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Weekly Cannabis News

January 7th-14th, 2022

Rise in Pediatric Emergency Room Visits in Ontario Following Legalization of Cannabis-Infused Products

Increased incidence in hospital visits among children: caution should be taken when ingesting cannabis products, a new report says.

A group of investigators in Canada aimed to determine whether the legalization of cannabis-infused products (i.e., edibles or candies) was related to the increase in pediatric emergency department (ED) visits and hospitalizations. [1]

There are five common methods to consume cannabis: inhalation, sublingual, ingestion, topical, and mucosal. Each method has unique characteristics of absorption leading to different onset times and duration of effects along with specific advantages and drawbacks.  Consuming cannabis via ingestion using edibles, candies, or drinks have increased over the last years, especially among adolescents. [2] This method allows for cannabis products to be absorbed into the bloodstream to the digestive system and pass to the liver before entering general circulation. Since the absorption takes place more slowly, time of onset ranges from about 30 min to 2h but the effects last longer (5 to 8h)​. [3] However, this method is difficult to get the appropriate dosage which may result in larger than expected quantity ingested and may cause delusions, hallucinations, and confusion.​ [4] Consequently, over-consumption of these products led to an increase in the rates of acute cannabinoid intoxication (ACI) with US poison control centers reporting a dramatic increase in the number of reports involving edibles, rising from 8.3% to 31.2% from 2017 to 2019. [5]

In this study, the authors reported on all ED visits and related hospitalizations due to cannabis exposures among  children aged 0 to 9 years in Ontario, Canada, between January 1, 2016, and March 31, 2021, and compared trends and characteristics of ED visits over 3 different periods related to cannabis legalization: pre-legalization (January 2016-September 2018); the period after legalization of flower products, or period 1 (October 2018-January 2020); and the period after commercial edibles became available, or period 2 (February 2021-March 2021). They found that there was a significant increase in the proportion of cannabis-related ED visits with hospitalization during period 2 (122 visits) compared to period 1 (29 visits) and during the pre-legalization period (20 visits).

They concluded:” these findings suggest that the introduction of legal commercial edible cannabis products was a key factor associated with changes in ED visit frequency and severity. Further regulatory measures, such as limiting formulations and appearance of commercial edibles, combined with education for parents and caregivers, may be required to decrease pediatric cannabis exposures”.

To solve this unresolved issue, Anebulo Pharmaceuticals’ lead compound, ANEB-001 is currently undergoing Phase 2 clinical trials to reverse the symptoms of ACI. [6]

Using Brain Imaging to Identify ∆9-Tetrahydrocannabinol (∆9-THC) Associated Impairment

A new report suggests that the use of functional near-infrared spectroscopy (fNIRS) may be a better suited method to measure brain activation patterns that may correlate with ∆9-THC impairment.

While it is known that ∆9-THC consumption leads to euphoric-like effects and impaired function, its concentration in the body does not correlate to the level of functional impairment since THC metabolites can stay in the blood long after period of intoxication. As such, it is necessary to explore alternative methods to accurately detect individuals with ∆9-THC impairment.

Researchers at the Massachusetts General Hospital, Cairo University, and Thomas Jefferson University aimed to investigate impairment following ∆9-THC consumption using fNIRS, a functional neuroimaging technology offers a relatively non-invasive, safe, portable, and low-cost method of indirect and direct monitoring of brain activity. [7],[8]

To do so, the authors performed a double-blind, randomized, cross-over study on participants who were randomly assigned to receive either a single oral dose of dronabinol (Marinol) capsules (FDA-approved synthetic THC used for the treatment of nausea associated with cancer chemotherapy) or placebo capsules on separate study visits, conducted at least 7 days apart. A double-blind, randomized placebo-controlled study is a type of study in which neither the participants nor the experimenters know who is receiving a particular treatment and is utilized to prevent bias in research results.

The authors found that there was an increased in oxygenated hemoglobin concentration in the prefrontal cortex, a brain region rich in cannabinoid receptor 1 (CB1) to which ∆9-THC binds to, in participants who reported intoxication compared to those who reported low or no intoxication. Impairment was defined by convergent classification of clinical ratings, an algorithm based on post-dose tachycardia and self-rated high.

They concluded: “impairment due to THC intoxication was associated with increased PFC activation on a simple memory task assessed with fNIRS. Future work is warranted to determine if observed brain signatures are specific to THC intoxication-related impairment or are a more general signature of impairment.”

Could Prince George Airport Be the First Airport in the World to Open a Cannabis Shop?

This British Columbian airport may be the world’s first airport to have a cannabis shop.

Prince George Airport (YXS) in British Columbia, Canada, announced that the company CoPilot may be opening a cannabis shop in one of its terminals. This company aims to make traveling a less stressful experience for those who suffer from anxiety or fear when boarding on a plane. It applied for a business license from the city to operate at the airport. [9] If approved, it anticipates opening its first cannabis retail store later in the year.  YXS CEO George Duke added: “we are very pleased to welcome Copilot if they receive a business license and provincial approval. City Council is expected to give their business license application the first reading on January 10. Copilot has satisfied regulatory requirements from both Transport Canada and the Province of BC in advance of their meeting with Council. Obtaining a business license is one of the last steps before they can open for business at YXS.” CoPilot founders Reed Horton and Owen Ritz added: “We felt Prince George was the best place to start because of the size of the airport and the community culture”. [10]

While smoking is still not permitted on airplanes, individuals traveling may have the opportunity to take cannabis infused products to help cope with the increased anxiety that may arise when traveling. However, options to have designed cannabis area to smoke at the airport could be a possibility for consumers.

Can Cannabinoids Be the Answer to Prevent SARS-CoV-2 Infections?

A new study suggests that compounds in the cannabis plant may block cellular entry of SARS-CoV-2 and associated variants.

In the last 20 years, several viral epidemics have been recorded. The most recent and currently occurring is the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) or COVID-19, first reported in December 2019 in Wuhan, China before spreading worldwide. [11] As of January 12th, 2022, at least 317 million cases worldwide, 5.5 million death and over 3.2 million new cases daily have been recorded. [12] While the FDA has authorized COVID-19 vaccines, their limited availability and the increased rate of virus mutation have led to a search for additional therapeutics which may help prevent entry of the virus.

SARS-CoV-2 is expelled in respiratory droplets from an infected individual and subsequently inhaled by another non-infected individual.  Common symptoms including cough, fever, respiratory distress, muscle pain, sore throat, loss of taste and/or smell, which may lead to severe illness and death. [13] The virus spike protein binds on angiotensin-converting enzyme II (ACE2) receptors on host cells and tricks the cell into swallowing it. There, it releases its content, multiply, replicate, transcribe and translate its message to finally release out its content of the cell to attack other organs. [14] As such, therapeutic agents blocking this point entry may prevent COVID-19 infections.

The cannabis plant contains more than 500 known compounds including phytocannabinoids, terpenes and flavonoids, with as many as 140 different phytocannabinoids present including cannabidiol (CBD) and ∆9-tetrahydrocannabinol (∆9-THC) which are the most used and studied. Cannabigerolic acid (CBGA) is the precursor compound acting as a building block for the formation of phytocannabinoids in Cannabis sativa via enzymatic processes converting CBGA to cannabidiolic acid (CBDA) and ∆9-tetrahydrocannabinolic acid (∆9-THCA), which are then decarboxylated to the most known and consumed phytocannabinoids, CBD and ∆9-THC.

Researchers at the Oregon Health and Science University aimed to investigate whether CBGA and CBDA, which had the highest affinity for the spike protein, can block SAR-CoV2 virus and other variants B.1.1.7 (alpha, first detected in the United Kingdom), B.1.351 (beta, first detected in South Africa). [15] They found that both compounds inhibited the SARS-CoV-2 cell entry in human cells incubated with the live SARS-CoV-2 virus. This was also achieved in the B.1.1.7 and B.1.351 variants.

They concluded: “our data show minimal impact of the variant lineages on the effectiveness of CBDA and CBGA, a trend that will hopefully extends to other existing and future variants. With widespread use of cannabinoids, resistant variants could still arise, but the combination of vaccination and CBDA/CBGA treatment should create a more challenging environment with which SARS-CoV-2 must contend, reducing the likelihood of escape”.

References

[1] Myran DT, Cantor N, Finkelstein Y, et al. Unintentional Pediatric Cannabis Exposures After Legalization of Recreational Cannabis in Canada. JAMA Netw Open 2022;5(1):e2142521. DOI: 10.1001/jamanetworkopen.2021.42521

[2] Knapp AA, Lee DC, Borodovsky JT, Auty SG, Gabrielli J, Budney AJ. Emerging Trends in Cannabis Administration Among Adolescent Cannabis Users. J Adolesc Health 2019;64(4):487-493. DOI: 10.1016/j.jadohealth.2018.07.012.

[3] National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division;

Board on Population Health and Public Health Practice; Committee on the Health Effects of

Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and

Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington

(DC): National Academies Press (US); 2017 Jan 12. 2, Cannabis. (Available from:

https://www.ncbi.nlm.nih.gov/books/NBK425762/).

[4] MacCoun RJ, Mello MM. Half-baked–the retail promotion of marijuana edibles. N Engl J Med

2015;372(11):989-91. DOI: 10.1056/NEJMp1416014.

[5] Dilley JA, Graves JM, Brooks-Russell A, Whitehill JM, Liebelt EL. Trends and Characteristics of Manufactured Cannabis Product and Cannabis Plant Product Exposures Reported to US Poison Control Centers, 2017-2019. JAMA Netw Open 2021;4(5):e2110925. DOI: 10.1001/jamanetworkopen.2021.10925

[6] https://www.anebulo.com/pipeline/

[7] Gilman JM, Schmitt WA, Potter K, et al. Identification of 9-tetrahydrocannabinol (THC) impairment using functional brain imaging. Neuropsychopharmacology 2022. DOI: 10.1038/s41386-021-01259-0

[8] Irani F, Platek SM, Bunce S, Ruocco AC, Chute D. Functional near infrared spectroscopy (fNIRS): an emerging neuroimaging technology with important applications for the study of brain disorders. Clin Neuropsychol 2007;21(1):9-37. DOI: 10.1080/13854040600910018.

[9] https://copilotcreative.com/ascend-cannabis-co/

[10] https://www.rmotoday.com/beyond-local/prince-george-may-become-first-airport-terminal-worldwide-to-open-cannabis-retail-store-4937523

[11] Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020;382(8):727-733. DOI: 10.1056/NEJMoa2001017

[12] https://www.worldometers.info/coronavirus/

[13] Lovato A, de Filippis C, Marioni G. Upper airway symptoms in coronavirus disease 2019 (COVID-19). Am J Otolaryngol 2020;41(3):102474. DOI: 10.1016/j.amjoto.2020.102474

[14] Ni W, Yang X, Yang D, et al. Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Crit Care 2020;24(1):422. DOI: 10.1186/s13054-020-03120-0

[15] van Breemen RB, Muchiri RN, Bates TA, et al. Cannabinoids Block Cellular Entry of SARS-CoV-2 and the Emerging Variants. J Nat Prod 2022. DOI: 10.1021/acs.jnatprod.1c00946

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Author Yoel H. Sitbon

Yoel is a Medical Writer in the Medical Content division at Csequence. His scientific expertise is in Neuroscience (neural mechanisms behind drug addiction) and Molecular & Cellular Pharmacology (molecular mechanisms behind mutations induced cardiovascular diseases). Yoel has over five years of scientific writing experience as evidenced by 8 peer-reviewed publications in scientific journals. He is an effective oral communicator having presented his PhD thesis work at many biomedical conferences nationally. He also has strong mentorship and leadership experience. Yoel has a B.S in Neuroscience at the University of California, Los Angeles and a Ph.D. in Molecular & Cellular Pharmacology at the University of Miami, Miller School of Medicine.

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