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Educating Anesthesia Providers On The Physiological Effects And Anesthesia Implications Of Cannabis, Carmel Loud

Doctor of Nursing Practice Projects

In the U.S., currently 37 states have legalized cannabis for medicinal use prescribed by qualified medical professionals (National Conference of State Legislatures [NCSL], 2022). In 2012, the legalization of recreational cannabis began; as of 2022, 19 states have legalized the recreational use of marijuana (NCSL, 2022). This project aimed to optimize care for patients using cannabis by increasing anesthesia provider knowledge about cannabis. The project's aim was accomplished through a thorough review of the current medical literature and implementation of education to anesthesia providers about the physiological effects and anesthesia implications of cannabis. Thirteen CRNAs took a pre- and post-quiz …

A Rare Case Of Acute Pancreatitis Associated With Cannabinoids Consumption, Mays Abdulazeez, Michael Perez, Alejandro Hidalgo Parada, Rani Rabah, Greity Dominguez, Rowel Perez Vargas, Jose Cano, Jesus Garza-Tamez, Sunand Kallumadanda

Research Symposium

Introduction: Acute pancreatitis is an inflammatory condition of the pancreas characterized by abdominal pain and elevated levels of pancreatic enzymes in the blood. Acute pancreatitis is a leading gastrointestinal cause of hospitalization in the United States. Several conditions are associated with acute pancreatitis, of which gallstones and chronic alcohol use disorder account for approximately two-thirds of the cases. Others, including smoking, hypertriglyceridemia, infections, trauma, drugs, malignancy, scorpion stings, hypercalcemia, endoscopic retrograde cholangiopancreatography (ERCP), opioids, angiotensin-converting enzyme (ACE) inhibitors, macrolides, diuretics, statins, and cannabis have also been associated with acute pancreatitis. Cannabis is the most widely used recreational drug worldwide, with …

Attitudes, Beliefs, And Perceptions On Cannabis Among Older Adults Aged 65 And Older: A Cross-Sectional Survey., Alex M Kleidon, Andrew M Peterson, Ilene Warner-Maron, Allen Glicksman

PCOM Scholarly Papers

OBJECTIVE: With the rise of medical and recreational cannabis use among older adults, concerns about the potential risks and benefits of cannabis use are increasing. This pilot study aimed to determine the attitudes, beliefs, and perceptions of older adults toward cannabis as a medicinal product, to establish a foundation for future research on how healthcare providers communicate with this population regarding cannabis.

METHODS: A cross-sectional survey was conducted on adults aged 65 and older living in Philadelphia. The survey included questions related to participants' demographics, knowledge, attitudes, beliefs, and perceptions of cannabis. Participants were recruited via flyer distributions, publications in …

Prevalence And Effect Of Cannabis Use In Acute Pancreatitis Of Unknown Etiology, Hanna Tran

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Simons-Linares CR, Barkin JA, Wang Y, et al. Is There an Effect of Cannabis Consumption on Acute Pancreatitis?. Dig Dis Sci. 2018;63(10):2786-2791. https://doi.org/10.1007/s10620-018-5169-2

for a patient with cannabis-associated acute pancreatitis.

Perceived Efficacy, Reduced Prescription Drug Use, And Minimal Side Effects Of Cannabis In Patients With Chronic Orthopedic Pain, Ari Greis, Eric Larsen, Conan Liu, Bryan Renslo, Anjithaa Radakrishnan, Adrianne R Wilson-Poe

Rothman Institute Faculty Papers

Introduction: Although cannabis is widely used for the treatment of chronic pain, most research relies on patient self-report and few studies have objectively quantified its efficacy and side effects. Extant inventories for measuring cannabis use were not designed to capture the medically relevant features of cannabis use, but rather were designed to detect problematic use or cannabis use disorder. Thus, we sought to capture the medically relevant features of cannabis use in a population of patients with orthopedic pain and pair these data with objective measures of pain and prescription drug use. Materials and Methods: In this prospective observational study, …

Associations Between Cannabis, Psychosis, And Schizophrenia In Adolescents, Lauren Moment

Academic Leadership Journal in Student Research

The effects of cannabis use on the brain, mind, and body have been studied for decades. The developing brain, particularly the adolescent and young adult brain, undergoes critical development that makes it especially susceptible to the effects of cannabis use. Among the adverse effects of cannabis use in adolescence and young adulthood, psychosis and psychotic disorders (e.g., schizophrenia) have been examined. The association of cannabis use with schizophrenia was first elucidated in a Swedish study of army conscripts. Specifically, conscripts reported their cannabis use exposure and were followed longitudinally to assess the emergence of schizophrenia. The authors found that those …

Cannabis And Acute Coronary Syndrome: A Case Report Exploring Potential Links, Fawaz Habba

Conference Presentation Abstracts

No abstract provided.

Case Report: Unintentional Edible Thc Ingestion (Gummi Worms) In A Child, James Espinosa, Kelly Hamilton, Alan Lucerna, David Ho, Henry Schuitema

Rowan-Virtua Research Day

We report the case of a 4 year male who presented to the ED with what his mother described as unusual fatigue and sleepiness. The mother related that family and friends had some to her house for a holiday gathering and that one of the guests had an accessible and open handbag that contained gummi worm THC. The guest observed the child eating the gummi worms and immediately notified the patient’s mother. Poison control was contacted. The child was observed for 6 hours and left the ED in good condition without any specific treatment needed. Awareness of the potential of …

Geotemporospatial And Causal Inferential Epidemiological Overview And Survey Of Usa Cannabis, Cannabidiol And Cannabinoid Genotoxicity Expressed In Cancer Incidence 2003–2017: Part 3 – Spatiotemporal, Multivariable And Causal Inferential Pathfinding And Exploratory Analyses Of Prostate And Ovarian Cancers, Albert Stuart Reece, Gary Kenneth Hulse

Research outputs 2022 to 2026

Background: The epidemiology of cannabinoid-related cancerogenesis has not been studied with cutting edge epidemiological techniques. Building on earlier bivariate papers in this series we aimed to conduct pathfinding studies to address this gap in two tumours of the reproductive tract, prostate and ovarian cancer. Methods: Age-standardized cancer incidence data for 28 tumour types (including “All (non-skin) Cancer”) was sourced from Centres for Disease Control and National Cancer Institute using SEER*Stat software across US states 2001–2017. Drug exposure was sourced from the nationally representative household survey National Survey of Drug Use and Health conducted annually by the Substance Abuse and Mental …

Geotemporospatial And Causal Inferential Epidemiological Overview And Survey Of Usa Cannabis, Cannabidiol And Cannabinoid Genotoxicity Expressed In Cancer Incidence 2003–2017: Part 1 - Continuous Bivariate Analysis, Albert Stuart Reece, Gary Kenneth Hulse

Research outputs 2022 to 2026

Background

The genotoxic and cancerogenic impacts of population-wide cannabinoid exposure remains an open but highly salient question. The present report examines these issues from a continuous bivariate perspective with subsequent reports continuing categorical and detailed analyses.

Methods

Age-standardized state census incidence of 28 cancer types (including “All (non-skin) Cancer”) was sourced using SEER*Stat software from Centres for Disease Control and National Cancer Institute across US states 2001–2017. It was joined with drug exposure data from the nationally representative National Survey of Drug Use and Health conducted annually by the Substance Abuse and Mental Health Services Administration 2003–2017, response rate 74.1%. …

Geotemporospatial And Causal Inferential Epidemiological Overview And Survey Of Usa Cannabis, Cannabidiol And Cannabinoid Genotoxicity Expressed In Cancer Incidence 2003–2017: Part 2 – Categorical Bivariate Analysis And Attributable Fractions, Albert Stuart Reece, Gary Kenneth Hulse

Research outputs 2022 to 2026

Background: As the cannabis-cancer relationship remains an important open question epidemiological investigation is warranted to calculate key metrics including Rate Ratios (RR), Attributable Fractions in the Exposed (AFE) and Population Attributable Risks (PAR) to directly compare the implicated case burden between emerging cannabinoids and the established carcinogen tobacco. Methods: SEER*Stat software from Centres for Disease Control was used to access age-standardized state census incidence of 28 cancer types (including “All (non-skin) Cancer”) from National Cancer Institute in US states 2001–2017. Drug exposures taken from the National Survey of Drug Use and Health 2003–2017, response rate 74.1%. Federal seizure data provided …

Geospatiotemporal And Causal Inference Study Of Cannabis And Other Drugs As Risk Factors For Female Breast Cancer Usa 2003-2017, Albert Stuart Reece, Gary Kenneth Hulse

Research outputs 2022 to 2026

Breast cancer (BC) is the commonest human cancer and its incidence (BC incidence, BCI) is rising worldwide. Whilst both tobacco and alcohol have been linked to BCI genotoxic cannabinoids have not been investigated. Age-adjusted state-based BCI 2003-2017 was taken from the Surveillance Epidemiology and End Results database of the Centers for Disease Control. Drug use from the National Survey of Drug Use and Health, response rate 74.1%. Median age, median household income and ethnicity were from US census. Inverse probability weighted (ipw) multivariable regression conducted in R. In bivariate analysis BCI was shown to be significantly linked with rising cannabis …

Impact Of Cannabis Use On Least Pain Scores Among African American And White Patients With Cancer Pain: A Moderation Analysis, Salimah H Meghani, Ryan Quinn, Rebecca Ashare, Kristin Levoy, Brooke Worster, Mary Naylor, Jesse Chittams, Martin Cheatle

Department of Medical Oncology Faculty Papers

Introduction: Based on many published reports, African American patients with cancer experience higher pain severity scores and lower pain relief than White patients. This disparity results from undertreatment of pain and is compounded by low adherence to prescribed non-opioid and opioid analgesics among African American patients with cancer. While nearly one in four patients use cannabis to manage cancer-related symptoms, less is known about how cannabis use influences pain relief in this patient population.

Methods: This study is based on preliminary data from an ongoing study of longitudinal outcomes of opioid therapy among African American and White patients with cancer. …

Non-Medical Cannabis Use Screening And Advising, William Dean Brown

Family Medicine Clerkship Student Projects

No abstract provided.

Prevalence Of Gastrointestinal Symptoms In Patients With Cannabis Abuse Presenting To The Emergency Room, Hadiatou Barry, Md, Mph, Botros Shenoda, Md, Phd, Msc, Purujit Thaker, Md, Mary Naglak, Phd

Health Equity and Quality Improvement (HEQI) Summit

Introduction: Cannabis is a common recreational drug among young adults that is used to induce euphoria, promote relaxation and enhance appetite. There is a recognized correlation between cannabis abuse and cyclic episodes of nausea, vomiting, and abdominal pain (cannabinoid hyperemesis syndrome). However, the contribution of such symptoms to emergency room visits and hospital admissions is not known.

Methods: A one-year, retrospective study was conducted on patients who presented to the emergency department and were later admitted at Abington Hospital-Jefferson Health with confirmed cannabis use (positive urine drug screen).

Aim/Goal: Our primary outcome was to understand the prevalence of gastrointestinal symptoms …

Effects Of Oral, Smoked, And Vaporized Cannabis On Endocrine Pathways Related To Appetite And Metabolism: A Randomized, Double-Blind, Placebo-Controlled, Human Laboratory Study., Mehdi Farokhnia, Gray R Mcdiarmid, Matthew N Newmeyer, Vikas Munjal, Osama A Abulseoud, Marilyn A Huestis, Lorenzo Leggio

Institute of Emerging Health Professions Faculty Papers

As perspectives on cannabis continue to shift, understanding the physiological and behavioral effects of cannabis use is of paramount importance. Previous data suggest that cannabis use influences food intake, appetite, and metabolism, yet human research in this regard remains scant. The present study investigated the effects of cannabis administration, via different routes, on peripheral concentrations of appetitive and metabolic hormones in a sample of cannabis users. This was a randomized, crossover, double-blind, placebo-controlled study. Twenty participants underwent four experimental sessions during which oral cannabis, smoked cannabis, vaporized cannabis, or placebo was administered. Active compounds contained 6.9 ± 0.95% (~50.6 mg) …

Pilot Study: Healthcare Cannabis Assessment, Nicole Wershoven

Family Medicine Clerkship Student Projects

Due to state legalization and increased access to cannabis, there is increasing use of cannabis in Vermont and nationwide. Cannabis is used medically for certain qualifying conditions in Vermont in addition to recreationally. In a recent study they found 45% of adult primary care patients in Vermont had used cannabis in the last year and only 18% of patients reported their clinician as being a good source of information regarding cannabis. Educating clinicians about cannabis is critical for quality comprehensive patient care. The objective of this project was the development of a short survey to deploy to primary care clinicians …

Contemporary Epidemiology Of Rising Atrial Septal Defect Trends Across Usa 1991–2016: A Combined Ecological Geospatiotemporal And Causal Inferential Study, Albert Stuart Reece, Gary Kenneth Hulse

Research outputs 2014 to 2021

© 2020, The Author(s). Background: Cardiovascular anomalies are the largest group of congenital anomalies and the major cause of death in young children, with various data linking rising atrial septal defect incidence (ASDI) with prenatal cannabis exposure. Objectives / Hypotheses. Is cannabis associated with ASDI in USA? Is this relationship causal? Methods: Geospatiotemporal cohort study, 1991–2016. Census populations of adults, babies, congenital anomalies, income and ethnicity. Drug exposure data on cigarettes, alcohol abuse, past month cannabis use, analgesia abuse and cocaine taken from National Survey of Drug Use and Health (78.9% response rate). Cannabinoid concentrations from Drug Enforcement Agency. Inverse …

The Financial And Psychosocial Impact Of Medicinal Cannabis, Chris Ahmed, Andrew Lee, Amanda Campbell, Gregory Garber, Msw, Lcsw, Neil D. Palmisiano, Md, Brooke Worster, Md

Phase 1

Introduction: Therapeutic utilization of medicinal cannabis for symptom management in oncology patients is a burgeoning area of research focus. We hypothesize that medicinal cannabis use can result in subjective improvements in quality of life (QOL) metrics for cancer patients.

Methods: Adult palliative care patients at a medical oncology clinic are consented to the study after being certified to access medicinal cannabis. After three months, subjective changes in QOL, including well-being, financial burden, pain, chemotherapy induced nausea and vomiting (CINV), and other categories are recorded via telephone interview. Responses are documented with a numerical Likert scale (from 1-5, with a score …

The Financial And Psychosocial Impact Of Medicinal Cannabis, Andrew Lee, Chris Ahmed, Amanda Campbell, Gregory Garber, Msw, Lcsw, Neil D. Palmisiano, Md, Brooke Worster, Md

Phase 1

Introduction: The use of medicinal cannabis for symptom management in cancer patients is a growing area of clinical interest. Past studies have demonstrated cannabis’s potential as an antiemetic and analgesic, but there is still much research to be done on its clinical efficacy. Our study hypothesizes that cancer patients using medicinal cannabis experience subjective improvements in pain, chemotherapy-induced nausea and vomiting (CINV), and quality of life (QOL) that justify related out-of-pocket costs.

Methods: Cancer patients are surveyed by phone three to six months after certification for access to medicinal cannabis. The survey assesses patient-reported changes in pain, CINV, QOL, and …

Marijuana And Its Cardiovascular Implications, Albert Bui, Daniel Powell, Victoria Cho, Kelsey Lindsley, Lindsey Peters

Pharmacy and Wellness Review

As marijuana becomes legalized for medical use, it is important for prescribers and pharmacists to be knowledgeable about the important aspects of marijuana such as mechanism of action, indications and abuse potential. Although marijuana's medicinal benefits are frequently reported, the risks, namely cardiovascular risks, associated with its utilization are often overlooked. Use of marijuana has been reported to increase the risk of myocardial infarction, tachycardia and hypotension, among others. Health care providers must determine if marijuana's benefits outweigh such risks when marijuana therapy is an option. It is also important for pharmacists to understand how to successfully counsel patients using …

Is There Less Opioid Abuse In States Where Marijuana Has Been Decriminalized, Either For Medicinal Or Recreational Use? A Clin-Iq, Aaron M. Wendelboe, Richard Mathew, Tana Chongsuwat, Elizabeth Rainwater, Mark A. Wendelboe, Elizabeth Wickersham Md, Ann F. Chou

Journal of Patient-Centered Research and Reviews

Opioid use, abuse, and associated mortality have reached an epidemic level. In some states, cannabis is being used to treat chronic pain. To examine the hypothesis that medical marijuana legislation may reduce adverse opioid-related outcomes if patients substitute cannabis for opioids for pain management, we conducted a clinical inquiry (Clin-IQ). We searched Ovid MEDLINE, Ovid MEDLINE In-Process, and Embase for studies using the search terms marijuana, cannabis, legal, marijuana smoking, medical marijuana, opioid-related disorders, cannabis use, medical cannabis, legal aspect, and opiate addiction. We included population-based articles published from January 1, 2012, through December 5, 2018, that assessed the relationship …

Associations Of First Trimester Co-Use Of Tobacco And Cannabis With Prenatal Immune Response And Psychosocial Well-Being, Kristin Ashford, Amanda Fallin-Bennett, Andrea Mccubbin, Amanda T. Wiggins, Sheila Barnhart, Joshua A. Lile

Perinatal Research and Wellness Center Faculty Publications

PURPOSE: This study aims to describe the association of first trimester co-use of tobacco and cannabis with maternal immune response and psychosocial well-being, relative to tobacco use only.

METHODS: A preliminary midpoint analysis included 138 pregnant women with biologically verified tobacco use, 38 of whom (28%) also tested positive for recent cannabis use. Maternal perceived stress (Perceived Stress Scale), depressive symptoms (Edinburgh Postnatal Depression Scale), and serum immune markers (IL-1β, IL-2, IL-6, IL-8, IL-10, TNFα, CRP, MMP8), were collected, although cytokine data were only available for 122 women.

RESULTS: Participant average age was 29.1 years, approximately half had a high …

Medical Marijuana-Induced Tacrolimus Toxicity., Daniel Moadel, Keira Chism

Department of Psychiatry and Human Behavior Faculty Papers

As both recreational and therapeutic marijuana use increases in the US, more attention is being paid to its direct medical and psychoactive effects. One crucial dimension is the potential for marijuana or marijuana-derived therapies to interact with other prescribed medications. Tacrolimus is an immunosuppressant medication prescribed to prevent rejection in patients receiving solid organ and bone marrow transplants. Clinically, it is characterized by a narrow therapeutic index and multiple drug-drug interactions. Constituents in marijuana are known to inhibit cytochrome P-450 3A, which is normally responsible for metabolizing tacrolimus, leading to the potential for a dangerous interaction. Though this phenomenon has …

Is Cannabis Effective In Reducing Muscle Spasticity And Body Pain Amongst Patients With Multiple Sclerosis?, William E. Johnson

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not cannabis is effective in reducing muscle spasticity and body pain amongst patients with Multiple Sclerosis (MS).

STUDY DESIGN: A systematic review of three peer-reviewed studies published between the years of 2003 and 2012.

DATA SOURCES: Three randomized control trials (RCTs) evaluating if cannabis can reduce muscle spasticity and body pain for patients diagnosed with Multiple Sclerosis. All three sources were selected from PubMed and examined for outcomes that were patient oriented.

OUTCOMES MEASURED: The two primary outcomes measured include: muscle spasticity measured by the Ashworth scale, …

An Educational Module For Adolescents On Cannabis Following Its Legalization, Anna Lidofsky

Family Medicine Clerkship Student Projects

Recreational use of cannabis has been recently legalized in Vermont. One year prior to its legalization, 42% of high school students in Washington County reported at least one-time use of cannabis. An educational module for adolescents was developed to address the increasing potency of cannabis and health risks associated with its use.

Cannabis Use And Association With Pain, Anxiety, And Depression Among Emergency Department Patients, John Detherage

Scholarship in Medicine - All Papers

Introduction:

Cannabis use is increasing nationwide. Many states have legalized medical and recreational use of cannabis. This study was undertaken to identify any association between cannabis use and chronic pain among ED patients.

Methods:

This was a prospective survey study of Emergency Department (ED) patients at Miami Valley Hospital, a level 1 trauma center in Dayton, Ohio conducted during June – August 2018. The survey included data regarding the frequency of cannabis use, chronic pain, and current mental illness.

Results:

Three hundred and sixty patients participated in this study. The majority of respondents were white (55%) or African American (42%). …

Ecg Findings In Pediatric Patients Under The Influence Of Marijuana, Jeffrey A. Robinson, Sahana Somasegar, Jill K. Shivapour, Christopher S. Snyder

Journal Articles: Pediatrics

Background: The effects of marijuana on the cardiac conduction system are ill defined. The purpose of this study is to describe the association between electrocardiogram (ECG) findings and positive urine drug screening (+UDS) for marijuana in the pediatric population. Methods: A retrospective review was conducted through the electronic medical record from Emergency Department (ED) visits dated 10/13- 11/14 of patients ≤ 18 years of age who tested positive for marijuana exposure by +UDS in the ED. Inclusion criteria included: 1) +UDS for marijuana performed in the ED and 2) electrocardiogram (ECG) performed on same day as +UDS. Each ECG was …

Frequency Of Cannabis Use Among Primary Care Patients In Washington State, Gwen T. Lapham, Amy K. Lee, Ryan M. Caldeiro, Dennis Mccarty, Kendall C. Browne, Denise D. Walker, Daniel R. Kivlahan, Katharine A. Bradley

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background and Objectives—Over 12% of U.S. adults report past-year cannabis use, and among those who use daily, 25% or more have a cannabis use disorder. Use is increasing as legal access expands. Yet, cannabis use is not routinely assessed in primary care, and little is known about use among primary care patients and relevant demographic and behavioral health subgroups. This study describes the prevalence and frequency of past-year cannabis use among primary care patients assessed for use during a primary care visit.

Methods—This observational cohort study included adults who made a visit to primary care clinics with annual behavioral health …

Impact Of Cannabis Use On Treatment Outcomes Among Adults Receiving Cognitive-Behavioral Treatment For Ptsd And Substance Use Disorders, Lesia M. Ruglass, Alina Shevorykin, Vanja Radoncic, Kathryn M. Z. Smith, Philip H. Smith, Isaac R. Galatzer-Levy, Santiago Papini, Denise A. Hien

Publications and Research

Background: Research has demonstrated a strong link between trauma, posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) in general and cannabis use disorders in particular. Yet, few studies have examined the impact of cannabis use on treatment outcomes for individuals with co-occurring PTSD and SUDs. Methods: Participants were 136 individuals who received cognitive-behavioral therapies for co-occurring PTSD and SUD. Multivariate regressions were utilized to examine the associations between baseline cannabis use and end-of-treatment outcomes. Multilevel linear growth models were fit to the data to examine the cross-lagged associations between weekly cannabis use and weekly PTSD symptom severity and primary …