Cannabis Nurse Truths

Several years ago, a medical case appeared that took the scientific and medical community by storm. A patient appeared for surgery who reported never feeling anxiety, depression, or pain, despite numerous injuries and surgeries for which she required treatment.  As scientists analyzed her genetic profile, they discovered something amazing - Joanne Cameron lacked the genetic code that was responsible for transmitting pain and creating anxiety and depression.
In this episode of Cannabis Nurse Truths, we examine the curious case of Joanne Cameron that has led to some very surprising research that targets this important physiological phenomenon, and drug companies are furiously developing drugs to capitalize on this incredible potential to decrease pain, anxiety, depression, and treat a number of psychological and physical disorders. One of the most incredible findings linked to this case: cannabinoids, like CBD, also enhance the natural physiological activities of the body linked to the FAAH-OUT gene, where inflammation is halted (reducing pain), while also reducing or eliminating anxiety and depression.  
 
EPISODE RESOURCES
Ahn, K., Johnson, D. S., & Cravatt, B. F. (2009). Fatty acid amide hydrolase as a potential therapeutic target for the treatment of pain and CNS disorders. Expert Opinion on Drug Discovery, 4(7), 763–784. https://pmc.ncbi.nlm.nih.gov/articles/PMC2882713/pdf/nihms-116402.pdf  
Bartel, S. J., Sherry, S. B., & Stewart, S. H. (2020). Self-isolation: A significant contributor to cannabis use during the COVID-19 pandemic. Substance Abuse, 41(4), 409–412. https://pubmed.ncbi.nlm.nih.gov/33044893/ 
Bisogno, T., & Maccarrone, M. (2013). Latest advances in the discovery of fatty acid amide hydrolase inhibitors. Expert Opinion on Drug Discovery. https://www.researchgate.net/publication/236044861_Latest_advances_in_the_discovery_of_fatty_acid_amide_hydrolase_inhibitors 
Boileau, I., Mansouri, E., Williams, B., Le Foll, B., Rusjan, P., Mizrahi, R., Tyndale, R. F., Huestis, M. A., Payer, D. E., Wilson, A. A., Houle, S., Kish, S. J., & Tong, J. (2016). Fatty acid amide hydrolase binding in brain of cannabis users: Imaging with the novel radiotracer [11C]CURB. Biological Psychiatry, 80(9), 691–701. https://pubmed.ncbi.nlm.nih.gov/27345297/  
Bornscheuer, L., Lundin, A., Forsell, Y., Lavebratt, C., & Melas, P. A. (2023). Functional variation in the FAAH gene is directly associated with subjective well-being and indirectly associated with problematic alcohol use. Genes, 14(9), 1826. https://pubmed.ncbi.nlm.nih.gov/37761966/ 
Cravatt, B.F., & Lichtman, A.H. (2003). Fatty acid amide hydrolase: An emerging therapeutic target in the endocannabinoid system. Current Opinion in Chemical Biology, 7(4), 469–475. https://pubmed.ncbi.nlm.nih.gov/12941421/ 
Di Marzo, V., & Petrosino, S. (2007). Endocannabinoids and the regulation of their levels in health and disease. Current Opinion in Lipidology, 18(2), 129–140. https://pubmed.ncbi.nlm.nih.gov/17353660/ 
D’Souza, D. C., Cortes-Briones, J., Creatura, G., Bluez, G., Thurnauer, H., Deaso, E., Bielen, K., Surti, T., Radhakrishnan, R., Gupta, A., Gupta, S., Cahill, J., Sherif, M. A., Makriyannis, A., Morgan, P. T., Ranganathan, M., & Skosnik, P. D. (2019). Efficacy and safety of a fatty acid amide hydrolase inhibitor (PF-04457845) in the treatment of cannabis withdrawal and dependence in men: A double-blind, placebo-controlled, parallel group, phase 2a single-site randomised controlled trial. Lancet Psychiatry, 6(1), 35–45. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30427-9/abstract 
Girella, A., Di Bartolomeo, M., Dainese, E., Buzzelli, V., Trezza, V., & D’Addario, C. (2024). Fatty acid amide hydrolase and cannabinoid receptor type 1 genes regulation is modulated by social isolation in rats. Neurochemical Research, 49(5),1278-1290. http://www.ncbi.nlm.nih.gov/pubmed/38368587 
Giuffrida, A., Leweke, F. M., Gerth, C. W., Schreiber, D., Koethe, D., Faulhaber, J., Klosterkötter, J., & Piomelli, D. (2004). Cerebrospinal anandamide levels are elevated in acute schizophrenia and are inversely correlated with psychotic symptoms. Neuropsychopharmacology, 29(11), 2108–2114. https://www.nature.com/articles/1300558 
Habib, A. M., Okorokov, A. L., Hill, M. N., Bras, J. T., Lee, M.-C., Li, S., Gossage, S. J., van Drimmelen, M., Morena, M.,Houlden, H., Ramirez, J. D., Bennett, D. L. H., Srivastava, D., & Cox, J. J. (2019). Microdeletion in a FAAH pseudogene identified in a patient with high anandamide concentrations and pain insensitivity. British Journal of Anaesthesia, 123(2), e249–e253. https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC6676009&blobtype=pdf  
Haseltine, W.A., (2023). No pain, FAAH-OUT. Forbes.https://www.forbes.com/sites/williamhaseltine/2023/06/19/no-pain-faah-out/ 
Huggins, J. P., Smart, T. S., Langman, S., Taylor, L., & Young, T. (2012). An efficient randomised, placebo-controlled clinical trial with the irreversible fatty acid amide hydrolase-1 inhibitor PF-04457845, which modulates endocannabinoids but fails to induce effective analgesia in patients with pain due to osteoarthritis of the knee. Pain, 153(9), 1837–1846. https://pubmed.ncbi.nlm.nih.gov/22727500/  
Jacobson, M. R., Watts, J. J., Silva, T. D., Tyndale, R. F., Rusjan, P. M., Houle, S., Wilson, A. A., Ross, R. A., Boileau, I., & Mizrahi, R. (2020). Fatty acid amide hydrolase is lower in young cannabis users. Addiction Biology, 26(1), e12872. https://pmc.ncbi.nlm.nih.gov/articles/PMC7944390/ 
Lever, I. J., Robinson, M., Cibelli, M., Paule, C., Santha, P., Yee, L., Hunt, S. P., Cravatt, B. F., Elphick, M. R., Nagy, I., & Rice, A. S. C. (2009). Localization of the endocannabinoid-degrading enzyme fatty acid amide hydrolase in rat dorsal root ganglion cells and its regulation after peripheral nerve injury. Journal of Neuroscience, 29(12), 3766–3780. https://doi.org/10.1523/JNEUROSCI.4071-08.2009 
Leweke, F. M., Giuffrida, A., Wurster, U., Emrich, H. M., & Piomelli, D. (1999). Elevated endogenous cannabinoids in schizophrenia. Neuroreport, 10(8), 1665–1669. https://pubmed.ncbi.nlm.nih.gov/10501554/ 
Leweke, F. M., Piomelli, D., Pahlisch, F., Muhl, D., Gerth, C. W., Hoyer, C., Klosterkötter, J., Hellmich, M., & Koethe, D. (2012). Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Translational Psychiatry, 2(3), e94–e94.  https://www.nature.com/articles/tp201215 
Machado-Vieira, R, & Haseeb, A. (2024). A trial of the fatty acid amide hydrolase inhibitor palmitoylethanolamide in bipolar depression. Identifier NCT06229977. https://clinicaltrials.gov/study/NCT06229977?cond=DEPRESSION%20&term=FAAH&rank=1&a=1  
Mikaeili, H., Habib, A. M., Yeung, C. W.-L., Santana-Varela, S., Luiz, A. P., Panteleeva, K., Zuberi, S., Athanasiou-Fragkouli, A., Houlden, H., Wood, J. N., Okorokov, A. L., & Cox, J. J. (2023). Molecular basis of FAAH-OUT-associated human pain insensitivity. Brain: A Journal of Neurology, 146(9), 3851–3865. https://pubmed.ncbi.nlm.nih.gov/37222214/ 
Minkkila, A. M., Saario, S., & Nevalainen, T. (2010). Discovery and development of endocannabinoid-hydrolyzing enzyme inhibitors. Current Topics in Medicinal Chemistry, 10(8), 828–858. https://doi.org/10.2174/156802610791164238 
Patel, S., Hill, M. N., Cheer, J. F., Wotjak, C. T., & Holmes, A. (2017). The endocannabinoid system as a target for novel anxiolytic drugs. Neuroscience and Biobehavioral Reviews, 76(Pt A), 56–66. https://pmc.ncbi.nlm.nih.gov/articles/PMC5407316/pdf/nihms843439.pdf 
Pfizer. (2009). A multiple dose trial evaluating the safety, tolerability, pharmacokinetics and pharmacodynamics of PF-04457845 in healthy volunteers. Identifier NCT00836082. https://clinicaltrials.gov/study/NCT00836082?term=pf%2004457845&checkSpell=&rank=1&tab=table 
Pfizer. (2010). A study to establish the effects of PF-04457845 on sleep in healthy volunteers. Identifier NCT01092845. https://clinicaltrials.gov/study/NCT01092845?term=pf%2004457845&checkSpell=&rank=7&a=7  
Pfizer. (2019). A study to investigate whether PF-04457845 is effective in treating pain, is safe and tolerable in patients with osteoarthritis of the knee. Identifier NCT00981357.https://clinicaltrials.gov/study/NCT00981357?cond=osteoarthritis%20&term=FAAH&rank=1  
Sanofi-Aventis. (2013). An eight-week study of SSR411298 as treatment for major depressive disorder in elderly patients (FIDELIO). Identifier NCT00822744. https://clinicaltrials.gov/study/NCT00822744?term=SSR-411298&rank=1&a=9  
Schlosburg, J. E., Kinsey, S. G., & Lichtman, A. H. (2009). Targeting fatty acid amide hydrolase (FAAH) to treat pain and inflammation. AAPS Journal, 11(1), 39. https://pmc.ncbi.nlm.nih.gov/articles/PMC2664876/pdf/12248_2008_Article_9075.pdf  
Tripathi, R. K. P. (2020). A perspective review on fatty acid amide hydrolase (FAAH) inhibitors as potential therapeutic agents. European Journal of Medicinal Chemistry, 188, 111953. https://pubmed.ncbi.nlm.nih.gov/31945644/  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

In the schizophrenic United States of Cannabis, Americans have been denied fundamental Constitutional Rights because of their choice to use a plant. Long after court requirements are satisfied from a marijuana charge, many Americans are denied basic rights like employment, voting, housing, property, child custody, and college loans that keep them from Life, Liberty, and the Pursuit of Happiness. As the laws and regulations regarding cannabis undergo extreme transformations, Americans are still subjected to discrimination, but now, there could be a light on the horizon.
In this episode of Cannabis Nurse Truths, we are excited to host our first poTcast guest, Tamara Lyn Netzel, a nationally-recognized cannabis advocate and author, who has just published her second book, Humans of Cannabis in a Renaissance of Hope, highlighting the struggles and successes of normal everyday Americans who have decided that cannabis is their drug - or medicine - of choice.  Tamara is the founder of the non-profit 501c3 Cruel Consequences: Portraits of Misguided Law after becoming a medical cannabis advocate for treatment of her multiple sclerosis symptoms and in this episode of CNT, we discuss her journey to cannabis as medicine and her passion for cannabis advocacy.
 
EPIDSODE RESOURCES
Cruel Consequences: Portraits of Misguided Law https://cruelconsequences.org/  
Amazon: Humans of Cannabis in a Renaissance of Hopehttps://www.amazon.com/Humans-Cannabis-Tamara-Lyn-Netzel/dp/B0DHJH9HJV?sr=8-1  
Portraits of Misguided Law: The Human Cost of Marijuana Prohibitionhttps://checkout.square.site/buy/RLKFXWPJQ5N4K6HDMBMBEVSL  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

In order to understand how we ended up in the schizophrenic United States of Cannabis, we have to travel back in time to when cannabis was part of the American experience.  For nearly 150 years after the first colony was established in Jamestown, Virginia, cannabis was utilized for spiritual rituals, rope, fibers, textiles, bird seed, oils and medicine, both for humans and pets. Until one day, a bunch of men in business suits decided that they needed a lot of money to start a war on drugs. 
In this episode of Cannabis Nurse Truths, we take a look at the very mixed-up and unfair hijinks used by the Federal government agencies that would later also benefit from its prohibition.  It is all too apparent that our federal government is seriously flawed and even worse, those government entities who created this national psychosis are still benefiting from the effects of prohibition over 80 years later.
 
EPISODE RESOURCES
Adams, E. S. (2024). Just don’t do it: Why cannabis regulations are the reason cannabis businesses are failing. Nevada Law Journal, 24(349). https://scholars.law.unlv.edu/cgi/viewcontent.cgi?article=1935&context=nlj0 
Galliher, J. F., & Walker, A. (1977). The puzzle of the social origins of the Marihuana Tax Act of 1937. Social Problems, 24(3), 367–376. https://doi.org/10.2307/800089  
Griffith, R. C. (2021). A breath of fresh air: A Constitutional amendment legalizing marijuana through an Article V Convention of the States. University of Massachusetts Law Review, 16(200), Article 2.https://scholarship.law.umassd.edu/umlr/vol16/iss2/2  
LaGuardia, F. (1944). The Laguardia Committee Report New York, USA (1944).https://rodneybarnett.net/PDF/Laguardia%20Report%201944.pdf  
Last Prisoner Project. (n.d.). Exactly how many people are locked up for weed? https://www.lastprisonerproject.org/cannabis-prisoner-scale 
National Conference of State Legislatures. (n.d.). State Medical Cannabis Laws.  https://www.ncsl.org/health/state-medical-cannabis-laws?__cf_chl_tk=jj5C1HNOjfrPgfuAOfFuEtsRvbrl0ufw5tdRo54kBBk-1730819983-1.0.1.1-3WmtBp1aGo4X66bWfielCviKdPcDqEI.k1hG1LmOiH4  
National Institute on Alcohol Abuse and Alcoholism. (2024). Alcohol Use in the United States: Age Groups and Demographic Characteristics.  National Institutes of Health. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-use-united-states-age-groups-and-demographic-characteristics
Musto, D. F. (1972). The 1937 Marijuana Tax Act. Archives of General Psychiatry, 26, 101-108. https://static1.squarespace.com/static/54b9fbd9e4b0b6737df63e5d/t/627af393d870030771a32aa1/1652224915619/The+1937+Marijuana+Tax+Stamp+Act-Musto-1972.pdf  
Patton, D. V. (n.d.). A history of United States cannabis law. Journal of Law & Health, 34(1). https://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?article=1567&context=jlh  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Previous research has indicated that driving impaired while under the influence of cannabis can increase safety concerns for both driver and passengers, and that cannabis users are more likely to drive while impaired because of the perception that drugged driving is not as risky as drunk driving.
However, prior driving research studies focused mainly on healthy individuals using intoxicating levels of THC, which do not provide real-world evidence of how new paradigms, such as medical cannabis, influence driving while high. In this episode of Cannabis Nurse Truths, we examine the safety concerns and current attitudes related to driving while high, and we emphasize an immediate need for more reliable drug testing methods and public education campaigns. 
 
EPISODE RESOURCES
Boicu, B., Al-Hakim, D., Yuan, Y., & Brubacher R. J. (2024). Attitudes toward driving after cannabis use: A systematic review and meta-analysis. Transportation Research Part F: Traffic Psychology and Behaviour, 106, 418–430. https://doi.org/10.1016/j.trf.2024.08.005 
Brooks-Russell, A., Brown, T., Rapp-Olsson, A. M., Friedman, K., & Kosnett, M. (2019). Driving after cannabis use and compensatory driving behaviors among current cannabis users in Colorado. Traffic Injury Prevention, 20(sup2), S199–S201. https://www.tandfonline.com/doi/full/10.1080/15389588.2019.1665424
Brown, T., Banz, B., Schmitt, R., Gaffney, G., Milavetz, G., Camenga, D., Li, K., Brooks-Russell, A., & Vaca, F. (2022). A study of self-reported personal cannabis use and state legal status and associations with engagement in and perceptions of cannabis-impaired driving. Traffic Injury Prevention, 23(sup1), S183–S186. https://www.tandfonline.com/doi/full/10.1080/15389588.2022.2124803 
Colizzi, M., & Bhattacharyya, S. (2018). Cannabis use and the development of tolerance: A systematic review of human evidence. Neuroscience and Biobehavioral Reviews, 93, 1-25. https://pubmed.ncbi.nlm.nih.gov/30056176/ 
Cuttler, C., Sexton, M., & Mischley, L. K. (2018). Driving under the influence of cannabis: An examination of driving beliefs and practices of medical and recreational cannabis users across the United States. Cannabis, 1(2), Article 2. https://publications.sciences.ucf.edu/cannabis/index.php/Cannabis/article/view/cannabis.2018.02.001 
Di Ciano, P., Rajji, T. K., Hong, L., Zhao, S., Byrne, P., Elzohairy, Y., Brubacher, J. R., McGrath, M., Brands, B., Chen, S., Wang, W., Hasan, O. S. M., Wickens, C. M., Kaduri, P., & Le Foll, B. (2024). Cannabis and driving in older adults. JAMA Network Open, 7(1), e2352233. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814053 
Dutra, L. M., Gourdet, C., Farrelly, M. C., & Bradfield, B. (2023). Perceived safety, not perceived legality, mediates the relationship between cannabis legalization and drugged driving. Health Education & Behavior: The Official Publication of the Society for Public Health Education, 50(6), 718–727. https://pubmed.ncbi.nlm.nih.gov/35822623/ 
Jones, C., Donnelly, N., Swift, W., & Weatherburn, D. (2006). Preventing cannabis users from driving under the influence of cannabis. Accident; Analysis and Prevention, 38(5), 854–861. https://pubmed.ncbi.nlm.nih.gov/16574046/ 
Kraemer, M., Madea, B., & Hess, C. (2019). Detectability of various cannabinoids in plasma samples of cannabis users: Indicators of recent cannabis use? Drug Testing and Analysis, 11(10), 1498–1506. https://pubmed.ncbi.nlm.nih.gov/31407526/ 
Manning, B., Arkell, T. R., Hayley, A. C., & Downey, L. A. (2024). A semi-naturalistic open-label study examining the effect of prescribed medical cannabis use on simulated driving performance. Journal of Psychopharmacology, 38(3), 247–257. https://journals.sagepub.com/doi/10.1177/02698811241229524
McDonald, A. J., Hamilton, H. A., Wickens, C. M., Watson, T. M., Elton-Marshall, T., Wardell, J. D., Rueda, S., Roerecke, M., Stoduto, G., & Mann, R. E. (2021). Driving under the influence of cannabis risk perceptions and behaviour: A population-based study in Ontario, Canada. Preventive Medicine, 153, 106793. https://www.sciencedirect.com/science/article/pii/S0091743521003625 
Miller, R., Brown, T., Schmitt, R., Gaffney, G., & Milavetz, G. (2024). Predicting changes in driving performance in individuals who use cannabis following acute use based on self-reported readiness to drive. Accident Analysis & Prevention, 195, 107376. https://www.sciencedirect.com/science/article/abs/pii/S0001457523004232?via%3Dihub  
National Center for Statistics and Analysis. (2022). Alcohol-Impaired Driving: 2020 Data(Traffic Safety Facts. DOT HS 813 294) https://www.nhtsa.gov/data 
National Survey on Drug Use and Health (NSDUH). Results from the 2021 NationalSurvey on Drug Use and Health: Detailed Tables. 2022; https://www.samhsa.gov/data/sites/default/files/reports/rpt39441/NSDUHDetailedTabs2021/NSDUHDetailedTabs2021/NSDUHDetailedTabsTOC2021.htm#toc 
Ramaekers, J. G., Kauert, G., Theunissen, E. L., Toennes, S. W., & Moeller, M. R. (2009). Neurocognitive performance during acute THC intoxication in heavy and occasional cannabis users. Journal of Psychopharmacology, 23(3), 266–277.  https://pubmed.ncbi.nlm.nih.gov/18719045/ 
Terry, P., & Wright, K. A. (2005). Self-reported driving behaviour and attitudes towards driving under the influence of cannabis among three different user groups in England. Addictive Behaviors, 30(3), 619–626. https://pubmed.ncbi.nlm.nih.gov/15718082/ 
Thomas, F. D., Berning, A., Darrah, J., Graham, L. A., Blomberg, R. D., Griggs, C., Crandall, M., Schulman, C., Kozar, R., Neavyn, M., Cunningham, K. W., Ehsani, J., Fell, J.C., Whitehill, J., Babu, K., Lai, J. S., Rayner, M., & Dunlap and Associates, Inc. (2020). Drug and alcohol prevalence in seriously and fatally injured road users before and during the COVID-19 public health emergency (DOT HS 813 013). https://rosap.ntl.bts.gov/view/dot/50941 
Watson, T., Mann, R., Wickens, C., & Brands, B. (2019). “Just a habit”: Driving under the influence of cannabis as ordinary, convenient, and controllable experiences according to drivers in a remedial program. Journal of Drug Issues, 49.  https://www.researchgate.net/publication/332427583_Just_a_Habit_Driving_Under_the_Influence_of_Cannabis_as_Ordinary_Convenient_and_Controllable_Experiences_According_to_Drivers_in_a_Remedial_Program  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Previous research has indicated that driving impaired while under the influence of cannabis can increase safety concerns for both driver and passengers, and that cannabis users are more likely to drive while impaired because of the perception that drugged driving is not as risky as drunk driving.
However, prior driving research studies focused mainly on healthy individuals using intoxicating levels of THC, which do not provide real-world evidence of how new paradigms, such as medical cannabis, influence driving while high. In this episode of Cannabis Nurse Truths, we examine the safety concerns and current attitudes related to driving while high, and we emphasize an immediate need for more reliable drug testing methods and public education campaigns. 
EPISODE RESOURCES
Boicu, B., Al-Hakim, D., Yuan, Y., & Brubacher R.J. (2024). Attitudes toward driving after cannabis use: A systematic review and meta-analysis. Transportation Research Part F: Traffic Psychology and Behaviour, 106, 418–430. https://doi.org/10.1016/j.trf.2024.08.005  
Brooks-Russell, A., Brown, T., Rapp-Olsson, A.M., Friedman, K., & Kosnett, M. (2019). Driving after cannabis use and compensatory driving behaviors among current cannabis users in Colorado. Traffic Injury Prevention, 20(sup2), S199–S201. https://www.tandfonline.com/doi/full/10.1080/15389588.2019.1665424  
Brown, T., Banz, B., Schmitt, R., Gaffney, G., Milavetz, G., Camenga, D., Li, K., Brooks-Russell, A., & Vaca, F. (2022). A study of self-reported personal cannabis use and state legal status and associations with engagement in and perceptions of cannabis-impaired driving. Traffic Injury Prevention, 23(sup1), S183–S186. https://www.tandfonline.com/doi/full/10.1080/15389588.2022.2124803   
Colizzi, M., & Bhattacharyya, S. (2018). Cannabis use and the development of tolerance: A systematic review of human evidence. Neuroscience and Biobehavioral Reviews, 93, 1-25.https://pubmed.ncbi.nlm.nih.gov/30056176/  
Cuttler, C., Sexton, M., & Mischley, L.K. (2018). Driving under the influence of cannabis: An examination of driving beliefs and practices of medical and recreational cannabis users across the United States. Cannabis, 1(2), Article 2. https://publications.sciences.ucf.edu/cannabis/index.php/Cannabis/article/view/cannabis.2018.02.001  
Di Ciano, P., Rajji, T.K., Hong, L., Zhao, S., Byrne, P., Elzohairy, Y., Brubacher, J.R., McGrath, M., Brands, B., Chen, S., Wang, W., Hasan, O.S.M., Wickens, C.M., Kaduri, P., & Le Foll, B. (2024). Cannabis and driving in older adults. JAMA Network Open, 7(1), e2352233. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814053  
Dutra, L.M., Gourdet, C., Farrelly, M.C., & Bradfield, B. (2023). Perceived safety, not perceived legality, mediates the relationship between cannabis legalization and drugged driving. Health Education & Behavior: The Official Publication of the Society for Public Health Education, 50(6), 718–727. https://pubmed.ncbi.nlm.nih.gov/35822623/  
Jones, C., Donnelly, N., Swift, W., & Weatherburn, D. (2006). Preventing cannabis users from driving under the influence of cannabis. Accident; Analysis and Prevention, 38(5), 854–861. https://pubmed.ncbi.nlm.nih.gov/16574046/  
Kraemer, M., Madea, B., & Hess, C. (2019). Detectability of various cannabinoids in plasma samples of cannabis users: Indicators of recent cannabis use? Drug Testing and Analysis, 11(10), 1498–1506. https://pubmed.ncbi.nlm.nih.gov/31407526/  
Manning, B., Arkell, T.R., Hayley, A.C., & Downey, L.A. (2024). A semi-naturalistic open-label study examining the effect of prescribed medical cannabis use on simulated driving performance. Journal of Psychopharmacology, 38(3), 247–257. https://journals.sagepub.com/doi/10.1177/02698811241229524 
McDonald, A.J., Hamilton, H.A., Wickens, C.M., Watson, T.M., Elton-Marshall, T., Wardell, J.D., Rueda, S., Roerecke, M., Stoduto, G., & Mann, R.E. (2021). Driving under the influence of cannabis risk perceptions and behaviour: A population-based study in Ontario, Canada. Preventive Medicine, 153, 106793. https://www.sciencedirect.com/science/article/pii/S0091743521003625  
Miller, R., Brown, T., Schmitt, R., Gaffney, G., & Milavetz, G. (2024). Predicting changes in driving performance in individuals who use cannabis following acute use based on self-reported readiness to drive. Accident Analysis & Prevention, 195, 107376. https://www.sciencedirect.com/science/article/abs/pii/S0001457523004232?via%3Dihub  
National Center for Statistics and Analysis. (2022). Alcohol-Impaired Driving: 2020 Data(Traffic Safety Facts. DOT HS 813 294). National Highway Traffic Safety Administration. Office of Behavioral Safety Research. Available at https://www.nhtsa.gov/data  
National Survey on Drug Use and Health (NSDUH). (2022). Results from the 2021 NationalSurvey on Drug Use and Health: Detailed Tables. 2022. Available at  https://www.samhsa.gov/data/sites/default/files/reports/rpt39441/NSDUHDetailedTabs2021/NSDUHDetailedTabs2021/NSDUHDetailedTabsTOC2021.htm#toc  
Ramaekers, J.G., Kauert, G., Theunissen, E.L., Toennes, S.W., & Moeller, M.R. (2009). Neurocognitive performance during acute THC intoxication in heavy and occasional cannabis users. Journal of Psychopharmacology, 23(3), 266–277. https://pubmed.ncbi.nlm.nih.gov/18719045/   
Terry, P., & Wright, K.A. (2005). Self-reported driving behaviour and attitudes towards driving under the influence of cannabis among three different user groups in England. Addictive Behaviors, 30(3), 619–626. https://pubmed.ncbi.nlm.nih.gov/15718082/  
Thomas, F.D., Berning, A., Darrah, J., Graham, L.A., Blomberg, R.D., Griggs, C., Crandall, M., Schulman, C., Kozar, R., Neavyn, M., Cunningham, K.W., Ehsani, J., Fell, J.C., Whitehill, J., Babu, K., Lai, J.S., Rayner, M., & Dunlap and Associates, Inc. (2020). Drug and alcohol prevalence in seriously and fatally injured road users before and during the COVID-19 public health emergency (DOT HS 813 013). National Highway Traffic Safety Administration. Office of Behavioral Safety Research. Available at https://rosap.ntl.bts.gov/view/dot/50941  
Watson, T., Mann, R., Wickens, C., & Brands, B. (2019). “Just a habit”: Driving under the influence of cannabis as ordinary, convenient, and controllable experiences according to drivers in a remedial program. Journal of Drug Issues, 49. https://www.researchgate.net/publication/332427583_Just_a_Habit_Driving_Under_the_Influence_of_Cannabis_as_Ordinary_Convenient_and_Controllable_Experiences_According_to_Drivers_in_a_Remedial_Program  
 
 
 
 
 
 
 
 
 
 
 
 
 

Cannabis users are both considered criminals and protected under federal laws.  What a mess.  One of the most significant issues surrounding cannabis use, especially in states where medical marijuana is legal, is the ability to use state-sanctioned medical marijuana, which is typically protected under disability laws, but yet can also be punitive as employers are allowed to terminate employees for cannabis use. Another pressing concern is how workers’ compensation activities will be affected by an employee’s medical marijuana use. 
In this episode of Cannabis Nurse Truths,  we continue to review how privacy laws, medical freedom, and workers’ compensation issues all have a significant impact on employers’ workplace policies, and we offer recommendations that employers should begin to consider as cannabis legalization is likely implemented in the near future. 
EPISODE RESOURCES
Anderson, D. M., Hansen, B., & Rees, D.I. (2013). Medical marijuana laws, traffic fatalities, and alcohol consumption. Journal of Law and Economics, 56(2), 333–369. https://docs.iza.org/dp6112.pdf 
Barnett, G. (2023, July 31). A growing number of companies are dropping marijuana drug testing. WTOP News. https://wtop.com/business-finance/2023/07/a-growing-number-of-companies-drop-marijuana-drug-testing/#:~:text=But%20some%20businesses%20have%20done,looking%20to%20hire%2C%20Clayton%20said   
Carnide, N., Lee, H., Frone, M.R., Furlan, A.D., & Smith, P.M. (2021). Patterns and correlates of workplace and non-workplace cannabis use among Canadian workers before the legalization of non-medical cannabis. Drug and Alcohol Dependence, 218, 108386. https://oem.bmj.com/content/oemed/79/12/824.full.pdf  
Chakraborty, A., Doremus, J., & Stith, S. (2020). The effects of recreational cannabis access on labor markets: Evidence from Colorado. IZA Journal of Labor Economics, 10(1). https://sciendo.com/pdf/10.2478/izajole-2021-0005  
Dylan, D., & Soltys, J. (2020). Accommodating the unknown: Balancing employee human rights with the employer duty to ensure safety: A Dialogue on Stewart v Elk Valley and the Cannabis Act.  Canadian Journal of Human Rights, 9(1), 57. https://heinonline.org/HOL/LandingPage?handle=hein.journals/canajo9&div=6&id=&page=  
Hazle, M.C., Hill, K.P., & Westreich, L.M. (2022). Workplace cannabis policies: A moving target. Cannabis and Cannabinoid Research, 7(1), 16-23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8864412/  
Hire Right. (2023, June). Employers Guide to Legalized Marijuana (Medical & Adult Use/Recreational).  E-book retrieved from https://www.hireright.com/resources/employers-guide-to-legalized-medical-and-recreational-marijuana  
Howard, J., Wurzelbacher, S., Osborne, J., Wolf, J., Ruser, J., & Chadarevian, R. (2021). Review of cannabis reimbursement by workers’ compensation insurance in the US and Canada. American Journal of Industrial Medicine, 64(12), 989-1001. https://onlinelibrary.wiley.com/doi/abs/10.1002/ajim.23294  
Green, C.P, & Paniagua, M.N. (2016). Play hard, shirk hard? The effect of bar hours regulation on worker absence. Oxford Bulletin of Economics and Statistics, Department of Economics, 78(2), 248-264. https://conference.iza.org/conference_files/riskonomics2012/green_c3422.pdf  
Kelly, J. (2024, June 14). Why workplace absenteeism is on the rise. Forbes. https://www.forbes.com/sites/jackkelly/2024/06/14/why-workplace-absenteeism-is-on-the-rise/  
Marmot, M.G., North, F., Feeney, A., & Head, J. (1993). Alcohol consumption and sickness absence: From the Whitehall II study. Addiction, 88(3), 369–382. https://doi.org/10.1111/j.1360-0443.1993.tb00824.x  
Martinez, A. (2024, April 29). 2024 Marijuana Legalization Review: A Guide for Employers In A Complex Legal Landscape. Available at https://www.hireright.com/blog/2024-marijuana-legalization-review-a-guide-for-employers-in-a-complex-legal  
Nicholas, L.H., & Maclean, J.C. (2016). The effect of medical marijuana laws on the health and labor supply of older adults: Evidence from the Health and Retirement Study. NBER Working Paper No. 22688. JEL No. I10,I18,J20. https://www.nber.org/system/files/working_papers/w22688/w22688.pdf  
Nissen, J. (2023, September 24). Michigan dropping marijuana drug testing for some new-hires on Oct.1. https://www.fox2detroit.com/news/michigan-dropping-marijuana-drug-testing-for-some-new-hires-on-oct-1  
Otañez, M. (2021). A labor studies approach to cannabis. In The Routledge Handbook of Post-Prohibition Cannabis Research (pp. 174-182). Routledge. https://cannalib.eu/wp-content/uploads/2022/03/The-Routledge-Handbook-of-Post-Prohibition-Cannabis-Research-2021.pdf#page=195  
Paychex. (2019, June 19). More than one-third of business owners not prepared to manage legalized marijuana in the workplace.  https://www.paychex.com/newsroom/news-releases/business-owners-not-prepared-to-manage-legalized-marijuana  
Pearlman, S. (2019, August 15). Illinois' hazy new law legalizing recreational use of marijuana. https://www.forbes.com/sites/stevenpearlman/2019/08/15/illinois-hazy-new-law-legalizing-recreational-use-of-marijuana/  
Perlman, A.I., McLeod, H.M., Ventresca, E.C., Salinas, M.G., Post, P.J., & Schuh, M.J. (2021, October). Medical cannabis state and federal regulations: Implications for United States health care entities. In Mayo Clinic Proceedings, 96(10), 2671-2681. https://www.mayoclinicproceedings.org/article/S0025-6196(21)00399-2/fulltext  
Ullman, D.F. (2017). The effect of medical marijuana on sickness absence. Health Economics, 26(10),1322-1327. doi:10.1002/hec.3390. https://pubmed.ncbi.nlm.nih.gov/27416978/  
U.S. Bureau of Labor and Statistics. (n.d.). Injuries, Illnesses, and Fatalities. Available at https://www.bls.gov/iif/home.htm  
West, B. (2020). The grass is greener somewhere: Protecting privacy rights of medical cannabis patients in the workplace. Chicago-Kent Law Review, 95, 751. https://scholarship.kentlaw.iit.edu/cgi/viewcontent.cgi?article=4334&context=cklawreview  
Worthy, S.L., & Kulkarni, S.R. (2021). Dazed and confused: Making sense of employers' risks from mandated coverage of non-FDA-approved cannabis products. Seton Hall Legislative Journal, 45, 379. https://scholarship.shu.edu/cgi/viewcontent.cgi?article=1187&context=shlj  
 

Cannabis legalization will have a profound impact across all levels of society. One of the most significant effects of cannabis legalization relates to employment. Employers have a financial interest in ensuring that employees are not intoxicated on the job and will not create a safety hazard related to impairment risks. On the other hand employers must also adhere to strict privacy and ADA guidelines which may conflict with federal requirements associated with a drug free workplace.
In this episode of Cannabis Nurse Truths, we review the concerns related to cannabis legalization in the workplace in which employers must be aware of the rapidly changing laws and regulations in order to help them develop legally defensive workplace policies that also legally balance the health needs of their employees who use cannabis. 
 
EPISODE RESOURCE
Anderson, D.M., Hansen, B., & Rees, D.I. (2013). Medical marijuana laws, traffic fatalities, and alcohol consumption. Journal of Law and Economics, 56(2), 333–369. https://docs.iza.org/dp6112.pdf  
Barnett, G. (2023, July 31). A growing number of companies are dropping marijuana drug testing. WTOP News. https://wtop.com/business-finance/2023/07/a-growing-number-of-companies-drop-marijuana-drug-testing/#:~:text=But%20some%20businesses%20have%20done,looking%20to%20hire%2C%20Clayton%20said     
Carnide, N., Lee, H., Frone, M.R., Furlan, A.D., & Smith, P.M. (2021). Patterns and correlates of workplace and non-workplace cannabis use among Canadian workers before the legalization of non-medical cannabis. Drug and Alcohol Dependence, 218, 108386. https://oem.bmj.com/content/oemed/79/12/824.full.pdf 
Chakraborty, A., Doremus, J., & Stith, S. (2020). The effects of recreational cannabis access on labor markets: Evidence from Colorado. IZA Journal of Labor Economics, 10(1). https://sciendo.com/pdf/10.2478/izajole-2021-0005 
Hazle, M.C., Hill, K.P., & Westreich, L.M. (2022). Workplace cannabis policies: A moving target. Cannabis and Cannabinoid Research, 7(1), 16-23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8864412/ 
Hire Right. (2023, June). Employers guide to legalized marijuana (medical & adult use/recreational).  E-book retrieved from https://www.hireright.com/resources/employers-guide-to-legalized-medical-and-recreational-marijuana 
Howard, J., Wurzelbacher, S., Osborne, J., Wolf, J., Ruser, J., & Chadarevian, R. (2021). Review of cannabis reimbursement by workers’ compensation insurance in the US and Canada. American Journal of Industrial Medicine, 64(12), 989-1001. https://onlinelibrary.wiley.com/doi/abs/10.1002/ajim.23294 
Green, C.P, & Paniagua, M.N. (2016). Play hard, shirk hard? The effect of bar hours regulation on worker absence. Oxford Bulletin of Economics and Statistics, Department of Economics, 78(2), 248-264. https://conference.iza.org/conference_files/riskonomics2012/green_c3422.pdf 
Kelly, J. (2024, June 14). Why workplace absenteeism is on the rise. Forbes. https://www.forbes.com/sites/jackkelly/2024/06/14/why-workplace-absenteeism-is-on-the-rise/
Marmot, M.G., North, F., Feeney, A., & Head, J. (1993). Alcohol consumption and sickness absence: From the Whitehall II study. Addiction, 88(3), 369–382. https://doi.org/10.1111/j.1360-0443.1993.tb00824.x 
Martinez, A. (2024, April 29). 2024 Marijuana legalization review: A guide for employers in a complex legal landscape. Available at https://www.hireright.com/blog/2024-marijuana-legalization-review-a-guide-for-employers-in-a-complex-legal 
Nicholas, L.H., & Maclean, J.C. (2016). The effect of medical marijuana laws on the health and labor supply of older adults: Evidence from the Health and Retirement Study. NBER Working Paper No. 22688. JEL No. I10,I18,J20. https://www.nber.org/system/files/working_papers/w22688/w22688.pdf 
Nissen, J. (2023, September 24). Michigan dropping marijuana drug testing for some new-hires on Oct.1. https://www.fox2detroit.com/news/michigan-dropping-marijuana-drug-testing-for-some-new-hires-on-oct-1 
Otañez, M. (2021). A labor studies approach to cannabis. In The Routledge Handbook of Post-Prohibition Cannabis Research (pp. 174-182). Routledge. https://cannalib.eu/wp-content/uploads/2022/03/The-Routledge-Handbook-of-Post-Prohibition-Cannabis-Research-2021.pdf#page=195 
Paychex. (2019, June 19). More than one-third of business owners not prepared to manage legalized marijuana in the workplace.  https://www.paychex.com/newsroom/news-releases/business-owners-not-prepared-to-manage-legalized-marijuana 
Pearlman, S. (2019, August 15). Illinois' hazy new law legalizing recreational use of marijuana. https://www.forbes.com/sites/stevenpearlman/2019/08/15/illinois-hazy-new-law-legalizing-recreational-use-of-marijuana/ 
Perlman, A.I., McLeod, H.M., Ventresca, E.C., Salinas, M.G., Post, P.J., & Schuh, M.J. (2021, October). Medical cannabis state and federal regulations: Implications for United States health care entities. Mayo Clinic Proceedings, 96(10), 2671-2681. https://www.mayoclinicproceedings.org/article/S0025-6196(21)00399-2/fulltext 
Soltys, J., & Dylan, D.W. (2020). Accommodating the unknown: Balancing employee human rights with the employer duty to ensure safety: A dialogue on Stewart v Elk Valley and the Cannabis Act. Canadian Journal of Human Rights, 57. https://cjhr.ca/articles/vol-9-no-1-2020/accommodating-the-unknown-balancing-employee-human-rights-with-the-employer-duty-to-ensure-safety-a-dialogue-on-stewart-v-elk-valley-and-the-cannabis-act/ 
Ullman, D.F. (2017). The effect of medical marijuana on sickness absence. Health Economics, 26(10):1322-1327. doi:10.1002/hec.3390. https://pubmed.ncbi.nlm.nih.gov/27416978/ 
U.S. Bureau of Labor and Statistics. (n.d.). Injuries, Illnesses, and Fatalities. Available at https://www.bls.gov/iif/home.htm  
West, B. (2020). The grass is greener somewhere: Protecting privacy rights of medical cannabis patients in the workplace. Chicago-Kent Law Review, 95, 751. https://scholarship.kentlaw.iit.edu/cgi/viewcontent.cgi?article=4334&context=cklawreview 
Worthy, S.L., & Kulkarni, S.R. (2021). Dazed and confused: Making sense of employers' risks from mandated coverage of non-FDA-approved cannabis products. Seton Hall Legislative Journal, 45, 379. https://scholarship.shu.edu/cgi/viewcontent.cgi?article=1187&context=shlj 
 

Our past several episodes have focused on how cannabis use is harmful across all stages of pregnancy, from the prenatal to the lactation period. However, there is another person in this equation that results in a pregnancy, and until just recently, men have been largely left out of the research regarding the effects of cannabis use in relation to reproduction. That is changing as increased legalization and access to cannabis has researchers examining the effects of its exposure on male reproduction. 
In this episode of CNT, we highlight the adverse effects of cannabis exposure in men that may create long-term genetic changes in their offspring.  From the accumulating evidence, we can state with certainty that men who are interested in contributing to a pregnancy should refrain from cannabis use, as it affects not only sperm cells but can also create harmful DNA alterations that are hereditary.  In other words, men should also just say no if they plan on contributing to a pregnancy.  
EPISODE RESOURCES
Carvalho, R.K., Andersen, M.L., & Mazaro‐Costa, R. (2020). The effects of cannabidiol on male reproductive system: A literature review. Journal of Applied Toxicology, 40(1), 132–150. https://doi.org/10.1002/jat.3831
Carvalho, R.K., Santos, M.L., Souza, M.R., Rocha, T.L., Guimarães, F.S., Anselmo‐Franci, J.A., & Mazaro‐Costa, R. (2018). Chronic exposure to cannabidiol induces reproductive toxicity in male Swiss mice. Journal of Applied Toxicology, 38(9), 1215–1223. https://doi.org/10.1002/jat.3631
Govahi, A., Eghbali, S., Ajdary, M., Amjadi, F., Nazari, M., Kazorgah, F.M., & Mehdizadeh, M. (2024). Cannabidiol impairs sperm quality and function in adult mice. Middle East Fertility Society Journal, 29(1), 26. https://doi.org/10.1186/s43043-024-00184-8
Gundersen, T.D., Jørgensen, N., Andersson, A.-M., Bang, A. K., Nordkap, L., Skakkebæk, N.E., Priskorn, L., Juul, A., & Jensen, T.K. (2015). Association between use of marijuana and male reproductive hormones and semen quality: A study among 1,215 healthy young men. American Journal of Epidemiology, 182(6), 473–481. https://doi.org/10.1093/aje/kwv135 
Ismaeil, A., Jankowski, P.M., Riffat Bibi, F., Hammadeh, M.E., & Amor, H. (2024). The effects of cannabis compounds (THC, CBD, and THC-COOH) on sperm motility in male participants: A prospective study. International Journal of Women’s Health and Reproduction Sciences, 12(1), 16–20. https://doi.org/10.15296/ijwhr.2024.6001
Lim, J., Squire, E., & Jung, K.-M. (2023). Phytocannabinoids, the endocannabinoid system and male reproduction. World Journal of Men’s Health, 41(1), 1–10. https://doi.org/10.5534/wjmh.220132
Lotfi, N., Khazaei, M., Shariatzadeh, S.M.A., Soleimani Mehranjani, M., & Ghanbari, A. (2013). The effect of cannabis sativa hydroalcoholic extract on sperm parameters and testis histology in rats. International Journal of Morphology, 31(1), 82–86. https://doi.org/10.4067/S0717-95022013000100012 
Maccarrone, M., Rapino, C., Francavilla, F., & Barbonetti, A. (2021). Cannabinoid signaling and effects of cannabis on the male reproductive system. Nature Reviews Urology, 18(1), 19–32. https://doi.org/10.1038/s41585-020-00391-8
Schrott, R., & Murphy, S.K. (2020). Cannabis use and the sperm epigenome: A budding concern? Environmental Epigenetics, 6(1). https://doi.org/10.1093/eep/dvaa002
Schrott, R., Modliszewski, J.L., Hawkey, A.B., Grenier, C., Holloway, Z., Evans, J., Pippen, E., Corcoran, D.L., Levin, E.D., & Murphy, S.K. (2022). Sperm DNA methylation alterations from cannabis extract exposure are evident in offspring. Epigenetics & Chromatin, 15(1), 33. https://doi.org/10.1186/s13072-022-00466-3
Schrott, R., Murphy, S.K., Modliszewski, J.L., King, D.E., Hill, B., Itchon-Ramos, N., Raburn, D., Price, T., Levin, E.D., Vandrey, R., Corcoran, D.L., Kollins, S.H., & Mitchell, J.T. (2021). Refraining from use diminishes cannabis-associated epigenetic changes in human sperm. Environmental Epigenetics, 7(1). https://doi.org/10.1093/eep/dvab009 
 

We continue to examine cannabis use during pregnancy, and in the last few episodes of Cannabis Nurse Truths, we highlighted the adverse physical and psychodevelopmental concerns that are associated with cannabis during pregnancy. None of the studies indicated that cannabis use during pregnancy was a good idea.
In this episode of CNT, we consider the effects of cannabis use AFTER pregnancy, the postpartum period, in which many new mothers choose to breastfeed their newborn.  Research indicates that cannabinoids are transferred through breast milk and remain in the breast milk for up to 6 weeks.  Since we already know that cannabinoids can affect fetal development during pregnancy, it is concerning that women who use cannabis during breastfeeding are also affecting the developing neuromodulatory systems of their newborn.  In other words, it is also a good idea to just say no during the postpartum period if you are a breastfeeding mother.  
 
EPISODE RESOURCES
Bach, W.A., & Wasilczuk, M.K. (2024, September). Pregnancy as a crime: A preliminary report on the first year after Dobbs. https://www.pregnancyjusticeus.org/press/new-pregnancy-justice-report-shows-high-number-of-pregnancy-related-prosecutions-in-the-year-after-dobbs/  
Baker, T., Datta, P., Rewers-Felkins, K., Thompson, H., Kallem, R.R., & Hale, T.W. (2018). Transfer of inhaled cannabis into human breast milk. Obstetrics and Gynecology, 131(5), 783–788. https://doi.org/10.1097/AOG.0000000000002575 
Barbosa-Leiker, C., Burduli, E., Smith, C. L., Brooks, O., Orr, M., & Gartstein, M. (2020). Daily cannabis use during pregnancy and postpartum in a state with legalized recreational cannabis. Journal of Addiction Medicine, 14(6), 467–474. https://doi.org/10.1097/ADM.0000000000000625 
Bergeria, C.L., & Heil, S.H. (2015). Surveying lactation professionals regarding marijuana use and breastfeeding. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 10(7), 377–380. https://doi.org/10.1089/bfm.2015.0051 
Bhatia, D., Rosenberg, S., Rees, R., & Brooks-Russell, A. (2024). Perinatal cannabis use and cannabis use during breastfeeding: The role of health care workers. American Journal of Perinatology, 41(S 01), e2686–e2695. https://doi.org/10.1055/a-2145-7775 
Crume, T. L., Juhl, A. L., Brooks-Russell, A., Hall, K. E., Wymore, E., & Borgelt, L. M. (2018). Cannabis use during the perinatal period in a state with legalized recreational and medical marijuana: The association between maternal characteristics, breastfeeding patterns, and neonatal outcomes. Journal of Pediatrics, 197, 90–96. https://doi.org/10.1016/j.jpeds.2018.02.005
Dakkak, H., Brown, R.A., Twynstra, J., Charbonneau, K., & Seabrook, J. (2018). The perception of pre- and post-natal marijuana exposure on health outcomes: A content analysis of Twitter messages. Journal of Neonatal-Perinatal Medicine, 11, 1–7. https://doi.org/10.3233/NPM-17133 
Govahi, A., Eghbali, S., Ajdary, M., Amjadi, F., Nazari, M., Kazorgah, F. M., & Mehdizadeh, M. (2024). Cannabidiol impairs sperm quality and function in adult mice. Middle East Fertility Society Journal, 29(1), 26. https://doi.org/10.1186/s43043-024-00184-8 
Graves, L.E., Robert, M., Allen, V.M., Dama, S., Gabrys, R.L., Tanguay, R.L., Turner, S.D., Green, C.R., & Cook, J.L. (2022). Guideline No. 425b: Cannabis Use Throughout Women’s Lifespans – Part 2: Pregnancy, the Postnatal Period, and Breastfeeding. Journal of Obstetrics and Gynaecology Canada, 44(4), 436-444.e1. https://doi.org/10.1016/j.jogc.2022.01.013 
Hill, M.G., & Reed, K.L. (2017). Chapter 55 Marijuana and Breastfeeding. In Handbook of Cannabis and Related Pathologies (pp. 527–532). Elsevier. ISBN 9780128007563. https://doi.org/10.1016/B978-0-12-800756-3.00064-8  
Leek, J.C, Arif, H. (2023, July 24). Pregnancy medications. In: StatPearls. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507858 
Navarrete, F., García-Gutiérrez, M.S., Gasparyan, A., Austrich-Olivares, A., Femenía, T., & Manzanares, J. (2020). Cannabis use in pregnant and breastfeeding women: Behavioral and neurobiological consequences. Frontiers in Psychiatry, 11. https://www.frontiersin.org/article/10.3389/fpsyt.2020.586447 
Panday, J., Taneja, S., Popoola, A., Pack, R., Greyson, D., McDonald, S.D., Black, M., Murray-Davis, B., Darling, E., & Vanstone, M. (2022). Clinician responses to cannabis use during pregnancy and lactation: A systematic review and integrative mixed-methods research synthesis. Family Practice, 39(3), 504–514. https://doi.org/10.1093/fampra/cmab146
Smith, C.B., Schmidt, J., Holdsworth, E.A., Caffé, B., Brooks, O., Williams, J.E., Gang, D.R., McGuire, M.A., McGuire, M.K., Barbosa-Leiker, C., & Meehan, C.L. (2024). Cannabis use, decision making, and perceptions of risk among breastfeeding individuals: The Lactation and Cannabis (LAC) Study. Journal of Cannabis Research, 6(1), 6. https://doi.org/10.1186/s42238-023-00212-w
Wymore, E.M., Palmer, C., Wang, G.S., Metz, T.D., Bourne, D.W.A., Sempio, C., & Bunik, M. (2021). Persistence of Δ-9-tetrahydrocannabinol in human breast milk. JAMA Pediatrics, 175(6), 632–634. https://doi.org/10.1001/jamapediatrics.2020.6098 

In our last episode of Cannabis Nurse Truths, we highlighted the adverse physical concerns associated with using cannabis during pregnancy that can result in outcomes like low birth weight and long-term metabolic disorders. In this episode, we review the developmental and psychological concerns associated with cannabis during pregnancy.
Research suggests that prenatal cannabis exposure in any trimester can cause specific deficits as well as behavioral excesses in the offspring, even a decade after exposure. In other words, it's never a good time to use cannabis during pregnancy
 
EPISODE RESOURCES
Allen, S., Natale, B. V., Ejeckam, A. O., Lee, K., Hardy, D. B., & Natale, D. R. C. (2024). Cannabidiol exposure during rat pregnancy leads to labyrinth-specific vascular defects in the placenta and reduced fetal growth. Cannabis and Cannabinoid Research, 9(3), 766–780. https://doi.org/10.1089/can.2023.0166 
Carvalho, R.K., Santos, M.L., Souza, M.R., Rocha, T.L., Guimarães, F.S., Anselmo‐Franci, J.A., & Mazaro‐Costa, R. (2018). Chronic exposure to cannabidiol induces reproductive toxicity in male Swiss mice. Journal of Applied Toxicology, 38(9), 1215-1223. https://pubmed.ncbi.nlm.nih.gov/29766538/ 
Cioffredi, L.A., Anderson, H., Loso, H., East, J., Nguyen, P., Garavan, H., & Potter, A. (2022). Prenatal cannabis exposure predicts attention problems, without changes on fMRI in adolescents. Neurotoxicology and Teratology, 91, 107089. https://pubmed.ncbi.nlm.nih.gov/35314358/ 
Evanski, J.M., Zundel, C.G., Baglot, S.L., Desai, S., Gowatch, L.C., Ely, S.L., ... & Marusak, H.A. (2024). The first “hit” to the endocannabinoid system? Associations between prenatal cannabis exposure and frontolimbic white matter pathways in children. Biological Psychiatry Global Open Science, 4(1), 11-18. https://psycnet.apa.org/record/2024-46428-005 
Lim, J., Squire, E., & Jung, K.-M. (2023). Phytocannabinoids, the endocannabinoid system and male reproduction. World Journal of Men’s Health, 41(1), 1. https://doi.org/10.5534/wjmh.220132
Lotfi, N., Khazaei, M., Shariatzadeh, S.M.A., Soleimani Mehranjani, M., & Ghanbari, A. (2013). The effect of cannabis sativa hydroalcoholic extract on sperm parameters and testis histology in rats. International Journal of Morphology, 31(1), 82–86. https://doi.org/10.4067/S0717-95022013000100012
Machado, A.S., Bragança, M., & Vieira-Coelho, M. (2024). Epigenetic effects of cannabis: A systematic scoping review of behavioral and emotional symptoms associated with cannabis use and exocannabinoid exposure. Drug and Alcohol Dependence, 111401. https://www.sciencedirect.com/science/article/pii/S0376871624003247 
Nashed, M.G., Hardy, D.B., & Laviolette, S.R. (2021). Prenatal cannabinoid exposure: Emerging evidence of physiological and neuropsychiatric abnormalities. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.624275
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