A University of Maryland School of Medicine review reveals a rise in cannabis-related psychiatric conditions, urging the need for improved awareness and treatment for cannabis use disorder, especially among young adults. Credit: University of Maryland School of Medicine
Cannabis use disorder is defined as problematic marijuana use. Symptoms include craving the drug and failing to control its use despite experiencing negative side effects like problems at work or school. It is most prevalent in people who use cannabis more than four days a week. While the primary risk factors are the frequency and duration of cannabis use, having another substance use disorder or other psychiatric condition also increases the likelihood of the diagnosis.
Psychiatric Conditions and Physical Symptoms
“Almost 50 percent of people with cannabis use disorder have another psychiatric condition such as major depression, post-traumatic stress disorder, or generalized anxiety disorder,” said Dr. Gorelick. “It’s vital that patients seek the right psychiatric treatment to address their risk factors.”
Physical signs and symptoms of cannabis use disorder can range from yellowing of the fingertips to increased depression and anxiety while using cannabis. To be properly diagnosed by a clinician, however, patients must meet two or more criteria for cannabis use disorder as outlined by the DSM-5-TR. These include doing poorly at school or work or missing important family obligations due to cannabis use. Experiencing withdrawal symptoms or cravings for cannabis are other symptoms.
Educational Efforts and Public Awareness
Dr. Gorelick, who is also Editor-in-Chief of the Journal of Cannabis Research, conducted the extensive review to educate physicians on the array of health issues that may be associated with short-term and long-term cannabis use as a growing number of individuals use cannabis products. He also aimed to heighten public awareness around cannabis user disorder, both in terms of recognizing its symptoms and understanding treatment options.
The paper also highlighted other dangers of excessive cannabis use: Cannabis use accounts for 10 percent of all drug-related emergency room visits in the U.S. and is associated with a 30 to 40 percent increased risk of car accidents. In 2022, 18 to 25-year-olds accounted for the highest rate of cannabis-related emergency department visits.
Addiction Research and Potential Therapies
“Approximately one in ten people who use cannabis will become addicted, and for those who start before age 18, the rate rises to one in six,” said Mark T. Gladwin, MD, the John Z. and Akiko K. Bowers Distinguished Professor and Dean, UMSOM, and Vice President for Medical Affairs, University of Maryland, Baltimore. “As use of this drug increases, we must delve deeply into basic research to understand the brain’s cannabinoid system. We must also design translational studies of therapies that target these brain mechanisms to help those with cannabis use disorder — particularly young adults and pregnant women — overcome their dependence on this drug.”
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Excerpt
“Cannabis use poses a global disease burden, albeit substantially less than that posed by other psychoactive substances such as alcohol, tobacco (nicotine), opioids, and stimulants. The Global Burden of Disease project calculated that cannabis use in 2016 was responsible for an estimated 646,000 years of healthy life lost to disability, an age-standardized rate of 8.5 years per 100,000 persons. Cannabis use is most strongly associated with an increased risk of motor vehicle crashes, suicidality, and cardiovascular and pulmonary disease…Cannabis use was associated with an estimated 10% of drug-related emergency department visits in the United States in 2021.
Adults who use cannabis over the long term have downregulation of brain CB1 receptors.18 receptors are also found outside the central nervous system in the myocardium, the vascular endothelium, adipose tissue, the liver, and reproductive organs. CB2 receptors are found primarily on immune cells, although some are found in the central nervous system. THC is a agonist at both types of cannabinoid receptor.
Cannabis use induces a variety of acute psychological and physiological effects that vary in intensity and duration according to the dose (chiefly of THC), the route of administration, and the degree of tolerance in the user.
Acute psychological effects include euphoria(“high), relaxation, and sedation (usually desired by persons who use cannabis recreationally), increased appetite (“munchies”) and impaired short-term memory, concentration, and psychomotor coordination. Some people experience increased anxiety, panic attacks, or paranoia, especially at higher doses. Psychotic symptoms, such as perceptual alterations, hallucinations, and delusions, are less common. Acute physical effects include impaired motor coordination, slurred speech, dry mouth, conjunctival injection (“red eye), tachycardia, orthostatic hypotension, and horizontal nystagmus. Smoked cannabis induces cough, wheezing, and dyspnea; increases sputum production; and exacerbates asthma. Cannabis use, regardless of the route of administration, may be associated with acute transient cardiac arrhythmias, including atrial fibrillation, supraventricular tachycardia, premature ventricular contractions, and nonsustained ventricular tachycardia.
Cannabis use is also associated with acute impairment of driving ability, as assessed by driving simulators and on-road tests. Cross-sectional surveys suggest that recent cannabis use increases the risk of motor vehicle crashes by 30 to 40%.26 By comparison, a blood alcohol concentration of 0.08% increases the risk of crashes by 250 to 300%.
(Source: New England Journal of Medicine 14th December 2023 David A. Gorelick, M.D., Ph.D.)
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- Researchers say they looked at 9,000 pregnancies and concluded cannabis is associated with a number of unhealthy pregnancy outcomes.
- They noted that they used testing rather than self-reporting, as in other studies, because of the amount of contradictory information about cannabis’ effect on pregnancies.
- The researchers concluded that exposure to cannabis was associated with a 1.5-fold increase in risk for people who are pregnant.
A study published today in the Journal of the American Medical Association (JAMA) may not clear the air entirely, but researchers say their findings do determine that pregnant people can be at greater health risk if they are using cannabis.
The University of Utah researchers looked at more than 9,000 pregnant women from eight medical centers across the United States.
They concluded that cannabis is associated with “a composite measure of unhealthy pregnancy outcomes, especially low birth weight, and that higher exposure is associated with higher risks.”
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So, What’s Wrong With Marijuana? Dr Drew Pinsky – Physician & Addiction Medicine Specialist, unpacks the reality, not the hype, of cannabis use. “Two of my family members are among these statistics, one developed an addition, the other psychosis.”