CCORC 2025 Program Book

THE FIFTH ANNUAL CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE

May 29-30, 2025

Orlando, FL

WELCOME FROM THE DIRECTORS & CONFERENCE CHAIRS

On behalf of the Consortium for Medical Marijuana Clinical Outcomes Research’s Scientific Program and Planning Committees, we welcome you to our 5th annual conference: Cannabis Clinical Outcomes Research Conference (CCORC), held in Orlando, FL on May 29th – 30th, 2025.

Our past conferences have offered an engaging hybrid venue gathering researchers, clinicians, policymakers, trainees, and other community stakeholders to explore our understanding of the health effects of medical marijuana. We eagerly anticipate another enriching experience this year built upon the momentum of our previous meetings.

One of the most exciting parts of CCORC 2025 is the opportunity to network, socialize, and get involved with cannabis clinical outcomes research. We 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 2025!

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

Amie J. Goodin, PhD, MPP

Assistant Director – Evidence

Consortium for Medical Marijuana Clinical Outcomes Research

PROGRAM AT A GLANCE DAY ONE

Time (EDT) Session Description

9:00-9:20 am Day 1 Welcome Address Δ

Almut Winterstein, PhD

Consortium for Medical Marijuana Clinical Outcomes Research

University of Florida

CCORC 2025 Agenda Overview Δ

9:20-9:30 am

9:30-10:30 am

Amie Goodin, PhD Consortium for Medical Marijuana Clinical Outcomes Research

University of Florida

Keynote: Rethinking Cannabis Use Disorder Treatment: Individualized Risks, Benefits, and Care* Δ

Introduction: Amie Goodin, PhD, University of Florida

Rachel Tomko, PhD Department of Psychiatry and Behavioral Sciences Medical University of South Carolina

10:30-10:45 am Exhibitor Hall | Coffee Break

Presentations of Top Abstracts: Cannabis Use in Specific Populations and Health Conditions

Moderator: Karina Villalba, PhD, University of Central Florida

10:45-11:45 pm

Ava A. Jones University of Houston

Amrit Baral, PhD University of Miami

Isabella Jimenez

University of Miami

Mitchell L. Doucette, PhD Leafwell

Time (EDT)

11:45-1:15 pm

MAY 29TH, 2025

Session Description

Poster Session 1 | Exhibitor Hall | Networking Lunch Reception

Please note lunch will begin at 12:15 pm

Keynote: Effects of Edible Cannabis Use on Pain, Sleep, and Mood* Δ

1:15-2:15 pm

2:15-3:15 pm

Introduction: Md Mahmudul Hasan, PhD, University of Florida

Angela Bryan, PhD

Department of Psychology and Neuroscience

University of Colorado Boulder

Parallel Sessions

Session A: Best Practices and Lessons Learned to Successfully Conduct NIH-/ConsortiumFunded CVD, Cancer, COVID-19, and HIV Cohort Studies of South FL Medical and Adult Cannabis Consumers

Denise Vidot, PhD | Amrit Baral, PhD | Ciné Brown

Bria-Necole Diggs | Kylee Krivijanski | Ranya Marrakchi El Fellah

University of Miami

Session B: Florida State-Based Analyses of Medical Marijuana Utilization: Results from the Medical Marijuana Clinical Outcomes Repository (MEMORY)

Almut Winterstein, PhD | Md Mahmudul Hasan, PhD

Nicole Smolinski, PhD | Earl Morris, PhD | Priyanka Kulkarni

University of Florida

3:15-3:30 pm

Exhibitor Hall | Coffee Break

Time (EDT)

3:30-4:30 pm

MAY 29TH, 2025

Session

Description

Parallel Sessions

Session A: Beyond THC: Exploring the Therapeutic Potential of Non-THC Cannabinoids

Mandip Singh Sachdeva, PhD Florida A&M University

Allan Steigleman, MD University of Florida

Yujia Zhou, MD University of Florida

4:30-5:30 pm

John Stauffer University of Florida

Joseph Wakshlag, PhD Cornell University, Cultivate Biologics

Session B: Epidemiology of Cannabidiol Use in Vulnerable Populations

Liva LaMontagne, PhD | Catalina Lopez-Quintero, PhD

Nicholas Rowe | Lina Velilla Jimenez University of Florida

Poster Session 2 | Exhibitor Hall | Networking Reception

PROGRAM AT A GLANCE DAY TWO

Time (EDT) Session Description

9:00-9:15 am

9:15-10:15 am

Day 2 Welcome Address Δ

Robert Cook, MD Consortium for Medical Marijuana Clinical Outcomes Research University of Florida

Keynote: Developing Cannabis-Based Treatments for Chemotherapy-Induced Peripheral Neuropathy and Adjuvant Anti-Tumor Activity* Δ Introduction: Yan Wang, PhD, University of Florida

Sara Jane Ward, PhD Center for Substance Abuse Research Temple University

Parallel Sessions

Session A: Building Cannabis Community Steering Committees: The National Cannabis Nurse Task Force as a TrustworthinessCommunity-Led Model to Transform Cannabis Clinical Practice from an Epidemiologic-Nursing Perspective

10:15-11:15 am

Renessa Williams, PhD | Denise Vidot, PhD | Francesco Bojorquez | Ranya Marrakchi El Fellah University of Miami

Session B: Advancing the Science of Medical Cannabis: Findings from the Medical Marijuana & Me (M3) Study

Catalina Lopez-Quintero, PhD | Yan Wang, PhD | Robert Cook, MD | Juan Perez | Kendall Robinson University of Florida

11:15-11:30 am Exhibitor Hall | Coffee Break

Time (EDT)

MAY 30TH, 2025

Session Description

Presentations of Top Abstracts:

Cognitive, Physical, and Biological Effects of Cannabis Use

Moderator: Barry Setlow, PhD, University of Florida

11:30-12:30 pm

Emely Gazarov, University of Florida

Teddy Salan, PhD University of Miami

Jennifer Attonito, PhD

Florida Atlantic University

Cataryna Senra University of Miami

12:30-1:00 pm Closing and Awards Ceremony Δ 1:00-2:00 pm Board Meeting and Lunch (Invitation Only)

CE Information

* May be eligible for CME and CPE credits. Please check ccorc.mmjoutcomes. org/continuing-education-credit/ for details. The University of Florida College of Medicine designates this live activity for a maximum of 3.00 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. This program has been approved by the Accreditation for Pharmacy Education for 3.00 hours of continuing pharmacy education credit.

KEYNOTE SPEAKERS

Angela Bryan, PhD

Effects of Edible Cannabis Use on Pain, Sleep, and Mood

Professor, Psychology and Neuroscience

Associate Chair, Faculty Development

Co-Director, CUChange University of Colorado Boulder

Dr. Angela Bryan is a Professor and Associate Chair for Faculty Development in the Department of Psychology and Neuroscience at the University of Colorado Boulder. She is co-director of the CU Center for Health and Neuroscience, Genes, and Environment (CUChange). Dr. Bryan’s research focuses on a transdisciplinary approach to the study of health and risk behavior, and the development of theorybased interventions to improve health behaviors including physical activity and healthy diet and reduce risk behaviors including unsafe sexual behavior and substance use. Recently, she and her colleagues have been heavily focused on the study of the public health implications of cannabis legalization. Funded by NIH, they study harm reduction in the context of high potency concentrates, possible impacts of cannabis use on health behaviors like diet and physical activity, as well as potential benefits of cannabis for pain, anxiety, and sleep.

Research focus: Health and risk behaviors, substance abuse, public health, cannabis use, cannabis effects on pain, anxiety, sleep

Rachel Tomko, PhD

Rethinking Cannabis Use Disorder Treatment: Individualized Risks, Benefits, and Care

Associate Professor, Psychiatry and Behavioral Sciences, Medical University of South Carolina

Dr. Rachel Tomko is a clinical psychologist and Associate Professor in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina. Dr. Tomko’s research focuses on individual differences in response to cannabis to determine who is at risk of developing cannabis use disorder (CUD) as a result of non-medical use. Ongoing work is examining sex and genderspecific recommendations for low-risk non-medical cannabis use, the influence of ovarian hormones on ability to reduce cannabis use during CUD treatment, whether cannabidiol can reduce stress reactivity during cannabis withdrawal, and individual

individual differences in subjective response to delta-9-tetrahydrocannabinol. Methodologically, her research is focused on removing barriers to conducting rigorous and generalizable research through the development and evaluation of screening assessments, outcome measures, and tools to measure adherence with treatment and trial procedures.

Research focus: Cannabis use disorder and treatments, non-medical cannabis use, individual differences in response to cannabis use

Sara Jane Ward, PhD

Developing Cannabis-Based Treatments for Chemotherapy-Induced Peripheral Neuropathy and Adjuvant Anti-Tumor Activity

Associate Professor, Neural Sciences Center for Substance Abuse Research Temple University

Dr. Sara Jane Ward is a tenured Associate Professor in the Department of Neural Sciences and Center for Substance Abuse Research at the Temple University Lewis Katz School of Medicine. Current research in her laboratory focuses on investigating the therapeutic potential of non-psychoactive cannabinoids and terpenes using animal models of pain, neuroinflammation and substance use disorders. Her work on the protective effects of cannabidiol (CBD) in rodent models of chemotherapyinduced neuropathic pain has been supported by the NIH since 2014 and has inspired the implementation of at least two clinical trials in this area.

Research focus: Non-psychoactive cannabinoids, terpenes, effects of cannabidiol (CBD) in rodent models of chemotherapy-induced neuropathic pain

SESSION LEADERS AND SPEAKERS

Ciné Brown, BS

Presenter: Best Practices and Lessons Learned to Successfully Conduct NIH-/ConsortiumFunded CVD, Cancer, COVID-19, and HIV Cohort Studies of South FL Medical and Adult Cannabis Consumers

Postbaccalaureate Research Fellow, Sylvester Comprehensive Cancer Center, University of Miami

Ciné Brown is a first-year postbaccalaureate fellow at the University of Miami’s Sylvester Comprehensive Cancer Center. She graduated with a Bachelor of Science in Health Sciences from the University of Miami in 2024. Currently funded by the American Cancer Society, her research focuses on the role of cannabis in cancer care, particularly in exploring how cannabis use and patient demographics influence cancer-related information-seeking behaviors. Ciné aims to advance equitable, evidence-based interventions that enhance communication, education, and outcomes in oncology care.

Research focus: Cannabis use, cancer care, health communication, patient education, age disparities, health equity, oncology research

Robert L Cook, MD, MPH

Presenter: Advancing the Science of Medical Cannabis: Findings from the Medical Marijuana & Me (M3) Study

Professor, Department of Epidemiology and College of Medicine, University of Florida Director, Southern HIV and Alcohol Research Consortium 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

Bria-Necole Diggs, MSPH

Presenter: Best Practices and Lessons Learned to Successfully Conduct NIH-/ConsortiumFunded CVD, Cancer, COVID-19, and HIV Cohort Studies of South FL Medical and Adult Cannabis Consumers

Co-Coordinator, Herbal Heart Study, University of Miami PhD Student, Epidemiology, Miller School of Medicine

Bria-Necole Diggs is a University of Miami Bachelor of Science in Public Health and Master of Science in Public Health graduate, as well as a Virginia Board of Pharmacy Certified Pharmacy Technician. She is currently an Epidemiology PhD student. Her research interests include plant medicine, specifically cannabis and psychedelics, and chronic health conditions. Bria-Necole has been conducting research within Dr. Vidot’s Global Cannabis and Psychedelic Research Collaboratory for approximately six years on multiple studies involving COVID-19, cancer, the judicial system, and HIV. She is the study coordinator to the Young Adult COVID-19 Transmission and Substance Use Study and the Co-Coordinator to the Herbal Heart Study.

Research focus: Blood diseases and disorders, cannabis, cardiovascular disease, COVID-19, cancer, the judicial system, HIV

Amie Goodin, PhD, MPP

Conference Co-Chair

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

Assistant Director, 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

Md Mahmudul Hasan, PhD, MSc

Presenter: Florida State-Based Analyses of Medical Marijuana Utilization: Results from the Medical Marijuana Clinical Outcomes Repository (MEMORY)

Assistant Professor, Department of Pharmaceutical Outcomes and Policy, Department of Information Systems and Operations Management, University of Florida Assistant Director, Consortium of Medical Marijuana Clinical Outcomes Research

Dr. Hasan is an assistant professor in the Department of Pharmaceutical Outcomes and Policy with a joint appointment in the Department of Information Systems and Operations Management at the University of Florida. He is also the Assistant Director and Faculty Lead of the Medical Marijuana Research Repository (MEMORY) for the Florida state-funded Consortium for Medical Marijuana Clinical Outcomes Research. Prior to joining the UF, Dr. Hasan worked as an ORISE Postdoctoral Fellow of Drug Safety and Artificial Intelligence Methods in the Center for Drug Evaluation and Research at FDA. Dr. Hasan has completed PhD and worked as a postdoctoral research scientist at the Decision Analytics Lab at Northeastern University.

Research focus: Substance use, mental health disorder, opioid related adverse health outcomes, and chronic diseases

Kylee Krivijanski, BS

Presenter: Best Practices and Lessons Learned to Successfully Conduct NIH-/ConsortiumFunded CVD, Cancer, COVID-19, and HIV Cohort Studies of South FL Medical and Adult Cannabis Consumers

Research Assistant, University of Miami

Kylee Krivijanski, a proud University of Miami alumna with a Bachelor of Science in Biochemistry and Nutrition, joined Dr. Vidot’s Cannabis and Psychedelic Research Collaborative as a volunteer in January 2024. Her dedication to advancing the field of plant medicine is evident through her impactful research contributions. With a passion for cardiology, Kylee brings experience from her tenure at the Miami Cardiac and Vascular Institute (MCVI). This expertise has tied greatly into her work with the Herbal Heart Study, where she explores the effects of cannabis on cardiovascular health. Kylee is committed to furthering her career in cardiology, with aspirations to pursue an M.D.

Research focus: Cannabis, cardiovascular disease, cardiovascular health

Priyanka Kulkarni, MPH

Presenter: Florida State-Based Analyses of Medical Marijuana Utilization: Results from the Medical Marijuana Clinical Outcomes Repository (MEMORY)

PhD Student, Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida Research Assistant, Consortium for Medical Marijuana Clinical Outcomes Research

Priyanka Kulkarni, MPH is a PhD student at the Department of Pharmaceutical Outcomes and Policy and a Research Assistant working at the Consortium for Medical Marijuana Clinical Outcomes Research. She is a registered pharmacist from India, and currently, her research focuses on using pharmacoepidemiologic methods to investigate safety, effectiveness and utilization patterns of drugs among pregnant individuals and individuals with chronic illnesses.

Research focus: Using pharmacoepidemiologic methods to assess utilization patterns of drugs and the impact of policy interventions

Ranya Marrakchi El Fellah, MPH

Presenter: Best Practices and Lessons Learned to Successfully Conduct NIH-/ConsortiumFunded CVD, Cancer, COVID-19, and HIV Cohort Studies of South FL Medical and Adult Cannabis Consumers

Presenter: Building Cannabis Community Steering Committees: The National Cannabis Nurse Task Force as a TrustworthinessCommunity-Led Model to Transform Cannabis Clinical Practice from an Epidemiologic-Nursing Perspective

Co-Study Coordinator, Herbal Heart Study, University of Miami Director of Volunteer Management/Research Assistant, Global Cannabis and Psychedelics Research Collaboratory

Ranya Marrakchi, a University of Miami medical graduate specializing in Epidemiology, is passionate about advancing public health and health equity. She began her research journey as a fellow in the NIH-funded Minority Health and Health Disparities Research Training Program, where she trained under her mentor Dr. Denise C. Vidot supporting HIV and cannabis research. Now a research assistant focused on cannabis and psychedelics, Ranya is committed to improve the heath of populations through science-based solutions.

Research focus: Medical Cannabis, Mental Health, Health Disparities, Sustainable Health Systems, Global Health, Complementary and Alternative Medicine

Liva G LaMontagne, PhD

Presenter: Epidemiology of Cannabidiol Use in Vulnerable Populations

Postdoctoral Fellow, NIDA T32 Substance Abuse Training Center in Public Health

Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida

Dr. Liva LaMontagne is a postdoctoral fellow within the Department of Epidemiology, College of Public Health & Health Professions and College of Medicine at the University of Florida studying how cannabis use affects pain severity and sleep quality among older adults.

Research focus: Cannabis, pain, sleep, older adults

Catalina Lopez-Quintero, MD, PhD, MPH

Presenter: Epidemiology of Cannabidiol Use in Vulnerable Populations

Presenter: Advancing the Science of Medical Cannabis: Findings from the Medical Marijuana & Me (M3) Study

Assistant Professor, Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida

Dr. Catalina Lopez-Quintero’s research focuses on examining the complex interactions between drug use and neuropsychological processes, socio-cultural factors, and contextual-level factors and its impact on health. Through her research, Dr. Lopez-Quintero aims to inform the design of effective and developmentally appropriate drug use prevention and treatment interventions, as well as public health policy. Dr. Lopez-Quintero’s federally and state-funded research on cannabis and medical cannabis spans several key areas, including epidemiological studies among diverse population groups as well as clinical trials investigating whether medical cannabis is safe and effective in improving mental health and neurobiological outcomes. Through her research, she aims to provide a balanced understanding of both the benefits and risks associated with cannabis and medical cannabis use.

Research focus: Medical cannabis, cannabis use disorder, population neuroscience, neurobiological and mental health outcomes, polydrug use

Earl J Morris, PharmD, MPH, PhD

Presenter: Florida State-Based Analyses of Medical Marijuana Utilization: Results from the Medical Marijuana Clinical Outcomes Repository (MEMORY)

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

Dr. Morris is a pharmacoepidemiologist with a primary focus in leveraging rigorous methods to answer clinically relevant questions in the areas of geriatric polypharmacy and cardiometabolic disease. He received a Pharm.D. degree and M.P.H. degree from the University of Arkansas for Medical Sciences and a Ph.D. in Pharmaceutical Sciences from the University of Florida. His research aims to improve the identification of adverse drug events, especially among older adults, and to better understand unintended cardiometabolic consequences of commonly used medications. He was awarded a 2024 consortium grant to study the cardiovascular effects of medical cannabis using linked data from the Florida Medical Marijuana Use Registry and Medicaid claims.

Research focus: Medical cannabis, cardiovascular disease, Medicaid, pharmacoepidemiology

Juan G Perez-Carreno, MD, MSc

Presenter: Advancing the Science of Medical Cannabis: Findings from the Medical Marijuana & Me (M3) Study

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

Kendall Robinson, BS

Presenter: Advancing the Science of Medical Cannabis: Findings from the Medical Marijuana & Me (M3) Study

PhD Student, Department of Epidemiology, University of Florida

Kendall Robinson is a second year PhD student in Epidemiology at the University of Florida. She received her Bachelor of Health Science from the University of Florida before joining the Department of Epidemiology to study the short- and long-term effects of medical cannabis use in older adults with chronic pain. In addition, she is currently involved with research on the sexual and reproductive health of women with HIV who use substances.

Research focus: Medical cannabis, chronic pain, substance use, sexual and reproductive health

Nicholas Rowe, BA

Presenter: Epidemiology of Cannabidiol Use in Vulnerable Populations

Research Volunteer, Department of Epidemiology, University of Florida

Nicholas Rowe graduated from the University of Florida in 2020 with a Bachelor of Arts in Political Science. He was awarded Summa Cum Laude for his thesis focused on the decrease of welfare caseloads in response to U.S. state policy decisions. He has been a research volunteer since August 2024 in Dr. Catalina Lopez-Quintero’s lab in the department of Epidemiology at the University of Florida. He is currently taking prerequisite coursework at Santa Fe College in preparation for his application to medical school. His research interests are CBD and cannabis usage patterns in vulnerable populations.

Research focus: CBD use, cannabis use, adolescents, health disparities, drug use patterns

Mandip Singh Sachdeva, PhD

Presenter: Beyond THC: Exploring the Therapeutic Potential of Non-THC Cannabinoids

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: Cancer drug delivery (breast and lung cancer), 3D-printing of tumor cells and human cornea, topical and transdermal delivery

Barry Setlow, PhD

Moderator: Presentations of Top Abstracts: Cognitive, Physical, and Biological Effects of Cannabis Use

Professor and Co-Chief of Research, Department of Psychiatry, Center for Addiction Research and Education, University of Florida

Dr. Barry Setlow is a professor in the Department of Psychiatry at University of Florida. His research focuses on the consequences of cannabis and cannabinoid use on cognitive functions in aging, and the neural mechanisms by which such use interacts with age-related cognitive changes. Additional research in his lab evaluates mechanisms by which cannabis interacts with other drugs of abuse such as cocaine and opioids.

Research focus: Cannabis, cannabinoids, aging, cognition, polysubstance use

Nicole Smolinski, PharmD, PhD

Presenter: Florida State-Based Analyses of Medical Marijuana Utilization: Results from the Medical Marijuana Clinical Outcomes Repository (MEMORY)

Research Assistant Professor, Department of Pharmaceutical Outcomes and Policy, University of Florida

Dr. Nicole Smolinski is a research assistant professor at University of Florida. She is a licensed pharmacist and pharmacoepidemiologist whose research focuses on child and maternal health. She has expertise in pregnancy safety work including risk mitigation strategies as well as pediatric infectious diseases and antibiotic overutilization. Her medical marijuana research focuses on pediatric and young adult utilization and safety. Future work will also include medical marijuana use during pregnancy in Florida.

Research focus: Child and maternal health, medical marijuana, pediatric infectious disease, drug safety

John Stauffer, MS

Presenter: Beyond THC: Exploring the Therapeutic Potential of Non-THC Cannabinoids

PhD Student, University of Florida Research Coordinator, Sports Medicine & Human Performance Research Laboratory

John Stauffer is the Research Coordinator at the Sports Medicine & Human Performance Research Laboratory at The University of Florida. In 2021, John received his bachelor’s degree in Health, Exercise and Sports Studies from Denison University. In 2023, John received his Master of Science in Applied Physiology and Kinesiology at the University of Florida. He is now working toward his PhD in Sports Medicine at the University of Florida. He is currently involved with clinical research, observing pain management and modulation through drug and technology mechanisms.

Research focus: Cannabis use, alcohol use, anxiety, depression, childhood abuse, intimate partner violence

W Allan Steigleman, MD

Presenter: Beyond THC: Exploring the Therapeutic Potential of Non-THC Cannabinoids

Director of Refractive Surgery, Cornea, External Disease and Refractive Surgery

Associate Professor, College of Medicine, University of Florida

After more than 25 years in the Navy, Dr. Allan Steigleman is now a cornea and refractive surgery specialist at the University of Florida College of Medicine in Gainesville, Florida. He is an active clinician treating a host of complicated corneal conditions as well as complex cataract surgery. He has a special interest in refractive surgery and performs a variety of laser and lens implant procedures. His clinical research pursuits have been mainly focused on refractive surgery outcomes and pain control.

Research focus: Refractive surgery techniques, pain control, corneal infections, patient safety and quality improvement

Karina Villalba, PhD, MPH, MBA

Moderator: Presentations of Top Abstracts: Cannabis Use in Specific Populations and Health Conditions

Assistant Professor, Violence Against Women Faculty

Cluster, Department of Population Health Sciences, College of Medicine, University of Central Florida

Dr. Karina Villalba is a behavioral researcher with a Ph.D. in Public Health and a specialization in Health Behavior, as well as an MPH in Environmental Health, from Florida International University. Dr. Villalba’s research focuses on the therapeutic potential of cannabis and cannabinoids, particularly cannabidiol (CBD), in the treatment and management of mental health and substance use disorders. Her work focuses on the role of cannabinoids in stress regulation, inflammation, and neurocognitive processes such as memory reconsolidation, with a specific emphasis on conditions like post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD). She also conducts epidemiological studies on the concurrent and simultaneous use of cannabis and alcohol, with a focus on their combined impact on health outcomes and addiction risk.

Research focus: Cannabis use, cannabinoids, PTSD, alcohol use disorder, health outcomes, addiction risk

Denise C Vidot, PhD

Presenter: Best Practices and Lessons Learned to Successfully Conduct NIH-/ConsortiumFunded CVD, Cancer, COVID-19, and HIV Cohort Studies of South FL Medical and Adult Cannabis Consumers

Presenter: Building Cannabis Community Steering Committees: The National Cannabis Nurse Task Force as a Trustworthiness-Community-Led Model to Transform Cannabis Clinical Practice from an EpidemiologicNursing Perspective

Associate Professor, Schools of Medicine, Nursing and Health Studies Director, Global Cannabis & Psychedelics Research Collaboratory, University of Miami Director, Community + Stakeholder Engagement, Miami Clinical Translational Science Institute

Dr. Denise Vidot is an epidemiologist certified in cannabis patient care who oversees a team of teams focused on improving health though integrative medicine in the US, Jamaica, Italy, and Egypt. She is the Principal Director for 5 ongoing studies focused on cannabis, and 2 dedicated to characterizing psilocybin use in cancer and COVID-19 survivors. She is dedicated to training the next generation of holistic scientists and clinicians from a community-centered approach.

Research focus: Medical cannabis, co-use of cannabis and psilocybin, chronic disease, health disparities

Lina Velilla Jimenez

Presenter: Epidemiology of Cannabidiol Use in Vulnerable Populations

PhD Student, Department of Epidemiology, College of Public Health and Health Professions, University of Florida

Research focus: Medical cannabis, cannabidioil, epidemiology, depression, Alzheimer’s disease

Joseph Wakshlag,

DVM, PhD, DACVIM, DACVSMR

Presenter: Beyond THC: Exploring the Therapeutic Potential of Non-THC Cannabinoids

Professor, Clinical Nutrition, Cornell University CSO, Cultivate Biologics

Dr. Wakshlag has been in academia for over 25 years and is a Professor at Cornell University College of Veterinary Medicine. He is well published in various fields of companion and agricultural domestic animals. Over the last 6 years he has been focused on the use of hemp related cannabinoids in domestic animal species and has recently collaborated on human cannabinoid consumption and pharmacokinetics of full spectrum hemp extracts.

Research focus: Canine and Feline osteoarthritis, canine cancer cell biology, CBD rich hemp extract pharmacokinetics

Yan Wang, PhD

Presenter: Advancing the Science of Medical Cannabis: Findings from the Medical Marijuana & Me (M3) Study

Associate Professor, Department of Epidemiology, University of Florida

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

Yan Wang is an Associate 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

Renessa S Williams, PhD, RN

Presenter: Building Cannabis Community Steering Committees: The National Cannabis Nurse Task Force as a TrustworthinessCommunity-Led Model to Transform Cannabis Clinical Practice from an Epidemiologic-Nursing Perspective

Assistant Professor, School of Nursing and Health Studies, University of Miami

Dr. Renessa Williams is a cannabis nurse scientist and psychiatric registered nurse whose research addresses the complex interplay of individual (e.g., depression), interpersonal (e.g., discrimination), and structural (e.g., racism) factors that contribute to health inequities among individuals living with HIV. She currently serves as the Principal Investigator of a Patient-Oriented Mentored Career Development Award (K23), which expands upon her prior work examining the relationship between serum-derived cannabis use, minority stress, and inflammation in Black men with HIV. This study serves as a critical platform to bridge the gap between cannabis research, clinical practice, and health policy.

Research focus: Cannabis, stigma, HIV, community engagement

Yujia Zhou, MD

Presenter: Beyond THC: Exploring the Therapeutic Potential of Non-THC Cannabinoids

Resident, Department of Ophthalmology, University of Florida College of Medicine

Dr. Yujia Zhou is a 2nd-year resident of Ophthalmology at the University of Florida. He has a background in photochemistry and attended medical school at the University of Florida. After graduation, he completed a research fellowship at the Massachusetts Eye Research and Surgery Institution before matching at the University of Florida where he is currently in residency. He has an interest in visual perception, ocular trauma, and neuro-ophthalmology and intends to pursue neuroophthalmology fellowship after residency.

Research focus: Medical marijuana, ophthalmology, pain medicine, refractive surgery, patient-reported outcomes

Almut G Winterstein, RPh, PhD, FISPE

Conference Co-Chair

Presenter: Florida State-Based Analyses of Medical Marijuana Utilization: Results from the Medical Marijuana Clinical Outcomes Repository (MEMORY)

Distinguished Professor, Department 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

PRESENTERS OF TOP ABSTRACTS

Jennifer Attonito, PhD

Abstract: Descriptive Outcomes from a Survey Investigating Cannabis Use Patterns Among Florida Adults at Risk for Alcohol Use Disorder

Instructor, Health Administration Programs, College of Business, Florida Atlantic University

Jennifer Attonito, Ph.D. has been an instructor and researcher at Florida Atlantic University since 2014. Previously, Dr. Attonito worked as an HIV education director at the New York City Department of Health, American Foundation for AIDS Research, and the University of Miami Pediatric Infectious Disease Department. A 2021 MMJCOR grantee, Dr. Attonito has investigated knowledge and beliefs around MMJ among healthcare providers in Florida’s long-term care settings. She is presently exploring impacts of CBD compounds on PTSD and alcohol cravings, as well as drivers behind opting to use illicit cannabis among adults who would qualify for the state MMJ program.

Research focus: CBD clinical outcomes, alcohol use and misuse, state and federal cannabis policy

Amrit Baral, MBBS, MPH, PhD

Abstract: Sleep Disorders Among Current and Former Cannabis Consumers Living with Cancer at an NCI-Designated Cancer Center

Research Fellow, Global Cannabis and Psychedelics Research Collaboratory, School of Nursing and Health Studies, University of Miami

Dr. Amrit Baral is a founding member of the Global Cannabis and Psychedelics Research Collaboratory at the University of Miami, where he serves as the Lead Biostatistician for the NHLBI-funded Herbal Heart Study, investigating the effects of cannabis, cannabinoids, and routes of administration on sub-clinical cardiovascular risk. Dr. Baral also serves as Study Coordinator for an NCI-funded project at Sylvester Comprehensive Cancer Center examining patterns of cannabis and psychedelics use among cancer patients. In July 2025, he begins his tenure as a T32 Post-Doctoral Research Fellow at Johns Hopkins University.

Research focus: Cannabis, classic psychedelics, chronic diseases, cancer, palliative care

Mitchell L Doucette, PhD, MS

Abstract: Impact of Medical Cannabis Treatment on Healthcare Utilization in Patients with Posttraumatic Stress Disorder: A Retrospective Cohort Study

Senior Research Director, Leafwell

Dr. Doucette is a trained public health scholar and currently the Senior Research Director at Leafwell. He earned his PhD from Johns Hopkins Bloomberg School of Public Health in 2018. His research interests include estimating the impact of policies, programs, and therapeutics on population-level health. Dr. Doucette has published over 35 peer-reviewed manuscripts, winning the Best Paper of the Year award from the American Journal of Public Health (2018) and the Journal of Urban Health (2022). His work has been featured in numerous media outlets and has been cited by the US Supreme Court.

Research focus: Causal inference, epidemiology, health economics and outcomes research, medical cannabis, effects of policy, real-world data

Emely Gazarov, MS

Abstract: The Effects of Oral Delta-9-THC Administration on Intertemporal Decision Making in Aged Rats

Graduate Student, Department of Neuroscience, University of Florida

Emely Gazarov is a second-year Neuroscience PhD student at the University of Florida, mentored by Drs. Barry Setlow and Jennifer Bizon. After earning an MS in Neuroscience in the same laboratory, she is continuing her cannabis-related research for her doctoral degree. Her current work investigates how cannabis exposure interacts with aging to influence cost-benefit decision making and the neural circuits that underlie these behaviors.

Research focus: Cannabis, aging, decision-making

Isabella Jimenez, BS

Abstract: Cannabis Use Patterns among Women Receiving Treatment for Gynecological Cancers at an NCI-Designated Cancer Center

MPH Student, University of Miami Miller School of Medicine Research Assistant, School of Nursing and Health Studies, University of Miami

Isabella is a graduate student in the Online MPH Program at the University of Miami. Since joining Dr. Denise Vidot’s lab, she has been able to take part in multiple research studies focused on cannabis and health. Her research interests lie in community and women’s health, chronic pain, and autoimmune diseases. She plans on applying to medical school and hopes to apply her research clinically in the future. Isabella is excited to be presenting at CCORC again.

Research focus: Cannabis, cancer, gynecological cancer, cannabis use patterns

Ava A Jones, BA

Abstract: Mobile Intervention to Address Cannabis Use Disorder Among Black Adults: A Proof-of-Concept Randomized Controlled Trial

Graduate Student, Clinical Psychology Program, University of Houston

Ava Jones is a first-year graduate student in the Clinical Psychology program at the University of Houston. Her research interests center on the effects of psychological stress related to minority status on addiction, mental health, and physical health. Within this area, she is particularly interested in exploring the systemic and individual risk factors that contribute to health inequalities in psychopathology and addiction.

Research focus: Addiction, mental health, health disparities, systemic risk factors

Teddy Salan, PhD

Abstract: Effect of Cannabis Use on Brain Metabolites in People with HIV Using WholeBrain Magnetic Resonance Spectroscopic Imaging

Research Assistant Professor, Department Radiology, University of Miami

Dr. Salan is a research assistant professor in the Department of Radiology, at the University of Miami. His research interests focus on the development of novel brain MRI processing and analysis techniques, for evaluating the neurophysiological processes that underlie various pathologies and other conditions on the brain, such as HIV, aging, AD, MS, TBI, and stroke. Dr. Salan is currently leading projects that investigate the effect of various interventions and treatment options on brain metabolism and morphology, and was involved in a recently completed MMJ Consortium-funded project evaluating the immune-modulatory effect of cannabis in the brains of people with HIV.

Research focus: Neuroimaging, neurodegenerative diseases, HIV, aging, cannabis as complimentary treatment.

Cataryna Senra, BS

Abstract: Age-Group Differences in Objectively Measured Abnormal Blood Pressure by Frequency of Cannabis Use within the Herbal Heart Study

Graduate student, Barry University

Cataryna is a recent graduate of the University of Miami, where she earned a dual degree in Microbiology and Immunology and Public Health, complemented by a minor in Sports Medicine. She is currently pursuing a master’s degree in Biomedical Sciences. While being a research volunteer in Dr. Vidot’s Global Cannabis and Psychedelics Collaboratory, she has had the opportunity to present research findings at conferences with Herbal Heart. She aspires to pursue MD/MPH programs in medical school, where she aims to merge her research experience with her dedication to public health and combine evidence-based medicine with compassionate patient care.

Research focus: Cannabis, cardiovascular health, cannabis use type, cannabis use frequency, blood pressure

ABSTRACTS

ORAL PRESENTATIONS OF TOP ABSTRACTS

Descriptive Outcomes from a Survey Investigating Cannabis Use Patterns Among Florida Adults at Risk for Alcohol Use Disorder

Jennifer Attonito, PhD Florida Atlantic University

Co-authors:

Karina Villalba, University of Central Florida

Background: Heavy alcohol use increases the risk of alcohol use disorder (AUD), contributing to significant personal, societal, and healthcare burdens. While evidence-based treatments exist, many individuals struggle with adherence or access. Emerging research suggests cannabis derivatives, particularly cannabidiol (CBD) and tetrahydrocannabinol (THC), may help reduce alcohol consumption. However, cannabis use patterns among individuals at risk for AUD remain poorly understood, and further research is needed.

Objectives: This study examines cannabis use among Florida adults at risk for AUD, defined as women consuming ≥8 drinks per week or ≥4 per sitting and men consuming ≥15 drinks per week or ≥5 per sitting. We assess demographic and clinical characteristics, alcohol use severity, readiness to change, and history of cannabis use for alcohol dependence, including reported effectiveness and product preferences.

Methods: A total of 451 adults in Central Florida and Palm Beach County completed a Qualtrics survey. Participants provided demographic data and completed validated measures of alcohol use severity (AUDIT), depression (PHQ-9), anxiety (GAD-7), and readiness to change (RCQ-12). They also reported their history of using CBD or marijuana to reduce alcohol consumption, their perceived effectiveness, and their preferred CBD-to-THC ratios. Additionally, we assessed comorbid conditions commonly managed with cannabis, such as anxiety, depression, PTSD, insomnia, and chronic pain. Sex-based differences were analyzed across all collected variables.

Results: The sample had a mean age of 45.12 years (SD = 14.29); 47.7% were female, 16.9% Hispanic, 16.4% Black, and 96.9% had at least a high school diploma. The mean AUDIT score was 19.19 (SD = 11.47), with men scoring significantly higher (p < 0.001), indicating high risk for alcohol dependence. Men drank more weekly than women (21.54 vs. 16.61 drinks; SD = 11.5, 10.89) and were more likely to use CBD for alcohol dependence (59.7% vs. 45.5%). Among those who used CBD or marijuana, over half reported it as effective. The majority preferred equal CBD-to-THC ratios. Women had higher self-reported rates of anxiety (59.5% vs. 48.7%; p = 0.014), PTSD (34.4% vs. 22.5%; p = 0.003), and insomnia (50.7% vs. 37.3%; p = 0.003).

Conclusion: These findings highlight the severity of AUD among at-risk drinkers in Florida and the high prevalence of comorbid mental health conditions. A significant proportion reported using cannabis to manage alcohol dependency, with many perceiving it as effective. Future research should explore cannabisbased interventions as strategies for AUD treatment and assess their long-term effectiveness.

Sleep Disorders Among Current and Former Cannabis Consumers Living with Cancer at an

NCI-Designated Cancer Center

Amrit Baral, PhD University of Miami

Co-authors:

Bria-Necole Diggs1, Michelle Thompson1, Girardin Jean-Louis1, Denise C Vidot1

1

University of Miami

Background: The endocannabinoid system is a complex network of receptors and neurotransmitters that have been shown to regulate sleep physiology. Cannabis has been shown to impact cancer- and sleep-related health independently. Despite this, research examining the interrelationship with all three: cannabis, sleep, and cancer is sparse.

Objective: To estimate the prevalence of sleep disorder in current, former, and never cannabis consumers who are patients within an National Cancer Institute-designated cancer center.

Methods: Data are from the Cannabis and Cancer study (N=437) of adult cancer survivors at Sylvester Comprehensive Cancer Center. Participants were recruited from MYUChart notification, flyers, and physician referral. Cannabis was self-reported as current (last use within the last 30-days), former (use beyond 30-days ago), and never use (no lifetime use). Sleep disorder diagnosis was reported via a medical history questionnaire. Cancer stage, active treatment status, demographics, and other substance use was reported. Chi-squared tests were employed to examine the differences in proportions between groups. Multivariable logistic regression analysis assessed the association between cannabis use and sleep disorders.

Results: The overall sample [mean age= 49.8 years (SD=15.6) 49.2% female, 41.7% Hispanic/Latino] consisted of 45.5% current cannabis consumers, 25.4% former cannabis consumers, and 29.1% non-cannabis consumers. Sleep disorder diagnosis was reported by 16.5% of the sample of adults living with cancer. Non-cannabis consumers had a higher prevalence of reported sleep disorders (29.9%) than current cannabis consumers (10.6%) and former cannabis consumers (11.7%, p<0.0001), combined. Most (75.1%) of the sample was in active cancer treatment. Sleep disorders were reported in 11.1% of cannabis consumers in active cancer treatment compared to 33.3% of non-consumers in active cancer treatment. After adjusting for age, cancer stage, sex, race/ethnicity, cancer treatment status, alcohol and tobacco use, current cannabis consumers had a 0.196 odds of reporting a sleep disorder than non-cannabis consumers (95% CI: 0.098 - 0.393); former cannabis consumers had 0.330 odds of reporting a sleep disorder than non-cannabis consumers (95% CI: 0.154 - 0.707).

Conclusion: Adults living with cancer who have a history of former or current cannabis consumption had lower odds of reporting sleep disorder diagnosis than non-consumers; the relationship persisted after adjusting for demographics, cancer details, and alcohol and tobacco use. Future studies should be prospective and include objective measurements of sleep, cannabis use, and cancer status.

A CBD-rich hemp supplement was effective in reducing strength loss but did not improve the rate of strength recovery after strenuous exercise

John W Stauffer University of Florida

Co-authors: Joshua A Crow2, Jenessa L Bailey1, Robert L Cook1, Paul A Borsa1 1University of Florida, 2Augusta University

Background: Hemp-based supplements that use CBD-rich extracts have increased in popularity among physically active adults. Research indicates that CBD may have a promising therapeutic potential and is of particular interest due to its positive safety profile and non-intoxicating effects. However, very little is known about how CBD functions in the human body from both an efficacy and mechanistic perspective. Additionally, no published research has shown how CBD-rich hemp extracts may influence muscle fatigue and exercise performance.

Objective: Our objective was to investigate the impact of a controlled short-term trial of CBD supplementation on fatigue resistance following a bout of high intensity resistance exercise (HIRE).

Methods: A double-blind, randomized, two-arm study design was used with participants randomly assigned to either a CBD dose group or a placebo control group. Participants completed a 15-day study trial which included baseline testing, supplementation (CBD/placebo dosing regimen), and follow-up assessments in otherwise healthy men (n=9) and women (n=20) [age: 20.1 yrs, weight: 64.2±8.5kg, height: 169±5.3cm]. Participants self-administered the investigational product (CBD or placebo) under the tongue (sublingual) twice daily for 15 days. Daily dosage of CBD was 67mg. Participants completed a HIRE for the quadriceps muscle group on day 10 of supplementation with strength measurements (maximal voluntary contractions or MVCs) completed pre- and post-exercise to determine the level of strength loss and muscle fatigue (fatigue index). In addition, pre-exercise (day 10) and follow-up strength measurements were completed on days 11 through day 15 (24 to 96-hours post-exercise) to determine the rate of strength recovery. Results: Fatigue indices showed that participants who used CBD demonstrated less strength loss [CBD 28.1 v. PLA 41.2 Nm/Kg] and fatigue [CBD 21.8% v. PLA 32.6%] (F(1,28) =3.7, p=0.07) after exercise. No differences for the rate of strength recovery were demonstrated between groups post-exercise.

Conclusions: A CBD-rich extract administered sublingually may attenuate strength loss and reduce the onset of fatigue after strenuous exercise. Clinical studies using larger sample sizes are needed to confirm the reported trends in physically active adults.

Impact of Medical Cannabis Treatment on Healthcare Utilization in

Patients with Post-traumatic Stress Disorder: A Retrospective

Cohort Study

Mitchell L Doucette, PhD Leafwell

Co-authors: D Luke Macfarlan1, Mark Kasabuski1, Emily Fisher1, Junella Chin1

1Leafwell, Health Economics and Outcomes Research Division

Introduction: Medical cannabis is increasingly used as a therapy for managing posttraumatic stress disorder (PTSD). Patients with PTSD often have high healthcare utilization rates, particularly for acute services. This study examines the association between medical cannabis treatment and healthcare utilization among patients with PTSD.

Methods: We conducted a retrospective cohort study using cross-sectional data with tem-poral elements, derived from administrative records provided by Leafwell, among patients with PTSD. The cohort was defined based on medical cannabis use: the treated group included patients who had used medical cannabis for at least one year (returning for medical card renewal), while the untreated group consisted of cannabis-naive patients reporting no prior cannabis use. The primary outcomes were healthcare utilization within the past six months, including at least one urgent care visit, emergency department (ED) visit, or hospitalization related to their primary medical condition. We used inverse probability weighting with regression adjustment (IPWRA) to estimate the average treatment effect (ATE) of medical cannabis use on healthcare utilization, controlling for key demographics and health factors, including PTSD severity. Sensitivity analyses were conducted to assess the robustness of our findings.

Results: Among the 1,946 participants, the treated group (n = 1,261) had significantly lower healthcare utilization rates compared to the untreated group (n = 685). Using the doubly robust IPWRA model, medical cannabis treatment was associated with a significant 35.6% reduction in urgent care visits (coefficient = -0.024, Standard Error (SE) = 0.0117) and a 35.1% reduction in ED visits (coefficient = -0.027, SE = 0.0124). Hospitalization rates were 26.3% lower among the treated group but did not reach statistical significance. Sensitivity analyses utilizing alternative ATE estimation strategies displayed consistent reductions in urgent care and ED visits among cannabis users, though hospitalizations remained non-significant. Adjusting the IPWRA model’s tolerance levels strengthened the found associations while maintaining strong covariate balance. Fewer than 2% of the treated group reported an adverse event.

Discussion: These findings suggest that medical cannabis treatment among patients with PTSD may be associated with reduced utilization of urgent care and ED services. This relationship remains robust across multiple statistical models and sensitivity analyses, underscoring the potential role of medical cannabis in reducing acute healthcare needs in this population. Further longitudinal research is warranted to explore causality and assess its impact on hospitalization rates.

The Effects of Oral Delta-9-THC Administration on Intertemporal Decision Making in Aged Rats

Emely A Gazarov University of Florida

Co-authors: Marina I Waisenberg1, Christos Raptis1, Max S Gotlin1, Samantha F

Pattey1, Jennifer L Bizon1, Barry Setlow1

1University of Florida

Background: With the rise in use of cannabis and cannabinoids among older adults, it is important to understand their effects on the cognitive and neural profiles in this age group. Older adults tend to exhibit greater preference for large, delayed over small, immediate rewards compared to younger adults (i.e., reduced “impulsive choice”). Although this age-related shift in intertemporal decision making is frequently framed as being beneficial, it has the potential to be maladaptive in that it can delay necessary medical procedures or other expenditures that could enhance quality of life.

Objectives: The goal of this study was to use rats to determine how acute and chronic delta-9-tetrahydrocannabinol (THC, the primary psychoactive component of cannabis) affects intertemporal decision making in aging, using an oral consumption model shown previously to differentially affect cognitive performance in young and aged rats.

Methods: Fischer 344 x Brown Norway F1 hybrid rats (N=19, 9F, 10M) were trained to make choices between two levers, one delivering a small, immediate food reward, and the other delivering a large food reward delivered after delays of varying durations. Once rats reached stable performance, they were habituated to consume 3.5 g of gelatin containing a small amount of ethanol (100 µl/kg). For acute testing, each rat received 0, 0.3, and 1 mg/kg THC gelatin in a randomized order thirty minutes before behavioral testing. Following a one-week washout period, chronic effects were assessed by administering either control or 1 mg/kg THC gelatin daily for four weeks. Task performance (percentage of large reward choices) was analyzed via repeated measures ANOVA, with drug condition as a between-subjects factor and week and delay as within-subject factors.

Results: Acute THC administration had no effect on intertemporal decision making. In contrast, chronic THC caused rats to reduced their preference for the large, delayed reward across weeks, while control showed no shifts in their preference. This was supported by a significant Week × Delay × Drug interaction (F(4,52) = 2.84, p = 0.033), suggesting that chronic THC administration increases discounting of delayed rewards (increases impulsivity) in aged rats.

Conclusion: These findings highlight the potential impact of chronic THC use on decision-making and impulsivity in aged individuals, emphasizing the need for further research to better understand cognitive effects of cannabis use in older adults. Future directions include comparisons of THC effects on decision making in young subjects and assessment of CB1 receptor expression in brain regions important for decision-making.

Cannabis Use Patterns among Women Receiving

Treatment for Gynecological Cancers at an NCIDesignated Cancer Center

Isabella Jimenez University of Miami

Co-authors: Amrit Baral1, Bria-Necole Diggs1, Ciné Brown1, JoNell Potter1, Genester Wilson King2, Sarah E Messiah3, Denise C Vidot1

1University of Miami, 2Victory Recovery Center, 3University of Texas

Background: Cannabis is used to mitigate cancer symptoms and treatment side effects. However, there is a gap in the research regarding specific cannabis use patterns among women receiving treatment for gynecological cancers.

Objective: To describe cannabis use patterns among women receiving treatment for gynecological cancers in South Florida.

Methods: Data are from a subsample of women (n=215) that participated in the NCI-funded Cannabis and Cancer study (N=437) at Sylvester Comprehensive Cancer Center. REDCap was employed to collect socio-demographic, cannabis, and cancer details. Cancer type was classified as gynecological and non-gynecological. Gynecological cancers included: breast, cervical, ovarian, and uterine. Cannabis use was measured via the NCI-Cannabis Core Questionnaire. Chi square tests were employed to compare cannabis use patterns by cancer type, with two-tailed alpha set to 0.05.

Results: Of those with gynecological cancers (n=95; 44.2% of sample), 51.6% were 40-to-59 years, 25.3% > 60 years, and 23.2% 20-39 years; 44.2% were receiving treatment for gynecological cancers; and 38.9% consumed cannabis in the past 30days. Stage 2 was the most reported (53.7%) compared to 29.5% in stage 1, 14.7% in stage 3, and 2.1% in stage 4. Most (73.0%) cannabis consumers with gynecological cancer initiated use prior to cancer diagnosis. Women with gynecological cancers reported cannabis use once a day (27.0%), weekly (18.9%), bi-weekly (18.9%), multiple times a day (16.2%), and monthly (10.8%). Smoking was the most prevalent route of use reported (71.4%) compared to 25.7% that eat/drink (p=0.02). More women with gynecological cancers reported consuming cannabis to deal with stress (70.3% vs 44.8%, p=0.015) than women with non-gynecological cancer types. Use to cope with illness was clinically different between women with gynecological cancers compared to those with other cancer types (43.2% vs 25.9%; p= 0.078).

Conclusion: Most women cannabis consumers with gynecological cancer started cannabis use prior to diagnosis, consume cannabis daily, and smoke as the most common method of consumption. Women with gynecological cancers were more likely to consume cannabis for stress management and coping with their diagnosis than those with non-gynecologic cancers. Further research is needed to explore cannabis reasons and use patterns across gynecological cancer stages and their potential link to disease progression.

Mobile Intervention to Address Cannabis Use Disorder Among Black Adults: A Proof-of-Concept Randomized Controlled

Trial

Ava A Jones

University of Houston

Co-authors: Pamella Nizio1, Tzuan A Chen1, Julia D Buckner2, Brooke Y Redmond1, Michael S Businelle3, Marshall K Cheney3, Ezemenari M Obasi4, Michael J Zvolensky1, Lorra Garey1

1University of Houston, 2Louisiana State University, 3University of Oklahoma, 4Wayne State University

Background: African American/Black (hereafter referred to as Black) adults face significant cannabis-related health disparities, including more frequent cannabis use and higher rates of Cannabis Use Disorder (CUD) relative to non-Hispanic/Latinx White adults. There is a need for interventions that are accessible, culturally tailored, and capable of addressing the unique needs of Black adults with CUD.

Objective: The current study aimed to evaluate the feasibility, utilization, acceptability, and initial efficacy of a culturally tailored mobile intervention (Culturally Tailored-Mobile Integrated Cannabis and Anxiety Reduction Treatment [CT-MICART]), integrating false safety behavior (FSB) reduction or elimination skills for cannabis use reduction or cessation among Black adults with probable CUD.

Methods: Participants (N= 50, 50.0% female, Mage= 42.9 years, SD= 10.7) were randomized to 1) CT-MICART+ ecological momentary assessments (EMAs) or 2) EMA-only for 6-weeks. Feasibility outcomes included enrollment, retention, and EMA completion rates, and utilization was assessed via app feature engagement. Acceptability was evaluated via self-reported app satisfaction, and preliminary efficacy was examined by testing whether CT-MICART was associated with greater reductions in cannabis use.

Results: Results demonstrated strong feasibility, with an EMA completion rate of 75.64% in the CT-MICART+EMA condition vs. 65.80% in the EMA-only condition and a follow-up assessment completion rate of 80% (44% in the CT-MICART+EMA condition vs. 36% in the EMA-only). App engagement and utilization were high, as participants in the CT-MICART+EMA condition accessed on-demand features 3,351 times. Additionally, acceptability was positive, with a System Usability Scale (SUS) mean of 74.06 (SD= 18.02) among the 40 participants who completed the follow-up assessment. There was a statistically significantly higher SUS acceptability in the CT-MICART+EMA condition (M= 80.11, SD= 15.36) compared to EMA-only (M= 66.67, SD= 18.65; t(38)= 2.50, p= .001, Cohen’s d= 0.80). Preliminary efficacy analyses indicated statistically significant lower cannabis use frequency rates (γ= -2.07, SE= 0.22, p< .001, R2= .18) and less time spent under the influence of cannabis (γ= -.56, SE= 0.10, p< .001, R2= .18) in the CT-MICART+EMA condition compared to the EMAonly condition.

Conclusion: Findings provide initial evidence for the feasibility, acceptability, and efficacy of CT-MICART+EMA for cannabis use frequency and quantity among Black adults with probable CUD. Larger scale studies are necessary to test whether CT-MICART, via targeting FSBs and integrating culturally relevant intervention components, holds potential as a scalable solution to support cannabis use goals for this underserved population.

Effect of Cannabis Use on Brain Metabolites in People with HIV Using Whole-Brain Magnetic Resonance

Spectroscopic Imaging

Teddy Salan,

PhD University of Miami

Co-authors: Fernando M Moradel Cano1, Sulaiman A Sheriff1, Dario N Ayala1, Ranya Marrakchi El Fellah1, Eva Widerstrom-Noga1, Suresh Pallikkuth1, Denise C Vidot1, Allan E Rodriguez1, Robert L Cook2, Varan Govind1 1University of Miami, 2University of Florida

Background: Cannabis use among people with HIV (PWH) is higher than the general population, with studies reporting 77% of lifetime cannabis use in PWH, compared to 44.5% generally. While both HIV and cannabis are known to alter metabolites in the brain, little is known about their additive effect.

Objective: The goal of this study is to investigate neurometabolite alterations due to cannabis and HIV infection at the whole-brain level, using our unique Magnetic Resonance Spectroscopic Imaging (MRSI) technique. Measured brain metabolites include N-acetyl aspartate (NAA; neuronal viability marker), creatine (Cre; cellular energy marker), choline (Cho; membrane turnover marker), glutamate+glutamine (Glx; neurotransmitters) and myo-inositol (m-Ins; inflammation marker).

Methods: MRI data were collected on a 3T scanner from 54 subjects, following a 2x2 design: 16 PWH using cannabis (PWH+C; 38±7.5 y.o.), 7 PWH not using cannabis (PWH; 39±4.2 y.o.), 17 people without HIV (PWoH) using cannabis (PWoH+C; 37.4±7.8 y.o.), and 14 PWoH not using cannabis (PWoH; 30.4±8.8 y.o.) as healthy controls. The protocol included whole-brain short-TE MRSI (TE/TR: 17.6/1551 ms; 17 minutes) and T1-MRI. MRSI data were processed using MIDAS software to estimate neurometabolite concentrations at 47 brain anatomical regions-of-interest (ROI) from the AAL47 atlas, using appropriate data quality criteria. At each ROI, we performed non-parametric two-way ANOVA to find the effect of HIV and cannabis on metabolite levels (significance at p<0.05 in this preliminary analysis).

Results: We found significant independent effects of cannabis and HIV, with significant interaction effect, on NAA in key brain regions (precentral lobe, p<0.001; frontal lobe, p=0.004; superior motor cortex, p=0.016; cingulate gyrus, p=0.007). Among PWoH, NAA was lower in PWoH+C compared to PWoH; among cannabis non-users, NAA was lower in PWH than PWoH. Similar findings were observed for Glx (precentral lobe, p=0.005; frontal lobe, p=0.006; superior motor cortex, p=0.02), Cho (precentral lobe, p=0.016), and Cr (precentral lobe, p=0.016; frontal lobe, p=0.003). We found significantly higher m-Ins for PWoH+C compared to PWoH (rolandic operculum, p=0.002; insula, p =0.002), with no significant interactions.

Conclusion: Significant interactions between HIV and cannabis on NAA, Glx, Cho, and Cr, with lower concentrations for PWoH+C vs. PWoH and PWH vs. PWoH, showed that cannabis and HIV both accentuates neurometabolite alterations, neuronal dysfunction, and neurotransmitters disruption. However, neuroinflammation (m-Ins) was only found to be higher in PWoH+C vs. PWoH. Future analyses will examine the effect of relevant co-variates such as BMI, sex, frequency/duration and mode of cannabis administration, and cannabinoid metabolites in blood.

Age-Group Differences in Objectively Measured Abnormal Blood Pressure by Frequency of Cannabis Use within the Herbal Heart Study

Cataryna Senra University of Miami

Co-authors:

Amrit Baral1, Bria-Necole Diggs1, Ranya Marrakchi El Fellah1, Kylee Krivijanski1, Claudia Martinez1, Denise C Vidot1

1University of Miami

Background: Cardiovascular disease, a leading cause of death in the US, is closely linked to abnormal blood pressure. However, the impact of cannabis use on cardiovascular health across different demographics remains unclear, with limited research on how age and frequency of use influence blood pressure. Therefore, this study examines the age-group differences in blood pressure measurements among low, moderate, and heavy cannabis users.

Objective: To examine age-group differences in objectively measured abnormal blood pressure among low-to-moderate and heavy cannabis consumers in the Herbal Heart Study cohort.

Methods: Data are from the baseline assessment of the ongoing cohort study of 18-to-35-year-olds to examine differences in subclinical cardiovascular disease risk. Cannabis use was urine-confirmed; frequency of use was self-repor ted within the Drug Use History Questionnaire. Blood pressure (BP) was ascertained in triplicate following American Heart Association standardized guidelines. Abnormal BP was identified using standardized cut off: ≥130mmHg systolic/≥85mmHg diastolic. Chisquared tests were employed to compare abnormal blood pressure in two groups and by frequency of consumption among cannabis users.

Results: The sample included 200 adults [mean age: 25.2y; SD(4.8)] of which 63.0% were current (past 30-days) cannabis consumers. Adults 27-to-35y had a higher prevalence (73.1%) of cannabis use than the 57.9% of 18-to-26y consumers (p=0.0351). Among the 21.5% of the sample with abnormal BP, 81.4% were cannabis consumers, 18.6% were non-consumers (p=0.0048). Majority of cannabis consumers with abnormal blood pressure were heavy cannabis consumers (88.6%, p=0.0255). Heavy cannabis consumption (use >21 days/month) was more prevalent among participants 27-to-35y (85.7%) than 18-to-26y (67.5%, p=0.0223). Cannabis consumers had a higher median systolic BP compared to non-consumers (p<.0001). Median diastolic BP was also higher among cannabis consumers (p=0.0014). Heavy consumers had a higher median systolic (120.3mmHg vs 112.0mmHg, p=0.0064) and diastolic (67.6mmHg vs 64.6mmHg, p=0.0398) BP than those consuming < 21 days/month. Heavy cannabis consumers had a higher odds of presenting with abnormal BP than non-consumers (AOR: 3.49, 95% CI: 1.47-8.31), adjusted by agegroup.

Conclusion: Findings suggest heavy cannabis use is associated with increased systolic and diastolic BP. Heavy cannabis consumers had greater odds of abnormal BP than non-consumers. Results emphasize the need for further research on cannabis use and its impact on cardiovascular health across various age groups.

Randomized, Controlled Crossover Comparison of Cannabidiol and Oral Opioid for Post-Operative Photorefractive Keratectomy (PRK) Pain Control

Walter Allan Steigleman, MD University of Florida

Co-authors: Yujia Zhou1, Kayla Swiatek1

1University of Florida

Background: PRK is a commonly performed corneal refractive surgery for the correction of refractive error. Keratorefractive surgeons prescribe topical and oral medications to promote healing and reduce post-operative discomfort after PRK, with additional topical anesthetics and/or oral narcotics for break-through pain. Current evidence, however, demonstrates that opioid use is associated with unfavorable side effects, and legitimate opioid prescriptions have fueled the current opioid addiction crisis. A safe, yet effective alternative to opioid medication in the management of post-operative PRK pain should be investigated.

Objective: To compare the safety and efficacy of a low-tetrahydrocannabidiolcontaining oral cannabidiol (CBD) chemovar with oral codeine-acetaminophen (T3) for controlling post-operative PRK pain.

Methods: In this crossover, randomized, paired-eye controlled trial, 35 participants were randomized to receive either a CBD chemovar or T3 to manage post-operative PRK pain for their first eye and the other treatment for their second eye. Adult myopic participants meeting criteria for PRK without surgical or medical contraindications were included. Primary outcome measures were self-reported side effects, including pain, nausea, vomiting, diarrhea, constipation, or altered sensorium, after PRK. Altered sensorium included drowsiness, clouded thinking, or change in sensory experience. Participants reported their side effects on an integer scale from 0-10 with the maximum and total score over a 5-day post-operative period recorded for each side effect. Secondary outcome measures were visual acuity and responses to surveys examining satisfaction, quality of life, and ocular surface symptoms pre- and post-operatively at various time points. Non-parametric U-test was used to determine differences in survey responses.

Results: Of the 35 participants, 16 were randomized to Group 1 (assigned to take CBD first) and 19 were randomized to Group 2 (assigned to take T3 first). For both groups, there was no significant difference in maximum or total self-reported pain post-operatively between drugs. There was also no significant difference in maximum self-reported side effects between drugs. There was a statistically significant increase in total sensorium reported in those taking CBD compared to T3 (p< 0.039). More specifically, Group 1 participants assigned to take CBD first reported higher sensorium than those who took T3, while Group 2 participants assigned to take CBD second did not report higher sensorium. Both groups yielded no significant difference in post-operative visual acuity or quality of vision between drugs.

Conclusion: This crossover, randomized, paired-eye controlled trial established no significant difference in the efficacy of T3 and a CBD chemovar for the control of post-PRK pain.

Cannabidiolic Acid: Re-emergence of a Forgotten Cannabinoid and its (24-hour) Pharmacokinetics in Five Mammalian Species Including Humans

Joseph J Wakshlag, PhD Cornell University, Cultivate Biologics

Co-authors:

Teddy Salan1, Varan Govind1, Eva Widerstrom-Noga1 1University of Miami

Background: Cannabidiolic acid (CBDA) has long been thought to be unstable and potentially converted to cannabidiol after ingestion. Full spectrum hemp CBDA has recently been shown to remain relatively stable at room temperature for up to 18 months.

Objective: A blend of CBDA and CBD from full spectrum hemp was examined for 24-hour pharmacokinetics across dogs (n=8), cats (n = 8), horses (n = 8), macaques (n = 4) and humans (n = 12) using similar dosing regimens of 1-1.3 mg per kilogram of CBD and similar proportions of CBDA to examine the pharmacokinetics using a commercially available product (Cultivate Biologics, Lewisville, CO).

Methods: Each species was dosed at a total of 2-2.5 mg/kg of CBD:CBDA at an equal portion with other minor cannabinoids delivered (< 0.1 mg/kg). The extract was emulsified in sesame oil for oral delivery. Fasted 24-hour pharmacokinetics for each species was performed before and at 0.5,1, 2, 4, 8, 12 and 24 hours after oral delivery. Serum was collected and transported frozen to the laboratory for liquid chromatography and mass spectroscopy (LS-MS/MS) analysis. Maximum serum concentration (Cmax) and time to maximal concentration (Tmax) is reported for all species mentioned. (PK solutions 2.0, Montrose, CA).

Results: The mean + SD CBD Cmax for dogs (1 mg/kg), cat (1.3 mg/kg), horse (1 mg/kg), macaque (1 mg/kg) and human (1 mg/kg) were 185 + 56, 282 + 149, 12 + 6, 9 + 6 and 32 + 19 ng/mL, respectively. Tmax for CBD was 1 + 1, 2 + 1, 2 + 1, 3 + 1 and 4 + 2 hr, respectively. The CBDA Cmax for dogs (1 mg/kg), cat (1.2 mg/kg), horse (1 mg/kg), macaque (1 mg/kg) and human (1 mg/kg) were 923 + 427, 1,011 + 495, 103 + 88, 159 + 87, 714 + 313 ng/mL, respectively. Tmax for CBDA was 1 + 0.5, 2 + 1, 1 + 0.5, 1 + 0.5, and 2 + 1.5 hr, in sequence of species.

Discussion: CBDA is absorbed/retained 5-20 fold more efficiently than CBD across species with a shorter Tmax. CBD and CBDA are absorbed differently across species providing evidence that animal models may differ with oral delivery. In addition, other cannabinoid acids were observed at higher serum concentration than the corresponding neutral cannabinoids (i.e. THCA:THC). These data have led to further clinical evaluation and proposals directed at CBDA as a therapeutic in ongoing proposals within the consortium.

ABSTRACTS

BASIC SCIENCE AND TRANSLATIONAL CATEGORY

Epigenetic Reprogramming and Drug Resistance

Reversal in TripleNegative Breast Cancer by Cannabichromene and Cannabidiol Combination Therapy

Mounika Aare Florida A&M University

Co-authors: Jassy Lazarte1, Breana Boirie1, Mandip Singh Sachdeva1 1Florida A&M University

Background: Triple-negative breast cancer (TNBC) is an aggressive subtype with few treatment options and a high likelihood of developing drug resistance. Cannabinoids have emerged as potential anticancer agents, and their “entourage effect”—the synergistic interplay between different cannabinoids—may enhance therapeutic efficacy. Epigenetic modifications, particularly histone methylation and acetylation, are critical in driving drug resistance and altering gene expression profiles. Moreover, DNMT2, an RNA methyltransferase primarily targeting tRNA, plays a role in cellular stress responses and may contribute through altered RNA methylation. This study investigates the combined effects of cannabichromene (CBC) and cannabidiol (CBD) on overcoming drug resistance in TNBC by modulating epigenetic and epitranscriptomic

regulators.

Objectives: This study evaluates the cytotoxicity of CBC, CBD, and their combination in drug resistant TNBC cells, examines their effects on cell cycle regulation and apoptosis, investigates histone methylation and acetylation changes, and validate in vitro findings using an in vivo xenograft model.

Methods: MTT assays determined IC50 values for CBC, CBD, and their combination in MDA-MB-468 RM RT cells. Flow cytometry analyzed cell cycle distribution, while western blotting assessed key signaling proteins. Epigenetic modifications were examined via histone profiling and DNMT2. In vivo studies used MCJB 20C PDX xenografts.

Results: Cytotoxicity studies in MDA-MB-468 Doxorubicin RT cells demonstrated that CBC+CBD exhibited a significantly lower IC50 (0.42 ± 0.022 μM) compared to individual treatments (CBD: 3.88 ± 0.54 μM, CBC: 5.06 ± 0.1 μM), and Doxorubicin suggesting strong synergy (CI: 0.34–0.64). Cell Cycle revealed that CBC+CBD induced significantly higher G1-phase arrest. Epigenetic Reprogramming studies revealed that CBC+CBD significantly reversed H3K27me3 and H3K4me3 modifications, suggesting chromatin remodeling and reactivation of tumorsuppressor genes. Notably, DNMT2 expression was downregulated, suggesting reduced RNA methylation linked to drug resistance. CBC+CBD reduced tumor volume by 65% (p<0.0001), compared to 27% with CBD and 22% with CBC alone respectively. Western blotting revealed significant reduction in vimentin (p<0.0001) and survivin, PARP (p<0.000), Nf-κB, mTOR (p<0.001) and an increase in cleaved PARP and cleaved caspases-9 and 3 in CBC+CBD-treated tumors. Current

studies are ongoing to explore the impact of CBC+CBD on additional histone modifications, including acetylation (H3K5ac, H3K9ac, H3K27ac, H4K16ac) and phosphorylation (H3S10ph), as well as on chromatin remodeling proteins such as HDAC1, EZH2, and p300.

Conclusion: The combination of CBC and CBD exhibits a synergistic entourage effect, leading to enhanced cytotoxicity, cell cycle arrest, apoptosis induction, and epigenetic reprogramming in drug-resistant TNBC. These findings warrant further investigation to translate CBC+CBD therapy into clinical applications.

Combination Therapy

Utilizing Nab-Paclitaxel and Cannabinoids in Combating Pancreatic Cancer

Breana Boirie Florida A&M University

Co-authors: Mounika Aare1, Arvind Bagde1, Sandeep Chary1, Mandip Singh Sachdeva1

1Florida A&M University

Background: Pancreatic ductal adenocarcinoma (PDAC) is among the deadliest cancers, ranking fourth in cancer-related mortality. Standard treatment with gemcitabine, alone or with nab-paclitaxel, improves drug delivery but remains limited by resistance. Cannabinoid receptors are overexpressed in PDAC, and recent evidence suggests cannabinoids possess anticancer properties, offering a potential strategy to overcome treatment resistance.

Objective: The study aimed to evaluate whether combining standard-ofcare chemotherapy with various cannabinoids could improve treatment

outcomes in PDAC, particularly by targeting resistance mechanisms linked to KRAS, an oncogene mutated in over 90% of cases.

Methods: Several cannabinoids, including cannabichromene (CBC), cannabidiol (CBD), cannabigerol (CBG), cannabinol (CBN), and cannabidivarin (CBDV), were initially screened for anticancer activity in MIAPACA-2 and PANC1 cell lines. Selected cannabinoids were combined, and their synergistic effects were assessed using Combination Index values calculated with compusyn software. Additional experiments such as migration study, western blotting and preliminary in-vivo tumor studies were conducted to better understand the molecular mechanisms.

Results: The cytotoxic effects of cannabinoids combined with standard chemotherapeutic agents were evaluated in MiaPaca pancreatic cancer cells. CBC and CBD were tested individually, each demonstrating an IC₅₀ of 4 μM. When used in combination, the IC₅₀ was reduced to 1.98 μM, indicating a synergistic cytotoxic effect. Nab-paclitaxel, evaluated as a single agent, exhibited potent cytotoxicity with an IC₅₀ of 80 nM. Remarkably, combining CBD+ Nab-paclitaxel further enhanced its efficacy, reducing the IC₅₀ to 6.09 nM. These findings suggest that the incorporation of cannabinoids can significantly enhance the potency of conventional chemotherapeutic agents in the context of pancreatic cancer treatment. Additional experiments focused on the molecular mechanisms underlying these effects. The combination of CBG+CBD significantly downregulated key apoptosis markers. When CBG or CBD was paired with Nab-paclitaxel, there was a pronounced reduction in KRAS expression compared to individual treatments. Western blot analyses further supported these observations by revealing significant

downregulation of multiple oncogenic and survival proteins—including survivin, PI3K110, caspase-3, KRAS, Notch1, and SOD2—in the CBG, CBD, and CBG+CBD treatment groups (p < 0.0001).

Moreover, in-vivo studies demonstrated that treatments with CBG, CBD, Nabpaclitaxel, and their combinations significantly downregulated KRAS relative to controls (p < 0.0001), with the effects of CBD+ Nab-paclitaxel being comparable (p<0.0149) demonstrating the role of CBD in pancreatic cancer.

Conclusion: Based on these results, combinations of the most promising cannabinoids were assessed, with focus on their impact on KRAS, a critical oncogene mutated in over 90% of PDAC cases and linked to chemoresistance.

Assessing

Florida Medical Marijuana Physicians’

Awareness of Cannabis Testing Standards and Best Storage Practices

Melanie Bone, MD

Florida Atlantic University

Co-authors: Andrew Luck1, Robert Speth2, Gabriel Spandau3, Carlton Bone4 1Florida Atlantic University, 2Nova Southeastern University, 3Tennessee State University, 4Portland State University

Background: As Florida’s medical marijuana program continues to grow, ensuring the safety and efficacy of cannabis products remains a critical concern. Although state regulations mandate testing for contaminants and potency, little is known about physicians’ knowledge of potential contamination or how effectively they educate patients on product quality, contamination and adulteration risks, as well as medical cannabis physicians perspective on

medical cannabis program policies.

Objectives: This study aims to assess Florida medical marijuana physicians’ knowledge of contamination, physicians patient communication strategies, awareness and knowledge of cannabis testing outputs like Certificates of Analysis (COA), and perspectives on policies that may contribute to patients experiencing medical cannabis product contamination. It also explores how physicians educate patients about potential contamination, and what kind of educational resources physicians would like to improve their knowledge on possible medical cannabis contaminants.

Methods: A cross-sectional survey was developed through collaborative dialogue with Florida based physicians while respondents were recruited through direct solicitation and snowballing samples in collaboration with the Florida Medical Cannabis Physicians Group (FMCPG). Data collection is currently underway targeting licensed medical marijuana physicians in Florida.

Results: Preliminary responses indicate that most physicians feel confident educating patients about cannabis contamination but lack formal training on specific contaminants. Information about contamination is primarily acquired through professional networks, continuing medical education, and conferences. Physicians generally believe that state agencies and licensed cannabis operators bear more responsibility for protecting patients from contaminated products than they do. Many participants support policy reforms such as increased state oversight of dispensaries, allowing patients to inspect products prior to purchase, and implementing secret shopper programs. Despite acknowledging the importance

of patient education, over half of respondents report either not discussing contamination at all or only doing so when prompted by the patient. When contamination is addressed, communication is typically verbal during consultations or through referral to online resources. Key barriers to patient education include time constraints during appointments and patients’ limited understanding of cannabis science. Nearly half of the physicians who responded to a question about needed resources recommended stateproduced educational tools such as videos, fact sheets, online lectures, or standardized materials.

Conclusion: These findings highlight a gap between physician knowledge, patient education, and regulatory standards. Results from this study will support the development of educational materials to better equip physicians in addressing contamination risks, ultimately improving patient safety and the effective use of medical cannabis in Florida.

Investigating Cannabidiol-

Mediated Drug-Drug Interactions using Physiologically Based Pharmacokinetic Modeling

Bassma Eltanameli Florida State University

Co-authors: Sulafa Al Sahlawi1, Brian Cicali1, Rodrigo Cristofoletti1 1University of Florida

Background: Cannabidiol (CBD), a nonpsychoactive component of cannabis, has gained significant attention for its therapeutic potential. Widespread legalization and weak regulation have led to its prevalent use, raising the risk of potential drug-drug interactions

(DDIs) in people with comorbidities requiring multiple medications. In vitro studies showed that CBD and its active metabolite, 7-hydroxycannabidiol (7-OHCBD), inhibit multiple Cytochrome P450 (CYP) enzymes via reversible and timedependent inhibition (TDI). Our study aims to utilize physiologically based pharmacokinetic (PBPK) modeling to predict the extent of CBD-induced metabolic DDIs across multiple CYP enzymes in diverse populations.

Methods: Leveraging available in vitro and in vivo data on CBD and 7-OH-CBD, we developed a PBPK model using the Simcyp Simulator v.22. An intravenous (IV) model was built to describe CBD distribution and elimination, followed by an oral PBPK model validated against various single- and multiple-dose data. Model predictive performance was evaluated by comparing the ratios of predicted to observed PK parameter values, with an acceptance range of 0.5 to 2-fold. To explore the inhibitory effects of CBD, we simulated CBD co-administration with midazolam, caffeine, clobazam, and stiripentol. Verified in vitro interaction parameters for CYP3A4 and CYP2C19, and CYP1A2 were subsequently used to predict DDI magnitude in untested populations, including pediatrics, geriatrics, CYP2C19 poor metabolizers, obese, and hepatically impaired patients.

Results: The PBPK model successfully recapitulated CBD and 7-OH-CBD plasma concentration profiles following IV and oral administration in healthy adults and special populations, with predictions within twofold of observed values across various dosing regimens. Initial DDI simulations using in vitro inhibition parameters over- or underpredicted interactions. After parameter refinement, the model accurately predicted clinical DDIs, showing no significant interactions with midazolam, caffeine, or stiripentol. However, CBD

increased the exposure of clobazam’s metabolite, N-desmethylclobazam, threefold due to CYP2C19 inhibition. This interaction remained consistent in pediatrics, geriatrics, and obese populations. Conversely, in hepatic impairment and CYP2C19 poor metabolizers, diminished enzyme activity led to a smaller relative impact of CBD’s inhibition.

Conclusions: Although CBD inhibited multiple CYP enzymes in vitro, this effect was not clinically evident except for a moderate CYP2C19 interaction risk, that was consistent across healthy, pediatric, geriatric, and obese populations. In vitro inhibition parameters may not reliably predict clinical DDI risk, emphasizing the need for caution when extrapolating in vitro data to clinical scenarios.

Cannabis and its Impact

disturbances. Emerging evidence indicates that cannabis may possess anti-inflammatory and neuroprotective properties through the Endocannabinoid System (ECS). However, its direct effects on brain health—via neuroimaging—and indirect effects through gut-immune interactions remain poorly understood. Additionally, little is known about the cost-effectiveness of cannabis compared to conventional treatments for improving both health outcomes and the quality of life.

Objective: This review synthesizes the literature on cannabis use in PLWH, focusing on neuroimaging outcomes and gut-immune biomarkers. It aims to identify research gaps and assess the therapeutic potential of cannabis for managing HIV-related neurological and systemic complications, as well as its influence on quality of life.

on Brain

Metabolism

in People

Living with HIV: Insights Derived from Neuroimaging and Gut-Immune Research

Erminia Fardone, PhD University of Miami

Co-authors: Don Lochana Ekanayake1, Kathryn E McCollister1 1University of Miami

Background: Despite effective antiretroviral therapy (ART), individuals living with HIV (PLWH) continue to experience persistent neuroinflammation and immune activation due to viral reservoirs, including those in the brain. The blood-brain barrier (BBB) restricts drug penetration and immune surveillance, contributing to neurological complications. Many PLWH utilize cannabis to alleviate symptoms such as pain, appetite loss, and mood

Methods: Following PRISMA guidelines, a systematic search of PubMed, Embase, CINAHL, Cochrane, and Web of Science was conducted through December 2024. Search terms included “cannabis,” “neuroimaging,” “gut-immune dysfunction,” and “HIV.” Zotero® managed references, and Covidence® facilitated study screening. Eligible studies examined cannabis use in PLWH, neuroimaging outcomes (e.g., Magnetic Resonance Spectroscopy, functional MRI), gut-immune biomarkers (e.g., microbiota composition, C-reactive protein), and costs when available. Data were extracted and organized using Microsoft Excel®.

Results: Out of 995 articles screened, two primary outcome categories were identified: (1) neuroimaging research focusing on cannabis’ direct effects on brain structure and function and (2) gutimmune biomarker studies evaluating the impact of cannabis on inflammation and microbiota composition. Additionally, some studies explored the

broader effects on quality of life and symptom management, although data regarding costs were limited.

Conclusions: This review presents initial evidence indicating that cannabis could alleviate neuroinflammation and influence gut-immune dysfunction in individuals living with HIV. Nonetheless, comprehensive longitudinal studies that include neuroimaging, biomarker analyses, and economic assessments are crucial to establish the therapeutic benefits and cost-effectiveness of cannabis in tackling HIV-related comorbidities.

Impact of Inflammasome Activation in Chronic Pain Patients by Medical Marijuana (MM)

Alexandra McMahon University of Miami

Co-authors: Juan Pablo de Rivero Vaccari1, Alex Li2, Jennifer J Hu1, Yan Wang2 1University of Miami, 2University of Florida

Background: Chronic pain, often influenced by inflammation, is managed by some patients using Medical Marijuana (MM). The long-term effects of MM on pain and the biological mechanisms affected by MM are unclear. This pilot study aimed to assess how MM usage affects inflammasome levels and pain in patients with chronic pain.

Objective: This pilot study examined the effects of MM on inflammasome biomarker expression and pain levels among older adults with chronic pain. Specifically, we evaluated (1) the association between pain severity and inflammasome levels in plasma, and (2) the differences

in pain and inflammasome levels by plasma cannabidiol (CBD) or delta-9tetrahydrocannabinol (THC) and their metabolites.

Methods: Data from 40 chronic pain patients (mean age = 65 years old) in the Study on Medical Marijuana and its Long-Term Effects (SMILE) were analyzed. Inflammasome biomarkers included apoptosis-associated specklike protein containing a caspase recruitment domain (ASC), caspase-1, and interleukin (IL-18), and the diseaseassociated macrophage marker

Triggering receptor expressed on myeloid cells 2 (TREM2). Pain scores using Brief Pain Inventory (BPI) were collected at baseline and 3-month follow-up. T-tests and Wilcoxon tests were used to assess the relationship between MM use, inflammasomes, and pain changes. Plasma levels of THC and CBD metabolites were analyzed at baseline and 3-month follow-up.

Results: Our results show that changes in ASC levels were associated with changes in both self-reported “worst pain” (p=0.026) and “average pain” levels (p=0.037). At the 3-month followup, pain scores were trending lower for individuals who had detectable plasma THC or THC metabolites than those who did not, particularly for least pain present (mean=1.21, SD=2.15 vs. mean=2.13, SD= 1.85, p=0.069). TREM2 levels were trending lower for individuals who had detectable plasma CBD or CBD metabolites compared to those who did not (mean=17,003, SD= 11243 vs. mean=22,389, SD= 10091, p= 0.086).

Conclusions: Our findings suggest that lower pain severity may be associated with reduction in inflammasome activation, while THC use seems to be associated with lower pain severity and CBD use seems to be associated with lower expression of the inflammatory marker TREM2. This pilot study

highlights the molecular mechanisms of MM in inhibiting inflammasome activation and inflammatory responses while improving pain scores in patients with chronic pain. Future larger internal and external studies are warranted to validate these promising findings and explore MM in pain management.

Cross Sectional Association Between Gut Microbiota and Cannabis Consumption in an Underrepresented Population of People with HIV

Donald

D Porchia, PhD University of Florida

Co-authors: Zhi Zhou1, Eric C Porges1, Smita Ghare2, Shish Barve2, Ronald Cohen1, Yan Wang1, Robert L Cook1, Zhigang Li1

1University of Florida, 2University of Louisville

Background and Aims: Cannabis use is widespread with an estimated 19.8% of the North American population reporting use in 2022. Because the gut-brain axis involves bidirectional communication between the gut microbiome and the brain, the ingestion of THC can alter the composition of the microbiota in the gut. Our aim is to examine the association between cannabis consumption and the gut microbiome among persons living with HIV (PLWH).

Methods: Of the participants in the Marijuana Associated Planning and Long-term Effects study, 71 provided fecal samples for this cross-sectional analysis. This under-represented sample population consisted of 71 PLWH (53% Female, 73% Black or Hispanic, mean Age 58) of which 36 (51%) were exclusive flower users, 11 (15%) used

a combination of flower and other cannabis products, and 24 (34%) were non-users. Cannabis use was measured through a timeline follow back instrument. For flower, THC content was measured by grams consumed times the percentage of THC in the flower if known, otherwise 15% was assumed. For other products, the most common THC percentage from medical dispensaries was used for each. Nonusers were recorded as zero. The fecal samples were sequenced using 16S rRNA sequencing. Each participant contributed one sample in the analyses. The IFAA method was used to identify genera, out of a possible 253 genera, associated with average milligrams of THC ingested per use day and Permanova was used to compare beta diversity between participants with heavy cannabis use verses those with light to no cannabis use. The association between the Simpson diversity index (SDI) and average THC per use day was also tested. All analyses adjusted for age, gender, and education. All p-values were adjusted for multiple testing.

Results: Genus Dialister (b = - 11.5% change per 50 mg, p = 0.0245) showed a significant, negative association with cannabis consumption. There were no significant differences in the high verses low to no cannabis group in terms of beta diversity (p = 0.35) and the SDI was not significantly associated with cannabis use (p = 0.19).

Conclusion: Genus Dialister is a gramnegative, anaerobic or microaerophilic, non-motile, non-spore forming and nonfermentative bacteria. It was negatively associated with cannabis consumption in the sample population. A decrease in Dialister has been associated with irritable bowel disease. The overall diversity was negatively associated with cannabis consumption although not statistically significant. These findings

are consistent with similar findings on younger, all male, HIV populations in the literature.

Pharmacokinetic/

Pharmacodynamic

Modeling of the Acute Heart Rate

Effects of Delta-9

Tetrahydrocannabinol and its Major Metabolites After Intravenous Injection in Healthy Volunteers

William Wolowich Nova Southeastern University

Co-authors: Robert Greif1,2, Lorenz

Theiler3, Maren Kleine-Brueggeney4

1University of Bern, 2University of Torino, 3Cantonal Hospital Aarau, 4Charité –Universitätsmedizin Berlin

Background and Objectives: Cannabis consumption is increasing in both the recreational and medical setting. Tetrahydrocannabinol (THC) is known to produce cardiovascular effects, but the specific roles of THC and its metabolites THC-OH and THC-COOH in cannabinoidinduced cardiovascular effects remain unclear. We hypothesized that THC and THC-OH mediate cannabinoid-induced increase in heart rate in either an additive or synergistic fashion.

Methods: The present study uses prospectively obtained data to evaluate the effect of THC and its metabolites on heart rate in healthy volunteers through non-linear mixed-effect pharmacokinetic/ pharmacodynamic (PK/PD) modeling.

Results: The PK/PD models reveal that THC, THC-OH and a combination of THC and THC-OH, but not THC-

COOH are responsible for THC-induced tachycardia. The EC50 of the THC Emax model was 0.47 µM, twenty-five-fold the EC50 for the THC-OH Emax model. The General Empiric Dynamic Model indicates that THC and THC-OH act synergistically to increase heart rate. Neither sex nor CYP2C9 polymorphism contribute to THC-induced tachycardia.

Conclusion: THC-OH but not THCCOOH contributes to the heart rate effect of THC and THC-OH may be acting in a synergistic manner with THC. This contributes to understanding the cardiovascular effects of THC and cannabis-induced cardiovascular events. Future research including further hemodynamic and endogenous cannabinoid data will allow a detailed systems pharmacology or response surface model approach.

Effects of Oleoylethanolamide and N-oleoylsulfamide in a Model of Alcohol Relapse in the Context of PTSD

Andrea Cippitelli, PhD Florida Atlantic University

Co-authors: Michael Lauber1, Meira Gildin1, Thamires Righi1, Fernando Rodriguez de Fonseca2,3 1Florida Atlantic University, 2Instituto de Investigación Biomédica de Málaga, 3Galea Therapeutics

Background: Alcohol use disorder (AUD) is frequently co-morbid in patients suffering from post-traumatic stress disorder (PTSD). Few therapeutic options are available for the individual disorders, and there are currently no drugs specifically shown to treat AUD in patients with comorbid PTSD. This is in part because it has been challenging to produce reliable animal

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models that allow evaluation of pharmacological interventions for the comorbidity. Oleoylethanolamide (OEA), an endocannabinoid-like lipid signaling molecule, which functions as a satiety factor, has been reported to decrease alcohol self-administration in rats and preclinical manifestations associated with stress exposure such as stressinduced anxiety-like behavior and prepulse inhibition.

Methods: Here, female and male Sprague-Dawley rats were initially trained to respond for alcohol in operant chambers. Their response was extinguished and then re-established by cues previously associated with alcohol availability. All rats were then subjected to Single Prolonged Stress to induce PTSD-like symptoms. Afterward, anxietylike behavior of individual rats was assessed and a second cue-induced reinstatement was conducted.

Objective: To test the model of alcohol relapse combined with exposure to traumatic stress we used OEA (4 mg/ kg, ip) and N-oleoylsulfamide (1 and 4 mg/kg, ip), a compound licensed by Galea Therapeutics. Like OEA, N-oleoylsulfamide binds at peroxisome proliferator-activated receptors-a (PPAR-a).

Results: Results support the efficacy of PPAR-a agonists to reduce the escalated as well as non-escalated alcoholseeking behavior in male rats. Research in the females is ongoing.

Conclusions: OEA and N-oleoylsulfamide could represent potentially novel pharmacotherapies for AUD-PTSD comorbidity.

Support: The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702-5014 is the awarding and administering acquisition office. This work was supported by the Office of

the Assistant Secretary of Defense for Health Affairs through the Alcohol and Substance Use Research Program under Award No. W81XWH-18-2-0044. Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense. In conducting research using animals, the investigator(s) adhered to the laws of the United States and the regulations of the Department of Agriculture.

ABSTRACTS

CLINICAL

RESEARCH, POPULATION HEALTH, HEALTH BEHAVIOR CATEGORY

Neural Correlates and Symptoms of ADHD as Predictors of Cannabis Use Frequency

Jacqueline

Aloumanis University of Florida

Co-authors: Amanda Elton, University of Florida

Background: Cannabis and other substance misuse is common among individuals with symptoms of attention-deficit hyperactivity disorder (ADHD), particularly young adults and college students. Despite the growing perception that cannabis can be used as a therapeutic for ADHD, cannabis use among individuals with ADHD symptoms can also lead to cannabis use disorder and potential exacerbation of ADHD symptoms. Neurocognitive predictors of the risk for cannabis

misuse among young adults with ADHD symptoms remain poorly understood.

Objectives: Our analysis prospectively explored the neural predictors of the relationship between ADHD symptomology and cannabis use frequency. We hypothesized that ADHD symptoms would predict increased cannabis use, mediated by neural correlates of ADHD symptoms during performance of an inhibitory control task.

Methods: Data were collected from 144 first-year college students (ages 18-19) enrolled in a longitudinal neuroimaging and alcohol use investigation. Subjects at risk for alcohol use disorder were oversampled, but alcohol and other substance use disorders were excluded at baseline. Baseline assessments included an fMRI stop-signal task and the Conners Adult ADHD Rating Scales (CAARS). Cannabis use was assessed at baseline and for three yearly followup timepoints, through a self-report of days used in the previous year. Neural correlates of ADHD symptoms (CAARS DSM-IV Symptom subscales) were identified using Pearson correlations with the successful-stop-versus-go contrast from the stop-signal task. Sex interactions were also considered.

Results: At baseline, 33% of participants reported having initiated cannabis use, with an average of 7.6 days of use in the previous year. After three years, 77% reported having used cannabis, averaging 21.4 days in the previous year. Participants with greater ADHD symptoms had higher a rate of dropout; however linear mixed effects models indicated a significant increase in cannabis use over time (p<0.0001). A significant three-way interaction between time, ADHD symptoms, and sex was found (p<0.0001). A median split analysis revealed that females reported more frequent cannabis

use than males, yet effects of ADHD symptoms appeared greater for males. ADHD symptoms were associated with reduced activation in the intraparietal sulcus, left inferior frontal gyrus, cerebellum, and left orbitofrontal cortex during the stop-signal task. Further analyses will leverage latent growth models to explore the role of brain regions as mediators of the relationship between ADHD symptoms and cannabis use.

Conclusions: Elevated ADHD-related symptoms predict increased cannabis use frequency in young adults. Inhibitory control processes could represent early brain markers for cannabis misuse in young adults, informing potential treatment approaches.

Benefits of Concomitant Use of Cannabis and Opioids in the Management of Chronic Pain

Kimberly Atkinson, PhD Touro University Nevada

Co-authors: Vladimir Bondarenko1, Rakesh Singh1, Isbel Curbelo-Navarro1 1Touro University Nevada

Background: Chronic pain affects millions of people worldwide and is defined as persistent pain lasting more than three months. Approximately 2030% of these patients are prescribed opioids. Many of these patients also self-treat with cannabinoid-containing products. Studies have shown that cannabis has analgesic properties, as well as may improve sleep, mood, and quality of life for chronic pain patients. With the increasing use of cannabis for pain and various conditions and with proven efficacy and safety over the years, use of cannabis may may reduce the risk of opioid addiction and

dependency, particularly in patients with chronic pain and opioid use disorder.

Objective: This systematic review aims to evaluate the benefits of the co-administration of cannabis-derived compounds and opioids for chronic pain management.

Methods: We searched PubMed, EMBASE, and Cochrane for clinical trials comparing the effects of opioids, cannabinoids, and their co-administration in patients with chronic pain. We analyzed data from 12 studies involving chronic pain patients, examining the impacts of various cannabis formulations and opioid therapies. The studies included randomized controlled trials, observational surveys, and qualitative assessments, with sample sizes ranging from 24 to 790 participants with chronic pain. These studies included patients with a wide variety of sources of chronic pain, including peripheral neuropathic pain, cancer-related pain, and osteoarthritis.

Results: Ten of the twelve studies showed significant benefits of cannabinoid-containing treatments in patients with chronic pain. Several studies showed that cannabinoids have analgesic effects, in many cases, equal to those of opioids. Adjuvant cannabis use was associated with a reduction in the need for opioids, a decrease in the number of medications prescribed, and reduced adverse effects of opioid treatment. The most common benefits of cannabis reported in these studies involved enhancing mood, quality of life, sleep, and relief of pain and opioiddependence.

Conclusion: Cannabinoid-based therapies demonstrate potential as effective adjuvants or alternatives to opioids for chronic pain management. The findings support the hypothesis

that treatment of chronic pain with cannabinoids reduced pain, curbed opioid consumption, enhanced quality of life, and reduced side effects. Future studies are warranted to further explore the long-term safety and efficacy of these therapies in diverse chronic pain populations.

Information-Seeking Behaviors on Cannabis in Cancer Care: Differences by Cannabis Use Status and Age

Ciné

Brown University of Miami

Co-authors: Amrit Baral1, Renessa Williams1, Bria-Necole Diggs1, Ranya Marrakchi El Fellah1, Denise C Vidot1 1University of Miami

Background: As cannabis use increases among cancer patients, understanding information-seeking behaviors is crucial for enhancing patient education, refining clinical guidance, and improving health outcomes. Evidence suggests cancer patients/survivors seek cannabisrelated information from healthcare providers, online sources, and peer networks. However, little is known about information-seeking behaviors by cannabis use status and age.

Objectives: To investigate how age and cannabis use status influence information-seeking behaviors about cannabis use in cancer care.

Methods: Data are from the NCI-funded Cannabis and Cancer Study (N=437) at Sylvester Comprehensive Cancer Center, University of Miami. Cannabis use status was self-reported (current, former, or never users). Age-groups included 18–39, 40–59, and ≥60y. Participants were asked where they

seek cannabis-related information for cancer. Options included: healthcare providers, oncologists, nurses, other patients, and dispensaries. Chisquared/Fisher’s exact tests, examined differences in information-seeking behaviors, with statistical significance set at p < 0.05.

Results: Among 437 participants (Mean age: 49.8, SD=15.6), 50.8% were male, with 45.5% current users, 25.4% former, and 29.1% never used. Cannabis use status was significantly associated with age (p<0.001). Younger patients (18–39y) were most likely to be current cannabis users (60.6%), while older patients (≥60y) comprised the largest proportion of former users (48.6%). A majority of respondents were currently undergoing treatment (43.9%) followed by those who completed therapy/ follow-up (39.6%). Current users were more likely to seek cannabisrelated information from primary care providers and online sources, while older patients and former users relied more on oncologists and healthcare professionals. Oncologists (47.1%) were the most common information source, followed by internet searches (33.2%), while pamphlets (8.7%) and hospital websites (8.9%) were least used. Current cannabis users (29.6%) compared to non-users (74.0%) and former users (47.7%, p<0.0001) were less likely to seek information from the oncologist in charge of their cancer treatment. Older patients were more likely to seek information from their oncologists as compared to their younger counterparts (p<0.01). In contrast, endorsement on seeking information from social media was more frequent among younger patients as compared to the older agegroups (p=0.01).

Conclusions: Our findings suggest cannabis use status and age shape information-seeking behaviors in cancer patients, with younger current users

favoring online sources while older and former users rely more on oncologists and healthcare professionals. Findings highlight the need for targeted educational interventions.

Delays in Receiving Treatment for Cannabis Use Disorder in US Adolescents

Helena De Azeredo Miranda Florida Atlantic University

Co-authors: Jhon Ostanin1, Simon Shugar2, Alan Kunz Lomelin2, Panagiota Kitsanta2

1Florida International University, 2Florida Atlantic University

Background: Limited research exists on treatment admission delays among adolescents with cannabis use disorder (CUD). Examining delays is essential, as they can adversely affect treatment outcomes, especially among young individuals.

Objectives: This study explored patterns of admission delays to publicly funded treatment facilities and assessed factors contributing to delays in treatment for CUD among U.S. adolescents.

Methods: The study used data from the 2012-2022 Treatment Episode Data Set-Admissions (TEDS-A), which included 124,501 adolescents (ages 12-17) diagnosed with CUD. Descriptive statistics, Chi-square tests, and multivariable logistic regression were employed to assess admission delays and factors associated with delayed treatment initiation. An admission delay was defined as waiting more than one day to receive care.

Results: Delays in receiving treatment for CUD were highest between 2012

(37.5%) and 2013 (38.1%) but decreased significantly from 2015 (24.7%) to 2018 (26.1%). However, delays began to rise again from 2019 onward, reaching 33.8% in 2022. Among those experiencing delays, longer delays (over a week) became more pronounced in 2021 and 2022, with 5.4% of adolescents waiting at least 30 days for treatment in 2022. Overall, delays in treatment were higher for children aged 12 to 14 years from 2018 to 2022 compared to those aged 15 to 17.

Males (OR=1.11, 95% CI 1.08-1.14) and White non-Hispanic adolescents (OR=1.29, 95% CI 1.25-1.34) had higher odds of experiencing delays compared to females and Hispanics, respectively. Homeless adolescents (0.50, 95% CI 0.35-0.73) and those with independent living arrangements (0.82, 95% CI 0.79-0.86) were less likely to experience delays compared to those with dependent living arrangements. Receiving a referral from a healthcare provider was associated with an increased likelihood of delay (OR=1.43, 95% CI 1.35-1.51) compared to individual/self-referrals. Significant delays were also observed if the treatment service/setting was rehabilitation/residential, short-term/ long-term (13.9, 95% CI 12.1-15.9), or ambulatory, intensive/non-intensive outpatient (11.5, 95% CI 10.1-13.2) compared to detox treatment services.

Conclusions: Delays in receiving treatment for CUD among adolescents have varied over time, with a noticeable increase starting in 2019. These trends underscore the urgent need for focused interventions to reduce treatment delays, especially for vulnerable groups like younger adolescents, White non-Hispanic adolescents, those in independent living situations, individuals receiving services outside of detox facilities, and those referred by healthcare providers. Addressing

these delays could improve treatment outcomes and more effectively address the growing prevalence of CUD among adolescents in the U.S.

Exploring the Reasons for Cannabis Use among People

Living with HIV: A Qualitative Analysis from CFAR Pilot Study Interviews

Bria-Necole Diggs University of Miami

Co-authors: Claudia Alonso1, Sophia Poslock1, Abigail Hurtado1, Hailey Meagher1, Mame Dioum1, Sara St. George1, Dushyantha Jayaweera1, Claudia Martinez1, Denise C Vidot1 1University of Miami

Background: Cannabis use has gained attention as an alternative to opioids, particularly among people living with HIV, who frequently face chronic pain, anxiety, and depression.

Objective: This study aims to explore the preferences and motivations behind cannabis and opioid use in this population.

Methods: This qualitative study analyzed data from a NIH/CFAR-funded administrative supplement study of cannabis consumers living with HIV and residing in South Florida. Eligible participants (N=15) were adults aged 18–65 with confirmed HIV diagnosis, undetectable viral loads, and cannabis consumers. Semi-structured interviews were conducted, transcribed verbatim, and analyzed using thematic analysis guided by a codebook approach. Transcripts were imported and independently coded in NVivo 15 based on an agreed upon codebook. All codes and themes were generated based on team consensus.

Results: The sample was 53.3% female, 73.3% non-Hispanic Black, 13.3% Hispanic/Latino, and had a mean age of 48.6 years (SD: 13.2). Four main themes for reasons for cannabis use among the participants living with HIV were generated from the analysis:

1. Soothing the Mind and Body: Interviews included the physical, mental, and emotional effects experienced when consuming cannabis. Participants reported that cannabis improved mood, induced relaxation, and increased appetite.

2. Finding Relief in the Storm: Participants described a range of coping mechanisms to manage daily mental and physical challenges, including physical activity, alcohol use, medication use, and frequently mentioned cannabis use. Cannabis was commonly used to cope with pain, stress, and anxiety, often perceived as more effective and less harmful than opioids.

3. Tailoring the Experience: Participants expressed preferences for cannabis sourced from dispensaries due to quality and legality, but often relied on the black market sources due to accessibility and cost.

4. Choosing Cannabis Over Alternatives: Compared to opioids, cannabis was favored due to its perceived lower addiction risk, fewer side effects, and comfortability, despite opioids being medically considered more effective and accepted for severe pain.

Conclusion: Adults living with HIV in South Florida prefer cannabis over opioids for symptom management, citing fewer adverse effects and greater emotional and mental relief. This study highlights the need for healthcare providers to support informed treatment decisions and suggests avenues for future research, particularly in the context of evolving cannabis legislation.

Sex Differences in Abnormal Blood Pressure among Heavy Cannabis Consumers Compared to Low-to-Moderate Cannabis Consumers within the Herbal Heart Study

Kylee

Krivijanski University of Miami

Co-authors: Amrit Baral1, Bria-Necole Diggs1, Ranya Marrakchi El Fellah1, Claudia Martinez1, Denise C Vidot1 1University of Miami

Background: Cannabis use has been shown to have diverse effects on blood pressure (BP). However, the relationship between cannabis use and BP remains inconsistent. Furthermore, sex differences in this relationship have been largely unexplored, warranting further investigation.

Objective: To examine sex-differences in objectively measured abnormal BP among low-to-moderate and heavy cannabis consumers in a cohort of 18-to-35-year-olds.

Methods: Data are from 18-to-35-yearolds (N=200) enrolled in the Herbal Heart Study in South Florida. Cannabis was urine-verified. Heavy cannabis use was defined as use > 21 days a month. Abnormal BP was based on an average of three American Heart Associationstandardized measurements of systolic and diastolic BP: ≥130mmHg systolic and ≥85mmHg diastolic. Descriptive statistics and Chi-squared tests assessed associations between cannabis use, sex, and BP, while logistic regression estimated the odds of having abnormal BP by cannabis use.

Results: Most (63.0%) of the sample consumed cannabis in the past-30

days. Cannabis use was confirmed by urine toxicology screen for carboxyTHC. There was a statistically significant difference between cannabis consumption (consumers vs. non-consumer) and sex (p=0.0024). Specifically, cannabis consumption was reported more frequently among males (77.1%, p=0.0024) compared to females. There was a statistically significant difference between frequency of cannabis use (low-to-moderate vs. heavy) and sex (p=0.0181), Heavy cannabis consumption (consuming >21 days a month) was found to be more prevalent among males (85.2%) than among females (66.7%, p=0.02). Male cannabis consumers were found to have a higher median systolic BP compared to females (130.7mmHg vs 111.3mmHg, p<0.0001). Abnormal BP was identified in 50.0% of male cannabis consumers compared to 11.1% of female cannabis consumers (p<0.0001). When examined by frequency of use, male heavy cannabis consumers had a higher prevalence of abnormal BP than female heavy cannabis consumers (52.2% vs 14.6%). After adjusting by sex, heavy cannabis consumers had a higher odds of presenting with abnormal BP than non-consumers (AOR: 2.72, 95% CI: 1.10-6.76). There was no association between low-to-moderate cannabis use and abnormal BP (AOR: 2.47, 95% CI: 0.74-8.24).

Conclusions: Heavy cannabis use was associated with increased odds of abnormal BP. Specifically, male cannabis consumers with heavy use exhibited higher systolic BP and a greater prevalence of abnormal BP compared to females.

Barriers and Enablers of Telehealth Services for Cannabis Use Disorder: A

National Survey Analysis

Alan Kunz-Lomelin, PhD Florida Atlantic University

Co-authors: Panagiota Kitsanta1, Xingquan Zhu1, Nyla Searles1, Mirella Balas1, Tabatha Spinks1 1Florida Atlantic University

Background: The legalization of cannabis has increased cannabis use while decreasing public perceptions of its health associated risks. The increase in telehealth services, because of COVID-19, has increased the availability and accessibility of treatment for those diagnosed with cannabis use disorder. However, there are still those who do not engage in telehealth treatment and continue to face barriers in getting access to care. Understanding factors associated with telehealth service use in this population may help increase treatment accessibility and prevent long term consequences of untreated cannabis use disorder (CUD).

Objectives: Utilizing Andersen’s Behavioral Model of Health Care Utilization, this study sought to understand factors associated with telehealth service use among a sample of participants diagnosed with cannabis use disorder over the past year.

Methods: Data were used from the 2023 National Survey of Drug Use and Health. Participants were at least 12 years old and had been diagnosed with cannabis use disorder within the last year (n = 5,091). Predictors included predisposing factors, enabling factors, and need factors. Binary logistic regression was used to determine their impact on pastyear telehealth use.

Results: Regression analysis revealed that factors associated with higher telehealth use among individuals with CUD included being female (OR = 1.97, 95% CI 1.36, 2.85), Hispanic (OR = 1.57,

95% CI 1.01, 2.43), 35 years old or older (OR = 1.80, 95% CI 1.08, 3.00), having public (OR = 2.04, 95% CI 1.21, 3.43) or private (OR = 1.81, 95% CI 1.01, 3.26) insurance, having higher psychological distress (OR = 1.04, 95% CI 1.00, 1.07), and having poor overall health (OR = 1.20, 95% CI 1.01, 1.43). In contrast, being of “other” (e.g., Native American, Asian, Native Hawaiian) race categories (OR = .30, 95% CI .11, .77), and being enrolled in school (OR = .65, 95% CI .37, 1.12), were associated with lower telehealth service use.

Conclusion: There are key characteristics of telehealth service use that Andersen’s model can help identify and which carry implications for the treatment of cannabis use disorder. These findings can help design implementation efforts that can increase accessibility of services and improve the long-term health outcomes of those diagnosed with cannabis use disorder.

Age-Group Differences in Reasons for Cannabis Use during Pregnancy:

Results from the COVID-19 Cannabis Moms Study

Francesca Lama University of Miami

Co-authors: Amrit Baral1, Bria-Necole Diggs1, Cynthia Lebron1, Genester Wilson-King2, JoNell Potter1, Sarah E Messiah3, Denise C Vidot1 1University of Miami, 2Victory Rejuvenation Center, 3University of Texas

Background: Studies suggest some pregnant women use cannabis for symptom management or personal preference, despite medical advice against it. Reasons may vary by age group, though research in this area

remains limited.

Objective: The objective of this study was to examine differences in reasons for cannabis use during pregnancy between 18-34-year-olds and ≥34 years.

Methods: The COVID-19 Cannabis Mom Study is a cross-sectional study (N=252) of women who were pregnant or breastfeeding during the COVID-19 pandemic. Self-reported data was collected on cannabis use and pregnancy and breastfeeding history. This study is a subgroup analysis of the pregnant respondents (n=81; 32.1% of overall sample). Chi-squared/Fisher’s exact tests and descriptive statistics were used to analyze cannabis use, reasons for use, and type of cannabis consumed by age group (18-34-yearolds vs ≥34 years).

Results: The majority (90.1%) of the sample of pregnant women [mean 29.4y (SD = 5.0; range: 18-40), 63.9% non-Hispanic white] reported cannabis consumption in the past 30-days. There were no differences in the trimester of respondents by age (p=0.47). A higher proportion of younger adults were currently pregnant in the overall study (35.9%) compared to ≥ 34years (20.6%; p=0.024). While not statistically significant, a slightly higher proportion of 18–34-year-olds reported use to relieve stress/anxiety (78.7% vs. 58.3%, p=0.15), and manage pain (50.8% vs. 50.0%, p=0.96) than participants ≥ 34 years. A slightly higher proportion of ≥ 34 years consumed cannabis during pregnancy for nausea relief (83.3% vs 80.3%, p=0.81), vomiting relief (66.7% vs. 60.7%, p=0.76), managing a chronic health condition (16.7% vs. 11.5%, p=0.64), and enjoyment/ relaxation (50.0% vs. 32.8%, p=0.33). A higher proportion of 18–34-year-olds consumed THC-dominant cannabis (62.7% vs. 58.3%, p=0.90); ≥ 34 years consumed a combination of CBD-THC

(33.3% vs. 27.1%, p=0.89).

Conclusions: Results here showed no statistically significant differences by age group in reasons for cannabis use during pregnancy. Findings suggest that public health strategies to improve the health of women that consume cannabis during pregnancy be ageinclusive.

Problematic Cannabis Use and Perceived Stress Among Young Adult Cannabis Consumers in the Herbal Heart Study: Differences by Age and Sex

Ranya

Marrakchi El Fellah University of Miami

Co-authors: Amrit Baral1, Bria-Necole Diggs1, Kylee Krivijanski1, Ciné Brown1, Renessa Williams1, Raul Gonzalez2 , Denise C Vidot1

1University of Miami, 2Florida International University

Background: Cannabis use is associated with perceived stress, though the relationship is complex. Reliance on cannabis for management of negative emotions is linked to cannabis use disorder and further distress, particularly in the context of emotion dysregulation. While some report relief of negative emotions from use, cannabis dependence may worsen stress and mental health.

Objective: To examine the relationship between problematic cannabis use and perceived stress while accounting for demographics.

Methods: Data are from 18-35y participants who consume cannabis (N=126) in the ongoing Herbal Heart Study in South Florida. Cannabis use

was confirmed via urine toxicology. The Cannabis Use Disorders Identification Test (CUDIT-R) score assessed problematic (<8) and nonproblematic (≥8) cannabis use. The Perceived Stress Scale (PSS) was used to assess self-reported stress across various life situations. Mann-Whitney U tests compared median PSS stress scores between problematic and nonproblematic consumers by age-groups (18-26y vs 27-35y) and sex (male vs female).

Results: Among the sample of cannabis consumers [mean age 25.9y (SD = 4.8), 60.3% Hispanic], 84.1% had problematic cannabis use. The majority of 18-26y and 27-35y cannabis consumers were found to have problematic cannabis usage. A higher proportion of males (92.6%) reported problematic cannabis use than females (77.8%; p=0.024). Overall, problematic cannabis users had higher median stress scores (18.0) than non-problematic users (15.0; p=0.016), both consistent with moderate stress. Among 27-35y, problematic cannabis consumers had a mean stress score of 17.0 (moderate stress) and non-problematic consumers had a score of 8.0 (low stress; p=0.076). Similarly, among 18-26y, problematic users showed higher stress (19.5) than non-problematic users (15.0; p=0.063), both indicating moderate stress. However, neither analysis was statistically significant. While similar trends were seen between the age groups, 18-26y problematic cannabis consumers tended to report higher median stress scores than 27-35y. Among males, stress scores did not differ significantly between problematic and non-problematic cannabis users (15.0 vs. 14.0; p=0.32, moderate stress). Among females, problematic users had significantly higher stress compared to non-problematic consumers (19.0 vs. 15.0; p=0.012, moderate stress).

Conclusions: Problematic users had higher median stress scores than non-problematic users, with minimal differences in males but significantly higher stress in females. These findings highlight the importance of addressing mental health to prevent problematic cannabis use in stressed individuals.

A Decade in Review:

Cannabis Use and Multiple Myeloma Cancer Research, 2015-2025

Hamza

Masoud University of Miami

Co-authors: Amrit Baral1, Ciné Brown1, Jasmine A Davis1, Denise C Vidot1 1University of Miami

Background: Multiple myeloma (MM) is a malignant blood cancer characterized by abnormal plasma cell proliferation, resulting in severe immunosuppression, bone degradation, and organ dysfunction. Cannabis and its cannabinoids [i.e., tetrahydrocannabinol (THC) and cannabidiol (CBD], have demonstrated potential anti-proliferative and pro-apoptotic effects in numerous trials. Given the increasing accessibility of cannabis alongside its growing use in medical care, further research is necessary to evaluate its impact on MM progression, symptom relief, and treatment outcomes.

Objective: To examine the past 10 years of published research on the impact of cannabis on Multiple Myeloma.

Methods: A comprehensive literature search was performed in February 2025 by two independent reviewers using a standardized rubric across PubMed, Scopus, and Embase. Keywords were “Multiple Myeloma,” “Marijuana”, “Cannabis,” and “Cannabinoids”.

Covidence software facilitated the screening, review, and extraction process. Studies were included if they addressed the therapeutic potential, risks, or clinical outcomes of cannabinoid use in multiple myeloma cancer studies.

Results: The search resulted in 135 abstracts for review (N=114 after removing duplicates). Specifically, Embase identified 101 (11 duplicates); PubMed identified 13; Scopus identified 10 (10 duplicates). Of the 114 abstracts for review, reviewers discussed/settled the inclusion decision for 26 articles that had opposing inclusion results. The team agreed on 22 that fit the inclusion criteria for full manuscript review. After the review of full texts, 8 were included in the proposed study. The primary reason for exclusion was due to the articles describing the endocannabinoid system as a pathway, but not including data on specific relationship between cannabinoids/cannabis/marijuana and multiple myeloma. Of the 8 studies, cannabinoids have been shown to exhibit significant anti-myeloma properties through numerous different mechanisms including apoptosis induction, immune modulation, and telomere regulation. Four studies indicated that cannabinoids have the potential to selectively trigger apoptosis in myeloma cells via caspase activation, Bax/Bak upregulation, and ceramide synthesis. Studies reported that cannabinoids can downregulate levels of transcription factors (NF-κB and XBP1), subsequently moderating telomere length and TP53 expression. Together, these biomarkers influence the maintenance, division, and lifespan of myeloma cells in the body. In addition, 2 studies found cannabinoids to be more effective when used in unison with standard anti-myeloma therapies such as bortezomib and dexamethasone.

Conclusions: While findings suggest the

anti-tumor potential of cannabinoids in multiple myeloma, variations in study design, cannabinoid administrations, and patient conditions indicate the need for further research to optimize dosing and treatment results.

A Review of Drug-Drug Interactions involving Medical Cannabis in Older Adults

Fatemeh Mehrabi University of Florida

Co-authors: Sebastian Jugl1, Amie J Goodin1, Earl J Morris1

1University of Florida

Background: The legalization of medical cannabis (MC) in the United States has resulted in a significant increase in its use among adults over 65 years old in the past two decades. Despite its growing popularity, few studies have assessed the potential for drug-drug interactions (DDIs) involving MC and potentially inappropriate medications (PIMs) in older adults (MC-PIM DDIs). There is a need for an updated review of MC-PIM DDIs given the recently updated 2023 Beers Criteria and advances in MC PK/PD research.

Objective: This study sought to develop a framework for assessing potential MCPIM DDIs in older adults, using current PK/PD data.

Methods: PIMs were defined using the 2023 Beers Criteria, and MC-PIM DDIs were systematically assessed using Clinical Pharmacology, FDA package inserts, and literature review. We created a detailed list of PIMs from the Beers Criteria, along with their potential interactions with THC and CBD.

Results: Cannabidiol (CBD) is a substrate of CYP2C19 and CYP3A4;

tetrahydrocannabinol (THC) is a substrate of CYP2C9 and CYP3A4. CBD and THC both inhibit CYP2B6, CYP2C9, CYP3A4, CYP2D6. CBD also inhibits CYP1A2, CYP1B1, and CYP2C19; while THC induces CYP1A2. We identified 6 PIM categories with potential for MCPIM DDIs, including antihistamines, cardiovascular/antithrombotics, central nervous system, endocrine, gastrointestinal, and pain.

Conclusions: The following clinical suggestions should be emphasized when prescribing MC with PIMs listed in this framework: a) Conduct medication reviews to identify potential DDIs and adverse drug effects; b) Assess the current evidence for MC and evaluate its effectiveness in relevant conditions; c) Evaluate fall risk, neuropsychiatric conditions, and cardiovascular disease; d) Titrate doses of THC/CBD gradually; e) Deprescribe MC and PIMs when possible.

Associations between Cannabis Use, HIV Status, and Myo-Inositol in Brain Regions Related to Stress and Emotion Processing in Adults

Fernando Moradel Cano University of Miami

Co-authors: Teddy Salan1, Sulaiman A Sheriff1, Dario N Ayala1, Yoibel Perez1, Anjalie Geffard1, Clara Morales1, Ranya Marrakchi El Fellah1, Suresh Pallikkuth1, Lisa J Reidy1, Eva Widerstrom-Noga1, Denise C Vidot1, Allan E Rodriguez1, Robert L Cook2, Varan Govind1 1University of Miami, 2University of Florida

Background: Myo-inositol (MI) is a brain metabolite associated with glial cell

activity and osmotic regulation, often linked to neuroinflammatory responses that may impact cognition and other processes. Acute HIV infection can induce neuroinflammation, which typically subsides after antiretroviral therapy (ART) initiation. However, research on how different brain cells respond to cannabis use in the context of HIV remains limited. This study examines associations between cannabis use (CB+) and brain MI levels in people with HIV (PWH) and HIVnegative (HIV-) individuals, focusing on brain regions involved in stress and emotion processing.

Methods: Ninety-three participants (males/females: n=47/46; HIV+/HIV-: n=48/45; Mean age = 36, SD = 7.7; agerange: 18-50 years) were enrolled into four groups: HIV+CB+, HIV-CB-, HIV+CB-, and HIV-CB+. Eligibility criteria included no MRI contraindications, no primary psychiatric or neurological conditions, and cannabis use within the past month, or no cannabis use at all. Assessment data consists of a 3-Tesla whole-brain magnetic resonance spectroscopy to examine MI levels in 47 brain regions, cannabis metabolite concentrations obtained from blood plasma, and perceived stress scale-10 (PSS-10) scores. Two-way ANOVA and Pearson correlation with significance testing at p < 0.05 were used.

Results: Significant MI levels were observed in combined interactions of cannabis use and HIV status in the right insula (F = 4.42, p = 0.041) and right putamen (F = 4.10, p = 0.049).

Independent cannabis associations on MI levels were observed in the left thalamus (F = 8.36, p = 0.006), left insula (F=5.37, p=0.025), and right putamen (F=8.51, p=0.005). Independent HIV status associations on MI were observed in the thalamus bilaterally (F=6.07, p=0.017 for left; F=6.40, p=0.015 for right) and right insula

(F=6.83, p=0.012). MI in all four groups had positive correlations with blood plasma Δ9-THC in the bilateral insula (R = 0.49, p = 0.0001) and right putamen (R = 0.64, p < 0.0001). HIV+CB+, HIV-CB+, and HIV-CB- groups showed moderate stress scores (16-19 range), with HIVCB+ having relatively higher scores. There were no significant correlations between MI levels and PSS-10 scores.

Conclusion: The findings indicate that cannabis and HIV status have combined and independent associations with MI in brain regions linked to stress and emotion processing. In all four groups, MI levels were positively correlated with blood plasma Δ9-THC. Additionally, the HIV-CB+ group exhibited higher stress scores. These results highlight the need for further exploration with larger samples to understand how cannabis influences brain inflammation and stress responses.

Pre-Existing Cardiovascular Disease among Florida Medicaid Beneficiaries Newly Dispensed Medical Cannabis

Earl Morris, PhD University of Florida

Co-authors: Fatemeh Mehrabi1 , Sebastian Jugl1, Amie J Goodin1 1University of Florida

Background: Medical cannabis use is increasing, and prior research suggests its use may be associated with a broad range of adverse cardiovascular (CV) outcomes, and the American Heart Association has emphasized the need for observational research to better understand the epidemiology of medical cannabis and its usage among individuals with pre-existing CV disease.

Objective: To assess whether preexisting CV disease is associated with differences in demographic and clinical characteristics among a population of Florida Medicaid beneficiaries dispensed medical cannabis.

Methods: We used data from the Medical Marijuana clinical Outcomes RepositorY (MEMORY), which contains Medical Marijuana Use Registry data linked to Florida Medicaid claims. We identified beneficiaries newly dispensed medical cannabis who were aged 19-65 with ≥ 365 days of continuous Medicaid enrollment. Next, we assessed for preexisting CV disease during the 365-day baseline period prior to first medical cannabis dispensing, which was defined as a composite of acute myocardial infarction, atrial fibrillation, heart failure, hypertension, ischemic heart disease, peripheral vascular disease, stroke/ transient ischemic attack, or unstable angina. We compared differences in demographic and clinical characteristics using Chi-squared tests or t-tests, where applicable.

Results: We identified 70,968 medical cannabis new users (63.2% female; 53.3% non-Hispanic white; 16.8% nonHispanic black; 16.2% Hispanic; mean age 35.0) who met eligibility criteria for our study. Of those, 4,554 (6.4%) had pre-existing CV disease, with hypertension (5.9%), ischemic heart disease (1.0%), and heart failure (0.7%) occurring most frequently. Medical cannabis new users with pre-existing CV disease were more likely to be older (mean age: 46.2 vs. 34.3, p<0.0001), male (41.8% vs. 36.4%, p<0.0001), and non-Hispanic (90.5% vs. 82.4%, p<0.0001), compared to those without CV disease.

Conclusions: We found that more than one out of every fifteen Florida Medicaid beneficiaries newly initiating medical cannabis had pre-existing CV

disease. More research is needed to better understand medical cannabis epidemiology and associated risks among those with CV disease to optimize medication safety and improve outcomes

Reasons for Interest or Non-interest in Medical Marijuana as a Treatment Among Older Adults with Chronic Pain: An Analysis of Open-ended Survey Response

Kendall Robinson University of Florida

Co-authors: Kimberly Sibille1, Zhigang Li1, Rene Przkora1, Siegfried Schmidt1, Margaret C Lo1, Robert L Cook1, Deepthi S Varma1, Yan Wang1 1University of Florida

Background: Medical marijuana (MM) use for chronic pain has become more common among older adults. Evaluating the contributory factors on the decision to use MM can help elucidate the differences between those who choose or choose not to use MM.

Objective: This study aims to explore reasons for interest or non-interest in using medical marijuana among older adults with chronic pain.

Methods: A total of 139 participants aged 50 and older with non-cancer chronic pain from an ongoing 12-month prospective cohort Study on Medical marijuana and Its Long-Term Effects (SMILE study) answered open-ended questions assessing the decision whether to use MM at baseline. Responses were analyzed using NVivo software. Responses were evaluated by the first author to generate initial codes.

Next, aligning codes were compiled collaboratively with the senior author to generate themes and sub themes. Two groups of participants were identified, those with: interest (n=92) and noninterest (n=47) in MM.

Results: Among those interested in MM (n=92), the main reasons included the desire to use MM as an alternative treatment or to reduce the use of other medications (45.7%) and the lack of options for pain treatments (16.3%); a lower perception of harm (15.2%) and the potential effectiveness of MM (15.2%) compared to other treatments; the potential to improve pain (50%), mental health (5.4%), sleep (5.4%), physical health (3.3%), and quality of life (1.1%). Among those not interested in MM (n=47), the main reason included concerns with the potential side effects (25.5%), safety (12.8%), and efficacy (12.8%) of MM; challenges with employment (14.9%) and legality and cultural concerns (8.5%); negative past experiences with marijuana use (12.8%) and negative perceptions of drugs (10.6%); the belief that current treatments are sufficient (8.5%) or that MM is not needed (6.4%). Affordability of MM was also discussed (6.4%).

Conclusions: These findings suggest that those interested in using MM tended to have more positive perceptions of MM than those who were not interested. Satisfaction with the current treatment regime and legal concerns also seemed to influence acceptance of MM treatments. This is consistent with the health belief model, where individuals weigh potential benefits and harms with the perceived need to try new treatments. Our findings help inform on the potential need for educational interventions (e.g., health benefits and safety of MM) and patientsupport tools (e.g., financial and/or employment support). Observational studies examining effectiveness of

MM should consider adjusting for preexisting attitudes and beliefs.

Diffusion Tensor Imaging with Free Water

Elimination

Reveal Compounded Brain Microstructural Injury in People with HIV who Use Marijuana

Teddy Salan, PhD University of Miami

Co-authors: Fernando M Moradel Cano1 , Dario N Ayala1, Ranya Marrakchi El Fellah1, Eva Widerstrom-Noga1, Suresh Pallikkuth1, Denise C Vidot1, Allan E Rodriguez1, Robert L Cook2, Varan Govind1

1University of Miami, 2University of Florida

Background: HIV infection is associated with chronic neuroinflammation and microstructural injury in people with HIV (PWH). On the other hand, the effect of chronic cannabis use on brain tissue microstructure is less established, with some studies showing that cannabis does not negatively affect white matter (WM) microstructure. However, these findings were dependent on age, frequency/duration and mode of administration.

Objective: The goal of this study is to evaluate the effect of HIV infection and cannabis use on brain microstructure using multi-shell diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) with free-water elimination (FWE).

Methods: MRI data were collected on a 3T scanner from 44 subjects, following a 2x2 design: 14 PWH using cannabis (PWH+C; 37±7.8 y.o.), 7 PWH not using cannabis (PWH; 38.5±5.1 y.o.), 13 people without HIV (PWoH) using

cannabis (PWoH+C; 37.2±7.2 y.o.), and 10 PWoH not using cannabis (PWoH; 31.3±8.5 y.o.) as healthy controls. The protocol included multi-shell diffusionweighted MRI (DWI; b = 1000/2000 s/ mm2; 30 gradient directions). DWI data were processed to obtain DTI metrics: fractional anisotropy (FA), mean-, axial-, and radial-diffusivities (MD, AD, RD); DKI metrics: kurtosis FA (kFA), mean-, axial-, and radial-kurtosis (MK, AK, RK); and FWE-DTI metrics: FWE-FA, FWEMD, FWE-AD, FWE-RD, and free water fraction (FW). These metrics were evaluated at 33 WM regions-of-interest (ROI) from the JHU-MNI-type2 atlas. At each ROI, we performed non-parametric two-way ANOVA to find the effect of HIV and cannabis on DTI/DKI/FWE metrics (significance at p<0.05, uncorrected in this preliminary analysis).

Results: Results showed extensive WM injury (lower FA and higher MD, AD, and RD) in PWH, PWoH+C, and PWH+C groups relative to controls, with few significant differences between PWH and PWoH+C groups, and the most widespread injury observed among PWH+C subjects. The most affected ROIs were the inferior (p<0.001) and superior longitudinal fasciculus (p<0.001), and post-thalamic radiation (p<0.001). Identical results were found with FWE-DTI including FW, while differences in DKI metrics were less significant.

Conclusions: Our results show that cannabis consumption can intensify white matter injury in PWH, as shown by the lower FA and higher diffusivities in PWH+C subjects compared to all groups, while PWH and PWoH+C subjects had comparable measurements. Higher FW also suggests higher inflammation in PWH+C, which may be a driving factor for the associated WM injury. Our future analyses will investigate the effect of relevant co-variates such

as BMI, sex, frequency/duration and mode of cannabis administration, and cannabinoid metabolites in blood.

Associations Between Plasma Δ9-THC

Metabolites and Brain Metabolite Concentrations in PWH Using Whole-Brain Magnetic Resonance Spectroscopic Imaging

Teddy Salan, PhD University of Miami

Co-authors: Fernando M Moradel Cano1 , Sulaiman A Sheriff1, Lisa J Reidy1, Dario N Ayala1, Ranya Marrakchi El Fellah1, Eva Widerstrom-Noga1, Suresh Pallikkuth1, Denise C Vidot1, Allan E Rodriguez1, Robert L Cook2, Varan Govind1 1University of Miami, 2University of Florida

Background: Delta-9tetrahydrocannabinol (Δ9-THC), one of the main psychoactive components in cannabis, acts on the central nervous system through interaction with cannabinoid receptors that are densely distributed within brain networks, altering brain chemistry. However, despite increasing cannabis use, especially among people with HIV (PWH), few studies have investigated the direct influence of cannabis on brain metabolites.

Objective: This study aims to associate plasma Δ9-THC, 11-hydroxy-Δ9-THC (11-OH-THC), and carboxy-Δ9-THC (THC-COOH) metabolites with brain metabolite concentrations in PWH and people without HIV (PWoH). Brain metabolites were evaluated using our whole-brain magnetic resonance spectroscopic imaging (MRSI) technique for measuring N-acetyl aspartate (NAA; neuronal viability), creatine (Cre; cellular

energy), choline (Cho; membrane turnover), glutamate+glutamine (Glx; neurotransmitters) and myo-inositol (m-Ins; inflammation).

Methods: Plasma samples and 3T MRI data were collected from 16 PWH (38±7.5 y.o.) and 17 PWoH (37.4±7.8 y.o.) who use cannabis. The protocol included whole-brain short-TE MRSI (TE/TR: 17.6/1551 ms; 17 minutes) and T1-MRI. MRSI data were processed using MIDAS software to estimate neurometabolite concentrations at 47 brain anatomical regions-of-interest (ROI) from the AAL47 atlas, using appropriate data quality criteria. Plasma samples were extracted using a solid phase extraction (SPE) technique and analyzed using a Gas Chromatography Tandem Mass Spectrometry (GC-MS/MS) to quantify Δ9-THC, 11-OH-THC, and THC-COOH. At each ROI, we performed Spearman correlations to associate plasma THC with neurometabolite level, and tested for homogeneity of variance between PWH and PWoH (significance at p0.05) was observed, this effect with stronger among PWH. Plasma COOHTHC positively correlated with m-Ins in multiple brain ROIs including caudate (rho=0.53, p=0.007), cuneus (rho=0.62, p=<0.001), occipital lobe (rho=0.55, p=0.004), and lingual gyrus (rho=0.43, p=0.03) with no differences between PWH and PWoH. However, Δ9-THC and 11-OH-THC correlated positively with m-Ins among PWoH, but negatively in PWH at the same ROIs.

Conclusions: Higher 11-OH-THC and COOH-THC associated with lower Cho and higher m-Ins, respectively, reflecting impaired myelinization and increased inflammation. However, Δ9-THC and 11-OH-THC had differential effects on m-Ins with higher inflammation in PWoH and lower inflammation in PWH. Further analysis should investigate whether plasma cannabinoid metabolite levels

are associated with overall systemic inflammation, measured by plasma biomarkers, and how this relates to brain outcomes. We will also evaluate the effect of co-variates such as BMI, sex, frequency/duration and mode of administration.

Comparing Clinical Research Participation and Retention Between

Pregnant CannabisExposed and Unexposed Participants

Nayana Sojin University of Florida

Co-authors: Rhea Parimoo1, Lauren Agliano1, Amie J Goodin1, Deepthi S Varma1, Bruce A Goldberger1, Kay Roussos-Ross1 1University of Florida

Background: While there is currently limited data on the effects of perinatal cannabis use, in-utero exposure has been linked to adverse neonatal health outcomes. As perinatal cannabis use rates reportedly increase, it is necessary to obtain conclusive, pregnancy-specific safety data through well-designed clinical research studies.

Objective: To compare clinical research participation and retention trends in a pilot study among cannabis-exposed and unexposed participants in the perinatal period.

Methods: Pregnant patients selfreporting cannabis exposure during prenatal visits at an academic healthsystem were recruited, along with control patients with no self-reported exposure. Biospecimens and imaging were collected throughout the perinatal period: maternal urine and fetal

ultrasound each trimester; fetal MRI in the third trimester; maternal urine, placenta, umbilical cord, and neonatal meconium at delivery; and postpartum maternal urine and breastmilk.

Participants received compensation for each biospecimen/imaging completion. Participation trends were identified by calculating proportions of missed/ completed biospecimens/imaging, study visit reschedules/cancellations, and losses-to-follow-up (LTFUs).

Results: 25 participants were recruited over 18 months: 80% (n=20) selfreported as cannabis-exposed and 20% (n=5) reported as unexposed (control).

Of 37 possible fetal ultrasounds, 30 (81%) were performed (82%, n=23 cannabis-exposed; 78%, n=7 control). 68% of participants (60%, n=12 cannabis-exposed; 100%, n=5 control) completed a fetal MRI. Of 239 biospecimen collections, 170 (71%) were completed (66%, n=126 cannabisexposed; 90%, n=44 control). 44% of participants (45%, n=9 cannabisexposed; 40%, n=2 control) missed at least one delivery sample. 24% of participants (30%, n=6 cannabisexposed; 0%, n=0 control) did not complete one or more postpartum breastmilk samples due to not breastfeeding or no longer lactating. 40% (n=8) of cannabis-exposed participants were loss-to-follow-up (LTFU), with the majority (88%, n=7) occurring postpartum and 13% (n=1) after the third trimester. Notably, no LTFUs were observed in the control group. 45% of cannabis-exposed participants either canceled or required rescheduling of at least one appointment, compared to 0% (n=0) of controls. Additionally, 40% (n=8) of cannabis-exposed participants canceled, did not attend, or did not schedule their postpartum appointment, compared to 0% (n=0) of controls.

Conclusions: Participants with self-

reported perinatal cannabis exposure were more likely to miss postpartum visits, become lost-to-follow-up, and require rescheduling of study visits compared to controls. Despite this trend, cannabis-exposed participants completed 68% of study visits, suggesting that it is feasible to retain cannabis-exposed pregnant women for long-term study. To improve retention/compliance rates among cannabis-exposed participants, future research could consider implementing a staggered increase in incentives and home visits for sample collections.

Intrauterine Fetal Demise/ Stillbirth Among Decedents with Cannabinoids and Other Substances

Armiel

Suriaga, PhD Florida Atlantic University

Co-authors: Lenny Chiang-Hanisko1, Panagiota Kitsanta1, Acel D Suriaga1, Jessica Mangila2 1Florida Atlantic University, 2Boston University

Background: Intrauterine fetal demise (IUFD) is a critical public health concern, with more than 20,000 cases in 2022, or 1 in 60 births annually in the United States. Several factors could be attributed to IUFD, such as placental issues, increased maternal age, infection, diabetes, and smoking. However, research on the association of cannabis with IUFD is seldom reported. Despite the warning from the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics not to use cannabis during pregnancy, about 9.8 % of women self-reported cannabis use pre-pregnancy, 4.2% during pregnancy, and 5.5% post pregnancy: either due to self-treatment of pain, anxiety, and to

relieve nausea and vomiting. However, there is insufficient information about the long-term effects of using cannabis prenatally, including death.

Objectives: 1) Report the intrauterine fetal demise or stillborn among those who were exposed to cannabinoids and other substances. 2) Examine the association of cannabinoid exposure to IUFD.

Methods: This cross-sectional study used de-identified data from the Florida Department of Law Enforcement from 2020 to 2022. We analyzed data using descriptive statistics and regression modeling using Stata 17. The medical examiners ascertained the primary outcome of IUFD through autopsy and toxicology results.

Results: One hundred twelve out of 46,347 decedents with any substances in their system at the time of death were less than a year old. 40 out of 112 of these deaths were considered fetal deaths, and 30 (0.03%) were recorded as intrauterine fetal demise/stillborn. Of the 30 IUFD cases, 21 (70%) were males, 23 (79%) were white, and 100% occurred in urban counties. 11 (36.67%) out of 30 IUFD cases had single drug vs. 19 (63.33%) with polydrug exposures. 4 out of 30 IUFD cases had drug toxicity. Three cases had cannabinoid exposures, 13 cases with opioids, 14 with stimulants, 9 with cocaine, 5 with alcohol, 1 with benzodiazepine, and 1 with mitragynine exposure. No other drugs were observed among those with cannabinoid exposure. In a univariate regression model, the odds of having IUFD among those exposed to cannabinoids were not statistically significant, OR=.36, 95% CI .12-1.20, p=0.09. However, in the multivariate regression model, among those exposed to cannabinoids, the odds of IUFD, OR= .23, 95% CI .07-.82, p=0.02, after adjusting for confounders.

Conclusion: Our results provided evidence of IUFD among those with cannabinoid exposures, particularly as a sole substance, underscoring the need for further research and interventions for this emerging issue.

Poor Sleep and Quality of Life by Cannabis Use Status in the Herbal Heart Study Cohort

Zoe

Szczotka University of Miami

Co-authors: Amrit Baral1, Bria-Necole Diggs1, Ranya Marrakchi El Fellah1, Kylee Krivijanski1, Michelle Thompson1, Girardin Jean-Louis1, Denise C Vidot1 1University of Miami

Background: Cannabis is used for sleep, but effects remain unclear. While it may aid sleep, chronic use is linked to disturbances and lower quality of life (QoL). With increasing cannabis use, understanding its impact on poor sleep and QoL is essential.

Objective: To examine poor sleep and QoL in cannabis consumers and nonconsumers.

Methods: Data are from the Herbal Heart Study cohort (N=200) of 1835 years old adults residing in South Florida. Cannabis use was urine-verified. Poor sleep was defined as difficulty falling or staying asleep reported via the Medical History Questionnaire. Quality of life (QoL) was assessed through the World Health Organization QoL Questionnaire in four domains: physical health (PH), psychological wellbeing (PWB), social relations (SR), and environment (ENV). Computed domain scores aligned with WHOQOL-100 standards and transformed to a 0–100 scale.

Results: Among the sample (mean age: 25.2, SD=4.8, 65.0% female, 54.5% Hispanic/Latino), 63.0% were current cannabis consumers (CCU), and 29.0% reported poor sleep. CCU (31.8%) reported poor sleep vs. 24.3% of non-consumers, though not statistically significant (p=0.26). Median QoL total score (61.7 vs 115.1, p<0.0001) and domain scores for PH (60.8 vs 115.5, p<0.0001), PWB (66.3 vs 113.2, p<0.0001), SR (77.2 vs 108.7, p=0.0004), and environment (67.9 vs 112.6, p<0.0001) were lower among those with poor sleep compared to those with no poor sleep, respectively in the overall sample. CCUs with poor sleep reported lower total QoL (-12.6 difference) PH (-14.3), PWB (-10.4), SR (-8.3), and environment (-9.4) scores than CCUs with no poor sleep. There were no differences in median QoL total score (60.1 vs 60.9; -0.8 difference) and SR median score (66.7 vs 66.7) in CCU compared to non-consumers with poor sleep, respectively. CCU with poor sleep reported lower PH (67.9 vs 75.0, -7.1 difference) than non-consumers with poor sleep.

Conclusions: Poor sleep was associated with lower QoL across all domains, regardless of cannabis use. Poor sleep was also associated with worse PH among CCUs. Research should examine long-term effects of cannabis use on sleep and QoL among emerging adults.

Parents’ Needs and Barriers to Accessing Medical Cannabis in Pennsylvania

Elizabeth

Valdez, PhD

Drexel University

Co-authors: Olivia Cordingley1, Samantha Pagán1, Emily Lincoln1, Janna Ataiants1, Stephen Lankenau1

1Drexel University

Introduction: Medical cannabis is legally available in most U.S. states, including Pennsylvania, where it is prescribed for a range of qualifying medical conditions. Despite its growing acceptance, significant stigma and systemic barriers continue to impact access, particularly for parents who use medical cannabis to manage their health conditions.

Objectives: To identify the specific needs of parents using medical cannabis in Pennsylvania. To examine the barriers parents face when accessing and using medical cannabis. To explore how stigma and systemic challenges impact parents’ experiences with medical cannabis. To provide insights to inform policies and practices aimed at improving access and reducing stigma for parents enrolled in medical cannabis programs.

Methods: We conducted 48 in-depth, semi-structured interviews with parents holding active medical cannabis certifications. Participants were all cisgender women, with 72.9% identifying as White, 12.5% as Black/African American, 6.9% as Hispanic/Latino, and 4.2% as Multiracial. Ages ranged from 26 to 73 (mean: 42), reflecting the demographics of the state registry and the state of Pennsylvania. Data were analyzed using NVivo, guided by a codebook.

Results: Participants highlighted barriers to program entry and recertification, including high costs of certification and products, insufficient patient-provider communication, and stigma as parents who use medical cannabis. Logistical challenges, such as inconsistent product availability, limited rural dispensary access, and inadequate public transportation, further impeded engagement in the program. Parents suggested innovations like expanded curbside pickup, drive-through services, and offering delivery options. Other

recommendations included lowering costs, ensuring product consistency, and integrating medical cannabis into treatment plans.

Discussion: Improving access to medical cannabis for parents requires expanding accessible services, reducing costs, and enhancing program usability. Dispensaries should improve online platforms and maintain consistent product availability. Tailored educational resources for patients and providers may reduce stigma and support informed use. Addressing these barriers will enable medical cannabis programs to meet the needs of parenting populations while promoting health equity and engagement.

Effects of CBD/CBD-A Oral Extract on Resting-state EEG and Neuropathic Pain Symptoms After SCI

Roberta Vastano, PhD University of Miami

Co-authors: Gabriel Fernandez1, Ian Frank Scott1, Meredith Pinkerton1, Timoth Simmons1, Alberto MartinezArizala1, Eva Widerstrom-Noga1 1University of Miami

Neuropathic pain (NP) is one of the most common consequences associated with spinal cord injury (SCI). Current treatments are not consistently effective. Analgesic, anti-inflammatory, and anti-epileptic effects of cannabidiol (CBD) have been demonstrated in multiple clinical populations, including SCI. In our recent survey study, respondents with SCI and NP reported that cannabis, including CBD and tetrahydrocannabinol (THC), reduced their pain and their use of opioids, gabapentin and over-the-counter pain medications.

However, to date the effects of CBD on neuropathic pain intensity, anxiety and electroencephalography (EEG) in participants with SCI remain still poorly understood.

In this study (cross-over, double-blind, placebo-controlled phase I/II) we aim to: 1) compare changes in momentary pain intensity/unpleasantness of the worst NP and resting state EEG power between CBD/CBD-A and placebo administration; 2) explore changes in neuropathic pain symptoms severity, sensory function, state anxiety and subjective drug effects after CBD/ CBD-A and placebo administration. The study involves a screening session, 2 study visits, and a follow-up visit. We will examine the effect of a single dose of a novel hemp-derived CBD/ CBD-A oral soft gel product containing 217.7mg of CBD/CBD-A and other minor cannabinoids (THC, THC-A, CBG, CBG-A, Cultivate Biologics) compared to placebo on momentary neuropathic pain intensity and unpleasantness and EEG resting state. We hypothesize that compared to placebo, CBD/CBD-A will significantly reduce NP symptoms intensity and unpleasantness and normalize EEG activity.

Men or women, with moderate to severe chronic neuropathic pain,18-64 years of age, incomplete or complete traumatic SCI will take part of this study. Exclusion criteria include drug or alcohol abuse, significant medical illness or other significant neurological trauma, psychopathology and women who are pregnant, breastfeeding, or not practicing an effective form of birth control. Individuals with renal or hepatic disease, elevated serum creatinine, transaminases, or bilirubin, use of valproate, strong CYP2C19 and CYP3A4 inducers, suicidal ideation, hypersensitivity to cannabidiol or tetrahydrocannabinol, sesame seed oil, lecithin, or bovine gelatin will also be

excluded.

The protocol has been approved by the FDA and the University of Miami’s IRB and is registered on clinical trials. gov (NCT05630235). The University of Miami clinical research monitoring process has been initiated. Potential participants have been identified, and we expect to start enrolling participants in March 2025.

Multiple Myeloma and Medical Cannabis: A Preliminary Glance into Patient-Provider Cannabis

Communication and Reasons for Use

Denise Vidot, PhD University of Miami

Co-authors: Amrit Baral1, Bria-Necole Diggs1, Hamza Masoud1, Yash Agrawal1, Ciné Brown1

1University of Miami

Background: The prevalence of cannabis use among Multiple Myeloma (MM) patients is increasing concurrent with access to medical cannabis. Studies suggest that cannabis may alleviate cancer-related symptoms; however, use patterns and patientprovider communication are not established among adults living with MM.

Objective: This ancillary study to an ongoing NCI-funded study aims to explore cannabis use and provider communication among adults living with MM.

Methods: Participants are respondents to the Cannabis and Cancer study (N=437) of patients at Sylvester Comprehensive Cancer Center. The analytic sample focused on the 10

participants with MM who reported cannabis use. REDCap was leveraged to collect socio-demographics, cancer stage, and treatment. The NCI-Cannabis Core Questionnaire measured cannabis frequency, source, method of use, and comfort in discussing with providers. Data were analyzed using a descriptive approach, with frequency and proportion reported for each variable.

Results: Of the sample (age range 37-76y; median=63y), 20.0% were former consumers that stopped before MM diagnosis, 50.0% were current consumers that started before diagnosis, and 30.0% were current consumers that started after diagnosis. All had health coverage, 50.0% were retired, 30.0% disabled, and 20.0% employed; 30.0% were foreign-born. Cancer stages varied: Unspecified (30.0%), Stage-4 (10.0%), Stage-3 (20.0%), Stage-2 (20.0%), Stage-1 (20.0%); 30.0% had a history of prior cancers (skin-non melanoma, blood, and prostate); 70.0% were undergoing treatment. Bone marrow transplants were performed on 70.0% of participants; 85.7% received autologous transplants. Most (75.0%) obtained cannabis from a dispensary. Only 50.0% knew what cannabinoids were in the cannabis consumed, of which 40.0% reported delta-9-THC-dominant cannabis, 40.0% reported CBD-dominant cannabis; and 20.0% reported delta8-THC-dominant cannabis. Majority (75.0%) of those that reported their most common route of use, reported that they most often consume cannabis by eating or drinking. Most (62.5%) reported daily use during MM treatment. Pain was the most common (90.0%) reason for use. Most (87.5%) felt comfortable discussing cannabis with their cancer provider, but only 62.5% communicated about cannabis use.

Conclusions: THC-dominant, daily cannabis use via eating or drinking

were most commonly reported among cannabis consumers with MM. Given its emerging use for pain management, further research should assess its effectiveness and safety in symptom relief. Objective prospective examination of a larger cohort of MM patients is needed to elucidate the long-term impact of use.

Cannabis, Alcohol Use, and ART Adherence Among Young People with HIV in Florida

Karina Villalba, PhD

University of Central Florida

Co-authors: Hanzhi Gao1, Lamisha Rogers1, Kayla Hicks1, Sylvie Naar1, Karen MacDonell1, Scott Pickett1, Sharon Nichols2

1Florida State University, 2University of California San Diego

Background: Alcohol and cannabis consumption is common among young people with HIV and may impact treatment outcomes. Extensive research shows that alcohol use is a risk factor for poor adherence to antiretroviral therapy (ART). However, cannabis use has a complex relationship with substance use and ART adherence; some studies suggest it as a harm reduction approach for other substances, while others associate it with ART non-adherence.

Objectives: This study aimed to determine whether cannabis use is associated with lower alcohol consumption and alcohol-related problems and poorer ART adherence. We hypothesized that higher cannabis use is associated with reduced alcohol consumption and predicts poorer ART adherence.

Methods: The longitudinal DEFINE study

recruited young people with HIV aged 18 to 29 who consumed alcohol at least once in the past 30 days. A total of 105 participants who completed the baseline questionnaire were included. To assess alcohol and cannabis use, we used the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) substance involvement score, which measures the frequency and consequences of alcohol and cannabis use separately. ART adherence was assessed using the self-reported item: “What percentage of your HIV medication have you taken in the past 30 days?”

Results: Findings showed that the mean age of participants was 26.3 years (SD = 2.7), with 44.8% identifying as Black, 33.3% as White, and 21.9% as Other, while 33.3% identified as Hispanic. The majority of participants (87.6%) were assigned male at birth. The mean ASSIST involvement score for alcohol use was reported as low risk, 9.0 (SD = 5.9), and for cannabis use was moderate risk, 9.3 (SD = 7.3). The percentage of ART medication taken in the past 30 days was 90.0% (SD = 16.8). Preliminary analysis shows that the cannabis and alcohol involvement scores were significantly positively correlated (r = 0.306). Both cannabis and alcohol use were significantly negatively correlated with ART adherence (cannabis: r = -0.292, alcohol: r = -0.238). To further examine these relationships, we will be developing regression models to analyze the effects of cannabis and alcohol use on ART adherence while accounting for potential confounding variables.

Conclusion: Preliminary findings suggest that cannabis involvement may be associated with higher alcohol consumption and alcohol-related problems that could negatively impact ART adherence in young people with HIV.

Cannabis Use, Sex, and

Medication

Profiles

in the Herbal Heart Study: Associations with Psychotropic, Non Psychotropic, and MixedUse Medications

Maxwell

Wray University of Miami

Co-authors: Amrit Baral1, Bria-Necole Diggs1, Michelle Weiner2, Hilliary Schlerf3, Lisa Reidy1, Denise C Vidot1 1University of Miami, 2Nova Southeastern University, 3University of Maryland

Background: Cannabis is perceived as an alternative to pharmaceuticals for psychiatric/medical conditions, despite mixed findings. Research suggests sex differences in psychiatric and physical conditions. Given potential drugcannabis-interactions, it is crucial to understand differences in medications used by cannabis use status (CB+/CB-).

Objective: This study examined sex differences in medication use and history of medical conditions (HxMC +/-) between CB+ and CB-.

Methods: Data are from the Herbal Heart Study (N=199) which investigates cannabis and cardiovascular risk. Participants’ current medications/ supplements were classified into three categories: psychotropic, nonpsychotropic, and mixed-use, based on FDA clinical indications. Chi-Square tests were conducted to examine 1) cannabis use, medication use, and HxMC; and 2) these variables and sex. Mann-Whitney tests compared medication use between CB+/CB- and HxMC+/-. Kruskal-Wallis tests evaluated differences in medication use by route of cannabis administration.

Results: Most of the sample (mean age = 25.62y, SD = 4.81) were female (64.8%), Hispanic/Latino (57.3%), and CB+ (62.8%). Within CB+, 27.2% used blunts, 37.6% joints, and 35.2% vape/mixed methods. Overall, 58.3% of participants reported current medication/supplement use; 29.2% had HxMC+. Cannabis use was associated with psychotropic medications (p = 0.002) but not HxMC, total medication use, or use of non-psychotropic/ mixed-use medications. Psychotropic medication use was higher among CB+ (17.6% vs 3.5%); the highest usage observed in the joint group (8.0% vs 3.02% blunt and 6.53% vape/mixed, p = 0.006). Sex-stratified associations were found with total medication use (χ² =7.0 , p=0.008) and non-psychotropic medication use (χ² = 8.4,p = 0.004).

Females reported significantly higher total (42.2% vs 16.1%, p=0.008) and non-psychotropic medication use (36.2% vs 12.1%, p=0.007) than males. Psychotropic medication use was significantly higher for both female (17.8% vs 5.43%, p=0.008) and male (17.4% vs 0.0%, p=0.042) CB+ than CB-. Among males, psychotropic medication use was highest among joint consumers than other routes of administration (8.6% vs 7.1%,1.4%, and 0.0% respectively, p=0.045). No significant differences in psychotropic medication use were observed between male and female CB+ participants.

Conclusions: Associations between sex, medications, and cannabis use were found. Further investigation should examine interactions and sex differences between cannabis use and psychotropic medication patterns of use.

Age and Sex Differences in Abnormal Blood Pressure among Cannabis and

Psilocybin Co-Consumers in the Herbal Heart Study

Melanie Zamora

University of Miami

Co-authors: Amrit Baral1, Bria-Necole Diggs1, Ranya Marrakchi El Fellah1, Kylee

Krivijanski1, Varan Govind1, Claudia Martinez1, Denise C Vidot1 1University of Miami

Background: Cannabis and classic psychedelic use, especially psilocybin, is increasing along with the rising prevalence of high blood pressure (BP) among young adults. Despite these patterns, the combined and individual impact of cannabis and psilocybin consumption on abnormal BP is understudied.

Objective: To examine differences in abnormal BP status among cannabis-only consumers, cannabis and psilocybin (cannabis+psilocybin) consumers, and non-consumers in South Florida by age-group and sex.

Methods: The analytic sample (N=189) are 18-to-35-year-old participants of the Herbal Heart Study in South Florida with complete psilocybin, cannabis, and BP data. Psilocybin and cannabis consumption were self-reported based on lifetime use and past 30-days, via the Drug Use History Questionnaire managed via REDCap software. BP was taken three times following American Heart Association standardized guidelines; abnormal BP was defined as: ≥ 130mmHg systolic or ≥ 85mmHg diastolic. Descriptive statistics and Chi-squared tests were calculated by consumption group. Logistic regression adjusted by age and sex were used to test associations between cannabis, psilocybin use, and abnormal BP.

Results: Of the sample [mean age: 25.2 years (SD=4.8); 54.5% Hispanic/

Latino; 64.5% female], 47.1% were cannabis-only consumers, 32.8% consumed a cannabis+psilocybin, and 20.1% were non-consumers. There was a significant difference in sex by consumption group (p=0.0139): a higher proportion of females were cannabis-only consumers (52.5%) compared to cannabis+psilocybin (25.4%), and non-consumers (22.1%). In contrast, among males, a majority were cannabis+psilocybin consumers (46.3%), followed by cannabis-only (46.3%) and non-consumers (16.2%). There was a higher proportion of cannabis+psilocybin consumers in the 27y+ age group (40.3%) compared to the 18-26y age group (29.1%) and no difference in age group (48.4% vs 46.7%) among cannabis consumers. More than half (53.9%) of participants with abnormal BP were cannabis-only consumers, followed by cannabis + psilocybin consumers (41.0%); nonconsumers made up only 5.3% of those with abnormal BP (p=0.031). Cannabisonly consumers had six-times greater odds (AOR: 6.68, 95% CI: 1.37-32.6, p=0.02) of abnormal BP compared to non-consumers. There was no difference between cannabis+psilocybin consumers and non-consumers (AOR: 4.34, 95% CI: 0.87 - 21.6, p=0.07).

Conclusions: Cannabis-only consumers had over six-fold greater odds of abnormal BP than non-consumers. Future research should focus on the long-term cardiovascular effects of combined cannabis and psilocybin use.

Investigating Steroid Hormone Changes After Short-term High-Dose Exposure to Cannabidiol in Healthy Subjects

Qingchen Zhang

University of Florida

Co-authors: Christopher A Singleton1, Josephine Raeuscher2, Philip W Melchert2, David J Greenblatt3, John S Markowitz2

1Callen Analytical Service, 2University of Florida, 3Tufts University

Background: Cannabis-derived CBD (Epidiolex®) is FDA-approved for the treatment of seizures caused by LennoxGastaut syndrome, Dravet syndrome, and tuberous sclerosis complex. However, the pharmacology and bioactivities of CBD in humans are not fully understood.

Objective: This study evaluates potential changes in plasma steroid hormone concentrations following short-term high-dose oral CBD administration in healthy subjects.

Methods: Twelve subjects (6 males, and 6 females) participated in a randomized, placebo-controlled crossover study and received either oral Epidiolex® (750 mg twice daily for three and one-half days) or a placebo solution on separate occasions with an intervening washout. Plasma samples collected at nine-time points after the final dose were analyzed for steroid hormone concentrations using LC-MS/MS. Statistical analysis was used to evaluate CBD’s influence on steroid hormone concentrations and correlations of CBD/metabolites and any observed hormonal changes. This study was made possible in part by a grant from the State of Florida Consortium for Medical Marijuana Clinical Outcomes Research.

Results: In the CBD-exposed group compared to the placebo group, cortisol, and cortisone significantly decreased only in males, progesterone concentrations significantly increased only in males, while pregnenolone, dehydroepiandrosterone (DHEA), 7-alpha-hydroxy-DHEA, corticosterone,

and deoxycorticosterone increased significantly in both sexes. No significant changes were noted in 11-deoxycortisol, testosterone, androstenedione, and aldosterone. Significant linear correlations were identified between corticosterone, pregnenolone, and progesterone with the area under the curve (AUC) of 7-COOH-CBD, the major metabolite of CBD.

Conclusions: The increase of progesterone, pregnenolone, DHEA, 7-alpha-hydroxy-DHEA, corticosterone, and deoxycorticosterone appeared to be a novel finding in clinical subjects. Further studies with a larger sample size are needed to validate the findings.

EXHIBITORS

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.

Learn more at knowthefactsmmj.com.

The Accelerating Innovations For Substance Use Disorders Program blends business, medicine, and science to help basic and clinical researchers. Applications open until July 6.

Learn more at i4sud.com.

Karger Publishers is home to the official journal of the Consortium for Medical Marijuana Clinical Outcomes Research, Medical Cannabis and Cannabinoids.

Learn more at karger.com/mca.

TLS Global Group offers innovative medical devices and equipment. They develop advanced restorative therapy devices, collaborate with clients in the healthcare sectors and more.

Learn more at tlsglobalgroup.com.

ABOUT THE 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 eleven 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.

CONSORTIUM MEMBER UNIVERSITIES

COMMITTEES Scientific Program Committee

Lisa Eckel, PhD – Florida State University

Amie Goodin, PhD – University of Florida

Jeevan Jyot, PhD – University of Florida

Mark Kindy, PhD – University of South Florida

Nancy Klimas, MD – Nova Southeastern University

Yiota Kitsanta, PhD – Florida Atlantic University

Sari Paikoff, PhD – Florida Gulf Coast University

Mandip Sachdeva, PhD – Florida A&M University

Barry Setlow, PhD – University of Florida

Rose Stiffin, PhD – Florida Memorial University

Matthew Sutherland, PhD – Florida International University

Karina Villalba, PhD – University of Central Florida

Renessa Williams, PhD – University of Miami

Almut Winterstein, PhD – University of Florida

Abstract Reviewers

Aman Cheema, PhD – Nova Southeastern University

Robert Cook, MD, MPH – University of Florida

Kempuraj Duraisamy, PhD – Nova Southeastern University

Lisa Eckel, PhD – Florida State University

Amie Goodin, PhD, MPP – University of Florida

Md Mahmudul Hasan, PhD – University of Florida

Sebastian Jugl, RPh, MS – University of Florida

Mark Kindy, PhD – University of South Florida

Nancy Klimas, MD – Nova Southeastern University

Yiota Kitsanta, PhD – Florida Atlantic University

Priyanka Kulkarni, MPH – University of Florida

Catalina Lopez-Quintero, PhD – University of Florida

Juan Perez, MD, MSc – University of Florida

Mandip Sachdeva, PhD – Florida A&M University

Barry Setlow, PhD – University of Florida

Rose Stiffin, PhD – Florida Memorial University

Matthew Sutherland, PhD – Florida International University

Karina Villalba, PhD – University of Central Florida

Renessa Williams, PhD – University of Miami

Yan Wang, PhD – University of Florida

Consortium Leadership

Almut Winterstein, RPh, PhD, FISPE – Director

Robert Cook, MD, MPH – Associate Director

Yan Wang, PhD – Assistant Director, Clinical Core

Amie Goodin, PhD, MPP – Assistant Director, Evidence

Md Mahmudul Hasan, PhD – Assistant Director, MEMORY

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

Consortium Board

Max Orezzoli, PhD (Chair) – Florida Memorial University

Dinender Singla, PhD (Vice Chair) – University of Central Florida

William Anderson, PhD – Florida International University

Ken Dawson Scully –Nova Southeastern University

Peter Holland, MD – Florida Atlantic University

Eric Holmes, PhD – Florida State University

Christopher McCurdy, PhD – University of Florida

Troy Quast, PhD – University of South Florida

Martha Rosenthal, PhD – Florida Gulf Coast University

Jacqueline Sagen, PhD – University of Miami

Charles Weatherford, PhD – Florida A&M University

Planning Committee

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

Jeevan Jyot, PhD, PMP – Coordination and Logistics

Allison Veliz, MA – Marketing and Communications

Other Contributers

Mike Begonia

Trier Cerwinsky

Brendan Clough

Gabrielle Gele

Pedro Martinez Giron

Jonathan Hernandez

Lauren Keiser

Katherine Risher

Matt Splett

Jonathan Tillett

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 2025, selected abstracts will be published in the Medical Cannabis & Cannabinoids. Read more about Medical Cannabis and Cannabinoids by clicking 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 2025, including: keynote speakers, session members, board members, exhibitors, and volunteers. We thank the University of Florida Conference Department, the College of Pharmacy Lake Nona IT, and the College of Pharmacy Office of Events team for technical support and event coordination. We hope to see you again at CCORC 2026!