Marijuana Smoking

Purpose of review: Prescribed and non-prescribed cannabis use is common. Providers in specialties treating chronic pain – primary care, pain management, and neurology–will be coming across medical cannabis as a treatment for chronic pain, regardless of whether they are prescribers. It is important to be aware of the systemic and syndromic complications of acute and chronic cannabis use in the differential diagnosis of cardiac, cardiovascular, cerebrovascular, gastrointestinal, and psychiatric disorders.

Recent Findings: Medical cannabis is legal in 36 states. Studies have shown several potentially serious adverse effects associated with cannabis use.

Summary: Cannabis use has the potential to cause several complications that can be easily overlooked without a preexisting high index of suspicion.

Author/s:

Shah, J., Fermo, O.

Interventions for Substance Use Disorders in Adolescents: A Systematic Review

Brian Desmarais — Fri, 05 Jun 2020 18:28:32 +0000

Date Added:

June 5, 2020

Journal/Publication:

Comparative Effectiveness Review

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

May 21, 2020

Volume:

225

URL:

Interventions for Substance Use Disorders in Adolescents: A Systematic Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.23970/AHRQEPCCER225

Keywords

MeSH

Family Characteristics

An AHRQ systematic review of substance abuse disorders in adolescents. James W. Mold, MD, MPH

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Structured Abstract

Objectives. This systematic review (SR) synthesizes the literature on behavioral, pharmacologic, and combined interventions for adolescents ages 12 to 20 years with problematic substance use or substance use disorder. We included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms.

Data sources. We conducted literature searches in MEDLINE, the Cochrane CENTRAL Trials Registry, Embase, CINAHL, and PsycINFO to identify primary studies meeting eligibility criteria through November 1, 2019.

Review methods. Studies were extracted into the Systematic Review Data Repository. We categorized interventions into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. We conducted meta-analyses of comparative studies and evaluated the strength of evidence (SoE). The PROSPERO protocol registration number is CRD42018115388 .

Results. The literature search yielded 33,272 citations, of which 118 studies were included. Motivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month, and overall substance use problems by a standardized mean difference of 0.5, compared with treatment as usual. Brief MI did not reduce cannabis use days (net mean difference of 0). Across multiple intensive interventions, Fam was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual. No intensive interventions reduced cannabis use days. Pharmacologic treatment of opioid use disorder led to a more than 4 times greater likelihood of abstinence with extended courses (2 to 3 months) of buprenorphine compared to short courses (14 to 28 days).

Conclusions. Brief interventions: MI reduces heavy alcohol use (low SoE), alcohol use days (moderate SoE), and substance use–related problems (low SoE) but does not reduce cannabis use days (moderate SoE). Nonbrief interventions: Fam may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Intensive interventions did not appear to decrease cannabis use (low SoE). Some interventions (CBT, CBT+MI, and CBT+MI+CM) were associated with increased cannabis use (low SoE). Both MI and CBT reduce combined alcohol and other drug use (low SoE). Combined CBT+MI reduces illicit drug use (low SoE). Subgroup analyses of interest (male vs. female, racial and ethnic minorities, socioeconomic status, and family characteristics) were sparse, precluding conclusions regarding differential effects. Pharmacological interventions: longer courses of buprenorphine (2–3 months) are more effective than shorter courses (14–28 days) to reduce opioid use and achieve abstinence (low SoE). SRs in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for opioid, alcohol, and cannabis use disorders.

Citation

Suggested citation: Steele DW, Becker SJ, Danko KJ, Balk EM, Saldanha IJ, Adam GP, Bagley SM, Friedman C, Spirito A, Scott K, Ntzani EE, Saeed I, Smith B, Popp J, Trikalinos TA. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225. (Prepared by the Brown Evidence-based Practice Center under Contract No. 290-2015-00002-I.) AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020. Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPCCER225 .

Author/s:

Steele, D.W., Becker, S.J., Danko, K.J., Balk, E.M., Saldanha, I.J., Adam, G.P., Bagley, S.M., Friedman, C., Spirito, A., Scott, K., Ntzani, E.E., Saeed, I., Smith, B., Popp J., Trikalinos, T.A.

Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids: A Systematic Review and Meta-analysis

Brian Desmarais — Sat, 11 Apr 2020 18:25:13 +0000

Date Added:

April 11, 2020

Journal/Publication:

JAMA Network Open

Publisher:

Journal of American Medical Association

Publication Date:

April 1, 2020

URL:

Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids: A Systematic Review and Meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2020.2370.

Keywords

MeSH

substance withdrawal syndrome

Health Behavior

A meta-analysis of the incidence (47%) and predictors (concomitant tobacco or other substance abuse) of cannabis withdrawal symptoms. James W. Mold, MD, MPH

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IMPORTANCE:

Cannabis withdrawal syndrome (CWS)-a diagnostic indicator of cannabis use disorder-commonly occurs on cessation of heavy and prolonged cannabis use. To date, the prevalence of CWS syndrome has not been well described, nor have the factors potentially associated with CWS.

OBJECTIVES:

To estimate the prevalence of CWS among individuals with regular or dependent use of cannabinoids and identify factors associated with CWS.

DATA SOURCES:

A search of literature from database inception to June 19, 2019, was performed using MEDLINE, Embase, PsycINFO, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, ProQuest, Allied and Complementary Medicine, and Psychiatry online, supplemented by manual searches of reference lists of included articles.

STUDY SELECTION:

Articles were included if they (1) were published in English, (2) reported on individuals with regular use of cannabinoids or cannabis use disorder as a primary study group, (3) reported on the prevalence of CWS or CWS symptoms using a validated instrument, (4) reported the prevalence of CWS, and (5) used an observational study design (eg, cohort or cross-sectional).

DATA EXTRACTION AND SYNTHESIS:

All abstracts, full-text articles, and other sources were reviewed, with data extracted in duplicate. Cannabis withdrawal syndrome prevalence was estimated using a random-effects meta-analysis model, alongside stratification and meta-regression to characterize heterogeneity.

MAIN OUTCOMES AND MEASURES:

Cannabis withdrawal syndrome prevalence was reported as a percentage with 95% CIs.

RESULTS:

Of 3848 unique abstracts, 86 were selected for full-text review, and 47 studies, representing 23 518 participants, met all inclusion criteria. Of 23 518 participants included in the analysis, 16 839 were white (72%) and 14 387 were men (69%); median (SD) age was 29.9 (9.0) years. The overall pooled prevalence of CWS was 47% (6469 of 23 518) (95% CI, 41%-52%), with significant heterogeneity between estimates (I2 = 99.2%). When stratified by source, the prevalence of CWS was 17% (95% CI, 13%-21%) in population-based samples, 54% in outpatient samples (95% CI, 48%-59%), and 87% in inpatient samples (95% CI, 79%-94%), which were significantly different (P < .001). Concurrent cannabis (β = 0.005, P < .001), tobacco (β = 0.002, P = .02), and other substance use disorders (β = 0.003, P = .05) were associated with a higher CWS prevalence, as was daily cannabis use (β = 0.004, P < .001).

CONCLUSIONS AND RELEVANCE:

These findings suggest that cannabis withdrawal syndrome appears to be prevalent among regularusers of cannabis. Clinicians should be aware of the prevalence of CWS in order to counsel patients and support individuals who are reducing their use of cannabis.

Author/s:

Bahji, A., Stephenson, C., Tyo, R., Hawken, E.R., Seitz, D.P.

Drug interactions with cannabinoids

John Bayhi — Mon, 02 Mar 2020 18:41:14 +0000

Date Added:

March 2, 2020

Journal/Publication:

CMAJ: Canadian Medical Association Journal = journal de l'Association medicale canadienne

Publisher:

Joule Inc.

Publication Date:

March 2, 2020

Issue:

Volume:

192

Pages:

E206

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

Cytochrome P-450 CYP1A2

cannabinoids

Cytochrome P-450 CYP3A Inhibitors

Cytochrome P-450 CYP3A

Tacrolimus

Trimethoprim

Sulfamethoxazole Drug Combination

Cytochrome P-450 CYP2C9

Cytochrome P-450 CYP2C9 Inhibitors

CYP2C19 protein

Cytochrome P-450 CYP2C19

Benzodiazepines

International Normalized Ratio

Marijuana Use

cholinergic antagonists

A nice one-page review of drug interactions with cannabinoids. James W. Mold, MD, MPH

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No abstract available

Author/s:

Antoniou, T, Bodkin, J, Ho, JMW

Practice: Five things to know about edible cannabis

Brian Desmarais — Tue, 18 Feb 2020 17:01:51 +0000

Date Added:

February 18, 2020

Journal/Publication:

Canadian Medical Association Journal

Issue:

Volume:

197

Pages:

e162

URL:

Practice: Five things to know about edible cannabis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.191305

Keywords

MeSH

Important clinical points about edible cannabis products. James W. Mold, MD, MPH

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Not available.

Author/s:

Zipursky, J.S., Bogler, O.D., Stall, N.M.

Deficient Functioning of Frontostriatal Circuits During the Resolution of Cognitive Conflict in Cannabis-Using Youth

Brian Desmarais — Wed, 26 Jun 2019 19:39:50 +0000

Date Added:

June 26, 2019

Journal/Publication:

Journal of American Academy of Child Adolescent Psychiatry

Publication Date:

June 1, 2019

Issue:

Volume:

Pages:

702-711

URL:

Deficient Functioning of Frontostriatal Circuits During the Resolution of Cognitive Conflict in Cannabis-Using Youth

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.jaac.2018.09.436

Keywords

cannabis use

frontostriatal circuits

functional magnetic resonance imaging

resolution of cognitive conflict

youth

MeSH

Adolescent Psychiatry

Magnetic Resonance Imaging

Functional MRI evidence supporting important adverse effects of marijuana on the brains of adolescents. James W. Mold, MD, MPH

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Abstract

OBJECTIVE:

Disturbances in self-regulatory control are involved in the initiation and maintenance of addiction, including cannabis use disorder. In adults, long-term cannabis use is associated with disturbances in frontostriatal circuits during tasks that require the engagement of self-regulatory control, including the resolution of cognitive conflict. Understudied are the behavioral and neural correlates of these processes earlier in the course of cannabis use disentangled from effects of long-term use. The present study investigated the functioning of frontostriatal circuits during the resolution of cognitive conflict in cannabis-using youth.

METHOD:

Functional magnetic resonance imaging data were acquired from 28 cannabis-using youth and 32 age-matched healthy participants during the performance of a Simon task. General linear modeling was used to compare patterns of brain activation during correct responses to conflict stimuli across groups. Psychophysiologic interaction analyses were used to examine conflict-related frontostriatalconnectivity across groups. Associations of frontostriatal activation and connectivity with cannabis use measures were explored.

RESULTS:

Decreased conflict-related activity was detected in cannabis-using versus healthy control youth in frontostriatal regions, including the ventromedial prefrontal cortex, striatum, pallidum, and thalamus. Frontostriatal connectivity did not differ across groups, but negative connectivity between the ventromedial prefrontal cortex and striatum was detected in the 2 groups.

CONCLUSION:

These findings are consistent with previous reports of cannabis-associated disturbances in frontostriatal circuits in adults and point to the specific influence of cannabis on neurodevelopmental changes in youth. Future studies should examine whether frontostriatalfunctioning is a reliable marker of cannabis use disorder severity and a potential target for circuit-based interventions.

Author/s:

Cyr, M., Tau, G.Z., Fontaine, M., Levin, F.R., Marsh, R.