Tag Archives: NIH

Lancet study: Insufficient evidence that medicinal cannabinoids improve mental health

30 Oct

The National Institute on Drug (NIH) Abuse article What is medical marijuana?

The term medical marijuana refers to using the whole, unprocessed marijuana plant or its basic extracts to treat symptoms of illness and other conditions. The U.S. Food and Drug Administration (FDA) has not recognized or approved the marijuana plant as medicine.
However, scientific study of the chemicals in marijuana, called cannabinoids, has led to two FDA-approved medications that contain cannabinoid chemicals in pill form. Continued research may lead to more medications.
Because the marijuana plant contains chemicals that may help treat a range of illnesses and symptoms, many people argue that it should be legal for medical purposes. In fact, a growing number of states have legalized marijuana for medical use.
Why isn’t the marijuana plant an FDA-approved medicine?
The FDA requires carefully conducted studies (clinical trials) in hundreds to thousands of human subjects to determine the benefits and risks of a possible medication. So far, researchers haven’t conducted enough large-scale clinical trials that show that the benefits of the marijuana plant (as opposed to its cannabinoid ingredients) outweigh its risks in patients it’s meant to treat.
Read more about the various physical, mental, and behavioral effects of marijuana in our Marijuana DrugFacts.
Medical Marijuana Laws and Prescription Opioid Use Outcomes
A new study underscores the need for additional research on the effect of medical marijuana laws on opioid overdose deaths and cautions against drawing a causal connection between the two. Early research suggested that there may be a relationship between the availability of medical marijuana and opioid analgesic overdose mortality. In particular, a NIDA-funded study published in 2014 found that from 1999 to 2010, states with medical cannabis laws experienced slower rates of increase in opioid analgesic overdose death rates compared to states without such laws.1
A 2019 analysis, also funded by NIDA, re-examined this relationship using data through 2017. Similar to the findings reported previously, this research team found that opioid overdose mortality rates between 1999-2010 in states allowing medical marijuana use were 21% lower than expected. When the analysis was extended through 2017, however, they found that the trend reversed, such that states with medical cannabis laws experienced an overdose death rate 22.7% higher than expected.2 The investigators uncovered no evidence that either broader cannabis laws (those allowing recreational use) or more restrictive laws (those only permitting the use of marijuana with low tetrahydrocannabinol concentrations) were associated with changes in opioid overdose mortality rates.
These data, therefore, do not support the interpretation that access to cannabis reduces opioid overdose. Indeed, the authors note that neither study provides evidence of a causal relationship between marijuana access and opioid overdose deaths. Rather, they suggest that the associations are likely due to factors the researchers did not measure, and they caution against drawing conclusions on an individual level from ecological (population-level) data. Research is still needed on the potential medical benefits of cannabis or cannabinoids.
Read more in our Marijuana Research Report. https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-safe-effective-medicine https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine

Resources:

Marijuana medical benefits – large review finds very few https://www.skepticalraptor.com/skepticalraptorblog.php/marijuana-medical-benefits-large-review/

Marijuana and Cannabinoids | NCCIH
https://nccih.nih.gov/health/marijuana

Science Daily reported the Lancet study: Insufficient evidence that medicinal cannabinoids improve mental health:

Meta-analysis finds inadequate evidence that cannabinoids relieve depression, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis.
The most comprehensive analysis of medicinal cannabinoids and their impact on six mental health disorders — combining 83 studies including 3,000 people — suggests that the use of cannabinoids for mental health conditions cannot be justified based on the current evidence. This is due to a lack of evidence for their effectiveness, and because of the known risks of cannabinoids.
The new findings, published in The Lancet Psychiatry journal, find insufficient evidence medicinal cannabinoids improve disorders overall or their symptoms, although there is a very low quality evidence that pharmaceutical tetrahydrocannabinol (THC) may lead to a small improvement in symptoms of anxiety in individuals with other medical conditions, such as chronic pain or multiple sclerosis.
Medicinal cannabinoids include medicinal cannabis and pharmaceutical cannabinoids, and their synthetic derivatives, THC and cannabidiol (CBD). Around the world, these are increasingly being made available for medicinal purposes (e.g. in the United States, Australia, and Canada), including for the treatment of mental health disorders. However, there are concerns around the adverse effects of this availability, as there is a large body of evidence indicating that non-medicinal cannabis use can increase the occurrence of depression, anxiety, and psychotic symptoms.
Professor Louisa Degenhardt of the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney, Australia, and lead author of the study says: “Our findings have important implications in countries where cannabis and cannabinoids are being made available for medical use. There is a notable absence of high-quality evidence to properly assess the effectiveness and safety of medicinal cannabinoids compared with placebo, and until evidence from randomised controlled trials is available, clinical guidelines cannot be drawn up around their use in mental health disorders.”
She continues: “In countries where medicinal cannabinoids are already legal, doctors and patients must be aware of the limitations of existing evidence and the risks of cannabinoids. These must be weighed when considering use to treat symptoms of common mental health disorders. Those who decide to proceed should be carefully monitored for positive and negative mental health effects of using medicinal cannabinoids.”
This study follows The Lancet Series on Drug Use, which includes a paper on cannabis where the authors assess the current and possible future public health impacts of the legalisation of cannabis production, sale, and use in the Americas. They summarise the overall evidence on medicinal use of cannabinoids, regulation, and how medicinal use may have affected recreational use.
The authors set out to examine the available evidence for all types of medicinal cannabinoids. They included all study designs and investigated the impact on remission from and symptoms of six mental health disorders in adults: depression, anxiety, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, post-traumatic stress disorder (PTSD), and psychosis.
They included published and unpublished studies between 1980 and 2018 and included 83 eligible studies, 40 of which were randomised controlled trials (RCTs) (the others were open-label trials, where participants knew which treatment they were taking). Of the 83 studies, 42 looked at depression (including 23 RCTs), 31 looked at anxiety (17 RCTs), eight looked at Tourette syndrome (two RCTs), three were on ADHD (one RCT), 12 were on PTSD (one RCT), and 11 were on psychosis (six RCTs).
In most RCTs examining depression and anxiety, the primary reason for cannabinoid use was for another medical condition such as chronic non-cancer pain or multiple sclerosis. In the studies looking at the other four disorders, the cannabinoid was used to treat the mental health disorder. Few randomised controlled trials examined the role of pharmaceutical CBD or medicinal cannabis; most looked at THC, with or without CBD.
The authors found that pharmaceutical THC (with or without CBD) improved anxiety symptoms among individuals with other medical conditions (seven studies of 252 people), though this may have been due to improvements in the primary medical condition. The authors suggest further research should explicitly study the effects of cannabinoids on anxiety and depression…. https://www.sciencedaily.com/releases/2019/10/191028213912.htm

Citation:

Insufficient evidence that medicinal cannabinoids improve mental health
Date: October 28, 2019
Source: The Lancet
Summary:
The most comprehensive analysis of medicinal cannabinoids and their impact on six mental health disorders — combining 83 studies including 3,000 people — suggests that the use of cannabinoids for mental health conditions cannot be justified based on the current evidence. This is due to a lack of evidence for their effectiveness, and because of the known risks of cannabinoids.

Journal Reference:
Nicola Black, Emily Stockings, Gabrielle Campbell, Lucy T Tran, Dino Zagic, Wayne D Hall, Michael Farrell, Louisa Degenhardt. Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis. The Lancet Psychiatry, 2019; DOI: 10.1016/S2215-0366(19)30401-8

Here is the press release from the Lancet:

NEWS RELEASE 28-OCT-2019

The Lancet Psychiatry: Insufficient evidence that medicinal cannabinoids improve mental health

Meta-analysis finds inadequate evidence that cannabinoids relieve depression, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis
THE LANCET
Meta-analysis finds inadequate evidence that cannabinoids relieve depression, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis.
The most comprehensive analysis of medicinal cannabinoids and their impact on six mental health disorders – combining 83 studies including 3,000 people – suggests that the use of cannabinoids for mental health conditions cannot be justified based on the current evidence. This is due to a lack of evidence for their effectiveness, and because of the known risks of cannabinoids.
The new findings, published in The Lancet Psychiatry journal, find insufficient evidence medicinal cannabinoids improve disorders overall or their symptoms, although there is a very low quality evidence that pharmaceutical tetrahydrocannabinol (THC) may lead to a small improvement in symptoms of anxiety in individuals with other medical conditions, such as chronic pain or multiple sclerosis.
Medicinal cannabinoids include medicinal cannabis and pharmaceutical cannabinoids, and their synthetic derivatives, THC and cannabidiol (CBD). Around the world, these are increasingly being made available for medicinal purposes (e.g. in the United States, Australia, and Canada), including for the treatment of mental health disorders. However, there are concerns around the adverse effects of this availability, as there is a large body of evidence indicating that non-medicinal cannabis use can increase the occurrence of depression, anxiety, and psychotic symptoms.
Professor Louisa Degenhardt of the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney, Australia, and lead author of the study says: “Our findings have important implications in countries where cannabis and cannabinoids are being made available for medical use. There is a notable absence of high-quality evidence to properly assess the effectiveness and safety of medicinal cannabinoids compared with placebo, and until evidence from randomised controlled trials is available, clinical guidelines cannot be drawn up around their use in mental health disorders.” [1]
She continues: “In countries where medicinal cannabinoids are already legal, doctors and patients must be aware of the limitations of existing evidence and the risks of cannabinoids. These must be weighed when considering use to treat symptoms of common mental health disorders. Those who decide to proceed should be carefully monitored for positive and negative mental health effects of using medicinal cannabinoids.” [1]
This study follows The Lancet Series on Drug Use, which includes a paper on cannabis where the authors assess the current and possible future public health impacts of the legalisation of cannabis production, sale, and use in the Americas. They summarise the overall evidence on medicinal use of cannabinoids, regulation, and how medicinal use may have affected recreational use. [2]
The authors set out to examine the available evidence for all types of medicinal cannabinoids. They included all study designs and investigated the impact on remission from and symptoms of six mental health disorders in adults: depression, anxiety, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, post-traumatic stress disorder (PTSD), and psychosis.
They included published and unpublished studies between 1980 and 2018 and included 83 eligible studies, 40 of which were randomised controlled trials (RCTs) (the others were open-label trials, where participants knew which treatment they were taking). Of the 83 studies, 42 looked at depression (including 23 RCTs), 31 looked at anxiety (17 RCTs), eight looked at Tourette syndrome (two RCTs), three were on ADHD (one RCT), 12 were on PTSD (one RCT), and 11 were on psychosis (six RCTs).
In most RCTs examining depression and anxiety, the primary reason for cannabinoid use was for another medical condition such as chronic non-cancer pain or multiple sclerosis. In the studies looking at the other four disorders, the cannabinoid was used to treat the mental health disorder. Few randomised controlled trials examined the role of pharmaceutical CBD or medicinal cannabis; most looked at THC, with or without CBD.
The authors found that pharmaceutical THC (with or without CBD) improved anxiety symptoms among individuals with other medical conditions (seven studies of 252 people), though this may have been due to improvements in the primary medical condition. The authors suggest further research should explicitly study the effects of cannabinoids on anxiety and depression.
Pharmaceutical THC (with or without CBD) worsened negative symptoms of psychosis (one study, 24 people) and did not significantly affect any other primary outcomes for the mental health disorders examined. It also increased the number of people who had adverse events (ten studies; 1,495 people) and withdrawals due to adverse events (11 studies; 1,621 people) compared with placebo across all mental health disorders examined.
The study highlights the limited evidence and the low quality of the evidence that exists around using cannabinoids for treatment of mental health conditions. There is a need for high-quality research to understand the effects of different cannabinoids on a range of outcomes for people with mental health disorders.
Professor Degenhardt says: “Cannabinoids are often advocated as a treatment for various mental health conditions. Countries that allow medicinal cannabinoid use will probably see increased demand for such use. Clinicians and consumers need to be aware of the low quality and quantity of evidence for the effectiveness of medicinal cannabinoids in treating mental health disorders and the potential risk of adverse events. Given the likely interest but scant evidence to guide patient and clinician decisions around cannabinoids for mental health, there is an urgent need for randomised controlled trials to inform whether there are benefits of cannabinoids for these indications.” [1]
The authors highlight that their analysis and conclusions are limited by the small amount of available data, small study sizes, and the differences in findings between small studies. There is no recommended approach for addressing these issues in systematic reviews, but they tried to minimise them by keeping the focus of the review narrow. They also note that most studies are based on pharmaceutical cannabinoids, rather than medicinal cannabis, but plant products are most often used by those taking cannabinoids for medicinal purposes in the USA.
In a related Comment article, Professor Deepak Cyril D’Souza of Yale University School of Medicine, USA, says: “The process of drug development in modern medicine is to first demonstrate efficacy and safety in clinical trials before using the drug clinically. With cannabinoids, it seems that the cart (use) is before the horse (evidence). For cannabinoids to be used in the treatment of psychiatric disorders they should be tested in RCTs and subjected to the same regulatory approval process as other prescription medications.”
###
NOTES TO EDITORS
This study was funded by Australian Therapeutic Goods Administration, the Commonwealth Department of Health, Australia, Australian National Health and Medical Research Council and the US National Institutes of Health. It was conducted by researchers from the National Drug and Alcohol Research Centre, UNSW, the University of Brisbane, Australia and King’s College London, UK.
The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf if you have any questions or feedback, please contact The Lancet press office pressoffice@lancet.com
[1] Quote direct from author and cannot be found in the text of the Article.
[2] Paper available here (begins page 29): http://www.thelancet-press.com/embargo/EMBARGOED-druguseseries.pdf
A press release for this report is also available.
Peer-reviewed / Meta-analysis / People
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

The Centers for Disease Control and Addiction wrote in Marijuana: How Can It Affect Your Health?

Marijuana is the most commonly used illegal drug in the United States, with 37.6 million users in the past year,1 and marijuana use may have a wide range of health effects on the body and brain. Click on the sections below to learn more about how marijuana use can affect your health.
ADDICTION
About 1 in 10 marijuana users will become addicted. For people who begin using before the age of 18, that number rises to 1 in 6. 1-3
Some of the signs that someone might be addicted include:
• Unsuccessful efforts to quit using marijuana.
• Giving up important activities with friends and family in favor of using marijuana.
• Using marijuana even when it is known that it causes problems fulfilling everyday jobs at home, school or work.4
People who are addicted to marijuana may also be at a higher risk of other negative consequences of using the drug, such as problems with attention, memory, and learning. Some people who are addicted need to smoke more and more marijuana to get the same high. It is also important to be aware that the amount of tetrahydrocannabinol (THC) in marijuana (i.e., marijuana potency or strength) has increased over the past few decades. The higher the THC content, the stronger the effects on the brain. In addition, some methods of using marijuana (e.g., dabbing, edibles) may deliver very high levels of THC to the user.5 Researchers do not yet know the full extent of the consequences when the body and brain (especially the developing brain) are exposed to high concentrations of THC or how recent increases in potency affect the risk of someone becoming addicted. 5
References
1. Lopez-Quintero, C, et al. (2011). Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend. 115(1-2): p. 120-30.
2. Hall, W, Degenhardt L. (2009). Adverse health effects of non-medical cannabis use. Lancet. 374(9698): p. 1383-91.
3. Budney, AJ, Sargent JD, and Lee, DC. (2015). Vaping cannabis (marijuana): parallel concerns to e-cigs? Addiction. 110(11): p. 1699-704.
4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
5. National Institute on Drug Abuse. Is marijuana addictive?external icon (2017) Rockville, MD: National Institutes of Health, National Institute on Drug Abuse.
BRAIN HEALTH
Marijuana use directly affects the brain — specifically the parts of the brain responsible for memory, learning, attention, decision making, coordination, emotions, and reaction time.1
What are the short-term effects of marijuana on the brain?
Heavy users of marijuana can have short-term problems with attention, memory, and learning, which can affect relationships and mood.
What are the long-term effects of marijuana on the brain?
Marijuana also affects brain development. When marijuana users begin using as teenagers, the drug may reduce attention, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions.
Marijuana’s effects on these abilities may last a long time or even be permanent. This means that someone who uses marijuana may not do as well in school and may have trouble remembering things. 1-3
The impact depends on many factors and is different for each person. It also depends on the amount of tetrahydrocannabinol (THC) in marijuana (i.e., marijuana potency or strength), how often it is used, the age of first use, and whether other substances (e.g., tobacco and alcohol) are used at the same time.
Marijuana and the developing brain
Developing brains, like those in babies, children, and teenagers are especially susceptible to the hurtful effects of marijuana. Although scientists are still learning about these effects of marijuana on the developing brain, studies show that marijuana use by mothers during pregnancy may be linked to problems with attention, memory, problem-solving skills, and behavior problems in their children. 3-7
References
1. Batalla A, Bhattacharyya S, Yücel M, et al. (2013). Structural and functional imaging studies in chronic cannabis users: a systematic review of adolescent and adult findings. PloS One. 8(2):e55821. doi:10.1371/journal.pone.0055821.
2. Filbey, FM, et al., Long-term effects of marijuana use on the brain. (2014) Proc Natl Acad Sci USA. 111(47): p. 16913-8.
3. Goldschmidt, L, et al. (2002). Richardson, Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicol Teratol. 22(3): p. 325-36.
4. Fried, PA, Watkinson, B, and Gray, R. Differential effects on cognitive functioning in 9- to 12-year olds prenatally exposed to cigarettes and marihuana. Neurotoxicol Teratol, 1998. 20(3): p. 293-306.
5. Leech, SL, et al., (1999). Prenatal substance exposure: effects on attention and impulsivity of 6-year-olds. Neurotoxicol Teratol. 21(2): p. 109-18.
6. Goldschmidt, L, et al., (2008) Prenatal marijuana exposure and intelligence test performance at age 6. J Am Acad Child Adolesc Psychiatry. 47(3): p. 254-63.
7. El Marroun, H, et al., (2011). Intrauterine cannabis exposure leads to more aggressive behavior and attention problems in 18-month-old girls. Drug Alcohol Depend. 118(2-3): p. 470-4.
CANCER
Marijuana and cannabinoids (the active chemicals in marijuana that cause drug-like effects throughout the body, including the central nervous system and the immune system). The main active cannabinoid in marijuana is delta-9-THC. Another active cannabinoid is cannabidiol (CBD), which may relieve pain and lower inflammation without causing the “high” of delta-9-THC. Although marijuana and cannabinoids have been studied with respect to managing side effects of cancer and cancer therapies, there are no ongoing clinical trials of marijuana or cannabinoids in treating cancer in people.9 Studies so far have not shown that cannabinoids help control or cure the disease.2 And like many other drugs, marijuana can cause side effects and complications.
Relying on marijuana alone as treatment or for managing side effects while avoiding or delaying conventional medical care for cancer may have serious health consequences.2
How can marijuana affect symptoms of cancer?
Studies of man-made forms of the chemicals found in the marijuana plant can be helpful in treating nausea and vomiting from cancer chemotherapy.1 Studies have found that marijuana can be helpful in treating neuropathic pain (pain caused by damaged nerves).1
At this time, there is not enough evidence to recommend that patients inhale or ingest marijuana as a treatment for cancer-related symptoms or side effects of cancer therapy.
Is there a link between marijuana and cancer?
Smoked marijuana delivers THC and other cannabinoids to the body, but it also delivers harmful substances to users and those close by, including many of the same substances found in tobacco smoke, which are harmful to the lungs and cardiovascular system.3
Researchers have found limited evidence of an association between current, frequent, or chronic marijuana smoking and testicular cancer (non-seminoma-type).4
Because marijuana plants come in different strains with different levels of active chemicals, it can make each user’s experience very hard to predict. More research is needed to understand the full impact of marijuana use on cancer.
References
1. National Academies of Sciences E, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for researchexternal icon. Washington, D.C.
2. National Cancer Institute. (2017). Cannabis and Cannabinoids (PDQ®)–Patient Versionexternal icon. Rockville, MD: National Institutes of Health, National Cancer Institute.
3. U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General pdf icon[PDF – 36MB]external icon. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
4. Gurney, J, et al. (2015). Cannabis exposure and risk of testicular cancer: a systematic review and meta-analysis. BMC Cancer. 15: p. 897.
CHRONIC PAIN
Even though pain management is one of the most common reasons people use medical marijuana in the U.S., there is limited evidence that marijuana works to treat most types of chronic pain.
A few studies have found that marijuana can be helpful in treating neuropathic pain (pain caused by damaged nerves). 1 However, more research is needed to know if marijuana is any better or any worse than other options for managing chronic pain.
References
1. National Academies of Sciences E, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for researchexternal icon. Washington, D.C.
HEART HEALTH
Using marijuana makes the heart beat faster.1 It could also lead to increased risk of stroke and heart disease. 2-6 However, most of the scientific studies linking marijuana to heart attacks and strokes are based on reports from people who smoked it. Smoked marijuana delivers THC and other cannabinoids to the body, but it also delivers harmful substances to users and those close by, including many of the same substances found in tobacco smoke, which are harmful to the lungs and cardiovascular system. 3 So it’s hard to separate the effects of the compounds in marijuana on the cardiovascular system from the hazards posed by the irritants and other chemicals contained in the smoke. More research is needed to understand the full impact of marijuana use on the circulatory system to determine if marijuana use leads to higher risk of death from these causes.
References
1. Sidney, S. (2002) Cardiovascular consequences of marijuana use. J Clin Pharmacol. 42(11 Suppl): p. 64S-70S.
2. Wolff, V, et al. (2013). Cannabis-related stroke: myth or reality? Stroke. 44(2): p. 558-63.
3. Wolff, V, et al. (2015). Characteristics and Prognosis of Ischemic Stroke in Young Cannabis Users Compared With Non-Cannabis Users. J Am Coll Cardiol. 66(18): p. 2052-3.
4. Franz, CA and Frishman, WH. (2016) Marijuana Use and Cardiovascular Disease. Cardiol Rev. 24(4): p. 158-62.
5. Rumalla, K, Reddy, AY, and Mittal, MK. (2016). Recreational marijuana use and acute ischemic stroke: A population-based analysis of hospitalized patients in the United States. J Neurol Sci. 364: p. 191-6.
6. Rumalla, K, Reddy, AY, and Mittal, MK. (2016). Association of Recreational Marijuana Use with Aneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis. 25(2): p. 452-60.
LUNG HEALTH
How marijuana affects lung health is determined by how it’s consumed. In many cases, marijuana is smoked in the form hand-rolled cigarettes (joints), in pipes or water pipes (bongs), in bowls, or in blunts—emptied cigars that have been partly or completely refilled with marijuana. Smoked marijuana, in any form, can harm lung tissues and cause scarring and damage to small blood vessels. 1-2 Smoke from marijuana contains many of the same toxins, irritants, and carcinogens as tobacco smoke. 3 Smoking marijuana can also lead to a greater risk of bronchitis, cough, and phlegm production. 4-8 These symptoms generally improve when marijuana smokers quit.9-10
Secondhand marijuana smoke
The known health risks of secondhand exposure to cigarette smoke—to the heart or lungs, for instance—raise questions about whether secondhand exposure to marijuana smoke poses similar health risks. While there is very little data on the health consequences of breathing secondhand marijuana smoke, there is concern that it could cause harmful health effects, including among children.
Recent studies have found strong associations between those who said there was someone in the home who used marijuana or a caretaker who used marijuana and the child having detectable levels of THC — the psychoactive ingredient in marijuana. 5,11 Children exposed to the psychoactive compounds in marijuana are potentially at risk for negative health effects, including developmental problems for babies whose mothers used marijuana while pregnant. 8 Other research shows that marijuana use during adolescence can impact the developing teenage brain and cause problems with attention, motivation, and memory.12
References
1. Tashkin, DP. (2013) Effects of marijuana smoking on the lung. Ann Am Thorac Soc. 10(3): p. 239-47.
2. Moir, D, et al. (2008). A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions. Chem Res Toxicol. 21(2): p. 494-502.
3. U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General pdf icon[PDF – 36MB]external icon. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
4. Aldington, S, et al., Effects of cannabis on pulmonary structure, function and symptoms. Thorax, 2007. 62(12): p. 1058-63.
5. Moore, C, et al. (2011). Cannabinoids in oral fluid following passive exposure to marijuana smoke. Forensic Sci Int. 212(1-3): p. 227-30.
6. Tan, WC, et al. (2009). Marijuana and chronic obstructive lung disease: a population-based study. CMAJ. 180(8): p. 814-20.
7. Taylor, DR, et al. (200). The respiratory effects of cannabis dependence in young adults. Addiction. 95(11): p. 1669-77.
8. National Academies of Sciences E, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for researchexternal icon. Washington, D.C.
9. Hancox, RJ, et al. (2015). Effects of quitting cannabis on respiratory symptoms. Eur Respir J, 2015. 46(1): p. 80-7.
10. Tashkin, DP, Simmons MS, and Tseng, CH. (2012). Impact of changes in regular use of marijuana and/or tobacco on chronic bronchitis. COPD. 9(4): p. 367-74.
11. Wilson KM, Torok MR, Wei B, et al. (2017). Detecting biomarkers of secondhand marijuana smoke in young children. Pediatr Res. 81:589–592.
12. Broyd, SJ, et al. (2016). Acute and Chronic Effects of Cannabinoids on Human Cognition-A Systematic Review. Biol Psychiatry. 79(7): p. 557-67.
MENTAL HEALTH
Marijuana use, especially frequent (daily or near daily) use and use in high doses, can cause disorientation, and sometimes cause unpleasant thoughts or feelings of anxiety and paranoia. 1
Marijuana users are significantly more likely than nonusers to develop temporary psychosis (not knowing what is real, hallucinations and paranoia) and long-lasting mental disorders, including schizophrenia (a type of mental illness where people might see or hear things that aren’t really there). 2
Marijuana use has also been linked to depression and anxiety, and suicide among teens. However, it is not known whether this is a causal relationship or simply an association.
References
1. National Academies of Sciences E, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for researchexternal icon. Washington, D.C.
2. Volkow ND, Swanson JM, Evins AE, et al. (2016). Effects of cannabis use on human behavior, including cognition, motivation, and psychosis: a review. JAMA Psychiatry. 73(3):292-297. doi:10.1001/jamapsychiatry.2015.3278.
POISONING
Edibles, or food and drink products infused with marijuana and eaten, have some different risks than smoking marijuana, including a greater risk of poisoning. Unlike smoked marijuana, edibles can:
• Take from 30 minutes to 2 hours to take effect. So some people eat too much, which can lead to poisoning and/or serious injury.
• Cause effects that last longer than expected depending on the amount, the last food eaten, and medications or alcohol used at the same time.
• Be very difficult to measure. The amount of THC, the active ingredient in marijuana, is very difficult to measure and is often unknown in edible products. Many users can be caught off-guard by the strength and long-lasting effects of edibles.
It is also important to remember that marijuana affects children differently than adults. Since marijuana has become legal in some states, children have accidentally eaten marijuana products that looked like candy and treats, which made them sick enough to need emergency medical care. 3
If you use marijuana products, keep them in childproof containers and out of the reach of children. For additional questions, you can contact your health care provider, your health department, the Poison Helplineexternal icon at 1-800-222-1222, or 911 if it’s an emergency.
RISK OF USING OTHER DRUGS
The concept of marijuana as a “gateway drug”—where using marijuana leads a person to use other drugs—generates a lot of disagreement. Researchers haven’t found a definite answer yet. 1-2 However, most people who use marijuana do not go on to use other, “harder” drugs. 1
It is important to remember that people of any age, sex, or economic status can become addicted to marijuana or other drugs. Things that can affect the likelihood of substance use include:
• Family history.
• Having another mental health illness (such as anxiety or depression).
• Peer pressure.
• Loneliness or social isolation.
• Lack of family involvement.
• Drug availability.
• Socioeconomic status. 2
References
1. National Institute on Drug Abuse. Is marijuana a gateway drug? (2017). Rockville, MD: National Institutes of Health, National Institute on Drug Abuse.
2. Robertson EB, David SL, Rao SA. (2003) Preventing Drug Use Among Children and Adolescents. A Research-Based Guide for Parents, Educators, and Community Leaders pdf icon[PDF-725KB]external icon. National Institute on Drug Abuse, 2nd edn. NIH Publication no. 04-4212 (A). Bethesda, MD: US Department of Health and Human Services.
3. Colorado Department of Public Health and Environment (2017) Monitoring Health Concerns Related to Marijuana in Colorado: 2016external icon.
Reference
1. Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Healthexternal icon. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
2. Batalla A, Bhattacharyya S, Yücel M, et al. (2013). Structural and functional imaging studies in chronic cannabis users: a systematic review of adolescent and adult findings. PloS One. 8(2):e55821. doi:10.1371/journal.pone.0055821. https://www.cdc.gov/marijuana/health-effects.html

THE JURY IS OUT ON THE MEDICAL USES OF MARIJUANA.

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Columbia University’s Mailman School of Public Health: Aspirin may halve air pollution harms

27 Oct

Yvette Brazier in the article, Uses, benefits, and risks of aspirin, which was reviewed by Justin Choi, MD, wrote:

Aspirin, or acetylsalicylic acid (ASA), is commonly used as a pain reliever for minor aches and pains and to reduce fever. It is also an anti-inflammatory drug and can be used as a blood thinner.
People with a high risk of blood clots, stroke, and heart attack can use aspirin long-term in low doses.
Aspirin contains salicylate, which derives from willow bark. Its use was first recorded around 400 BCE, in the time of Hippocrates, when people chewed willow bark to relieve inflammation and fever.
It is often given to patients immediately after a heart attack to prevent further clot formation and cardiac tissue death.
Fast facts on aspirin
Here are some key points about aspirin. More detail is in the main article.
• Aspirin is one of the most widely used medications in the world.
• It comes from salicylate, which can be found in plants such as willow trees and myrtle.
• Aspirin was the first non-steroidal anti-inflammatory drug (NSAID) to be discovered.
• It interacts with a number of other drugs, including warfarin and methotrexate.
What is aspirin?
Aspirin has a range of uses, including the treatment of pain and inflammation and reduction of blood clotting.
Aspirin is a non-steroidal anti-inflammatory drug (NSAID).
NSAIDs are medications with the following effects:
• Analgesic: Relieves pain without anesthesia or loss of consciousness
• Antipyretic: Reduces a fever
• Anti-inflammatory: Lowers inflammation when used in higher doses
Non-steroidal means they are not steroids. Steroids often have similar benefits, but they can have unwanted side effects.
As analgesics, NSAIDs tend to be non-narcotic. This means they do not cause insensibility or stupor. Aspirin was the first NSAID to be discovered…. https://www.medicalnewstoday.com/articles/161255.php

Another use for aspirin is to reduce the harm caused by pollution.

Science Daily reported in Aspirin may halve air pollution harm:

A new study is the first to report evidence that nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin may lessen the adverse effects of air pollution exposure on lung function. The team of researchers from the Columbia Mailman School of Public Health, Harvard Chan School of Public Health, Boston University School of Medicine published their findings in the American Journal of Respiratory and Critical Care Medicine.
The researchers analyzed a subset of data collected from a cohort of 2,280 male veterans from the greater Boston area who were given tests to determine their lung function. The average age of participants was 73 years. The researchers examined the relationship between test results, self-reported NSAID use, and ambient particulate matter (PM) and black carbon in the month preceding the test, while accounting for a variety of factors, including the health status of the subject and whether or not he was a smoker. They found that the use of any NSAID nearly halved of the effect of PM on lung function, with the association consistent across all four weekly air pollution measurements from same-day to 28 days prior to the lung function test.
Because most of the people in the study cohort who took NSAIDs used aspirin, the researchers say the modifying effect they observed was mainly from aspirin, but add that effects of non-aspirin NSAIDs are worthy of further exploration. While the mechanism is unknown, the researchers speculate that NSAIDs mitigate inflammation brought about by air pollution.
“Our findings suggest that aspirin and other NSAIDs may protect the lungs from short-term spikes in air pollution,” says first and corresponding author Xu Gao, PhD, a post-doctoral research scientist in the Department of Environmental Health Sciences at the Columbia Mailman School. “Of course, it is still important to minimize our exposure to air pollution, which is linked to a host of adverse health effects, from cancer to cardiovascular disease.”
“While environmental policies have made considerable progress toward reducing our overall exposure to air pollution, even in places with low levels of air pollution, short-term spikes are still commonplace,” says senior author Andrea Baccarelli, MD, PhD, chair of the Department of Environmental Health Sciences at the Columbia Mailman School. “For this reason, it is important to identify means to minimize those harms.”
An earlier study by Baccarelli found that B vitamins may also play a role in reducing the health impact of air pollution…. https://www.sciencedaily.com/releases/2019/10/191002165233.htm

Citation:

Aspirin may halve air pollution harms
Date: October 2, 2019
Source: Columbia University’s Mailman School of Public Health
Summary:
A new study is the first to report evidence that nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin may lessen the adverse effects of air pollution exposure on lung function. The researchers found that the use of any NSAID nearly halved of the effect of PM on lung function, with the association consistent across all four weekly air pollution measurements from same-day to 28 days prior to the lung function test.

Journal Reference:
Xu Gao, Brent Coull, Xihong Lin, Pantel Vokonas, Joel Schwartz, Andrea A Baccarelli. Nonsteroidal Anti-Inflammatory Drugs Modify the Effect of Short-Term Air Pollution on Lung Function. American Journal of Respiratory and Critical Care Medicine, 2019; DOI: 10.1164/rccm.201905-1003LE

Here is the press release from Columbia:

Aspirin may prevent air pollution harms

by Columbia University’s Mailman School of Public Health

A new study is the first to report evidence that nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin may lessen the adverse effects of air pollution exposure on lung function. The team of researchers from the Columbia Mailman School of Public Health, Harvard Chan School of Public Health, Boston University School of Medicine published their findings in the American Journal of Respiratory and Critical Care Medicine.
The researchers analyzed a subset of data collected from a cohort of 2,280 male veterans from the greater Boston area who were given tests to determine their lung function. The average age of participants was 73 years. The researchers examined the relationship between test results, self-reported NSAID use, and ambient particulate matter (PM) and black carbon in the month preceding the test, while accounting for a variety of factors, including the health status of the subject and whether or not he was a smoker. They found that the use of any NSAID nearly halved of the effect of PM on lung function, with the association consistent across all four weekly air pollution measurements from same-day to 28 days prior to the lung function test.
Because most of the people in the study cohort who took NSAIDs used aspirin, the researchers say the modifying effect they observed was mainly from aspirin, but add that effects of non-aspirin NSAIDs are worthy of further exploration. While the mechanism is unknown, the researchers speculate that NSAIDs mitigate inflammation brought about by air pollution.
“Our findings suggest that aspirin and other NSAIDs may protect the lungs from short-term spikes in air pollution,” says first and corresponding author Xu Gao, Ph.D., a post-doctoral research scientist in the Department of Environmental Health Sciences at the Columbia Mailman School. “Of course, it is still important to minimize our exposure to air pollution, which is linked to a host of adverse health effects, from cancer to cardiovascular disease.”
“While environmental policies have made considerable progress toward reducing our overall exposure to air pollution, even in places with low levels of air pollution, short-term spikes are still commonplace,” says senior author Andrea Baccarelli, MD, Ph.D., chair of the Department of Environmental Health Sciences at the Columbia Mailman School. “For this reason, it is important to identify means to minimize those harms.”
An earlier study by Baccarelli found that B vitamins may also play a role in reducing the health impact of air pollution.
________________________________________
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More information: Xu Gao et al, Nonsteroidal Anti-Inflammatory Drugs Modify the Effect of Short-Term Air Pollution on Lung Function, American Journal of Respiratory and Critical Care Medicine (2019). DOI: 10.1164/rccm.201905-1003LE
Journal information: American Journal of Respiratory and Critical Care Medicine
Provided by Columbia University’s Mailman School of Public Health
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The National Institute of Environmental Health Sciences (NIH) site has good basic information about air pollution.

According to NIH:

Air pollution is a mixture of natural and man-made substances in the air we breathe. It is typically separated into two categories: outdoor air pollution and indoor air pollution.
Outdoor air pollution involves exposures that take place outside of the built environment. Examples include:
• Fine particles produced by the burning of fossil fuels (i.e. the coal and petroleum used in energy production)
• Noxious gases (sulfur dioxide, nitrogen oxides, carbon monoxide, chemical vapors, etc.)
• Ground-level ozone (a reactive form of oxygen and a primary component of urban smog)
• Tobacco Smoke
Indoor air pollution involves exposures to particulates, carbon oxides, and other pollutants carried by indoor air or dust. Examples include:
• Gases (carbon monoxide, radon, etc.)
• Household products and chemicals
• Building materials (asbestos, formaldehyde, lead, etc.)
• Outdoor indoor allergens (cockroach and mouse dropping, etc.)
• Tobacco smoke
• Mold and pollen
In some instances, outdoor air pollution can make its way indoors by way of open windows, doors, ventilation, etc.
What health effects are linked to air pollution?
Over the past 30 years, researchers have unearthed a wide array of health effects which are believed to be associated with air pollution exposure. Among them are respiratory diseases (including asthma and changes in lung function), cardiovascular diseases, adverse pregnancy outcomes (such as preterm birth), and even death.
In 2013, the World Health Organization concluded that outdoor air pollution is carcinogen to humans.
How can I reduce my risk for air pollution exposure?
Indoor air pollution can be reduced by making sure that a building is well-ventilated and cleaned regularly to prevent the buildup of agents like dust and mold. Occupants would also be wise to remove any known pollutants and or irritants (aerosols, stringent cleaning supplies, etc.) whenever possible.
Outdoor air pollution exposures can be reduced by checking one’s Air Quality Index (AQI), avoiding heavy traffic when possible, and avoiding secondhand tobacco smoke…. https://www.niehs.nih.gov/health/topics/agents/air-pollution/index.cfm

As with any medical procedure, before beginning a medical regime, a competent medical practitioner must be consulted.

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