Cannabis Nurse Truths

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
Sorkhou, M., Singla, D.R., Castle, D.J., & George, T. P. (2024). Birth, cognitive and behavioral effects of intrauterine cannabis exposure in infants and children: A systematic review and meta-analysis. Addiction, 119(3), 411–437. https://doi.org/10.1111/add.16370
Tadesse, A.W., Dachew, B.A., Ayano, G., Betts, K., & Alati, R. (2024). Prenatal cannabis use and the risk of attention deficit hyperactivity disorder and autism spectrum disorder in offspring: A systematic review and meta-analysis. Journal of Psychiatric Research, 171, 142-151. https://pubmed.ncbi.nlm.nih.gov/38281464/ 
Tadesse, A.W., Ayano, G., Dachew, B.A., Tusa, B.S., Damtie, Y., Betts, K., & Alati, R. (2024). The association between prenatal cannabis use and congenital birth defects in offspring: A cumulative meta-analysis. Neurotoxicology and Teratology, 102, 107340. https://pubmed.ncbi.nlm.nih.gov/38460861/ 
Torres, J., Miller, C., Apostol, M., Gross, J., & Maxwell, J.R. (2024). The impact of recreational cannabinoid legalization on utilization in a pregnant population. Frontiers in Public Health, 12, 1278834. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10912290/ 
 

Prenatal cannabis exposure is associated with a higher risk of many different forms of birth defects and long-term neurodevelopmental effects. Cannabis during pregnancy not only exposes the developing fetus to harmful outcomes, but also can create adverse effects for offspring later in life.
In this episode of CNT, we review these known adverse birth outcomes, which underscores the significance of implementing preventative strategies for guiding cannabis use during pregnancy. The bottom line: Just Say No.
 
EPISODE RESOURCES
Allen, S., Natale, B.V., Ejeckam, A.O., Lee, K., Hardy, D.B., & Natale, D.R. (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). https://doi.org/10.1089/can.2023.016
Braillon, A. & Bewley, S.(2018, January). Committee Opinion No. 722: Marijuana Use During Pregnancy and Lactation. Obstetrics & Gynecology 131(1), 164. https://pubmed.ncbi.nlm.nih.gov/28937574/ 
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/ 
Dickson, B., Mansfield, C., Guiahi, M., Allshouse, A.A., Borgelt, L.M., Sheeder, J., ... & Metz, T.D. (2018). Recommendations from cannabis dispensaries about first-trimester cannabis use. Obstetrics & Gynecology, 131(6), 1031-1038. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5970054/ 
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://pubmed.ncbi.nlm.nih.gov/38021250/ 
Lee, K., & Hardy, D.B. (2021). Metabolic consequences of gestational cannabinoid exposure. International Journal of Molecular Sciences, 22(17), Article 17. https://doi.org/10.3390/ijms22179528 
Li, Y., Dewar, A., Kim, Y.S., Dey, S.K., & Sun, X. (2020). Pregnancy success in mice requires appropriate cannabinoid receptor signaling for primary decidua formation. eLife, 9, e61762. https://doi.org/10.7554/eLife.61762
Lin, A., Dent, G.L., Davies, S., Dominguez, Z.M., Cioffredi, L.A., McLemore, G.L., & Maxwell, J.R. (2023). Prenatal cannabinoid exposure: Why expecting individuals should take a pregnancy pause from using cannabinoid products. Frontiers in Pediatrics, 11, 1278227. https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2023.1278227/full 
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.proxy.lib.odu.edu/science/article/pii/S0376871624003247 
Moore, B.F., Sauder, K.A., Shapiro, A.L., Crume, T., Kinney, G.L., & Dabelea, D. (2022). Fetal exposure to cannabis and childhood metabolic outcomes: The Healthy Start Study. Journal of Clinical Endocrinology & Metabolism, 107(7), e2862-e2869. https://pubmed.ncbi.nlm.nih.gov/35357471/ 
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
Sorkhou, M., Singla, D.R., Castle, D.J., & George, T.P. (2024). Birth, cognitive and behavioral effects of intrauterine cannabis exposure in infants and children: A systematic review and meta-analysis. Addiction, 119(3), 411–437. https://doi.org/10.1111/add.16370
Tadesse, A.W., Ayano, G., Dachew, B.A., Tusa, B.S., Damtie, Y., Betts, K., & Alati, R. (2024). The association between prenatal cannabis use and congenital birth defects in offspring: A cumulative meta-analysis. Neurotoxicology and Teratology, 102, 107340. https://pubmed.ncbi.nlm.nih.gov/38460861/ 
Tadesse, A.W., Dachew, B.A., Ayano, G., Betts, K., & Alati, R. (2024). Prenatal cannabis use and the risk of attention deficit hyperactivity disorder and autism spectrum disorder in offspring: A systematic review and meta-analysis. Journal of Psychiatric Research, 171, 142-151. https://www-sciencedirect-com.proxy.lib.odu.edu/science/article/pii/S0022395624000591 
Torres, J., Miller, C., Apostol, M., Gross, J., & Maxwell, J.R. (2024). The impact of recreational cannabinoid legalization on utilization in a pregnant population. Frontiers in Public Health, 12, 1278834.  https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1278834/full 
 

Cannabidiol, or CBD, was discovered in 1940 by Dr. Roger Adams in a sample of hemp he was testing for intoxicating compounds. Prior to the discovery of THC in 1964, scientists were busy looking for the magic ingredient that caused all of the impairing effects of cannabis and happened upon CBD during their search. Fast forward to modern day research, where we now understand how CBD works in the body to create many beneficial physiological and psychological effects.
On this episode of CNT, we highlight the wonders of CBD, the miracle drug that seems to be able to affect numerous chronic conditions, including hypertension, cancer, neurodegenerative disease, and even COVID-19 infection. It can also prevent numerous conditions, such as autoimmune and psychological disorders. So, why isn't CBD part of your daily wellness regimen?
Episode Resources
Appendino, G. (2020). The early history of cannabinoid research. Cannabis and Cannabinoids, 31(4), 919–929. https://doi.org/10.1007/s12210-020-00956-0
Bhunia, S., Kolishetti, N., Arias, A.Y., Vashist, A., & Nair, M. (2022). Cannabidiol for neurodegenerative disorders: A comprehensive review. Frontiers in Pharmacology, 13. https://doi.org/10.3389/fphar.2022.989717
Britch, S.C., Babalonis, S., & Walsh, S.L. (2021). Cannabidiol: Pharmacology and Therapeutic Targets. Psychopharmacology, 238(1), 9–28. https://doi.org/10.1007/s00213-020-05712-8
Dujic, G., Kumric, M., Vrdoljak, J., Dujic, Z., & Bozic, J. (2024). Chronic Effects of Oral Cannabidiol Delivery on 24-h Ambulatory Blood Pressure in Patients with Hypertension (HYPER-H21-4): A Randomized, Placebo-Controlled, and Crossover Study. Cannabis and Cannabinoid Research, 9(4), 979–989. https://doi.org/10.1089/can.2022.0320
Esposito, G., Pesce, M., Seguella, L., Sanseverino, W., Lu, J., Corpetti, C., & Sarnelli, G. (2020). The potential of cannabidiol in the COVID-19 pandemic. British Journal of Pharmacology, 177(21), 4967–4970. https://doi.org/10.1111/bph.15157
Mabou Tagne, A., Pacchetti, B., Sodergren, M., Cosentino, M., & Marino, F. (2020). Cannabidiol for Viral Diseases: Hype or Hope? Cannabis and Cannabinoid Research, 5(2), 121–131. https://doi.org/10.1089/can.2019.0060
Nguyen, L.C., Yang, D., Nicolaescu, V., Best, T.J., Gula, H., Saxena, D., Gabbard, J.D., Chen, S.-N., Ohtsuki, T., Friesen, J. B., Drayman, N., Mohamed, A., Dann, C., Silva, D., Robinson-Mailman, L., Valdespino, A., Stock, L., Suárez, E., Jones, K.A., … Rosner, M.R. (2022). Cannabidiol inhibits SARS-CoV-2 replication through induction of the host ER stress and innate immune responses. Science Advances, 8(8), eabi6110. https://doi.org/10.1126/sciadv.abi6110
Peng, J., Fan, M., An, C., Ni, F., Huang, W., & Luo, J. (2022). A narrative review of molecular mechanism and therapeutic effect of cannabidiol (CBD). Basic & Clinical Pharmacology & Toxicology, 130(4), 439–456. https://doi.org/10.1111/bcpt.13710
Seltzer, E.S., Watters, A.K., MacKenzie, D., Granat, L.M., & Zhang, D. (2020). Cannabidiol (CBD) as a Promising Anti-Cancer Drug. Cancers, 12(11), Article 11. https://doi.org/10.3390/cancers12113203
 

Cannabis is the most over regulated, yet under regulated prohibited drug on the market - and the most studied! Through eight decades of research, we know of all of the potential harms and risks associated with both use of the plant and access to the plant. Lab testing of all cannabis products is what helps keeps our consumers safe. But what if that's not the case?
On this episode CNT, we review cannabis testing industry considerations and highlight some of the issues we are already facing as we try to provide safe, lab-tested products to either medical or adult use consumers.
 
Episode Resources
Association of Public Health Laboratories. (2016, May). Guidance for State Medical Cannabis Testing Programs. Association of Public Health Laboratories.
Azwell, T., Ciotti, C., Adams, A., & Pauli, G.F. (2022). Variation among hemp (Cannabis sativus L.) analytical testing laboratories evinces regulatory and quality control issues for the industry. Journal of Applied Research on Medicinal and Aromatic Plants, 31, 100434. https://doi.org/10.1016/j.jarmap.2022.100434
Hazle,C., Hill, K. P., & Westreich, L. M. (2022). Workplace Cannabis Policies: A Moving Target. Cannabis and Cannabinoid Research, 7(1), 16–23. https://doi.org/10.1089/can.2020.0095
 
Jikomes, N., & Zoorob, M. (2018). The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products. Scientific Reports, 8(1), 4519. https://doi.org/10.1038/s41598-018-22755-2
 
Kapur, B.M., & Aleksa, K. (2020). What the lab can and cannot do: Clinical interpretation of drug testing results. Critical Reviews in Clinical Laboratory Sciences, 57(8), 548-585.
 
Schwabe, A. L., Johnson, V., Harrelson, J., & McGlaughlin, M. E. (2023). Uncomfortably high: Testing reveals inflated THC potency on retail Cannabis labels. PLOS ONE, 18(4), e0282396. https://doi.org/10.1371/journal.pone.0282396
 
Shaffer, C. (2019). Medical Cannabis Poses Unique Testing Challenges. Genetic Engineering & Biotechnology News, 39(8), 22–24, 26. https://doi.org/10.1089/gen.39.08.07
 
Spindle, T.R., Cone, E. J., Schlienz, N.J., Mitchell, J.M., Bigelow, G.E., Flegel, R., Hayes, E., & Vandrey, R. (2019). Acute Pharmacokinetic Profile of Smoked and Vaporized Cannabis in Human Blood and Oral Fluid. Journal of Analytical Toxicology. https://doi.org/10.1093/jat/bky104
 
Valdes-Donoso, P., Sumner, D.A., & Goldstein, R. (2019). Costs of mandatory cannabis testing in California. California Agriculture, 73(3). https://doi.org/10.3733/ca.2019a0014
 
 
 
 

Medical or adult use? Which should you use? What are the differences? Are there differences? Currently in the United States, cannabis users have two legal options in states that have legalized either medical or adult-use cannabis. Although many of the differences between them are related to access, there are many other issues at hand when consumers make the decision to purchase at either a legal adult-use or medical dispensary.
In this episode of CNT, we highlight the differences between medical and adult-use cannabis, but keep in mind... it's all the same weed.
 
Episode Resources
French, M.T., Zukerberg, J., Lewandowski, T. E., Piccolo, K.B., & Mortensen, K. (2022). Societal Costs and Outcomes of Medical and Recreational Marijuana Policies in the United States: A Systematic Review. Medical Care Research and Review, 79(6), 743–771. https://doi.org/10.1177/10775587211067315
 
Gibson, L.P., Giordano, G.R., Bidwell, L.C., Hutchison, K.E., & Bryan, A.D. (2023). Acute Effects of Ad Libitum Use of Commercially Available Cannabis Products on the Subjective Experience of Aerobic Exercise: A Crossover Study. Sports Medicine (Auckland, N.Z.). https://doi.org/10.1007/s40279-023-01980-4
 
Lin, L.A., Ilgen, M.A., Jannausch, M., & Bohnert, K.M. (2016). Comparing adults who use cannabis medically with those who use recreationally: Results from a national sample. Addictive Behaviors, 61, 99–103. https://doi.org/10.1016/j.addbeh.2016.05.015
 
Page, R.L., Allen, L.A., Kloner, R.A., Carriker, C.R., Martel, C., Morris, A.A., Piano, M.R., Rana, J.S., & Saucedo, J.F. (2020). Medical Marijuana, Recreational Cannabis, and Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation, 142(10), e131–e152. https://doi.org/10.1161/CIR.0000000000000883
 
Szejko, N., Becher, E., Heimann, F., Grotenhermen, F., & Müller-Vahl, K.R. (2024). Medicinal Use of Different Cannabis Strains: Results from a Large Prospective Survey in Germany. Pharmacopsychiatry, 57, 133–140. https://doi.org/10.1055/a-2261-2269
 
Turna, J., Balodis, I., Munn, C., Van Ameringen, M., Busse, J., & MacKillop, J. (2020). Overlapping patterns of recreational and medical cannabis use in a large community sample of cannabis users. Comprehensive Psychiatry, 102, 152188. https://doi.org/10.1016/j.comppsych.2020.152188
 

In 2020, an estimated 209 million people around the world, or just less than four per cent of the global population, reported using cannabis in the past 12 months. Around the world, cannabis is being legalized or decriminalized and hundreds of thousands of patients are currently being treated with medicinal cannabis. Cannabis products are becoming increasingly diverse, and vary considerably in their concentrations of the one psychoactive cannabinoid found in cannabis, delta 9 tetrahydrocannabinol, also known as THC. It is in use of THC that we develop risks and harms from cannabis.
Currently, there is no standardized THC dose or measure that has been recommended by experts, and there are no approved treatments for THC intoxication. On this episode of Cannabis Nurse Truths, we review the concerns with standard THC dosing - just how high is too high?
 
Episode Resources
Bhaskar, A., Bell, A., Boivin, M., Briques, W., Brown, M., Clarke, H., Cyr, C., Eisenberg, E., de Oliveira Silva, RF., Frohlich, E., Georgius, P., Hogg, M., Horsted, T.I., MacCallum, C.A., Müller-Vahl, K.R., O’Connell, C., Sealey, R., Seibolt, M., Sihota, A., … Moulin, D.E. (2021). Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: Results of a modified Delphi process. Journal of Cannabis Research, 3(1), 22. https://doi.org/10.1186/s42238-021-00073-1
 
Freeman, T. P., & Lorenzetti, V. (2020). ‘Standard THC units’: A proposal to standardize dose across all cannabis products and methods of administration. Addiction, 115(7), 1207–1216. https://doi.org/10.1111/add.14842
 
Glare, P., Chye, R., Bloch, M., Arya, M., Moore, A., & Montgomery, J. (2023). Tolerability and Efficacy of a 10:25 Preparation of Δ9-Tetrahydrocannabinol and Cannabidiol for Treatment of Chronic Back or Neck Pain: A Multiple-Dose Escalation Study. Medical Cannabis and Cannabinoids, 6(1), 66–76. https://doi.org/10.1159/000531232
 
Leung, J., Stjepanović, D., Dawson, D., & Hall, W. D. (2021). Do Cannabis Users Reduce Their THC Dosages When Using More Potent Cannabis Products? A Review. Frontiers in Psychiatry, 12, 630602. https://doi.org/10.3389/fpsyt.2021.630602
 
Rozanc, J., Klumpers, L.E., Huestis, M.A., & Tagen, M. (2024). Tolerability of High-Dose Oral Δ 9 -THC: Implications for Human Laboratory Study Design. Cannabis and Cannabinoid Research, can.2023.0209. https://doi.org/10.1089/can.2023.0209
 
 

It is well known that individuals who use high doses of cannabis for a long period of time will develop tolerance to THC. To overcome tolerance to THC, there are two choices - use more THC or take a THC break, also known as a T- Break. Numerous online forums suggest varying ways to manage a T-Break; a recent Internet search resulted in over 36 million hits on how to reduce THC tolerance.
The problem with these online T-Break guides, however, is that none of them are empirically based, meaning that there is currently no evidence to support the methods suggested online. In this episode of Cannabis Nurse Truths, we consider the data related to cannabis tolerance and how numerous factors may interfere with your T-Break.
 
Episode Resources
Allsop, D. J., Copeland, J., Norberg, M. M., Fu, S., & Molnar, A. (2012). Quantifying the Clinical Significance of Cannabis Withdrawal. PLoS ONE, 7(9), e44864.
Ansell, E. B., Bedillion, M. F., Farris, S. R., Gilbert, J. M., Koch, M. M., & Thureen, S. E. (2023). Cannabis use breaks in young adults: The highs and lows of tolerance breaks. Drug and Alcohol Dependence, 249, 109951.
D'Souza, D., Cortes-Briones, J., Ranganathan, M., Thurnauer, H., Creatura, G., Surti, T., ... & Skosnik, P. (2015, December). Rapid changes in CB1 receptor availability in cannabis dependent males after abstinence from cannabis. In Neuropsychopharmacology (Vol. 40, pp. S589-S590).
 
Fontana, T. (2024). T-Break Guide: Take a Cannabis Tolerance Break. University of Vermont.
 
Fontana, T. J., Schulz, J. A., Budney, A. J., & Villanti, A. C. (2022). Feasibility and utility of a structured guide for cannabis tolerance breaks in young adults. Journal of American College Health, 1-5.
 
Ramaekers, J. G., Mason, N. L., & Theunissen, E. L. (2020). Blunted highs: Pharmacodynamic and behavioral models of cannabis tolerance. European Neuropsychopharmacology, 36, 191-205.
 
Spindle, T. R., Cone, E. J., Schlienz, N. J., Mitchell, J. M., Bigelow, G. E., Flegel, R., ... & Vandrey, R. (2019). Acute pharmacokinetic profile of smoked and vaporized cannabis in human blood and oral fluid. Journal of Analytical Toxicology, 43(4), 233-258.
 
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