Cannabis use disorder and adverse cardiovascular outcomes: A population-based retrospective cohort analysis of adults from Alberta, Canada
Aim: To measure the association between cannabis use disorder (CUD) and adverse cardiovascular disease (CVD) outcomes.
Participants: We identified participants with CUD diagnosis codes and matched them to participants without CUD codes by gender, year of birth and time of presentation to the health system. We included 29 764 pairs (n = 59 528 individuals in total).
Conclusions: Canadian adults with cannabis use disorder appear to have an approximately 60% higher risk of experiencing incident adverse cardiovascular disease events than those without cannabis use disorder.
Question Have cannabis-involved traffic injury emergency department visits changed after cannabis legalization and the subsequent commercialization of the cannabis retail market (ie, store and product expansion) in Ontario, Canada?
Findings In this cross-sectional study capturing 426 cannabis-involved traffic injury emergency department visits, annual rates of cannabis involvement increased by 475.3% over 13 years. After accounting for time trends, legalization with restrictions was not associated with increased cannabis involvement during traffic injury emergency department visits; however, market commercialization, which overlapped with the COVID-19 pandemic, was.
Conclusions and Relevance This cross-sectional study found large increases in cannabis involvement in ED visits for traffic injury over time, which may have accelerated following nonmedical cannabis commercialization. Although the frequency of visits was rare, they may reflect broader changes in cannabis-impaired driving. Greater prevention efforts, including targeted education and policy measures, in regions with legal cannabis are indicated.
(Summary: the following demographics should completely ABSTAIN from cannabis use:
People aged 0-28 years of age (children and adolescents – developing brain)
Pregnant women
People with mental illness or vulnerable to such
Drivers/Driving (one could also assume, anyone operating a vehicle of any kind)
Whilst there are only some minor benefits from some cannabis derivatives, they come with adverse side effects and there is no curative properties in cannabis. More clinical, double-blind, placebo accounted for trials are required to further understand limitations, risks and potential benefits of cannabis. Dalgarno Institute)
Abstract:
Objective: To systematically assess credibility and certainty of associations between cannabis, cannabinoids, and cannabis-based medicines and human health, from observational studies and randomised controlled trials (RCTs).
Searches and inclusion criteria: We conducted an umbrella review of meta-analyses of observational studies(i.e., case-control and cohort studies) and randomised controlled trials that reported on any outcome associated with cannabis and cannabinoids use in humans.
Conclusions: Convincing or converging evidence supports that cannabis use is associated with poor mental health and cognition, increased the risk of car crashes, and can have detrimental effects on offspring if used during pregnancy. Cannabis use should be avoided in adolescents and young adults (when neurodevelopment is still occurring), when most mental health disorders have onset and cognition is paramount for optimising academic performance and learning, as well as in pregnant women and drivers. Conversely, cannabidiol could be considered a potential beneficial treatment option in epilepsy across age groups to reduce seizures. Cannabis based medicines could also be considered for chronic pain across different conditions, such as multiple sclerosis, spasticity in multiple sclerosis, for nausea and vomiting in people with mixed conditions and for sleep in cancer. However, clinical relevance must be considered before a possible incorporation into clinical guidelines; for example, including numbers needed to treat for benefit, risk to benefit ratios, comparative efficacy and safety with existing treatment options, and development of patient information concerning potential adverse events. Cannabidiol appears to be safe regarding psychiatric symptoms, but more research needs to be conducted before this drug can be recommended for the treatment of any psychiatric disorder. The remaining associations between cannabis and health outcomes are not supported by converging or convincing evidence.
Law and public health policy makers and researchers should consider this evidence synthesis when making policy decisions on cannabinoids use regulation, and when planning a future epidemiological or experimental research agenda, with particular attention to the tetrahydrocannabinol content of cannabinoids. Future guidelines are needed to translate current findings into clinical practice, while involving stakeholders.
Subtle but pervasive changes can occur between uses.
Understanding THC’s interaction with the brain’s important natural cannabinoid chemistry and physiology will now make sense of the impact that overly frequent cannabis use has on the brain and mental functioning.
Because THC stimulates our brain’s natural cannabinoid receptors (CB1) far more strongly and longer than the endogenous cannabinoid neurotransmitters anandamide and 2-AG, cannabis use throws brain chemistry out of balance temporarily, usually to people’s enjoyment. This loss of chemical equilibrium lasts an average of 4 hours when cannabis is inhaled and 8 hours when ingested orally before the liver metabolizes the THC and it is eliminated in the feces (55%) and urine (20%).
Most occasional cannabis users feel little or no effect the following day, but an interesting experiment reveals a subtle impact 24 hours after smoking a single joint. Private licensed pilots with over 200 hours of flight experience had their baseline skills measured in a flight simulator, then were provided a joint containing 10 or 20 mgs of THC to smoke. This was considered the equivalent of a moderate social dose in the mid-1980s.
A variety of pilot actions during routine landings were impaired 24 hours after smoking the joint, including the number and size of adjustments to stabilize the plane, distance off center on landing, and vertical and lateral deviation on approach to landing. Pilots showed no awareness of these impairments. Performance returned to baseline 48 hours after being high.
When the task became more complex by introducing turbulent weather conditions calling on pilots to react in real time to avoid trouble, responses were slower and less well organized than their baseline performance. In other words, the pilots’ response to novel events was altered (see the post How Cannabis Makes Everything So Interesting for clarification on the role our internal cannabinoid system plays in the experience of novelty.)
When THC stimulates CB1 receptors in the amygdala, cannabinoid tone increases, lowering the bar for any stimulus being imbued with a sense of novelty. Novelty draws our attention to unexpected stimuli. This phenomenon is largely responsible for cannabis making everything more interesting. But this is not the end of the story.
Whenever neurons containing CB1 receptors are over-stimulated by THC’s stronger and longer activation, a homeostatic response follows in an effort to rebalance the brain. The phrase “over-stimulated” means only that THC’s stimulation of CB1 receptors exceeds normal physiologic levels, leading to greater than normal negative feedback on the neuron’s release of transmitters with each firing. THC quells neuronal activity not by reducing the rate of nerve cell firing, but rather the amount of transmitter released each time the neuron fires.
As a result, neurons immediately react to THC’s over-stimulation by reducing the number of CB1 receptors. This reduction of receptors is called downregulation. A variety of mechanisms, including pulling receptors inside the cell so they are no longer available to be stimulated, begins with a single exposure to cannabis. By downregulating CB1 receptors, neurons partially regain some balance. Fewer receptors reduce the amount of negative feedback produced by cannabinoid stimulation and a more physiologic balance is re-established.
After THC has been metabolized and eliminated, CB1 receptors begin upregulating back to their normal level of availability. Upregulation after a single or occasional dose of cannabis occurs rapidly. Most people feel unaffected the following day.
In recent years, Cannabis use/misuse for treating pregnancy-related symptoms and other chronic conditions has increased among pregnant women, favored by decriminalization and/or legalization of its recreational uses in addition to its easy accessibility. However, there is evidence that prenatal Cannabis exposure might have adverse consequences on pregnancy progression and a deleterious impact on proper neurodevelopmental trajectories in the offspring. Maternal Cannabis use could interfere with the complex and finely controlled role performed by the endocannabinoid system in reproductive physiology, impairing multiple gestational processes from blastocyst implantation to parturition, with long-lasting intergenerational effects. In this review, we discuss current clinical and preclinical evidence regarding the role of endocannabinoids in development, function, and immunity of the maternal–fetal interface, focusing on the impact of Cannabis constituents on each of these gestational processes. We also discuss the intrinsic limitations of the available studies and the future perspectives in this challenging research field.
World Federation Against Drugs (W.F.A.D) Dalgarno Institute is a member of this global initiative. For evidence based data on best practice drug policy in the global context.
The Institute for Behavior and Health, Inc. is to reduce the use of illegal drugs. We work to achieve this mission by conducting research, promoting ideas that are affordable and scalable...
Drug Free Australia Website. Drug Free Australia is a peak body, representing organizations and individuals who value the health and wellbeing of our nation...
(I.T.F.S.D.P) This international peak body continues to monitor and influence illicit drug policy on the international stage. Dalgarno Institute is a member organisation.
The National Alliance for Action on Alcohol is a national coalition of health and community organisations from across Australia that has been formed with the goal of reducing alcohol-related harm.
RiverMend Health is a premier provider of scientifically driven, specialty behavioral health services to those suffering from alcohol and drug dependency, dual disorders, eating disorders, obesity and chronic pain.
