Perinatal Marijuana Use and the Developing Child

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Lauren M. Jansson, MD1; Chloe J. Jordan, PhD2; Martha L. Velez, MD1

JAMA. Published online July 16, 2018. doi:10.1001/jama.2018.8401 

Increasing public attention has recently been paid to the opioid epidemic and attendant effects on prenatally exposed infants and children. 1Current literature has emerged proposing marijuana as a safe alternative to opioids in addressing pain 2 and cannabis legalization as a way to decrease opioid fatalities. 3 As a result, perceptions of cannabis safety have increased, and the prevalence of marijuana use among pregnant women has expanded; past-month cannabis use among pregnant US women increased from 2.4% to 3.9% between 2002 and 2014. 4 Further, cannabis potency has been substantially increasing over the past 4 decades in the United States, and will likely continue to do so as extraction procedures of active components improve.

Although cannabis does have known medical utility for some conditions, its associated acute and long-term psychoactive effects on brain function are also known. Expanding use of cannabis among pregnant and lactating women (as likely will occur with legalization) may lead to increased risk from fetal and child exposures if the teratogenic potential of cannabis remains underappreciated …The exogenous supply of cannabinoids resulting from THC exposure can adversely affect fetal growth as well as structural and functional neurodevelopment. 6

Prenatal THC exposure has been documented to adversely affect infant neurobehavior and child development up through the teen years,5and postnatal exposures may compound prenatally acquired deficits. Neurobehavioral effects associated with prenatal THC exposure range from dysregulated arousal and motor difficulties at birth to disturbed sleep, memory impairment, aggression, and other developmental and behavioral concerns in childhood. 5

Despite these risks, it appears that clinicians are not addressing cannabis use during pregnancy or lactation; in one study of 74 lactation professionals, 85% encouraged breastfeeding among marijuana-using mothers. 7 Most national breastfeeding guidelines (eg, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists) have remained steadfast in recommending against cannabis use during lactation….

The medical community should advise pregnant women to avoid perinatal THC exposure and intervene for women needing treatment, for children at risk for neurobiological and developmental problems, or for dyads at risk for negative outcomes associated with an untreated substance use disorder. Advice from medical professionals should be consistent: pregnant and lactating women should be advised to avoid cannabis use, and women (and men) caring for developing children also should be advised to maintain abstinence. Treatment programs for women with CUD should be available and accessible, and gender and culturally specific, particularly during pregnancy and postpartum periods. Converging, systematic research is necessary at both the preclinical and clinical levels to address insufficient evidence regarding maternal cannabis use 9 and to fully understand the short- and long-term effects of perinatal THC exposure, the effects of maternal cannabis use on fetal outcomes, and the consequences of polysubstance use in treatment and intervention efforts.

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Cannabis, NOT the answer to the Opioid Crisis! Yet again!

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We wanted to make sure you had seen four key studies just into play

• A groundbreaking study in The Lancet found that marijuana use over four years actually made it harder for patients to cope with chronic pain, and did not reduce their use of opioids.
• A study in Frontiers in Psychiatry found that increasing self-exposure to non-medical marijuana was a predictor of greater odds of opioid dependencediagnosis.
• A study in the International Review of Psychiatry found an increased rate of serious mental illness in states that had legalized medical marijuana.
• In JAMA: "(The) associated acute and long-term psychoactive effects on brain function (of marijuana) are...known. Expanding use of cannabis among pregnant and lactating women (as likely will occur with legalization) may lead to increased risk from fetal and child exposures if the teratogenic potential of cannabis remains underappreciated."

Additional Resources on Link Between Marijuana and Opioids

These articles follow other warnings from medical professionals: the recent editorial published in the Journal of the Society for the Study of Addiction, which cautions against drawing policy conclusions from population studies, and the editorial comment from the American Society of Addiction Medicine on February 20, 2018. And don't forget NIDA's rigorous study showing pot users are twice as likely to have abused opioids and have an opioid use disorder than non-marijuana users.

SAM has published a one-pager describing the overwhelming link between marijuana and opioid abuse. While not every marijuana user will go on to use heroin, nearly all heroin users previously abused marijuana. We need smart policies that discourage use, get people back on their feet, and restore people to participate in and contribute to society. States that have legalized marijuana, by contrast, see increased drugged driving, increased arrests of minority youth, and increased emergency room visits. Colorado is experiencing the highest number of drug overdoses in its history. Legalization is a failed experiment.

Sincerely, Dr. Kevin Sabet President, Smart Approaches to Marijuana (SAM)                         

Affiliated Fellow, Yale University

THC exposure of human iPSC neurons impacts genes associated with neuropsychiatric disorders

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Translational Psychiatry volume 8, Article number: 89 (2018) 

Abstract 

There is a strong association between cannabis use and schizophrenia but the underlying cellular links are poorly understood. Neurons derived from human-induced pluripotent stem cells (hiPSCs) offer a platform for investigating both baseline and dynamic changes in human neural cells. Here, we exposed neurons derived from hiPSCs to Δ9-tetrahydrocannabinol (THC), and identified diagnosis-specific differences not detectable in vehicle-controls. RNA transcriptomic analyses revealed that THC administration, either by acute or chronic exposure, dampened the neuronal transcriptional response following potassium chloride (KCl)-induced neuronal depolarization. THC-treated neurons displayed significant synaptic, mitochondrial, and glutamate signaling alterations that may underlie their failure to activate appropriately; this blunted response resembles effects previously observed in schizophrenia hiPSC- derived neurons. Furthermore, we show a significant alteration in THC-related genes associated with autism and intellectual disability, suggesting shared molecular pathways perturbed in neuropsychiatric disorders that are exacerbated by THC. 

In summary, we found significant associations of THC- related pathways to autism and intellectual disability. Furthermore, we have used a dynamic, human-relevant system to demonstrate a phenotypic link between THC treatment and schizophrenia. We hypothesize that THC exposure, by impacting many of the same synaptic and epigenetic pathways already associated with psychiatric disorders, may serve as an additive risk to existing genetic/ epigenetic risk factors.  

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REAAAALLLY important article!

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All Young Cannabis Users Face Psychosis Risk  (Medscape and JAMA Psychiatry)  June 15, 2018

Cannabis use directly increases the risk for psychosis in teens, new research shows. A large prospective study of teens shows that "in adolescents, cannabis use is harmful" with respect to psychosis risk, study author Patricia J. Conrod, PhD, professor of psychiatry, University of Montreal, Canada, told Medscape Medical News.

The study included 3720 adolescents from the Co-Venture cohort, which represents 76% of all grade 7 students attending 31 secondary schools in the greater Montreal area.

Cannabis use, in any given year, predicted an increase in psychosis symptoms a year later, said Conrod. This type of analysis is more reliable than biological measures, such as blood tests, said Conrod. "Biological measures aren't sensitive enough to the infrequent and low level of use that we tend to see in young adolescents," she said.

The effect was observed for the entire cohort. This finding, said Conrod, means that all young cannabis users face psychosis risk, not just those with a family history of schizophrenia or a biological factor that increases their susceptibility to the effects of cannabis.

"The whole population is prone to have this risk," she said.

In light of these results, Conrod called for increased access by high school students to evidence-based cannabis prevention programs.

The study was published online June 6 in JAMA Psychiatry.

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