Cannabis

Abstract—Background: Cannabis is one of the most abused drugs worldwide, with more than 20 million users in the United States (US). As access to cannabis products increases with expanding US legislation and decriminalization of marijuana, emergency physicians must be adept in recognizing unintentional cannabis toxicity in young children, which can range from altered mental status to encephalopathy and coma. Case Report: We report the case of a 13- month-old female presenting with self-limiting altered mental status and lethargy, with a subsequent diagnosis of tetrahydrocannabinol exposure on confirmatory urine gas chromatography-mass spectrometry. 

Why Should an Emergency Physician Be Aware of This?: Considering caretakers rarely report possible cannabis exposure, history-taking must review caretakers’ medicinal and recreational drug exposures to prevent inadvertently missing the diagnosis. In the young child with altered mental status, prompt urine screening for cannabinoid detection can prevent further invasive and costly diagnostic investigations, such as brain imaging and lumbar puncture. © 2018 Elsevier Inc. All rights reserved.

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Marijuana can be incredibly easy for kids to sneak into school, but now some school districts across the country are using a new gadget to spot it in just seconds. TODAY national investigative correspondent Jeff Rossen heads to Colorado, where marijuana is legal, to show viewers how the new “test kit” works. 

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What are Marijuana Concentrates or THC Concentrates? 

A marijuana concentrate is a highly potent THC concentrated mass that is most similar in appearance to either honey or butter, which is why it is referred to or known on the street as “honey oil” or “budder.”

What Does it Look Like?

Marijuana concentrates are similar in appearance to honey or butter and are either brown or gold in color. The different forms include: hash or honey oil (a goey substance), wax or butter (soft, lip balm-like substance), and shatter (a hard, solid substance). (See photo gallery at the bottom of the article)

What are the Street Names?

710 (the word “OIL” flipped and spelled backwards), wax, ear wax, honey oil, budder, butane hash oil, butane honey oil (BHO), shatter, dabs (dabbing), black glass, and errl.. 

How is it Used?

It's used a few ways:

  • Infusing marijuana concentrates in various food or drink products
  • Smoking remains the most popular form of ingestion by use of water or oil pipes or heated in a glass bong.
  • Electronic cigarettes (also known as e-cigarettes) or vaporizers. Many users of marijuana concentrates prefer the e-cigarette/vaporizer because it’s smokeless, odorless, and easy to hide or conceal. The user takes a small amount of marijuana concentrate, referred to as a “dab,” then heats the substance using the e-cigarette/vaporizer producing vapors that ensures an instant “high” effect upon the user. Using an e-cigarette/vaporizer to ingest marijuana concentrates is commonly referred to as “dabbing” or “vaping. 

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Whilst much research has focussed on the effects of endocannabinoids in the adult brain relatively little research has looked at the impact of these same effects in the developing brain of the foetus and neonate. Whilst the brain stem is almost devoid of type 1 cannabinoid receptors (CB1Rs) they are in high concentration in many parts of the midbrain, limbic system, subcortical regions and cerebral and cerebellar cortices 3. Foetal CB1Rs have been shown to play key roles in virtually all aspects of brain development including neural stem cell function, determining the ratio of glial v neuronal differentiation, brain inflammation, axonal growth cone guidance, stem cell niche function and signalling, blood flow signalling, white matter and CNS tract formation, glial cell differentiation, myelination, dendrite formation, neural migration into the developing cortex, synapse formation and integration of newly formed neurons into the neural network. They are also found in high density on endoplasmic reticulum and mitochondria from which latter they indirectly control major issues including cognition, DNA maintenance and repair systems both by supplying energy and by metabolite shuttle and RNA signalling 4 5.

Hence it is not surprising that gestational cannabis has been linked with a clear continuum of defects…

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PAIN: October 2018 - Volume 159 - Issue 10 - p 1932–1954                                                                   

doi: 10.1097/j.pain.0000000000001293

This review examines evidence for the effectiveness of cannabinoids in chronic noncancer pain (CNCP) and addresses gaps in the literature by: considering differences in outcomes based on cannabinoid type and specific CNCP condition; including all study designs; and following IMMPACT guidelines. MEDLINE, Embase, PsycINFO, CENTRAL, and clinicaltrials.gov were searched in July 2017. 

Analyses were conducted using Revman 5.3 and Stata 15.0. A total of 91 publications containing 104 studies were eligible (n = 9958 participants), including 47 randomised controlled trials (RCTs) and 57 observational studies. Forty-eight studies examined neuropathic pain, 7 studies examined fibromyalgia, 1 rheumatoid arthritis, and 48 other CNCP (13 multiple sclerosis–related pain, 6 visceral pain, and 29 samples with mixed or undefined CNCP). 

Across RCTs, pooled event rates (PERs) for 30% reduction in pain were 29.0% (cannabinoids) vs 25.9% (placebo); significant effect for cannabinoids was found; number needed to treat to benefit was 24 (95% confidence interval [CI] 15-61); for 50% reduction in pain, PERs were 18.2% vs 14.4%; no significant difference was observed. Pooled change in pain intensity (standardised mean difference: −0.14, 95% CI −0.20 to −0.08) was equivalent to a 3 mm reduction on a 100 mm visual analogue scale greater than placebo groups. In RCTs, PERs for all-cause adverse events were 81.2% vs 66.2%; number needed to treat to harm: 6 (95% CI 5-8). 

There were no significant impacts on physical or emotional functioning, and low-quality evidence of improved sleep and patient global impression of change. Evidence for effectiveness of cannabinoids in CNCP is limited. Effects suggest that number needed to treat to benefit is high, and number needed to treat to harm is low, with limited impact on other domains. It seems unlikely that cannabinoids are highly effective medicines for CNCP.

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