Early Maternal Prenatal Cannabis Use and Child Developmental Delays
Journal: JAMA Network Open, 2024, doi: 10.1001/jamanetworkopen.2024.40295
Authors: Lyndsay A. Avalos, Nina Oberman, Stacey E. Alexeeff, Lisa A. Croen, Meghan N. Davignon, Sara R. Adams, … Kelly C. Young-Wolff
Abstract:
Importance: Maternal prenatal cannabis use is associated with adverse neonatal health effects, yet little is known about its association with child developmental outcomes.
Objective: To evaluate associations between maternal prenatal cannabis use in early pregnancy and child early developmental delays.
Design, setting, and participants: This cohort study included 119 976 children born to 106 240 unique individuals between January 2015 and December 2019 and followed up to aged 5.5 years or younger (through December 31, 2021) at Kaiser Permanente Northern California. Individuals were screened for prenatal cannabis use via self-report and urine toxicology at entrance into prenatal care (approximately 8- to 10-weeks’ gestation). Data were analyzed from February 2023 to March 2024.
Exposure: Maternal prenatal cannabis use defined as any use (self-reported or by urine toxicology testing) and use frequency.
Main outcomes: Early developmental delays (speech and language disorders, motor delays, global delays) in children up to age 5.5 years defined by International Statistical Classification of Diseases and Related Health Problems, Ninth Revision and Tenth Revision diagnoses codes ascertained from electronic health records.
Results: In this cohort of 119 976 pregnancies among 106 240 unique pregnant individuals, there were 29 543 Hispanic pregnancies (24.6%), 6567 non-Hispanic Black pregnancies (5.5%), 46 823 non-Hispanic White pregnancies (39.0%), 12 837 pregnancies (10.7%) to individuals aged 24 years or younger, and 10 365 pregnancies (8.6%) to individuals insured by Medicaid. Maternal prenatal cannabis use was documented for 6778 pregnancies (5.6%). Daily maternal prenatal cannabis use was reported for 618 pregnancies (0.5%), weekly for 722 pregnancies (0.6%), and monthly or less for 1617 pregnancies (1.3%). No association was observed between maternal prenatal cannabis use and child speech and language disorders (HR, 0.93; 95% CI, 0.84-1.03), global developmental delays (HR, 1.04; 95% CI, 0.68-1.59), or motor delays (HR, 0.86; 95% CI, 0.69-1.06). No association was detected between the frequency of maternal prenatal cannabis use and child early developmental delays.
Conclusions and relevance: In this cohort study, maternal prenatal cannabis use was not associated with an increased risk of child early developmental delays. Future research is needed to assess different patterns of cannabis use throughout pregnancy. Given the association between maternal prenatal cannabis use and other adverse outcomes, pregnant individuals should be educated on those risks.
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A 10-Year Trend in Cannabis Potency (2013-2022) in Different Geographical Regions of the United States of America
Journal: Frontiers in Public Health, 2024, doi: 10.3389/fpubh.2024.1442522
Authors: Mahmoud A. ElSohly, Chandrani G. Majumdar, Suman Chandra, & Mohammed M. Radwan
Abstract:
Background: The prevalence of cannabis as the most commonly used illicit substance in the United States and around the globe is well-documented. Studies have highlighted a noticeable uptrend in the potency of cannabis in the United states. This report examines the concentration of cannabinoids in illicit cannabis samples seized by the United States Drug Enforcement Administration (DEA) over the last 10 years (2013-2022).
Methods: Samples received during the course of study (2013-2022) were categorized based on the geographical region where collected, as Western Region, Midwest Region, Northeast Region, South East Region, Southern Region as well as Alaska and Hawaii. These samples were processed for analysis using a validated gas chromatography with flame ionization detector method.
Results: The data showed that the cannabinoids profile of all high Δ9-THC cannabis samples, regardless of the state or region from which the samples are seized or the state from which the sample is produced under a state medical marijuana program, is basically the same with the major cannabinoid being Δ9-THC (>10% for most samples) and all other cannabinoids with less than 0.5%, with the exception of CBG (<1%) and CBN (<1%).
Conclusion: Overall, it appears the cannabinoids profile is controlled by the genetics of the plant and is not affected much by the geographical location in which the plants are cultivated.
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Vicarious Heterosexism-Based Stress Induces Alcohol, Nicotine, and Cannabis Craving and Negative Affect Among Sexual Minority Young Adults: An Experimental Study
Journal: Neurobiology of Stress, 2024, doi: 10.1016/j.ynstr.2024.100668
Authors: Ethan H Mereish, & Robert Miranda
Abstract:
Purpose: Sexual minority young adults are at increased risk for hazardous drinking and alcohol use disorder compared to heterosexual adults. Heterosexism-based stressors contribute and often explain inequities in alcohol outcomes. However, the extant research primarily relies on correlational designs, and often neglects the importance of alcohol craving, despite its foundational role in addiction. Leveraging a novel experimental mood induction paradigm, this study examined the effects of exposure to vicarious heterosexism-based stress on alcohol craving and negative affect among sexual minority young adults who drink heavily. We also examined its effects on cannabis and nicotine craving among participants who used cannabis and nicotine, respectively. Lastly, we examined moderating factors that could influence the impact of exposure to heterosexism-based stress on alcohol craving.
Methods: Participants were 101 heavy drinking sexual minority young adults, ages 20-35 (M = 26.46 years old; SD = 3.49), recruited from the community (51.5% female sex assigned at birth; 76.3% cisgender; 51.5% plurisexual; and 42.6% racial and ethnic minorities). They completed three mood induction trials counterbalanced over three visits on different days: heterosexism stress, general stress, and neutral. Structured interviews assessed criteria for DSM-5 alcohol use disorder (AUD) and substance use, and self-report measures assessed lifetime traumatic stressors.
Results: Most participants met criteria for past-year AUD (74.7%). Exposure to heterosexism stress produced more negative affect and substance craving than the neutral mood induction, even while controlling for demographic variables and lifetime exposure to traumatic and heterosexism stressors. Exposure to heterosexism-based stress had large effects on alcohol craving among participants who had greater drinking to cope motives and heterosexism-specific rejection sensitivity, whereas the effects were small for those who had lower drinking to cope motives and heterosexism-specific rejection sensitivity. Demographic, lifetime stress, prior alcohol use, and AUD symptom severity variables were not significant moderators. Greater substance craving induced by heterosexism-based stress in the laboratory was associated with greater recent and current substance use.
Conclusions: This study findings show that vicarious exposure to heterosexism elicits negative mood and alcohol, cannabis, and nicotine craving among sexual minority young adults who engaged in heavy drinking. The effects for alcohol craving were largest among those who endorse high levels of drinking to cope motives and heterosexism-based rejection sensitivity. These findings have implications for oppression-based stress and motivational models of addiction.
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Synthetic Opioids Have Disrupted Conventional Wisdom for Treating Opioid Overdose
Journal: Drug and Alcohol Dependence Reports, 2024, doi: 10.1016/j.dadr. 2024.100268
Authors: Phil Skolnick, Jordan Paavola, & Christian Heidbreder
Abstract:
More than 90 % of opioid overdose deaths in North America are now caused by synthetic opioids, and while they are not as prevalent in the European illicit drug market, there are indications that they may become so in the near future. Multiple publications have argued that neither higher doses of naloxone nor more potent opioid receptor antagonists are needed to reverse a synthetic opioid overdose. However, the unique physicochemical properties of synthetic opioids result in a very rapid onset of respiratory depression compared to opium-based molecules, reducing the margin of opportunity to reverse an overdose. While intravenous administration rapidly delivers the high naloxone concentrations needed to reverse a synthetic opioid overdose, this option is often unavailable to first responders. A translational mechanistic model of opioid overdose developed by the FDA’s Division of Applied Regulatory Science provides an unbiased approach to evaluate the effectiveness of overdose reversal strategies. Reports using this model demonstrated the naloxone tools (2 mg intramuscular and 4 mg intranasal) used by many first responders can result in an unacceptable loss of life following a synthetic opioid (fentanyl, carfentanil) overdose. Moreover, sequential (2.5 minutes between doses) administration of up to four doses of intranasal naloxone was no more effective at reducing the incidence of cardiac arrest (a surrogate endpoint for lethality) than a single dose, suggesting that attempts at titration may not provide the rapid absorption required to reverse a synthetic opioid overdose. This model was also used to compare the effectiveness of intranasal naloxone to intranasal nalmefene, a recently FDA-approved opioid receptor antagonist with a more rapid absorption and a higher affinity at mu-opioid receptors compared to intranasal naloxone. Intranasal nalmefene resulted in large and clinically meaningful reductions in the incidence of cardiac arrest compared to intranasal naloxone. Furthermore, simultaneous administration of four doses of intranasal naloxone was needed to reduce the incidence of cardiac arrest to levels approaching those produced by a single dose of intranasal nalmefene. These data are consistent with evidence that synthetics have indeed disrupted conventional wisdom in the treatment of opioid overdose.
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Published
October 2024