Background: Methadone maintenance treatment (MMT) is a commonly prescribed therapy for patients with opioid use disorder, yet inter-individual variability in terms of treatment response is evident. Given the high prevalence of cannabis use in this population, this thesis aims to elucidate the association between cannabis use and MMT outcomes. Methods: We conducted a systematic review and meta-analysis to comprehensively evaluate the literature and quality of evidence, as well as to identify gaps in the literature to inform future research. We then conducted a cross-sectional study investigating sex differences in the association between cannabis use and illicit opioid use in MMT patients. We employed a multivariable logistic regression analysis to assess the influence of any cannabis use as well as heaviness of cannabis use within men and women. Results: The systematic review included 22 observational studies. Results revealed the low quality of available evidence as well as substantial heterogeneity among studies. We identified several limitations in the evidence base including reliance on crude measures of cannabis use and inadequate consideration of confounding variables. Our cross-sectional study included a sample of 777 patients on MMT. Consistent with previous research, we found cannabis use to be unrelated to illicit opioid use in the entire sample. However when we stratified the analysis by sex, we found cannabis use was associated with increased odds of having concurrent illicit opioid use. Conclusion: Results of this thesis suggest certain populations within MMT patients may be at higher risk of experiencing adverse effects of cannabis in terms of treatment outcomes. Future work can build on the results of these studies to identify unique risk factors for patients in order to inform the use of tailored treatment options to improve MMT effectiveness. / Thesis / Master of Science (MSc)

Die vorliegende Arbeit widmet sich der Frage „Welche Bedürfnislagen haben Eltern im Raum Leipzig mit Blick auf die geplante Legalisierung von Cannabis?“ und untersucht mittels einer qualitativen Erhebung Wünsche und Bedarfe mit Blick auf die geplante Cannabislegalisierung von Eltern jugendlicher Kinder aus dem Raum Leipzig. Im Besonderen wurden Eltern im Rahmen leitfadengestützter Interviews zu ihrer Einschätzung und Bewertung der derzeitigen Hilfelandschaft im Bereich Beratung und Prävention in der Region mit Blick auf die geplante regulierte Abgabe von Cannabis, ihrer Beurteilung des eigenen Wissens zur Substanz und deren Bewertung hinsichtlich der Angemessenheit in Bezug auf die Erziehung ihrer jugendlichen Kinder, sowie ihren Angebotswünschen im Themenbereich befragt. Die theoretische Rahmung der vorliegenden Untersuchung umfasst Aspekte der gegenwärtigen Gesetzeslage und der Verbreitung von Cannabis in Deutschland. Außerdem wird das Vorgehen bei der Legalisierung bzw. Regulierung von Cannabis in anderen Ländern und die Bedeutung, welche Eltern in Prävention und Drogenerziehung sowie in der Drogensozialisation zukommt, beleuchtet. Den finalen Teil der Arbeit bilden sowohl eine Diskussion der Ergebnisse und die Schlussfolgerung, die aus dem Abgleich der Elternwünsche und der bestehenden Hilfeangebote im Raum Leipzig abgeleitet werden kann, sowie ein ergänzendes Resümee, das die Ergebnisse der Untersuchung abschließend zusammenfasst.:Abkürzungsverzeichnis Danksagung 1 Präambel 2 Legalisierung von Cannabis in Deutschland 2.1 Cannabis – Substanz und Wirkung 2.2 Entkriminalisierung von Cannabis in Deutschland 2.3 Regelungen zur Entkriminalisierung von Cannabis und deren Effekte im Ländervergleich 2.3.1 Folgeeffekte der Legalisierung in Colorado (USA) 2.3.2 Folgeeffekte der Legalisierung in Kanada 2.3.3 Folgeeffekte der Legalisierung in den Niederlanden 2.3.4 Folgeeffekte der Legalisierung in Portugal 2.3.5 Fazit zum Ländervergleich bezüglich der Entkriminalisierung von Cannabis und der daraus entstehenden Effekte 3 Cannabisgebrauch von Heranwachsenden und die Hilfelandschaft 3.1 Drogensozialisation 3.1.1 Einfluss der Eltern auf den Substanzgebrauch ihrer Kinder 3.1.2 Suchtprävention und Eltern 3.1.3 Drogenerziehung 3.2 Drogenpolitik und Soziale Arbeit – eine Bestandsaufnahme 3.2.1 Drogenpolitischer Leitfaden bzw. Konzepte auf Bundes- und Landesebene sowie in den Kommunen Stadt Leipzig & Landkreis Leipzig 3.2.2 Hilfelandschaft im Bereich Cannabisgebrauch von Jugendlichen in Leipzig und Umgebung 4 aktuelle Forschungslage 5 Fragestellung & Thesen 6 Beschreibung des Forschungsvorhabens 6.1 Forschungslayout 6.2 Beschreibung der Erhebung 6.3 Beschreibung der Auswertung 7 Erkenntnisse der Elternbefragung 7.1 Auswertung zu These 1 7.2 Auswertung zu These 2 7.3 Auswertung zu These 3 7.4 Elterliche Erziehung und Cannabis 7.5 Haltung und Wünsche der Eltern bezüglich der Legalisierung von Cannabisgebrauch 7.6 Wünsche der Eltern bezüglich der Präventions- und Beratungsangebote 8 Fazit 8.1 Diskussion der Ergebnisse 8.2 Abgleich der Elternwünsche und der bestehenden Hilfeangebote im Raum Leipzig 8.3 Resümee Anhang Eidesstattliche Erklärung

No description available.

BACKGROUND: Low rates of physical activity and high rates of cannabis use among adolescents are concerning given the health outcomes associated with these health behaviours. Although individual-level characteristics are strongly associated with physical activity and cannabis use, research also suggests that the school setting may influence these health behaviours. PURPOSE: To: 1) Determine the extent to which students’ cannabis use and physical activity vary across school and classroom settings, 2) Identify characteristics of the school setting that are associated with cannabis use and physical activity among students in grades 6-12 in Ontario. METHODS: This study used data from the School Mental Health Surveys, a cross-sectional school-based survey of 31,124 students, 3,373 teachers, and 206 principals from 248 schools across Ontario. Multilevel modelling was used to explore school and class effects while controlling for student compositional effects. RESULTS: About 5% of the variability in student physical activity and 14% of the variability in student cannabis use was attributable to between school and classroom differences. Students’ perception of school climate was positively associated with physical activity, and negatively associated with cannabis use. CONCLUSIONS: Findings highlight the potential influence of the school and classroom environment on students’ physical activity and cannabis use. School and classroom contexts may be important environments for targeted interventions, policies and programs. / Thesis / Master of Public Health (MPH) / Despite the known benefits of physical activity and harms associated with cannabis use, physical activity rates are low while cannabis use is high among Canadian youth. Previous research has highlighted the potential for the school environment to influence students’ health behaviours. The current study examined the extent to which physical activity and cannabis use varied across school and classroom settings and identified characteristics of the school environment that were associated with these health behaviours. There was significant between school and classroom variability in levels of physical activity and cannabis use. School climate was positively associated with physical activity, and negatively associated with cannabis use. Identifying modifiable characteristics of the school environment that are associated with students’ health behaviours can inform development of interventions, policies, and programs to increase physical activity and reduce cannabis use.

The etiology of many gestational disorders is still unknown. However, insufficient trans-placental passage of nutrients and wastes due to poor placentation is characteristic of several pathologies and may be due, in part, to altered function of placental mitochondria. Mitochondrial activity is essential in pregnancy because it sustains the metabolic activity of the placenta throughout gestation. Exposure to stressors that perturb processes governing placentation, including maternal drug use, can negatively impact fetal development. Cannabis use is prevalent during pregnancy. The psychoactive constituent, delta-9-tetrahydrocannbinol (THC), can cross the placenta to affect placental and fetal physiology. Importantly, cannabinoid receptors have been reported on trophoblast cells, and on mitochondria which are abundant in placentae. It has been reported that THC may target the mitochondria in various tissue types, including placental tissue, and alter its function. However, few studies have addressed the physiological control of mitochondria within the placenta, an organ that is critical for fetal growth and pregnancy maintenance. I investigated the role of mitochondria in trophoblast differentiation and syncytialization using rotenone, a complex I inhibitor. Subsequently, I investigated the role of THC on two important aspects of placentation – invasion and syncytialization – using placental trophoblast cells HTR8/SVneo and BeWo, respectively. In response to rotenone and THC, there was increased ROS production, oxidative stress, and altered transcriptional markers favouring mitochondrial fragmentation. Treatment with 20µM THC for 48 hours led to reduced mitochondrial respiration, ATP production and loss of mitochondrial membrane polarity. Critically, these THC-induced mitochondrial changes occurred concomitant with evidence of reduced trophoblast invasion and syncytialization. Furthermore, THC exposure reduced levels of human chorionic gonadotropin, human placental lactogen and insulin-like growth factor 2, which are growth factors necessary for fetal development. Placental mitochondrial dysfunction, particularly when THC-induced, may be critical in a range of gestational disorders which have important implications for maternal and fetal/offspring health. / Dissertation / Doctor of Philosophy (Medical Science) / Cannabis is commonly used by pregnant women. Fetal exposure to cannabis and its components can impair fetal growth and neurological development. These negative fetal outcomes may be the result of poor placental formation, due to placental cell exposure to cannabis and its psychoactive component, delta-9-tetrahydrocannabinol (THC). Importantly, THC can also target intracellular organelles, like the mitochondria which are known as the “powerhouses” of the cell. Few studies have investigated the direct effects of THC on placental development. The purpose of this study was to determine how THC exposure to placental cells may alter their function. We found that THC impaired processes that allow placental attachment to the uterus and form a protective barrier, and compromised mitochondrial function, which are important for placental formation. These findings serve to inform scientists and doctors, thus stimulating the creation of new ideas and methods to further explore the impact of THC on pregnancy outcomes.

Industrial hemp is legally defined in the United States by the Agriculture Improvement Act of 2018 (2018 Farm Bill) as Cannabis containing <0.3% total tetrahydrocannabinol (THC). The 2018 Farm Bill does not, however, specify standard methods for sample preparation or quantification of cannabinoids (including THC) in Cannabis. Extraction efficiency of phytochemicals is well-known to depend on the solvent and extraction method used. In this project, we evaluated the effect of sample preparation extraction methods on the quantitative analysis of five cannabinoids found in industrial hemp with regulatory or commercial significance: cannabidiol (CBD), cannabidiolic acid (CBDA), delta-9-tetrahydrocannabinol (THC), tetrahydrocannabinolic acid (THCA), and cannabinol (CBN). Extraction methods evaluated include: QuEChERS, diethyl ether, ethanol, and methanol. Extracts obtained via these methods were subject to quantitative cannabinoid analysis by UPLC/PDA. Standard curves for quantification of each cannabinoid were constructed using authentic standards for quantification. The concentrations of each cannabinoid in the plant material determined via each of the extraction methods were compared using one-way ANOVA followed by Tukey's HSD (significant difference defined as p <0.05). All extraction methods evaluated returned different concentrations of total THC in the plant material. The QuEChERS extraction resulted in the highest calculated concentrations of THC, THCA and CBDA, reporting three to four times greater than obtained via other extractions evaluated. Classification of the starting plant material as hemp or marijuana depended on the extraction method used. These findings clearly and quantitatively demonstrate the need for standardization of extraction methods for hemp analysis and regulation. / Master of Science in Life Sciences / Hemp is a type of Cannabis plant that produces an insignificant amount of the psychoactive cannabinoid tetrahydrocannabinol (THC). Hemp was federally illegal in the United States until the 2018 Farm Bill differentiated hemp from Marijuana, defining hemp as containing less than 0.3% total THC. Standard methods for cannabinoid testing in hemp have not been defined. In this project, four extraction methods with potential use for sample preparation in hemp analysis were evaluated and compared. The extraction methods evaluated included: ethanol, methanol, QuEChERS, and diethyl ether. The concentrations of cannabinoids in each of the plant extracts were then determined using an appropriate analytical method and authentic standards for Cannabidiol (CBD), Cannabidiolic Acid (CBDA), THC, Tetrahydrocannabinolic Acid (THCA), and Cannabinol (CBN). Total concentrations of each cannabinoid in the plant material were then calculated using each extraction method. All extraction methods evaluated resulted in different concentrations of total THC in the plant material, with QuEChERS resulting in the highest calculated concentrations of THC, THCA, and CBDA. The identify of this plant material as hemp or marijuana depended on the extraction method used. This result is not surprising, as extraction efficiency of phytochemicals is well known to depend on the solvent and extraction method used. Nonetheless, our findings clearly demonstrate the need for standardization of extraction methods for hemp analysis and regulation.

No description available.

Adverse childhood experiences (ACEs) are associated with substance use problems, however, few studies have examined the mechanisms underlying this relationship. Research has found that cannabis use motives may mediate the association between ACEs and cannabis-related problems among young adults. However, research has not identified the affective components driving coping motives. Further, higher instances of ACEs predict an increased tendency to experience internalized shame. Coping with shame may be the mechanism linking ACEs to cannabis-related problems. Data were collected using Prolific, an online crowdsourcing platform. Participants were young adults (n = 155, 61.9% Female, 56.8% White) ages 18-29 years (M =22.8, SD = 3.01), who used cannabis in the past year. A serial mediation model examined whether cannabis use coping motives and shame mediate the association between ACEs and cannabis-related problems 6-months later. The overall model showed good fit to the data (χ2(8) =14.30, p=.07, CFI=.96, SRMR=.04, RSMEA=.07). There was a significant indirect effect from ACEs to cannabis-related problems (IND=0.06; 95% CI=0.01 to 0.16) through internalized shame and cannabis-use coping motives. The model accounted for 41% of the variance in cannabis-related problems. Findings suggest that individuals who reported greater ACEs were more likely to endorse cannabis-use coping motives, and this association was fully mediated by internalized shame. Coping motives in turn were associated with greater cannabis-related problems, and coping motives fully mediated the link between shame and problems. Interventions that target reduction in maladaptive affective responses to ACEs, such as shame may be a promising avenue for cannabis use disorder treatment.

Background: Attention deficit and hyperactivity disorder (ADHD) is a neurodevelopmental disorder presenting with three core symptoms: inattention, hyperactivity, and impulsivity. The ADHD population is 3 times more susceptible to developing a cannabis use disorder compared to the general population. Psychostimulants are the first-line treatment for ADHD. There is currently no literature on the impact of cannabis on the psychostimulant response. Objectives: To compare the response to psychostimulant treatment in adults with ADHD between cannabis and non-cannabis users Methods: Sixty-five participants with a primary diagnosis of ADHD were recruited from the MacAnxiety Research Clinic and St. Joseph's Psychiatric Community Clinic. Participants were assigned to the cannabis, or non-cannabis group based on their cannabis status at baseline. The study was 8 weeks long and included 3 visits. The first visit of the study was called “Baseline” and would occur prior to the start of stimulant medication. Participants would be seen at two additional time points 4- and 8-weeks post-baseline visit at which point they would be taking their stimulant medication. At each study visit all participants would fill out the self-reported assessment battery conducted through REDCap. The study psychiatrist would assign a CGI-S score at the end of each visit and a CGI-I score at the end of week 4 and week 8. Results: Cannabis and non-cannabis users did not differ statistically in their BAARS-IV, CGI-S, and CGI-I scores over the study. Secondary outcomes investigating CUD, stimulant type, stimulant dosage, comorbidities, and responder rate did not produce significant outcomes. Conclusions: There was no difference in the treatment response to psychostimulants in adults with ADHD between cannabis and non-cannabis users. Further studies should continue exploring treatment response in populations with co-occurring adult ADHD and cannabis use. / Thesis / Master of Science (MSc) / Attention deficit and hyperactivity disorder (ADHD) has three main symptoms including inattention, hyperactivity, and impulsivity. Substance use disorder is commonly associated with ADHD. The ADHD population is at a 3 times greater risk for developing a cannabis use disorder compared to the general population. Psychostimulants are used to treat ADHD but there is currently no data looking at how cannabis use may affect the treatment response. This study aims to compare the response to ADHD treatment in adults with ADHD between cannabis and non-cannabis users. The study recruited forty participants who filled out a study questionnaire over 3 study visits for a total study length of 8 weeks. Study findings did not report a difference between cannabis and non-cannabis users in their ADHD symptoms, clinical severity, and clinical improvement throughout the study. Further studies should continue investigating populations with co-occurring ADHD and cannabis use in relation to treatment response.

Thèse ou mémoire avec insertion d'articles / Compte tenu de l'usage croissant du cannabis médical pour des raisons, entre autres, de soulager les symptômes dépressifs, alors que les évidences sur l'innocuité du cannabis ne sont pas clairement établies, nous avons proposé cette étude dont l'objectif était d'évaluer l'association entre l'autorisation d'utilisation médicale du cannabis et le risque des troubles dépressifs. A travers les données jumelées provenant de cliniques de cannabis de l'Ontario et des données administratives de l'Ontario, nous avons mené une étude de cohorte longitudinale rétrospective avec un total de 54 006 patients ayant une autorisation d'utilisation médicale du cannabis entre le 19 juin 2014 et le 28 janvier 2019, appariés à 161 265 contrôles sélectionnés dans la population générale d'Ontario. L'autorisation d'utilisation du cannabis pour des raisons médicales était l'exposition de l'étude et les visites aux urgences ou hospitalisations pour troubles dépressifs en étaient l'issue. D'après nos résultats le risque de visites aux urgences ou hospitalisations pour troubles dépressifs chez les patients avec autorisation d'utilisation du cannabis médical était de 2 fois celui des témoins. Ces résultats suggèrent que les patients ayant une autorisation d'utiliser du cannabis à des fins médicales présentaient un risque significativement plus élevé de visites aux urgences ou d'hospitalisations pour des troubles dépressifs par rapport à leurs témoins appariés. Un risque similaire était également observé chez les utilisateurs du cannabis médical sans antécédents de troubles mentaux. Ce risque n'avait pas varié en fonction de l'âge ou du sexe. Les conclusions de cette étude soulignent donc la nécessité d'une évaluation minutieuse du risque de ces troubles chez les patients à la recherche de cannabis pour des soins médicaux et au cours du traitement. / Given the increasing use of medical cannabis for reasons including the relief of depressive symptoms, while the evidence on the safety of cannabis is not clearly established, we proposed this study to assess the association between medical cannabis authorization and the risk of depressive disorders. Using clinical data from a group of Ontario cannabis clinics linked to Ontario health administrative data, we conducted a retrospective longitudinal cohort study with a total of 54,006 patients with medical cannabis authorization between June 19, 2014, and January 28, 2019, matched to 161,265 controls selected from the Ontario general population. Medical cannabis authorization was the study exposure and emergency department visit or hospitalization for depressive disorders was the outcome. According to our results, the risk of emergency department visits or hospitalizations for depressive disorders in patients with medical cannabis authorization was twice that of controls. These results suggest that patients authorized to use cannabis for medical reason had a significantly higher risk of emergency department visits or hospitalizations for depressive disorders compared to their matched controls. A similar risk was also observed among medical cannabis users without history of mental disorders. This risk did not vary with age or gender. The findings of this study therefore highlight the need for careful risk assessment of depressive disorders in patients seeking cannabis for medical care and during cannabis use.