Session
Modern Public Health Issues Associated with Cannabis and Hemp-Products
APHA 2022 Annual Meeting and Expo
Abstract
In flagrante delicto derivatives of hemp-CBD
APHA 2022 Annual Meeting and Expo
Background: Not long ago, there was little publicity on hemp-cannabidiol (CBD)-derived isomers such as Delta8-tetrahydrocannabinol (THC). Similar to COVID, the public seems to be exposed to a new varient or isomer regularly. New isomers are available and highlighted in the local boutique shops across America. These unregulated isomers represent significant economic, policy, and safety issues in the cannabis and hemp industry. Tragically, adverse event reporting systems are not equippned to mitigate the explosion of product diveristy regarding hemp-CBD-derived-THC-isomers.
Objective: To improve the availability of despartely needed public data regarding the increasing numbers of hosptializations and deaths due to hemp-CBD-derived-THC-isomers, which are manufactured and distributed without any regulatory oversight, caveat emptor regarding the 2018 Hemp Farm Bill.
Methods: A search for all cannabis and hemp-derived isomers was performed using the FDA adverse events database (FAERS). All cases where a cannabinoid was deemed a suspect drug were included in the analysis.
Results: FAERS data as of September 2021, reports over 400 serious adverse events and dozens of deaths associated with exposure to products labeled as containing cannabinoids derived from hemp or cannabis.
Conclusion: It is likely that many of these hemp-derived products are outside of regulatory systems that oversee medical and adult-use cannabis programs. The availability of these products has significantly changed the clinical landscape. Due to the risks poised by these compounds, and a lack of any reliable national efforts to track these products, an adverse event reporting tool was developed and implemented to assist with monitoring cannabis and hemp health issues.
Abstract
“Stick with regular weed”: Did the FDA and CDC warnings about delta-8 THC reach mainstream social media?
APHA 2022 Annual Meeting and Expo
Background: On September 14, 2021, the FDA and CDC issued health advisories on the dangers of delta-8 tetrahydrocannabinol (∆8THC) because of numerous hospitalizations. Unlike medical and adult-use cannabis, ∆8THC is sold at unlicensed businesses without any safety testing to consumers of all ages.
Objective: We sought to determine the impact of the CDC and FDA health advisories on attitudes towards ∆8THC among Twitter users.
Methods: We analyzed 500 tweets regarding ∆8THC before and after September 14th, 2021. Three independent researchers scored the sentiment of each tweet using a Likert scale of 1-5 (1= highly positive; 5=highly negative).
Results: Prior to September 14th there were few cautionary tweets (i.e., Likert score of 4-5). There was an increase in warnings and precautions in the post-health advisory timeframe. During the 30-day post-advisory period some tweets specifically named the FDA/CDC health advisories while others were general warnings. The most common reasons for using ∆8THC included getting high and alleviating sleep, pain, and mental health issues. The adverse effects mentioned in tweets include induced anxiety, lung pain, harshness, and dehydration. Both pre and post health advisory tweets mention the lack of regulations and non-existent standards.
Conclusion: Twitter, a social networking service with over 330 million active users, showed an increase in ∆8THC warnings post FDA/CDC health advisories. Based on the types of tweets regarding the use of ∆8THC, Twitter could become an avenue to quickly disseminate information on the risks and potential benefits of ∆8THC.
Abstract
OCCUPATIONAL SKIN EXPOSURE RISKS RELATED TO HEMP/CANNABIS: MODELING CANNABIS-ASSOCIATED DERMATITIS IN MICE
APHA 2022 Annual Meeting and Expo
Background Exposure to cannabis components can result in allergy-like reactivity including urticarial rash, contact dermatitis, angioedema, rhinitis, exacerbation of asthma and rarely anaphylaxis. With an ever-burgeoning hemp and cannabis industry, more individuals are likely to demonstrate allergic reactions.
Objective The present study was conducted to identify the major allergens of cannabis and examine their mechanisms of action. We hypothesized that chronic administration of the terpene beta-caryophyllene (BCP), but not the phytocannabinoids cannabidiol (CBD), would produce allergic dermatitis in a murine itch model.
Methods: CBD, BCP, or vehicle was applied to the neck of mice to induce allergic dermatitis. Topical application to the neck of mice occurred 2 times a week for 5 weeks. Once weekly, mice were placed into observation boxes and the number of scratching bouts directed to the neck was counted for 60 min. Skin was also evaluated and dermatitis was scored.
Results: Chronic administration of BCP, but not CBD, induced significant dermatitis. Microscopic examination of the tissue sections revealed accumulation of inflammatory infiltrates in the epidermal compartments of murine skin following administration of BCP in a dose dependent manner. When BCP was applied chronically to mice genetically lacking the cannabinoid CB2 receptor, significantly less dermatitis and scratching behavior was noted.
Conclusions: Our results suggest that chronic topical exposure to BCP produces an allergic dermatitis-like response in mice. Further research is necessary to determine the extent to which this and other terpenes may represent a high risk for allergic responses in employees exposed to cannabis.
Abstract
Get your thinking cap on; Implementation of a cannabis awareness program (CAP) for high school students
APHA 2022 Annual Meeting and Expo
Background: Drug abuse education programs have been met with limited success. (REF) There are many reasons these programs have been criticized, including utilizing antiquated data and speakers that do not have a scientific background in the subject matter.
Objective: To develop a cannabis awareness program (CAP) that is an educational series focused on increasing the understanding of the effects of cannabis on the body and the brain, especially the developing brain. This content would be delivered by the scientists and researchers who developed the program.
Methods: A 6-part series was developed and includes: an introduction to the fundamentals of substance use disorders, cannabis in society and law, and the effects of cannabis on the human physiology (3 parts). Knowledge checks within each section and a pre-and post-assessment of 13 questions complements the program. A pilot program in a high school and one with young adults were executed.
Results: From 2021 to 2022 this program was presented to teenagers and young adults at educational centers. Pre-presentation assessment results include: 50% are unsure if cannabis is damaging to the brain and 43% say it is damaging to the body. Post seminar assessments are underway.
Conclusion: The program was well received. Additional pilot sessions are being considered in other high school health and science curriculums in various jurisdictions. Below is a scan to our pre-course assessment.
Abstract
Safety data on cannabis-derived products in the FAERS database
APHA 2022 Annual Meeting and Expo
Background: The FDA and CDC issued health alerts recently on delta-8 Tetrahydrocannabinol (∆8THC). ∆8THC is an isomer of ∆9THC. The FDA and DEA list ∆8THC as schedule 1 drug however, some believe it is legal to manufacture and distribute ∆8THC under the 2018 Hemp Farm bill.
Objective: We searched and evaluated adverse event (AE) reports on ∆8THC and other cannabis/hemp-derived products in FAERS, the only national adverse event data base.
Methods: Product names: ∆8THC, ∆8THC with cannabidiol, Marinol and CBD were searched and proportional reporting ratios (PRR) were used to compare the proportion of a specific AE system organ class of each compound, compared to the same event pairs for CBD. A PRR of >2 is considered a potential safety signal.
Results: As of December 31, 2021, among all the product comparisons, the most notable PRR occurred with ∆8THC and ∆8THC with CBD (9.7 and 8.7 respectively) compared to CBD only for the respiratory system. Dyspnea was the most common (16%) AE in all ∆8THC exposed cases. Monitoring of FAER’s data continues.
Conclusion: ∆8THC continues to have a high number of respiratory AEs reported in FAERS. A PRR of 10 indicates respiratory events are reported 10 times more frequently in those where ∆8THC was a suspect product. It is unclear if ∆8THC or another factor, such as an adulterant, is the cause of these events. Due to this potential safety signal, a new AE tool was developed and implemented to assist with monitoring cannabis and hemp health issues.