CCORC 2023 Program Book

CCORC

CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE

May 18-19, 2023

Orlando, FL

TABLE OF CONTENTS WELCOME FROM

THE DIRECTORS 3

PROGRAM 4

At a Glance

Keynote Speakers

Session Moderators and Speakers

Top Abstracts Speakers

ABSTRACTS 23

Oral Presentations of Top Abstracts

Basic Science and Translational

Education, Quality, Safety, and Reviews

Clinical Research, Population Health, and Health Behavior

EXHIBITORS 77 ABOUT 77

WELCOME FROM THE DIRECTORS

On behalf of the Consortium for Medical Marijuana Clinical Outcomes Research’s Scientific Program and Planning Committees, we extend a warm welcome to you for our 3rd annual conference: Cannabis Clinical Outcomes Research Conference (CCORC), held in Orlando, FL on May 18th – 19th, 2023.

CCORC 2022, our first in-person conference, offered an engaging venue for researchers, clinicians, policy makers, trainees and other community stakeholders to gather and explore our understanding of the health effects of medical marijuana.

One of the most exciting parts of CCORC 2023 is the opportunity to network, socialize, and get involved with cannabis clinical outcomes research. It is our hope that you will leave this conference having expanded your knowledge surrounding cannabis research and made new connections that may spark future collaborations.

We welcome you to CCORC 2023!

Sincerely,

Almut G. Winterstein, RPh, PhD, FISPE Director Consortium for Medical Marijuana Clinical Outcomes Research

Robert L. Cook, MD, MPH Associate Director Consortium for Medical Marijuana Clinical Outcomes Research

9:20-9:30am

Dr. Almut Winterstein

Consortium for Medical Marijuana Clinical Outcomes Research

University of Florida

Agenda Overview and Introduction to Keynote# Δ

Dr. Amie Goodin

Consortium for Medical Marijuana Clinical Outcomes Research

University of Florida

Keynote: Recreational and Medical Cannabis: Potential Implications on Cognition and Clinical Outcomes * Δ

9:30-10:45am

10:45-11:00am

Dr. Jodi Gilman

Harvard Medical School

Massachusetts General Hospital

Exhibitor Hall | Coffee Break

Presentations of Top Abstracts w/ Q&A#

Moderator: Dr. Mandip Sachdeva, Florida A&M University

Isabella Jimenez

11:00-12:00pm

University of Miami

Dr. Simone Marini

University of Florida

Sabrina Zequeira

University of Florida

Ruba Sajdeya

University of Florida

12:00-1:00pm Lunch

Time (EDT) Session Description

Keynote: Cannabis Use During Pregnancy: Research from Policy to Practice* Δ

1:00-2:15pm

Dr. Kelly Young-Wolff

Center for Addiction and Mental Health Research

Kaiser Permanente Northern California

2:15-3:30pm

Poster Session 1 | Exhibitor Hall | Coffee Break

Clinical Challenges in Medical Cannabis Practice# Moderator: Dr. Robert Cook, University of Florida

3:30-4:15pm

Dr. John “Jack” Crump Releafe Now

Dr. Kelly King ReleafMD

Dr. Melanie Bone

Private Practitioner

Dr. Justin Davis

FMD Green

Note: Sessions A & B Will Be Held Simultaneously

Session A: The Medical Marijuana & Me (M3) Study overview and findings from the crosssectional survey of Florida medical marijuana patients#

Dr. Yan Wang | Dr. Robert Cook | Dr. Catalina LopezQuintero

4:15-5:00pm

Juan Perez | Hannah Fechtel

University of Florida

Session B: Using Contemporary Communication Approaches to Educate Athletes About Marijuana#

Dr. Jeff G Konin

University of Florida

Corey Tremble

Detroit Tigers Baseball Club

5:00-6:30pm

Poster Session 2 | Exhibitor Hall | Networking Reception

8:00-8:15am

Dr. Robert L. Cook

Consortium for Medical Marijuana Clinical Outcomes Research

University of Florida

Keynote: Opioid and Cannabinoid Interactions: Abuse Potential and Clinical Implications* Δ

8:15-9:30am

Dr. Shanna Babalonis

University of Kentucky

Director of the University of Kentucky Cannabis Center

Presentations of Top Abstracts w/ Q&A#

Moderator: Dr. Rose Stiffin, Florida Memorial University

Bassma Eltanameli

University of Florida

9:30-10:30am

Mounika Aare

Florida A&M University

Kristin Perrucci

University of Miami

Martina Compagno

Florida State University

10:30-10:45am

Exhibitor Hall | Coffee Break

10:45-11:30am

Note: Sessions A & B Will Be Held Simultaneously

Session A: Using a hemp pathway to probe the entourage effect. What other questions can be answered using this regulatory pathway?#

Dr. Anthony Ferrari | Dr. Jeff Konin Florida International University

Dr. Paul Borsa | Sheila Austin University of Florida

Session B: Role of Exosomes containing CBD in cancer and chemotherapy induced peripheral neuropathy#

Dr. Mandip Sachdeva Florida A&M University

11:30-12:00pm

CE Information

* May be eligible for CME and CPE credits. Please check ccorc.mmjoutcomes.org/ agenda/cme-credit/ and ccorc.mmjoutcomes.org/agenda/cpe-credit/ for details. The University of Florida College of Medicine designates this live activity for a maximum of 3.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Florida is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Each of the Keynote addresses is eligible for 1.25 CPE credits. # Not accredited for CPE

KEYNOTE SPEAKERS

Jodi Gilman, PhD

Recreational and Medical Cannabis: Potential Implications on Cognition and Clinical Outcomes

Director of Neuroscience, Center for Addiction Medicine, Massachusetts General Hospital Associate Professor, Dept. of Psychiatry, Harvard Medical School

Dr. Jodi Gilman is an Associate Professor in Psychiatry at Harvard Medical School and the Director of Neuroscience at the Massachusetts General Hospital Center for Addiction Medicine. She received her PhD in Neuroscience from Brown University. Dr. Gilman’s research uses multi-modal imaging, behavioral and cognitive testing to understand the biological, psychological, and clinical aspects of addiction. Specifically, she studies the effects of cannabis use on addiction and other health outcomes. Her goal is to conduct research that can inform decision-making among the public, patients, and clinicians regarding evidence-based decisions to use or not use cannabis for recreational or medical purposes.

Research Focus: alcohol drinking; alcoholism; alcohols; central nervous system depressants; choice behavior; drug addiction; ethanol; impulsive behavior; marijuana; marijuana smoking; neuroimaging; nucleus accumbens; peer group; reward

Kelly Young-Wolff, PhD, MPH

Cannabis Use During Pregnancy: Research from Policy to Practice

Adjunct Associate Professor, Dept. of Psychiatry, UC San Francisco

Consulting Assistant Professor, School of Medicine, Stanford University

Associate Professor, Bernard J. Tyson School of Medicine, Kaiser Permanente Clinical Psychologist and Research Scientist, Northern California Division of Research, Kaiser Permanente

Kelly C. Young-Wolff, PhD, MPH, is a licensed clinical psychologist and research scientist at the Kaiser Permanente Northern California Division of Research. She is also an Adjunct Associate Professor in the Department of Psychiatry, University of California, San Francisco; Consulting Assistant Professor at the Stanford University School of Medicine; and Associate Professor,

Kaiser Permanente Bernard J. Tyson School of Medicine. Her research focuses on understanding and preventing substance use problems among vulnerable populations with a focus on pregnant individuals.

Research Focus: Disparities in the onset and course of drug and alcohol abuse, tobacco use, and psychiatric disorders. Behavioral interventions for individuals with multiple, co-occurring psychiatric and addictive disorders.

Shanna Babalonis, PhD

Opioid and Cannabinoid Interactions:

Abuse Potential and Clinical Implications

Director, Cannabis Center, University of Kentucky Assistant Professor, Dept. of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky

Dr. Babalonis is an Assistant Professor in the Dept. of Behavioral Science and Center on Drug and Alcohol Research at the University of Kentucky. She also serves at the Director of the University of Kentucky Cannabis Center. She has received several NIH grants to conduct clinical cannabis studies, including cannabis interactions with opioids and cannabis driving outcomes, and is currently conducting studies to examine the risk/benefit profile of cannabis for various medical conditions.

Research Focus: Controlled human laboratory and clinical trials on the therapeutic and abuse potential of opioids and cannabinoids.

SESSION LEADERS AND SPEAKERS

Sheila Austin, MS, ACRP-CP

Panelist: Using a hemp pathway to probe the entourage effect. What other questions can be answered using this regulatory pathway?

Regulatory Specialist, Clinical and Translational Science Institute, University of Florida

Sheila provides assistance to UF Faculty and staff navigating the FDA Investigational New Drug (IND)/Investigational Device Exemption (IDE) process. She started her academic regulatory career as the IRB coordinator at UNF, then Administrative Coordinator for the UF College of Medicine, Jacksonville IRB. Upon completion of fur ther education in Regulatory Affairs, Sheila transferred to the UF CTSI in Gainesville and enjoys the regulatory challenges that are a part of translational research.

Melanie Bone, MD, FACOG

Panelist: Clinical Challenges in Medical Cannabis Practice

Director, Cannabinoid-Based Therapies, MorseLife Health System

Clinical Affiliate Assistant Professor, Charles E Schmidt College of Medicine, Florida Atlantic University

Dr. Melanie Bone is both a cannabis practitioner and a boardcertified OB/GYN working in Palm Beach County for more than 30 years. In addition to her private cannabis practice, she is Director of Cannabinoid-Based Therapies at MorseLife Health System, the only five-star, gold seal teaching nursing home facility in Florida. Dr. Bone lectures to colleagues and to the community about the benefits of cannabinoid therapies for seniors, and teaches medical students about cannabis as an elective rotation. She lives in Delray with her husband, Ernesto. She plays tennis and bakes cookies. Her 5 children are 28, 27, 26, 25, and 21 - one of whom, CB, is also presenting a poster at CCORC!

Research Focus: Seniors/dementia

Paul A Borsa, PhD, ATC

Panelist: Using a hemp pathway to probe the entourage effect. What other questions can be answered using this regulatory pathway?

Associate Professor, Department of Applied Physiology & Kinesiology, College of Health & Human Performance, University of Florida

Director, Sports Medicine Research Laboratory

Affiliated Faculty, Pain Research & Intervention Center of Excellence (PRICE), Clinical & Translational Science Institute

Dr. Paul Borsa has been an associate professor in the Department of Applied Physiology & Kinesiology, College of Health & Human Performance at the University of Florida since 2003. In that time period he has served as the director of the graduate athletic training/sports medicine program (2003 to 2006), as well as the director of the Sports Medicine Research Laboratory (2003-present). He is also an affiliated faculty member of the Pain Research and Intervention Center of Excellence (PRICE) at UF. Dr. Borsa has been a NATA Board-certified athletic trainer since 1989.

Research Focus: Understanding the biopsychosocial influences of musculoskeletal pain and identifying novel treatments to improve structural and functional recovery following injury. The anti-inflammatory, anxiolytic and analgesic effects of a CBD-rich hemp-extract in a variety of clinical populations who suffer from acute and chronic pain.

Robert L Cook, MD, MPH

Moderator:

Clinical Challenges in Medical Cannabis Practice

Panelist: The Medical Marijuana & Me (M3) Study overview and findings from the crosssectional survey of Florida medical marijuana patients

Professor, Department of Epidemiology and College of Medicine, University of Florida

Director, Southern HIV and Alcohol Research Consortium (SHARC)

Associate Director, Consortium for Medical Marijuana Clinical Outcomes Research

Over the past 20 years, Dr. Cook’s research has focused on strategies to improve health outcomes related to HIV and sexually transmitted diseases. He is the Director of the Southern HIV Alcohol Research Consortium (SHARC), which supports collaborative research and training related to alcohol and HIV infection across the state of Florida. Dr. Cook is also the co-lead of the “medical marijuana and me” cohort study and a co-investigator on several other research projects examining health outcomes of cannabis use.

Research Focus: HIV, sexually transmitted diseases, alcohol, cannabis, effects of marijuana on HIV-related health and cognition, gut microbiome, neuro-inflammation

John “Jack” Crump, MD

Panelist: Clinical Challenges in Medical Cannabis Practice

Physician, Releafe Now Fellow, American College of Surgeons Founding Member, North Florida Surgeons

Within over twenty five years of practice at Baptist Hospital, he served many roles, such as Chief of Staff, Chairman of Surgery, Director of Medical Records, and Director of Bloodless Medicine. Since retirement, he developed a program to educate patients and families undergoing major illnesses. This lead to an interest in the benefits of medical marijuana in people suffering from chronic illness. He is doing what he loves, seeing and treating patients. He says, “Our patients don’t want to get high, they want to get well.”

Justin Davis, MD

Panelist: Clinical Challenges in Medical Cannabis Practice

Physician, Florida Marijuana Doctors

Dr. Justin Davis, also known as Doc Davis, is a boardcertified physician in Florida and California, specializing in integrative and alternative medicine, housecalls, and boutique medicine. He is authorized to recommend medical marijuana in both states. Dr. Davis obtained his MD from the University of Florida and completed his residency in Pennsylvania. His medical philosophy integrates modern medicine with cultural anthropology and the natural sciences. He has traveled extensively, studying yoga and meditation in India and practicing Traditional Chinese Medicine in China.

Hannah Fechtel

Panelist: The Medical Marijuana & Me (M3) Study overview and findings from the crosssectional survey of Florida medical marijuana patient

Clinical Research Coordinator, Department of Neurology, University of Florida

Hannah Fechtel is a clinical research coordinator at the University of Florida Department of Neurology and former coordinator for the Consortium for Medical Marijuana Clinical Outcomes research. Her coordination experiences are in both qualitative and quantitative research in anthropology, epidemiology, and psychology disciplines. She completed her

bachelor’s degrees in Public Health and Statistics at the University of Florida in 2021, and is returning for a Master of Public Health fall of 2023. She intends to pursue research project coordination long term.

Anthony Ferrari, PhD

Panelist: Using a hemp pathway to probe the entourage effect. What other questions can be answered using this regulatory pathway?

Chief Science Officer, SunMed CBD

Courtesy Assistant Professor, Florida International University

Dr. Anthony Ferrari, originally from Farmington Maine, holds a Ph.D. in Analytical Chemistry from Florida State University, where he studied microwave catalysis with a specific application in the coal gasification processes. Dr. Ferrari began studying terpene characterization and its interaction with CBD and other cannabinoids in 2015 while working for a Colorado-based essential oil and CBD company. His research interest in plant medicine has led him to SunMed where he designs CBD-based formulations using modern chemical applications.

Research Focus: Cannabinoid decarboxylation, ingredient analysis, and dosing

Amie Goodin, PhD, MPP

Conference Co-Chair

Assistant Professor, Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida

Assistant Director – Evidence, Consortium for Medical Marijuana Clinical Outcomes Research

Dr. Goodin is an Assistant Professor within the Department of Pharmaceutical Outcomes and Policy (POP) and the Center for Drug Evaluation and Safety (CoDES). She is the lead for the Pharmaceutical Health Services Research track within POP’s graduate program as well as the assistant director for Evidence within the Consortium for Medical Marijuana Clinical Outcomes Research. Currently, her research projects incorporate mixed-method approaches to assess the impact of policy changes related to treatment access and utilization for Substance Use Disorders, particularly among persons enrolled in Medicaid and pregnant women.

Research focus: Assessing the impact of controlled substance policies and improving policy-driven access for Substance Use Disorder treatments

Kelly Ennix King, MD

Panelist: Clinical Challenges in Medical Cannabis Practice

Founder, Chief Medical Officer, ReleafMD and Wellness

A disabled Air Force veteran and co-founder of Releaf MD, The Center for Medical Marijuana, Dr. Kelly King is a boardcertified internal medicine physician and a graduate of the University of Tennessee, School of Medicine. She has used her experience and influence as a Hospitalist, Hospice, Palliative, and Geriatric Care Provider to become a key influencer within the medical cannabis industry. She is licensed and registered to tailor safe treatment plans for medical cannabis patients in Florida, New York, and California.

Research focus: Clinical outcomes and dosing therapeutics

Jeff Konin, PhD

Panelist: Using Contemporary Communication Approaches to Educate Athletes About Marijuana

Panelist: Using a hemp pathway to probe the entourage effect. What other questions can be answered using this regulatory pathway?

Clinical Professor, Department of Athletic Training, Florida International University Director, DAT Program, Florida International University

Dr. Jeff G. Konin is a Clinical Professor and the Director of the Doctor of Athletic Training program at Florida International University in Miami, Florida where he also directs the Global Initiative for Cannabinoid Research & Education. He is a recognized Fellow of the American College of Sports Medicine (ACSM) and the National Athletic Trainers’ Association (NATA), and a member of the NATA’s Hall of Fame. Dr. Konin serves as a consultant in the area of performance related to cannabinoid use.

Research focus: sports medicine, physical therapy, athletic related trauma, kinesiology, sports injury pain management

Catalina Lopez-Quintero, PhD, MPH

Panelist: The Medical Marijuana & Me (M3) Study overview and findings from the crosssectional survey of Florida medical marijuana patients

Assistant Professor, Department of Epidemiology, University of Florida

Dr. Catalina Lopez-Quintero is an assistant professor at the Department of Epidemiology at the University of Florida. Dr. Lopez-Quintero is a Colombian medical doctor with a PhD in public health and post-graduate training and research experience in drug dependence and psychiatric epidemiology, drug use neuropsychology, and drug use and HIV/AIDS disparities.

Research focus: Investigating the mechanisms that generate and sustain disparities in drug use transitions and trajectories by examining the complex interactions between drug use and neuropsychological processes, socio-cultural factors, and systemic level factors.

Juan G Perez-Carreno, MD, MSc

Panelist: The Medical Marijuana & Me (M3) Study overview and findings from the crosssectional survey of Florida medical marijuana patients

PhD Student, Department of Epidemiology, University of Florida

Juan is a Colombian MD, epidemiologist, and bioethicist with over 12 years of experience in clinical research. Throughout his career, he has been actively involved in conducting multicentric clinical trials, collaborating with the Ministry of Health and the Pharmaceutical Industry to increase knowledge on neglected diseases. In addition, he has served as a research synthesis specialist for different National Clinical Guidelines, including COVID-19, HIV, hypertension, and asthma. He is interested in consolidating his medical research training by pursuing a doctoral program in epidemiology at the University of Florida. Research focus: Health disparities, clinical trials, medical cannabis.

Mandip Singh Sachdeva, PhD

Moderator: Presentations of Top Abstracts w/ Q&A

Presenter: Role of Exosomes containing CBD in cancer and chemotherapy induced peripheral neuropathy

Professor and Section Leader – Pharmaceutics, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University

Dr. Sachdeva got his M.Sc. and Ph.D. of Biopharmaceutics from Dalhousie University, Canada, in 1986 and 1989, respectively. He then worked with SynPhar laboratories in Edmonton, Canada, as a Group Leader, Drug Targeting, during 1989-93, and then moved to academia as an Assistant Professor, Pharmaceutics, at Florida A&M University in 1993 and got promoted to Full Professor in 2002. He has guided 28 Ph.D.’s, 31 Post-Doctorates, and scores of postgraduate and undergraduate students. He has been Editor-in-Chief for CRC Critical Reviews in Therapeutic Drug Carrier Systems (current impact factor of 4.89), since 2007. To his credit he has around 185 original publications, one edited book and 10 book chapters and several Conference Proceedings papers, with Google H-index of 53.

Research focus: His research interests include cancer drug delivery (breast and lung cancer), 3D-printing of tumor cells and human cornea, topical and transdermal delivery. He is also an expert in formulating and developing targeted nanoparticles, exosomes, liposomes for delivery of various drug molecules including cannabinoids. Recently he has been investigating the role of cannabinoids and terpenes in cancer and chemotherapy induced neuropathy.

Rose Mary Stiffin, PhD

Moderator: Presentations of Top Abstracts w/ Q&A

Chair, Health and Natural Sciences, Florida Memorial University

Dr. Stiffin has a PhD in Biochemistry and an MS in Organic Chemistry. She has been affiliated with Florida Memorial University for 23 years.

Research focus: Enzymology, drug discovery, and Green Chemistry

Corey S Tremble, LAT, ATC, CSCS, MAT-JS

Panelist: Using Contemporary Communication Approaches to Educate Athletes About Marijuana

Coordinator, Medical and Rehabilitation, Detroit Tigers Inc.

Corey S. Tremble is an award-winning athletic trainer with over twenty years of experience in Sports Medicine. Currently serving as the Medical and Rehabilitation Coordinator for the Detroit Tigers Baseball Club, Tremble holds leadership positions throughout the Professional Baseball and Athletic Training landscapes. The New Jersey native is working towards his Doctor of Athletic Training degree at Florida International University with an emphasis in Interprofessional Development and Education. He currently serves as the Chair of the National Athletic Trainers’ Association Cannabis Task Force and is a member of Major League Baseball’s Medical Advisory Committee and Electronic Medical Records Committee. He is the CEO of Corey Tremble Enterprises which specializes in Interprofessional Education in the Sports Medicine space.

Research focus: Cannabis in athletics, interprofessional development and collaboration in sports medicine.

Yan Wang, PhD

Panelist: The Medical Marijuana & Me (M3) Study overview and findings from the crosssectional survey of Florida medical marijuana patients

Assistant Professor, Department of Epidemiology, University of Florida

Assistant Director - Clinical Core, Consortium for Medical Marijuana Clinical Outcomes Research

Yan Wang is an Assistant Professor of Epidemiology at the University of Florida (UF). She current leads or co-leads several National Institutes of Health (NIH) funded projects that utilize advanced technologies and methods (e.g., wearable sensors, ecological momentary assessment/EMA) to improve the understanding of epidemiology, etiology, and intervention of substance use (e.g., alcohol, medical marijuana).

Research focus: Leveraging advanced methodology and new technology (e.g., wearable sensor) to improve health behavior monitoring and intervention, especially cannabis and alcohol use.

Almut G Winterstein, RPh, PhD, FISPE

Conference Co-Chair

Distinguished Professor and Dr. Robert and Barbara Crisafi Chair in Medication Safety, Depart. of Pharmaceutical Outcomes & Policy, University of Florida Director, Center for Drug Evaluation and Safety (CoDES) Director, Consortium for Medical Marijuana Clinical Outcomes Research

Almut Winterstein has been a fixture within the University of Florida’s College of Pharmacy since 2000, serving as principal investigator on more than 25 extramurally funded grants and contracts and publishing more than 400 manuscripts and conference abstracts. As an expert in drug safety, she chaired the FDA’s Drug Safety and Risk Management Advisory Committee from 2012-2018. Recognizing her contributions in the field, Dr. Winterstein became a fellow of the International Society of Pharmacoepidemiology in 2013, where she currently serves as president. In 2022 she was inducted into the Academy of Science, Engineering, and Medicine of Florida.

Research focus: Post-marketing evaluation of drugs in pediatrics and perinatal care, infectious disease and psychiatry and the evaluation and improvement of quality surrounding medication use using real-world data

ORAL PRESENTATIONS OF TOP ABSTRACTS

Mounika Aare, MS

Abstract: In-vitro Evaluation Of Cannabinoids In Combination with Terpenes In Overcoming Cancer Resistance

Graduate Scholar, Department of Pharmacy and Pharmaceutical Sciences, Florida State University

Mounika Aare is a first-year graduate student working under Dr. Mandip Sachdeva in the department of pharmacy and pharmaceutical sciences, Florida A&M University. She did her Masters in Pharmaceutics from National Institute of Pharmaceutical Education and Research, India.

Research focus: Developing Exosome-based drug delivery systems for the treatment of Resistant Triple Negative Breast Cancer. Evaluating effective combinations of cannabinoids and terpenes for the treatment of cancer.

Martina Compagno

Abstract: Health and Behavioral Consequences of Perinatal Cannabidiol Exposure in Mice Raised to Adult

PhD Student, Institute of Molecular Biophysics, Florida State University

Martina Compagno is a 2nd year PhD student in the Institute of Molecular Biophysics at Florida Statue University under the mentorship of Dr. Debra Ann Fadool. Martina’s research focuses on the connection between changes in neural activity and behavior. Currently, she and Dr. Fadool lead a team of undergraduate researchers examining the impact of in utero CBD exposure on behavior, metabolism, and brain development.

Research focus: Examining changes in anxiety-like behavior, memory, ADHD-like behavior, obsessive compulsive behavior, ingestive and metabolic parameters, immediate early gene activation, and transcriptomics in response to in utero CBD exposure in mice.

Bassma Eltanameli, BPharm, MSc

Abstract: Predicting the potential for cannabinoids-drug interactions with major CYP450 using model-based approaches

PhD Student, Department of Pharmaceutics, University of Florida

Bassma Eltanameli recently graduated from the Master of pharmaceutical Nanotechnology program at university of south Florida where she investigated the effect of quercetin loaded chitosan nanoparticles on Dry eye diseases using 2D cell culture. She joined the Department of Pharmaceutics at the Center of Pharmacometrics & Systems Pharmacology, University of Florida in 2022 as PhD student under the mentorship of Dr. Rodrigo Cristofoletti.

Research focus: Utilization of Physiological based pharmacokinetic modeling and simulation (PBPK) as a tool for quantitative PK estimations and predictions of drugdrug interaction by combining two or more models. Application of PBPK models to allow mechanistic interpretation of drug absorption and food effect. Using PBPK modeling as a mechanistic approach to assess factors responsible for patient variability that impacts the PK of drugs and its impact on drug concentrations in patients with renal or hepatic impairment.

Isabella Jimenez

Abstract: Pain Severity Changes among Cannabis Consumers before and after KetamineAssisted Psychotherapy: Results from a Pilot Study Comparing Psycholytic and Psychedelic Approaches

Undergraduate Research Assistant, University of Miami

Isabella Jimenez is a junior majoring in microbiology and immunology and minoring in psychology. She has been a part of the Global Cannabis and Psychedelic Research Collaborative since 2020 under the direction of founder Denise Vidot, PhD.

Research focus: Chronic pain, psychedelics, cannabis, ketamine-assisted psychotherapy

Simone Marini, PhD

Abstract: An anti-inflammatory gene expression signature is associated with CBD treatment in people living with HIV

Assistant Professor, Dept. of Epidemiology, University of Florida

Simone Marini, PhD is a biomedical engineer by training. He designs AI applications for medicine, molecular biology, and public health. These applications are aimed at (a) enhancing the understanding the molecular machinery of the studied phenomena, e.g., providing a biological insight, hypothesis generation; (b) assisting clinical and public health decision making, e.g., diagnosis, prognosis, causal inference; and (c) facilitating research and data analysis (bioinformatics tools). Dr. Marini is currently focused on HIV, SARS-CoV-2, antimicrobial resistance, and the molecular aspects of the inflammatory process. Dr. Marini teaches two graduate courses: Topics in Precision Medicine and Public Health Informatics, and Computational Data Science for Epidemiology.

Research focus: inflammation, HIV, AI, data integration, SARS-CoV-2, antimicrobial resistance

Kristin Perrucci

Abstract: Evaluation of cannabis constituents in preventing or reversing phantom limb pain in rats

Research Associate, Miami Project to Cure Paralysis, University of Miami

Kristin recently graduated from the University of Miami and began working at the Miami Project to Cure Paralysis, where she previously volunteered for two years during her undergraduate degree. This June, she will begin medical school at the University of Miami Miller School of Medicine, where she will pursue her MD/MPH dual degree. Along with this, Kristin will continue working in research, exploring new therapeutic strategies for chronic pain management.

Under the guidance of Dr. Jacqueline Sagen, Kristin evaluated the combined analgesic potential of delta-9-tetrahydrocannabinol (THC), Cannabidiol (CBD) and β-caryophyllene (BCP) in preventing or reversing phantom limb pain.

Ruba Sajdeya, MD

Abstract: A novel natural language processing algorithm to unlock preoperative cannabis use status data from unstructured narrative clinical notes

PhD Candidate, Dept. of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida

Ruba Sajdeya, MD is a PhD Candidate in the Department of Epidemiology/Clinical and Translational Science Interdisciplinary Program at the University of Florida. With a background in epidemiology and anesthesiology, her research focuses on the intersections of substance use and perioperative outcomes, using state-of-the-art artificial intelligence and data science techniques. Her research aims to improve our understanding of substance use impacts on surgical outcomes and patient safety. Her research investigating the perioperative implications of cannabis use employing natural language processing to improve the accuracy of cannabis exposure measurement in medical records has been recognized with the prestigious Madelyn Lockhart Fellowship Award.

Research focus: Anesthesiology, epidemiology, substance use, health outcomes, artificial intelligence, data science

Sabrina Zequeira, MS

Abstract: Chronic oral administration of delta-9tetrahydrocannabinol (THC) enhances working memory in aged but not young rats

Graduate Student, Dept. of Neuroscience, University of Florida

Sabrina is a second-year Ph.D. student in the Neuroscience department at the University of Florida in the lab of Dr. Jennifer Bizon and Dr. Barry Setlow. She received her master’s in medical science with a concentration in Neuroscience from the University of Florida in 2021. Her work has focused on understanding how cannabis exposure impacts cognition in older adults using a rodent model of age-related cognitive decline. Her dissertation project will continue to further investigate the interactions between cannabis use, age, and cognition and identify underlying mechanisms that may be driving these interactions.

Research focus: Aging, cannabis, pre-clinical models, memory, cognition

ORAL PRESENTATIONS OF TOP ABSTRACTS

Pain Severity Changes among Cannabis Consumers before and after Ketamine-Assisted Psychotherapy: Results from a Pilot Study Comparing Psycholytic and Psychedelic Approaches

Isabella Jimenez University of Miami

Co-authors: Daniella

Batievsky1, Shari Kaplan1, Michelle Weiner1, Denise C. Vidot2 1Spine and Wellness Centers of America 2University of Miami

Background: Ketamine is an anesthetic that has been proven to treat chronic pain via clinical trials; yet there is a gap in knowledge regarding the impact of the concomitant use of ketamine and cannabis on pain severity. This study examined cannabis consumers who participated in a pilot Ketamine-Assisted Psychotherapy (KAP) intervention study to examine pain severity.

Methods: A subanalysis of regular cannabis consumers from a pilot intervention study comparing psychedelic (n=5) and psycholytic (n=5) KAP approaches were analyzed. Participants were placed into one of the two one a week for 6-weekslong treatment groups based on the recommendations of their integrative pain management physician. The Brief Pain Inventory Short Form was administered via redcap to measure severity of pain and impact of pain on daily functioning via scores collected prior to and after participant’s first, third, and sixth treatment sessions. Data was analyzed via SAS to compare pain severity at each timepoint.

Results: There were no statistically significant differences observed between the psychedelic and psycholytic KAP treatment’s impact on participants’ pain severity at any time points of the study (T-1, p =.85), (T-2, p =.34), (T-3, p = .67). The psychedelic group’s mean pain severity decreased by 21.88% from baseline to treatment termination, while the psycholytic group’s mean pain severity decreased by 3.39%. Furthermore, the psychedelic group saw a steady mean decrease in pain severity over time with a halt at the third session. We noticed a 4.69% decrease between baseline and session one, no change between session one and session three, and a 18.03% decrease between session three and session six. The psycholytic group’s progression was inconsistent; the group’s mean pain severity increased by 7.81% between baseline and session 1, decreased by 32.81% between session 1 and session 3, and then increased again by 24.56% between session 3 and session 6.

Conclusions: Changes in pain severity was variable based on psychedelic and psycholytic treatment groups. Due to the small sample size of this pilot, it is highly recommended that future studies should examine this phenomenon among a diverse population of a sample size with enough statistical power..

An anti-inflammatory gene expression signature is associated with CBD treatment in people living with HIV

Simone Marini University of Florida

Co-authors: Amanda Huber1, Melanie N. Cash2, Marco Salemi2, Robert L. Cook2, Paul Borsa2, Carla

Mavian2

1University of Michigan 2University of Florida

Introduction: HIV-related comorbidities appear to be related to chronic inflammation, a condition characterizing people living with HIV (PLWH). Prior work indicates that cannabidiol (CBD) might reduce inflammation; however, the genetics underpinning this effect are not well investigated. In this work, we detect gene expression changes in human peripheral blood mononuclear cells (PBMCs) from PLWH after at least one month of CBD treatment.

Methods: We collected PBMCs three HIV-positive subjects at baseline and after CBD treatment (at least 27 days) via single-cell RNA sequencing. After quality control, we obtained a data set of ~30,300 cells expressing a total of ~42,000 distinct genes.

Results: We identified of seven cell populations: CD4 T cells, CD8 T cells, NKT cells, NK cells, Myeloid cells (including monocytes), B cells and plasmablasts/plasma cells. Gene expression analysis revealed myeloid cells to carry a CBD-associated anti-inflammatory signature. The signatures including genes such CXCL8, CCL3, EREG, IL1B, KLF6, JUN and FOS, all underexpressed after CBD treatment. To further confirm the anti-inflammatory shift in myeloid cells, we designed an inflammation score based on a group of over 100 genes under the Gene Ontology term “”Positive regulation of inflammatory response””. The score decreases 12% after CBD in myeloid cells, and the decrease is conserved by analyzing the score distribution per subject. Decline in c-reactive protein (CRP) and erythrocyte sedimentation rate was also observed.

Conclusion: Our study shows how CBD is associated with underexpression of pro-inflammatory genes in myeloid cells after CBD treatment. While this study helps understand the genetic underpinning of CBD anti-inflammatory action, and the potential of its anti-inflammatory effects, the molecular chain leading to inflammation reduction remains to be unveiled.

Chronic oral administration of delta-9tetrahydrocannabinol (THC) enhances working memory in aged but not young rats

Sabrina Zequeira University of Florida

Co-authors: Emely Gazarov1, Alara A. Güvenli1, Johleen Seedansingh1, Erin C. Berthold1, Alexandria Senetra1, Abhisheak Sharma1, Chris R. McCurdy1, Barry Setlow1, Jennifer L. Bizon1

1University of Florida

Cannabis is one of the most widely used drugs in the US, and individuals over the age of 65 are the fastest-growing demographic of users. As the number of older adults in the US is expected to reach 90 million by 2050, it is imperative to understand the potential cognitive impacts of cannabis use in this population. This is especially true given that cannabis use in young adults can impair cognition, and that many aged individuals already exhibit such deficits, particularly in forms of cognition supported by prefrontal cortex (PFC) and hippocampus. The effects of chronic oral administration of delta-9-tetrahydrocannabinol (THC; the major psychoactive component of cannabis) were evaluated on a delayed response task that assessed PFC-dependent working memory and a water maze task that assessed hippocampaldependent spatial memory in young adult (5 months) and aged (23 months) Fischer 344xBrown Norway F1 hybrid rats of both sexes. Rats were trained on the delayed response task until reaching a stable baseline. In agreement with prior findings, aged rats were impaired compared to young adults, particularly at longer delays. Rats of both ages then consumed either plain gelatin or gelatin containing 1 mg/kg THC daily in their home cage. Drug was administered following daily behavioral testing to dissociate chronic from acute effects. Working memory was assessed after three weeks of daily consumption. No effects of THC were observed on working memory performance in young adult rats; however, aged rats consuming THC performed reliably better than aged rats consuming control gelatin. Rats were then trained on the water maze while continuing to consume gelatin following daily training. While aged rat performance on water maze was worse than young, no reliable effects of THC were observed at either age. These findings suggest that chronic THC does not impair, and may actually provide benefit to, cognition in older subjects. Mechanisms of this age-dependent cognitive enhancement are being explored. This work was supported by R01 AG072714, FL DoH grant 21A11 and funding from the McKnight Brain Research Foundation to BS and JLB.

A novel natural language processing algorithm to unlock preoperative cannabis use status data from unstructured

narrative clinical notes

Ruba Sajdeya University of Florida

Co-authors: Chen Bai1, Sebastian Jugl1, Ronald L. Ison1, Mamoun T. Mardini1, Patrick J. Tighe1, Kimia Zandbiglari1, Hanzhi Gao1, Almut G. Winterstein1, Thomas A. Pearson1, Robert L. Cook1, Masoud Rouhizadeh1

1University of Florida

Background: Utilizing electronic health record (EHR) data in clinical cannabis research is limited and prone to significant bias when relying on structured data types. This is due to most cannabis-related information being documented in unstructured narrative clinical notes. We aimed to develop a natural language processing algorithm (NLP) using machine learning (ML) techniques to extract preoperative cannabis use status documentation from unstructured narrative clinical notes.

Methods: We created a comprehensive lexicon with 3,630 concepts corresponding to cannabis use that may appear in clinical notes. We applied a keyword search strategy to identify note snippets with matching cannabis use status concepts within 60 days of surgery among 1,500 random surgery patients aged ≥ 65 years old at Shands Hospital in 2018-2020. We manually annotated and classified 1,928 matching snippets from 463 unique notes of 173 patients into eight different categories based on context, time, and certainty of cannabis use documentation. Using the labeled snippets, we trained two conventional ML and three deep learning classifiers to replicate human annotation.

Results: Of 1,928 annotated snippets, 56.28% were classified as “”Positive current use,”” 22.93% as “”Not a true cannabis mention,”” 10.79% as “”Positive past use,”” 6.38% as “” True mention not reporting use status,”” and 3.63% as “”Negative current use.”” There was no documentation representing “”Uncertain past use,”” “”Uncertain current use,”” or “”Negative past use.”” The top two matching keywords were “marijuana” 1,086 (56.33%) and “CBD” 538 (27.90%). The tested classifiers achieved classification results close to human performance with up to 93% precision and 95% recall of preoperative cannabis use status documentation.

Conclusion: Our NLP model successfully replicated human annotation of preoperative cannabis use documentation, providing a baseline framework for identifying and classifying documentation of cannabis use. Our model can be employed to identify clinical cohorts with reliable cannabis exposure data and appropriate control groups from EHR data. This will support high-quality cannabisrelated clinical outcomes research aiming to address the existing knowledge gaps and guide clinical practices and policies. Moreover, our systematically developed lexicon provides a comprehensive knowledge-based resource covering a wide range of cannabis-related concepts for future NLP applications.

Predicting the potential for cannabinoids-drug interactions with major CYP450 using model-based approaches

Bassma Eltanameli University of Florida

Co-authors: Sulafa Al Sahlawi1, Rodrigo Cristofoletti1

1University of Florida

Introduction: Patients receiving medical marijuana are likely to be taking concomitant drugs and thus, have a higher risk for drug-drug interactions (DDI). Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) are the most abundant phytocannabinoids in marijuana. In vitro, Δ9-THC and CBD were found to precipitate several CYP-mediated DDIs via reversible and time-dependent inhibition (TDI). We aim to predict the magnitude of CBD and Δ9-THC-induced metabolic DDIs leveraging available in vitro and in vivo data and using a forward stepwise, model-based approach as recommended by the FDA guidance.

Method: A comprehensive literature review was carried out to collect in vitro reversible inhibition (Ki) and inactivation (KI,u and kinact) parameters for CBD and Δ9-THC in human liver microsomes. The basic model was applied to predict the potential for metabolic DDI precipitated by CBD and Δ9-THC. R1 and R1,gut were calculated to address reversible inhibition in the liver and intestine, and R2 was calculated to address TDI. An R1 ≥ 1.02, R1,gut ≥11, or R2 value ≥1.25 was considered a potential risk for DDI and was further investigated using the static mechanistic model. Resulting DDIs from the static model were classified as weak (AUCR <2), moderate (25) as per FDA criteria.

Results: The basic model showed a DDI potential of CBD with all tested major CYP enzymes, whereas, for Δ9-THC, DDI risk was detected with CYPs 1A1, 1A2, and 2C9. Using the static mechanistic model, orally administered CBD precipitated severe DDIs with drugs predominantly metabolized by CYPs 1A1, 1B1, 2C19, and 3A; and moderate DDIs with drugs metabolized by CYPs 1A2, 2C9, and 2E1. On the other hand, orally administered Δ9-THC showed a moderate risk for DDIs with drugs extensively metabolized by CYPs 1A1, and 2C9.

Conclusion: CBD and, to a lesser extent, Δ9-THC showed potential for severe to moderate DDIs on major CYP-mediated metabolic pathways. Further confirmation of these DDIs is warranted using a dynamic physiological-based pharmacokinetics model.

In-vitro Evaluation Of Cannabinoids In Combination with Terpenes In Overcoming Cancer Resistance

Mounika Aare Florida A&M University

Co-authors: Sukhmandeep Kaur1, Breana Boire1, Mandip Singh Sachdeva1

1Florida A&M University

Purpose: To study the effect of combinations of various cannabinoids and terpenes against cancer resistance.

Methods: Several cannabinoids such as cannabidiol (CBD), cannabichromene (CBC), cannabidiolic acid (CBDA), cannabidivarin (CBDV), cannabinol (CBN), cannabigerol (CBG) were screened for their anticancer activity against MDA MB 231 DOX RT, H1975 OSM RT, PDX Lung cancer cell lines using 2D cytotoxicity and 3D spheroids assay. Terpenes such as β-caryophyllene, bisabolol, myrcene, linalool, limonene, geraniol, neralidol, α-pinene, α-terpineol, γ-terpinene were tested individually against MDA MB 231 DOX RT, H1975 OSM RT, PDX Lung cancer cell lines for their anticancer potential in 2D cytotoxicity and 3D spheroid assay. The potential cannabinoids (all) and terpenes (β-caryophyllene) obtained from the individual screening were tested in combinations against resistance cancer cell lines. The mode of action of combinations either synergistic, additive or antagonistic was determined from combination index (CI) values using compusyn software. Other assays such as colony formation assay and wound healing assay were performed using the potential combinations obtained. The anticancer activity of combination was also confirmed by live/dead staining using Hoechst’s stain. The anticipated mechanism of action by which cannabinoids acts along with terpenes in overcoming resistance are through mitogen-activated protein kinase (MAPK), Phosphatidylinositol 3-Kinase (PI3K) pathway, epigenetics histone modifications.

Results: The IC50 values of cannabinoids were found to be around 10µM against all the three resistant cancer cell lines in a 2D cytotoxicity assay. The IC50 values of β-caryophyllene and bisabolol were found to be 35µM and 90µM respectively in 2D cytotoxicity assay. Other terpenes screened had IC50 values more than 150µM and hence were not studied further. The IC50 values of combinations of cannabinoids and β-caryophyllene decreased by 10 folds and was 1µM for all the combinations. Same pattern was replicated in 3D spheroid assay i.e., the IC50 values dropped from 50µM to 6µM. The colony formation ability of cells post treatment with combinations reduced significantly(p<0.001).

Discussion: The results obtained emphasizes that combinations of cannabinoids and terpenes plays a magical role in overcoming cancer resistance.

Evaluation of cannabis constituents in preventing or reversing phantom limb pain in rats

Kristin Perrucci University of Miami

Co-authors: Anjalika Eeswara1, Vama Shah1, Stanislava Jergova1, Jacqueline Sagen1 1University of Miami

Phantom Limb Pain (PLP) arising from a missing limb affects up to 85% of amputees. One of the most frequently reported uses of medical marijuana is for pain relief. CB constituents such as delta-9-tetrahydrocannabinol (THC), Cannabidiol (CBD) and β-caryophyllene (BCP) may be beneficial for managing complex chronic pain syndromes like PLP due to their distinct and possibly synergistic mechanisms. The goal of this study was to evaluate the combined analgesic potential of these compounds in preventing or reversing PLP-like behavior. To model complex extremity injuries leading to medically-indicated amputation, male Sprague-Dawley rats underwent chronic constriction injury (CCI) of the sciatic nerve (day 0) and intraplantar formalin, followed by complete axotomy of the sciatic nerve (day 7). CB dosing was initiated either immediately following transection or at the start of PLP symptoms to evaluate whether CB treatment could prevent or reverse PLP, respectively. To assess for PLP, animals were observed daily using a scale designed to capture autotomy severity. Animals were injected twice daily with either CBD:BCP, CBD:BCP:THC, THC or vehicle with doses based on other studies in our lab showing good analgesia without side effects. Animals were sacrificed when proximal injury appeared or at the 10 wk study end and tissues were evaluated for inflammatory cytokines and spinal pathology. In both the prevention and reversal dosing scenario, all administered CB combinations attenuated the severity and onset of PLP symptoms compared to vehicle controls. When treatment was initiated immediately, either THC alone or CBD:BCP combination reduced autotomy scores more than the full CBD:BCP:THC. However, when treatment was initiated following the onset of PLP symptoms, the full complement of CBD:BCP:THC was most effective in reducing PLP behavior. Effective CB treatment combinations were found to significantly upregulate anti-inflammatory cytokines IL-4 and IL-10 and restore inhibitory GABAergic function in lumbar spinal tissue. These results suggest that cannabis constituents, CBD, BCP and THC, when used in combination have the potential to both prevent PLP symptoms from occurring and reverse the course of PLP severity development. These findings further substantiate the use of cannabis constituents as therapeutic agents for the management of neuropathic pain.

Health and Behavioral Consequences of Perinatal Cannabidiol Exposure in Mice Raised to Adult

Martina Compagno Florida State University

Co-authors: Caroline Bishop1, Aidan Carley1, Joshua Cazorla1, Jenna Claydon1, Alexis Cox1, Tyla Dolezel1, Ezabelle Franck1, Camilla Ann May1, Alejandro Navarez1, Claudia Rose Silver1, Olivia Turner1, Kari B. Basso2, Debra Ann Fadool1

1Florida State University 2University of Florida

PAnxiety- and attention-like behaviors, and memory were examined in adult mice following gestational and lactational exposure to cannabidiol (CBD), the nonpsychoactive ingredient of cannabis. Primiparous dams were trained to orally consume 100 mg/kg CBD or ethanol vehicle mixed in strawberry jam. Using GCMS, we were able to detect 40 ng/ul CBD in maternal plasma within 1 h following oral consumption. There was no significant difference in the rate of retrieval of displaced pups back to the nest by CBD-treated dams, indicating lack of druginduced changes in maternal behavior (2-W ANOVA, p>0.05). Fetal exposure to CBD significantly decreased survival of the pups – 37% of CBD-treated pups died before weaning age (23 days) whereas only 14% of jam-treated pups died prior to weaning. Cross-fostering of CBD-treated pups to a drug-free dam did not improve survival rates (38% died prior to weaning). We did not observe changes in litter size, maternal body weight or pup birth weight (postnatal day 1, P1) between CBD vs. jam-treated animals, however, by postnatal day 10 and 21 (P10, P21), CBD-exposed mice weighed significantly more. CBD-exposed female mice cleared glucose slower than those of jam-treated mice, indicating predisposition for metabolic disorder as an adult (2w RM ANOVA, treatment x time interaction, p=0.0078). At 3 months of age, adult offspring were behaviorally phenotyped. In utero exposure caused mice of both sexes to bury more marbles as adults (1-W ANOVA, p≤0.05), and females, not males, lost this behavior if they were cross-fostered to control, drug-free dams. In utero exposure decreased time spent in the light compartment of an LDB apparatus when females were raised to adults, but had no effect on male mice. In utero exposure did not affect performance in an object attention task (ADHD-like behavior) or the 1-hour object recognition test (short-term memory) but it decreased performance of female mice in the 24-hour object recognition test (long-term memory; p=0.01279). Perinatal CBD therefore increases obsessive compulsive behavior in both sexes, while it decreases anxiety-like behavior and long-term memory in female mice raised to adults.

BASIC SCIENCE AND TRANSLATIONAL CBD

Attenuates

Hyperglycemia Induced Pro-Inflammatory Cytokines, Chemokines and M1 Polarization in THP1 monocytes

Chandrakala Aluganti Narasimhulu

University of Central Florida

Co-authors: Karina Villalba1, Dinender K. Singla1

1University of Central Florida

Aim: Hyperglycemia is well established as a potent stimulator of monocyte activity which is a major event in the pathogenesis of various diseases including atherosclerosis, diabetes, cancer, and neurological diseases.

Cannabidiol (CBD), the most abundant non-psychotropic cannabinoid found in Cannabis sativa L. is well known for its anti-inflammatory properties; however, the mechanisms of antiinflammatory properties of CBD are obscure. Therefore, we investigated the mechanisms of anti-inflammatory properties of CBD attenuates under hyperglycemic conditions of monocyte infiltrations.

Methods: THP-1 cells were divided into 3 groups: Control, Glucose and Glucose+CBD. Cells were incubated with glucose (50mM) for 24 hrs, followed by with CBD (20 µg/ml) for additional 24hrs. After 48hrs incubation cells were harvested and used for immunocytochemistry (ICC), and RNA isolation followed by RT-PCR. Glucose induced monocyte differentiation either in the presence or absence of

CBD was established by analyzing M1 (iNOS) and M2 (CD206, and Arginase-1) macrophage markers. Additionally, Cytokine array (62 cytokines) was performed for all the three groups to evaluate inflammatory cytokine profile. Further, Pro-inflammatory cytokines TNFα and IL-6 were analyzed by ELISA.

Results: A significant (p<0.05) increase in the M1 macrophage markers and pro-inflammatory markers were observed in Glucose treated cells, whereas CBD treatment significantly polarized monocytes to M2 macrophages and attenuated glucose-induced inflammation. Further a significant (p<0.05) increase in M2 macrophage markers CD206 and Arginase were observed. Hyperglycemia upregulated the expression of 43-proinflammatory cytokines (~1.2 to 7-fold) that are involved in inflammation, apoptosis, angiogenesis, macrophage inflammatory proteins, growth factors and adhesion molecules as compared to control, whereas CBD treatment reduced differentially the pro-inflammatory cytokine expression.

Conclusion: We suggest that CBD has a greater therapeutic potential in diabetic conditions by decreasing proinflammatory monocytes, macrophages, and cytokines. We also provide evidence that CBD enhances anti-inflammatory M2 macrophages.

The Potential Role of Cannabinoid Receptors in Protecting Against Salmonella Infection:

Insights from a Mouse Model Study

Hailey Barker University of Florida

Co-authors:

(Edelmann)1

1University

Mariola J. Ferraro

of Florida

Due to the rise of multi-drug resistant strains of disease-causing microbes from the overuse of treatments such as antibiotics, there is a need for a shift toward alternative therapies which target the host immune system. With the prevalence of drug-resistant strains of enteric pathogens, foodborne illnesses such as Salmonella Typhimurium are becoming harder to treat with traditional antibiotics. Salmonella Typhimurium is a Gram-negative intracellular bacterium that relies on the ability to infect a variety of cells, including antigen-presenting cells such as macrophages, to cause an infection. The endocannabinoid (eCB) system is a pathway composed of bioactive lipids called endocannabinoids (eCBs, a set of receptors and associated biosynthesis/ degradative proteins. The cannabinoid receptors type 1 and 2 (CB1R and CB2R) are coupled to G-proteins widely expressed among many cell types. CB2R is highly expressed in immune cells and may play a role in cell proliferation and differentiation. However, there is a lack of understanding of how cannabinoid receptors (CB1R and CB2R) participate in downstream signaling functions in immune cells during bacterial infections. By further understanding the role of cannabinoid receptors in bacterial infections, cannabinoid receptors could

provide for a novel target for therapies against Salmonella. Our study aimed to characterize the role of cannabinoid receptors 1 and 2 (CB1R and CB2R) in activating the immune system and preventing the colonization of Salmonella. To study this, we challenged wild-type, CB1R knockout, and CB2R knockout mice with Salmonella Typhimurium. Four days post-infection, an array of experimentations was performed to evaluate the burden of infection, proinflammatory response, and polarization of macrophages. Mice lacking the CB1R or CB2R showed increased colonization of Salmonella in the liver and spleen as well as increased inflammatory responses. Post-infection, macrophages lacking CB1R and CB2R primarily polarized towards an M1 phenotype characterized by increased pro-inflammatory response compared to macrophages derived from wildtype mice. Overall, our results indicate the potential role of CB1R and CB2R to play a protective role in vivo against Salmonella infection. Future directions will include using select cannabinoids as treatments for mice challenged against Salmonella.

Evaluation of cannabidiol effects on oxycodone-induced analgesia and rewardrelated behaviors

Ariana Brice-Tutt

University of Florida

in rats

Co-authors: Wendi Malphurs1, Azin Behnood-Rod1, Cassidy Kramer1, Alexandria Senetra1, Robert M. Caudle1, Marcelo Febo1, Adriaan W. Bruijnzeel1, Abhisheak Sharma1, Barry Setlow1, Niall P. Murphy1, John K. Neubert1

1University of Florida

We evaluated the effects of cannabidiol and oxycodone combinations on pain- and reward-related behavior in rats. Rats were trained to consume sweetened condensed milk solution under painful (44.5°C) and non-painful (37°C) conditions in an operant pain assay. They were then treated daily for 14 days with oxycodone (0.56 mg/kg, i.p.), cannabidiol (3.2 and 10 mg/kg, i.p.), cannabidiol + oxycodone combinations, or vehicle, and operant pain responding was evaluated. Rearing behavior was also recorded. Oxycodone alone increased operant responding under both painful and non-painful conditions. Neither dose of cannabidiol alone altered responding. Combined with oxycodone, however, cannabidiol dosedependently increased the analgesic effect of oxycodone, but this effect was only statistically significant at the painful (44.5°C) temperature. Oxycodone also produced locomotor sensitization, which was neither attenuated nor potentiated by cannabidiol. In a separate study, rats conditioned with oxycodone in a conditioned place preference paradigm developed a significant preference for the oxycodone-paired chamber, an effect that was not impacted by

combination with cannabidiol. These results suggest that while being devoid of inherent analgesic and rewarding effects, cannabidiol potentiates the analgesic effects of oxycodone without affecting its rewarding properties. As such, cannabidiol may be useful as an opioid-sparing approach to treating pain.

The effects of voluntary THC consumption on oxycodone demand and oxycodone seeking in a novel rat model

Katherine Driver University of Florida

Co-authors: Cassidy Jones-Goucher1, Alexandra Sanchez1, Barry Setlow1, Marek Schwendt1, Lori Knackstedt1 1University of Florida

Opioid use disorder (OUD) lacks an effective, broad-spectrum treatment. Limited clinical evidence suggests that co-use of cannabinoids can reduce the rates of opioid dependence and severity of withdrawal, though at the cost of elevated anxiety, and depression. Despite poor understanding of risks and benefits of opioid-cannabinoid interactions, OUD is currently considered a qualifying condition for the use of medical marijuana in several US states. Thus, well-controlled, translational animal models are necessary to investigate the neural and behavioral consequences of cannabinoidopioid co-use. The current study aimed to investigate the effects of daily oral D9- tetrahydrocannabinol (THC) consumption on behavioral economic demand for intravenously self-administered (IVSA) oxycodone in male and female Sprague-Dawley rats. Rats were first trained to selfadminister oxycodone or sucrose. Rats

administering oxycodone were trained under a FR (fixed ratio) 1 and 3 schedule for 6 days each. Rats administering sucrose trained at FR 1 for the duration of the experiment. Somatic signs of withdrawal and anxiety-like behavior were assessed at 22 hr withdrawal. After reaching stable oxycodone intake during training, rats underwent demand curve procedures in which FR requirements to earn a single oxycodone infusion increased in quarter log unit increments until zero infusions were attained for a given FR. Throughout the demand curve, rats also received access to unsweetened gelatin containing either THC or Vehicle in the home cage for one hour following the oxycodone/sucrose session. Oxycodone self-administration was re-established on an FR-3 schedule prior to 14 days of home cage abstinence. On Day 15, rats underwent a cued relapse test. No effects of sex on oxycodone seeking behavior or intake were found during the training portion of either self-administration period (sucrose or oxycodone). THC consumption increases demand elasticity for oxycodone IVSA in male and female rats, with no effects on sucrose intake. The findings of this study, once completed, will provide firstever preclinical evidence regarding the effects of THC on motivation to seek oxycodone.

Evaluating naturallyderived cannabis combinations and conopeptides in a rat SCI pain model

Yousra Erritouni University of Miami

Co-authors: Anjalika Eeswara1, Kristin Perrucci1, Stanislava Jergova1, Jacqueline Sagen1

1University of Miami

Chronic neuropathic pain resulting from spinal cord injury (SCI) is often difficult to treat, as most available therapies are associated with undesirable side effects or are only modestly effective. Activation of cannabinoid receptors have been known to regulate pain responses. Cannabinoid receptor 1 (CB1) in particular is found throughout the CNS and is a promising target for attenuating neuropathic pain. As such, we looked at two sources of CB receptor agonists, plant-derived cannabis constituents and Conus venoms, for SCI pain. For phytocannabanoids, we explored combinations of cannabidiol (CBD) and β-caryophyllene (BCP), as neither is associated with psychoactive side effects. The venom of marine snail genus Conus is a natural source of various peptides with potent antinociceptive activity. We screened several Conus venoms for their ability to induce CB1 receptor internalization and chose C. Textile venom samples as the best candidate to search for CB1 receptor ligands.

The analgesic properties of CBD, BCP and their combination in a rat SCI clip model, and their in vitro CB1 receptor activity were tested. Animals were treated with CBD, BCP and CBD/BCP combination at various doses and evaluated for mechanical and thermal

hypersensitivity. Analgesic effects were observed for drug combinations at lower doses than that of single drug administration suggesting synergism. The effect of CBD/BCP was blocked by CB1 antagonist AM251, but not by CB2 antagonist AM630. Treatment of cells expressing CB1 and CB2 receptors in an internalization assay showed minimal effect of single treatment on either receptor. The combination of CBD/BCP showed significant activity at CB1 receptors and enhanced activity at CB2 receptors compared to individual treatments, and was reduced by AM251 and AM630. In a separate cohort of SCI animals C. textile venom sub-fractions with the highest CB1 agonist activity were evaluated in animals after a single intrathecal injection or after prolonged delivery by Alzet pumps. Screening of these samples identified at least two cannabinoid acting peptidergic fractions that may have promise in further development towards therapeutics for the management of chronic pain. Our results suggest that compounds targeting the CB1 receptor may prove beneficial in the management of neuropathic pain.

Funding through the 2019 Research Grants Program of the Consortium for Medical Marijuana Clinical Outcomes Research through State of Florida appropriations and Department of Defense (CDMRP SCIRP SC170295).

Effects of cannabis smoke exposure in young and aged mice

Emely Gazarov University of Florida

Co-authors: Sabrina Zequeira1 , Alexandria S Senetra1, Bailey McCracken1, John Howard1, Abhisheak Sharma1, Christopher R McCurdy1, Jada Lewis1, Jennifer L Bizon1, Barry Setlow1

1University of Miami

With the rise in cannabis use among older adults, as well as increasing cases of Alzheimer’s disease (AD), there is an urgent need to investigate the impacts of cannabis use on the aging brain and AD pathology. As a first step in this process, we evaluated the pharmacokinetics of Δ9THC and two of its metabolites following acute exposure to smoke from burning cannabis cigarettes in mice of different ages and strains.

To determine the time course of Δ9THC and its two major metabolites (11-OHTHC and 11-COOH-THC), young-adult C57BL/6J mice (n = 72, half female) were exposed to smoke generated from burning 5 cannabis cigarettes sequentially over one hour. Trunk blood and brain were collected at 6 time points (10, 20, 40, 60, 120 & 240 min following smoke exposure). Plasma and brain homogenates were analyzed for Δ9THC and metabolites using a validated UPLC-MS/MS method. To assess the effects of age and strain on Δ9THC pharmacokinetics, male and female B6, FVB, SW, and 129 mice (n = 89, 4-24 months old) followed the same smoke regimen, with samples collected 10 and 40 min following smoke exposure. To determine the effect of dose on Δ9THC and its metabolites, mice (n = 20) were exposed to smoke from either 3 or 5 cannabis cigarettes and samples were

collected 40 min post-smoke exposure.

The results revealed that plasma

Δ9THC concentrations peaked at 10 and 40 minutes for males and females, respectively, while brain

Δ9THC concentrations peaked at 20 and 40 minutes for males and females, respectively. Females had significantly greater plasma 11-COOH-THC concentrations than males. There were no age or strain differences in plasma

Δ9THC concentrations at 10 or 40 min; however, 129 mice had significantly higher brain Δ9THC concentrations than FVB mice. Additionally, a 3-cigarette dose produced significantly lower 11-COOH-THC plasma concentrations compared to a 5-cigarette dose. This effect was not evident in plasma or brain concentrations of Δ9THC and 11-OHTHC. Ongoing studies are determining the effects of chronic cannabis smoke exposure on markers of inflammation in young-adult and aged mice, and on ADlike tau pathology in rTg4510 mutant tau transgenic mice.

THC attenuates weight loss in a preclinical animal model of

activitybased anorexia

Savoya Joyner

Florida State University

Co-authors: Lisa Eckel1

1Florida State University

Objective: Clinical studies report impaired cannabinoid signaling and elevated peripheral markers of inflammation in anorexia nervosa (AN). Because the endocannabinoid system modulates immune function, food intake, and energy expenditure, all of which are dysregulated in AN, it represents an important therapeutic target. Despite this, there is a paucity

of studies examining whether cannabinoids can attenuate AN symptoms. The current study examined whether Δ9-tetrahydrocannabinol (THC) attenuates hypophagia, hyperactivity, weight loss, and inflammation in a preclinical animal model of AN.

Methods: Female rats were exposed to the ABA paradigm, which combines food restriction (2h access to food/day) with unlimited access to running wheels (RWs). These conditions promote rapid, progressive weight loss, and rats are removed from the paradigm after losing 22% of their baseline body weight or 7 days, whichever occurs first. Rats in the ABA-VEH group received daily injections of vehicle (1 mL/kg, i.p.), whereas rats in the ABA-THC group received daily injections of vehicle for three days (at which time rats had lost 10-12% of their baseline body weight) followed by daily injections of THC on days 4-7 (1 mg/ kg, i.p.). At the end of the study, rats were perfused and brain tissue was processed for Iba1 immunoreactivity to quantify microglial expression (a measure of central inflammation) in brain areas that control energy balance.

Results: ABA-induced weight loss was attenuated by THC treatment, with ABATHC rats losing less weight than ABAVEH rats (33.9 ± 3.3 vs. 46.1 ± 3.8 g, p < 0.05). This effect of THC was mediated by a decrease in energy expenditure as ABA-THC rats displayed a 50% decrease in RW activity relative to ABA-VEH rats (day 4-7 average: 4477 ± 766 vs. 9810 ± 594 revolutions, p < 0.05). Food intake in ABA-THC and ABA-VEH groups was similar (day 4–7 average: 9.2 ± 0.6 vs. 10.0 ± 0.5 g).

Conclusion: Daily THC treatment helps to rescue the ABA phenotype in underweight, symptomatic female rats primarily through decreases in RW activity resulting in reduced energy expenditure. Ongoing analyses will

determine whether microglial expression is elevated in ABA rats, and whether THC treatment attenuates ABA-induced inflammation.

Using a Mouse Model to Explore the Neuroprotective Potential of Cannabidiol

Camilla May Florida State University

Co-authors: Ashley Mae Loeven1, Alexis Cox1, Debra Ann Fadool1

1Florida

State University

As the medicalization of marijuana occurs across the U.S., the main nonpsychoactive component cannabidiol (CBD), has gained recognition for its therapeutic potential. Studies have explored the therapeutic ability of CBD in the treatment of certain neurodegenerative diseases or traumatic brain injury. We and others have reported a link between fatty diet consumption and increased neuronal loss and neuroinflammation in the olfactory and taste systems of mice. The objective for my project, therefore, was to assess the potential of CBD to mitigate neuroinflammation and neuronal loss induced by diet-induced obesity. Mice used in this study (OMPtauGFP) expressed GFP restricted to mature olfactory sensory neurons (OSNs). One-month old mice of both sexes were weaned to moderately highfat (MHF) diet (32% kcals from fat) and received 20 mg/kg CBD or vehicle by intraperitoneal injection every weekday for four weeks. Mice were fix-perfused, and their brains were post-fixed and cryoprotected. The main olfactory epithelium (MOE) was cryosectioned at 16 µm thickness; the sections were collected on slides and processed for immunohistochemistry. The MOE

sections were incubated with antibodies associated with inflammation (antiIba-1) and cell proliferation (anti-Ki67), while the endogenous GFP marked mature OSN abundance. The sections were imaged on a Zeiss microscope (Axiovert S 100) to quantify the number of OSNs that were positive for these antigens. Photomicrographs were acquired from the septal region of the MOE. CBD-treated mice had greater abundance of GFP+ OSNs in the MOE, regardless of sex (Student’s t-test p = 0.0159). There was no significant difference in the abundance of Ki67+ or Iba-1+ cells, however, across drug treatment groups (Student’s t-test, p > 0.05). We conclude that CBD treatment of MHF-fed mice induced neuroprotection without observed changes in neuroinflammation or cell proliferation as indicated by these markers. Planned acquisition of additional MOE regions will expand the interpretation or universality of our findings. Whether CBD can reverse the deleterious effects of obesity, rather than prevent it, is being explored in a separate cohort of mice maintained on the MHF diet for 3 months prior to beginning CBD treatment.

Inflammation as a Prognostic Biomarker to Evaluate the Effects of Medical Cannabis on Breast

Cancer Patients’ Short- and Long-Term Outcomes

Alexandra McMahon University of Miami

Co-authors: Dr. Yan Wang1, Veronica Zhang2, Dr. Jennifer Hu2

1University of Florida 2University of Miami

Objectives: Despite the increasingly prevalent use of medical cannabis (MC) in cancer patients as a treatment strategy for symptom management, few studies have examined the underlying biological mechanisms such as inflammation in predicting patient outcomes after MC use. The objective of this abstract was to bridge recent literature and our own data to illustrate how cannabis use may impact inflammation measured by C-reactive protein (CRP), which may subsequently predict treatment responses, quality of life (QOL), and clinical outcomes among cancer patients.

Methods: A review of literature was conducted to explore applications of C-reactive protein (CRP) as a potential prognostic biomarker in breast cancer patients initiating MC. PubMed and Medline databases were utilized with search terms ‘Cannabis’, ‘Marijuana’, C-Reactive Protein’, ‘Medical Cannabis, ‘Medical Marijuana’, and Breast Cancer’. We also capitalized on our laboratory’s pilot data from three NCI-funded projects (2010-2023) measuring highsensitivity C-reactive protein (hsCRP) levels in pain, radiotherapy (RT)-induced

skin toxicity and survival outcomes in breast cancer patients.

Results: A review of the literature suggests that cannabis usage, specifically cannabinoid-2 receptor activation, promotes an antiinflammatory response. There is growing evidence that inflammation/ inflammatory biomarkers, such as C-reactive protein (CRP), are affected by cannabinoid activation. Multiple studies reported alterations in CB1R and CB2R expression levels in breast cancer and previous small studies associated MC usage with lower CRP levels. All these findings suggest cannabis use may reduce inflammation measured by CRP. On the other hand, findings from our study found CRP to be significantly associated with patient outcomes including pain (p=0.002), radiotherapyinduced skin toxicities (p=0.028) and survival (p=0.005) in a multi-ethnic breast cancer population (n=63), suggesting CRP can be a prognostic biomarker for cancer patient outcomes.

Conclusions: Bridging the two pieces of evidence together, we hypothesize that CRP may have clinical significance as a prognostic biomarker in breast cancer patients initiating MC. Future research characterizing the longitudinal relationship between cannabis and C-reactive protein could provide insight into molecular mechanisms and effects on treatment responses, QOL and clinical outcomes in breast cancer patients initiating MC.

In vitro evaluation of mitragynine metabolism

to 7-hydroxymitragynine and the influence of major cannabinoids

Philip Melchert

University of Florida

Co-authors:

Qingchen Zhang1, John S. Markowitz1

1University of Florida

Kratom (Mitragyna speciosa) is an indigenous tree native to Southeast Asia whose leaves have been traditionally ingested in a raw form by chewing or drinking as a tea. Kratom preparations are widely consumed in the US with an estimated usage prevalence of 1% and have been marketed in combination with cannabis products. Although kratom and its constituents presently have no FDA approved uses, it’s extracts or major alkaloids have psychoactive properties and may hold promise for the treatment of opioid cessation and pain management –in part due to its ability to partially agonize mu opioid receptors. Kratom’s pharmacological effects are attributed to its major alkaloids (e.g. mitragynine, 7-hydroxymitragynine). Although present in kratom extracts at low concentrations, 7-hydroxymitragynine is the primary metabolite formed by the metabolism of mitragynine and the most potent, thus it contributes to the overall pharmacodynamic effects of kratom extracts. Given its potential clinical applications, there is an interest in the potential for kratom extracts to interact with various drug metabolizing enzymes (DMEs) including those of the cytochrome P450 (CYP) family. CYP3A appears to be a major metabolic pathway for the conversion of mitragynine to 7-hydroxymitragine

and the coadministration of cannabidiol (CBD) increased the systemic concentration of kratom alkaloids in a rodent model. However, the in vitro metabolism parameters of mitragynine metabolism mediated through the CYP3A isoform have yet to be well defined. In addition, the preliminary in vitro work investigating the impacts of known CYP3A inhibitors has not been thoroughly examined. Our hypothesis is that mitragynine’s conversion to 7-hydroxymitragynine through CYP3A mediated metabolism will be significantly impaired by known CYP3A inhibitors, such as the cannabinoids, CBD and Δ-9-tetrahydrocannabinol (THC). Our ongoing studies utilizing human liver microsomes will establish the in vitro parameters of metabolism for mitragynine through CYP3A and its impact by CYP3A inhibitors. Both THC and CBD will be evaluated for its impact on the metabolism of mitragynine. This investigation will help elucidate the drug-drug interaction (DDI) potential of coadministering kratom extracts and cannabis-containing products.

Pharmacokinetic interactions of cannabidiol and oxycodone after oral administration in rats

Alexandria Senetra University of Florida

Co-authors: Michelle A. Kuntz1, Siva Rama Raju Kanumuri1, Yi-Hua Chiang1 , Ariana C. Brice-Tutt1, Niall P. Murphy1 , Adriaan W. Bruijnzee1, Marcelo Febo1 , Barry Setlow1, John K. Neubert1 , Christopher R. McCurdy1, Abhisheak Sharma1

1University of Florida

Cannabinoids and opioids share many pharmacologic properties and may act synergistically. Cannabidiol (CBD) exhibits analgesic and anti-inflammatory properties, but a major concern is its potential to interact with prescription drugs, specifically, opioids. Oxycodone is a commonly prescribed opioid used to treat moderate to severe pain. Recent studies show patients using both CBD and oxycodone concomitantly report greater analgesia. Cannabinoid consumption has been shown to cause impairment of a wide range of cognitive functions in a dose-related manner, along with exhibiting adverse effects in the cardiovascular, respiratory, neural, and psychological systems. Due to the depressant effects of both CBD and opioids, co-administration of these substances can suppress the central nervous system to dangerous levels, as well as increase the risk of opioid use disorder. To date, there have been no studies to assess the pharmacokinetic interactions of opioids and CBD. This study was performed to investigate the potential interactions of CBD and oxycodone. A single oral dose of CBD (25 mg/kg), oxycodone (1.4 mg/kg), or

combination of both was administered to male Sprague-Dawley rats (N=4). Blood samples were collected up to 24 hours post administration. When administered concomitantly, CBD had a 1.3-fold lower exposure (AUC), while oxycodone had a 24-fold higher exposure (AUC) than when each drug was administered alone. The metabolites, 7OH-CBD, 7COOH-CBD, noroxycodone, and noroxymorphone had a 1.2-, 1.4-, 2.9-, and 1328-fold lower exposure (AUC), respectively with concomitant administration. A delayed absorption phase for both CBD and oxycodone was exhibited in rats when dosed concomitantly. These results uncover the pharmacokinetic interactions between CBD and oxycodone that could manifest as interactions at a physiological level, which may also extend to other prescription opioids.

Although this book does not look directly at cannabis cells under a microscope, it does closely examine the compounds of the plant as it relates to different diseases, symptoms, and cancers. The book has 26 diseases or symptoms and 19 different cancers broken down into cannabinoids, terpenes, and flavonoids. Together they make up medical cannabis.

A Microscopic View of Medical Cannabis provides the medical practitioner, allied medical professionals, cannabis dispensary agents, and patients a resource that is in-depth enough to understand the topic and assist in effectively managing conditions using cannabinoid medicine but not be overwhelming. The format allows quick access to clinically useful referenced information for the experienced cannabis practitioner, medical cannabis dispensary agents, patients, caregivers, and medical and mental health practitioners who will need to understand this ancient medication which more of their patients are using now and will in the future.

A MICROSCOPIC VIEW OF MEDICAL CANNABIS

A Handbook for Clinicians, Medical Professionals, Dispensary Staff, and Patients

Cathie Hiegel, CT

Dr. Brian Nichol, M.D.

Cathie Hiegel, CT (Cytotechnologist)

Forward by Brian Nichol, M.D.

CCORC 2023 Exhibitor Cathie Hiegel, Author of…

EDUCATION, QUALITY, SAFETY, AND REVIEWS

Cannabinoids Hyperemesis Syndrome – A dilemma, Underdiagnosis, and Future Directions? – A Review of the Current Literature

Jinal Choudhari Larkin Community Hospital

Co-authors: Nisha Panta1, Ellie Soheili2 , Diana Limon2, Claudia Maria Cuevas Lou2, Tulram Yadav3, Sujan Poudel2

1Kathmandu Medical College

2Larkin Community Hospital

3Jinnah Postgraduate Medical Centre

Introduction: Cannabinoid Hyperemesis Syndrome (CHS) is characterized by a cyclical pattern of hyperemesis every few weeks to months, obsessive thoughts, and the compulsive act of needing to take hot baths or shower in the background of chronic Marijuana use. It is the illicit drug most commonly used in the United States, with an estimated 42 to 46% lifetime use prevalence. Unfortunately, clinicians’ lack of knowledge of CHS imposes a significant delay in the patient’s diagnosis and redirects them to undergo intrusive examinations and intensive investigation for years. This article aims to bring the attention of CHS to enable clinicians and, more specifically, addiction medicine specialists and psychiatrists to diagnose it as early as possible and thus avoid needless invasive examinations and investigations.

Methods: A thorough bibliographic review was conducted using PubMed,

Cochrane, Embase, and Medline. In addition, databases were used to search for articles on CHS published between January 2011 and February 2023, yielding relevant articles. Keywords used were “hyperemesis,” ” Cyclical Vomiting,” “cannabis,” and “cannabinoid.”

Results: CHS is found to be associated with long-term marijuana use and typically presents as diffuse acute abdominal pain and uncontrolled cyclical vomiting; and usually alleviates symptoms by taking hot baths. They have a typical history of frequent emergency department (ED) visits and undergo many needless supplementary examinations and lab tests. No organic cause has been mentioned in the literature to explain the pathophysiology and clinical symptomatology; these patients are commonly referred to the psychiatry department; and frequently consulted to addiction medicine, given their history of chronic marijuana use. The only available treatment option is the complete cessation of consumption of cannabis.

Conclusion: Although rare, CHS is an underdiagnosed condition that clinicians do not know as much about. This syndrome has a pathognomonic clinical presentation and clinically mimics an acute abdomen. Early CHS detection prevents unnecessary repeated ED visits, and needless followup examinations and investigations increase patients’ overall quality of life.

Substance Use, Health, and Mental Health Outcomes in States with and without Medical Marijuana Laws

Cristiana Nelise de Paula Araujo University of Florida

Co-authors:

JeeWon Cheong1, Ali M. Yurasek1

1University of Florida

Introduction: Many states within the US have enacted medical marijuana laws (MML). However, how MML may impact the prevalence of marijuana, other substance use, and mental health conditions remains unclear. The purpose of this study was to examine differences in substance use, general health, and mental health outcomes in states with and without MML.

Method: This study was a secondary data analysis of the Behavioral Risk Factor Surveillance System (BRFSS) publicly available data collected in 2020 by the Centers for Disease Control and Prevention (CDC). Of 22 states that elected the marijuana use module, 14 states had passed MML (n = 143,151) and 8 states had not (n = 67,744). We used ordinary least squares (OLS) multiple regression analyses for continuous outcome variables and logistic regression analyses for the binary outcomes. For count data outcome variables (e.g., the number of days using marijuana), we used generalized linear modeling with zeroinflated negative binomial distribution in SAS.

Results: People living in states with MML were more likely to be marijuana users (p < .001) and have higher levels of marijuana use (p < .05), compared to those in non-MML states. Similarly,

those living in MML states were more likely to be cigarette smokers and have used e-cigarettes (ps < .01). However, residents in MML states were more likely to be non-drinkers, non-binge drinkers, and less likely to drive under the influence (ps < .01), compared to those in non-MML states. Although those in MML states reported experiencing better general health (p < .001), they reported significantly worse mental health, including more days feeling stressed, depressed or having emotional problems, having depressive disorder, and having fewer hours of sleep (ps < .001).

Conclusions: Residents of MML states may be at increased risk to use marijuana and cigarettes as well as experience more mental health symptoms. Although it is unclear if MML influenced those health outcomes or if those with more negative health outcomes are more likely to live in MML states, the findings suggest that MML states should ensure adequate access to substance use and mental health treatment beyond medical marijuana.

Marijuana Use for Treatment of Endometriosis Pain: A Systematic Review

Nicole Ennis Florida State University

Co-authors: Savannah Calleson1, Katie Kloss1

1Florida State University

Background: Endometriosis is a common, chronic inflammatory condition in women due to the presence of endometrial-like tissue found outside the uterus. Endometriosis can cause a myriad of symptoms such as chronic pelvic pain, fatigue, dyspnea, dyspareunia, dyschezia, and dysuria. The chronic health implications for women with endometriosis can lead to a decreased quality of life. Management of endometrial pain can include pain medications, oral contraceptives, laparoscopy, and even hysterectomy. The objective of this study was to determine what evidence exists for the use and effectiveness of medical marijuana (cannabis) for endometriosis related pain.

Methods: The literature for this review was collected from the following databases: PubMed, Web of Science, Cochrane Central Register of Controlled Trials, MEDLINE, and Embase. Cohort studies, case-control studies, cross-sectional surveys, and systematic reviews from 1996 to August 2022 assessing any relationship between marijuana/cannabis use and endometriosis were eligible for inclusion. Duplicate articles, nonaccessible full text articles, and articles not published in English were excluded. Retrieved articles were independently reviewed by two reviewers and any discrepancies were resolved by

consensus by a third reviewer.

Results: A total of 522 references were identified and retrieved. Following screening, eight articles were included for review: four cross-sectional surveys, two systematic reviews, one retrospective cohort study, and one review of literature. Total participants who used cannabis for endometriosis symptom management was N= 1817 across five studies. All included studies were from high-income countries where marijuana is legalized medicinally or recreationally. Overall, results showed that cannabis consumption for symptom relief was common among women with endometriosis and some women even reported use of cannabis reduced their use of analgesics.

Discussion: We found no randomized controlled trials on the use of marijuana for endometriosis related pain indicating an important gap for future research given the recent findings that dysfunction in the endocannabinoid system (ECS) may play a role in endometriosis related pain. This study was limited by the lack of literature specifically analyzing the relationship between endometriosis and therapeutic marijuana use. Although, endometriosis is very common, it can often go undiagnosed which may attribute to the lack of literature.

Cannabinoids Exposure Levels and its Relation to Anxiety Symptoms and Sleep Disturbances: A

Scoping Review

Gabriela A Garcia University of Florida

Co-authors: Juan Guillermo PerezCarreno1, Krishna Vaddiparti1, Elizabeth Castaneda1, Pranav Sai Gupta1, Ryan Hossain2, Benjamin Z Churba1, Catalina Lopez-Quintero1

1University of Florida 2University of Central Florida

Background: At least 60% of individuals with anxiety disorders report sleep disturbances, which might be explained by shared physiological mechanisms, including cortisol dysregulation and executive function skills disruption (1–3). The scientific literature regarding medical cannabis as a potential therapeutical candidate for these conditions increased about 15 times in the last 10 years. (3–5). However, assessments of cannabinoid exposure, anxiety, and sleep are inconsistent across studies, and the quality of the evidence is not often assessed.

Methods: We developed a Scoping Review protocol to examine the current knowledge on cannabinoid use for anxiety and sleep disturbances. A search strategy was run on PubMed, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, LILACS, and PsycINFO. We calibrated the screening process in 5% of the results using Rayyan. Papers were selected by duplicate using PRISMA guidelines. Quality assessment was conducted for included studies and data extraction and charting were performed

according to our predefined protocol.

Results: The proposed search algorithms retrieved 1113 documents. The calibration helped to reduce discrepancies from 32% to 10.7%. A total of 319 documents were selected after reviewing titles and abstracts (22 trial protocols and 297 observational and intervention studies). At the point of this abstract, 40 papers with clear cannabis exposure measures and their association with sleep and anxiety were selected based on full content: 31 observational studies and 9 clinical trials. We plan to finish the quality assessment and data charting by the conference date.

Conclusion: We showed Scoping Reviews are subject to iterative changes, leading to a more informed protocol. We will provide evidence of the relationship between cannabis dosage and anxiety and/or sleep effects. Based on the screening phase we anticipate difficulties establishing dosage and heterogeneity in anxiety and sleep assessments among selected studies.

Machine Learning in Non-Medical Cannabis Use Study: A Review

Mingming Peng Florida A&M University

Co-authors: Hongmei Chi1

1Florida A&M University

Non-medical cannabis uses has long been a widely discussed issue in human society. With the gradual legalization of non-medical cannabis uses in many countries and some states in the United States, research on the health effects of cannabis has regained attention from the public. In this context, the application of machine learning to address related issues has attracted much interest. We know that, with the popularity of IoT devices and smartphones, some of the ML architectures, including deep neural networks (DNN), convolutional neural networks (CNN), and recurrent neural networks (RNN), have been applied to fields such as digital health during the last decade. Many popular Health apps adopt Machine Learning algorithms. Therefore, we need to review the application and research progress of machine learning in non-medical cannabis use fields. This study presents a systematic review of how machine learning has been applied to the study of non-medical cannabis use over the past 10 years. We conducted a search of published literature from PubMed and IEEE Xplore and ACM digital Library.

Medical cannabis contaminates concerns: A qualitative content analysis of Reddit posts

Gabriel Spandau University

of Florida

Co-authors: Jamie Loizzo1, Hannah Fechtel1, Brian Pearson1, James Charles Bunch1, Nicole Stedman1

1University of Florida

Background: An online Reddit community, FLmedicaltrees, began in 2017 as a space for Florida medical cannabis patients to discuss laws, doctors, treatment, and products. The community has more than 54,000 members and several daily posts. Contaminated medical cannabis product is a hot button issue within FLmedicaltrees. The researchers used qualitative content analysis methods to examine patients’ posts about contaminated cannabis products.

Research Questions:

• What are medical cannabis patients’ experiences with contaminated products?

• What are patients’ knowledge levels of contaminates found in medical cannabis products?

• What are patients’ feelings towards the current state of the medical cannabis program in Florida?

• What changes do patients want to see made to the Florida medical cannabis program?

Methods: The lead researcher used specific key words (mold, contaminate, fiber) to identify and collect 300 contaminant-related posts from date ranges 06/01/2022-06/04/2022.

All posts that appeared during the search were pulled for review. The lead researcher screened posts for relevancy to the contamination research questions, excluding 202 and leaving a final sample of posts (n = 98). The three lead researchers then developed a coding framework that included deductive codes such as contamination concern, information seeking, providing information and added inductive codes as they emerged. The lead researcher was the primary coder for this study, coding all 98 posts and used constant comparison to maintain validity. Second and third researchers reviewed 20% of the coded posts and confirmed coding accuracy. After initial coding, codes were grouped into overlapping categories, and categories became themes.

Results: Preliminary results include the following themes:

1) Patients experience multiple forms of contamination throughout different products purchased from medical cannabis dispensaries, 2) Patient knowledge level of contaminates appears to be low and this community is used to help find answers and second opinions, 3) Some patients expressed feelings of anxiety and worry about health, safety, and quality control, while others had a lack of concern, 4) Patients want changes regarding vertical integration, company accountability, state oversight, and home grow law.

A case Study on the Challenges in Approvals for Cannabis Clinical Outcomes Research

Nicholas Toll

Florida Atlantic University

Co-authors: Ximena Levy1, Melanie Bone1

1Florida Atlantic University

Objective: To describe the process and limitations a multidisciplinary team encountered in conducting a pilot study on the effects of Delta-8 THC in patients admitted to a memory care unit. Methods: The objective of the pilot study, funded by a private organization, was to explore the effects on vital signs, sleep patterns, and anxiety in patients admitted to a memory care unit authorized to offer cannabis-based therapies. The facility and healthcare providers are experienced in medical cannabis and collaborated with an academic institution to design and conduct the study. Patients were clinically eligible to receive Delta-8 THC as part of the standard of care; however, since the providers intended to collect data for research purposes, several layers of approvals were needed before the facility was allowed to provide the cannabis product and start the pilot study.

Results: A research proposal, a clinical trial agreement (CTA), and IRB approval were required to be in place before starting the study. The initial step in the process was the signature of the CTA between the memory facility and the academic institution. Challenges related to liability, disposition of the cannabis product, limited knowledge, and regulations in the field required reprocessing the CTA once the initial agreement was signed. The IRB

approval required several iterations of the protocol presented. The committee’s limited experience in the review of proposals involving cannabis was one of the main challenges encountered. In addition, overlapping roles of the facility providers and the academic institution created additional delays in the process. The total time for approvals was eighteen months, resulting in the sponsor withdrawing the funding and the study being canceled.

Conclusion: Training, guidance, legal support, and standardized processes are required to advance the field of clinical research in medical cannabis. We are in urgent need of generating scientific evidence on the clinical effects of medical marijuana, but the limitations on the administration path to achieve the goal may be causing harm to populations using cannabis in a regular basis.

CLINICAL RESEARCH, POPULATION HEALTH, HEALTH BEHAVIOR

Generalized Anxiety Disorder among Cannabis Consumers before and after Ketamine-Assisted Psychotherapy: Results from a Pilot Study Comparing Psycholytic and Psychedelic Approaches

Yash Agrawal

University of Miami

Co-authors: Daniella Batievsky1, Shari Kaplan1, Michelle Weiner1, Denise C. Vido2

1Spine and Wellness Centers of America

2Unviersity of Miami

Background: Alternative methods to manage anxiety have been exercised to mitigate increased utilization of mental health services. Cannabis has been used to mitigate anxiety; however, legal access varies since anxiety is rarely a medical cannabis qualifying condition. Ketamine is legal for use; but it is unclear how anxiety symptoms are impacted by the co-use of ketamine and cannabis. The purpose of this study was to conduct a sub-analysis of generalized anxiety disorder among adults in a pilot Ketamine-Assisted Psychotherapy (KAP) intervention study.

Methods: A sub-analysis of data of cannabis consumers (N=10) from a

pilot intervention study comparing two 6-week long KAP approaches to determine the optimal route of administration in patients with major depressive disorder and chronic pain.

Generalized Anxiety Disorder (GAD-7) Scale scores were summed at baseline, timepoint 1, timepoint 2, and timepoint 3.

Results: All participants’ anxiety symptoms declined throughout treatment as evidenced by the sum of their responses on the GAD-7. Participants (n=5) who consumed the psychedelic treatment dose (high doses administered intramuscularly 24 hours before therapy) saw a larger, more consistent decrease at each time point. All ten participants transitioned from having a severe GAD diagnosis at baseline (mean scores above 15 points) to having a moderate GAD diagnosis by treatment termination (mean scores below 15 points). A larger overall decrease in symptoms was seen in the psychedelic group, whose mean symptoms decreased by 19.57% by the study’s completion in comparison to the psycholytic group, whose mean symptoms decreased by 16.25% by the study’s completion. Furthermore, the psychedelic group’s mean symptoms consistently declined throughout the course of treatment (T=1= 9.78% decrease, T-2=8.43% decrease, T-3=2.64% decrease). The psycholytic group’s mean symptoms, on the other hand, increased after the third treatment session (T-1 = 13.57% decrease, T-2 = 8% increase, T-3=10.67% decrease)

Conclusions: KAP among cannabis consumers resulted in a reduction of anxiety symptoms over time, particularly among the psychedelic dose group. Future studies should examine the relationship between ketamine and cannabis co-use and their impact on anxiety symptoms among larger sample sizes.

Knowledge, Attitudes, and Perceptions on Cannabis and its Use: A Qualitative Study among

Young Adult Cannabis Consumers and NonConsumers in South Florida

Amrit Baral University of Miami

Co-authors: Denise C. Vidot1, Vanessa Morales1, Yetunde Tagrum1, Meghal Desai1, Nawaf Alhazmi1, Bria-Necole

Diggs1, Walter Ramsey1

1University of Miami

Background: Quantitative studies have reported an increase in cannabis use; however, scientific and public understanding of cannabis has been outpaced by the trend in the legalization and availability of cannabis products. Qualitative studies are essential to gain perspective insight into highly stigmatized topics, such as cannabis. This study aims to examine the knowledge, attitudes, and perceptions of cannabis and its use among young adult cannabis consumers and nonconsumers in South Florida.

Methods: This qualitative study analyzed interviews from 45 participants in the Herbal Heart Study (HHS), a cohort study examining the impact of cannabis use on subclinical cardiovascular risk among healthy young adults (18-35 years old) in South Florida. The current study included cannabis consumers (40%) and non-consumers (60%), with a majority being female (66.7%). A qualitative thematic analysis of the interviews was performed using a deductive approach driven by the Health Belief Model (HBM) theory.

Results: The interviews revealed five emergent themes: perceived health benefits of cannabis use, the perceived health risk of cannabis use, motivation for cannabis use, knowledge of cannabis, and perceived barriers to cannabis use. Participants reported the medical benefits of cannabis, including pain management, and treating side effects of cancer, while also acknowledging perceived health risks associated with mental health, cardiovascular, and respiratory health. For majority of consumers, the motivation for use was health reasons or relaxation of mind. Cannabis users endorsed its use for medical and recreational purposes equally. A few participants expressed their knowledge on cannabis compounds, strains, and methods of consumption. While some participants had knowledge deficits, the majority expressed their interest in learning more about the effects of cannabis on human health based on scientific research.

Conclusions: This study highlights mixed attitudes towards cannabis use among young adults, with perceived risks and benefits of cannabis stemming from personal experience and other sources. The findings underscore 1) the need for evidence-based cannabis literacy for young adults to keep pace with policy changes and liberalization around cannabis use; and 2) implications for public health messaging and policymaking. Results suggest the need for additional research to elucidate the impact of cannabis on human health.

Self-Reported Changes in Depressive Symptoms

among Cannabis Consumers with Major Depressive Disorder before and after Ketamine-Assisted Psychotherapy: Results from a Pilot Study Comparing Psycholytic and Psychedelic Approaches

Kyra Berwitz

University of Miami

Co-authors: Daniella Batievsky1, Shari Kaplan1, Michelle Weiner1, Denise C. Vidot1

1University of Miami

Background: Ketamine, primarily known as the most widely used anesthetic in the world, has recently been established to effectively treat depressive disorders. Specifically, randomized controlled trials have demonstrated intravenous ketamine’s efficacy, feasibility, and tolerability for major depressive disorder. While Ketamine is approved by the FDA and legal for use, little is documented about the impact of the co-use of ketamine and cannabis on depressive symptoms. This study aimed to conduct a sub-analysis of cannabis consumers who participated in a pilot Ketamine-Assisted Psychotherapy (KAP) intervention study to examine changes in depressive symptoms over the duration of the study.

Methods: Cannabis consumers (N=10) from a pilot intervention study comparing psychedelic and psycholytic

KAP approaches in patients with major depressive disorder and chronic pain were analyzed in the current study. The Beck Depression Inventory (BDI) was used to assess depressive symptoms via summed scores collected prior to and after participant’s first, third, and sixth treatment sessions. According to the BDI scoring guidelines, a score of 17-20 is borderline clinical depression, 21-30 is moderate depression, a score of 31-40 is severe depression, and extreme depression is present if they score above 40.

Results: The participants in the psychedelic group (n=5) enrolled in the study with a mean BDI score of 42 and left the study with a mean BDI score of 36.8. The participants in the psycholytic group enrolled in the study with a mean BDI score of 44.6 and left the study with a mean BDI score of 38.4. All participants transitioned from extreme to severe after their third treatment session (T-2); psychedelic group scores declined from a mean of 43.8 to a mean of 39.4 and psycholytic group scores declined from a mean of 41.4 to 37.0. Thus, both psychedelic and psycholytic treatment approaches were associated with participants’ improvement in depression severity; their decrease in symptoms moved their depression status from extreme to severe.

Conclusion: Results from this sub analysis among cannabis consumers found that KAP reduced depressive symptoms over time in both the psychedelic and psycholytic treatment groups. Future studies should examine among larger samples sizes and of diverse socioeconomic status.

Noid Therapy: A Survey Exploration of THCO Medical Use

CB (Carlton) Bone Portland State University

Co-authors: Jessica Kruger1, Daniel Kruger2, Meredith Meacham3, Charles Klein4, Kaelas Munger4, Robert Strongin4 1University at Buffalo, SUNY 2University of Michigan 3University of California San Francisco 4Portland State University

Introduction: In February of 2023 the FDA announced that cannabinoid acetate esters – colloquially known as [Delta-8 and Delta-9] THCO – were not compliant with the 2018 Farm Bill and that they remained a controlled substance. Given the widespread market for cannabinoid acetates, there is a need to contextualize consumer relationships with this product.

Background: Prior research has focused on the product ontology of THCO, and its role in online communities that are structured around cannabinoid interest to contextualize the social and material forces that have shaped the rise in popularity of this substance. This study seeks to explore the use of THCO for medical purposes.

Methods: This report analyzes survey data collected from various communities on the social media platform Reddit interested in cannabinoids. Survey design and outreach were facilitated through a multidisciplinary and collaborative manner to best address the multitude of questions facing the diverse group of invested stakeholders from consumers to regulators. Survey questions were designed to mirror existing questionnaires for medical marijuana and other cannabinoid interventions to identify differences in health

antecedents and outcomes between THCO and other cannabinoids like THC and CBD.

Results: Results are still being analyzed the initial results suggest that (n=320) there is a clear indication of users selfreport consuming THCO for medical reasons, while also highlighting an acute awareness of potential short- and longterm harms associated with use as well as a desire for greater research into the specific respiratory and cardiovascular risks associated with THCO.

Conclusion: THCO has similar perceived medical benefits to botanical cannabinoids found in cannabis, and consumers self-report use strategies that mirror those for THC. Limitations with these results derive from the nature of online survey research compounded by the dynamic nature of THCO products and markets.

Discussion: The implications for the regulatory shift surrounding THCO have yet to be fully realized but how consumers utilize THCO for medical purposes is an important area of future research. Physicians and researchers should be aware of the potential medical use of THCO amongst patients and research cohorts while trying to distinguish what specific cannabinoids may be consumed when conducting observational research.

Substitution Effect of Cannabinoid Based Therapies for Pharmaceuticals: Findings from a Survey of South Florida Medical Marijuana Patients

Melanie Bone

Dr. Melanie Bone (Private Medical Practice)

Co-authors: Carlton Bone1, Hannah Fechtel2

1Portland State University 2University of Florida

Cannabis physicians recommend varying ratios of cannabinoids and delivery devices to their patients from an increasingly wide array of products in the Florida Medical Marijuana market. This research leverages the unique position of private medical marijuana practices, as avenues for corroborating clinical research studies and developing more demographically targeted insights into medical marijuana patients. Survey data were collected from a cohort of patients in a private medical marijuana practice in South Florida. Responses were collected during the normal patient screening process before and after starting to use cannabinoid products, and have additionally been used by the Physician to guide care and monitor cannabinoid product outcomes. Despite not being able to establish a correlation between specific cannabinoids, the analysis found no patients reported an increase in pharmaceutical medication use, 35% reported no change, 37% reported a decrease, and 21% reported complete cessation. These results reinforce the idea that many patients report using Medical Marijuana to substitute

and supplement pharmaceutical treatments. The researchers believe future research, that focuses on a wider spectrum of cannabinoids and specific pharmaceuticals can help yield practical insights for clinicians and regulators alike.

Effects of cannabidiol (CBD) on resting-state electroencephalography (EEG) and neuropathic pain severity in people with spinal cord injury (SCI)

Nicholas Cherup University of Miami

Co-authors: Eva Widerstrom-Noga12 , Roberta Vastano|12, Linda Robayo12 1University of Miami 2The Miami Project to Cure Paralysis

Neuropathic pain is one of the most common, distressing, and treatmentresistant symptoms associated with spinal cord injury (SCI). While cannabidiol (CBD) has been shown to produce limited analgesic effects in chronic pain populations, there is a lack of research examining the impact of a single dose of CBD on electrocortical activity reflected by abnormalities in electroencephalography (EEG) spectral power among those with SCI-related neuropathic pain. The primary purpose of this study is to 1) evaluate the effect of CBD on neuropathic pain symptoms, momentary pain intensity and unpleasantness, and thermal pain thresholds and 2) assess the effect of CBD on brain electrocortical activity measured during resting-state EEG by conducting EEG power spectrum analysis across theta, alpha, and beta rhythms. Methods: In this randomized,

double-blind, placebo-controlled pilot study, fifteen (N=15) men and women with an incomplete or complete traumatic SCI and who also experience continuous neuropathic pain will receive a single dose of CBD (250mg) or a single dose of a placebo in a cross-over design. During the two study visits, resting brain activity will be recorded for 10 minutes, 30 minutes before and after CBD or placebo administration. Participants will also be assessed for momentary neuropathic pain symptoms severity, pain intensity, and state anxiety symptoms, followed by quantitative sensory testing to measure thermal pain thresholds and the presence of allodynia in the painful area. Results: Unforeseeable regulatory issues have led the study team to submit an investigational new drug application to the FDA before IRB approval is granted. We have secured a CBD source and are in the process of submitting the necessary documents to the FDA.

Discussion: The data collection for the study has been significantly delayed.

Comparison of COVID-19 Preventative Social Behaviors Among Cannabis Users and Non-Cannabis Users:

Preliminary Results from the COVID-19 Cannabis Health Study

Bria-Necole Diggs

University of Miami

Co-authors: Ranya Marrakchi El Fellah1, Jessica Y. Islam2, Camacho-Rivera3 , Sarah E. Messiah4, Johis Ortega1, Denise

C. Vidot1

1University of Miami 2Moffitt Cancer Center 3SUNY Downstate 4University of

Texas

Background: Preventative social behaviors like physical distancing, wearing masks, and avoiding crowds are all documented ways in which a person can reduce their risk of being infected with SARS-CoV-2, the virus that causes COVID-19. In this study, we aimed to evaluate the preventative social behaviors between cannabis users and non-cannabis users throughout the COVID-19 pandemic by examining changes in their social behavior reported among respondents to the COVID-19 Cannabis Health Study.

Methods: An online survey was distributed March 2020 when COVID-19 was declared a pandemic until March 2023. Subsamples of cannabis and noncannabis adult users were generated for analyses. The COVID-19 Cannabis Health Questionnaire was used to collect self-report quantitative data on social behaviors in their daily life such as gathering attendance and personal protective equipment use. Prevalence estimates and chi-square analyses were conducted using SAS Analytics.

Results: Of the overall analysis sample(N=2816), 2,660 reported cannabis use within the past year. Of the cannabis users, the majority were males (n=1, 383) and Non-Hispanic White (n=1962). Majority of cannabis users completed some college (32.76%), while 34.84% of non-users completed a Bachelor’s degree. Of the social behavior measures captured, a significant difference was found in the prevalence of self-quarantining (p=0.0014), working from home (p=0.0016), not working before COVID-19 (p=0.0012), following media coverage (p=0.0035), and COVID-19 having “very much” impact on their daily life (p=0.0412) when comparing cannabis users (n=1076) to non-users (n=76).

Conclusion: Our findings suggest that

there was a difference in COVID-19 social behaviors among cannabis users compared to nonusers during the pandemic. With more non-users having a higher level of education, it is also important for future researchers to explore how education level may have shaped social behaviors through the COVID-19 pandemic for cannabis users.

Daily Physical and Psychiatric Symptom Trajectories Before and After Medical Cannabis Use

Robert Dvorak University of Central Florida

Older adults account for a disproportional amount of medical costs. Conditions such as pain, emotional distress, and malnutrition are common in this population. Treatment for these conditions has been purported by Medical Cannabis (MC). Cannabis legalization is becoming widely accepted. MC may offer an important alternative approach to treating such conditions, and may reduce polypharmacy, a significant issue in this population. Furthermore, reports indicate a growing acceptance of MC among older adults, and an increase in their use of MC as a way to treat common and persistent medical and psychiatric symptoms. However, there are several issues associated with the proliferation of MC, particularly in this population. Due to a lack of rigorous randomized control studies, the efficacy of MC remains unclear. The current study examines physical (pain, nausea, appetite) and psychiatric (trauma, anxiety, depression) symptoms before and after medical cannabis use at the momentary level in older adults (M = 61.41, SD = 2.11). Participants with

medical cannabis cards were enrolled in a 15-day ecological momentary assessment study. They completed up to 6 surveys per day assessing physical and psychiatric symptoms and MC use in the moment. Data were analyzed using a multilevel latent trajectory model that examined depression, anxiety, trauma symptoms, nausea, loss of appetite, and pain across the day. The model included time of day (time), day separated by pre- and post- use (use), and an interaction of the time x use to model trajectories across the day. For every symptom, there was a significant and robust effect of medical cannabis (ps = <.001 to .034). Most symptoms were elevated prior to MC, decreased following MC, and remained decreased for the day. One symptom, trauma, increased steadily prior to MC use (b = 0.11, p = .002) then dropped precipitously following use (b = -0.57, p < .001). Once trauma decreased, the trajectory for the remainder of the day was constant (b = 0.01, p = .470). The results highlight the effectiveness of MC in reducing symptoms at the momentary level and suggest broad effects across a wide array of physical and psychiatric symptoms.

Perception

of Risks of Cannabis and CBD

Use during Pregnancy among Pregnant versus Non-Pregnant Patients in an Obstetrics and Gynecology Clinic

Amie Goodin University of Florida

Co-authors: Karamveer Dhillon1, Sahar Kaleem1, Bruce Goldberger1, Reem Abu-Rustum1, Adolfo Ramirez-Zamora1 , Deepthi S. Varma1, Dikea Roussos-Ross1

1University of Florida

Background: The American College of Obstetrics and Gynecology advises against cannabis and cannabidiol (CBD) use during pregnancy. However, recent studies suggest cannabis and CBD use is increasing for the relief of pregnancyrelated symptoms, such as nausea and anxiety.

Objective: To assess risk perceptions of cannabis and CBD use during pregnancy among pregnant and non-pregnant patients.

Methods: The study design is a crosssectional survey. Participation was offered in a tertiary care OBGYN Women’s Health Clinic in Florida from October 2022 through February 2023. The survey instrument combined question items from validated instruments that assess cannabis and CBD use and risk perceptions, including: the Pregnancy Risk Assessment Monitoring System (PRAMS) the NIDA-modified Alcohol, Smoking and Substance Involvement Survey (NM-ASSIST), and items assessing sociodemographics and pregnancy/ breastfeeding status. Respondents were presented with a statement explaining:

1) preservation of anonymity, and 2) completion of the survey was an indication of consent. Comparisons of response frequency distributions for pregnant versus nonpregnant participants were calculated with chi-square analysis for individual risk perception question items.

Results: A total of 261 participants submitted survey responses. Of these, 198 (75.9%) were currently pregnant, 55 (21.1%) were not pregnant, and 8 (3.1%) did not disclose pregnancy status. Approximately 5.0% (n=13) reported currently breastfeeding. For the question, “How risky is it to use marijuana [cannabis] once or twice a week during pregnancy?”, pregnant versus nonpregnant participants responded as follows: “Great risk” (29.2% vs. 27.3%), “Moderate risk” (13.8% vs. 18.2%), “Slight risk” (6.2% vs. 7.3%), “No risk” (10.8% vs. 12.7%), and “Not sure” (40.0% vs. 34.5%), where p=0.88 (not significant) between pregnant vs. nonpregnant response distribution. For the question, “How risky is it to use CBD once or twice a week during pregnancy?” pregnant vs. nonpregnant participants responded as follows: “Great risk” (22.1% vs. 20.0%), “Moderate risk” (10.3% vs. 10.9%), “Slight risk” (4.6% vs. 14.5%), “No risk” (10.8% vs. 12.7%), and “Not sure” (52.3% vs. 41.8%), where p=0.12 (not significant).

Conclusion: Findings indicate uncertainty of risk about cannabis and CBD use during pregnancy regardless of current pregnancy status, suggesting an urgent need for tailored risk communication about cannabis and CBD in pregnancy.

Characterization of the Effects of Chronic Marijuana

Use and its Routes of Administration on the Brain, Inflammation, Immune Function and Pain in People with HIV Infection

Varan Govind University of Miami

Co-authors: Teddy Salan1, Suresh Pallikkuth1, Denise Vidot1, Eva Widerstrom-Noga1, Robert Cook2 1University of Miami 2University of Florida

Despite the success of antiretroviral therapy (ART) in suppressing HIV and achieving virological control, chronicinflammation and immune-activation persist in people living with HIV (PLWH). This plays a major role in causing HIV disease progression and developing non-AIDS comorbidities such as neuropathic pain, anxiety, depression, and cognitive dysfunction. Varying proportions of PLWH use medicinal or recreational marijuana (MJ) to alleviate these symptoms. The effects of MJ and its different routes of administration on the immune system, and brain structure and metabolism have not been investigated fully in PLWH. This crosssectional study aims to characterize the effects of marijuana (MJ) and its routes of administration on the 1) metabolism, morphology, and neural circuits of the whole-brain, 2) systemic inflammation, and immune-cell phenotypes associated with activation, exhaustion and homing, and 3) pain and behavioral measures in HIV+/HIV- chronic MJ users (MJ+), compared to MJ-non-users (MJ-). A

total of 128 subjects will be enrolled into four groups: MJ+HIV+ (n=48), MJ+HIV(n=48), MJ-HIV+ (n=16) and MJ-HIV(n=16). MJ users will be equally divided into those who smoke blunts, joints, or vape pens. A comprehensive MRI protocol will acquire diffusion kurtosis imaging (DKI) for evaluating brain white-matter neuronal integrity and graymatter microstructural changes, wholebrain MR spectroscopic imaging (MRSI) for mapping metabolite concentrations as a measure of neuroinflammation and neuronal viability, and neuromelanin MRI, a proxy for dopamine, to investigate the effects of chronic MJ use on dopamine levels in the brain. Bloodbased measures will evaluate multiple plasma markers of immune activation, gut barrier disruption, and systemic inflammation. Taken together, these measures will allow us to establish relationships between peripheral immune activation and inflammation, CNS inflammation, and pain. Preliminary findings from our prior studies on HIV showed higher systemic inflammation and immune activation and brain metabolic and structural alterations in PLWH. For the present study, we hypothesize that MJ use will modulate the extent of these alterations, and that THC and CBD metabolites in blood will associate with brain-imaging and bloodbased markers, and pain and behavioral measures in HIV+/HIV- MJ+ groups.

Perceived Risks and Benefits of Cannabis Use among Cancer Patients: Preliminary Results from a Survey of Patients within an NCI-Designated Cancer Center

Nicolas Hernandez-Ortega University of Miami

Co-authors: Denise C. Vidot1, Maria Hidalgo1, Michaela Larson1, Jessica Islam2, Marlene Camacho-Rivera3 , Claudia Martinez1, Frank J. Penedo2 1University of Miami 2Moffitt Cancer Center 3SUNY Downstate Medical Center

Background: Cancer is a qualifying condition for the medical authorization of cannabis use in Florida; however, previous exposure, sociodemographic variables, and stigmas foster variable acceptance among physicians and patients. The Sylvester Comprehensive Cancer Center (SCCC) catchment area serves over 6 million residents of diverse ethnic/racial backgrounds with broad cancer disparities and barriers to healthcare access. The purpose of this study was to examine the perceived risks and benefits of cannabis use among cancer patients in the SCCC catchment area.

Methods: A redcap-based questionnaire was administered to patients over 18 at SCCC classified as being within 5 years of initial cancer treatment. The questionnaire was created in collaboration with 11 NCI-designated cancer centers to obtain a harmonized set of questions detailing demographics, cancer site and treatment history, and cannabis use. A preliminary analysis of responses from October 2021 – January

2023, was conducted using SAS to obtain the frequencies of perceived risks and benefits associated with cannabis use before, during and after any cancer treatment.

Results: The patient-sample surveyed (n=266) held a mean age of 47.5 years with 36.6% in active treatment and yielded varying prevalence of cancer type; the most common were breast (14.9%), prostate (6.5%), leukemia (6.2%) and lymphoma (6.2%). Benefits for cannabis use were reported in 75.2% of surveyed patients, noting pain management, stress relief, side effect management, and increased appetite as net benefits for cannabis use. About a third of patients noted cannabis use for stress relief (33.9%) and pain relief (30.4%). Among patients who experienced symptom improvement (n=115), 80.2% noted moderate to major improvements in symptom management. Perceived risks for cannabis use were prevalent among 58.2% of surveyed patients, noting daytime somnolence, headaches and a difficulty concentrating.

Conclusion: Preliminary results indicate that the majority of cancer patients who use cannabis report benefits and symptom improvement and that about 58% report side effects as perceived risks. Future studies should examine the risks and benefits via prospective designs. In the meantime, education programs may consider including potential mitigation for daytime somnolence, headaches and difficulty concentrating to be inclusive of potential outcomes of cannabis use.

Preliminary Analysis of Reasons for “ScreenFails” due to Screening

Criteria of the Herbal Heart Study: A NHLBIFunded Cohort of Young Adults who Consume Cannabis for NonMedical Reasons

Lesharyn Jackson University of Miami

Co-authors: Bria-Necole A. Diggs1, Amrit Baral1, Shay P. Hagan1, Jaya Batyra1 , Waheeda Deen1, Denise C. Vidot1

1University of Miami

Background: The Herbal Heart Study is a cohort study of healthy 18-to-35-yearolds who consume cannabis and do not consume cannabis in South Florida. One of the most important aspects of the Herbal Heart Study involves the screening portion to ensure participants meet inclusion criteria to not bias the results. To date, no studies have published data on screening methods nor evidence-based revisions to screening criteria to a cannabis cohort study. The purpose of this study was to review the screening criteria at the start of the study in 2021 compared to 2023 to create South Florida’s first NHLBIfunded cohort of young adult cannabis consumers and non-consumers.

Methods: A preliminary analysis of screening and documented metrics was conducted by the screening team within the Herbal Heart Study data from 2021 to 2023 to estimate to trends in exclusions, challenges in screening methods, and to document mitigation efforts. Quantitative and qualitative weekly reporting metrics developed for

the Herbal Heart Study were analyzed by the screening team via SAS for quantitative measures and via Dedoose as appropriate for qualitative measures developed by the Herbal Heart Study team.

Results: Screening data between 2021 and 2023 from the Herbal Heart Study cohort is being conducted. Inclusion criteria to the Herbal Heart Study is: Preliminary results suggest two highly prevalent themes in screen-fails: 1) tobacco/cigarette use is more prevalent than hypothesized in this population; a significant proportion attributed to e-cigarette use; 2) Routes of cannabis administration is more diverse than expected; therefore, potential participants have screen-failed due to the self-report a route other than joint, blunt, or vape as their primary route of cannabis use. An example of high prevalence for example is the self-report of dabbing as their primary route of use with occasional blunt and vape use. At the time, investigators did not create a “mixed use” category.

Conclusion: Preliminary results of an analysis of screening criteria and screen fails of the Herbal Heart Study suggest tobacco and mixed route of cannabis use as two prevalent themes in participants not meeting screening criteria for cohort enrollment.

Prevalence of Qualifying Medical Conditions across Florida Medical Marijuana Patients and Florida’s General Population

Sebastian Jugl University of Florida

Co-authors: Nicole E. Smolinski1, Tansu

Aydogan1, Almut G. Winterstein1 1University of Florida

Introduction: Medical Marijuana (MMJ) has been accessible to Floridians with specific medical conditions since 2017. Little is known about the uptake of MMJ across each of these conditions. This study aimed to compare the prevalence of qualifying conditions among MMJ patients with the population-based prevalence of these conditions in Florida.

Method: We extracted the number of each condition listed on MMJ certifications from the 2020 Physician Certification Pattern Review Annual Report, covering the time between October 1, 2018, and September 30, 2019. We then searched scientific peerreviewed literature and national reports for population-based prevalences of conditions in Florida. If no Floridaspecific estimates were available, we prioritized estimates reported for the southern part of the US over national estimates.

Results: The three conditions with the highest prevalence in Florida’s general population were chronic nonmalignant pain (CNP) (20.4%), posttraumatic stress disorder (PTSD) (4.7%), and glaucoma (2.1%), whereas amyotrophic lateral sclerosis (ALS) had the lowest prevalence (0.004 %). The conditions

with the most significant representation in MMJ certification were CNP (36.2%), PTSD (23.9%), and cancer (6.9%), not considering medical conditions of the same kind (25.2%). The conditions with the smallest proportion in certifications were acquired immunodeficiency syndrome (AIDS) and ALS (0.1 %).

By comparing the distributions of conditions on certifications to prevalence estimates in Florida’s general population, our analysis suggests that certain health conditions had higher representation in certifications than expected, including PTSD (23.9% to 4.7%), multiple sclerosis (1.3% to 0.3%), and ALS (0.1% to 0.004%). Conversely, glaucoma (1.5% to 2.1%) and AIDS (0.1% to 0.3%) were underrepresented in certifications.

Conclusion: The prevalence of conditions listed on MMJ certifications suggest differences in the extent to which MMJ is used as treatment modality. Further research is needed to explore whether and how these discrepancies correlate with perceived or evidence-supported risk-benefit profiles of medical marijuana for each of the medical conditions.

Patient Experience with Medical Cannabis: Development of the Utah Medical Cannabis Prospective Cohort Evaluation

Alan Taylor Kelley University of Utah

Co-authors: Clinton J. Hardy1, Michael A. Incze1, Adam J. Gordon12, Kathryn Szcotka1, Kristi Carlston1, Rajiv Radhakrishnan3, Samuel T. Wilkinson3 , Gerald Cochran12

1University of Utah 2VA Salt Lake City Healthcare System 3Yale University

Background: Medical cannabis (MC) use is expanding across the US and is now authorized in 37 states and the District of Columbia. States have authorized cannabis for a wide variety of medical conditions, including chronic pain, post-traumatic stress disorder (PTSD), and cancer. However, knowledge about patient experience with MC and its effects on long-term health are limited. To address this gap, we sought to partner with a state MC program (Utah) to develop an evaluation responsive to program needs.

Methods: We used a formative process based on a community-based participatory research (CBPR) paradigm to develop a proposal to evaluate Utah’s MC program. This involved engaging stakeholders, including state officials, clinicians, and evaluation experts, in iterative discussions to identify evaluation needs and obtain funding.

Results: Stakeholders raised concerns in four areas: (1) patient experience of program enrollees; (2) barriers to MC access; (3) patient-reported effects of MC over time, especially among patients

with chronic pain, PTSD, and cancer; and (4) recommendations for program improvement. We then developed a three-stage mixed-methods evaluation responsive to these concerns. In the first stage, we establish an evaluation advisory board comprised of program enrollees, providers, state officials, and other stakeholders to provide feedback on the evaluation design and implementation. In the second stage, we recruit a cohort of 334 patients, including MC program enrollees and comparable non-enrollees, to assess patient-reported outcomes with sufficient power to detect differences between enrollee and non-enrollee groups with chronic pain, PTSD, or cancer. Patient outcomes will be collected at 6, 12, and 18 months using surveys of patient experience with cannabis use and patient-reported measures of access to MC and physical/behavioral health. We also conduct in-depth interviews for 20 MC program enrollees in the cohort. In the third stage, evaluation advisory board members and a subset of cohort patients meet to discuss barriers and facilitators for long-term extension of the prospective cohort evaluation.

Conclusion: Stakeholders identified patient-reported program experience, treatment effectiveness, access to care, opportunities for improvement as evaluation priorities. Our evaluation is responsive to these priorities and will lay the groundwork to assess long-term outcomes related to MC use.

An Assessment of Farmers’ Perspectives of Medical Marijuana as an Alternative Treatment for Chronic Pain: A Survey

Carmen Lyttle-Nguessan Florida A&M University

Co-authors: Victoria Adigun1

1Florida A&M University

Background: Many farmers suffer from chronic pain conditions needing constant/continuous medical treatment. Research studies found higher drugrelated deaths among rural farming communities due to misuse and a divide in access to health-related information. The literature also suggests that using alternative treatments to opioids to treat chronic pain would be helpful. Given chronic illnesses’ clinical and economic burden on patients and society, it would be beneficial to evaluate any potential treatment options to reach the most desirable outcomes. Knowing individuals’ views of medical marijuana as an alternative treatment for chronic pain may help policy decisions and development.

Objectives: The main aim is to assess individuals’ perspectives about medical marijuana as a treatment alternative for chronic pain.

Methods: A survey designed to elicit individuals’ perspectives on treating chronic pain conditions. Individuals 18 years or older were selected to participate in the study. We developed, pre-test, and administered the revised survey via an electronic anonymous survey link to a farmers’ database. We used descriptive statistics to summarize the data.

Results: Of those responding, 85% would use, and 25% would consider using medical marijuana to treat a covered illness if health authorities designate it as safe and effective. Only eight percent of them were or have ever been medical marijuana patients.

Conclusion: The preliminary results suggest that farmers are willing to use medical marijuana as an alternative treatment for chronic pain. This outcome highlights the importance of accounting for individuals’ perspectives in healthcare policy decision-making.

Association between Positive COVID-19 Diagnosis and Polysubstance Use Behavior Among Cannabis Users During the COVID-19 Pandemic: Preliminary Results from the COVID-19 Cannabis Health Study

Ranya Marrakchi El Fellah University of Miami

Co-authors: Bria-Necole A. Diggs1, Sitara Weerakoon2, Jessica Y. Islam2, Marlene Camacho-Rivera3, Sarah E. Messiah4 , Johis Ortega1, Denise C. Vidot1

1University of Miami 2Moffitt Cancer Center 3SUNY Downstate 4University of Texas

Background: Since the COVID-19 Pandemic was declared a national emergency in March 2020, there has been an increase in substance use (NIH, 2022). In this study, we aimed to evaluate polysubstance use after a positive COVID-19 diagnosis among cannabis users throughout

the COVID-19 pandemic by examining changes in substance use reported among respondents to the COVID-19 Cannabis Health Study.

Methods: An online survey was distributed March 2020 when COVID-19 was declared a pandemic until March 2022. A subsample of cannabis users who received a positive COVID-19 diagnosis was generated for analyses. The COVID-19 Cannabis Health Questionnaire was used to collect selfreport quantitative data on substance use behaviors with Tobacco, Alcohol, Opioids, Methamphetamine, Cocaine and Psilocybin. Prevalence estimates were conducted using SAS Analytics.

Results: The analysis sample consisted of 2,816 participants. From this, 261 self-reported their COVID-19 diagnosis with 70 reporting a positive COVID-19 test result (26.82%). Majority of positive test results were males (n=37) and the majority of positive test results were Non-Hispanic White race/ ethnicity(17.29%). The prevalence of cannabis users with a self-reported positive diagnosis of COVID-19 (26.82%) was higher than non-cannabis users (0.0%). Among cannabis users, the majority of positive COVID-19 diagnoses was associated with less alcohol use (34.29%) than those without a positive diagnosis (p=0.05). With this, 24.29% of positive COVID-19 cases led to an increase in alcohol use. Among cannabis users that tested positive for COVID-19, majority reported never using psilocybin (72.86%), cocaine (80.00%), methamphetamine (98.57%), opioids (91.43%), tobacco (58.57%). However, there was a larger self-reported increase in cannabis use among COVID-19 positive users (52.86%) compared to the majority of non-positive cannabis users reporting no change in their cannabis usage (n=88, 46.07%).

Conclusion: While the study sample

had a limited number of responses to the COVID-19 testing questions, preliminary data begin to show the need to further explore the impact of COVID-19 on substance usage within a larger population. While cannabis usage increased for cannabis users and alcohol usage decreased, the reasons for this change can guide future research in better understanding social behaviors.

Physical Health Impact of Cannabis Vaping Versus Cannabis

Dabbing: A Review of the Literature over the Past Decade

Chase Moed University of Miami

Co-authors: Bria-Necole A. Diggs1, Amrit Baral1, Shay P. Hagan1, Jaya Batra1, Denise C Vidot1

1University of Miami

Background: Cannabis use has increased in prevalence among all age groups over the past decade in the United States. Concurrent to an increased prevalence of use is the increase in routes of cannabis use beyond traditional smoking. Studies have suggested a difference in respiratory disease outcomes based on whether a consumer smoked or vaped cannabis; however, little is known about the cardiovascular health impact of dabbing high concentrates of cannabis and vaping. The purpose of this review is to examine the past 10 years of studies to identify the physical health impact of cannabis vaping compared to cannabis dabbing among all age groups with emphasis on cardiovascular health.

Methods: In February of 2023, a PubMed

search was conducted. Inclusion criteria was: 1) manuscripts published between 2010 to 2023; 2) human subjects; 3) manuscripts available in English; 4) manuscripts about cannabis vaping and dabbing. Exclusion criteria for the initial search was: 1) non-cannabis illicit drugs; 2) manuscripts published before 2010; 3) abstracts without a peer-reviewed manuscript. Initial articles yielded were filtered by date relevance, title relevance, abstract relevance, and full paper relevance. The presentation will focus on results from analyzing results individually and synthesizing key findings.

Results: The following number of articles were found based on search term: “cannabis dabbing AND vaping” = 16; “marijuana dabbing and vaping” = 21; “dab and vape” = 3; “cannabinoid dabbing and vape” = 8. Majority of articles examined prevalence estimates of cannabis use by routes of administration: smoking joint, smoking blunts, vaping, dabbing, edibles, butane hash oil use, water pipe use, etc. Adherent articles ranged in topics such as chemical pneumonitis, pulmonary disease, cancer risk, and inflammatory bowel disease. The presentation will summarize dabbing and vaping within respiratory disease, cancer, and inflammatory disease.

Conclusion: Vaping is the second most common route of cannabis use and dabbing is gaining popularity at an increased rate based on articles excluded. Despite the high prevalence, little is known about the physical health impact of these routes of cannabis administration that require a device and high heat. There were no studies published on cardiovascular disease effects.

Understanding Cannabis Use During Pregnancy: Prevalence, Motivations, and Healthcare Provider

Communication

Vanessa Morales

University of Miami

Co-authors: Cynthia N. Lebron1, Sarah E. Messiah2, Denise C. Vidot1

1University of Miami 2University of Texas

Background: Pregnant women seek information and support on online forums, such as the BabyCenter. com message board, “GanjaMamas”. These discussions include topics like dosage, form of use, and effects on fetal health, indicating a potential lack of support from healthcare professionals. The aim of this study is to explore communication with healthcare providers, prevalence, and reasons for cannabis use among a sample of women who reported using cannabis during pregnancy.

Methods: An online survey was used to collect data on cannabis behaviors from currently or previously pregnant and breastfeeding women. Of the 189 women surveyed, three were excluded because they did not report using cannabis while pregnant, resulting in a final sample of 186 women. The survey collected information on demographics, cannabis use during pregnancy, and interactions with healthcare providers regarding cannabis use. Descriptive statistics were used to report the prevalence of cannabis use during pregnancy, reasons for use, and communication with healthcare providers.

Results: Most participants identified as White (66.13%, n=123) and were born in the United States (86.02%, n=160),

with an average age of 29.80 ± 5.69. The majority reported using cannabis for medical reasons (79.33%, n=142), the most common reasons being to relieve pain (31.68%, n=51), for fun/ relaxation (32.30%, n=52), and to relieve stress/anxiety (17.39%, n=28). The most reported form of cannabis used was oil (e.g., a vape pen) (28.13%, n=45), followed by joints (20.63%, n=33), edibles (13.75%, n=22), and tinctures (13.75%, n=22). Half (55.10%; n=27) reported not discussing cannabis use with their healthcare provider, 20.41% (n=10) reported discussing cannabis use before getting pregnant, and 24.49% (n=12) reported discussing cannabis use after getting pregnant. Among women who discussed cannabis use with their healthcare provider, only 21.71% (n=38) reported discussing alternatives to cannabis use during pregnancy.

Conclusions: The high prevalence of cannabis use during pregnancy in this sample, coupled with the low percentage of women who discussed cannabis use with healthcare providers highlights the need for greater healthcare providers communication in a clinical setting for women who use cannabis during pregnancy. Clinical cannabis research is needed to better uncover the risks and benefits of cannabis use during pregnancy.

The Prevalence of Anxiety and Depression Symptoms in Older Women That Substitute Prescription Medications For Marijuana or CBD

Jocelyn Mueller

University of Central Florida

Co-authors: Karina Villalba1, Jamia Sapp1, Christa Cook1, Dinender Singla1, Jennifer Attonito2, Robert Cook1

1University of Central Florida 2Florida Atlantic University 1University of Florida

Marijuana and CBD are considered as a potential source to reduce symptoms of anxiety and depression. There are growing trends in anxiety and depression patients whether to use marijuana or CBD alone as a therapy or combine CBD with their prescription medications. This study is designed to understand the potential use of marijuana in older women which remains unknown. Additionally, this study aimed to determine whether marijuana or CBD was associated with improved mental health in women between 50 and 64 years old who substituted their prescription medications (e.g., anti-depressants, anxiety). This was an online crosssectional study evaluating a subset of 258 participants who used either marijuana or CBD in the past 12 months. To compare women who substituted their medication to those who did not we dichotomized the following question “substituted marijuana or CBD for anti-depressants or anxiety prescription drugs” (Yes/No). We used the continuous scores for PHQ8 scale to measure depression and the OASIS scale to measure anxiety symptoms.

The t-test was used to measure group differences, and linear regression was used to identify associations between marijuana/CBD use and mental health symptoms. A total of 37% of participants reported moderate to moderately severe symptoms of depression and 46% reported moderate to severe symptoms of anxiety, and 22% substituted marijuana and/or CBD for prescription medication. The mean use for marijuana was 21 days (SD = 65), and CBD was 11 days (SD = 35) per month in the last 12 months. We found significant differences in depression (mean score 11.2 vs. 8.2 p =.001) and anxiety (mean score 8.9 vs. 12.3 p = .001) symptoms in women who substituted prescription drugs reporting worse mental health outcomes compared to women who did not substitute prescription drugs for marijuana or CBD. The linear regression analysis showed a significant positive association between marijuana/CBD use and anxiety and depression (β .32, 95% CI 2.1-4.4; β .19, 95% CI 1.3-4.1, respectively) among women who substituted their prescription medication. It is important to understand the potential effect of marijuana or CBD on mental health treatment and drug prescription substitution.

Assessment of Cannabis Use Before Partnered Sex on Women Who Report Orgasm Difficulty

Suzanne Mulvehill

Female

Orgasm

Research Institute

International Institute of Clinical Sexology

Co-authors: Jordan Tishler12 1Harvard University 2Association of Cannabis Specialists

Objective: Evaluate the effect of cannabis use before partnered sex on women who report difficulty orgasming.

Method: This IRB-approved observational study was conducted between March 24, 2022 and November 18, 2022 using Qualtrics® software. The survey assessed baseline demographics, health status, cannabis use, sexual relationship status, difficulty orgasming, and the orgasm sub-scale questions of the Female Sexual Function Index (FSFI) with and without cannabis use before sex.

Women 18 years and older, who used cannabis and had partnered sex within the last month were invited to take the anonymous, uncompensated survey. Women who were pregnant, breast feeding or using other recreational substances were excluded. Women who reported not using cannabis before partnered sex or not having female genitalia, were excluded from the data analysis.

Findings: There were a total of 1,037 survey responses, with 37% (n=387) completed surveys after exclusion and inclusion criteria were applied. The majority of women 52% (n=202) reported difficulty orgasming, were

between the ages of 25-34 (45%, n=91), reported their race as white, 75% (n=152), were married or in a relationship (82%, n=165), and 50% (n=100) reported being “very satisfied” in their partnered relationship.

In the group of all women the frequency of orgasming increased for 59.2% (229/387, p < .0001) after using cannabis before partnered sex. In the group of 202 women with difficulty orgasming the frequency of orgasming increased 72.8% (147/202, p<0.0001) after using cannabis before partnered sex. Of the women with difficulty orgasming who almost never or never orgasm without cannabis, 28.7% (n=58, p<.0001) achieved orgasm when using cannabis before partnered sex.

Conclusion: We conclude that cannabis use before partnered sex provides women who have difficulty achieving orgasm a 28.7% greater likelihood of orgasming for women who almost never or never orgasm without cannabis and 72.8% increase in frequency of orgasm. A randomized controlled trial is planned to explore cannabis as a treatment for the persistently high percentage of women who have difficulty orgasming.

Preliminary Analysis of Recruitment Methods of

the Herbal Heart Study: A NHLBI-Funded Cohort of Young Adults who Consume Cannabis for Non-Medical Reasons

Tomas Panqueva Baena University of Miami

Co-authors: Bria-Necole A. Diggs1, Amrit Baral1, Shay P. Hagan1, Jaya Batyra1, Waheeda Deen1, Denise C. Vidot1

1University of Miami

Background: The prevalence of cannabis use has increased among adults 18-to35-year-olds in the United States in the past 5 years according to the National Survey on Drug Use and Health. Despite the increase of use, there is a dearth in scientific research of cannabis consumers beyond cross-sectional studies. Among the few cannabis cohort studies published, there is a lack of sociodemographic diversity and published reports on best practices to recruit diverse cannabis consumers to have more representative results to improve health outcomes. The purpose of this study was to review recruitment methods employed to create South Florida’s first NHLBI-funded cohort of young adult cannabis consumers and non-consumers.

Methods: An analysis of recruitment methods and metrics was conducted by the recruitment team within the Herbal Heart Study to identify challenges to recruitment in effort to mitigate. Pivots in recruitment methods and an analysis of strategies employed was conducted by the team using quantitative and qualitative weekly reporting metrics developed for the study.

Results: Recruitment of the first 50 participants in the Herbal Heart Study cohort was conducted. There were three key themes found when reviewing recruitment for cannabis consumers: 1) challenges presented by COVID-19 pandemic lockdowns; 2) challenges with the use of E-Recruitment as a viable tool; and 3) challenges with inperson recruitment at cannabis events in the community. Creative relationship building with community stakeholders was one of the most impactful pivots to mitigate challenges faced by the team. Staff belonging to the age-range being recruited was another impactful pivot identified upon review of recruitment methods and metrics.

Conclusion: A multi-dimensional approach in recruitment methods proved to be most successful in recruiting the first 50 participants of a NHLBI-funded cohort of young adult cannabis consumers and nonconsumers. Challenges included barriers to technology access, competing demands, and in-person recruitment event alignment in eligibility criteria. Future studies should consider the above when creating recruitment strategies for cohort studies of cannabis consumers.

Medical Cannabis Use and Its Impact on Health among Older Adults: Recent Research

Findings and Future Directions

Kendall Robinson University of Florida

Co-authors: Hannah Fechtel1, Alexis Hartog1, Yan Wang1 1University of Florida

Purpose of Review: With the rapidly changing landscape of state level legalization of cannabis, older adults has become one of the fastest growing populations initiating medical cannabis (MC). However, research evidence on the risks and benefits of MC use in this population remains limited. This review aims to synthesize recent literature on the impacts of MC use in older adults and identify critical knowledge gaps to be addressed future research.

Recent Findings: While some adverse events were reported as associated with MC use, it is generally well tolerated in older adults. MC shows some potential as an alternative treatment for symptoms of dementia, pain, nausea and vomiting, and sleep. However, available evidence is inconsistent and tend to be rely on self-report and noncontrolled studies. The great diversity of MC products and lack of standardized dosing guideline may contribute to the conflicting results. Additionally, there are financial and educational barriers associated with the access to MC which may contribute to disparity.

Summary: There is a need for more systematic and rigorous research on MC in older adults to determine its safety and efficacy. Research on dosing

procedures and product characteristics as well as how these may impact health outcomes is crucial. More consistent evidence may lead to policy changes and better education to minimize potential risks and optimize benefits among older adults seeking MC as an alternative treatment.

The Association of Marijuana or CBD Use to Mental Health Among Young, Middle Age and Older Women

Jamia Sapp

University of Central Florida

Co-authors: Jocelyn Mueller1, Dinender Singla1, Robert Cook2, Jennifer Attonito3 , Christa Cook1, Karina Villalba1

1University of Central Florida 2University of Florida 3Florida Atlantic University

There is evidence that age plays a significant factor in the association between marijuana use and mental health. Studies focusing on age group differences are scarce, and even more when focusing on women. The aim of this study was to determine whether marijuana or CBD use is associated with differences in mental health symptoms and to determine whether the association between marijuana or CBD and mental health differs by age groups (young 18-49 vs. middle age 50-64; vs. old age ≥65 years). In 2022, a total of 625 participants were recruited from Florida and Georgia, with (63%) reporting current marijuana or CBD use. We used the PHQ8 scale to measure depression and OASIS to measure anxiety, with higher scores indicating severe levels. The descriptive analysis was done using Chi-Square for categorical variables and a t-test to compare groups. Linear regression was used to identify

associations between marijuana use or CBD and mental health stratified by age groups. The majority identified as White (79%), educated (43%) women who reported being in good health (63%). Most reported an average of 10 mgs of THC and CBD use daily (52% THC, 54% CBD), followed by 11-40 mgs (29% THC, 24% CBD). Significant group difference in anxiety between women that used marijuana or CBD compared to nonuse was observed (p = .02). When age groups were compared, the 18-49 group reported significant differences (mean 11.2 SD=5.3, p=.006) compared to other age groups (middle age, mean 10.0 SD=4.3; old age, mean 7.4 SD =3.8). Results from the regression analyses showed that marijuana or CBD use was negatively associated with anxiety (β -.09, p=.024) and not for depression. For the age group analyses, marijuana or CBD use was negatively associated with anxiety in the 18-49 group (β -.26, p=.001) but not for the other age groups. Studies suggest that THC may potentially decrease anxiety at lower doses but increase anxiety at higher doses, while CBD may decrease anxiety at all doses. However, this study is limited because it’s a cross-sectional analysis. Prospective data will help to determine whether marijuana is causally linked to reductions in anxiety.

Analysis of Certifying Conditions for Medical Cannabis based on the 2017 National Academy of Medicine Report

Elena Stains

Geisinger Commonwealth School of Medicine

than three of such conditions.

Co-authors:

Amy Kennalley1, Alexander Bachir1, Brian J. Piper1

1Geisinger Commonwealth School of Medicine

Background: The National Academies of Sciences, Engineering, and Medicine (NAS) published a report in 2017 of conclusions on the therapeutic effects of cannabis for over 20 conditions based on the highest quality studies available[1]. Our objective was to compare each state’s current qualifying conditions (QCs) with the NAS findings.

Methods: We collected the QCs of each of the 36 states where medical cannabis is legal in 2023[2]. These conditions were divided into the NASestablished categories into which they fit: substantial evidence of effectiveness (chronic pain), moderate or limited evidence of effectiveness (PTSD), limited evidence of ineffectiveness (glaucoma), and no/insufficient evidence to support effectiveness (epilepsy).

Results: The number of QCs for medical cannabis varied widely between states, with South Dakota having the fewest (5) and Illinois the most (52). While 91.7% of states had at least one QC with substantial evidence, on average, only 9.3% of a state’s QCs met this standard. In contrast, 88.9% of states had one or more QCs with limited evidence of ineffectiveness or no/insufficient evidence, and 41.7% of states had more

Twelve states allowed physicians to recommend medical cannabis at their discretion–while three left the decision entirely up to the physician, requiring no specific QCs whatsoever. Of any state’s list of QCs, South Dakota had the highest percentage (20.0%) with substantial evidence, while Massachusetts the lowest (0.0%). Illinois had the highest percentage (53.9%) of QCs not included in the NAS report, while Maryland, Oregon, and South Dakota tied for the lowest percentage (0.0%).

Conclusion: We found that most states are condoning medical cannabis use for conditions that have not been appropriately studied–ALS symptoms, Parkinson’s, opioid dependence—or are known to some degree to be ineffective–dementia symptoms and depression. Thirty states listed one or more QCs that were not included in the NAS report. Overall, these data show: 1) a large gap between statelevel recommendations for medical cannabis and the quality evidence to support them, and 2) the need for more randomized controlled trials using the products currently available in dispensaries.

Disclosures: BJP’s research is supported by the Pennsylvania Academic Clinical Research Center. The other authors have no disclosures.

Mystical Experiences among Cannabis

Consumers before and after Ketamine-Assisted Psychotherapy: Results from a Pilot Study Comparing Psycholytic and Psychedelic Approaches

Nikka Staron

University of Miami

Co-authors: Daniella Batievsky1, Shari Kaplan1, Michelle Weiner1, Denise C. Vidot2

1Spine and Wellness Centers of America

2University of Miami

Background: Ketamine has been identified as a substance that produces consciousness altering effects, known as mystical experiences. This study begins to fill gaps in the literature by conducting a sub-analysis of mystical experiences among medical cannabis consumers who participated in a pilot Ketamine-Assisted Psychotherapy (KAP) intervention study.

Methods: The current analysis is on a same of 10 cannabis consumers from a pilot intervention study comparing psychedelic (n=5) and psycholytic (n=5) KAP approaches. Mystical experiences were measured via the Mystical Experiences Questionnaire (MEQ) administered to all participants after participant’s first, third, and sixth treatment sessions. Data was analyzed via SAS to compare the results of the MEQ at 3 time points (after the first, third, and sixth sessions of six total sessions). The scale was not given to participants at baseline because responses to its questions

are dependent upon having received treatment.

Results: The mean differences in MEQ scores between the psychedelic and the psycholytic group were not statistically significant after participants’ first (T1: p= .46), third (T-2: p=.46) or sixth sessions (T-3: p =.19). Despite limited statistical significance, results do have clinical significance. Results indicate that the participants in the psychedelic treatment group had greater mean scores on the MEQ than the participants in the psycholytic treatment group. Individuals in psychedelic group consistently scored higher on the MEQ than participants who underwent psycholytic ketamine treatment across all timepoints. After their first treatment session, participants in the psychedelic group scored higher than the psycholytic group by 22.8 points. After their third treatment session, participants in the psychedelic group scored higher by 25.6 points. Finally, after their sixth treatment session, those in the psychedelic group scored higher by 33.4 points.

Conclusion: Results of this pilot study suggest that cannabis consumers in the psychedelic group of KAP reported greater mystical experiences than the psycholytic group of cannabis consumers.

The neural consequences and firearm-related deaths among decedents with cannabis use

Armiel Suriaga Florida Atlantic University

Co-authors: Ruth M. Tappen1, Cassandra Atkin-Plunk1, Adam Dobrin2

1Florida Atlantic University

The National Institute on Drug Abuse reported that long-term cannabis use was associated with loss of IQ points, memory impairments, problems with coordination, attention, and time perception, and suicidality, particularly among young adults. While more research is needed to elucidate the role of cannabis in neurocognitive deficits, we aimed to report the neural consequences of decedents with cannabinoids in their system at the time of death.

This study examined de-identified data from the Florida Department of Law Enforcement in 2021. We used descriptive statistics to describe decedents who died from cannabinoidrelated deaths (CRD). We used binary logistic regression to examine the association of cannabis use to firearmrelated injuries or fatalities among these decedents in Florida. All data were analyzed using Stata 17.

A total of 3,845 decedents with CRD in Florida in 2021 were included in the analysis. Age ranged from 0 to 87 years, with a mean age of 38.96 (SD=14.564). Fifty-five out of 3845 people died from cannabinoids as a cause of death, as determined by the medical examiners through urine, autopsy, and toxicology results. Fifty-seven cases involved tetrahydrocannabinol or THC (no

amount specified). Males had more CRD at 3,044 (79.17%) than females at 801 (20.83%). Most decedents were non-Hispanic (n=2,646) or nearly 69%. Neural consequences among 654 cases included stroke, venous thrombosis, anoxic encephalopathy, and head traumas.

While 2, 405 decedents died in accidents while under the influence of cannabis, 530 deaths were homicides, and 389 as suicides, 712 cases were attributable to gunshot wounds or firearm-related deaths (FRD). Six hundred seventy-six decedents with FRD were below 64 years old, with more FRD among the 25-34 age group at 223 deaths, followed by 18-24 at 189 deaths. Those with multiple substances besides cannabis had .42 times the odds of dying from firearm-related injuries than those who used cannabis alone, OR=.413 (95% CI .34- .49).

The results of this study have safety implications, particularly those young adults and the college-aged population with more FRD than older adults. As the risk perception from cannabis use decreases among younger adults, more efforts are needed to curb avoidable deaths from cannabinoids.

Documented Methods to Quantify Cannabis and

Cannabinoid Consumption in Epidemiological Studies: A Review of the Literature of the Past 5 Years

Sol Tobolski University of Miami

Co-authors: Bria-Necole A. Diggs1, Amrit Baral1, Shay P. Hagan1, Jaya Batyra1, Denise C Vidot1

1University of Miami

Background: Cannabis and cannabinoid quantification screening or measurement guidelines have not yet been universally accepted. Lack of universal screening guidelines for identification of cannabis use frequency, cannabinoid use, and route consumed leads to ineffective and time-consuming processes for the identification of cannabis and cannabinoid in a patient’s system. It also leads to lack of uniformity, comparability, and generalizability in the results of cannabis studies. Considering the rapidly changing acceptance of cannabis use in the United States, there is an urgent demand for reliable screening assessment tools for cannabis and cannabinoids to accomplish an effective screening guide that has not yet been universally accepted. To begin that process it is important to understand the current state of literature with respect to cannabis and cannabinoid measurement and quantification screening. The purpose of this review is to examine the past 5 years of studies to identify documented methods of cannabis quantification screening and

measurement in epidemiological studies with emphasis on cardiovascular health.

Methods: In February of 2023, a PubMed search was conducted. Inclusion criteria was: 1) manuscripts published between 2018 to 2023; 2) human subjects; 3) manuscripts available in English; 4) manuscripts about cannabis quantification screening; 5) manuscripts about cannabis measurement. Exclusion criteria for the initial search was: 1) noncannabis illicit drugs; 2) manuscripts published before 2008; 3) abstracts without a peer-reviewed manuscript. Initial articles yielded were filtered by date relevance, title relevance, abstract relevance, and full manuscript relevance.

Results: The presentation will summarize results from analyzing manuscripts individually and synthesizing key overall findings. A preliminary search found the following number of manuscripts based on search term used: “cannabis use quantification” = 205; “marijuana use quantification” = 47; “marijuana dose measurement” = 240; “cannabis dose measurement = 226”. Preliminary review of results indicates self-report, hair, urine, blood, and wastewater to be among the methods used to quantify cannabis and cannabinoids in epidemiological research in the past 5 years.

Conclusion: There are diverse methods to quantify cannabis and cannabinoids. Future studies may consider the diversity in methods to quantify cannabis and employ more than one within their studies.

Predictors of replacing alcohol with marijuana among older and younger adult women

Karina Villalba University of Central Florida

Co-authors: Jennifer

Attonito1, Christa Cook1

1University of Central Florida

The use of alcohol has been increasing among older adults and risks of liver disease, cognitive decline, heart disease, and some cancers are especially high for women who drink regularly. The risks of cannabis use are lesser known, but research thus far suggests that low-to-moderate use of cannabis is not accompanied by the severity of risks seen with similar degrees of alcohol use. This study sought to explore anxiety relief and severity of alcohol use as predictors of substituting marijuana for alcohol among a sample of younger and older women. This was an online cross-sectional study evaluating 298 women who reported use of either marijuana or CBD in the past 12 months. Participants were stratified by age at ≥55 and <55. Predictors included alcohol use severity using the AUDIT instrument (scale of 1-40 with higher scores suggesting more severe use) and degree of relief from anxiety symptoms from marijuana on a scale of 1 (none) to 4 (substantial). Ages ranged from 17 to 81 (mean=54.65; SD=12.72) with 72.2% being 55+. Over 90% identified as non-Hispanic, 84.5% were White race, and 11.1% identified as Black or African American. About 75% had at least some college education and 42.4% were employed. Younger women in this study experienced greater anxiety relief than older women (p=0.011). The mean AUDIT score for the full group was 4.57 (SD=5.92) and there was no significant

difference in mean AUDIT scores between age groups (t=0.906, p=0.183). A total of 46.3% experienced moderate to substantial anxiety relief from marijuana, and 11% of the total sample stated they had substituted marijuana for alcohol. In a logistic regression model (including race, Hispanic ethnicity, and employment status as covariates), only severity of alcohol use among <55 women (OR=6.6, p=0.01) and the degree of relief from anxiety from marijuana use among 55+ women (OR=16.741; p<0.001) predicted replacing marijuana for alcohol. As alcohol use is on the rise among older adults and moderateto-heavy drinking is especially risky for older women, findings from this study indicate that marijuana may serve as a harm reduction therapy among heavier drinkers and older adult women struggling with anxiety.

An analysis of the pharmacokinetic variability of oral cannabidiol in healthy volunteers

Qingchen Zhang

University of Florida

Co-authors: Philip W. Melchert1, Rodrigo Cristofoletti1 1University of Florida

Cannabidiol (CBD) is a medically used compound extracted from the cannabis plant. Epidiolex® CBD solution is the first FDAapproved therapeutic derived from cannabis indicated for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome. Additional pharmacological activity has been attributed to CBD through in vitro research and clinical use,

including anti-inflammatory and anti-oxidative effects. Current clinical research has identified a large degree of variability in CBD pharmacokinetics, but the source of this variability is not yet clear, especially with regard to long-term use of the cannabinoid.

We conducted a healthy volunteer drug-drug interaction study with CBD which permitted us the opportunity to further evaluate potential correlations between CBD pharmacokinetic profiles on the fourth day of administration and individual subjects’ race, gender, age and weight. Twelve healthy subjects (six male and six female) were administered 75 mL of Epidiolex (750 mg CBD orally) twice daily for three days. The subjects were then admitted to a research unit on the fourth day, and their plasma was collected at nine time points over an 8 hour period after CBD administration in the morning. CBD concentrations were then determined by LC/MS-MS.

We analyzed the pharmacokinetic profile of CBD with noncompartmental analysis. In 12 subjects, the maximum plasma concentration (Cmax) is 389.17 ± 153.23 ng/mL (mean ± SD), the total area under the timeconcentration curve (AUCtotal) is 1542.19 ± 488.04 ng/mL*hr (mean ± SD). We further compared the individual PK parameters grouped by age, gender, race and weight. Additionally, we will present a physiologically-based pharmacokinetics model to further characterize the sources of variability in CBD pharmacokinetic parameters.

EXHIBITORS

Cathie Hiegel has been researching cannabis since 2016. She is the author of A Microscopic View of Medical Cannabis, which was published in 2022. Building on analysis from hundreds of research articles, her writing emphasizes the need for more studies related to cannabis.

Every day, the OMMU works to provide qualified patients, caregivers and physicians the information and resources they need to access Florida’s medical marijuana program.

The mission of the Medical Marijuana Education and Research Initiative is to educate and inform Florida’s diverse minority communities about medical marijuana and the potential consequence to health and well-being from recreational use. Learn more.

CONSORTIUM FOR MEDICAL MARIJUANA CLINICAL OUTCOMES RESEARCH

The Consortium for Medical Marijuana Clinical Outcomes Research, founded by the state of Florida legislature, conducts, disseminates and supports research on the clinical effects of medical use of marijuana.

Composed of nine universities in the state of Florida, the Consortium works to enhance the evidence on the safe and effective use of medical marijuana to inform clinical decision-making and guide policy.

Learn more at mmjoutcomes.org.

COMMITTEES Scientific Program Committee

John Crump, MD – Releafe Now

Debra Fadool, PhD – Florida State University

Amie Goodin, PhD – University of Florida

Jeevan Jyot, PhD – University of Florida

Jeff Konin, PhD – Florida International University

Sari Paikoff, PhD – Florida Gulf Coast University

Mandip Sachdeva, PhD – Florida A&M University

Dinender Singla, PhD – University of Central Florida

Rose Stiffin, PhD – Florida Memorial University

Denise Vidot, PhD – University of Miami

Karina Villalba, PhD – University of Central Florida

Almut Winterstein, PhD – University of Florida

Volunteer Abstract Reviewers

Martina Compagno – Florida State University

Robert L. Cook, MD, MPH. – University of Florida

Amie J. Goodin, PhD, MPP – University of Florida

Sebastian Jugl – University of Florida

Jeff Konin, PhD – Florida International University

Catalina Lopez – Quintero, PhD – University of Florida

Philip Melchert – University of Florida

Sunil Nagaraja, PhD – University of Central Florida

Chandrakala Narasimhulu, PhD – University of Central Florida

Juan Perez, MD, MSc – University of Florida

Mandip Sachdeva, PhD – Florida A&M University

Ruba Sajdeya, MD – University of Florida

Dinender Singla, PhD – University of Central Florida

Rose Stiffin, PhD – Florida Memorial University

Denise Vidot – University of Miami

Qingchen Zhang – University of Florida

Consortium Leadership

Almut G. Winterstein, RPh, PhD, FISPE – Director

Robert L. Cook, MD, MPH – Associate Director

Amie J. Goodin, PhD, MPP – Assistant Director, Evidence

Jeevan Jyot, PhD, PMP – Assistant Director, Research Administration

Yan Wang, PhD – Assistant Director, Clinical Core

Sam McKee – Communications Specialist

Consortium Board

William Anderson, PhD (Chair) – Florida International University

Martha S. Rosenthal, PhD (Vice Chair) – Florida Gulf Coast University

Roger B. Fillingim, PhD – University of Florida

Peter Holland, MD – Florida Atlantic University

Eric H. Holmes, PhD – Florida State University

Max C. E. Orezzoli, PhD – Florida Memorial University

Jacqueline Sagen, PhD – University of Miami

Dinender K. Singla, PhD – University of Central Florida

Charles A. Weatherford, PhD – Florida A&M University

Planning Committee

Amie J. Goodin, PhD & Almut Winterstein, PhD – Conference Co-Chairs

Jeevan Jyot, PhD, PMP – Coordination and Logistics

Sam McKee – Marketing and Communications

MEDICAL CANNABIS AND CANNABINOIDS JOURNAL

As the official journal of the Consortium, Medical Cannabis & Cannabinoids will publish the Consortium’s conference proceedings, guidelines, and position statements.

For CCORC 2023, selected abstracts will be published in the Medical Cannabis & Cannabinoids. Read more about Medical Cannabis and Cannabinoids by clicking the ad below.

THANK YOU

On behalf of the Consortium for Medical Marijuana Clinical Outcomes Research’s Scientific Program and Planning Committees, we would like to express our gratitude to all involved in organizing and conducting CCORC 2023, including: keynote speakers, session members, board members, exhibitors, and volunteers. We thank the Creative Works and LifeLong Learning Team as well as the Office of Events at the University of Florida College of Pharmacy for technical support and event coordination. We hope to see you again at CCORC 2023!