The lack of significant adverse effects in this study encourages further investigation into the use of cannabis-based interventions including CBD to treat chronic SCD pain in prospective trials with a larger cohort over a longer duration.Questionnaire-based approaches have provided insight into the prevalence of cannabis use in the SCD community, and these studies have given first-hand accounts of the patients’ perceived benefits and motivations for seeking cannabis.A 2018 survey of 58 patients living with SCD revealed cannabis use in 42% of respondents.The majority of these individuals reported medicinal purposes, though some indicated recreational use of cannabis.An anonymous questionnaire study of Sickle Cell patients in the United Kingdom included 31 patients who had used cannabis and 51 patients who had never used it, although this group represents only 34% of individuals that qualified for the study and chose to participate.Responses indicated that cannabis users had more frequent and more severe episodes of pain, but many of the users indicated that cannabis was an attempt at managing their pain.Cannabis users reported improvement in mood , reduced use of painkillers , improvement in feelings of anxiety and depression , and improvement in sleep.In addition, 58% of respondents indicated an interest in participating in future clinical trials for the study of cannabis in SCD pain management.This questionnaire-based study underscores the attractiveness of cannabis as a means of self-medicating for pain, but this also presents another potential concern; to circumvent the prohibition of cannabis, individuals may resort to use of unregulated, potentially dangerous synthetic cannabinoid analogs.Neuropathic pain is disabling and impairs the HRQoL in adolescents as well.In a preliminary study of 12 adolescents with mean age of 15 years, with 75% females and 83% of subjects on hydroxyurea, higher PainDETECT scores were significantly associated with lower PedsQL scores.
Cannabis use in teenagers with SCD and cystic fibrosis is prevalent, although to a lower extent than their peers, which may be due to the perception of grow cannabis in containers use associating with worse self-care, more stress, and more distress.A 2017 retrospective analysis of patients with SCD indicated that patients using cannabis, confirmed by urinalysis, had higher frequency of VOCs.This study comprised 37 SCD patients that tested positive for a THC metabolite and 35 that tested negative.Notably, patients who tested positive admitted to smoking cannabis as their route of administration.Additionally, cannabis users had significantly higher use of benzodiazepine, cocaine, and phencyclidine compared to non-users.The use of other illicit compounds may potentiate the negative effects associated with cannabis use in this retrospective analysis.In addition, cannabis users had significantly fewer visits to the clinic and increased hospital admissions compared to non-users; the lack of regular treatment and increased disease severity may also represent contributing variables that are difficult to control.Priapism, mortality, and other SCD co-morbidities were not different between groups.Opioid-induced hyperalgesia and tolerance to specific opioids has been suggested to lead to cannabinoid and phencyclidine use in an individual with SCD.The reason for using cannabis in this patient was that pain relief was inadequate with Percocet.After switching to morphine, his urine showed the presence of phencyclidine, which provided him better pain relief than morphine.These studies highlight the inadequacy and changing needs of patients with persistent and/or VOC pain in SCD leading to cannabis use and perhaps of other drugs that they can get to find relief.In a retrospective observational study on 9350 patients 18 years and older admitted for acute ischemic stroke who underwent urine drug screening screening, 18% tested positive for cannabis.Among cannabis users unadjusted risk ratio showed a 50% decrease in risk of AIS.However, upon adjusting for SCD, cardiovascular disease, diabetes, cigarette smoking, ethnicity, age, race, etc., the effect was lost.
Many limitations in this study included dosage and duration of cannabis use, but it does not show any adverse effect of cannabis on AIS.These findings are important because stroke is one of the major comorbidities of SCD.A 2016 case study of a sickle cell patient indicated development of acute chest syndrome and failure to modify pain with opioids after the patient had been exposed to the synthetic cannabinoid K2, also known as “Spice”.The patient exhibited delirium and required oxygen support for his first 3 days following hospital admission, after which point the patient admitted to use of K2 at home.The patient’s behavior indicated to the physicians that K2 use was continuing during the hospitalization, and during day 3 acute systolic heart failure was detected.At day 10, the patient was discharged and requested treatment for substance abuse.Use of synthetic drugs labeled cannabinoids share many of the characteristics of intoxication, and also carry risks of dangerous and potentially fatal side effects that include psychosis, seizure, and myocardial infarction.The potency of synthetic cannabinoids derives from their chemical interaction with cannabinoids receptors, for which they are full agonists, whereas THC, the major psychoactive constituent of cannabis, is a partial agonist.These biochemical properties underlie the contrast between synthetic cannabinoids’ apparent toxicity and the lack thereof with THC.The lack of acute toxicity does not mean that THC exposure is without risk.Due to often life-long chronic pain, fear of emerging VOC and rising opioidphobia, SCD patients are more vulnerable to use of cannabis as pain medicine.Cannabis derived cannabinoids have been shown to be safe and well-tolerated in adults across various conditions and, most recently, in SCD.Several studies have indicated mild to moderate effectiveness of cannabis in treating pain arising from various disease states, though heterogeneity and low sample sizes mandate replication.Two major considerations for the use of cannabis products in SCD are pregnancy: the use of cannabinoids has been rising in pregnant women, and in women with SCD this may be a significant concern due to the discontinuation of hydroxyurea during pregnancy.
Early preclinical studies provide mixed evidence for the teratogenicity of cannabinoids, so extreme caution must be taken during pregnancy; depression: Volkow et al.reviewed several studies on adverse health effects of recreational cannabis use and found high confidence in the association between cannabis use and addiction to cannabis, symptoms of chronic bronchitis, motor vehicle accidents, and diminished lifetime achievement, as well as medium confidence in its association with abnormal brain development and depression or anxiety.Recent data indicate the prevalence of depression associated with past month’s cannabis use in adults, thus diligent monitoring for the well-being of patients’ physical and mental health is required.The existence of anxiety, depression and cognitive impairment in SCD warrants the need for a close examination of these features in cannabis users.Innumerable medical cannabis preparations are available from “Dispensaries”, but most of them are not validated for their contents and their effectiveness through regulatory analysis and controlled clinical trials, respectively.Majority of Medical cannabis preparations tested either did not contain the labeled contents or had a small % compared to the labeled amount.All medical cannabis preparations are not made equal and may have different cannabinoid content and composition.Therefore, the cannabinoid composition specific to the needs of the underlying pathobiology and symptoms needs to be selected for treatment.Outbreaks of coagulopathy from products marketed as cannabinoids but containing long-acting rodenticide raises life-threatening concerns.Commercially available, mislabeled and adulterated cannabis products pose major health risks.Therefore, awareness and education of individuals regarding potential harms of the adulterated and unreliable cannabis products needs to be raised and users and healthcare providers need to validate the reliability of the contents.While many of the aforementioned clinical studies suggest that cannabinoids may be effective therapeutic agents for treating pain, cannabinoid use in the U.S.remains controversial.The illicit use of cannabis remains a major concern due in part to racial biases in cannabis sanctions in the U.S., especially for SCD patients that mostly comprise individuals of African descent.As a Schedule I substance, federal law designates pot for cannabis as a drug “with no currently accepted medical use and a high potential for abuse,” but medical cannabis is currently approved in 36 states, Guam, Puerto Rico, US Virgin Islands and District of Columbia.
Given the growing legality of medical cannabis use, this substance warrants rigorous study to accurately determine its risks and benefits in SCD.There is a strong need for randomized, placebo-controlled studies to accurately determine the effects of specific cannabinoids on SCD.Such studies require special attention to not only cannabis dosing and route of administration , but also to the chemical composition of cannabis plants due to existence of variable cannabinoid contents in cannabis plants.Access to cannabis for research purposes remains a major roadblock in the U.S.and many parts of the world despite increasing preclinical evidence suggesting that it may be a valuable strategy for treating otherwise difficult to manage pain, which may be the case in SCD.Research funding allocation for cannabis’s safe use in disease-specific manner is needed to prevent the cannabinoid epidemic before it is too late.Given the growing body of evidence supporting the potential benefits of cannabinoids for the treatment of pain in adults, but the lack of randomized, placebo-controlled studies evaluating their use in treating SCD pain, this area of research deems high significance in order to develop more effective therapeutic options requiring more effective management of sickle pain.Observing patterns in retail prices is fundamental for understanding the economics of any agricultural consumer product.The study of cannabis retail prices, like the study of other economic aspects of the cannabis industry, is fraught with difficulty, in part because cannabis remains a Schedule I narcotic under U.S.federal law.Consumer price indexes, tax records, commercial retail scanner data, industry association reports and other sources of data typically available for agricultural products such as wine, almonds and cut flowers are unavailable for cannabis.Cannabis retailers have limited access to banking services; most cannabis retail transactions are conducted in cash; and cannabis businesses are understandably reluctant to share their financial data.There is a need for better information about all aspects of the cannabis industry, including prices and price patterns.In this article, we aim to contribute to the scant literature on cannabis retail prices by describing the basic patterns of price ranges at retailers in California over a 21-month time span during which the industry underwent a series of significant regulatory changes.Several times between October 2016 and July 2018, researchers at the UC Agricultural Issues Center gathered cannabis retail prices published on Weed maps, a leading online cannabis retail platform.We report average maximum and minimum prices for three common types of cannabis packages: one-eighth ounce of dried cannabis flower, 1 ounce of dried cannabis flower and 500-milligram cannabis-oil cartridges.In our first 11 months of data collection , we collected prices from retailers in seven representative counties around California.Next, in November 2017, we collected prices from all retailers in California that listed prices on Weed maps, while continuing to track prices in the representative counties.
After mandatory licensing began in January 2018, we collected three more rounds of prices from all retailers that listed prices on Weed maps and that had received temporary licenses to operate legally from the Bureau of Cannabis Control, a state regulatory agency.Despite differences in coverage among our rounds of data collection, the data seem to represent a wide swath of cannabis retail prices for retailers that posted prices openly and were part of the legal medicinal or adult-use cannabis segments during a period of unusual change for the cannabis industry.Under California law, medicinal cannabis patients have been able to legally purchase a variety of cannabis products since the Compassionate Use Act of 1996.However, state regulation of the industry was minimal for the two decades following the passage of the Act.The legislative process that finally introduced regulation and taxation to the California cannabis market is summarized in Gold stein and Sumner and covered in greater depth in Sumner et al.and UC Agricultural Issues Center.Here we will review only the major regulatory changes that occurred between 2016 and 2018, when we were collecting price data.Proposition 64, a voter initiative, decriminalized adultuse cannabis in November 2016, the month following our first round of price data collection.The proposition — the Adult Use of Marijuana Act — eliminated criminal penalties for possession, by adults 21 and over, of up to 1 ounce of cannabis flower and/or six cannabis plants.Changes to criminal penalties took effect almost immediately, but state regulatory agencies were given until January 1, 2018 to write regulations for licensing, safety and taxation for all legal cannabis.This left a period of about 13 months, from November 2016 to December 2017, during which California’s 20-year-old medicinal cannabis industry was able to continue operating largely as it had before AUMA: permitted but unregulated on the state level, partially and inconsistently regulated at the county and/or municipal levels and mostly untaxed on any level.