Facts & Risks

Abstract
Background: Cannabis (CAN) use has risen significantly over the last few decades. CAN has potent immunosuppressive properties, which could antagonize the effect of immunotherapy (IO). The impact of CAN use on clinical cancer outcomes remains unclear.

Objectives: In this study, we evaluated the clinical effect of CAN use on clinical outcomes among patients with solid malignancies receiving IO.

Design: This is a retrospective cohort study of all patients with solid malignancies receiving IO between August 2014 and August 2018.

Importance: Whether state implementation of medical and recreational cannabis laws is associated with increased cannabis use disorder (CUD) and/or cannabis poisoning among adults is not evident.

Objective: To examine state-level medical and recreational cannabis laws’ associations with CUD and cannabis poisoning, overall and by sex and age subgroups.

Design, setting, and participants: In this longitudinal cohort study, state-level CUD and cannabis poisoning diagnoses from January 2011 to December 2021 were examined across all 50 US states and the District of Columbia before and after the implementation of medical and recreational cannabis laws (MCLs and RCLs, respectively) using a staggered adoption difference-in-differences approach. Event studies were conducted to estimate the magnitude of the association for each year-quarter relative to the time of each policy implementation. This study was conducted among all adults aged 18 to 64 years enrolled in the Merative MarketScan Commercial Claims and Encounters Database, a database of employer-sponsored health insurance enrollees, with 1 year or more of continuous enrollment from 2011 to 2021. Data analysis was performed from January to August 2024.

Abstract

A six-year-old boy presented to the pediatric emergency department following an accidental ingestion of a synthetic cannabinoid. The child ingested an edible product containing tetrahydrocannabinol (THC) and presented with lethargy, altered mental status, and increased muscle tone. The airway was protected, and the patient was breathing spontaneously. Initial assessment included a thorough history provided by the caregivers, which confirmed ingestion of cannabinoid gummies approximately two hours prior to presentation. An electrocardiogram demonstrated sinus tachycardia with a prolonged QTc. Toxicology screening was presumed positive for cannabinoids. Therapeutic management focused on supportive care. The patient was admitted to the hospital and discharged on hospital day two with no neurologic sequelae. The caregivers were provided with expectant management and counseled regarding safe storage and use of cannabis and cannabis-derived products. This case report discusses the growing incidence of cannabis exposure in the pediatric population while highlighting the biochemistry, clinical presentation, and therapeutic management of accidental ingestion of synthetic cannabinoids.

Abstract
Introduction: Florida’s medical cannabis (marijuana) program is among the largest in the United States. Smokable cannabis forms were not legally available in this program until 2019, and five years after other forms of cannabis were available. This study assessed changes in Δ-9 tetrahydrocannabinol (THC) dispensed per patient following legalization of smokable cannabis in Florida. Materials and Methods: This quasi-experimental study used data from the Florida Department of Health Office of Medical Marijuana Use Reports on THC dispensing from April 6, 2018, through March 13, 2020. Certified medical cannabis user during the study period was included. The exposure was the dispensed amount of THC from legalized smokable forms of medical cannabis (statute identified as SB182), effective as of March 2019. Changes in level and trend of average milligram (mg) of dispensed THC per certified patient with 95% confidence intervals (CIs), before and after SB182, were calculated by fitting a generalized least squares linear model and allowing a 17-week phase-in period. Results: The number of certified patients increased by 24.8% from 197,107 (March 22, 2019) to 246,079 (July 19, 2019) and to 325,868 by March 13, 2020. Assuming that a 20% THC concentration in smokable products, there was a significant level increase in the mean weekly dispensed THC amount per certified patient of 138.45 mg (95% CI: 102.69-174.20), translating to a 42.18% increase (95% CI: 33.14-50.28), from the pre-policy period. We noted a continuous increase of 5.62 mg per certified patient per week (95% CI: 4.35-6.89) throughout the 35 weeks following the policy, when compared with the period before. Assuming 10% THC concentration in smokable products, we observed a significant level increase of 35.10 mg (95% CI: 5.31-64.88), corresponding to an increase of 10.70% (95% CI: 1.70-18.89), and a trend increase of 2.23 mg per certified patient per week (95% CI: 1.18-3.29). Discussion: The expansion of the Florida medical cannabis program to include smokable cannabis forms was associated with a significant increase in the mean amount of weekly dispensed THC per certified patient. Findings suggest that the dispensed amount of THC after legalization of smokable medical cannabis far exceeds the maximum recommended daily dose, based on extrapolation from oral cannabis product dosing recommendations from one expert consensus statement, raising questions about the safety, and need for consumer education.

Key Points
Question What is the association between cannabis use during adolescence or young adulthood and academic achievement?

Findings In this meta-analysis of 63 studies including 438 329 individuals, moderate-certainty evidence showed cannabis use during adolescence and young adulthood is probably associated with lower school grades; less likelihood of high school completion, university enrollment, and postsecondary degree attainment; and increased school dropout rate and school absenteeism. Low-certainty evidence suggested cannabis use may be associated with increased unemployment.

Meaning Cannabis use during adolescence and young adulthood is associated with worse academic performance; further research is needed to mitigate upstream and downstream factors associated with early cannabis exposure.