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Doctors are being told not to use medicinal cannabis to treat patients with chronic pain, warning there is no solid evidence it is effective, as Australia’s medical regulator approves its 100,000th cannabinoid script.
The recommendation from the country’s peak pain advisory body to doctors is: “Do not prescribe currently available cannabinoid products to treat chronic non-cancer pain unless part of a registered clinical trial.”
The Faculty of Pain Medicine at the Australian and New Zealand College of Anaesthetists (ANZCA) says there is no robust evidence from gold-standard studies that proves cannabinoid products effectively treat these patients’ suffering. Cannabinoids are the active chemicals in cannabis.
But the Therapeutic Goods Administration (TGA) is allowing doctors to apply for special access to prescribe medicinal cannabis products. Proponents argue the substances should be given the benefit of the doubt and offered to patients on compassionate grounds.
Dean of ANZCA’s pain medicine faculty Professor Michael Vagg said medicinal cannabis products on the market “are not even close” to showing they are effective in the management of patients with complex chronic pain.
“The research available is either unsupportive of using cannabinoid products in chronic non-cancer pain or is of such low quality that no valid scientific conclusion can be drawn,” the pain specialist and physician said.
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Combined exposure to even low doses of alcohol with THC, HU-210, or CP 55,940 caused a greater incidence of birth defects, particularly of the eyes, than did either treatment alone. Consistent with the hypothesis that these defects are caused by deficient Shh, we found that CBs reduced Shh signaling by inhibiting Smoothened (Smo), while Shh mRNA or a CB1 receptor antagonist attenuated CB-induced birth defects. Proximity ligation experiments identified novel CB1-Smo heteromers, suggesting allosteric CB1-Smo interactions. In addition to raising concerns about the safety of cannabinoid and alcohol exposure during early embryonic development, this study establishes a novel link between two distinct signaling pathways and has widespread implications for development, as well as diseases such as addiction and cancer.
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DOI: 10.1097/EDE.0000000000001303
Abstract
Background: Male marijuana use has increased steadily over the last decade, but its effect on risk of spontaneous abortion to our knowledge has not been studied.
Results: Among 1535 couples who conceived during follow-up, 9% of men reported preconceptional marijuana use <1 time/week and 8% ≥1 time/week. Nineteen percent of pregnancies ended in spontaneous abortion. Compared with no use, adjusted hazard ratios (HRs) for male marijuana use were 1.1 (95% confidence interval [CI] = 0.64, 1.7) for <1 time/week and 2.0 (95% CI = 1.2, 3.1) for ≥1 time/week. The association for ≥1 time/week persisted after restricting to couples where the female partner did not use marijuana (HR = 2.0, 95% CI = 1.1, 3.3), and was stronger for losses at <8 weeks' gestation (HR = 2.5, 95% CI = 1.4, 4.3) and among males aged ≥35 years (HR = 4.1, 95% CI = 1.54, 11).
Conclusions: Couples with male partners who used marijuana ≥1 time/week during preconception had greater risk of spontaneous abortion than couples with males who did not use marijuana.
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- Researchers looked at 25 pregnant women who had a history of marijuana use when admitted to hospitals for delivery
- Within two weeks of giving birth, the women had levels of tetrahydrocannabinol (THC) of 5.5 nanograms per milliliter (ng/mL) on average in their breast milk
- This is higher than the blood THC level of five ng/mL or higher needed to charge drivers with a DUI, in some states
- By six weeks post-delivery, the THC levels in breast milk had dropped to about two ng/mL, low but still detectable
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European Journal of Public Health, ckab007, https://doi.org/10.1093/eurpub/ckab007
Abstract - Published: 24 February 2021
Background: Knowledge of factors relating to patterns of cannabis use is important for informing drug policy. This study determined factors associated with recent and current cannabis use. In addition, we explored factors related to having a cannabis use disorder (CUD)—defined using the Diagnostic and Statistical Manual of Psychiatric Disorders—among current users.
Methods: We analyzed data from Ireland’s 2010–11 and 2014–15 National Drug Prevalence Surveys, which recruited 5134 and 7005 individuals respectively, aged 15 years or more, living in private households. Multinomial logistic regression was used to identify factors associated with recent (last year) and current (last month) cannabis use compared to experiential use. Binary logistic regression was used to determine factors related to CUD among current users.
Results: The weighted prevalence of experiential cannabis use was 18.3%, with 3.0% and 3.3% of participants indicating recent or current use, respectively; 41.3% of current users indicated having a CUD. Factors associated with both recent or current cannabis use included younger age, not being married or cohabiting, having no dependent children and current use of tobacco or alcohol. Male gender, younger age and lower educational levels were significantly related to CUD among current users.
Conclusions: Males, adolescents/young adults and individuals with lower educational levels are more likely to be current users of cannabis and are at a greater risk of having a CUD. Health professionals should be aware of these factors to improve detection and prevention of CUD.