Reversible cardiomyopathy associated with acute inhaled marijuana use in a young adult

Marijuana is a frequently used recreational drug. We describe the first published case of marijuana related cardiomyopathy.

Marijuana Smoking and the Risk of Head and Neck Cancer: Pooled Analysis in the INHANCE Consortium

Background: Marijuana contains carcinogens similar to tobacco smoke and has been suggested by relatively small studies to increase the risk of head and neck cancer (HNC). Because tobacco is a major risk factor for HNC, large studies with substantial numbers of never tobacco users could help to clarify whether marijuana smoking is independently associated with HNC risk. Methods: We pooled self-reported interview data on marijuana smoking and known HNC risk factors on 4,029 HNC cases and 5,015 controls from five case-control studies within the INHANCE Consortium. Subanalyses were conducted among never tobacco users (493 cases and 1,813 controls) and among individuals who did not consume alcohol or smoke tobacco (237 cases and 887 controls). Results: The risk of HNC was not elevated by ever marijuana smoking [odds ratio (OR), 0.88; 95% confidence intervals (95% Cl), 0.67-1.16], and there was no increasing risk associated with increasing frequency, duration, or cumulative consumption of marijuana smoking. An increased risk of HNC associated with marijuana use was not detected among never tobacco users (OR, 0.93; 95% Cl, 0.63-1.37; three studies) nor among individuals who did not drink alcohol and smoke tobacco (OR, 1.06; 95% Cl, 0.47-2.38; two studies). Conclusion: Our results are consistent with the notion that infrequent marijuana smoking does not confer a risk of these malignancies. Nonetheless, because the prevalence of frequent marijuana smoking was low in most of the contributing studies, we could not rule out a moderately increased risk, particularly among subgroups without exposure to tobacco and alcohol. (Cancer Epidemiol Biomarkers Prev 2009;18(5):1544-51)

Medical marijuana initiatives - Are they justified? How successful are they likely to be?

The principal constituent of cannabis, Delta(9)-tetrahydrocannabinol (THC), is moderately effective in treating nausea and vomiting, appetite loss, and acute and chronic pain. Oral THC (dronabinol) and the synthetic cannabinoid, nabilone, have been registered for medical use in the US and UK, but they have not been widely used because patients find it difficult to titrate doses of these drugs. Advocates for the medical use of cannabis argue that patients should be allowed to smoke cannabis to relieve these above-mentioned symptoms. Some US state governments have legislated to allow the medical prescription of cannabis, but the US federal government has tried to prevent patients from obtaining cannabis and threatened physicians who prescribe it with criminal prosecution or loss of their licence to practise. In the UK and Australia, committees of inquiry have recommended medical prescription (UK) and exemption from criminal prosecution (New South Wales, Australia), but governments have not accepted these recommendations. The Canadian government allows an exemption from criminal prosecution to patients with specified medical conditions. It has recently legislated to provide cannabis on medical prescription to registered patients, but this scheme so far has not been implemented. Some advocates argue that legalising cannabis is the only way to ensure that patients can use it for medical purposes. However, this would be contrary to international drug control treaties and is electorally unpopular. The best prospects for the medical use of cannabinoids lie in finding ways to deliver THC that do not involve smoking and in developing synthetic cannabinoids that produce therapeutic effects with a minimum of psychoactive effects. While awaiting these developments, patients with specified medical conditions could be given exemptions from criminal prosecution to grow cannabis for their own use, at their own risk.

Marijuana Craving Questionnaire (MCQ-SF/Versão Brasil): validação semântica

OBJETIVO: O objetivo deste estudo foi realizar tradução e adaptação transcultural do Marijuana Craving Questionnaire (MCQ-SF)10, que avalia o craving por maconha em uma amostra brasileira. MÉTODO: O MCQ-SF foi traduzido do inglês para o português, aplicado em 10 sujeitos, submetido ao brainstorming num grupo de três indivíduos para reprodução individual e verbal, item a item. Realizou-se o back-translation, uma versão para o idioma de origem, a partir da primeira tradução e do brainstorming. Logo após, traduziu-se novamente para o português. Um comitê de juízes especialistas analisou todas as traduções. RESULTADOS: Após as considerações do comitê e um estudo-piloto com 30 sujeitos, a versão final do MCQ-SF/Versão Brasil foi construída. CONCLUSÃO: Os resultados demonstraram uma equivalência semântica satisfatória entre as versões. O MCQ-SF/Versão Brasil pode ser útil para avaliar o craving pela maconha nos dependentes dessa substância.

A fatal overdose of cocaine associated with coingestion of marijuana, buprenorphine, and fluoxetine. Body fluid and tissue distribution of cocaine and its metabolites determined by hydrophilic interaction chromatography-mass spectrometry(HILIC-MS).

Chromatographic separation of highly polar basic drugs with ideal ionspray mass spectrometry volatile mobile phases is a difficult challenge. A new quantification procedure was developed using hydrophilic interaction chromatography-mass spectrometry with turbo-ionspray ionization in the positive mode. After addition of deuterated internal standards and simple clean-up liquid extraction, the dried extracts were reconstituted in 500 microL pure acetonitrile and 5 microL was directly injected onto a Waters Atlantis HILIC 150- x 2.1-mm, 3-microm column. Chromatographic separations of cocaine, seven metabolites, and anhydroecgonine were obtained by linear gradient-elution with decreasing high concentrations of acetonitrile (80-56% in 18 min). This high proportion of organic solvent makes it easier to be coupled with MS. The eluent was buffered with 2 mM ammonium acetate at pH 4.5. Except for m-hydroxy-benzoylecgonine, the within-day and between-day precisions at 20, 100, and 500 ng/mL were below 7 and 19.1%, respectively. Accuracy was also below +/- 13.5% at all tested concentrations. The limit of quantification was 5 ng/mL (%Diff < 16.1, %RSD < 4.3) and the limit of detection below 0.5 ng/mL. This method was successfully applied to a fatal overdose. In Switzerland, cocaine abuse has dramatically increased in the last few years. A 45-year-old man, a known HIV-positive drug user, was found dead at home. According to relatives, cocaine was self-injected about 10 times during the evening before death. A low amount of cocaine (0.45 mg) was detected in the bloody fluid taken from a syringe discovered near the corpse. Besides injection marks, no significant lesions were detected during the forensic autopsy. Toxicological investigations showed high cocaine concentrations in all body fluids and tissues. The peripheral blood concentrations of cocaine, benzoylecgonine, and methylecgonine were 5.0, 10.4, and 4.1 mg/L, respectively. The brain concentrations of cocaine, benzoylecgonine, and methylecgonine were 21.2, 3.8, and 3.3 mg/kg, respectively. The highest concentrations of norcocaine (about 1 mg/L) were measured in bile and urine. Very high levels of cocaine were determined in hair (160 ng/mg), indicating chronic cocaine use. A low concentration of anhydroecgonine methylester was also found in urine (0.65 mg/L) suggesting recent cocaine inhalation. Therapeutic blood concentrations of fluoxetine (0.15 mg/L) and buprenorphine (0.1 microg/L) were also discovered. A relatively high concentration of Delta(9)-THC was measured both in peripheral blood (8.2 microg/L) and brain cortex (13.5 microg/kg), suggesting that the victim was under the influence of cannabis at the time of death. In addition, fluoxetine might have enhanced the toxic effects of cocaine because of its weak pro-arrhythmogenic properties. Likewise, combination of cannabinoids and cocaine might have increase detrimental cardiovascular effects. Altogether, these results indicate a lethal cocaine overdose with a minor contribution of fluoxetine and cannabinoids.

Adolescents' beliefs about marijuana use: a comparison of regular users, past users and never/occasional users.

A questionnaire investigating adolescents' opinions and experiences regarding marijuana use was administered to 163 adolescents and young adults (96 boys and 67 girls) aged 13 to 20 (mean age = 16.8, s.d. = 1.5). Items referred to marijuana and other substances' dangerousness, representations regarding the positive and negative consequences of marijuana use. Responses were compared according to marijuana use status (classified into never/occasional use, current regular use and past regular use). Results show that adolescents' opinions differ according to their experience with marijuana use. Current regular users evaluate marijuana as less dangerous, but alcohol and heroin as more dangerous in comparison with never/occasional and past users. Current and past users are more likely to define marijuana as a medical drug and a plant used in agriculture, and less likely to define it as an illegal drug. Current and past users evaluate marijuana use as a way to cope with stress, to relax to a greater extent than do never/occasional users do. The latter attribute more negative consequences to marijuana use such as diminished driving ability and school performance and a pathway to hard drugs.

Marijuana use, diet, body mass index, and cardiovascular risk factors (from the CARDIA study).

Marijuana use has been associated with increased appetite, high caloric diet, acute increase in blood pressure, and decreases in high-density lipoprotein cholesterol and triglycerides. Marijuana is the most commonly used illicit drug in the United States, but its long-term effects on body mass index (BMI) and cardiovascular risk factors are unknown. Using 15 years of longitudinal data from 3,617 black and white young adults participating in the Coronary Artery Risk Development in Young Adults (CARDIA) study, we assessed whether marijuana use was associated with caloric intake, BMI, and cardiovascular risk factors. Of the 3,617 participants, 1,365 (38%) reported ever using marijuana. Marijuana use was associated with male gender, tobacco smoking, and other illicit drug use. More extensive marijuana use was associated with a higher caloric intake (2,746 kcal/day in never users to 3,365 kcal/day in those who used marijuana for > or = 1,800 days over 15 years) and alcohol intake (3.6 to 10.8 drinks/week), systolic blood pressure (112.7 to 116.5 mm Hg), and triglyceride levels (84 to 100 mg/dl or 0.95 to 1.13 mmol/L, all p values for trend < 0.001), but not with higher BMI and lipid and glucose levels. In multivariate analysis, the associations between marijuana use and systolic blood pressure and triglycerides disappeared, having been mainly confounded by greater alcohol use in marijuana users. In conclusion, although marijuana use was not independently associated with cardiovascular risk factors, it was associated with other unhealthy behaviors, such as high caloric diet, tobacco smoking, and other illicit drug use, which all have long-term detrimental effects on health.

The Association between Tobacco Control Policies and Marijuana Use among Ontario Undergraduate Students

Background: Research indicates a steady increase in marijuana use and that it is concurrent with tobacco. There is speculation this concurrency reaches beyond use, to where policies aimed at reducing one may result in the reduction of the other. Purpose: To investigate the association between tobacco control policies and marijuana use among young adult undergraduates. Methods: A stratified sample of Ontario universities resulted in a sample of 4,966 participants. Results: Campuses with a moderately strong policy was found to be significantly associated with decreased marijuana use compared to campuses with a weak tobacco control policy. (OR=0.52, 95% CI: 0.36-0.76). Conclusions: The findings show tobacco control strategies are related to decreased odds of marijuana use among Ontario undergraduates. These findings are important to both policy makers and researchers interested in health strategies pertaining to marijuana and tobacco use and/or how health policies aimed at reducing one risk behaviour can affect another.

Encadrement normatif visant l'utilisation de la marijuana à des fins médicales en Occident

"Mémoire présenté à la Faculté des études supérieures en vue de l'obtention du grade de Maîtrise en droit, option recherche (LL.M.)"

Comportements de contrôle de poids et consommation de tabac, d'alcool et de marijuana à l'adolescence : le rôle modérateur du soutien parental

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Developmental trajectories of marijuana use and psychological distress : exploring the co-occurrence of these phenomena in early adolescence

Le début de l’adolescence est une période de changements rapides où la détresse psychologique et l’expérimentation de la marijuana sont choses fréquentes. Certaines études longitudinales ont démontré que ces deux phénomènes ont tendance à se manifester conjointement tandis que d’autres n’ont pu observer de tel lien. Ces résultats divergents suggèrent que plusieurs questions persistent concernant la nature de cette relation. Cette thèse a pour objectif d’explorer la consommation de marijuana et la détresse psychologique en début d’adolescence afin de mieux saisir les changements à travers le temps, ainsi que d’examiner si ces deux problématiques évoluent conjointement et s’influencent réciproquement. Un échantillon de 448 adolescents garçons et filles fréquentant deux écoles secondaires de Montréal, ont été suivi de secondaire I à secondaire III. De 1999 à 2001, les participants ont complété un questionnaire à chaque année de l’étude incluant des mesures portant sur la consommation de marijuana et la détresse psychologique (IDPESQ-14). Un modèle de mixture semi-paramétrique (Nagin, 2005) a été utilisé afin d’identifier les trajectoires développementales de la consommation de marijuana et de détresse psychologique. Des analyses ont également été effectuées afin d’établir les liens d’appartenance entre chacune des trajectoires de consommation identifiées et la détresse psychologique lors de la première année de l`étude, ainsi qu’entre chacune des trajectoires de détresse psychologique et la consommation de marijuana en première année du secondaire. Finalement, des analyses de trajectoires jointes ont été effectuées afin de déterminer l’interrelation entre la consommation de marijuana et la détresse psychologique. Les résultats de notre étude suggèrent qu’il existe une grande hétérogénéité au niveau de la consommation de marijuana et la détresse psychologique. Trois trajectoires développementales ont été identifiées pour la consommation de marijuana: consommation légère, consommation grandissante et consommation élevée et stable. Trois trajectoires ont également été observées pour la détresse psychologique : basse, moyenne et élevée. Nos résultats démontrent la présence d’un lien entre la détresse psychologique rapportée lors de la première année de l’étude et les trajectoires de consommation problématiques. Ce lien a également été observé entre la consommation de marijuana rapportée lors de première année de l’étude et les trajectoires problématiques de détresse psychologique. Les analyses de trajectoires jointes démontrent la présence d’une concordance entre la consommation de marijuana et la détresse psychologique. Cette interrelation est toutefois complexe puisque les trajectoires de détresse psychologique élevée sont associées à un niveau de consommation de marijuana plus problématique mais l’inverse de cette association est moins probable. Notre étude met en lumière la nature asymétrique de la concordance entre la consommation de marijuana et la détresse psychologique.

Whither RDS? An investigation of respondent driven sampling as a method of recruiting mainstream marijuana users.

Background: An important challenge in conducting social research of specific relevance to harm reduction programs is locating hidden populations of consumers of substances like cannabis who typically report few adverse or unwanted consequences of their use. Much of the deviant, pathologized perception of drug users is historically derived from, and empirically supported, by a research emphasis on gaining ready access to users in drug treatment or in prison populations with higher incidence of problems of dependence and misuse. Because they are less visible, responsible recreational users of illicit drugs have been more difficult to study. Methods: This article investigates Respondent Driven Sampling (RDS) as a method of recruiting experienced marijuana users representative of users in the general population. Based on sampling conducted in a multi-city study (Halifax, Montreal, Toronto, and Vancouver), and compared to samples gathered using other research methods, we assess the strengths and weaknesses of RDS recruitment as a means of gaining access to illicit substance users who experience few harmful consequences of their use. Demographic characteristics of the sample in Toronto are compared with those of users in a recent household survey and a pilot study of Toronto where the latter utilized nonrandom self-selection of respondents. Results: A modified approach to RDS was necessary to attain the target sample size in all four cities (i.e., 40 'users' from each site). The final sample in Toronto was largely similar, however, to marijuana users in a random household survey that was carried out in the same city. Whereas well-educated, married, whites and females in the survey were all somewhat overrepresented, the two samples, overall, were more alike than different with respect to economic status and employment. Furthermore, comparison with a self-selected sample suggests that (even modified) RDS recruitment is a cost-effective way of gathering respondents who are more representative of users in the general population than nonrandom methods of recruitment ordinarily produce. Conclusions: Research on marijuana use, and other forms of drug use hidden in the general population of adults, is important for informing and extending harm reduction beyond its current emphasis on 'at-risk' populations. Expanding harm reduction in a normalizing context, through innovative research on users often overlooked, further challenges assumptions about reducing harm through prohibition of drug use and urges consideration of alternative policies such as decriminalization and legal regulation.