Category: Substance Use

THC Lingers in Breastmilk with no Clear Peak or Decline

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The psychoactive component THC of cannabis showed up in breastmilk in a study published in the journal Breastfeeding Medicine. Unlike alcohol, when THC was detected in milk there was no consistent time when its concentration peaked and started to decline.

Importantly, the researchers discovered that the amount of THC they detected in milk was low – they estimated that infants received an average of 0.07mg of THC per day. For comparison, a common low-dose edible contains 2mg of THC. The research team stressed that it is unknown whether this amount has any impact on the infant.

“Breastfeeding parents need to be aware that if they use cannabis, their infants are likely consuming cannabinoids via the milk they produce, and we do not know whether this has any effect on the developing infant,” said Courtney Meehan, a WSU biological anthropologist who led the project and is the study’s corresponding author.

Since other research has shown that cannabis is one of the most widely used drugs during breastfeeding, the researchers aimed to uncover how long cannabinoids, like THC, persisted in breastmilk.

For this Washington State University-led study, the researchers analysed milk donated by 20 breastfeeding mothers who used cannabis. The participants, who all had infants younger than six months, provided detailed reports on their cannabis use. They collected milk after abstaining from using cannabis for at least 12 hours and then at regular intervals after use. All of this was done in their own homes, at a time of their choosing and with cannabis they purchased themselves.

The researchers then analyzed the milk for cannabinoids. They found that the milk produced by these women always had detectable amounts of THC, even when the mothers had abstained for 12 hours.

“Human milk has compounds called lipids, and cannabinoids are lipophilic, meaning they dissolve in those lipids. This may mean that cannabinoids like THC tend to accumulate in milk – and potentially in infants who drink it,” said Meehan.

The research also revealed that people had different peak THC concentrations in their milk. For participants who used cannabis only one time during the study, cannabinoids peaked approximately 30 minutes to 2.5 hours after use and then started to decline. For participants who used multiple times during the study, the majority showed a continual increase in concentrations across the day.

“There was such a range. If you’re trying to avoid breastfeeding when the concentration of THC peaks, you’re not going to know when THC is at its peak in the milk,” said lead author Elizabeth Holdsworth, who worked on this study while a WSU post-doctoral researcher and is now on the faculty of The Ohio State University.

A related qualitative study by the research team revealed that many breastfeeding moms are using cannabis for therapeutic purposes: for the management of anxiety, other mental health issues or chronic pain. The mothers often chose cannabis over using other medications because they felt it was safer.

“Our results suggest that mothers who use cannabis are being thoughtful in their decisions,” said co-author Shelley McGuire, a University of Idaho professor who studies maternal-infant nutrition. “These women were mindful about their choices. This is far from a random lifestyle choice.”

While in most cases, the women were using cannabis as alternative treatment for a variety of conditions, McGuire pointed out that there is no evidence yet whether it is safer or more harmful. In fact, scientists know almost nothing about how many commonly used drugs may impact breastfeeding babies, partly because women, especially those who are breastfeeding, have historically been left out of clinical trials on medicines.

“This is an area that needs substantial, rigorous research for moms to know what’s best,” McGuire said.

Some research has been done regarding alcohol with guidelines for new mothers to wait at least two hours after consuming alcohol before breastfeeding. Nothing similar has been developed for cannabis, which has been growing in popularity.

The collaborative research team is currently working to address some of that knowledge gap with further research on cannabis use in breastfeeding moms, holistic composition of the milk they produce and its effects on infant development.

Source: Washington State University

Substance Use Disorder Treatment Better than Punishment, Study Shows

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Substance use disorder treatment in the community is a superior alternative to incarceration for offenders with a substance misuse background, according to a recent study evaluating the effectiveness of the contract treatment sanction in Sweden.

Contract treatment refers to a criminal penalty in which the offender voluntarily consents to treatment in accordance with a specific implementation plan.

“Contract treatment is an alternative to incarceration. It is mainly used when the offence is deemed to have occurred as a result of substance misuse or some other condition requiring treatment,” says Suvi Virtanen, a University Lecturer in Psychology at the University of Eastern Finland.

A rehabilitation period is always planned based on individual needs. In addition to psychosocial treatment, it may include opioid substitution therapy.

In addition to Sweden, a sanction similar to contract treatment is in use in, e.g., Norway and many EU countries; however, not in Finland. The United States, in turn, has adopted a model of specialised drug courts.

Contract treatment carries a smaller risk of recidivism

Although contract treatment has been in use in Sweden since the late 1980s, its effectiveness has not been studied until now. The present study combined data from the Swedish Prison and Probation Service’s client register with other national registries, including data on visits to specialised health care. The study cohort included 11 893 individuals who were serving a contract treatment sanction between 1999 and 2012, and they were followed up for at least two years.

“With the introduction of contract treatment, criminal behaviour and substance-related adverse health events, such as overdoses and hospitalisations due to psychiatric and somatic reasons, decreased significantly compared to the period before contract treatment,” Virtanen says.

A significant proportion of those sentenced to contract treatment had also served community sanctions and prison sentences. In the within-individual research design, an individual’s risk of recidivism and adverse health events during contract treatment was examined compared to periods when the individual was serving a community sanction or was on parole after a prison sentence.

“The risk of recidivism and adverse health events was lower during contract treatment than during a community sanction or probation,” Virtanen notes.

Providing treatment yields better results than punishment

Substance misuse problems and criminality often go hand in hand. The most effective way to prevent recidivism is to address its root causes, which often are, in one way or another, linked to the use of substances.

“Substance use disorders are increasingly understood as a health issue that should primarily be addressed by means of health care. Usually, prison is not the best place for an individual who needs appropriate treatment and support for recovery,” Virtanen says.

The results of the study provide support for the notion that, from the viewpoint of societal security and public health, providing treatment can lead to better outcomes than penalties that emphasise punishment.

In the future, the researchers intend to study the effectiveness of contract treatment in more recent data.

Source: University of Eastern Finland

New Online Recovery School a First for South Africa

South Africa is a traumatised nation

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Dr Siya Mjwara, founder of the AskDrSiya Psychotherapy and Wellness Coaching Practice, has just launched the first online recovery school in South Africa. The Recovery School will support individuals in identifying and confronting their challenges and businesses in developing and implementing wellness solutions in order to reduce absenteeism and improve productivity, as well as overall workplace culture. Dr Mjwara will provide a supportive and transformative environment where healing and growth are possible for all.

She says, “We create a virtual sanctuary where individuals can find healing, empowerment and community support. We strive to cultivate a space where you can reclaim your life and thrive, no matter what you’ve been through.

“After 17 years of working with individuals, couples and families, I can say, without a doubt, that we South Africans are a traumatised nation. Unfortunately, many of us are completely unaware of how our traumas are negatively impacting our lives, as well as the decisions we take on a daily basis. Recently, I’ve been hearing people say, “avoid dating anyone who has never been to therapy”. This is an indication that more of us are recognising how unresolved trauma can negatively impact our relationships.

“Besides our personal experiences, such as childhood trauma, relationship, family and workplace traumas, many of us are still dealing with the effects of intergenerational trauma.

This is part of the background that informs the vision for The Recovery School. My wish is for individuals to not only cope with trauma, but also to be able to thrive and become the best version of themselves. It takes courage to face your fears and begin living authentically, and you don’t need to walk the journey alone.

The school’s programmes are primarily designed to enable individuals to

  1. Rediscover themselves
  2. Break free from limiting beliefs
  3. Cultivate resilience
  4. Forge meaningful connections
  5. Live fully in the present
  6. Achieve their goals

Dr Mjwara BSW Hons (UWC), MA FCS (UWC), Dphil (UNIZULU) can be contacted on Ask@DrSiya.co.za or 079 772 1950.

Low Social Status Increases Risk of Health Problems from Alcohol Problems

People with low income or education levels may benefit from screening for alcohol-related conditions

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Men and women with lower income or education levels are more likely to develop medical conditions related to alcohol abuse compared to similar individuals with a higher socioeconomic status. Alexis Edwards of Virginia Commonwealth University, US, and colleagues report these findings in a new study published March 19th in the open access journal PLOS Medicine.

The World Health Organization estimates that harmful alcohol use accounts for 5.1% of the global burden of disease and injury worldwide, and results in three million deaths each year. Excessive alcohol consumption can also take an economic toll. Previous studies have identified links between a person’s socioeconomic status and alcohol use, but currently it is unclear how an individual’s social class impacts their future risk of acquiring alcohol-related medical conditions, like alcoholic liver disease.

In the new study, researchers used a model that follows people over time to estimate their risk of developing medical conditions from alcohol abuse using two indicators for socioeconomic status: income and education level. The researchers analysed data from more than 2.3 million individuals in a Swedish database to show that both men and women with a lower income or education level were more likely to develop these conditions. The associations held true, even when researchers controlled for other relevant factors, such as marital status, history of psychiatric illness and having a genetic predisposition to abuse alcohol.

The new findings are important for understanding which populations are most likely to suffer from medical conditions resulting from alcohol abuse, and contribute to a growing body of literature on health disparities that stem from socioeconomic factors. The researchers recommend that individuals with lower income or education levels might warrant additional screening by clinicians to evaluate their alcohol consumption and identify related conditions.

The authors add, “Among individuals with an alcohol use disorder, those with lower levels of education or lower incomes are at higher risk for developing an alcohol-related medical condition, such as cirrhosis or alcoholic cardiomyopathy. Additional screening and prevention efforts may be warranted to reduce health disparities.”

Source: PLOS

Proposed Update to Schedule 6 of the Medicines and Related Substances Act

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By Rodney Africa, Partner, Adriano Esterhuizen, Partner & Daveraj Sauls, Associate at Webber Wentzel

The Minister of Health (the Minister) in terms of section 22A(2) of the Medicines and Related Substances Act 101 of 1965 (the Medicines Act), and on the recommendation of the South African Health Products Regulatory Authority, has invited interested persons to submit substantiated comments or representations on the proposed update of Schedule 6 to the Medicines Act.

The proposed update to Schedule 6 of the Medicines Act intends to exclude certain cannabis products containing Tetrahydrocannabinol (THC), the psychoactive compound in cannabis, from the operation of the Schedules to the Medicines Act and will, inter alia, permit the manufacturing of cannabis consumer items and products, with no limitation on the percentage of THC content, provided that the items and products have no pharmacological action or medicinal purpose. This will also allow adults to cultivate and possess cannabis in private for personal consumption, with no limitation on the percentage of THC content.

This proposed update appears to be a move away from utilising THC content as a threshold to distinguish between consumable and industrial cannabis. This shift seemingly comes in response to the growing South African market for cannabis products and aims to augment the Cannabis for Private Purposes Bill 2023 [B19 – 2020] recently passed by the National Council of Provinces and submitted to the President for his assent and signature.

Interested persons have until Thursday, 14 March 2024 to submit any substantiated comments or representations by emailing mihloti.mushwana@health.gov.za or paul.tsebe@health.gov.za.

Continued Cocaine Use Disrupts Communication between Major Brain Networks

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A collaborative research endeavour by scientists in the Departments of Radiology, Neurology, and Psychology and Neuroscience at the UNC School of Medicine have demonstrated the deleterious effects of chronic cocaine use on the functional networks in the brain.

Their study titled “Network Connectivity Changes Following Long-Term Cocaine Use and Abstinence,” was highlighted by the editor of Journal of Neuroscience in “This Week in The Journal.” The findings show that continued cocaine use affects how crucial neural networks communicate with one another in the brain, including the default mode network (DMN), the salience network (SN), and the lateral cortical network (LCN).

“The disrupted communication between the DMN and SN can make it harder to focus, control impulses, or feel motivated without the drug,” said Li-Ming Hsu, PhD, assistant professor of radiology and lead author on the study. “Essentially, these changes can impact how well they respond to everyday situations, making recovery and resisting cravings more challenging.”

Hsu led this project during his postdoctoral tenure at the Center for Animal MRI in the Biomedical Research Imaging Center and the Department of Neurology. The work provides new insights into the brain processes that underlie cocaine addiction and creates opportunities for the development of therapeutic approaches and the identification of an imaging marker for cocaine use disorders.

The brain operates like an orchestra, where each instrumentalist has a special role crucial for creating a coherent piece of music. Specific parts of the brain need to work together to complete a task. The DMN is active during daydreams and reflections, the SN is crucial for attentiveness, and the CEN, much like a musical conductor, plays a role in our decision-making and problem-solving.

The research was motivated by observations from human functional brain imaging studies suggesting chronic cocaine use alters connectivity within and between the major brain networks. Researchers needed a longitudinal animal model to understand the relationship between brain connectivity and the development of cocaine dependence, as well as changes during abstinence.

Researchers employed a rat model to mimic human addiction patterns, allowing the models to self-dose by nose poke. Paired with advanced neuroimaging techniques, the behavioural approach enables a deeper understanding of the brain’s adaptation to prolonged drug use and highlights how addictive substances can alter the functioning of critical brain networks.

Hsu’s research team used functional MRI scans to explore the changes in brain network dynamics on models that self-administrated cocaine. Over a period of 10 days followed by abstinence, researchers observed significant alterations in network communication, particularly between the DMN and SN.

These changes were more pronounced with increased cocaine intake over the 10 days of self-administration, suggesting a potential target for reducing cocaine cravings and aiding those in recovery. The changes in these networks’ communication could also serve as useful imaging biomarkers for cocaine addiction.

The study also offered novel insights into the anterior insular cortex (AI) and retrosplenial cortex (RSC). The former is responsible for emotional and social processing; whereas, the latter controls episodic memory, navigation, and imagining future events. Researchers noted that there was a difference in coactivity between these two regions before and after cocaine intake. This circuit could be a potential target for modulating associated behavioural changes in cocaine use disorders.

“Prior studies have demonstrated functional connectivity changes with cocaine exposure; however, the detailed longitudinal analysis of specific brain network changes, especially between the anterior insular cortex (AI) and retrosplenial cortex (RSC), before and after cocaine self-administration, and following extended abstinence, provides new insights,” said Hsu.

Source: University of North Carolina Health Care

The Effect of Cannabis Use in Binge Eating Disorder

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New research published in the journal Experimental and Clinical Psychopharmacology examined how often people experiencing binge eating are also using cannabis recreationally, and whether patients who use cannabis experience more severe eating disorder symptoms or symptoms of struggling with mental health. The results indicated that many cannabis users with binge eating disorder feel a strong desire to use cannabis, as well as having greater risks for drinking problems.

Though much research has focused on the impact of cannabis on eating habits, less is known about the effects of cannabis use on individuals with a binge eating disorder. Binge eating is the experience of feeling out of control when eating or unable to stop eating. Cannabis may play a particular role in maintaining binge eating as research suggests cannabis can increase how pleasurable or rewarding people find high sugar or high fat foods.

The research from Drexel University’s Center for Weight, Eating and Lifestyle Science (WELL Center) found that more than 23% of the 165 study participants reported using cannabis in the past three months – either “once or twice” or “monthly.” These participants were individuals seeking treatment for binge eating and reported their cannabis and alcohol use as part of that process.

“Distinguishing the relationship between cannabis use, eating disorder severity and other psychiatric symptoms in binge eating patients is necessary for informing screening and clinical recommendations,” said lead author Megan Wilkinson, a doctoral student in Drexel’s College of Arts and Sciences.

While study participants who used cannabis reported “a strong desire or urge to use cannabis” and they also drank alcohol more frequently and reported more problems related to their alcohol use; the research team noted that participants with binge eating disorders who used cannabis did not have more severe eating disorder or depression symptoms.

“Both alcohol and cannabis can impact an individual’s appetite and mood. Our finding that patients with binge eating who use cannabis also drink more alcohol may suggest that these individuals are at a higher risk for binge eating, given the compounded effects on appetite and mood from these substances,” said Wilkinson. “Treatments for binge eating should explore how substance use affects hunger, mood, and eating for patients.”

Participants also completed surveys and interviews about their binge eating, other eating disorder symptoms and depression. The research team compared individuals who reported cannabis use to individuals who did not report cannabis use to see if there were statistically significant differences in their alcohol use, eating disorder symptoms, or depression symptoms.

The findings indicate that a notable subset of the participants with binge eating disorders use cannabis and experience strong desires or urges to use cannabis. Additionally, using cannabis appears to be related to drinking patterns and problems with drinking (eg, needing more alcohol to feel intoxicated, inability to control drinking) for patients with binge eating.

“We hope this research is helpful for clinicians treating patients with binge eating, as it can provide them with updated information about the prevalence of cannabis use in their patients,” said Wilkinson. “We recommend that clinicians screen for cannabis and alcohol use in all their patients and assess any potential problems the patient may be experiencing related to their substance use.”

Wilkinson also noted that updated research on cannabis use in patients with binge eating will be required regularly due to changing social norms and laws related to cannabis in the United States. Next, Wilkinson and her colleagues are planning to explore the ways that cannabis use may impact hunger and mood for patients with binge eating, and therefore potentially exacerbate their binge eating symptoms.

Source: Drexel University

Alcohol Metabolites Play a Complex Role in Cardiovascular Harms and Benefits

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Although past research has indicated that moderate alcohol consumption can reduce cardiovascular disease (CVD) risk, more recent studies suggest that moderate levels of drinking may be hazardous to heart health. A new analysis now sheds new insight on this complex relationship between alcohol consumption and the progression of CVD, showing that a few particular alcohol metabolites strongly influence its protective effects.

Published in the journal BMC Medicine, the study observed a total of 60 alcohol consumption-related metabolites, identifying seven circulating metabolites that link long-term moderate alcohol consumption with an increased risk of CVD, and three circulating metabolites that link this same drinking pattern with a lower risk of CVD.

The findings from the study led by Boston University School of Public Health and Friedman School of Nutrition Science and Policy at Tufts University (Friedman School) detail the molecular pathway of long-term alcohol consumption and show that further research on these metabolites is needed for targeted prevention and treatment of alcohol-related CVD.

“The study findings demonstrate that alcohol consumption may trigger changes of our metabolomic profiles, potentially yielding both beneficial and harmful outcomes,” says Dr Chunyu Liu, assistant professor of biostatistics at BUSPH and co-corresponding/co-senior author of the study along with Dr.Jiantao Ma, assistant professor in the Division of Nutrition Epidemiology and Data Science at the Friedman School.

“However, rather than definitively settling that debate, this study underscores the intricate effects of alcohol consumption on cardiovascular health and generates a useful hypothesis for future investigations,” Dr Liu says.

The researchers analysed blood samples to measure the association between the cumulative average consumption of beer, wine, and liquor and 211 metabolites among Framingham Heart Study Offspring Study participants, who are the children of participants in the long-running Boston University-based Framingham Heart Study, over 20 years.

Of the 2428 participants, 636 developed CVD over the study period. Among the 60 drinking-related metabolites, 13 metabolites had a stronger association with alcohol consumption in women than in men, perhaps due to higher blood alcohol levels from women’s generally smaller body size versus the same amount of alcohol.

Consuming different types of alcohol was also linked to different metabolomic responses, with beer consumption generating a slightly weaker association overall than wine and liquor.

In roughly two-thirds of the 60 metabolites, higher plasma levels were detected in participants who consumed greater amounts of alcohol. Branched-chain amino acids (BCAAs), were among the metabolites not associated with alcohol consumption.

The researchers then calculated two alcohol consumption-associated metabolite scores, which had opposite associations with the development of CVD.

“While our study presents intriguing findings, validation through state-of-the-art methods and large and diverse study populations is crucial,” Dr Ma says.

“To enhance reliability, we aim to conduct larger-scale research involving a more diverse racial and ethnic background, as the current study participants are all white. In addition, we will expand our study to integrate with other molecular markers such as genetic information to illustrate the complex relationships between alcohol consumption, metabolite features, and cardiovascular risk.”

Source: Boston University School of Public Health

Cannabis Users Found to Have Higher Levels of Empathy

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A study of regular cannabis users and non-users found that users tend to have a greater understanding of the emotions of others, based on psychological assessments. Brain imaging tests also revealed that cannabis users’ anterior cingulate – a region generally affected by cannabis use and related to empathy – had stronger connectivity with brain regions related to sensing the emotional states of others within one’s own body.

The study, published in the Journal of Neuroscience Research, included 85 regular cannabis users and 51 non-consumers who completed psychometric tests and a subset of 46 users and 34 nonusers who underwent functional magnetic resonance imaging exams.

“Although further research is needed, these results open an exciting new window for exploring the potential effects of cannabis in aiding treatments for conditions involving deficits in social interactions, such as sociopathy, social anxiety, and avoidant personality disorder, among others,” said co-author Víctor Olalde-Mathieu, PhD, of the Universidad Nacional Autónoma de México.

Source: Wiley

Cannabis Use in Pregnancy Linked to Adverse Birth Outcomes

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A meta-analysis of studies published over the past 40 years on cannabis use during pregnancy has found an association between foetal exposure to cannabis in the womb and preterm delivery, low birth weight and the need for neonatal intensive care admission (NICU). The study was published today in the journal Addiction

Previous research has indicated that THC, the main psychoactive component in cannabis, can cross the placenta to the foetus during pregnancy and bind to receptors in the foetal brain.

The meta-analysis examined the results of 57 studies around the world that included almost 13 million infants in total.  Based on either self-reports from pregnant women, or blood and saliva testing depending on the study, just over 100 000 infants were found to be exposed to cannabis in the womb. While none of the studies found a direct causal relationship between cannabis use during pregnancy and adverse birth outcomes, the combined results indicated that newborns exposed to cannabis during pregnancy were twice as likely to require NICU admission, twice as likely to have a low birth rate and one and a half times more likely to be born early.

While there has been little research on cannabis use during pregnancy since cannabis was legalised in Canada five years ago, an American study has indicated an increase in cannabis use during pregnancy in states where it has been legalised and the perceived risk of harm from cannabis has decreased. The study states that overall cannabis use in pregnancy has doubled in the past 20 years, with approximately 10% of pregnancies associated with cannabis exposure. Some studies indicated it was being used to alleviate symptoms of nausea, poor appetite, insomnia or anxiety during pregnancy.

Canada’s Lower Risk Cannabis Use Guidelines, developed by a nationwide team led by CAMH scientists, recommends cannabis abstinence during pregnancy.

“This research emphasizes the importance of healthcare providers making an effort to create a safe space talking to pregnant women and women planning to be pregnant about their cannabis use and their motivations for using it to educate them about the potential risks and empower them to make informed decisions for their child,” says lead author Maryam Sorkhou, a PHD student within the addictions division at CAMH as well as the University of Toronto. Ms Sorkhou is overseen at CAMH by Senior Scientist and paper co-author Dr Tony George.

Source: Centre for Addiction and Mental Health