CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE NOVEMBER 5-6, 2026 ORLANDO, FL
CCORC 2026 - PROGRAM AND ABSTRACT BOOK
THE SIXTH ANNUAL
TABLE OF CONTENTS WELCOME FROM THE DIRECTORS PROGRAM
4
At a Glance ................................................................................................................ 4 Keynote Speakers ................................................................................................. 9 Session Leaders and Speakers .................................................................... 11 Presentations of Top Abstracts Speakers ............................................ 18
ABSTRACTS
22
Parallel Session Abstracts ............................................................................... 22 Oral Presentations of Top Abstracts ........................................................ 26 Basic Science and Translational ................................................................ 34 Clinical Research, Population Health, and Health Behavior .... 52 Education and Policy Evaluation ................................................................ 84
EXHIBITORS ABOUT
2 - CCORC 2026
89
88
3
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 6th annual conference: the Cannabis Clinical Outcomes Research Conference (CCORC), held in Orlando, FL on November 5–6, 2026. 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. We are delighted that CCORC 2026 is our most attended in-person meeting yet! Additionally, we welcome the largest number of scientific presentations since CCORC’s inception, demonstrating the expanded reach and impact of our Consortium community. 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 2026! 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
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 3
DAY 1 SCHEDULE Time (ET)
Session Description Day 1 Welcome Address Δ
9:00-9:20 am
Almut G. Winterstein, PhD
Consortium for Medical Marijuana Clinical Outcomes Research University of Florida
CCORC 2026 Agenda Overview Δ 9:20-9:30 am
Amie J. Goodin, PhD
Consortium for Medical Marijuana Clinical Outcomes Research University of Florida
Keynote: Using behavioral economics to understand cannabis use and misuse* Δ 9:30-10:30 am
Introduction: Amie J. Goodin, PhD, University of Florida
James MacKillop, PhD
Department of Psychiatry & Behavioral Neurosciences McMaster University
10:30-10:45 am
Exhibitor Hall | Coffee Break Presentations of Top Abstracts: Medical Cannabis Across the Lifespan: Patient Characteristics, Clinical Outcomes, and Safety Considerations
10:45-11:45 am
Moderator: Mark Kindy, PhD, University of South Florida Nicole E. Smolinski, PhD Lihi Bar-Lev Schleider, PhD Tikun Olam University of Florida Wen Wen, MS University of Florida
Δ = AVAILABLE VIA LIVESTREAM 4 - CCORC 2026
Masoud Rouhizadeh, PhD University of Florida See room assignments at ccorc.mmjoutcomes.org/agenda
NOVEMBER 5, 2026 Time (ET)
Session Description
11:45-1:15 pm
Poster Session 1 | Exhibitor Hall | Networking Lunch Reception Please note the poster session will begin at 12:15 pm
Keynote: To eat or not to eat? Cannabinoid control of food intake and energy metabolism* Δ 1:15-2:15 pm
Introduction: Md Mahmudul Hasan, PhD, University of Florida
Nicholas DiPatrizio, PhD
Department of Biomedical Sciences University of California Riverside
2:15-2:20 pm
Room Transition
Parallel Sessions Session A: Cannabis, cognition, and clinical care: From adolescent risk to intervention Patricio Viera Perez, PhD
Chase Shankula, MS
Benjelene Sutherland, PhD
Kathryn Gex, PhD
Florida International University University of Wisconsin Florida International University Medical University of South Carolina
2:20-3:20 pm
Session B: Cannabis use in aging; vulnerabilities and potential benefits
Moderator: Barry Setlow, PhD, University of Florida John S. Markowitz, PharmD Robert L. Cook, MD University of Florida
University of Florida
Jennifer L. Bizon, PhD
Nicole Ennis, PhD
University of Florida
Florida State University
Yan Wang, PhD
University of Florida
Δ = AVAILABLE VIA LIVESTREAM
See room assignments at ccorc.mmjoutcomes.org/agenda
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 5
NOVEMBER 5, 2026 Time (ET) 3:20-3:30 pm
Session Description Exhibitor Hall | Coffee Break Parallel Sessions Session A: Cannabinoid Trials Unlocked: From IND to Impact Catalina Lopez-Quintero, PhD
Anthony Ferrari, PhD
Karina Villalba, PhD
Sheila Austin, MS
University of Florida
University of Central Florida
Sym Sciences, LLC
University of Florida
Lina M. Velilla Jimenez, MS University of Florida
3:30-5:00 pm
Session B: Cannabinoids in Cancer Care: From Mechanisms and Delivery to Evidence-Based Dosing
Moderator: Sebastian Jugl, PhD, University of Florida Mandip Sachdeva, PhD
Justin Kander, MS
Harold Han, PhD
Terel Newton, MD
Cancer Playbook
Florida A&M University
Total Pain Relief LLC
Vertosa
Stephen Zimberg, MD
Nova Southeastern University
Session C: The Medical Marijuana Clinical Outcomes Repository (MEMORY): Data Architecture and Hands-on Applications Almut G. Winterstein, PhD | Arthur N. Rosales, MS | Nicole E. Smolinski, PhD University of Florida
5:00-6:00 pm
Poster Session 2 | Exhibitor Hall | Networking Reception
Δ = AVAILABLE VIA LIVESTREAM 6 - CCORC 2026
See room assignments at ccorc.mmjoutcomes.org/agenda
DAY 2 SCHEDULE Time (ET)
Session Description Day 2 Welcome Address Δ
9:00-9:15 am
9:15-10:15 am
Robert L. Cook, MD
Consortium for Medical Marijuana Clinical Outcomes Research University of Florida
Keynote: Tolerance breaks and other forms of controlled cannabis use: Implications for clinical research and practice* Δ Introduction: Robert L. Cook, MD, University of Florida
Stephen Lankenau, PhD
Department of Community Health and Prevention Drexel University
10:15-10:20 am
Room Transition
Parallel Sessions Session A: Advancing Medical Cannabis Practice: Integrating Patient, Clinical, Pharmacological, and Policy Perspectives
Moderator: Christopher R. McCurdy, PhD, University of Florida Robert Welch, PharmD
10:20-11:20 am
University of Mississippi
Melani Kane, PharmD,
International Society of Cannabis Pharmacists
Christine Roussel, PharmD
International Society of Cannabis Pharmacists
Session B: Who, What, and How much? Decoding Modern Cannabis Exposure
Catalina Lopez-Quintero, PhD | Madelyn Eason | Tracy Qu | Andrew Velarde | Ryan Kalina University of Florida
Δ = AVAILABLE VIA LIVESTREAM
See room assignments at ccorc.mmjoutcomes.org/agenda
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 7
NOVEMBER 6, 2026 Time (ET) 11:20-11:30 am
Session Description Exhibitor Hall | Coffee Break Presentations of Top Abstracts: Medical Cannabis: Patterns of Use, Therapeutic Dosing, and Emerging Therapies
11:30-12:30 pm
Moderator: Barry Setlow, PhD, University of Florida Sandeep Chary Padakanti, PhD Florida A&M University
Terel Newton, MD
Total Pain Relief LLC
Marina Alacoque Rodrigues, MS Mehdi Nouraei, PhD University of Florida
Micellae Delivery Systems
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.
Δ = AVAILABLE VIA LIVESTREAM 8 - CCORC 2026
See room assignments at ccorc.mmjoutcomes.org/agenda
KEYNOTE SPEAKERS Nicholas DiPatrizio, PhD
Professor, Biomedical Sciences Director, UCR Center for Cannabinoid Research University of California Riverside
Keynote title - To eat or not to eat? Cannabinoid control of food intake and energy metabolism Dr. Nicholas DiPatrizio is a Professor of Biomedical Sciences in the School of Medicine at UCR, and Founding Director of the UCR Center for Cannabinoid Research. The DiPatrizio laboratory investigates roles for the endocannabinoid system in the integrative neurobiology and physiology that controls food intake, energy homeostasis, and reward, and dysregulation of these pathways in metabolic disorders. Moreover, the DiPatrizio laboratory studies the impact of cannabis exposure on endocannabinoid system function in metabolic health and disease. This work will support the discovery and development of novel therapeutic strategies to safely treat obesity, type-2 diabetes, and related disorders.
Stephen Lankenau, PhD
Professor, Community Health and Prevention Director, Medical Cannabis Research Center Drexel University
Keynote title - Tolerance breaks and other forms of controlled cannabis use: Implications for clinical research and practice Dr. Stephen Lankenau is a Professor in the School of Public Health and Director of the Medical Cannabis Research Center at Drexel University. Dr. Lankenau has published over a 100 peer-reviewed and other scholarly monographs focused on substance use and misuse, particularly in the areas of young adults, ketamine, prescription drugs, cannabis, and opioid overdose prevention. Currently, he is leading a 5-year registry study of medical cannabis patients in Pennsylvania, coleading a 15-year NIH-funded longitudinal study of young adults in California and Pennsylvania focused on controlled use of cannabis, and co-leading a 5-year NIHfunded study on opioid overdose prevention in Philadelphia using mobile phone technologies.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 9
James MacKillop, PhD
Professor, Psychiatry & Behavioral Neurosciences Director, Centre for Addictions Research, Centre for Medicinal Cannabis Research McMaster University
Keynote title - Using behavioral economics to understand cannabis use and misuse
Dr. James MacKillop holds the Peter Boris Chair in Addictions Research and a Canada Research Chair in Translational Addiction Research at McMaster University and St. Joseph’s Healthcare Hamilton. There, Dr. MacKillop directs both the Peter Boris Centre for Addictions Research and the DeGroote Centre for Medicinal Cannabis Research. His research uses a multidisciplinary approach that integrates psychology, economics, neuroscience, and genetics to gain unique insights into addiction and medical cannabis. Using the hybrid disciplines of behavioral economics, neuroeconomics, and genoeconomics, maladaptive decision making in health behavior is a core focus of his research program. Over the past two decades, Dr. MacKillop’s lab has generated 500 peer-reviewed publications and other works.
10 - CCORC 2026
SESSION LEADERS AND SPEAKERS Cannabis, cognition, and clinical care: from adolescent risk to intervention Thursday, November 5, 2026, 2:20 - 3:20 pm Patricio M. Viera Pérez, PhD Assistant Teaching Professor Florida International University
Dr. Patricio Viera Perez’s research focuses on assessing the structural and functional dynamics across brain networks that contribute towards substance use initiation and continuation behavior, integrating advanced neuroimaging techniques and clinically relevant behavioral assessments.
Chase Shankula, MS
Clinical Psychology Doctoral Candidate University of Wisconsin-Milwaukee Chase’s research focuses on delineating mechanisms of risk for problematic substance use behaviors in adolescents. He leverages neuroimaging and bioassay data in conjunction with advanced statistics to characterize risk-factors and biomarkers, ranging across measures of endocannabinoid signaling, internalizing symptoms, and traumatic brain injury.
Benjelene Sutherland, PhD NIEHS Postdoctoral Fellow Florida International University
Dr. Sutherland’s research revolves around gaining and promoting a better understanding of adolescent substance use etiology in the context of environmental risks impacting brain development and modifiable risk factors that can inform prevention strategies to reduce use onset.
Kathryn S. Gex, PhD
Assistant Professor Medical University of South Carolina Dr. Gex’s research focuses on improving the efficacy and uptake of interventions for the prevention and treatment of substance use and related harms across the lifespan. Her work leverages various research methods including qualitative, mixed methods, and survey research with target populations to inform substance-specific and developmentally-tailored interventions.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 11
Cannabis use in aging; vulnerabilities and potential benefits Thursday, November 5, 2026, 2:20 - 3:20 pm MODERATOR:
Barry Setlow, PhD Professor & Chief of Research University of Florida
Dr. Setlow’s laboratory uses preclinical models to investigate behavioral and neural mechanisms of cognition and motivated behavior in the context of both advanced age and substance use.
John S. Markowitz, PharmD, BCPP
Professor & Associate Chair University of Florida
Yan Wang, PhD
Associate Professor University of Florida Dr. Wang currently leads or co-leads several NIH funded projects that utilize advanced technologies and methods to improve the understanding of epidemiology, etiology, and intervention of substance use.
Nicole Ennis, PhD Associate Professor & Vice-Chair Florida State University
Dr. Markowitz’s research program has encompassed both in vitro and clinical assessment of drug-drug interactions and adverse effects of neuropsychiatric medications and natural products. He has published over 200 peer-reviewed papers and book chapters.
Dr. Ennis is an implementation scientist focused on generating rigorous, clinically actionable evidence to inform patient care, risk assessment, and health policy. Her research examines the functional consequences of substance use in older adults.
Jennifer L Bizon, PhD
Robert Cook, MD, MPH
Dr. Bizon’s research program is dedicated to understanding how aging affects the brain and cognitive function, with a long-term goal of identifying strategies and interventions that promote resilience and preserve cognitive health into advanced age.
Dr. Cook’s research is focused on strategies to improve health outcomes related to HIV and sexually transmitted diseases. He is the Director of Southern HIV and Alcohol Research Consortium, which supports collaborative research related to alcohol and HIV infection in Florida.
Professor & Chair University of Florida
12 - CCORC 2026
Professor & Director University of Florida
Cannabinoid Trials Unlocked: From IND to Impact Thursday, November 5, 2026, 3:30 - 5:00 pm Catalina Lopez-Quintero, PhD Assistant Professor University of Florida
Dr. 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.
Anthony Ferrari, PhD Co-Founder Sym Sciences LLC
Dr. Ferrari is an analytical chemist with over a decade of experience in botanical product development and cannabinoid research. He has supported numerous university-led clinical trials across Florida and the United States.
Sheila Austin, MS
Clinical Research Coordinator University of Florida Sheila works with Investigators to negotiate the FDA Investigational New Drug (IND) and Investigational Device Exemption (IDE) submission and approval process. Sheila is also a part of the admin team for UF ClinicalTrials.gov.
Karina Villalba, PhD
Assistant Professor University of Central Florida Dr. Villalba’s research examines the therapeutic potential of cannabis and cannabinoids in mental health and substance use disorders. Her work primarily focuses on the role of cannabidiol (CBD) in stress regulation, inflammation, and memory reconsolidation.
Lina M. Velilla Jimenez, MS PhD Student University of Florida
Lina’s research focus includes medical cannabis, cannabidiol, epidemiology, depression, and Alzheimer’s disease.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 13
Cannabinoids in Cancer Care: From Mechanisms and Delivery to EvidenceBased Dosing Thursday, November 5, 2026, 3:30 - 5:00 pm MODERATOR:
Sebastian Jugl, PhD
Research Assistant Professor University of Florida Dr. Jugl’s research aims to generate real-world evidence on the safety, effectiveness, and utilization of medications, with a particular emphasis on cancer survivorship and cardiovascular health.
Mandip Sachdeva, PhD Professor Florida A&M University
Dr. Sachdeva’s lab works in a multidisciplinary approach using Nanotechnology to combat diseases like Breast and lung cancer. Another emphasis is to use 3D printing approaches to develop tumor scaffolds and conduct cytotoxicity assays using 3D printed co-cultures of tumor cells and fibroblasts.
Justin Kander, MS
Patient-Reported Outcomes Specialist, Cancer Playbook Justin Kander has studied the use of cannabis to treat cancer for over 18 years. He has written several books on the subject and continues to produce educational content.
Stephen Zimberg, MD Clinical Associate Professor Nova Southeastern University
Dr. Zimberg’s research focuses on using microRNAs to alter treatment resistance in established and fresh patient-derived luminal, HER2-overexpressing, and triplenegative breast cancer specimens using a tissue engineering system without transforming agents or gene constructs.
Harold Han, PhD
Terel Newton, MD
Dr. Han is the Chief Science Officer of Vertosa, a leading provider of watercompatible cannabinoid ingredients for infused products. He has dedicated his career to the art and science of nanoemulsions, transforming plantderived active ingredients into stable, predictable and effective formulations.
Dr. Newton is a board-certified anesthesiologist and fellowship-trained interventional pain specialist who serves as Florida Medical Director for Trulieve. He is a recognized advocate and educator on alternatives to opioids for patients with acute and chronic pain.
Co-founder & CSO Vertosa
14 - CCORC 2026
Medical Director Total Pain Relief LLC
The Medical Marijuana Clinical Outcomes Repository (MEMORY): Data Architecture and Hands-on Applications Thursday, November 5, 2026, 3:30 - 5:00 pm Almut G. Winterstein, PhD
Distinguished Professor & Director University of Florida
Dr. Winterstein serves as the Director for both the Consortium for Medical Marijuana Clinical Outcomes Research and the Center for Drug Evaluation and Safety. Her research interests center on the post-marketing evaluation of drugs in pediatrics and perinatal care and the evaluation and improvement of quality surrounding medication use using real-world data.
Nicole E. Smolinski, PharmD, PhD Research Assistant Professor University of Florida
Dr. Smolinski’s research focuses on child and maternal health with a special interest in pediatric infectious diseases. She currently engages in research related to the management of pediatric acute otitis media, congenital hearing loss, the safety and use of medical marijuana in the pediatric and pregnancy populations, and medication safety in women’s health.
Arthur Rosales, MS Data Scientist University of Florida
Arthur Rosales is a Data Scientist at the University of Florida. He is the primary data manager for the Medical Marijuana Clinical Outcomes Repository (MEMORY), and he provides data analysis expertise in support of the Consortium for Medical Marijuana Clinical Outcomes Research.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 15
Advancing Medical Cannabis Practice: Integrating Patient, Clinical, Pharmacological, and Policy Perspectives Friday, November 6, 2026, 10:20 - 11:20 am MODERATOR:
Christopher McCurdy, PhD
Distinguished Professor & Director University of Florida
Dr. McCurdy is a broadly trained medicinal chemist, behavioral pharmacologist and pharmacist whose research focuses on the design, synthesis and development of drugs to treat pain and drug abuse. In addition to his discovery chemistry roles, McCurdy serves as the director of the UF Translational Drug Development Core.
Robert Welch, PharmD Professor & Director University of Mississippi
Dr. Welch is the Director of the National Center for Cannabis Research and Education at the University of Mississippi. Dr. Welch directs the NCCRE in the following areas: conducting Real World Evidence and patient outcomes studies, examining drugdrug interactions of cannabinoid products with pharmaceutical products, and developing novel cannabinoid drugs.
Melani Kane, PharmD
President & Executive Director International Society of Cannabis Pharmacists Dr. Kane is a former medical cannabis pharmacist in Minnesota and serves as President and Executive Director of the International Society of Cannabis Pharmacists. Her work focuses on medical cannabis education, medication safety, and the development of practical frameworks to support cannabinoid assessment, documentation, and pharmacist-led care.
Christine Roussel, PharmD Systems Director of Pharmacy Geisinger
Dr. Roussel is a pharmacy leader at Geisinger with expertise in oncology pharmacy, medical cannabis, hazardous drug safety, and sterile compounding. She serves as Secretary of the International Society of Cannabis Pharmacists and is a nationally recognized educator and speaker. She has been named one of the “40 Under 40 in Oncology.”
16 - CCORC 2026
Who, What, and How much? Decoding Modern Cannabis Exposure Friday, November 6, 2026, 10:20 - 11:20 am Catalina Lopez-Quintero, PhD Assistant Professor University of Florida
Dr. 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.
Madelyn Eason
Student University of Florida Madelyn Easton is currently in the medical school application cycle and plans to attend starting next fall. She aspires to practice medicine in the future with a focus on preventative and community health.
Tracy Qu
Graduate Student University of Florida Tracy Qu is a second-year Master of Public Health student with a concentration in Epidemiology at the University of Florida. She is passionate about community health, health equity, and substance use.
Andrew Velarde
Graduate Student University of Florida Andrew Velarde is a second-year Master of Public Health student concentrating in Epidemiology. His research spans cannabis epidemiology and endocannabinoid biology, including populationbased research on medical cannabis use.
Ryan Kalina
Graduate Student University of Florida Ryan Kalina is an MPH Epidemiology student whose work focuses on substance use research and community-engaged public health practice. He is committed to translating epidemiologic evidence into actionable interventions that improve population health and equity.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 17
PRESENTERS OF TOP ABSTRACTS Medical Cannabis Across the Lifespan: Patient Characteristics, Clinical Outcomes, and Safety Considerations Thursday, November 5, 2026, 10:45 - 11:45 am MODERATOR: MODERATOR:
Mark Kindy, PhD
Professor University of South Florida Dr. Kindy’s research focuses on inflammation in neurological and neurodegenerative disorders. In addition to the topics of cancer, cardiovascular disease, inflammatory diseases and epigenetic effects.
Nicole E. Smolinski, PhD
Research Assistant Professor University of Florida Abstract - Assessing Clinical Characteristics among Children Using Medical Marijuana in Florida Medicaid Dr. Smolinski’s research focuses on child and maternal health with a special interest in pediatric infectious diseases. She currently engages in research related to the management of pediatric acute otitis media, congenital hearing loss, the safety and use of medical marijuana in the pediatric and pregnancy populations, and medication safety in women’s health.
Wen Wen, MS
PhD Student University of Florida Abstract - Medical Marijuana Use and Clinical Characteristics of Users among Pregnant Women in Florida Wen Wen is currently a PhD student in the Department of Pharmaceutical Outcomes and Policy. Her working experiences at Sanofi (Beijing) pharmaceutical company as a SAS programmer and at the Center for Adverse Drug Reaction of Chongqing Drug Administration sparked her interest in the investigation of real-world evidence and their application in the evaluation of post-market drug safety and effectiveness.
18 - CCORC 2026
Lihi Bar-Lev Schleider, PhD Medical Director Tikun Olam
Abstract - Clinical Outcomes and Changes in Concomitant Medication Use Following Initiation of Medical Cannabis Treatment in Patients with PostTraumatic Stress Disorder: A Six-Month Prospective Cohort Study Dr. Lihi Bar-Lev Schleider is a clinical researcher with more than 18 years of experience in randomized placebo-controlled trials and real-world evidence studies in medical cannabis. She established and directed Israel’s largest real-world medical cannabis data registry, and her research across multiple clinical indications has been published in leading peer-reviewed journals and cited more than 2,300 times.
Masoud Rouhizadeh, PhD Assistant Professor University of Florida
Abstract - Beyond Use Status: Characterizing the Setting and Source of Cannabis Use in Clinical Notes Using Large Language Models Supported by awards from NIH, CDC, FDA, and PCORI, Dr. Rouhizadeh develops privacy-preserving, auditable AI systems that turn electronic health record (EHR) data into computable phenotypes, risk prediction models, and decision support tools. He applies these systems to research in mental health, substance use, cardiovascular disease, and Alzheimer’s disease, and they have processed the records of 26 million patients.
MODERATOR:
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 19
Medical Cannabis: Patterns of Use, Therapeutic Dosing, and Emerging Therapies Friday, November 6, 2026, 11:30 - 12:30 pm MODERATOR:
MODERATOR:
Barry Setlow, PhD
Professor & Chief of Research University of Florida Dr. Setlow’s laboratory uses preclinical models to investigate behavioral and neural mechanisms of cognition and motivated behavior in the context of both advanced age and substance use. A portion is directed toward understanding the mechanisms by which cannabis and cannabinoids influence cognition across the lifespan.
Sandeep Chary Padakanti, PhD Postdoctoral Research Fellow Florida A&M University
Abstract - Biomimetic Milk Lipid Nanoparticles Outperform Natural Camel Milk-Derived Exosomes for Enhanced Oral Cannabidiol Delivery Dr. Sandeep Chary Padakanti is a Postdoctoral Research Fellow at Florida A&M University whose research focuses on translational drug delivery and nanomedicine for cancer and other complex diseases. His expertise includes extracellular vesicles, lipid nanoparticles, oral peptide delivery, advanced pharmaceutical formulations, pharmacokinetics, bioanalytical sciences, and preclinical drug-delivery research.
Marina Alacoque Rodrigues, MS, BPharm PhD Student University of Florida
Abstract - Cannabis Use and Cannabis Use Disorder Among Adult Cancer Survivors in the United States: A Population-Based Cross-Sectional Analysis Marina Alacoque Rodrigues is a second-year PhD student in Pharmaceutical Outcomes and Policy. Her research focuses on substance use and policy, building on her previous work in cancer research and her background in pharmacy practice and health outcomes research. Her interests include investigating the safety of cannabis use among older adults using real-world data.
20 - CCORC 2026
Terel Newton, MD Medical Director Total Pain Relief LLC
Abstract - Is There an Optimal Medical Cannabis Dosage for Cancer Pain? A Focused Analysis of Primary Clinical Studies Dr. Terel Newton is a dedicated physician, medical director, and educator specializing in alternatives to opioids for acute and chronic pain. Board-certified in Anesthesiology and fellowship-trained in interventional pain procedures, he currently serves as Florida Medical Director for Trulieve, where he advances clinical education and patient-centered approaches to medical cannabis.
Mehdi Nouraei, PhD
Founder Micellae Delivery Systems Abstract - Mucopenetrative intranasal cannabinoid nanoparticles as a steroid-sparing approach for chronic rhinosinusitis(crs) Dr. Mehdi Nouraei is a formulation scientist with more than 20 years of experience in lipid-based delivery systems and an inventor of multiple proprietary drug delivery technologies. He is co-founder of Sinucellae, which is developing MSIN-001, a non-steroidal, CBD-based intranasal therapy for chronic rhinosinusitis. He also founded Micellae Delivery Systems, a University of Toronto spin-out focused on water-dispersible cannabinoid delivery.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 21
PARALLEL SESSION ABSTRACTS Cannabis, cognition, and clinical care: from adolescent risk to intervention Thursday, November 5, 2026, 2:20 - 3:20 pm
Cannabis remains a commonly used substance during adolescence, a developmental period characterized by ongoing maturation of brain regions supporting cognitive control and reward processing. Cannabis initiation at a younger age is linked with elevated risk for later use disorder, cognitive difficulties, and other adverse mental health outcomes. Meanwhile, evolving regulation, commercialization, and social acceptance may reduce perceived risks and increase accessibility among adolescents. Understanding why some young people progress from initial curiosity to more problematic use, and how this progression can be delayed or prevented, requires an integrated framework incorporating epidemiological, neurobiological, and clinical perspectives. This presentation will highlight intervention approaches with the strongest evidence to date, identify areas where evidence remains limited, and describe how current strategies can be refined to better prevent and treat problematic cannabis use among young people. By bridging epidemiology, neurodevelopment, and clinical science, this symposium will offer CCORC attendees a coherent perspective on how cannabis-related vulnerabilities emerge and how associated risk may be mitigated among adolescents. The session will be relevant to researchers, clinicians, educators, and policymakers considering developmentally appropriate approaches to address adolescent cannabis use in a rapidly changing social and legal environment.
Cannabis use in aging; vulnerabilities and potential benefits Thursday, November 5, 2026, 2:20 - 3:20 pm
Adults aged 50 and older are the fastest-growing age cohort among people who use cannabis in the US, yet most cannabis research to date has been conducted in younger adults. Given that older adults are distinct from young across a wide range of physiological, cognitive, and behavioral variables, as well as the fact that older adults are more likely than young to experience co-occurring health conditions, it is important to evaluate the consequences of cannabis use in this population. The speakers in this session will describe the results of research that addresses how cannabis and cannabinoids affects cognition and behavior in older populations. Particularly given the demographics of the state of Florida, this session should be of interest to a broad range of CCORC attendees, including clinicians, researchers, trainees, policy-makers, and industry partners. In combination, the findings presented in this session will highlight the complexity of understanding the consequences of cannabis use in older adults, and the importance of considering co-existing medical conditions, as well as the cognitive domains being assessed, when evaluating cannabis effects on cognition.
22 - CCORC 2026
Cannabinoid Trials Unlocked: From IND to Impact Thursday, November 5, 2026, 3:30 - 5:00 pm
The clinical‑trial landscape for cannabinoid therapeutics is in rapid flux, shaped by evolving scientific evidence, regulatory policy, and public policy debates. With a growing portfolio of cannabinoid‑based interventions ranging from phytocannabinoid extracts to purified, semi‑synthetic analogues, investigators must navigate a complex web of pre‑clinical safety data requirements, Investigational New Drug (IND) filings, and trial‑site operational logistics. The workshop is designed for a multidisciplinary audience, including pharmacologists, clinical researchers, regulatory affairs professionals, project managers, cannabis industry representatives, and patients. Participants will gain a comprehensive, step‑by‑step roadmap that clarifies the statutory requirements for cannabinoids, provides actionable templates for IND dossiers, and equips them with the operational mindset needed to manage the intricacies of a cannabinoid clinical trial. By the end, attendees will be able to articulate the regulatory pathway, assemble a robust investigational plan, and anticipate operational hurdles, thereby accelerating the translation of cannabinoid science into evidence‑based therapies. This workshop aims to offer a critical overview of clinical trials for cannabis products, addressing the evolving policy landscape in a timely manner.
Cannabinoids in Cancer Care: From Mechanisms and Delivery to EvidenceBased Dosing Thursday, November 5, 2026, 3:30 - 5:00 pm
Cannabis and cannabinoids are widely used by people with cancer, and compelling patient reports describe relief of symptoms and, more controversially, unexpected disease outcomes. However, anecdotes cannot establish anticancer efficacy. Most evidence for direct antitumor activity remains preclinical, while clinical evidence is limited and often complicated by poorly characterized products, variable dosing, inconsistent absorption, and a lack of exposure data. Without knowing what was administered, absorbed, and sustained, outcomes cannot be compared, replicated, or translated into trusted clinical evidence. This session will compare inhaled, conventional oral oils and capsules, oromucosal, emulsified oral, and topical or transdermal delivery in terms of dose accuracy, bioavailability, onset, duration, interpatient variability, metabolite formation, adherence, safety, drug–drug interactions, and practicality during cancer treatment. This session will also review evidence surrounding low, moderate, and high THC/ CBD doses for cancer-related pain, including dose-response relationships, adverse effects, formulations, and cautious titration as well as present emerging preclinical evidence examining the combination of cannabichromene (CBC) and cannabigerol (CBG) with low-dose gemcitabine in pancreatic cancer.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 23
The Medical Marijuana Clinical Outcomes Repository (MEMORY): Data Architecture and Hands-on Applications Thursday, November 5, 2026, 3:30 - 5:00 pm
The Consortium for Medical Marijuana Clinical Outcomes Research is charged by Florida statute to evaluate medical uses of marijuana. For this purpose, the Consortium collaborates with the Florida Department of Health (DoH) to develop the Medical Marijuana Clinical Outcomes Repository (MEMORY). Central to MEMORY is the Medical Marijuana Use Registry (MMUR), maintained by the Office of Medical Marijuana Use at the DoH, which includes patient-level detail on MMJ certifications and order fills, including demographics, qualifying conditions, certified and purchased product types, administration routes, quantities, and adverse events. As such, MMUR provides unique insights into Floridian’s MMJ use. To allow capture of relevant health outcomes, the Consortium has linked the MMUR to administrative billing records (claims data) of Florida Medicaid and Medicare beneficiaries, Florida vital statistics databases, and UF EHR data. In this workshop, we will provide an overview of the data available through MEMORY including the marijuana exposure data and linked administrative claims data. This will include details on the data structure and variables available to researchers interested in using the data. We will include application examples to show how studies were designed and executed using the data. Participants are invited to share specific research questions to receive hands-on feedback on feasibility and possible approaches using MEMORY.
Advancing Medical Cannabis Practice: Integrating Patient, Clinical, Pharmacological, and Policy Perspectives Friday, November 6, 2026, 10:20 - 11:20 am
Pharmacists possess specialized expertise in medication management that is increasingly important as medical cannabis use expands and cannabinoid-based therapies become more complex. Despite their unique training in pharmacotherapy, pharmacokinetics, drug interactions, adverse effect management, and patient counseling, pharmacists remain underutilized members of the medical cannabis care team in many healthcare systems. This session presents the key recommendations from the International Society of Cannabis Pharmacists (ISCPh) position statement, The Essential Role of Pharmacists in Medical Cannabis Care, while exploring the evolving role of pharmacists in advancing safe, evidence-informed cannabinoid therapy. This presentation will also share preliminary results from the “Medical Cannabis Use and Quality of Life among Certified Mississippi Medical Cannabis Patients: A Longitudinal Study,” a 4-week intensive longitudinal study of certified Mississippi medical cannabis patients. Beyond clinical practice, the session will examine regulatory and policy
24 - CCORC 2026
considerations that influence pharmacist involvement in medical cannabis programs, including current barriers to implementation, opportunities for expanded clinical services, and strategies to strengthen pharmacist integration into patient care models. Speakers will also discuss emerging research priorities, educational initiatives, and future directions for the profession as medical cannabis continues to evolve worldwide. Attendees will gain a broader understanding of how pharmacists can improve medication safety, optimize therapeutic outcomes, and help shape the future of cannabis care through clinical practice, policy development, education, and research.
Who, What, and How much? Decoding Modern Cannabis Exposure Friday, November 6, 2026, 10:20 - 11:20 am
Accurate characterization of cannabis exposure remains one of the major methodological challenges in cannabis epidemiology. Although the effectiveness and safety of medical cannabis have been investigated across a wide range of health outcomes, exposure assessment has frequently relied on broad measures such as frequency of use or diagnostic codes. These approaches provide limited information about the quantity and composition of cannabinoids consumed and may not adequately reflect the complexity of contemporary cannabis use. As medical and recreational cannabis markets continue to diversify, improving exposure characterization has become increasingly important for producing valid, interpretable epidemiologic evidence. This presentation uses data from the Medical Marijuana and Me (M3) Study, a cross-sectional study of 632 adults receiving medical cannabis in Florida. Participants were recruited through medical cannabis clinics across the state and completed detailed questionnaires assessing sociodemographic and clinical characteristics, medical indications for cannabis use, product types, routes of administration, cannabinoid content, and patterns of cannabis use. This symposium is organized to move from a general epidemiologic framework for cannabis exposure characterization to product-specific applications, including vaping, edibles, tinctures, and concentrates.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 25
ABSTRACTS
ORAL PRESENTATIONS OF TOP ABSTRACTS Cannabis Use and Cannabis Use Disorder Among Adult Cancer Survivors in the United States: A Population-Based Cross-Sectional Analysis Marina Alacoque Rodrigues, MSc, BPharm University of Florida Co-authors: Amie Goodin, University of Florida Background: The epidemiology of Cannabis Use Disorder (CUD) in cancer survivors, a clinically vulnerable population, remains poorly characterized despite increasing cannabis use. Objectives: To characterize trends and prevalence in cannabis use and cannabis use disorder (CUD) among adult cancer survivors, including sociodemographic correlates, cannabis use characteristics, and healthcare-based substance use screening practices. Methods: We conducted a repeated cross-sectional analysis of the 2021–2024 National Survey on Drug Use and Health (NSDUH). We included adults aged ≥18 years with a self-reported lifetime history of cancer diagnosis. Sampling-weighted analyses estimated annual and pooled prevalence of past-year and past-month cannabis use. CUD prevalence was assessed using DSM-5 criteria. Multivariable logistic regression models accounting for complex survey design estimated correlates of cannabis use and CUD among cancer survivors. Severity and healthcare-based substance screenings were also described for cancer survivors with CUD. Results: Among adult cancer survivors (n = 7,769), the weighted prevalence of pastyear cannabis use increased from 12.74% (95% CI, 10.24%–15.25%) in 2021 to 15.39% (95% CI, 13.17%–17.61%) in 2024 (2024 vs. 2021: adjusted odds ratio [AOR], 1.40; p = 0.029). Younger age (e.g., age 18–25 vs. ≥65 years: AOR, 7.82; p < 0.001), male sex, and poverty were independently associated with cannabis use in this population. Among past-year cannabis users with a history of cancer, CUD prevalence across pooled years was 16.79% (95% CI, 13.83%–19.75%), increasing to 21.98% (95% CI, 17.92%–26.04%) among past-month users, compared with 30.45% and 39.50%, respectively, in the general population. In multivariable analyses, the strongest predictors of CUD among cannabis-using cancer survivors were younger age (18–25 vs. ≥65 years: AOR, 21.31; p < 0.001) and multimodal use (AOR, 7.24; 95% CI, 4.33–12.12; p < 0.001), whereas cancer type was not associated with the outcome. Although 87.98% of cancer survivors with CUD had at least one outpatient visit in the previous year, and most CUD cases were of mild severity, only 68.51% (95% CI, 57.27%–79.74%) reported being asked about drug use, and 43.12% (95% CI, 33.31%–52.94%) reported discussing substance use with a healthcare professional. Conclusions: Cannabis use among adult cancer survivors increased significantly between 2021 and 2023-2024 in adjusted models. Use was concentrated among younger, male, and lower-income individuals. Routine substance use screening remained suboptimal, with approximately one-third of CUD-positive cancer survivors with healthcare visits going unscreened.
26 - CCORC 2026
Clinical Outcomes and Changes in Concomitant Medication Use Following Initiation of Medical Cannabis Treatment in Patients with Post-Traumatic Stress Disorder: A Six-Month Prospective Cohort Study Lihi Bar-Lev Schleider, PhD Tikun Olam Co-authors: Lihi Bar-Lev Schleider¹, Ilya Reznik², Ben Amit³˒⁴, Vered Hermush⁵˒⁶ ¹Tikun Olam, ²MaReNa Diagnostic and Consulting Center, ³Tel Aviv University, ⁴Tel Aviv Sourasky Medical Center, ⁵Laniado Hospital, ⁶Technion School of Medicine Background: Post-traumatic stress disorder (PTSD) is a chronic psychiatric condition frequently accompanied by pain, impaired quality of life, and extensive use of psychotropic medications. Although medical cannabis is increasingly used by patients with PTSD, prospective data describing its clinical outcomes, safety, and impact on concomitant medication use remain limited. Objective: To evaluate six-month changes in PTSD-related symptoms, pain intensity, quality of life, concomitant medication use, and safety following initiation of medical cannabis treatment in patients with PTSD. Methods: This prospective observational cohort study included patients initiating medical cannabis treatment for PTSD. Participants completed standardized questionnaires before treatment initiation and after six months of treatment. Outcome analyses included patients who completed the relevant six-month followup questionnaire, with denominators varying according to outcome-specific data availability. Outcomes included PTSD-related symptoms, pain intensity, quality of life, changes in concomitant medication use, and adverse events. Results: A total of 870 patients initiated medical cannabis treatment. Outcome analyses included patients who completed the relevant six-month follow-up questionnaire (up to n=595, depending on outcome-specific data availability). The proportion of patients reporting intrusive memories on a daily or frequent basis decreased from 63.2% at baseline to 41.7% after six months, while rage attacks on a daily or frequent basis declined from 58.2% to 22.1%. Mean pain intensity (VAS 0–10) decreased significantly (p<0.001), accompanied by a significant improvement in patient- reported quality of life (5-point Likert scale, p<0.001). Dose reduction or treatment discontinuation was most frequently observed for opioid analgesics (58.7%), hypnotics and sedatives (48.9%), anxiolytics (44.7%), and antidepressants (42.2%). Overall, 29.0% of patients reported at least one adverse event. The most commonly reported adverse events were increased appetite (6.5%), dry mouth (6.2%), and dizziness (3.6%). Conclusions: Medical cannabis treatment was associated with clinically meaningful improvements in PTSD-related symptoms, pain intensity, and quality of life over six months, accompanied by reductions in the use of several classes of concomitant medications. These findings suggest a potential role of medical cannabis as part of acomprehensive treatment approach for PTSD and warrant further studies to confirm these observations.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 27
Is There an Optimal Medical Cannabis Dosage for Cancer Pain? A Focused Analysis of Primary Clinical Studies Terel Newton, MD Total Pain Relief LLC Background: Cancer pain affects over half of patients undergoing cancer treatment. Medical cannabis is increasingly used for cancer-related pain, however, optimal dosing remains undefined given heterogeneity in formulations, cannabinoid ratios, routes, and titration schedules. Objective: To review primary studies reporting THC and CBD use for cancer pain, their outcomes for evidence of optimal formulation and dosing, including efficacy, dose response, and adverse effects. Methods: PubMed and related citation search through August 1, 2026 combined terms including cannabinoid, CBD, THC, nabiximols, Sativex, cancer pain, dose, titration, and opioid. Original human studies reporting medical cannabis use for cancer pain or related palliative outcomes were retained; reviews, meta-analyses, guidelines, protocols, noncancer studies, and studies limited to chemotherapyinduced nausea were excluded. To facilitate monitoring of dose-responses, daily THC dose was categorized as low (<15 mg), medium (15–30 mg), or high (>30 mg). Results: Seven primary studies were identified, including randomized placebocontrolled trials, one pilot randomized trial, one single-arm trial, and one pharmacokinetic study. In a graded dose trial (Portenoy, n=360), primary outcome failed to show > 30% responder rate, while secondary analyses favored low (≤10.8 mg THC/day) and medium (≤27 mg) nabiximols (2.7 mg THC, 2.5 mg CBD) over placebo, with dose-related toxicity observed in the high dose arm. Johnson (n=177) found 1:1 THC:CBD extract superior to placebo (43% vs 21% achieving ≥30% pain reduction) at an average of 23.6 mg THC/day, while THC only group was not superior. Lichtman (n=397) missed its primary endpoint, with benefit limited to US participants, who received lower baseline opioid doses. Hardy (1:1 oil, 2.5–30 mg/ day) did not reduce symptom distress but modestly improved pain at the cost of psychotomimetic toxicity. Zylla (n=30) reported 34 mg THC/17 mg CBD daily with possible opioid sparing; Segar (n=14, single-arm) found 4 of 14 patients reduced opioids ≥20% on dronabinol 10 mg twice daily. Clarke characterized exposure from a nanoparticle buccal spray. Conclusions: Available primary data suggest that low to moderate doses of THC (10-30 mg/day), in combination with CBD (1:1 ratio), may provide modest analgesic benefit for cancer pain with acceptable tolerability. Higher doses do not improve efficacy and were shown to increase side effects. A “”start low, go slow”” titration approach is supported by these findings. Further higher powered RCTs with standardized dosing protocols and titration schedules are needed.
28 - CCORC 2026
Mucopenetrative Intranasal Cannabinoid Nanoparticles as a Steroid-sparing Approach for Chronic Rhinosinusitis (CRS) Mehdi Nouraei, PhD Micellae Delivery Systems Co-authors: Mehdi Nouraei¹, John J.W. Lee², Amr F. Hamour², Edgar Acosta² ¹Micellae Delivery Systems, ²University of Toronto Introduction: Chronic rhinosinusitis (CRS) is a chronic inflammatory disorder affecting approximately 10–12% of adults worldwide and is associated with substantial morbidity, impaired quality of life, and significant healthcare utilization. Despite widespread use of intranasal and systemic corticosteroids, many patients remain symptomatic, while prolonged steroid therapy is limited by wellrecognized adverse effects. Cannabidiol (CBD) exhibits anti-inflammatory and immunomodulatory properties and represents a promising non-steroidal therapeutic candidate; however, its clinical translation has been limited by poor aqueous solubility and the inability of conventional formulations to effectively penetrate the protective sinonasal mucus barrier. Methods: A PEG-free, muco-penetrating nanoparticle formulation was engineered to enhance intranasal delivery of CBD across the sinonasal mucus layer while maintaining stable nanoparticle formation following dilution in saline. Therapeutic efficacy was evaluated in an 8-week murine model of CRS. Histopathological outcomes following treatment with intranasal CBD nanoparticles were compared with untreated CRS controls, conventional PEG-based CBD formulations, and intranasal mometasone (gold-standard corticosteroid therapy). Results: CRS induction produced significant inflammatory and histopathological changes compared with healthy controls. Treatment with muco-penetrating CBD nanoparticles significantly reduced epithelial hyperplasia, epithelial folding, eosinophilic infiltration, hyaline droplets, and Charcot–Leyden crystals compared with untreated CRS mice, with histological evidence of partial restoration of normal respiratory epithelial architecture. Therapeutic outcomes were comparable to those observed with intranasal mometasone, with no significant differences between treatment groups across measured endpoints. In contrast, conventional PEG-based CBD formulations failed to demonstrate comparable therapeutic benefit, despite containing the same active pharmaceutical ingredient. No treatment-related adverse effects or abnormal clinical behavior were observed. Conclusions: Muco-penetrating intranasal CBD nanoparticles demonstrated therapeutic efficacy comparable to corticosteroid therapy in a murine model of CRS, supporting CBD as a potential steroid-sparing therapeutic strategy. Importantly, the findings demonstrate that successful delivery across the sinonasal mucus barrier is a critical determinant of therapeutic outcome, emphasizing that formulation and drug delivery engineering are enabling components of clinical translation rather than formulation refinements. These results support continued development toward INDenabling studies and early clinical evaluation.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 29
Biomimetic Milk Lipid Nanoparticles Outperform Natural Camel Milk-Derived Exosomes for Enhanced Oral Cannabidiol Delivery Sandeep Chary Padakanti, PhD Florida A&M University Co-authors: Sandeep Chary Padakanti1, Aakash Nathani1, Arvind Bagde1, Mandip Singh Sachdeva1 1 Florida A&M University Background: Cannabidiol (CBD) has substantial therapeutic potential, but its oral delivery is limited by poor aqueous solubility, variable intestinal absorption, and extensive first-pass metabolism. In our previously published work, camel milk-derived exosomes significantly enhanced the intestinal permeability and oral bioavailability of CBD. Building on this biological platform, we rationally reconstructed camel milk exosomal lipids into biomimetic lipid nanoparticles designed to preserve the membrane-fusion and gastrointestinal transport properties of natural exosomes while overcoming their limitations in drug loading, manufacturing reproducibility, and scalability. Objectives: To evaluate whether biomimetic camel milk-inspired lipid nanoparticles reconstructed from exosomal lipids could outperform natural camel milk-derived exosomes as an oral CBD delivery platform. Methods: CBD-loaded camel milk-derived exosomes and biomimetic camel milk lipid nanoparticles were prepared and characterized using various analytical tools. Lipid nanoparticles were formulated from major camel milk exosomal lipids with oral absorption enhancers. CBD incorporation were evaluated using analytical method. In-vitro release, epithelial permeability, release kinetic modeling, and oral pharmacokinetic studies in SpragueDawley rats were performed and compared with the previously reported exosome formulation and free-CBD controls. Results: Camel milk lipid-based nanoparticles demonstrated superior physicochemical and oral delivery performance compared with CBD-loaded camel milk-derived exosomes. The lipid nanoparticles exhibited a smaller particle size of 100.6±0.23 nm, compared with 138.4±4.37 nm for CBD-loaded exosomes, while maintaining a comparable negative surface charge of −42.39±0.51 mV versus −42.07±0.99 mV. CBD entrapment efficiency increased markedly from 56.56±4.26% in the natural exosomes to 87.68±0.51% in the lipid nanoparticles. CBDloaded exosomes increased apparent permeability to 22.9±0.34 × 10⁻⁶ cm/s, representing a 3.95-fold improvement over free CBD, whereas the lipid nanoparticles produced an even greater permeability response 30.12±0.84 × 10⁻⁶ cm/s. The lipid nanoparticles also provided sustained CBD release over 24 hours, with the Weibull model showing the best overall kinetic fit. In-vivo studies shows, the exosome formulation achieved a Cmax of 448.90±78.53 ng/mL and an AUC₀–₂₄ of 1350.56±187.50 h·ng/mL. The lipid nanoparticle plasma profile showed a higher peak concentration, approximately 651.41±81.23 ng/mL at 4 hours, indicating further improvement in systemic CBD exposure. Thus, rational reconstruction of camel milk exosomal lipids produced a smaller, more drug-efficient nanocarrier with enhanced permeability and greater peak oral absorption than the natural exosome platform. Conclusion: These findings establish biomimetic milk lipid nanoparticles as a nextgeneration, scalable oral nanocarrier platform that preserves the biological advantages of natural exosomes while delivering superior formulation performance and enhanced oral bioavailability of cannabinoids and other poorly bioavailable lipophilic therapeutics.
30 - CCORC 2026
Beyond Use Status: Characterizing the Setting and Source of Cannabis Use in Clinical Notes Using Large Language Models Masoud Rouhizadeh, PhD University of Florida Co-authors: Amie Goodin, University of Florida Background: Identifying whether a patient uses cannabis is now tractable at scale. Our foundational work developed an LLM-based pipeline to determine cannabis use status across UF Health’s longitudinal clinical notes, finding more than three times as many users as diagnosis codes. Use status, however, is a low-information exposure variable. Cannabis now reaches patients through multiple channels, including state-authorized medical programs, retail hemp products, and illicit supply, so patients pooled as current users differ in product, potency, and regulatory context. Toxicology cannot resolve these differences, detecting analytes rather than exposure characteristics. These distinctions surface only in free text, which has not been examined beyond use status. Objective: To characterize documentation of cannabis use setting and source in clinical notes, and to determine whether these distinctions can be extracted at scale using locally deployable LLMs. Methods: From the same UF Health cohort (1,000 randomly sampled patients; 132,500 notes, 2017-2025), our foundational pipeline yielded 1,887 snippets with manually confirmed cannabis use. Two rounds of expert annotation (94.5% agreement) and an internal-consistency audit assigned each snippet to one of four mutually exclusive categories based on explicit wording about how or where cannabis was obtained or used: authorized (medical card, state program, clinician certification, or dispensary); illicit (outside legal channels, “off the street”); recreational (social use, “socially with friends”); and unknown. Snippets were classified by Gemma-4-31B-it, an open-weight LLM run in UF HiPerGator (HIPAAcompliant), using expert-defined few-shot prompting. Results: Setting or source was documented in 269 of 1,887 snippets (14.3%): 179 authorized (9.5%), 45 illicit (2.4%), and 45 recreational (2.4%). The remaining 1,618 (85.7%) recorded use with no setting or source. Average F1 across the three documented categories ranged from 0.748 to 0.904 over three prompting strategies. The best strategy reached F1=0.951 for authorized (precision=0.982, recall=0.922), 0.898 for illicit (0.830, 0.978), and 0.864 for recreational (0.972, 0.778), with fourcategory accuracy 0.980. Errors were almost entirely missed mentions rather than misclassifications: when the model detected relevant wording, it assigned the correct category in 268 of 269 cases (99.6%). Conclusions: Cannabis use setting and source are extractable from clinical notes with high accuracy using locally deployable, open-weight LLMs without model training. The binding constraint is documentation rather than technology: 86% of snippets do not document setting or source. More consistent documentation at the point of care would substantially expand what these methods can deliver for cannabis outcomes research.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 31
Assessing Clinical Characteristics among Children Using Medical Marijuana in Florida Medicaid Nicole E. Smolinski, PharmD, PhD University of Florida Co-authors: Matthew R. Muschett1, Andrew T. Chamberlin1, Yanning Wang1, Jeevan Jyot1, Md Mahmudul Hasan1, Almut G. Winterstein1 1 University of Florida Background: Medical marijuana (MMJ) was approved in Florida in 2017 for all ages including children. Comparison of clinical diagnoses and listed qualifying conditions has not been previously described among children. Objective: To describe clinical diagnoses among pediatric MMJ users in Florida Medicaid. Methods: Within the Medical Marijuana Outcomes Research Repository (MEMORY), we linked children age 1 and 17 years with MMJ certifications from 2017-2025 to Florida Medicaid claims data. We required 1 year of continuous medical and prescription coverage in Medicaid prior to certification. Among linked patients, we described the most common chronic clinical conditions listed on in in- and outpatient encounter claims using Clinical Classification Software Refined (CCSR) categories in the year before certification. Condition prevalences were further stratified by qualifying medical condition on the MMJ certification. Finally, we conducted latent class analysis to group patients based on clinical characteristics. Results: We identified 1,465 MMJ pediatric patients with an MMJ certification linked to Florida Medicaid. The most common qualifying conditions were post-traumatic stress disorder (PTSD, 24.2%), epilepsy (19.3%), chronic nonmalignant pain (10.0%), and other similar conditions not specified (13.2%). The most common clinical diagnoses on medical encounters were autism spectrum disorder (37.5%), learning disorder (29.4%), any pain condition (28.5%), attention-deficit hyperactivity disorder (27.5%), any seizure disorder (25.5%), anxiety (23.3%), and epilepsy (21.9%). We were able to identify a potential indication based on approved conditions for medical marijuana across US MMJ programs for 82.9% of all patients. Latent class analysis identified four groups of patients based on their clinical history: seizure conditions (12.3%), mental health + pain (16.0%), autism spectrum disorder (33.3%), and miscellaneous (38.4%). Among pediatric patients qualified for PTSD or similar, the latent class analysis identified 4 groups: ASD + ADHD (29.7%), Mental Health + Pain (11.8%), Mental Health (11.9), and miscellaneous (46.6%). Conclusion: In Florida, the number of children certified for MMJ use is small. Among Medicaid pediatric patients qualified for MMJ in Florida, we identified a variety of potential indications for use beyond those listed on the certification. Autism spectrum disorder, pain, epilepsy, and anxiety were most common diagnoses among pediatric MMJ users.
32 - CCORC 2026
Medical Marijuana Use and Clinical Characteristics of Users Among Pregnant Women in Florida Wen Wen, MS University of Florida Co-authors: Nicole E. Smolinski1, Arthur N. Rosales1, Yanning Wang1, Almut G. Winterstein1 1 University of Florida Background: With increasing legalization, use of cannabis is growing. We aimed to describe the utilization pattern of medical marijuana (MMJ) during pregnancy and clinical characteristics of users. Methods: Using the Medical Marijuana Research Repository (MEMORY 2017-2024), we identified pregnant women with ≥1 MMJ dispensing during pregnancy, livebirth deliveries, and enrollment in Florida Medicaid from 90 days before to 30 days after pregnancy. We described the timing of MMJ dispensing and QMCs on the MMJ certification. From Medicaid claims, we extracted clinical characteristics and prescription medication dispensings. Pregnancies were grouped by new users (i.e., first MMJ certification during pregnancy) and prevalent users (i.e., first certification before pregnancy). Prevalent users were split into continuers (i.e., MMJ dispensings in second or third trimester) and discontinuers (i.e., no dispensings in second or third trimester). Using no MMJ-exposed pregnancies as reference, we compared clinical characteristics and medication dispensings of new MMJ users in the month before certification, whereas for prevalent users we focused on clinical characteristics and medications in the second trimester. Results: Among 248,829 livebirth pregnancies in Florida Medicaid, 3,955 pregnancies (1.6%) had MMJ dispensings during pregnancy. About one quarter (22.2%) initiated MMJ during pregnancy. Among prevalent users, most continued use throughout (67.2%). The most common QMCs were post-traumatic stress disorder or similar, chronic nonmalignant pain, and multiple sclerosis or similar. Compared to pregnancies without MMJ use, prevalent users had higher prevalence of medical encounters indicating substance use disorders (12.9% among continuers and 9.0% among discontinuers vs. 2.1% in non-users), anxiety (9.3% and 7.0% vs. 2%), depression (5.1% and 5.2% vs. 1.7%), and cannabis-related disorders (6.3% and 3.2% vs. <0.01%). Among MMJ continuers, 15.8% used antiemetics compared to 13.4% in discontinuers, and 8.3% in non-users. Conversely, prenatal vitamins were used by 16.2% of non-users and 9.6% of continuers and 10.3% of discontinuers. Among first trimester new users, the most common comorbidities were anxiety (8.7% vs. 1.7% in non-users), depression (6.5% vs. 1.3%), and tobacco-related disorders (4.9% vs. 2.6%). The most common medications were antidepressants (12.2%) compared to 2.6% among non-users, antiemetics (5.3% vs. 4.2%), and anxiolytics (5.3% vs. 0.8%). Conclusion: While most prenatal MMJ exposure originated from continuation of pre-pregnancy use into the first trimester, about one quarter of exposed pregnancies were new initiations. Women with prenatal MMJ use had more substance use and mental health disorders, pointing to the need for further research to investigate the complex clinical scenarios that may explain use.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 33
ABSTRACTS BASIC SCIENCE AND TRANSLATIONAL CATEGORY
A Synthetic Cannabinoid Uncouples Intracellular Inflammation from TNF Release During Infection Aubrey Atkins University of Florida Co-authors: Hailey A. Barker¹, Jorge J. Canas¹, Aubrey Atkins¹, Samantha M. Enslow¹, Dana R. Amin¹, Xin Wang¹, Mariola J. Ferraro¹ ¹University of Florida Background: Cannabinoid signaling is increasingly recognized as a regulator of immune function, but its effects during bacterial infection remain incompletely understood. WIN 55,212-2 is a synthetic cannabinoid receptor agonist with reported immunomodulatory activity; however, whether it suppresses or redirects inflammatory cytokine responses during intracellular bacterial infection is unclear. Objectives: This study investigated how WIN 55,212-2 modulates macrophage inflammatory responses during Salmonella enterica serovar Typhimurium infection, with emphasis on TNFα production, intracellular cytokine accumulation, cytokine release, and cannabinoid receptor involvement. Methods: RAW 264.7 macrophages and bone marrow-derived macrophages from wild-type, CB1R-deficient, and CB2R-deficient mice were treated with WIN 55,212-2 or vehicle and infected with Salmonella Typhimurium. Cytokine
34 - CCORC 2026
responses were assessed by ELISA, flow cytometry, Western blotting, RT-qPCR, and label-free quantitative proteomics. An oral Salmonella infection model was used to evaluate systemic inflammatory responses in vivo. Direct bacterial effects of WIN 55,212-2 were assessed using bacterial proteomics, growth curves, viability assays, and macrophage infection assays. Results: WIN 55,212-2 broadly reshaped the macrophage proteome during Salmonella infection, altering pathways associated with metabolism, proteostasis, inflammatory signaling, and intracellular trafficking. Unexpectedly, WIN 55,212-2 increased intracellular abundance of inflammatory mediators, including TNFα, IL-6, and IFNγ, while markedly reducing extracellular TNFα accumulation. This divergent TNFα phenotype persisted in macrophages lacking either CB1R or CB2R alone. In vivo, WIN 55,212-2-treated mice showed reduced circulating TNFα during Salmonella infection, with altered splenic myeloid activation markers. Direct exposure of Salmonella to WIN 55,212-2 changed selected bacterial proteins but did not alter bacterial growth, viability, early macrophage infection, or macrophage TNFα induction. Conclusions: WIN 55,212-2 does not simply suppress macrophage inflammation during bacterial infection. Instead, it uncouples intracellular cytokine accumulation from extracellular TNFα release, revealing a distinct mode of cannabinoidassociated immunomodulation during Salmonella infection.
Cannabigerol Potentiates Chemotherapy Through Synergistic Suppression of Tumor-Promoting Signaling
in Pancreatic Cancer Breana Boirie, PharmD Florida A&M University Co-authors: Breana Boirie1, Mounika Aare1, Sandeep Chary1, Mandip Sachdeva1 1 Florida A&M University Background: Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy with poor survival and limited therapeutic options. Although gemcitabine (GEM) and nab-paclitaxel (NAB-PTX) are standard therapies, their therapeutic efficacy is frequently compromised by chemoresistance. Cannabigerol (CBG), a non-intoxicating cannabinoid, has demonstrated antitumor and chemosensitizing properties; however, its potential to enhance the efficacy of standard PDAC chemotherapy remains unclear. Objective: This study evaluated the anticancer efficacy of CBG alone and in combination with GEM and NABPTX and investigated the cellular and molecular mechanisms underlying CBGmediated therapeutic enhancement in pancreatic cancer models. Methods: CBG, GEM, and NABPTX were evaluated in MIAPaCa-2 and PANC-1 cells utilizing 2D/3D cytotoxicity assays, combination index analysis, and assessments of apoptosis, migration, and cell cycle progression. Mitochondrial dysfunction, oxidative stress, and tumor-associated signaling pathways were evaluated to characterize the mechanisms underlying the combination’s efficacy. in vivo efficacy was evaluated using a PANC-1 xenograft model. Results: Cytotoxicity studies demonstrated that CBG markedly potentiated the cytotoxic activity of
GEM and NAB-PTX, with the triple combination producing enhanced cytotoxicity, reducing IC₅₀ values to 6.53 ± 0.0072 nM in MIAPaCa-2 cells and 427 ± 0.07 nM in PANC-1 cells. Combination index analysis demonstrated strong synergistic interactions with CI values ranging from 0.10–0.35 and 0.40– 0.73, respectively. CBG enhanced chemotherapy-induced cell-cycle disruption, potentiating GEM-induced S-phase arrest and NAB-PTX-induced G2/M arrest. The triple combination significantly reduced migratory capacity compared with CBG+GEM and CBG+NAB-PTX (p < 0.0001 Additionally, the triple combination treatment induced pronounced mitochondrial dysfunction and oxidative stress, characterized by mitochondrial depolarization and increased reactive oxygen species generation. Western blot analysis demonstrated reduced KRAS expression and suppression of MAPK and PI3K/AKT survival signaling across CBG-based treatments (p < 0.0001). The triple combination further downregulated vimentin, p-NF-κB, 5-HT1B, and 5-HT1D (p < 0.0001). In vivo, the triple combination of CBG (100 mg/kg), GEM (12.5 mg/kg), and NAB-PTX (5 mg/kg) produced the most durable tumor-growth control, with suppression maintained through 52 days compared with CBG+GEM (51 days), CBG+NAB-PTX (18 days), GEM (35 days), CBG (21 days), and NAB-PTX (11 days). Consistent with the antitumor response, the triple combination significantly downregulated KRAS, VEGF-A, and p-NF-κB expression (p < 0.0001). CBG+GEM additionally reduced KRAS, GPX4, p-NF-κB, and 5-HT1D expression, whereas CBG+NABPTX decreased KRAS and p-NF-κB expression (p < 0.0001), supporting modulation of multiple tumor-promoting pathways by CBG-based combination therapy.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 35
36 - CCORC 2026
Conclusions: These findings identify CBG as a potential chemosensitizing cannabinoid that enhances the antitumor activity of GEM and NABPTX through synergistic cytotoxicity, mitochondrial and oxidative stress, and suppression of KRAS-associated survival signaling. Collectively, these findings support CBG-based combination therapy as a promising strategy to overcome therapeutic resistance and improve chemotherapy efficacy in PDAC.
Effects of voluntary oral THC on oxycodone seeking and protein kinase signaling in rat nucleus accumbens and prefrontal cortex Katherine E. Driver, MS University of Florida Co-authors: Katherine Driver1, Barry Setlow1, Lori Knackstedt1, Marek Schwendt1 1 University of Florida Background: Despite a poor understanding of the risks and benefits of opioid-cannabinoid interactions, opioid use disorder (OUD) is currently considered a qualifying condition for the use of medical marijuana in several US states. There is some clinical evidence suggesting that co-use of cannabinoids can reduce rates of opioid use and severity of withdrawal. However, these reductions in behavior may be at the cost of elevated anxiety and/ or depression in OUD patients. Thus, well-controlled, translational animal models are necessary to investigate the neural and behavioral consequences of cannabinoid-opioid co-use. Objectives: Here, we investigated the effects of daily oral Δ9tetrahydrocannabinol (THC)
consumption on behavioral economic demand for intravenously (IV) selfadministered oxycodone in adult and adolescent male and female Sprague Dawley rats, and subsequently assessed protein kinase signaling associated with CB1 cannabinoid and mu opioid receptor activity in brain regions implicated in opioid-seeking behavior. Methods: Rats were trained to selfadminister IV oxycodone or sucrose pellets on an FR3 schedule of reinforcement. After reaching stable intake, rats underwent economic demand procedures in which FR requirements to earn a single reinforcer increased in quarter-log unit increments every second day until 0 reinforcers were earned. Throughout demand curve testing, rats also consumed gelatin containing either THC (1.0 mg/kg) or vehicle, immediately following each operant session (and 22 hr prior to the next session). After several doses of daily THC, somatic signs of withdrawal and anxiety-like behavior were assessed at 22 hr withdrawal. Upon completing the demand curve (0 rewards earned at FR), self-administration was reestablished, followed by 14 days of home-cage abstinence and a cue-primed test of oxycodone/sucrose seeking. Immunoblotting was used to assess (phospho)protein levels in relevant brain regions. Results: THC increased demand elasticity (i.e., reduced seeking) for oxycodone but not sucrose, in adult but not adolescent rats. Total expression and phosphorylation activity of the kinases AKT and PKA were not affected by either oxycodone experience or THC within the adult cohort, with adolescent data pending. There were no effects of THC on withdrawal or anxiety-like behavior in either age group. Conclusions: Our data suggest that, in male and female Sprague Dawley
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 37
rats that initiated oxycodone use during adulthood, THC consumption leads to increased demand elasticity for oxycodone IV self-administration and reduced oxycodone seeking. In rats that initiated oxycodone IVSA in adolescence, however, THC had no effects on oxycodone seeking. Further research into neural mechanisms mediating age-dependent THC effects is needed.
Assessment of Cannabidiol Effects on Whole-Blood Coagulation Dynamics Using a Novel Point-of-Care Radial Expansion Assay Leah K. DuBose FAMU - FSU College of Engineering Co-authors: Rojan Saghian1, Domenica Jaramillo1, Oluwadara Soremi1, Leah DuBose1, Jingjiao Guan1, Kyle Smith2, Zixiang Leonardo Liu, PhD, Assistant Professor1,2 1 FAMU-FSU College of Engineering, 2 Florida State University Statement of the problem (Objectives): The surging incidence of cannabinoidassociated coagulopathy (CAC) underscores a critical diagnostic gap: the inability of current paradigms to evaluate the complex interplay between cannabinoid exposure and hemostatic stability. Background: Cannabinoids, including cannabidiol (CBD), are widely used by patients receiving anticoagulant therapies, yet their effects on hemostasis remain poorly understood. While case reports and drug-interaction studies have suggested potential associations between cannabinoid exposure and altered bleeding risk, experimental evidence describing the direct effects of cannabinoids on
38 - CCORC 2026
blood coagulation is limited and often conflicting. Current coagulation assays primarily assess isolated plasma coagulation pathways and may not fully capture the integrated rheological and clotting behavior of whole blood. Methods: To investigate the effects of cannabidiol (CBD) on wholeblood coagulation, we employed a miniaturized Radial Flow Assay (RFA), a point-of-care platform that quantifies temporal changes in blood spreading area as a surrogate measure of viscosity and coagulation dynamics under low-shear conditions. Experiments were conducted using citrated whole blood (3.2% w/v sodium citrate) and heparinized whole blood (3.5 USP units/ mL heparin). CBD was evaluated across physiologically relevant concentrations, and coagulation responses were assessed using radial expansion area. RFA measurements were compared against established coagulation assays, including a lateral flow assay (LFA) for recalcified blood and Activated Clotting Time (ACT) testing for heparinized blood. Results: The RFA detected dosedependent coagulation responses during recalcification of citrated whole blood, confirming assay sensitivity to coagulation-induced changes in blood spreading dynamics. Across physiologically relevant concentrations, CBD produced no significant changes in radial expansion behavior of recalcified blood. Consistent with these findings, ACT measurements of heparinized blood following protamine neutralization showed no significant differences between CBD-treated and control groups. Conclusions: CBD produced no measurable changes in whole-blood coagulation, indicating minimal direct effects on secondary hemostasis. Differences observed between RFA
and conventional coagulation assays suggest that clot microstructure, in addition to fibrin quantity, contributes to assay-specific responses. These findings support the hypothesis that cannabinoid-associated coagulopathy may be driven predominantly by platelet dysfunction and impaired shearinduced platelet aggregation rather than alterations in coagulation factor activity. Ongoing studies using physiologically relevant microfluidic models will evaluate the effects of cannabinoids on platelet mechanobiology and thrombus formation under high-shear flow conditions.
Cannabidiol-Loaded Microemulsion: Pharmaceutical Development and Preliminary Hemocompatibility Assessment Sócrates Egito Federal University of Rio Grande do Norte Co-authors: Lucas Gabriel da Silva Oliveira1, Ícaro Chaves Girão1, Fabia Julliana Jorge de Souza1, Wógenes Nunes de Oliveira2, Eryvaldo Sócrates Tabosa do Egito1 1 Federal University of Rio Grande do Norte, 2State University of Paraíba Cannabidiol (CBD) has substantial therapeutic potential, but its pharmaceutical development remains challenged by its poor aqueous solubility and variable biopharmaceutical performance. Oil-in-water microemulsions offer a versatile approach to increase the apparent aqueous dispersibility of highly lipophilic compounds while
enabling dilution and incorporation into different pharmaceutical dosage forms. This study developed a CBD-loaded microemulsion (CBD-ME), characterized its physicochemical properties, and performed a preliminary safety assessment based on in vitro hemolytic activity in human erythrocytes. CBDME was composed of Lipoid® S100 (6.3% w/w), Tween® 80 (14.7% w/w), Miglyol® 812N (11% w/w), purified water (68% w/w), and CBD (15 mg/mL). A high-energy sonication procedure was employed to facilitate preparation of the phospholipid-containing system while avoiding heating and organic solvents. Physicochemical characterization included droplet size (DS), polydispersity index (PdI), pH, conductivity, and entrapment efficiency (EE). Hemolytic activity was evaluated using a 5% suspension of human erythrocytes exposed to CBD-ME at CBD concentrations of 25, 50, and 75 μg/ mL and to corresponding amounts of blank ME for 1 h at 37 ± 2 °C. Hemolytic activity was evaluated using a 5% suspension of human erythrocytes exposed to blank microemulsion (blank ME) and CBD-loaded microemulsion (CBD-ME) at CBD-equivalent concentrations of 25, 50, and 75 μg/mL for 1 h at 37 ± 2 °C. Hemoglobin release was quantified spectrophotometrically at 540 nm using Triton X-100 and 0.9% saline as positive and negative controls, respectively. CBD-ME exhibited a DS of 27.69 ± 0.05 nm, PdI of 0.261 ± 0.017, conductivity of 132.47 ± 0.23 μS/cm, pH of 6.10 ± 0.06, and EE of 97.3 ± 0.7%. The formulation combined a nanometric droplet size with a CBD payload of 15 mg/mL in a water-rich oil-in-water system containing only 11% oil. Both blank ME and CBD-ME produced less than 1% hemolysis at all evaluated concentrations, indicating negligible erythrocyte membrane damage under the tested conditions. These findings provide preliminary evidence of the
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 39
favorable blood compatibility of CBD-ME and support its further investigation as a flexible pharmaceutical platform for CBD delivery. Its aqueous continuous phase, nanometric organization, and ability to maintain CBD dispersed at 15 mg/mL may facilitate dilution and incorporation into route-specific dosage forms. Additional hemocompatibility and safety studies tailored to the intended route of administration are warranted.
Repeated THC Exposure and Respiration after Subacute Cervical Spinal Cord Injury Rebecca Harbert, MDS University of Florida Co-authors: Rebecca A. Harbert1, Aaron A. Jones1, Alyssa Mickle1, Gabriel Lopez1, Barry Setlow1, Erica A. Dale1 1 University of Florida Background: Cervical spinal cord injury (cSCI) disrupts descending respiratory drive and reduces ventilatory capacity (Berlowitz et al., 2016), among other quality of life altering sequelae. A quarter of individuals with SCI report using cannabis for sensorimotor function, mood, and pain (Acland, 2018). Cannabinoids signal through CB1 and CB2 receptors and can modulate serotonergic signaling (HajDahmane and Shen, 2011; Haynes et al., 2023). Spinal serotonergic signaling contributes to respiratory motor plasticity (Baker-Herman and Mitchell, 2002), and cSCI alone upregulates ventral spinal 5-HT₂A receptors (Fuller et al., 2005). Objectives: In rats with cSCI, we hypothesized that THC would further increase spinal 5-HT and 5-HT₂A and, given their role in some forms of respiratory neuroplasticity (Dale-Nagle
40 - CCORC 2026
et al., 2010), we tested whether this: 1) occurs near the phrenic motor nucleus and 2) improves ventilatory capacity. Methods: Adult male Sprague–Dawley rats (n = 5/group) received a C2 hemisection (C2HS) and then Δ⁹tetrahydrocannabinol (THC; 50 mg/ mL) or vehicle vapor on days 7, 9, and 11 post-C2HS. Plethysmography was conducted before and after exposure under room air and hypercapnic– hypoxic conditions. C4 sections were immunolabeled for 5-HT or processed using multiplex RNAscope for ChAT and 5-HT₂A transcripts around cholera toxin B-labeled phrenic motor neurons. Results: THC-treated rats exhibited greater 5-HT immunoreactivity surrounding contralesional C4 phrenic motor neurons (est dif = +0.505, 95% CI [0.180, 0.830], p = 0.011), with no ipsilesional or rostrocaudal differences. Additionally, there were more ChATpositive motor neurons expressing 5-HT₂A ipsilesionally (95% CI [11.10, 82.39], p = 0.013), contralesionally (95% CI [8.30, 79.59], p = 0.0155), rostrally (95% CI [13.37, 87.88], p = 0.0057), in the middle (95% CI [14.22, 88.74], p = 0.0049), but not caudally (95% CI [−1.81, 72.70], p = 0.0657). However, contrary to our hypothesis, repeated THC exposure did not improve tidal volume or minute ventilation (both p>0.05) but reduced breathing frequency 11d post-C2HS (DID ≈ -22.2, 95% CI [-36.8, -7.7], p = 0.003), prolonged inspiratory time on day 9 (room air: + 39.0 msec, 95% CI [7.6, 70.4], p = 0.0155; hypercapnic–hypoxia: +39.7 msec, 95% CI [10.3, 69.2]) and day 11 (Room Air: + 56.1 msec, 95% CI [26.6, 85.6], FDR p = 0.0003) (Harbert et al., 2026). Conclusion: Repeated THC increased cervical spinal 5-HT and 5-HT₂A expression without improving tidal volume, suggesting that these adaptations alone are insufficient to
enhance spinal respiratory plasticity, within this timeframe and dose, after cSCI.
Cannabinoid and Terpene Modulation of Microglial Neuroinflammatory Pathways in Neurodegenerative Disease: Implications for Cognitive and Emotional Dysfunction Precious Melchizedek, MS University of Maryland - Baltimore Background: Neurodegenerative diseases such as Alzheimer’s, Parkinson’s disease, and multiple sclerosis, have distinct pathological characteristics but converge on chronic neuroinflammation, microglial dysfunction, oxidative stress, and progressive neuronal injury. These hallmarks contribute to cognitive decline and disturbances in emotional processing and regulation. Research has emerged supporting phytocannabinoids and cannabis-derived terpenes as potential multi-target novel therapeutic agents capable of influencing neuroimmune and neuronal signaling pathways. Objective(s): This review examined evidence regarding the effects of phytocannabinoids and cannabisderived terpenes on microglial activation and associated neuroinflammatory pathways in neurodegenerative disease, with particular emphasis on mechanisms potentially relevant to cognitive and emotional function. Methods: A structured literature review was conducted of peer-reviewed studies examining cannabinoids, terpenes,
microglial activation, neuroinflammation, oxidative stress, neuroprotection, cognition, and emotional function in neurodegenerative disorders. Literature was evaluated according to compound, molecular target, disease context, experimental model, and reported neurological or behavioral outcomes. Results: The literature demonstrates that cannabinoid signaling, particularly through CB2-associated pathways, can influence microglial inflammatory responses, cytokine signaling, and oxidative stress. Additional evidence implicates cannabinoid-responsive pathways including PPARγ, NFκB, NLRP3, and TRP channels in neuroinflammatory regulation. Emerging preclinical evidence suggests that minor phytocannabinoids and selected terpenes, including β-caryophyllene, linalool, and α-pinene, may exert complementary anti-inflammatory, antioxidant, and neuroprotective effects. Across neurodegenerative models, these mechanisms may converge on preservation of neuronal and synaptic function within circuits supporting cognition and emotional processing. Conclusions: Current evidence supports further investigation of cannabinoids and cannabis-derived terpenes as multitarget modulators of neuroimmune dysfunction in neurodegenerative disease. Although clinical evidence remains limited and substantial mechanistic and translational gaps persist, targeting microglial dysregulation, oxidative stress, and neural circuit dysfunction represents a promising framework for developing novel cannabinoid-based therapeutic strategies.
Subchronic Oral Cannabidiol (CBD) Attenuates Post-Injury
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 41
Macrophage Density without Altering Olfactory Epithelial Regeneration Bridger Menlove Florida State University Co-authors: Bridger Menlove1, Olivia C. Turner1, Zachary Arnold1, Chloe Crespi1, Madison Klick1, Debra A. Fadool1 1 Florida State University Background: Evidence supports that CBD may reverse neurogenic deficits in the central nervous system, as well as assist peripheral nerve repair. The olfactory epithelium maintains continuous, lifelong turnover of olfactory sensory neurons (OSNs). Albeit neurogenesis being well studied in this unique peripheral sensory organ, the ability for CBD to interact with the regenerative process of OSNs is completely unexplored. Objective(s): This study examined whether subchronic, oral administration of CBD affects normal olfactory epithelial homeostasis or regenerative recovery in adult mice following acute chemical injury. Methods: Adult male OMPtauEGFP reporter mice were administered vehicle control or 100 mg/kg CBD daily via voluntary oral consumption (strawberry jam) for two weeks prior to receiving either an intraperitoneal injection of saline (control) or 75 mg/ kg methimazole (MeZ) to ablate mature OSNs. Mice were tested for anticipated anosmia using the buried cookie assay and then histologically evaluated across post-injury time points (3, 10, 15, and 30 days). OSN abundance, epithelial thickness, sustentacular cell integrity (CK18), cellular turnover (Ki67, Caspase-3), and macrophage density (Iba-1) were anatomically quantified using confocal microscopy facilitated
42 - CCORC 2026
by the GFP reporter expressed in mature olfactory neurons (Olfactory Marker Protein+). Results: Subchronic CBD treatment significantly attenuated the acute macrophage accumulation three days post-ablation, marked by a reduction in olfactory mucosal macrophage density (1ba-1+ cells; p = 0.0262). Interestingly, the macrophage reduction was independent of epithelial regeneration. Following chemical injury, there was no main effect of CBD treatment on the recovery of olfactory ability across a 28day window after the onset of produced anosmia . CBD did not significantly modulate OSN abundance (p = 0.6146) or epithelial thickness (p = 0.8969) in MeZ-treated mice during the recovery phase, and markers for cellular turnover similarly remained unchanged 30-days post-ablation (Ki67 p = 0.1599; Cas3 p = 0.5620). Finally, in uninjured control mice, subchronic CBD administration had no effect on gross olfactory behavior, baseline OSN abundance , epithelial thickness, macrophage density, or cellular turnover (all p > 0.05); demonstrating that CBD does not disrupt normal epithelial homeostasis. Conclusions: We conclude that a subchronic, oral dose of CBD attenuates macrophage density in the olfactory system following chemical injury, while epithelial regeneration and homeostasis remain robustly independent Our experiments suggest limited use of CBD as a peripheral neuro-regenerative agent and do not indicate off-target effects of oral CBD on olfactory function or homeostasis.
Cannabinoids and Cancer in Zebrafish: A Systematic Review Josue Munguia University of Miami
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 43
Co-authors: Josue F. Munguia1, Mark Moffat1, Anthony Alfonso1, Ciné Brown1, Amrit Baral1,2, Denise C. Vidot1 1 University of Miami, 2Johns Hopkins University Background: The recent rescheduling of cannabis has opened opportunities for research using this substance medicinally. Zebrafish Danio rerio are a useful model for cancer research because they share around 70% of their DNA with humans and grow tumors that closely resemble human cancers. Cannabinoids interact with the endocannabinoid system to influence cell growth, immune function, and other cancer-relevant pathways, yet no prior review has synthesized the use of zebrafish to study the intersection of cannabinoids and cancer. Objectives: The objective of this review was to assess the current state of the literature on zebrafish as a model for studying cannabinoids and cancer. Methods: Articles were retrieved from PubMed and Web of Science and screened for eligibility in Covidence by three independent reviewers using a predefined PICOS framework. Search matrices were established as follows: “Zebrafish AND (Cannabinoids OR Cannabis OR CBD OR THC OR Marijuana)”, “Zebrafish AND (Cannabinoids OR Cannabis OR CBD OR THC OR Marijuana) AND Cancer”. Inclusion criteria included in vivo exogenous phytocannabinoid exposure in zebrafish, published after January 1, 2013. Exclusion criteria included endocannabinoid exposure, in vitro studies, other animal models, and other published reviews. Results: Out of 664 articles imported, 45 studies met final inclusion criteria. Results showed CBD was the most frequently studied phytocannabinoid, followed by THC and CBN. Studies also
44 - CCORC 2026
showed these phytocannabinoids being used to compare their effects with other synthetic substances. Most of the included studies focused on embryonic development and disease treatments rather than cancer-specific outcomes. No published studies found in this review examined phytocannabinoids and cancer within zebrafish. Two studies examined endocannabinoids and cancer; however, they were not included in this review since they did not meet inclusion criteria. Conclusion: These results highlight the knowledge gap we are trying to address. Recent federal reclassification of cannabis from Schedule I to III may mitigate the dearth in knowledge as researchers use zebrafish as a model for translational work at the intersection of cannabinoids and cancer. Despite the exclusion of the two endocannabinoid and cancer articles, it is still important to acknowledge their existence underlining the necessity for phytocannabinoid research in this area.
Dopaminergic System Alterations in Multiple Sclerosis and Cannabis Use: Evidence from Neuromelanin-Sensitive MRI Tara Najafi, BA University of Miami Co-authors: Tara Najafi1, Varan Govind1, Sandra Diadhiou1, Micheline McCarthy1, Kottil Rammohan1, Ramon Flores Gonzalez1, Flavia Nelson1, Teddy Salan1 1 University of Miami Background: Multiple sclerosis (MS) is a chronic autoimmune disease characterized by neurodegeneration, neuroinflammation, and iron
accumulation affecting the substantia nigra (SN), a key dopaminergic region, leading to dopaminergic neuronal loss and reduced dopamine function. Cannabis (CB) is commonly used by people with MS (PwMS) to manage symptoms, and while acute cannabis exposure may increase brain dopamine levels, chronic heavy use has been associated with reduced dopamine release. However, few studies have evaluated the effect of cannabis on brain dopamine in PwMS. Neuromelanin-sensitive MRI (NMMRI) provides a noninvasive marker of dopaminergic neuronal integrity by quantifying neuromelanin signal as the contrast ratio (CR) between the neuromelanin-rich SN and a reference region, the crus cerebri (CC). Objectives: To evaluate the effect of cannabis on brain dopamine in PwMS who use cannabis (MS+CB+), compared to PwMS who do not use cannabis (MS+CB−) and age-matched non-MS, cannabis-naive controls (MS−CB−) using NM-MRI proxy. Methods: NM-MRI data was collected from 6 MS+CB+ (3M/3F; age= 41.6±12.9), 7 MS+CB− (2M/5F; age= 36.8±8.5), and 11 MS−CB− subjects (4M/7F; age= 35.9±14.3). All participants completed MRI scans, including high-resolution NM-MRI acquired from an oblique slab covering the midbrain (TR/TE = 273/3.87 ms; 10 axial slices; 0.8×0.8×2 mm3 voxel). The SN and CC regions were manually segmented from an axial slice. The CR was computed using the mean signal intensity from the segmented SN and CC as CR = (μSN–μCC)/μCC. Betweengroup differences were evaluated using Kruskal-Wallis, with post hoc Dunn’s test for pairwise comparisons. Results: MS+CB+ participants exhibited a slightly higher NM signal CR (0.257) than MS+CB− participants (0.241),
whose values were lower than controls (MS−CB−; 0.265); however, neither overall nor pairwise group differences were significant (p = 0.534). Conclusions: In this preliminary analysis, NM signal did not differ significantly between PwMS by cannabis-use status and controls. However, a descriptive trend was observed, with lower CR in non-cannabis-using PwMS (MS+CB−) and higher CR in cannabis-using PwMS (MS+CB+) approaching control levels. These findings are consistent with reports of reduced dopaminergic function in MS and cannabis-associated increases in dopamine signaling. Although the current sample is underpowered, ongoing enrollment of 16 participants per MS group is expected to provide more robust effect size estimates. Further studies examining cannabis use characteristics, including frequency, potency, recency, and route of administration, are warranted.
Cannabis Use and Neuromelanin MRI Biomarkers of Dopaminergic Integrity in People With and Without HIV Tara Najafi, BA University of Miami Co-authors: Tara Najafi1, Suresh Pallikkuth1, Lisa Reidy1, Denise Vidot1, Allan Rodriguez1, Fernando M. Moradel1, Eva Widerstrom-Noga1, Varan Govind1, Teddy Salan1 1 University of Miami Background: Neuromelanin (NM), a byproduct of dopamine metabolism that accumulates in the substantia nigra (SN), can be noninvasively assessed using neuromelanin-sensitive MRI (NM-
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 45
MRI), with SN-to-crus cerebri contrast ratio (CR) serving as a marker of nigral dopaminergic integrity. People with HIV (PWH) exhibit heightened dopaminergic vulnerability compared to people without HIV (PWoH), while cannabis (CB) use may initially enhance but chronically attenuate dopaminergic function. However, the combined effects of HIV infection and cannabis use on NM-MRI measures remain poorly understood. Objectives: To examine the independent and interactive effects of HIV serostatus and cannabis use on NM-MRI signal (CR) in the SN using a 2×2 design (HIV+/HIV− × CB+/CB−), and to evaluate associations between CR and cannabis use severity (CUDIT score) and cannabinoid metabolites. Methods: NM-MRI data were collected from four groups: HIV−CB− (n=14; 4M/10F; age=30.7±8.6), HIV+CB− (n=9; 2M/7F; age=38.8±3.8), HIV−CB+ (n=16; 9M/7F; age=36.0±8.5), and HIV+CB+ (n=17; 9M/8F; age=38.5±6.8). The SN and CC were segmented, and CR computed as (μSN−μCC)/μCC. A twoway factorial ANOVA evaluated main and interaction effects of HIV and CB status on CR, with a follow-up ANCOVA controlling for age and sex. Pearson correlations assessed CR against CUDIT score and cannabinoid metabolites within HIV+ and HIV− cannabis users; age-CR associations were also examined post hoc within HIV+CB− and HIV+CB+. Results: Neither HIV status (p=0.31) nor cannabis use (p=0.889) was significantly associated with CR, with no HIV × CB interaction (p=0.6). Among cannabis users, the CUDIT-CR association was more positive in HIV+CB+ (r=0.23, p=0.38) than HIV−CB+ (r=−0.08, p=0.79). CR was not significantly correlated with cannabinoid metabolites (all p>0.15). After controlling for age and sex, group effects remained non-significant; however, age was significantly
46 - CCORC 2026
associated with CR (F=6.91, p=0.011, partial η²=0.12), increasing across all participants. Post hoc, this age-CR association was stronger in HIV+CB− (r=0.82, p=0.006) than HIV+CB+ (r=0.45, p=0.068). Conclusions: Nigral NM-MRI signal did not differ significantly by HIV serostatus or cannabis use overall, nor was it associated with cannabinoid metabolites. Notably, CR increased with age across all participants, consistent with well-established age-related NM accumulation; this relationship appeared shallower among cannabis-using PWH, raising the possibility that cannabis use may attenuate HIV-related dopaminergic aging. The CUDIT-CR association was also more positive in HIV+ than HIV− cannabis users, possibly reflecting heightened dopaminergic vulnerability of the HIV brain to cannabis, consistent with reports of elevated neuromelanin signal in cannabis use disorder. Both trends are exploratory and warrant confirmation in an adequately powered sample.
Cannabis Use is Associated with Altered Peripheral Biomarker Profiles in People Living with HIV Suzanne E. Queen, MS Johns Hopkins University Co-authors: Suzanne E Queen1, Hayley Romero1, Erin N Shirk1, Raha M Dastgheyb1, Leah H Rubin1, Rebecca T Veenhuis1 1 Johns Hopkins University Background: Despite effective antiretroviral therapy (ART), latent HIV reservoirs persist in brain-resident microglia. These reservoirs promote HIV-associated neuropathology through chronic neuroinflammation
and the continued production of neurotoxic viral proteins. Cannabis use is common among people living with HIV (PLWH). The major cannabinoids, Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), regulate microglial activation and inflammatory signaling pathways linked to HIV-associated neurotoxicity. These properties suggest that cannabinoids may modulate pathways involved in HIV-driven neuroinflammation. Objectives: To determine whether cannabis use and detectable THC exposure are associated with differences in inflammatory, immune, neurovascular, and neuronal injury biomarkers, as well as circulating monocyte and lymphocyte subsets in PLWH. Methods: A total of 187 virally suppressed PLWH (plasma HIV RNA <150 copies/mL) enrolled in the Johns Hopkins Brain Health Program (BHP) cohort were categorized into four groups based on cannabis use history assessed using the Structured Clinical Interview for DSM-IV (SCID-IV) and urine THC status: current cannabis users who tested THC-positive (n = 44), current users who tested THC-negative (n = 26), former users who tested THC-negative (n = 49), and never-users who tested THC-negative (n = 68). Thirty-six plasma biomarkers covering inflammation, immune activation, neuronal injury, and vascular function, along with phenotypic subsets of circulating monocytes and lymphocytes, were compared across cannabis use groups using linear regression after log transformation and windsorized 3-standard deviation thresholding. Multivariable models were subsequently adjusted for age and sex. Results: Compared with neverusers, current cannabis users had lower plasma concentrations of the proinflammatory cytokines IL-18 (β=-
0.170, p=0.033) and MIP-1β (β=-0.17, p=0.030), but higher concentrations of IL-15 (β=0.20, p=0.010). Current cannabis use was also associated with trends toward altered concentrations of biomarkers involved in myeloid regulation including cystatin-C (β=0.149, p=0.076), VEGFR (β=0.15, p=0.070), and M-CSF (β=-0.141, p=0.081). Conversely, markers of neuronal injury and endothelial dysfunction, neurofilamentlight (NfL; β=0.18, p=0.010) and vonWillebrand factor (vWF; β=0.27, p=0.001) were higher among current THC-positive users. No significant differences were observed in circulating monocyte and T-cell subsets across cannabis use groups. Conclusion: Current cannabis use was associated with a distinct peripheral biomarker profile involving inflammatory, neurovascular, and neuronal injury pathways compared to former and never users. These findings support the hypothesis that cannabinoids influence biological mechanisms relevant to brain health in PLWH while highlighting the need for larger sample, and longitudinal studies to determine whether these biomarker changes are associated with cognitive trajectories and long-term clinical outcomes.
Effect of Cannabis on Sleep and Glymphatic Function in People with Multiple Sclerosis Teddy Salan, PhD University of Miami Co-authors: Varan Govind1, Sandra Diadhiou1, Micheline McCarthy1, Kottil Rammohan1, Ramon Flores Gonzalez1, Flavia Nelson1 1 University of Miami Background: Sleep disruption is a
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 47
48 - CCORC 2026
common symptom affecting half of people with multiple sclerosis (PwMS). Consequently, PwMS are increasingly turning to cannabis to alleviate sleep difficulties. However, the effect of cannabis on sleep is not well established, evidence from the literature suggests that cannabis may help reduce sleep disturbances in PwMS, while other studies report no benefit. Furthermore, sleep regulates the brain’s glymphatic system (GS), a clearance system responsible for the removal of toxic waste products and molecules. Impaired GS function is also common in neurodegenerative disorders including MS, yet the impact of cannabis on GS remains understudied Objectives: To evaluate the effect of cannabis on sleep, and its association to GS function in PwMS. Methods: In this ongoing study, we enrolled 6 PwMS using cannabis (MS+CB+; 3M/3F; age= 41.6±12.9) and 7 PwMS not using cannabis (MS+CB−; 2M/5F; age= 36.8±8.5). Sleep data were collected using subjective (Pittsburgh Sleep Quality Index; PSQI) and objective measurements (total sleep time, time in different stages: light, deep, REM) obtained from Fitbits worn over 2 weeks. We also collected brain MRI data including diffusion tensor imaging (DTI) and processed using established methods to evaluate DTI along the perivascular space (DTI-ALPS) index, a marker of GS function. We performed t-tests to find group differences in sleep measurements and DTI-ALPS index, and spearman correlations to associate DTIALPS with sleep outcomes. Results: While none of the sleep measures were statistically significant, MS+CB+ subjects recorded more time in deep sleep and less in light and REM sleep, and had more sleep records per day compared to MS+CB−. They also had higher DTI-ALPS index (1.73)
compared to MS+CB− (1.61), although this was not statistically significant either (p=0.45). In addition, DTI-ALPS index negatively correlated with REM sleep for all subjects (p=0.007), with stronger correlation among MS+CB+ (p=0.007). Conclusions: In this preliminary analysis, we found that MS+CB+ subjects spent more time in deep sleep rather than light or REM sleep stages. This may explain the higher DTI-ALPS index in MS+CB+ as the GS is primarily active during deep or slow-wave sleep. However, MS+CB+ subjects also had more sleep records per day indicating more fragmented sleep. In addition, we found that higher REM sleep time associated with lower ALPS, as more REM time may induce less time in deep sleep. Although the current sample size is underpowered, ongoing enrollment of 16 participants per group is expected to provide more robust effect size estimates.
Effect of Cannabis Use on Glymphatic Function in People with Multiple Sclerosis Using DTI-ALPS Teddy Salan, PhD University of Miami Co-authors: Varan Govind1, Sandra Diadhiou1, Micheline McCarthy1, Kottil Rammohan1, Ramon Flores Gonzalez1, Flavia Nelson1 1 University of Miami Background: The glymphatic system (GS) is the brain’s clearance system, responsible for removing toxic waste products and molecules. The GS has recently gained attention for its role in neurodegenerative disorders such as multiple sclerosis (MS), with studies showing reduced GS function in people with MS (PwMS). GS function can be
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 49
assessed using diffusion tensor imaging (DTI) along the perivascular space (DTIALPS), a non-invasive MRI technique that accurately reflects GS function. Sleep also plays a role in GS function, such that poor sleep causes decline in glymphatic function and clearance. Since sleep disruption is common in PwMS, cannabis is commonly used to alleviate sleep disruption among other symptoms. However, the impact of cannabis use on GS function in PwMS remains unexplored. Objectives: To evaluate GS function in PwMS who use cannabis (MS+CB+), compared to PwMS who do not use cannabis (MS+CB−) and age-matched non-MS, cannabis-naive controls (MS− CB−). Methods: MRI data including DTI (b = 1000/2000 s/mm2, 30 directions, 2.5 mm iso voxel), were collected from 7 MS+CB− (2M/5F; age= 36.8±8.5), 6 MS+CB- (3M/3F; age= 41.6±12.9), and 11 MS−CB− subjects (4M/7F; age= 35.9±14.3), Data were processed using FSL and Dipy to obtain diffusivity maps in the x, y, and z directions (Dx, Dy, and Dz). The DTI-ALPS index was calculated using established methods by evaluating Dx, Dy, and Dz at projection and association tracts along the perivascular space, with manually placed regions of interest. Group differences in DTI-ALPS index were assessed using Kruskal-Wallis, with post hoc Dunn’s test for pairwise comparisons. Results: MS+CB− subjects had reduced DTI-ALPS index (1.61) compared to cannabis-using MS patients (MS+CB+; 1.73), and to controls (MS−CB−; 1.77), however, neither overall nor pairwise group differences were significant (p=0.480). Conclusions: In this preliminary analysis, we did not find significant differences
50 - CCORC 2026
in DTI-ALPS index between PwMS by cannabis-use status and controls. However, MS+CB− subjects trended towards lower DTI-ALPS relative to controls, indicating poorer GS function, while DTI-ALPS for MS+CB+ was comparable to controls. These results suggest that cannabis use may increase DTI-ALPS and glymphatic clearance and corroborate findings in the literature that show lower DTI-ALPS in PwMS. Although the current sample size is underpowered, ongoing enrollment of 16 participants per MS group is expected to provide more robust effect size estimates. Further examination of sleep patterns and cannabis use characteristics are warranted to fully characterize the effect of cannabis on sleep and GS function in PwMS.
Evaluation of Circadian Variations of Circulating Endocannabinoids Sarvesh Kumar Verma University of Florida Co-authors: Sarvesh Kumar Verma1, Abhishek Gour1, Azin Behnood-Rod1, Barry Setlow1, John Neubert2, Niall Murphy2, Abhisheak Sharma1 1 University of Florida, 2Texas A&M University Background: The endocannabinoid system (ECS) is a lipid signaling network involved in central nervous system development and the regulation of numerous physiological and cognitive functions. It comprises endogenous cannabinoid ligands, cannabinoid receptors, and the enzymes responsible for their synthesis and degradation. Anandamide (AEA) and 2-arachidonoylglycerol (2-AG) are the primary endogenous ligands that activate cannabinoid receptors. However, accurate quantification of
these endocannabinoids in blood remains challenging because of their low circulating concentrations, poor stability, and rapid enzymatic degradation following sample collection. Objective: To develop and validate a robust analytical strategy for stabilization, extraction, and quantification of AEA and 2-AG in blood and to evaluate their blood distribution and 24-hour concentration-time profiles in rats. Methods: Blood-to-plasma partitioning of AEA and 2-AG was evaluated after 1 h incubation at 37°C by measuring their concentrations in whole blood and plasma. Endocannabinoid stability was then assessed under treated and untreated conditions, with whole blood samples either immediately stabilized with phenylmethylsulfonyl fluoride and acetic acid or left untreated to evaluate degradation. An optimized liquid-liquid extraction method was subsequently developed for the quantitative analysis of AEA and 2-AG in rat whole blood. Finally, the BASi Culex automated sampling system was used to collect serial blood samples over 24 h from female Fischer 344 × Brown Norway F1 hybrid rats to characterize the concentration–time profiles and circadian patterns of circulating AEA and 2-AG. Results: AEA degraded rapidly under untreated conditions, with only 47.9 ± 8.3% remained after 1 h of incubation, whereas stabilization effectively maintained AEA stability during sample handling. Blood-to-plasma ratio analysis revealed distinct distribution patterns, with ratios of 1.0 ± 0.1 for AEA and 37.1 ± 2.3 for 2-AG, demonstrating preferential partitioning of 2-AG into blood components. Rats exhibited consistently higher circulating 2-AG levels compared to AEA throughout the 24-hour light-dark cycle.
Conclusion: This study presents a reliable analytical method for stabilization, extraction, and quantification of circulating endocannabinoids in blood. Sample stabilization improved endocannabinoid measurement, while blood-to-plasma partitioning analysis demonstrated that whole blood is the preferred matrix for 2-AG quantification. This approach provides a practical approach for investigating endocannabinoid dynamics and evaluating the effects of novel chemical entities targeting the endocannabinoid system.
CBD Drives Neurogenic Differentiation in Human Dental Pulp Stem Cells Airam Vivanco, MSc, DDS University of Florida Co-authors: Airam Nicole VivancoEstela1,2, Daniele P. Ferrari3, Roger R. Fernandes1, Bianca Andretto de Mattos2, Mauricio dos-Santos-Pereira4, Francisco S. Guimarães2, Karina F. BombonatoPrado2, Elaine Del-Bel2, Glauce Crivelaro Nascimento2 1 University of Florida, 2University of Sao Paulo, 3University of British Columbia, 4 Broad Institute of MIT and Harvard Dental pulp stem cells (DPSCs) exhibit intrinsic neurogenic potential and represent a promising cell source for regenerative strategies targeting neurological disorders. Cannabidiol (CBD), a non-psychotomimetic phytocannabinoid, has emerged as a potent modulator of neurogenesis, neuronal survival, and redox homeostasis. However, its effects on neuronal differentiation of DPSCs remain poorly understood. Here, we investigated whether CBD enhances neuronal differentiation of DPSCs and modulates oxidative stress during this
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 51
process. DPSCs (OD-21 cells) were subjected to neuronal induction using Neurobasal medium in the presence or absence of CBD (1, 2.5, and 10 µM). Cell viability, neuronal differentiation markers, and reactive oxygen species (ROS) production were evaluated at distinct stages of differentiation. CBD did not affect DPSC viability at any concentration or experimental period analyzed (24 h to 21 days), demonstrating low cytotoxicity under neurogenic conditions. Western blot and immunofluorescence analyses revealed that CBD differentially modulated neuronal markers according to the stage of differentiation. CBD at 2.5 µM significantly increased Nestin expression during the early phase of differentiation (24 h and 4 days), indicating enhanced neural progenitor commitment. In intermediate stages (7–14 days), CBD markedly upregulated NeuN expression, suggesting increased neuronal maturation and commitment. Among all concentrations tested, 2.5 µM consistently produced the strongest pro-neurogenic effects. At later stages (21 days), CBD (2.5 and 10 µM) significantly enhanced MAP-2 expression, consistent with acquisition of a mature neuronal phenotype. Neuronal induction with Neurobasal medium increased intracellular ROS production, whereas CBD treatment significantly attenuated oxidative stress throughout differentiation, particularly at days 4, 7, and 14. These findings indicate that CBD promotes neuronal differentiation of DPSCs in a timeand dose-dependent manner while maintaining redox homeostasis during neuronal commitment and maturation. These findings support the therapeutic potential of CBD as a pharmacological adjunct in stem cell-based regenerative approaches for neurodegenerative and neurological disorders.
52 - CCORC 2026
ABSTRACTS CLINICAL RESEARCH, POPULATION HEALTH, HEALTH BEHAVIOR CATEGORY Policy and Research Gaps in Therapeutic Cannabis Use for GWOT Combat Veterans with Traumatic Brain Injury, PTSD, and CoOccurring Conditions Roberto Antonacci, MD Green Express Med, LLC Co-authors: Roberto Antonacci1, David Miller1, Roscoe Moore1, Alexandra Perkins1, Max Orezzoli1, Greg Daniel1 1 Green Express Med, LLC Background: Combat arms veterans of the Global War on Terror (GWOT, 2001–present), defined by Military Occupational Specialty (MOS), experience elevated rates of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Approximately 11–23% of GWOT veterans have sustained a TBI, with mild TBI often linked to repetitive blast exposure, including shoulder-fired weapon systems. PTSD prevalence estimates range from 15–30% in this population, with substantial comorbidity between TBI and PTSD. Frequent co-occurring conditions, including suicidality and polysubstance use, further complicate treatment. Despite increasing interest in medical cannabis as a therapeutic modality, research has been constrained by federal scheduling,
inconsistent methodologies, and limited standardization. Objective: This policy-focused analysis evaluates critical deficiencies in research on therapeutic cannabis use among GWOT veterans. Emphasis is placed on the lack of models correlating TBI mechanisms, PTSD symptom clusters, and therapeutic outcomes. This work highlights the absence of cannabis cultivar (chemovar) differentiation and the systematic exclusion or underrepresentation of concurrent conditions, including suicidality and polysubstance use. Methods: A structured review of over 40 peer-reviewed studies (2015–2024) focusing on GWOT veteran populations was conducted. Studies were evaluated for design rigor, population stratification (including MOS and exposure type), outcome measures, and cannabis characterization. Policy analysis included recent federal cannabis rescheduling actions and implications for research expansion. Attention was given to methodological limitations of research conducted without cannabinoid and terpene profiling (chemovar standardization), as well as the exclusion of high-risk populations from clinical trials. Results: The current evidence base is fragmented and lacks methodological cohesion. Few studies adequately stratify TBI by etiology (blast vs. blunt force), nor do they model the interaction between PTSD severity and cannabis use. Cannabis is frequently treated as a homogeneous intervention, obscuring differential therapeutic effects attributable to specific cannabinoid and terpene compositions. Furthermore, the exclusion of individuals with active suicidal ideation or polysubstance use significantly limits external validity. The absence of integrated, multidimensional correlation frameworks prevents
meaningful interpretation of therapeutic outcomes across complex clinical presentations. Conclusion: Recent federal actions on medical cannabis rescheduling present a pivotal opportunity to address longstanding research limitations. Future policy must prioritize large-scale, multicenter trials stratified by MOS, TBI mechanism, and PTSD phenotype, while mandating standardized cannabis chemovar characterization. Inclusion of populations with suicidal ideation and polysubstance use is essential to reflect real-world clinical conditions. Without these advancements, research will continue to lack translational utility. Addressing these gaps is critical to developing precise, evidence-based, and personalized therapeutic frameworks for GWOT veterans.
Cannabis Use Profiles Differ by Age Among Adult Women Jennifer Attonito, PhD University of Central Florida Co-authors: Karina Villalba1, Jocelyn Mueller2, Christa Cook3 1 University of Central Florida, 2University of South Florida, 3University of Florida Background: As cannabis products diversify, understanding age-related differences in cannabinoid preferences and cannabis use behaviors may inform the medical cannabis industry, public health, education, and research. This study examined age-related differences in cannabis preferences and use behaviors among adult women in Florida. Methods: This online cross-sectional study included 412 Florida women aged ≥18 years who reported cannabis use, including tetrahydrocannabinol
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 53
(THC) and/or cannabidiol (CBD), within the previous 12 months. Participants were recruited through Qualtrics (2022–2023). Participants were stratified by the sample median age (<56 vs. ≥56 years), resulting in two equal comparison groups (n = 206 each). Demographic characteristics, cannabinoid preferences, and cannabis use behaviors were compared using chi-square analyses and independentsamples t-tests. Results: The mean participant age was 54.7 years, and participants were predominantly White and nonHispanic. Compared with older women, younger women were more likely to identify as Black/African American, be employed, and have lower educational attainment, whereas older women were more likely to be widowed or divorced. A consistent pattern of agerelated differences emerged. Younger women were significantly more likely to prefer high-THC/low-CBD marijuana products (36.9% vs. 24.8%), whereas older women were more likely to prefer high-CBD/low-THC products (16.0% vs. 10.7%; p = 0.005). Consistent with these preferences, younger women were more likely to report current use of THC-dominant formulations, whereas older women more commonly reported using balanced (1:1) or CBD-dominant formulations (p = 0.004). These agerelated differences extended beyond cannabinoid preference. Collectively, these findings define distinct age-related cannabis use profiles. Younger women reported more frequent marijuana use (p < 0.001) and CBD use (p = 0.037) and were significantly more likely to use flower (p < 0.001), vape products (p < 0.001), live resin (p = 0.008), and edible cannabis products (p < 0.001). In contrast, older women reported higher monthly marijuana expenditures (p = 0.002) despite less frequent cannabis use. No significant age differences were
54 - CCORC 2026
observed in medical marijuana card ownership, age at marijuana initiation, duration of marijuana or CBD use, or most other cannabis product categories. Conclusions: The findings suggest distinct age-related cannabis use profiles among adult women. Younger women demonstrated a profile characterized by THC-dominant preferences, more frequent cannabis use, and greater use of inhaled and edible products, whereas older women more commonly preferred balanced or CBD-dominant formulations and reported higher monthly cannabis expenditures. These findings may inform the Florida medical cannabis industry, public health initiatives, educational efforts, and future longitudinal research.
Association of Recent Cannabis Use with Attention-Deficit/ Hyperactivity Disorder Symptom Severity in U.S. Adults Chidimma Azubuike, PharmD, MA University of Florida Co-authors: Amie Goodin, University of Florida Background: Prenatal cannabis (marijuana) exposure has been associated with an increased risk of attention-deficit/hyperactivity disorder (ADHD) in offspring. However, less is known about the relationship between cannabis use and ADHD symptoms among adults. Objective: To examine the association between recency and frequency of cannabis use and ADHD symptom severity among adults. Methods: We conducted a cross-
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 55
sectional study using data from the 2024 National Survey on Drug Use and Health. An ADHD symptom scale was constructed from five survey items assessing domains consistent with DSM-5 ADHD symptom criteria, including difficulty with remembering tasks, restlessness or fidgeting, difficulty concentrating, managing daily responsibilities at work or school, and completing work as quickly as needed. Higher scores indicated greater symptom severity. The analysis included adults aged ≥18 years who worked or attended school and completed all ADHD symptom items (n = 13,294). Marijuana use recency was categorized as use within the past 30 days, 30 days to 12 months, or more than 12 months. Frequency was measured as the number of days of marijuana use in the past year. Survey-weighted linear regression accounting for complex survey design was used to assess the association between recency of marijuana use and ADHD symptom severity. The model adjusted for demographic characteristics, health status, and use of other substances. A sensitivity analysis included participants who completed at least four of the five items. Results: The ADHD symptom scale ranged from 5 to 21, with a mean score of 11. Compared with individuals who never used cannabis, ADHD symptom scores were associated with 0.88, 0.95, and 0.62 higher points among those who used cannabis within the past 30 days, 30 days to 12 months prior, and more than 12 months prior, respectively (p<0.001). Each additional 30 days of cannabis use in the past year was associated with a 0.03-point increase in ADHD symptom score (p=0.26). Higher ADHD symptom scores were also associated with younger age, race/ ethnicity, divorced or separated marital status, some college or college or higher education, lower income, and poorer
56 - CCORC 2026
self-rated health. Sensitivity analysis findings were consistent with the primary analysis. Conclusion: Among adults, recent marijuana use was associated with greater ADHD symptom severity. Although the findings were statistically significant, they were not clinically meaningful. These findings provide evidence of an association but do not establish causality. Further longitudinal controlled studies are needed to clarify the temporal and causal relationship between cannabis use and ADHD symptoms.
Sublingual Administration of Cannabidiol for Knee Osteoarthritis (SLACK-OA): a Randomized, Placebocontrolled Feasibility Trial Paul Borsa, PhD University of Florida Co-authors: Paul A. Borsa1, John W. Stauffer1, Jenessa L. Bailey1, Mark D. Bishop1, Joseph W. Stauffer2 1 University of Florida, 2Delta Life Sciences, LLC Background: Knee osteoarthritis (KOA) is the most common joint disease and a major cause of functional limitation and pain in older adults. Although pharmacologic treatment for KOA such as NSAIDs may help in the short-term with reducing pain-related symptoms, they are known to have mild to severe side effects. Consequently, many Americans have turned to cannabisrelated products like cannabidiol (CBD) for reducing pain-related symptoms associated with KOA. Evidence indicates that phytocannabinoids may have a promising therapeutic potential in a variety of physical ailments, and CBD is of particular interest due to its positive
safety profile, non-intoxicating effects, and purported therapeutic capabilities in several musculoskeletal diseases. There is an extremely large consumer base for CBD-related products which is expanding exponentially; and therefore, scientific investigation is necessary. Objectives: Our primary objectives were threefold. First, to confirm the safety of the CBD product. Second, to examine the feasibility of the tests and measures used to determine preliminary efficacy. Last, to examine effect sizes and variance parameters to make preliminary estimations of efficacy. Methods: We used a randomized, double-blind, placebo-controlled, crossover design to assess and monitor symptomatic relief and improved function following treatment with CBD or placebo-control. We studied 12 adult men and women between 40 and 75 years of age, with symptomatic KOA. Participants were required to complete a cross-over (CBD/placebo) trial spanning baseline testing, 30-day dosing regimen with follow-up testing. Outcomes included self-reported disability (Western Ontario and McMaster Universities Arthritis Index or WOMAC), pain intensity/interference (Brief Pain Inventory or BPI), and psychological well-being (Pain Catastrophizing Scale or PCS, and the Pain Anxiety Symptom Scale-20 or PASS-20). Data was compared between the CBD and placebo-control phases. Results: Overall, the drug product was found to be safe and well-tolerated by the participants. Side effects (SEs) were common, however no serious adverse reactions were reported. Paired comparisons showed no statistically significant differences between the CBD and placebo treatment conditions on composite self-reported disability (WOMAC), pain intensity/interference (BPI), and psychological well-being (PCS
and PASS-20) outcome measures. Conclusions: Despite preclinical evidence suggesting therapeutic benefits of CBD use, we found no statistically significant improvements compared to placebo across all outcomes. Our findings do not support its clinical utility at the dose and duration utilized in this study. In future trials, other phytocannabinoids (e.g., THC) should be explored in combination with CBD.
Adapting ANCHOR for Cancer Patients and Survivors: A Cannabis Nurse-Led Harm Reduction Intervention to Improve Cannabis Use Disclosure and Safety Ciné Brown, BS University of Miami Co-authors: Ciné Brown1, Renessa Williams1, Bria-Necole Diggs1, Bright Tamakloe1, Benedictus Atsu Hlormenu1, Denise C. Vidot1 1 University of Miami Background: Cannabis is increasingly used by individuals with current or prior cancer to manage symptoms and treatment-related effects, yet disclosure to oncology clinicians remains limited. Nondisclosure may hinder clinicians’ ability to assess product potency, routes of administration, drug-drug interactions, and other safety concerns. Advancing Nurse-led Cannabis Harm Reduction (ANCHOR) is a nurse-led, technologydelivered brief harm-reduction intervention originally designed for young adults 18-35 who self-medicate with cannabis. Objective: To use cancer patient and
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 57
survivor data to 1) adapt ANCHOR for cancer care; and 2) define intervention components that strengthen cannabis disclosure, informed decision-making, and clinical safety. Methods: Cross-sectional data from the ongoing cannabis and cancer study (P30CA240139) adult cancer patients and survivors (N=472) were analyzed to characterize 1) cannabis and/or psychedelic use before, during, and after cancer cancer care and 2) disclosure to healthcare professionals. Findings were mapped through the Intervention Mapping framework and cannabis nursing guidance to an adaptation matrix addressing population needs, intervention content, delivery, and implementation. Core ANCHOR components were retained when compatible with oncology care, and modifications were specified for cancer-related symptoms, treatments, medications, caregivers, and referral pathways. Results: Of the sample, 43.8% in active chemotherapy reported the use of cannabis to mitigate side effects of chemotherapy and/or comorbidities; 37.9% reported daily cannabis use during chemotherapy; 61.8% reported cannabis use at time of survey. Only 2.6% of cannabis consumers reported they received instructions on how to use cannabis from their oncologist; yet 85.7% reported asking their oncologist about cannabis. The most prevalent reported reasons for SCCC patients to consume cannabis were pain (57.9%), difficulty sleeping (50.0%), and nausea/ vomiting (28.9%). An estimated 47.4% of our sample stopped consuming cannabis after a cancer diagnosis. The most reported reasons for stopping use were high cost (33.3%), drugdrug interaction concern (33.3%), and uncertainty about safety/effectiveness (22.2%). The cancer-adapted ANCHOR model retained a synchronous, single-
58 - CCORC 2026
session telehealth encounter with a trained cannabis nurse and added nonjudgmental disclosure prompts; review of symptom goals, product composition, potency, dose, and route; medication and cancer-treatment interaction screening; high-THC harm-reduction counseling; red-flag escalation to oncology clinicians; caregiver inclusion when appropriate; and survivorship, supportive-care, and palliative-care referrals. Patient materials were reframed around informed use and shared decisionmaking rather than abstinence. Conclusions: The marked gap between cannabis-related use and clinical disclosure identifies an actionable safety and communication target in cancer care. The cancer-adapted ANCHOR model preserves the accessibility and relational strengths of nurse-led telehealth while adding oncology-specific risk assessment and referral pathways.
Refining THC Exposure Estimation for Cannabis Vaping Using Inhalation Duration Madelyn Eason University of Florida Co-authors: Madelyn Eason1, Donald Porchia1, Juan Perez1, Robert Cook1, Yan Wang1, Catalina Lopez-Quintero1, Karina Villalba2 1 University of Florida, 2University of Central Florida Background: Quantifying tetrahydrocannabinol (THC) exposure from cannabis vaping is challenging because self-reported use is often recorded as frequency, episodes, and hits rather than directly measured product consumption. Universal grams-
per-hit-ratio (GPHR) approaches provide a practical literature-based exposure estimator but do not distinguish shorter from longer inhalations. Objectives: This study estimated vapingrelated THC exposure using a universal GPHR estimator and a novel durationinformed adaptation. Methods: We analyzed data from the Medical Marijuana and Me (M³) Study of Florida adults using medical cannabis. The analytic sample included 618 current cannabis vapers with complete data on vaping frequency, daily vaping episodes, hits per episode, and inhalation duration. The universal estimator used the published vaping/ concentrate GPHR of 0.012 g/hit. The duration-informed estimator assigned GPHRs of 0.004, 0.012, and 0.020 g/ hit for short (1–2 seconds), medium (3–5 seconds), and long (≥6 seconds) inhalations, respectively. The shortinhalation value was selected as a conservative adaptation consistent with consumer-facing estimates of oil delivered per vape puff, and the medium category retained the published universal GPHR. THC exposure was calculated assuming 80% THC concentration and a vaping method-of-administration efficiency constant (MAEC) of 0.5. Estimates were summarized per episode, vaping use day, and calendar day and compared by CUDIT-R risk group, age, and sex. Results: Using the universal estimator, mean THC exposure was 16.4 mg per vaping episode, 64.7 mg per vaping use day (amount vaped divided by days used in past four weeks), and 49.7 mg per calendar day (amount vaped divided by 28 days). Corresponding estimates using the duration-informed estimator were 16.8 mg, 70.9 mg, and 55.0 mg. The duration-informed estimator produced modestly higher mean exposure with a mean difference of 6.2
mg per-use-day. The two estimators were strongly correlated, indicating that the universal estimator largely preserved relative ranking. Long-duration users had the highest estimated exposure, averaging 186.3 mg per vaping use day. Exposure estimates were higher among younger participants and those with hazardous CUDIT-R risk. Sex differences were small and not statistically significant. Conclusions: Cannabis vaping THC exposure can be operationalized using self-reported frequency, episodes, hits, and inhalation duration. In this conservative MAEC-adjusted analysis, the duration-informed estimator produced only modestly higher overall estimates, but identified substantially higher exposure among long-duration inhalers. These findings support incorporating inhalationduration information as a refinement to GPHR-based exposure estimation in observational studies of cannabis vaping.
THC On a Glass: A Cross-Sectional Study of Consumption Patterns Across Sex Demographics Rosa Martha Felipe Hidalgo University of Central Florida Co-authors: Rosa Felipe Hidalgo1, Brandon Zamora1, Jennifer Attonito1, Sixiao Vivian Liu1, Karina Villalba1 1 University of Central Florida Background: Hemp-derived THC beverages, including THC seltzers, sodas, and other infused drinks, have expanded in the U.S. marketplace. However, little is known about who uses these products or whether patterns of use and associated substance use risk differ by sex among young adults.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 59
Objective: To examine demographic characteristics, patterns of hempderived THC beverage use, and substance use risk by sex among young adults in the United States. Methods: This ongoing online crosssectional study is recruiting 400 U.S. young adults (ages 21-45) who use hemp-derived THC beverages via Qualtrics research panels. This analysis includes the first 40 participants enrolled. Demographic characteristics, cannabinoid preferences, and alcohol and cannabis use behaviors were compared by sex using chi-square tests and independent-samples t-tests. Statistical significance set at p < .05. Results: Participants were primarily male (60%) and White (83%); 22% identified as Hispanic or Latino and 15% as Black. Most participants were single (48%), 62% had completed a bachelor’s or master’s degree, and 58% reported household incomes greater than $50,000. Men and women reported similar duration of hemp-derived THC beverage use in the past 12 months (men: M = 8.5 months, SD = 2.7; women: M = 8.0 months, SD= 3.0), and 93% of the sample reported use in the past 30 days, with no significant sex differences. Among past-30-day users, men reported more days of use on average than women, although it was not statistically significant (men: M = 11.0, SD = 5.1; women: M= 9.0, SD = 3.7; p = 210). Typical-day (2 beverages) and heaviestday consumption (5 beverages) also did not differ significantly by sex. Those who reported using 5 mg beverages, women were slightly higher (55% vs. 45%), however for the 10 mg beverages, men were the majority (77% vs. 23% women). Men scored significantly higher than women on measures of hazardous alcohol use (AUDIT) and hazardous cannabis use(CUDIT). AUDIT (men: M = 10.1, SD = 7.5; women: M = 4.3, SD = 5.6; p = .014) and CUDIT (men: M = 8.5, SD =
60 - CCORC 2026
8.5; women: M = 4.6, SD = 3.2; p = .009). Conclusion: In this preliminary sample, men and women showed similar use duration, frequency, and quantity, but men reported significantly more hazardous alcohol and cannabis use, suggesting sex-related differences in substance use risk. As we continue to recruit, the study will yield more robust results describing this emerging trend.
Conducting a Multicenter Randomized Trial in Hospice-Eligible Individuals with Dementia: Recruitment Strategies, Ethical/ Operational Challenges, and Implementation Lessons from the LiBBY Study Arianne Fritts, MS Medical University of South Carolina Co-authors: Jacobo Mintzer1, Brigid Reynolds2 1 Medical University of South Carolina, 2 Georgetown University Background: Approximately 45% of patients with dementia experience agitation near the end of life, and an estimated 35% of those individuals continue to experience symptoms despite treatment with benzodiazepines, opioids, and atypical antipsychotics. Despite the prevalence and burden of agitation, there is little evidence to guide the management of end-of-life agitation in dementia. Emerging literature suggests that cannabis-based therapies may offer a safe and effective treatment approach. The Life’s End Benefits of cannaBidiol and tetrahYdrocannabinol (LiBBY) Study was designed to evaluate this hypothesis. Conducting randomized clinical trials in hospice-
eligible populations presents challenges related to recruitment, informed consent, caregiver engagement, homebased data collection, and medication administration. Additional complexities arose from the use of a Schedule I investigational product, which was not available in the U.S. when the study was initiated and required extensive regulatory oversight. Objectives: To describe the operational, regulatory, ethical, and methodological challenges encountered in conducting a multicenter randomized clinical trial of cannabis-based therapies for agitation in hospice-eligible individuals with dementia and to identify strategies that enabled successful study implementation. Methods: This presentation will review key lessons learned during the design and conduct of the LiBBY Study. Topics will include recruitment feasibility, definition of the target syndrome, selection and delivery of the investigational product, implementation of home-based assessments, caregiver engagement, management of concomitant medications, regulatory requirements, and the standardization of study procedures across multiple clinical and hospice settings. Results: Recruitment was completed in November 2025, with 120 participants randomized across diverse care settings, including a high proportion of individuals from underrepresented ethnoracial backgrounds (58%) and participants living in the community (75%). Key recruitment insights include successful enrollment through partnerships with hospice organizations and non-traditional pathways. Consent processes required careful consideration of capacity, surrogate consent, and sensitivity to caregiver burden in an end-of-life context. Study procedures were adapted to both
home and hospice settings. Caregiver involvement was essential for study conduct and outcome assessment. Standardized training approaches were required to ensure protocol consistency across clinical and hospice settings. Study medication had to be imported from Canada, and each site needed to be qualified, registered, and licensed by the DEA to handle Schedule I medications. Conclusion: The LiBBY study demonstrates that randomized clinical trials in hospice-eligible populations are feasible with tailored implementation strategies. Lessons learned regarding recruitment pathways, hospice partnerships, ethical consent processes, and caregiver-centered approaches provide a practical framework for future trials in advanced dementia and other end-of-life populations.
Patterns of Cannabis Consumption and Cannabis Use Disorder Risk Among Young Adult Mothers in the Herbal Heart Study Kayla Hearon University of Miami Co-authors: Kayla Hearon1, Bria-Necole Diggs1, Kieran Kenig1, Anabela Paglia1, Denise C. Vidot1 1 University of Miami Background: Young adult mothers may use cannabis for symptom management, recreation, or both, yet patterns of consumption and risk for cannabis use disorder (CUD) are poorly characterized in this population. Understanding product type, route, potency, and CUD may help inform harm-reduction approaches. Objective: To describe cannabis use
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 61
behaviors and the risk of CUD among women with children enrolled in the Herbal Heart Study. Methods: We conducted a crosssectional analysis of Herbal Heart Study participants who reported female sex and answered “yes” to having children (mothers). Sociodemographics and cannabis-use patterns were assessed by self-report. Cannabis route, strain, and potency were measured using items from the Cannabis Potency Questionnaire, and CUD risk was assessed using the Cannabis Use Disorders Identification Test–Revised (CUDIT-R). Regular cannabis use was defined as self-reported use at least once a week for the past year. Descriptive statistics were calculated using SAS University Edition. Results are presented for the full maternal sample and, where applicable, for regular cannabis consumers and participants with complete CUDIT-R data. Results: The analytic sample included 22 mothers; median age was 32.5 years (interquartile range: 29–34), with children ranging in age from 1 to 17 years. Most (77.3%; n=17) mothers in our sample were regular cannabis consumers, 22.7% were non-consumers. Overall, 72.7% of mothers in our sample were Hispanic/Latino. Among nonconsumers, 80.0% were Hispanic and 20.0% were non-Hispanic-other; 70.6% of cannabis-consumers were Hispanic, 17.7% non-Hispanic Black, and 11.8% non-Hispanic White (p=0.36). The most common routes of cannabis use were blunts (41.2%) and joints (41.2%), followed by vaping (17.7%). Most (82.3%) cannabis-consumers reported use of mid-grade potency cannabis; 17.7% reported regular potency, and none reported high-grade potency. Hybrid strains were most common (52.9%), followed by sativa (29.4%), indica (11.8%), and unknown (5.9%). Overall, 35.3% reported receiving
62 - CCORC 2026
a medical cannabis recommendation, most commonly for anxiety (23.5%), pain (17.6%), PTSD (11.8%), and depression (5.9%). Among the cannabisconsumers with CUDIT-R data, 69.2% screened positive for possible CUD, 15.4% for hazardous use, and 15.4% for nonhazardous use. Possible CUD was identified among 100% of joint and vape consumers with complete data, compared with 33.3% of blunt consumers. Conclusions: In this small sample of young adult mothers, cannabis use was characterized primarily by combustible routes, mid-grade potency products, and a high prevalence of possible CUD. Findings support integrating CUD screening and harm-reduction counseling into care for reproductiveage women and mothers
Artificial Intelligence (AI) for Substance Use Disorder Screening and Management: A Narrative Review of Barriers and Facilitators to Clinical Implementation Benedictus Atsu Hlormenu, BPHN, RN University of Miami Co-authors: Benedictus Atsu Hlormenu1, Isaac Frimpong1, Denise C. Vidot1 1 University of Miami Background: Substance use disorder (SUD) continues to be one of the most pressing global public health challenges, even though machine learning and artificial intelligence (AI) have produced numerous predictive models for SUD risk stratification, screening, and management across alcohol, opioid, and cannabis use disorders. Few of these models have progressed
beyond development, validation, and implementation into real-world clinical practice. Objective: This narrative review synthesizes current evidence on AI applications for SUD and CUD screening and management using a hybrid implementation science framework organized across four domains: data and model characteristics, clinician and workflow integration, patient-level factors, and system-level and regulatory considerations. Methods: A comprehensive literature search was conducted using goggle scholar, Pubmed, Web of Science, PsyINFO, arXiv and Embase for articles published in English from January 1, 2015 to July 1, 2026 with emphasis on articles published from 2018 related to development, evaluation, implementation, deployment, or acceptance of AI or machine learning tools relevant to substance use disorder screening or management. Results: At the data and model level, opioid use disorder has the most advanced evidence base for predictive modeling and fairness evaluation, whereas alcohol use disorder has a larger but methodologically heterogeneous literature with substantial validation limitations. Cannabis use disorder remains at an earlier stage related to its clinical implementation focused models. Though not limited in methodological rigor, most cannabis predictive studies rely on smaller, single site samples failing the AI predictive modeling and fairness evaluation across a broader spectrum, creating a gap in implementation into daily clinical practice. Few studies include multi level datasets, varied demographic populations, real-time evaluation, or standardized validation frameworks, impending replicability, and evidence-
based clinical translation in patient care. This limitation therefore reduces model generatability, creates weak external validation, limits fair clinical applicability, and ultimately slows cannabis AI-driven decision support tools for screening and management of cannabis use disorder. Clinician and workflow factors highlight the importance of EHR integration while patient-level implementation is shaped by stigma, concerns about data sharing, digital access, and trust. System-level implementation is further influenced by the unique regulatory requirements governing substance use disorder data confidentiality under 42 CFR Part 2. Conclusion: AI tools for SUD screening and management show substantial predictive potential, but their integration into routine care remains limited, especially with respect to cannabis use. Successful implementation requires further research into external validation, systematic evaluation across diverse populations, and continued adaptation to the evolving regulatory landscape surrounding substance use disorder data.
Cannabis Initiation and Longitudinal Sleep Quality in Older Adults with Chronic Pain: An Analysis Based on Plasma Level THC and CBD Jennifer Jean-Jacques, MPH University of Florida Co-authors: Jennifer Jean-Jacques1, Yancheng Li1, Kimberly T. Sibille1, Zhigang Li1, Siegfried O.F. Schmidt1, Margaret C. Lo1, Cristina Sempio2, Jost Klawitter2, Robert L. Cook1, Yan Wang1 1 University of Florida, 2University of Colorado Background: Although medical cannabis is an increasing treatment option to
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 63
manage sleep problems among the aging population, longitudinal evidence evaluating its effectiveness is limited, particularly with consideration for concentration levels of THC, CBD, or the combination. Objective: This study evaluated plasmalevel of THC, CBD, and the combination and associations with sleep latency, sleep duration, and overall perceived sleep quality over six months among older adults with chronic pain. Methods: We analyzed the baseline, 3-month, and 6-month survey data from 181 adults (≥50 years old) from the Study on Real-Time and Long-Term Effects of Medical Marijuana in Older Adults (SMILE). SMILE is a prospective cohort study investigating the effect of initiating medical cannabis on chronic pain and related outcomes (e.g., sleep) with a non-initiating comparison group. Cannabinoid type was quantified through plasma-level tests and categorized into 4 exposure groups:1) No THC or CBD 2) THC only, 3) CBD only, and 4) THC and CBD. Sleep latency, sleep duration, and overall perceived sleep quality were measured using the Pittsburgh Sleep Quality Index questionnaire. Descriptive analyses (e.g., mean, standard deviation, frequency, and percentages) were conducted to characterize the sample. ANCOVA assessed mean differences between the 4 exposure groups. Separate linear mixed effects models with random intercepts examined the longitudinal effects of cannabinoid group on self-reported sleep latency, sleep duration, and sleep quality, respectively. Covariates included baseline value of the corresponding sleep outcome, visit (3 vs. 6 months), age, sex, race, and income. Results: Average age of the participants was 64.9 years old (SD=9.3); 64.6% identified as female. After adjusting
64 - CCORC 2026
for covariates, over the six-month study period, the “THC and CBD” group had significantly better sleep quality (i.e., lower PSQI score) (β= -1.49, p<0.01) and longer sleep duration (e.g., slept more) (β = 0.73, p=0.01) at follow-up compared to the “no THC or CBD” group. There were no significant differences between the 3-month and 6-month follow-up visits in both models, suggesting these changes were stable over time for both perceived sleep quality and sleep duration. Cannabinoid type was not significantly associated with sleep latency (all groups p>0.05). Conclusions: Findings suggest that medical cannabis, specifically concurrent use of THC and CBD, may contribute to better sleep quality and longer sleep duration at follow-up among older adults with chronic pain. Future analyses using larger samples should include additional key covariates, such as pain intensity, to further evaluate these associations.
Comparing Smokable and Oral Concentrate Users in Florida’s Medical Marijuana Program Ryan Kalina University of Florida Co-authors: Juan Perez1, Catalina Lopez-Quintero1, Krishna Vaddiparti1, Yan Wang1, Donald Porchia1, Robert L. Cook1 1 University of Florida Background: Cannabis concentrate use is increasingly common among medical patients, yet little is known about how demographic characteristics, reasons for use, and behavioral patterns differ between adults who use smokable versus oral concentrate products. Describing these route-specific patterns
can support more informed clinical approaches and improve understanding of how patients use high-potency cannabis products. Objective: To compare demographic profiles, reasons for use, patterns of use, and cannabis-related risk between adults who use smokable concentrates and those who use oral concentrates. Methods: Data was used from the Medical Marijuana & Me (M3) Current User Survey, a cross-sectional survey of adults using medical cannabis products in Florida. The analytic sample included 77 oral concentrate users and 188 smokable concentrate users. This sample does not include users who used both. Variables included demographics, primary reasons for use, daily frequency of use, and cannabisrelated risk measured via the Cannabis Use Disorder Identification Test-Revised (CUDIT-R) where scores ≥12 indicate high‑risk use. Descriptive statistics and proportional comparisons were used to summarize group differences. Results: Smokable concentrate users were younger (40.4 vs. 45.2 years), more racially diverse (67.6% White vs 80.5% White), and more commonly employed full-time (49.5% vs. 41.6%), while oral users were more likely to be female (68.8% vs. 59.6%) and report disability or inability to work (22.1% vs. 15.1%). Reasons for use differed by route: smokable users more frequently endorsed anxiety (70.2% vs. 58.4%), depression (49.5% vs. 39.0%), PTSD (47.3% vs. 33.8%), insomnia (44.7% vs. 37.7%), and migraine/headache (27.7% vs. 16.9%). Oral users more often reported chronic pain (49.4% vs. 42.6%) and fibromyalgia (13.0% vs. 7.4%). Smokable users showed slightly higher cannabis-related risk: 21.3% scored in the high-risk CUDIT-R category compared to 18.2% of oral users. Patterns of use also differed: 81.8% of
oral users consumed concentrates once daily, whereas smokable users reported multi‑session daily use, including 33.9% once daily, 20.4% twice daily, and 17.7% three times daily. Conclusion: Route of concentrate use is associated with different demographic, behavioral, and reason for use profiles. Smokable concentrate users tend to be younger, more frequent consumers with modestly elevated cannabisrelated risk, while oral users are older, more female, and more likely to use concentrates in stable once-daily patterns. These findings highlight meaningful route specific differences in concentrate use among Florida medical cannabis patients and provide a clearer understanding of how patients engage with high potency cannabis products.
The Cannabinoid Evaluation and Recommendation System (CbERS): Development of a Clinical Decision Framework for Medical Cannabis Therapy Melani Kane, PharmD International Society of Cannabis Pharmacists (ISCPh) Background: Medical cannabis therapy often requires iterative modification of dose, cannabinoid ratio, timing, frequency, formulation, or route of administration to optimize therapeutic response and tolerability. However, there is no standardized clinical framework for classifying common therapeutic problems and linking them to targeted treatment modifications. Objective: To develop a structured clinical decision framework for classifying therapeutic response to medical cannabis and identifying the
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 65
primary treatment domain requiring modification. Methods: The Cannabinoid Evaluation and Recommendation System (CbERS) was developed as a clinically derived framework based on recurring therapeutic management patterns observed during pharmacist-led medical cannabis care and further refined during scholarly work examining cannabinoid safety and therapeutic optimization. Common interventions used to address inadequate therapeutic response or treatment-related adverse effects were organized according to three modifiable treatment domains: dose or cannabinoid ratio, timing or frequency, and formulation or route of administration. These domains were incorporated into a bidirectional classification system designed to distinguish inadequate therapeutic response from treatmentrelated adverse effects and link the identified clinical problem to a targeted therapeutic modification. Results: Framework development resulted in a seven-point bidirectional classification system ranging from −3 to +3 and a corresponding clinical decision pathway. Negative classifications represent persistent or inadequately controlled target symptoms, positive classifications represent treatmentrelated adverse effects, and 0 represents adequate symptom control with acceptable tolerability. The absolute value identifies the primary therapeutic intervention domain: dose or cannabinoid ratio (±1), timing or frequency (±2), and formulation or route of administration (±3). The classification therefore identifies both the direction of the therapeutic problem and the treatment domain for modification rather than grading symptom or adverse-effect severity. Conclusions: CbERS provides a structured approach for translating
66 - CCORC 2026
assessment of therapeutic response and tolerability into targeted modifications of medical cannabis therapy. By standardizing classification around modifiable treatment domains, the framework may support more consistent clinical decision-making and documentation across medical cannabis practice settings. Formal evaluation of the framework’s validity, reliability, clinical utility, and relationship to patient outcomes is warranted.
Mental Health and Perceived Stress among Hispanic/Latina Mothers who Consume and Do Not Consume Cannabis: A Matched Case Series from the Herbal Heart Study Kieran Kenig, BS University of Miami Co-authors: Kieran Kenig1, Bria-Necole Diggs1, Kayla Hearon1, Denise C. Vidot1 1 University of Miami Background: Hispanic/Latina women experience unique social and structural factors that contribute to disparities in maternal mental health and access to care. Concurrently, cannabis use among women of reproductive age has increased, with anxiety, depression, and stress commonly reported as reasons for use. The relationship between cannabis use and mental health among Hispanic/Latina mothers remains poorly characterized. Objective: To explore anxiety, depression, and perceived stress among cannabis using and non-using young adult Hispanic/Latina mothers. Methods: Cross-sectional data from the Herbal Heart Study were analyzed,
where 22 participants reported having children (n=22). Cannabis-consuming mothers were individually exact matched (1:1) to non-consuming mothers by age and race/ethnicity, yielding three matched pairs (n=6). Mental health outcomes were selfreported using the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Perceived Stress Scale (PSS), with scores categorized according to established clinical cutoffs. Descriptive statistics summarized participant characteristics and mental health outcomes. Results: The matched sample (n=6) was entirely Hispanic mothers with a median age of 32 years (IQR: 32–34). Among cannabis consumers (n=3), one participant each reported smoking blunts (33.3%), joints (33.3%), or vaping cannabis (33.3%). Cannabis consumers had one to three children ranging from 2–16 years of age, while non-consumers had one to two children ranging from 1–13 years. Overall, 33.4% of participants reported mildto-moderate anxiety, 16.7% reported severe depression, and 50.0% reported moderate perceived stress. There was no difference in BAI-defined anxiety (33.3%) between cannabis consumers and non consumers. All cannabis consumers reported none/minimal depression compared to 66.7% of non-consumers. One non-consumer (33.3%) reported severe depression. Moderate perceived stress was reported by 66.7% of cannabis consumers, with no consumers reporting high perceived stress. Among non-consumers, perceived stress was distributed across low (33.3%), moderate (33.3%), and high (33.3%) categories. Conclusions: In this exploratory matched sample of Hispanic/ Latina mothers, patterns of anxiety, depression, and perceived stress varied between cannabis consumers and
non-consumers. Preliminary findings underscore the need for adequately powered studies that incorporate cannabis use details and relevant social and structural determinants to clarify whether cannabis use is associated with maternal mental health risk, symptom management, or both among Hispanic/ Latina women.
Medical Cannabis Use among US Women of Reproductive Age Panagiota (Yiota) Kitsantas, PhD George Mason University Co-authors: Panagiota Kitsantas1, Lea Sacca2, Jabed Al Faysal3, Xingquan Zhu2, Peter J. Holland2, Maria C. Mejia2, Md Mahmudul Hasan3, Charles H. Hennekens2 1 George Mason University, 2Florida Atlantic University, 3University of Florida Objectives: In the United States, medical cannabis (MC) use among pregnant and non-pregnant women of reproductive age (WRA) is increasing. In this study, we described qualifying medical conditions, prescribed daily tetrahydrocannabinol (THC) dosages over time, and medical cannabis product types as well as routes of administration among WRA, with comparisons between pregnant and non-pregnant women. Methods: We utilized medical cannabis certification data from the Florida Medical Marijuana Use Registry (20212024) among WRA (18-45 years old, n=615,219 certifications). Certification characteristics were explored overall and stratified by pregnancy status. Qualifying medical conditions, the number of conditions listed per certification, prescribed daily THC dosages during the first three months, and months 3–7 following certification initiation, and recommended product
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 67
types and routes of administration were described. Differences between pregnant and non-pregnant women were evaluated using appropriate statistical tests. Results: The distribution of qualifying medical conditions was largely similar between pregnant and non-pregnant women. Posttraumatic stress disorder was the most common qualifying condition (47.8%), followed by chronic non-malignant pain (9.8%), and multiple sclerosis (7.6%). Most certifications included either one (39.6%) or two (52.2%) qualifying conditions, with no significant differences by pregnancy status. Prescribed THC dosages increased over time, with higher-dose certifications becoming more common during months 3–7 than during the first three months after certification. A greater proportion of certifications involving pregnant women reported at least 31 mg of THC per day at both time periods compared with certifications involving non-pregnant women. For example, among certifications involving pregnant women, 23.5% reported 31–45 mg of THC per day at both <3 months and 3–7 months, compared with 16.5% and 18.7%, respectively, among certifications involving nonpregnant women. Product types were distributed relatively evenly across standard non-smokable, low-THC and smokable MC. Pregnant women more frequently received certifications for low-THC products and less frequently for smokable MC. Recommendations for oral, topical, sublingual, edible, nonsmokable inhalation, and suppository routes were slightly more common among pregnant women, whereas smoking was recommended less frequently. Conclusions: Medical cannabis certification patterns among WRA were generally similar between pregnant and non-pregnant women. However,
68 - CCORC 2026
pregnant women were more likely to receive higher prescribed THC dosages while being less likely to receive smokable MC. These findings provide important descriptive evidence on MC certification practices in WRA, and particularly during pregnancy, and highlight the need for further research to evaluate the clinical rationale, safety, and maternal and fetal health implications of these prescribing patterns.
Cannabis Perceptions Among Breast Cancer Patients by History of Cannabis Use: Preliminary Findings from a Prospective Cohort Study Veronica H. Lima Bornas, MPH, CPH University of Florida, University of Miami Co-authors: Veronica H. Lima1, Veronica Z. Paley2, Eli Avisar2, Priscila Barreto2, Julie Bradley1, Dejana Braithwaite1, Carmen Calfa2, Tracy Crane2, Richa Dawar2, Milena Elimelakh2, Zhigang Li1, Erin Mobley1, Lawerence Maximus Negret2, Alejandra Perez2, Isildinha M. Reis2, Lisa Spiguel1, Jose Suarez2, Cristiane Takita2, Juan Pablo de Rivero Vaccari2, Frances Valdes2, Jennifer J. Hu2, Yan Wang1 1 University of Florida, 2University of Miami Background: In recent years, medical cannabis (MC) use among patients with breast cancer has increased, particularly for managing treatmentrelated symptoms. Despite growing interest and use, patients often rely on personal experience to form opinions about cannabis. Therefore, perceptions of cannabis may vary among patients and may be shaped by prior exposure to cannabis use. However, limited research
has investigated how history of previous cannabis use influences patients’ perceptions of its benefits and risks, which is important for decision-making on MC use in oncology care. Objective: This study aims to explore differences in perceptions of cannabis use among breast cancer patients by history of cannabis use. Methods: A cross-sectional analysis was conducted using baseline data from the Cannabis-Associated Relief Effects (CARE) Study, which is an ongoing NIH/ NCI-funded prospective cohort study investigating the benefits and harms of MC in breast cancer patients during and after treatments. Participants were categorized based on self-reported lifetime cannabis use (ever vs never) at baseline. Survey measures assessed perceived benefits and risks of cannabis and related attitudes. Differences between non-users and users were assessed using Fisher’s exact test. Results: A total of 92 participants were included (67% White, mean age 53, SD = 12, 63% reported never using cannabis). Cannabis users were more likely to report that cannabis has benefits compared to non-users (82% vs 47%, p = 0.001). Furthermore, they were more likely than non-users to report perceived benefits like “decreased use of other medications” (32% vs 2%, p < 0.001) and “enjoyment or recreation” (38% vs 0%, p < 0.001). There was no significant difference between groups in perceived risks of cannabis use. There was a significant difference in risk perception about “addiction to cannabis”, which was more commonly stated among nonusers than ever users (31% vs 12%, p = 0.044). Conclusions: These findings suggest that a history of cannabis use is associated with more favorable perceptions of benefits and lower
perceived risk, suggesting that prior exposure may shape cannabis-related beliefs and expectations in this population and may be influential in their decision on whether to use MC during cancer treatments.
A pilot double-blind placebo-controlled, randomized, safety, efficacy, and acceptability trial of a hemp-derived cannabidiol extract for the treatment of anxiety Catalina Lopez-Quintero, PhD University of Florida Co-authors: Catalina Lopez-Quintero1, Isabel Abril1, Robyn Nelson1, Lina M Velilla-Jimenez1, Adaeze Anamege1, Juan Perez-Carreno1, Liva G LaMontagne1, Carol Mathews1 1 University of Florida Background and Study Aims: About a third of Americans will experience an anxiety disorder in their lifetime, and anxiety is the most common reason for using medical cannabis. However, evidence supporting its efficacy remains limited, and concerns about safety persist, underscoring the need for safer anxiolytics. Our pilot trial was designed to evaluate the safety, tolerability, and preliminary efficacy of a hemp derived CBD extract, a compound with a favorable safety profile and promising preliminary anxiolytic effects. The findings will inform larger clinical investigations of CBD as a potential adjunct to conventional antidepressants and benzodiazepines. Study design: A double blind, placebo controlled, randomized pilot study (NCT06672666) examined the safety, tolerability, feasibility, and preliminary
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 69
efficacy of a hemp derived cannabidiol (CBD) extract in adults with moderate to severe anxiety. Thirty participants (aged 18–55) were recruited from the Gainesville area and randomized to receive either CBD or placebo over a four week period that included a two week titration phase (a titrated dosage ranging between 50 to 150 mg/day followed by a two week maintenance phase (maintenance dose of 150 mg/ day). The protocol received approval from the UF Institutional Review Board and was conducted in accordance with federal regulations on cannabinoid products (IND 171489), ensuring the product contained < 0.3 % Δ⁹ THC. Standardized self report instruments (Hamilton Anxiety Rating Scale [HAM A] and Pittsburgh Sleep Quality Index [PSQI]) and laboratory safety measures (urine analysis, blood chemistry, liver enzymes) were collected at baseline and at each follow up visit. Adherence to and acceptability of the procedures were monitored regularly. Results: Analyses will determine whether the CBD arm compared with placebo experienced a statistically significant reduction in HAM A scores and whether sleep quality improved as measured by the PSQI. None of the 30 participants have reported serious adverse events, or have laboratory results of concern, supporting tolerability of the 50–150 mg/day dose range. Feasibility metrics were encouraging: 26 of 29 participants (89 %) completed the study. The primary protocol deviations involved delays in scheduled evaluations, causing some visits to occur outside the proposed time window. Participants reported high acceptability of the study procedures. Conclusions: These findings support the safety and acceptability of a four-week CBD regimen for anxiety and provide early evidence of dose safety. The data demonstrate that recruitment, retention,
70 - CCORC 2026
and data collection were feasible within a university setting, laying the groundwork for a larger phase II trial. The full dataset will be available for exploration, analyses, and discussion following study unblinding at the end of August.
“r/pregnant”: A look into the anonymous online Reddit forum to analyze patterns and reasons for use of cannabis by pregnant women Anika Mellacheruvu University of Florida Co-authors: Anika Mellacheruvu1, Simone Jackson1, Jieun Shin1, Nathan Carpenter1, Deepthi S. Varma1, Ellen L. Terry1 1 University of Florida Background: Despite stringent guidelines against prenatal cannabis use, self-reported use of cannabis amongst pregnant women rose from 1.5% to 5.4% from 2002-2020. Along with this, guidelines by the American College of Obstetricians and Gynecologists outline the adverse effects that using marijuana while pregnant can have on infant and child development. As pregnant women continue to use marijuana, this exhibits a negative feedback loop in provider communication and patient understanding. However, due to restrictions surrounding the substance, patients may leave conversations about this topic undiscussed with their provider, due to fear of legal repercussions. Anonymous digital spaces have become a safe space for discussion about the subject by providing a platform for individuals to provide their insights and inquiries about
cannabis use. Objective: The objective of this study is to examine anonymous online narratives to find reasons and mechanisms of use of cannabis by pregnant women, through the website Reddit.com. In doing this, the study aims to provides perspective on patient choices notwithstanding provider recommendations, and into how pregnant individuals conceptualize cannabis use outside of clinical environments. Methods: Prenatal cannabis use discussions were extracted from Reddit between March 2023 and June 2025, utilizing the software quid.com. Of these messages, data from the subreddit, r/ pregnant, was extracted, resulting in a sample of 530 posts and comments. An iterative content analysis was conducted using the qualitative data analysis tool, ATLAS.ti. Results: From this analysis, two major themes emerged: (1) reasons for use and (2) modes of use. Reasons for use encompassed themes such as, lack of perceived harm in child development (n=104), symptom relief (n=66), ineffectiveness of prescription medications (n=13), and use for previous diagnoses (n=21). Modes of use included a variety of cannabis formulations, such as THC (n=66), and CBD (n=23), through various means, such as smoking (n=189) and vaping (n=18), and different frequencies of use, from regular use (n=17) to an isolated event (n=1). Conclusions: Online discussions reveal that individuals frequently frame prenatal cannabis use as palliative treatment and harm reduction. Patterns of use range from use of undefined cannabis formulations to specific compositions, mostly consumed through inhalation. Findings highlight
disparities between clinical guidelines and patient perceptions, underscoring the need for non-judgmental clinical counseling. Along with emphasizing the need for stigma-free patient-provider dialogue, this understanding can inform provider and clinicians to tailor their educational messages regarding the harmful effects of perinatal cannabis use in an effective manner.
Cannabis Use and the Psychological and Psychosocial Outcomes after Psilocybin-Assisted Therapy in Adults with Cancer: A Systematic Review Mark Moffatt University of Miami Co-authors: Mark Moffatt1, Josue F. Munguia1, Anthony Alfonso1, Ciné Brown1, Amrit Baral1,2, Winston de la Haye1,3, Denise C. Vidot1 1 University of Miami, 2Johns Hopkins University, 3University of West Indies Mona Background: Psilocybin-assisted therapy (PAT) has emerged as an intervention for psychological and existential distress among adults with cancer, concurrent to cancer serving as a qualifier for medical cannabis. Despite the increased access to both medical cannabis and psilocybin, there is limited clinical research and evidence examining the effects of PAT in cancer patients who may or may not consume cannabis. Objective: To evaluate the psychological (depression, anxiety, distress, wellbeing), psychosocial (spiritual, existential functioning, post-traumatic growth), and cannabis use following PAT
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 71
among cancer survivors. Methods: PubMed and ClinicalTrials. gov were searched using a specific Boolean search strategy; 732 studies were imported into Covidence for screening; 605 duplicates were removed. A strict eligibility criterion was developed using the PICOS framework, and three independent reviewers conducted a multistage screening. Eligible studies included adults aged >18y with any cancer type or stage who received ≥1 dose of psilocybin with structured therapeutic support before, during, and after treatment, and that reported psychological, psychosocial, or quality-of-life outcomes. Nonhuman studies, non-English publications, incomplete/ongoing studies, reviews, meta-analyses, case reports, and other nonoriginal reports were excluded. Authenticity and methodological rigor was also enhanced by filtering for other systematic reviews on PubMed; 36 were found and evaluated against our specific eligibility criteria. Evidence quality was assessed using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale. Results: Eight studies conducted in the United States (7) and Canada (1), representing 79 unique participants, met inclusion criteria. Designs included randomized controlled trials, openlabel trials, pilot studies, longitudinal follow-up studies, and qualitative investigations. A single psilocybin dose of 0.3 mg/kg or 25 mg, administered with psychotherapy, was associated with rapid and sustained reductions in depression, anxiety, demoralization, and existential distress, alongside improvements in spiritual well-being and quality of life. Long-term followup suggested persistent clinical benefit in approximately 60%–80% of participants at 3.2 to 4.5 years within all psychological domains. Findings for death anxiety were mixed and
72 - CCORC 2026
PAT was generally tolerated. Several included studies noted that participants used cannabis and drew comparisons between cannabis and psilocybin. This suggests that familiarity and perception of cannabis may influence acceptability of or engagement with psychedelicassisted therapy in oncology populations. Conclusion: Larger, more diverse randomized trials are needed to clarify efficacy, durability, safety, mechanisms, and the independent contributions of cannabis, psilocybin and psychotherapy. These findings highlight an area for future research direction over how prior cannabis use exposure could influence psilocybin-assisted therapy sessions in cancer populations.
An Examination of Emotion Regulation and Dispositional Mindfulness as Mediators of the Relationship Between Trauma and Cannabis Use Among Young People With HIV Lauren Nicole Nunez University of Central Florida Co-authors: Lauren Nunez1, Kayla Reyes1, Hanzhi Gao2, Scott Pickett3, Sharon L Nichols4, Karina Villalba1 1 University of Central Florida, 2University of South Florida, 3Florida State University, 4 University of California San Diego Background: Young people with HIV (YPWH) experience multiple cooccurring stressors that increase risk for cannabis use, including PTSD/ trauma symptoms, discrimination, HIV stigma, adverse childhood experiences, racial/ethnic microaggressions, and
perceived stress. Emotion dysregulation and low dispositional mindfulness are associated with maladaptive coping behaviors, including substance use, but it is unknown whether they mediate associations between stress/traumarelated factors and cannabis use in YPWH. Identifying these mechanisms may help define modifiable targets for interventions to reduce cannabis use and improve mental health among YPWH. This study examined whether stress/trauma-related factors were associated with greater cannabis use and whether emotion dysregulation and/ or dispositional mindfulness mediated these associations. Methods: DEFINE study participants (YPWH, ages 18–34; at least one episode of alcohol use during the prior month) were assessed at baseline and 9 months. Cannabis use was measured with the ASSIST cannabisinvolvement score (use frequency and consequences). Single-mediator models (stress/trauma → difficulties with emotion regulation [DERS] or dispositional mindfulness [FFMQ] → cannabis-involvement) with indirect effects (bootstrapped 5,000 resamples) were tested for each stress/traumarelated factor (PTSD symptoms [PCL5], perceived stress [PSS], adverse childhood experiences [ACEs], trauma symptoms of discrimination [TSDS], racial and ethnic microaggressions [REMS], everyday discrimination [EDS], and HIV stigma [BHSS])). Longitudinally, stress/trauma factors and DERS/FFMQ were tested as predictors of residualized change in cannabis use. Analyses were exploratory; no correction for multiple comparisons was applied. Results: Cross-sectionally (n=4653 across models), PCL-5 was associated with ASSIST cannabis involvement almost entirely through DERS (indirect=0.18, 95% CI 0.06– 0.35, p=.005). DERS also mediated
associations of cannabis-involvement with BHSS (0.13, p=.001), ACEs, (0.84, p=.003), REMS (0.15, p=.038), and PSS (0.45, p=.050). FFMQ mediated fewer pathways, with significant indirect effects for BHSS (0.07, p=.033) and PCL-5 (0.08, p=.045); TSDS and REMS showed no significant indirect effect via DERS or FFMQ. Longitudinally (n=2935 across models), baseline stress predicted DERS, but neither DERS nor FFMQ predicted change in ASSIST cannabis involvement at 9 months, consistent with high stability of use in this cohort. Conclusions: In this study, emotion dysregulation mediated the crosssectional associations between PTSD, adverse childhood experiences, discrimination, perceived stress, and cannabis involvement. Neither emotional dysregulation nor mindfulness predicted longitudinal change in cannabis use; however, longitudinal analyses were likely underpowered due to loss to followup. These results highlight the need for longitudinal studies to establish causality and identify additional intervention targets.
Coping and Conformity Motives as Indirect Links Between Social Interaction Anxiety, Fear of Being Scrutinized, and Hazardous Cannabis Use Jordan Ortman, MS University of Central Florida Co-authors: Amie R. Newins, University of Central Florida Background: Social anxiety is associated with elevated risk for hazardous cannabis use, and cannabis
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 73
motives may help explain this association. Coping motives, or using cannabis to manage negative affect, may be especially relevant for students with elevated social anxiety. Conformity motives may also be relevant because cannabis may be used to manage interpersonal pressure or negative evaluation concerns. Less is known about whether these motives explain hazardous cannabis use similarly across two types of social fears – social interaction anxiety and fear of being scrutinized. Objective(s): This study examined whether cannabis coping and conformity motives accounted for indirect associations between social interaction anxiety, fear of being scrutinized, and hazardous cannabis use, and whether these indirect effects differed across social anxiety dimensions. Methods: Participants were 168 college students who reported cannabis use in the past 6 months (53.2% White; 65.9% female). They completed selfreport measures of two types of social fears (Social Interaction Anxiety Scale [SIAS] and Social Phobia Scale [SPS]), cannabis motives (Marijuana Motives Questionnaire), and hazardous cannabis use (Cannabis Use Disorders Identification Test-Revised [CUDIT-R]). Path models were estimated in Mplus. Results: When examined in separate models, SIAS and SPS were both positively associated with coping and conformity motives. Coping motives were positively associated with CUDIT-R scores in both models (SIAS: B = 4.326, p < .001; SPS: B = 4.295, p < .001), whereas conformity motives were not. Indirect effects through coping motives were significant for SIAS (B = 0.063, 95% CI [0.022, 0.109], p = .004) and SPS (B = 0.051, 95% CI [0.016, 0.089], p = .006) scores. Indirect effects through
74 - CCORC 2026
conformity motives were not significant. In the simultaneous model, coping motives remained positively associated with CUDIT-R scores (B = 4.306, p < .001), but SIAS and SPS scores were not associated with either type of motive or CUDIT-R scores. Indirect effect of SIAS and SPS scores on CUDIT-R were not significant and did not differ in magnitude. The simultaneous model explained 40.2% of variance in CUDIT-R scores. Conclusions: Coping motives appear to be more important than conformity motives in accounting for associations between social anxiety and hazardous cannabis use. Different types of social fears did not seem to lead to differences in hazardous cannabis use, suggesting that multiple forms of social anxiety may increase risk of hazardous cannabis use. Interventions may benefit from targeting coping-motivated cannabis use and skills for managing negative affect without cannabis.
Feasibility of Engaging High-Risk Breast Cancer Populations in Medical Cannabis Research: MultiSite Recruitment Dynamics in the Cannabis-Associated Relief Effects (CARE) Study Veronica Zhang Paley, MPP, MS University of Miami Co-authors: Veronica Z. Paley1, Carmen Calfa1, Veronica H. Lima2, Eli Avisar1, Priscila Barreto1, Julie Bradley2, Dejana Braithwaite2, Tracy Crane1, Richa Dawar1, Milena Elimelakh1, Zhigang Li2, Erin Mobley2, Lawerence Maximus Negret1, Alejandra Perez1, Isildinha M. Reis1, Lisa Spiguel2, Jose Suarez1, Cristiane Takita1, Juan Pablo de Rivero Vaccari1, Frances
Valdes1, Yan Wang2, Jennifer J. Hu1 1 University of Miami, 2University of Florida Background: Prospective studies evaluating cannabinoid use during breast cancer treatment require diverse patient cohorts, as cannabis access, symptom burden, and potential therapy interactions vary. However, recruiting and retaining participants undergoing multimodal cancer treatment in longitudinal studies poses significant challenges. Therefore, evaluating the feasibility of recruitment strategies and cohort diversity and representativeness are crucial to ensure findings are generalizable. Objective: This analysis aimed to evaluate recruitment trends, strategy optimizations, demographic, and unique clinical characteristics of participants enrolled in the Cannabis-Associated Relief Effects (CARE) study. Methods: CARE is a prospective cohort study investigating the benefits and harms of medical cannabis among breast cancer patients during and after systemic therapy. Participants are recruited across three sites: University of Miami (UM), University of Florida (UF) Gainesville, and UF Jacksonville. Strategies to identify potentially eligible participants to approach for recruitment included electronic health record (EHR) screening, discussion at tumor board, and provider referrals, with recruitment occurring in-person at clinic visits. Throughout the study, strategy optimization included expanding eligibility criteria, Spanish-translated materials, and EHR workflows. We analyzed monthly enrollment from March 2025–July 2026 alongside baseline demographics and tumor characteristics. Results: As of July 16, 2026, cumulative enrollment reached 131 participants.
Following strategy optimizations, average monthly enrollment surged from 4.7 participants (March–December 2025) to 12.0 (January–July 2026), reaching 15-16 participants monthly from April to July 2026. Among participants at baseline (n=89), 72% were White, 21% Black, 34% Hispanic, and 13% under age 40. Diversity varied markedly by site: Black participants comprised 41% of UF-Jacksonville, 26% of UF-Gainesville, and 10% of UM, while Hispanic participants represented 61% of UM. Clinically (n=87), 11% had stage III and 9% stage IV disease. Notably, 37% overall had triple-negative breast cancer (TNBC), with marked site variations: 82% at UF-Jacksonville, 33% at UM, and 17% at UF-Gainesville. Discussion & Conclusion: Recruitment strategies, coupled with real-time optimization, successfully facilitated enrollment of a high-risk, diverse breast cancer cohort. Expanding eligibility criteria and strategies accelerated enrollment. Non-Hispanic Black women face disproportionately high TNBC rates; notably, our cohort-particularly at UF-Jacksonville (82%) and UM (33%)-demonstrates exceptional representation of TNBC populations. The study team will continue to monitor recruitment and retention of participants during and following systemic therapy completion, while maintaining engagement with the clinical teams to support enrollment and retention. This study provides the real-world feasibility of recruiting women with breast cancer undergoing systemic therapy for participation in a complex, longitudinal quality of life study.
Impact of Cannabis Use on Intraoperative Anesthetic and Analgesic Requirements: A
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 75
Systematic Review Dhruvi Patel, OMS-II Nova Southeastern University Co-authors: Dhruvi Patel1, Kevin Tran1, Amani Ally1, Sajan Parikh1, Khavir Sharieff1 1 Nova Southeastern University Background: The association between cannabis use and intraoperative anesthetic and analgesic requirements among adult surgical patients remains uncertain. Heterogeneity in exposure definitions, surgical populations, anesthetic techniques, and outcomes limits evidence-based perioperative dosing recommendations. Objective: To systematically review whether adult surgical patients with documented cannabis use require higher intraoperative anesthetic or analgesic dosing compared with nonusers during surgical procedures requiring general anesthesia. Methods: A systematic review of studies published January 2016– July 2026 was conducted using PubMed, Embase, and Web of Science. Eligible studies included prospective/ retrospective cohorts of adults (>18 years) undergoing surgery requiring general anesthesia with documented cannabis exposure. Excluded were pediatric populations, animal/in vitro models, emergent cases, conditions associated with altered anesthetic requirements, case reports/series (<10 patients), conference abstracts, and reviews. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Cohort Studies. Due to heterogeneity across exposures, populations, and outcomes, findings were synthesized narratively. Results: Seven observational studies comprising 26,700 surgical patients were included, representing orthopedic,
76 - CCORC 2026
bariatric, oral/maxillofacial, and general surgery populations. Cannabis exposure definitions varied, with limited reporting of dose, frequency, route, or use type. Cannabis exposure was variably associated with intraoperative anesthetic and analgesic requirements. The strongest evidence involved volatile anesthetics, with two studies reporting significantly increased requirements. Findings included higher time-weighted minimum alveolar concentration (MAC) values among cannabis users (0.58 vs 0.54; MD, 0.04; 95% CI, 0.01–0.06; p = 0.021) and increased sevoflurane volumes (37.4 mL vs 25.0 mL; p = 0.023). One large prospective cohort reported greater intraoperative fentanyl administration among cannabis-positive patients versus non-users (174.5 mcg vs 124.7 mcg; MD, 49.80 mcg; 95% CI, 47.28–52.32; p < 0.001). Propofol findings were inconsistent. Three studies reported no significant dosing differences between cannabis-exposed patients and non-users, while one oral/ maxillofacial cohort demonstrated significantly higher propofol administration among cannabis users (152.5 mg vs 117.5 mg; p < 0.05). No consistent differences emerged for midazolam, ketamine, desflurane, neuromuscular blockers, or reversal agents. Conclusions: Evidence is insufficient to support definitive cannabis-specific intraoperative dosing recommendations. Cannabis use may be associated with increased intraoperative volatile anesthetic and opioid requirements in some adult surgical populations. Findings regarding propofol and adjunct anesthetics remain inconsistent. Heterogeneity across studies limits definitive conclusions. Future research should standardize exposure assessment, differentiate recreational from medicinal use, and evaluate doseresponse relationships to better guide
anesthetic management.
The Relationship Between Medical Cannabis Knowledge and Attitudes Among Nursing Home Administrators and Directors of Nursing Andrew M. Peterson, PharmD, PhD Saint Joseph’s University Co-authors: Andrew M. Peterson1, Rebecca Lucas1, Ilene Warner-Maron2, Allen Glicksman3 1 Saint Joseph’s University, 2Philadelphia College of Osteopathic Medicine, 3 Eastern Pennsylvania Geriatrics Society Background: As state medical cannabis programs expand, skilled nursing facilities (SNFs) face growing pressure to develop policies addressing resident access, storage, administration, and staff training. Implementation science emphasizes organizational readiness— including leadership knowledge and attitudes—as a prerequisite for successful policy adoption. However, little is known about how Nursing Home Administrators (NHAs and Directors of Nursing (DONs) perceive medical cannabis or how their knowledge relates to their attitudes toward its integration into facility care. Objective(s): This study examined knowledge of and attitudes toward medical cannabis among NHAs and DONs in Pennsylvania SNFs. Specifically, it tested the hypothesis that greater cannabis-related knowledge is associated with more favorable attitudes toward medical cannabis in SNFs, while accounting for administrator role, years in current role, facility size, and multistate organizational status.
Methods: A cross-sectional online survey was administered to licensed NHAs and DONs in Pennsylvania. The final analytic sample comprised 124 respondents who completed all 44 survey items. Exploratory factor analysis was used to develop composite scores for knowledge and attitudes. Ordinary least squares regression tested the association between knowledge and attitudes in unadjusted and covariateadjusted models. Results: Respondents expressed moderately favorable attitudes toward medical cannabis (mean attitude score = 3.91, SD = 0.77). Knowledge was more limited and variable across items. In the unadjusted regression model, greater knowledge was significantly associated with more favorable attitudes (b = 0.49, R² = .033, p = .044). After adjusting for administrator role, years in current role, facility size, and multistate organizational status, the knowledge coefficient was not statistically significant (b = 0.48, R² = .085, p = .055). However, the effect size (β =0.18) remained virtually unchanged, indicating that the knowledge-attitude association was not confounded by administrator or facility characteristics. Conclusions: Among Pennsylvania NHAs and DONs, greater knowledge of medical cannabis is associated with more favorable attitudes toward its use in facility care. These findings suggest that knowledge represents a small but key component of organizational readiness. Targeted education for SNF leadership addressing state law, safety, and operational procedures may help build the capacity needed to support resident-centered policies. Future research should examined.
Medical Cannabis Edibles: Patient Use Patterns,
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 77
Reasons of Use, and Perceived Efficacy among Adults in Florida Tracy Qu University of Florida Co-authors: Tracy Qu1, Juan PerezCarreno1, Yan Wang1, Robert Cook1, Catalina Lopez-Quintero1 1 University of Florida Background: Among medical marijuana patients, cannabis edibles have grown in popularity, yet less is known about how use, dosing, and perceived effectiveness vary by edible type and reported reason for use. Florida’s medical marijuana program, one of the nation’s largest, offers a unique opportunity to examine these patterns using statewide patientreported data. Objectives: This study aims to characterize the sociodemographic profile of Florida patients who use medical cannabis edibles, identify patients’ self-reported reasons for use, and describe patterns of edible use and dosage across product types. Methods: This study used crosssectional survey data from the Medical Marijuana and Me (M³) Study (IRB202200068), conducted May– December 2022. Florida medical cannabis patients were recruited via convenience sampling at ten clinics statewide (N=632). Participants selfreported sociodemographics, edible type (gummies, cookies, capsules), frequency of use, average THC and CBD content per session, and reasons for and perceived outcomes. Analyses were restricted to the 344 participants reporting edible use (gummies, cookies, or capsules) within the 30 days preceding the survey. Results: Among participants reporting edible use (n=344) the majority were
78 - CCORC 2026
female (68.3%), with a mean age of 45.4 years; most had at least some college education (85.2%) and reported at least good overall health (72.4%). Anxiety was the most common self-reported reason for use (63.1%), followed by chronic pain (43.0%) and depression (41.6%). Perceived efficacy varied by condition: edibles were rated most effective for chronic pain (53.4%) and insomnia (53.0%), and least effective for PTSD (30.3%). Gummies were the most popular and most frequently consumed edible type, with 30.5% of participants reporting almost daily or daily use versus 14.3% for capsules and 5.8% for cookies. Most participants reported low-dose THC use per session (≤10 mg, 57.3%), consistent with recommended clinical dosing guidance; yet awareness of cannabinoid content was uneven across compounds. Only 8.1% of participants were unaware of their THC dose, compared with 28.5% who did not know their CBD dose. Conclusion: The Florida medical marijuana patients of this sample were predominantly female and middle-aged, and used edibles, most commonly gummies, primarily to manage anxiety, chronic pain, and depression. The disparity between THC and CBD awareness suggests a need for strategies to increase patient confidence in cannabinoid content. Limitations include convenience sampling, self-report bias, and a cross-sectional design, which may overestimate perceived efficacy, since patients who remain engaged in the medical marijuana program tend to report favorable outcomes.
Associations between sources of influence and perceived medical cannabis product effectiveness for
chronic pain: A longitudinal study Kendall R. Robinson University of Florida Co-authors: Kendall R Robinson1, Juan G Perez1, Robert L Cook1, Yan Wang1 1 University of Florida Background: Chronic pain (CP) accounts for a large proportion of medical cannabis (MC) qualifying conditions. Since multiple MC product types are available, patients often rely on various sources of information (healthcare professionals, dispensary staff, peers, personal experiences) to identify products they perceive as effective. Objective: This study examines how sources of influence are associated with perceived MC product effectiveness for CP. Methods: Data came from the Floridabased Medical Marijuana & Me (M3) longitudinal study surveying individuals over the first nine months of access to MC. The sample included individuals whose main reason for using MC at baseline was CP: 205 at baseline, 124 at three months, and 113 at nine months. Demographic data were collected at baseline. At each follow-up, participants who identified a perceived most effective method for CP were given a list of product types (flower, vape, capsules/ edibles, concentrates, tinctures, topicals, other) and were asked to check all that apply. Participants were also given a list of potential sources of influence on the products they have tried (physicians, medical and dispensary staff, peers, personal experience, online sources, dispensary websites, price, and product sales) and were asked the rate the level of influence from ‘not at all influential’ to ‘extremely influential’. Chi-square and Fisher’s exact tests were conducted at
the three- and nine-month timepoints. Results: At baseline, participants were 74.6% Non-Hispanic White, 66.9% female, and mean age was 45.89. Personal experience and product sales were most reported as being very or extremely influential at both three months (58.9% and 57.3%, respectively) and nine months (60.2% and 61.9%, respectively). At three months, influence from product sales was associated with perceived effectiveness of flower (p=0.03) and capsules/edibles (p=0.03), while influence from dispensary websites (p=0.03) and friends (p=0.004) were associated with perceived effectiveness of concentrates. At nine months, influence from medical staff was associated with perceived effectiveness of capsules/edibles (p=0.03) and concentrates (p=0.048), while influence from price (p=0.049) and product sales (p=0.04) were associated with perceived effectiveness of vapes. Conclusions: Associations between sources of influence and perceived MC product effectiveness varied by product type and survey timepoint. These findings suggest the need to further examine the role that non-clinical guidance and external influences have on perceived treatment effectiveness. Results should be interpreted with caution due to small sample sizes within each product type and source of influence combination. Future research should utilize longer follow-up and qualitative methodologies to better understand these relationships.
Fine-Tuning Open-Weight Large Language Models to Extract Cannabis Use Frequency and Mode from Clinical Notes
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 79
Masoud Rouhizadeh, PhD University of Florida Co-authors: Surya Yadavilli1, Amie Goodin1 1 University of Florida Background: Detecting cannabis users in clinical notes is no longer the bottleneck. Our foundational work at UF Health paired high-sensitivity retrieval with high-specificity fine-tuned large language models (LLMs) to extract cannabis use status, identifying more than three times as many users as diagnosis codes. Use status alone, however, does not capture use frequency or mode of administration, both of which are clinically meaningful. Electronic health records (EHRs) have no structured field for either, and toxicology confirms recent use without indicating frequency or route, leaving free text as the only source. Objective: To measure the prevalence of documentation for cannabis use frequency and mode in clinical notes, and to evaluate extraction accuracy across open-weight LLMs. Methods: From a UF Health cohort (1,000 randomly selected patients; comprising 132,500 notes; 2017–2025), 2,965 snippets with adjudicated-positive cannabis use were annotated for frequency and mode (inter-annotator agreement 96.7%). Frequency and mode were modeled as separate two-step cascades, mirroring the clinical reading of a note. The frequency cascade first detected whether frequency was documented, then classified it as daily or non-daily; the mode cascade first detected whether mode was documented, then classified it as inhaled or oral. Topical mentions were excluded (n=7). Six open-weight models from two families (Gemma 3, 270M to 27B; GPT-OSS, 20B and 120B) were fine-tuned with low-rank adaptation
80 - CCORC 2026
(LoRA) and evaluated by 10-fold crossvalidation, with macro F1 reported for each step. Results: Frequency was documented in 778 of 2,965 snippets (26.2%) and mode in 602 (20.4%); among documented snippets, 41.4% were daily versus 58.6% non-daily, and 57.5% inhaled versus 42.5% oral. Detection was high and largely unaffected by model scale, with macro F1 of 0.958 to 0.975 for frequency and 0.961 to 0.973 for mode across all six models. Mode classification was similarly stable (0.945 to 0.971), whereas frequency classification was the only step to gain from scale, ranging from 0.857 at 270M to 0.952 at 120B parameters. The smallest model (270M) reached 0.958, 0.961, and 0.950 on frequency detection, mode detection, and mode classification, within 2 points of a model 440 times its size. Conclusion: One in four cannabispositive snippets documents use frequency and one in five documents mode, and both can be extracted with near-perfect accuracy using openweight LLMs. Detection and mode classification are within reach of models small enough to run on modest local hardware; only use frequency classification benefits from scale.
Wearable-Derived Physical Activity and Sleep Outcomes Following SubLingual Administration of Cannabidiol for Knee OsteoArthritis (SLACK-OA): A Randomized PlaceboControlled Crossover Trial John Stauffer, MS University of Florida
Co-authors: John W. Stauffer1, Jenessa L. Bailey1, Paul A. Borsa1 1 University of Florida Background: Cannabidiol (CBD) is a heavily marketable product for pain management, sleep-optimization and overall recovery. Despite increased consumer use, evidence supporting objective measurements within sleep and physical activity (PA) remain limited. Wearable technology offers an opportunity to continuously monitor these physiological behaviors in ecologically valid conditions providing insight past patient reported outcomes (PROs). Objective(s): Adults with diagnosed symptomatic knee osteoarthritis (KOA) aged 40-75 years participated in a randomized, double-blind placebocontrolled crossover trial. Across two 30-day observation periods, participants were provided with both CBD (150mg/d) and placebo (0mg/d) separated by a 14-day washout period to avoid potential carryover effect. By utilizing the Ametris® LEAP, an FDA approved medical-grade device, PA and sleep metrics were able to be continuously monitored. PA outcomes included daily step count, total moderate-tovigorous physical activity (MVPA) and specific time allocated in each light, moderate, vigorous, and very vigorous activity. Sleep outcomes included total sleep time (TST), minutes in bed, wake after sleep onset (WASO), number of awakenings, average awakening length, movement index, fragmentation index, sleep fragmentation index, and overall sleep efficiency. All participant-level median values for these metrics were evaluated and compared with paired Wilcoxon signed-rank tests. Results: Across these metrics there were no statistically significant differences between CBD and placebo as all values recorded p-values >
0.05. Despite non-significance, trends favoring CBD across sleep outcomes including TST (286.0 vs. 270.0 minutes; p = 0.109), total minutes in bed (289.5 vs 283.0 minutes; p = 0.068) were observed. MVPA similar to sleep had reported non-significant trends as both vigorous and very vigorous activity demonstrated trends in favor of CBD (% Vigorous: 2.754 vs 2.47; p = 0.093, % Very Vigorous: 0.23 vs 0.16; p= 0.058). Conclusions: Sublingually administrated CBD for thirty days did not significantly alter wearable-derived physiological behavior when compared against placebo in adults diagnosed with KOA. Despite small trends favoring CBD across several sleep and PA metrics, these differences were marginal. These findings however may suggest that possible physiological effects induced by CBD in ecologically valid sleep and activity conditions are minimal due to the dosing protocol used in this study design. However, integrating wearable technology for objective evaluation in intervention efficacy for chronic pain trials has demonstrated value that can further be explored.
Lessons Learned from Designing an Artificial Intelligence-Assisted Recruitment Strategy of Young Adults into ANCHOR: a Cannabis Nurse-Led Cannabis Use Disorder Harm Reduction Pilot Bright Yaw Tamakloe, BSN, RN University of Miami Co-authors: Bright Tamakloe1, Renessa Williams1, Bria-Necole Diggs1, Ciné Brown1, Denise C. Vidot1 1 University of Miami
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 81
Background: Population-based data suggests that young adults between the ages 18-35 have the highest prevalence of daily cannabis use and may face elevated risk for problematic cannabis use. Stigma, limited access to cannabisinformed clinicians, and distrust of conventional outreach can impede engagement in harm-reduction services. Artificial intelligence (AI) may improve recruitment efficiency, but its use requires transparent, nurse-governed safeguards when informing clinical care and practice. Objective(s): To describe lessons learned and the feasibility of an AIassisted recruitment workflow for Advancing Nurse-led Cannabis Harm Reduction (ANCHOR), a nurse-led, technology-delivered brief cannabis intervention for young adults who selfmedicate with cannabis and are enrolled in the Herbal Heart Study (HHS). Methods: An artificial intelligence (AI)assisted recruitment workflow was designed to identify, engage, screen, and schedule potentially eligible young adults from an established cohort of 150 daily cannabis consumers. The design process incorporated the AAMC’s Principles of Trustworthiness and was completed alongside the National Cannabis Nurse Task Force (CNTF). The workflow included four linked components: (1) AI-assisted drafting of recruitment messages using nonjudgmental, harm-reduction language; (2) tailoring of messages according to participant characteristics, including cannabis-use patterns, CUDIT-R scores, reasons for use, and desire to reduce consumption; (3) automated preliminary eligibility screening using prespecified study criteria; and (4) scheduling and followup support through standardized invitations, reminders, and response pathways. The CNTF and HHS staff reviewed AI-generated language, verified
82 - CCORC 2026
eligibility, and retained responsibility for participant communication. Results: The design process produced a structured, reproducible recruitment workflow that integrates personalized outreach, preliminary screening, scheduling, and follow-up within a single recruitment pathway. AI assistance improved recruitment efficiency by reducing the manual effort required to draft and adapt outreach messages, supporting identification of potentially eligible participants, and standardizing routine screening and scheduling tasks. AI-generated messages required nurse review to ensure clinical appropriateness, accuracy, and alignment with harmreduction principles. Tailoring was most useful when limited to study-relevant participant characteristics and approved message templates. Automated screening increased efficiency but did not replace staff verification of eligibility or informed consent. Additional priorities included minimizing the personal information entered into AI systems, maintaining an auditable record of message revisions, monitoring differential response across participant groups, and clearly disclosing the role of automation in recruitment. Conclusions: AI-assisted, nursegoverned recruitment may efficiently connect high-need young adults with cannabis harm-reduction services. Transparent messaging, human oversight, and monitoring for differential recruitment yield are essential implementation safeguards.
Characterizing Medical Cannabis Tincture Users in Florida Andrew Velarde University of Florida
Co-authors: Andrew Velarde1, Juan Guillermo Perez-Carreno1, Robert Cook1, Yan Wang1, Krishna Vaddiparti1, Catalina Lopez-Quintero1 1 University of Florida Background: Cannabis tinctures are increasingly used by medical cannabis patients, yet the sociodemographic and cannabis use characteristics of patients who use them remain poorly described in the literature. This study aims to describe medical cannabis tincture users in Florida, including their sociodemographic factors, product and dosing preferences, cannabis use history, and risk for cannabis use disorder (CUD). Methods: Cross-sectional data were analyzed from the Medical Marijuana and Me (M³) Study conducted between May and December 2022 among adults receiving medical cannabis in Florida. Participants were recruited through convenience sampling at 10 geographically dispersed medical cannabis clinics. Analyses were restricted to 149 adults reporting cannabis tincture use within the past 30 days. Descriptive statistics were used to summarize demographic characteristics, reasons for use, and cannabis use patterns, which include preferred products, self-reported THC dosage, and tincture-specific characteristics. Cannabis Use Disorders Identification Test-Revised (CUDIT-R) scores were also summarized and subsequently categorized using established cutoffs (≥8 hazardous use, ≥12 possible CUD). Results: Cannabis tincture users had a mean age of 48.7 years and were predominantly female (67.8%), nonHispanic white (73.8%), and had at least some college education (69.1%). The most reported reasons for medical cannabis use were anxiety (62.4%), chronic pain (53.7%) and insomnia
(40.9%). Cannabis use was frequent, with 91.3% reporting weekly and 88.6% reporting daily use. Flower (50.3%) and tinctures (46.3%) were the most preferred methods of cannabis consumption. The most frequently reported THC dose per tincture use session was 10 mg (24.2%); however, 22.8% of participants were unable to report the amount of THC consumed per use. Participants also demonstrated established cannabis use histories, initiating cannabis use at a mean age of 21.6 years. The mean CUDIT-R score for participants was 8.4 ± 4.0, with 51.0% classified as hazardous users and 18.8% screening within the possible CUD range. Conclusion: Medical cannabis tincture users in this sample were characterized by predominantly female participation, frequent cannabis use, established cannabis use histories, and variable awareness of cannabinoid composition. These findings provide a descriptive profile of the contemporary medical cannabis tincture user, though the clinic-based Florida sample may not generalize to tincture users in other settings or regions. Clinician-patient discussions regarding cannabinoid composition, cannabis use behaviors, and CUD risk remain important given these patterns.
Relationship Between Frequency of Medical Marijuana Use and Psychosis-related Outcomes in Adolescents and Young Adults with PTSD Mohammad Yaseliani, MS University of Florida
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 83
Co-authors: Mohammad Yaseliani1, Lake Lindo1, Youngsuhk Jo1, Md Mahmudul Hasan1 1 University of Florida Background: The prevalence of marijuana use has previously been estimated to range from 15.3-30.1% among high school-aged adolescents and 52.4% among young adults aged 18-25. Qualifying conditions for medical marijuana (MMJ) use within the U.S. vary according to state; however, can include post-traumatic stress disorder (PTSD). Literature has shown that marijuana use could be considered a risk factor for psychosis. Objectives: Our present study aims to investigate the relationship between MMJ use and psychosis-related outcomes including psychosis-related hospitalization, time to first psychosisrelated hospitalization, new psychosis diagnosis, and new antipsychotic prescription. Methods: We conducted a retrospective cohort study using the Medical Marijuana Consortium data from 2017 to 2023. Eligible individuals were MMJ users aged 12-24 with PTSD. Index date was defined as the earliest date of MMJ dispensation. Individuals with prior antipsychotic prescription were excluded from the analysis. The primary outcome was psychosis-related hospitalization within 1 year of the index date. The secondary outcomes were: (1) time to first psychosis-related hospitalization, (2) antipsychotic prescription within 1 year, and (3) any diagnosis (inpatient or outpatient) of psychosis within 1 year. We used: (1) independent-samples t-tests to compare the number of MMJ fills per month between groups for the primary outcome and the secondary outcomes of antipsychotic prescription and any diagnosis of psychosis, and (2) Pearson correlation to assess the association
84 - CCORC 2026
between the number of MMJ fills per month and time to first hospitalization. Results: The study sample included 9,266 individuals with PTSD (52.24 % female). Within 12 months of first MMJ dispensation, 50 (0.54%) were hospitalized due to psychosis, 217 (2.34%) received an antipsychotic medication, and 76 (0.82%) had any psychosis diagnosis. The number of MMJ fills per month was statistically significantly correlated with psychosisrelated hospitalization (mean difference = 2.3187, 95 % CI = 0.2986, 4.3388; p 0.0253), time to first hospitalization (r = −0.4820; p = 0.0004), antipsychotic prescription after the index date (mean difference = 1.6179, 95 % CI = 1.0111, 2.2246; p <.0001), and any psychosis diagnosis (mean difference = 2.5182, 95 % CI = 1.0158, 4.0205; p = 0.0013). Conclusion: The use of MMJ is associated with psychosis-related hospitalization, new psychosis diagnosis, new antipsychotic prescription, and decreased time to first psychosis-related hospitalization. It is crucial to consider these risks when considering MMJ use, particularly in younger patient populations.
ABSTRACTS EDUCATION AND POLICY EVALUATION CATEGORY Medical Marijuana Education among Healthcare Students: Assessing Knowledge, Barriers, and Curriculum
Gaps in a Multicenter Institution Mark Kelley, MSHI Lake Erie College of Osteopathic Medicine Co-authors: Sabrina Fayaz, Lake Erie College of Osteopathic Medicine Background: As medical marijuana (MMJ) legalization expands, healthcare providers face new obstacles with patient treatment, with a profound lack of established formal training in cannabis therapeutics. Objectives: Evaluate the current baseline knowledge, attitudes, opinions, and perceived barriers to MMJ in reallife practice, and determine interest levels in dedicated MMJ education among healthcare students. Methods: A cross-sectional survey was administered to 355 students across LECOM campuses (Erie, PA; Elmira, NY; Seton Hill, PA; Bradenton, FL). The 13-item instrument evaluated student status (pre-clinical vs clinical), self-rated knowledge (evidencebased recommendations, risks/ adverse effects, cannabinoids and endocannabinoid system [ECS], state certification process), attitudes and confidence (discussing MMJ with patients/staff, addressing drug-drug interactions and treatment), personal opinions (educational opportunities and institutional support, legalization status), current sources of information, and an optional free-text response identifying the biggest barrier to understanding and clinical use. The cohort included 194 female, 245 White, 215 pre-clinical, 161 aged 24-26 years, and 213 freetext responses, categorized by major themes. Results: Overall, 87.3% of students reported no formal training on MMJ,
but 85.6% agreed additional education would benefit their role as a healthcare provider. 78.0% showed interest in additional education opportunities surrounding MMJ, but only 51.0% knew of LECOM’s additional 2-year accredited master’s program in cannabinoid therapeutics. 79.7% agreed MMJ has therapeutic applications and 6065.4% reported understanding specific treatment recommendations and major cannabinoids, but only 44.2% felt they understand the ECS and 24.2% their states patient certification process. Furthermore, only 42.0% felt confident discussing MMJ with patients/staff, and 36.6% addressing drug-drug interactions and MMJ into patient treatment. Regarding policy, 59.4% supported fulllegalization (medical and recreational), whereas 32.4% medical-only. Primary sources of current information included colleagues (69.6%), medical literature (62.0%), news/media (61.1%), and clinical experience (54.9%). Key barrier themes included time and lack of education in current curricula (n=91), stigma or bias (n=72), state/federal regulations (n=33), and lack of clinical evidence (n=26). Conclusions: Despite an apparent basic understanding of MMJ and its therapeutic value, healthcare students lack formal training and fall short when it comes to confidence incorporating MMJ into discussions with real-world patients. Notably, time and lack of education being a repeated barrier theme – combined with the seemingly low knowledge of additional master’s programs – highlights the need for exposure to MMJ early in healthcare training, potentially supported by CME, either as part of current programs or easily incorporated certifications to combat stigma and bridge the gap between student interest and clinical preparedness.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 85
A National Review of State Regulation of HempDerived CBD and THC Beverages in the United States Katherin Sanchez, BS University of Central Florida Co-authors: Karina Villalba1, Jennifer Attonito1, Brandon Zamora1 1 University of Central Florida Background: After the passage of the 2018 Agriculture Improvement Act (Farm Bill), Hemp-derived cannabidiol (CBD) and tetrahydrocannabinol (THC) beverages consumption has grown exponentially. While the Farm Bill legalized hemp containing no more than 0.3% delta-9 THC by dry weight, it did not establish a comprehensive regulatory framework for hempderived cannabinoid beverages. Consequently, individual states have each implemented their own legislative approaches, resulting in variability in product regulation, consumer access, and public health protections. Objectives: This study aimed to examine and compare state-level legislation governing hemp-derived CBD and THC beverages across the United States and evaluate how state policies align with or diverge from the current federal regulatory landscape. Methods: A comprehensive review of publicly available state statutes, administrative regulations, and agency guidance was conducted for all 50 states and the District of Columbia. Legislative data was collected on key regulatory domains, including product legality, THC concentration limits, age restrictions and licensing requirements. States were categorized according to the overall restrictiveness of their
86 - CCORC 2026
regulatory frameworks to identify patterns and regional differences in policy implementation. Results: Preliminary findings indicate substantial differences in the regulation of hemp-derived cannabinoid beverages across the United States. Some states have adopted comprehensive regulatory frameworks that include age restrictions, detailed labeling requirements, and licensing standards, whereas others maintain limited oversight or prohibit certain hempderived THC products entirely. Differences in regulatory requirements create inconsistencies in product availability, quality assurance, and consumer protections, contributing to a fragmented national marketplace. Conclusion: The current regulatory landscape for hemp-derived CBD and THC beverages is characterized by significant state-to-state variation in the absence of uniform federal oversight. These findings highlight a significant issue in the marketplace and the need for more uniform regulations among states which will provide security and protection for consumers. A recently amended federal definition of hemp, effective November 12, 2026, will replace the previous delta-9 THC threshold with a total THC standard and establish new restrictions on hemp-derived cannabinoid products, signaling a major shift toward tighter federal regulation of the cannabis beverage market. Continued evaluation of evolving cannabinoid legislation will be essential as the market for hempderived beverages continues to expand.
When Legal Access Is Not Enough: Equity Barriers to Medical Cannabis Access— Evidence from Oklahoma’s
Medical Cannabis Program
influencing equitable access.
Sheena C. Wilton, MS, MCT Lake Erie College of Osteopathic Medicine
Results: The analysis consistently demonstrated a gap between legal access and equitable access across regulatory, clinical, laboratory, and industry perspectives. Although Oklahoma maintains one of the nation’s most accessible medical cannabis programs in terms of legal eligibility, representative barriers included affordability, administrative complexity, transportation limitations, declining caregiver availability, physician participation, federal housing restrictions, and compliance requirements that increase operational costs. Despite differing stakeholder perspectives, all evidence sources consistently identified persistent barriers affecting equitable access for medically vulnerable populations. Collectively, the findings indicate that legal eligibility alone does not ensure equitable access to cannabinoid therapeutics.
Background: Medical cannabis legalization has expanded legal eligibility for cannabinoid therapeutics; however, legal access and equitable access are distinct concepts. Oklahoma was selected as the study site because it operates one of the nation’s most accessible medical cannabis programs, providing an opportunity to examine whether broad legal eligibility translates into equitable patient access. Equitable access requires that patients can realistically obtain, afford, and safely utilize cannabinoid therapeutics within healthcare and regulatory systems. Understanding this distinction is essential when evaluating medical cannabis programs serving medically vulnerable populations. Objective(s): To evaluate the gap between legal access and equitable access within Oklahoma’s medical cannabis program by identifying regulatory and structural barriers affecting medically vulnerable populations despite legal eligibility. Methods: A qualitative policy evaluation and document analysis were conducted using publicly available Oklahoma Medical Marijuana Authority (OMMA) regulations, licensing and patient data, federal housing guidance, demographic information, peer-reviewed literature, and four semi-structured executive interviews representing regulatory, clinical, laboratory, and vertically integrated industry perspectives. Evidence from these sources was triangulated and synthesized using a comparative policy and health equity framework to identify recurring regulatory, structural, geographic, economic, and institutional barriers
Conclusions: Legalization represents an essential first step toward patient access, but legal eligibility alone is an incomplete measure of equitable access. Medical cannabis programs should be evaluated by considering regulatory, structural, geographic, economic, and institutional barriers alongside legal eligibility. These findings support incorporating equity-focused evaluation measures into future medical cannabis policy development and program assessment to improve patient access while maintaining regulatory oversight and patient safety.
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 87
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.
Students completing the Master of Science in Medical Cannabinoid Therapeutics program are equipped with the skills and knowledge to be highly trained health professionals capable of contributing to innovative, culturally sensitive, and evidence-based approaches in both current and emerging medical cannabinoid applications and community wellness initiatives. Learn more at lecom.edu.
The Collaborative Institutional Training Initiative (CITI Program) is dedicated to serving the training needs of colleges and universities, healthcare institutions, technology and research organizations, and governmental agencies, as they foster integrity and professional advancement of their learners. Learn more at about.citiprogram.org.
Tikun Olam products address pain, sleep, neurological balance, and gastrointestinal conditions. Standardized with precise THC:CBD ratios and strain-specific terpenes, its formulas are backed by over two decades of research, peer-reviewed studies, and one of the world’s largest patient feedback datasets. Learn more at tikunolam.com.
88 - CCORC 2026
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
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 89
COMMITTEES Scientific Program Committee Nicole Ennis, PhD – Florida State University
Sabrina Fayaz, MS, MCST – Lake Erie College of Osteopathic Medicine Amie Goodin, PhD – University of Florida Jeevan Jyot, PhD – University of Florida
Mark Kindy, PhD – University of South Florida
Amie Newins, PhD – University of Central Florida Sari Paikoff, PhD – Florida Gulf Coast University Lea Sacca, PhD – Florida Atlantic University
Mandip Sachdeva, PhD – Florida A&M University Teddy Salan, PhD – University of Miami
Candice Sareli, MD – Nova Southeastern University Barry Setlow, PhD – University of Florida
Rose Stiffin, PhD – Florida Memorial University
Matthew Sutherland, PhD – Florida International University Almut Winterstein, PhD – University of Florida
Abstract Reviewers Nicole Ennis, PhD – Florida State University
Sabrina Fayaz, MS, MCST – Lake Erie College of Osteopathic Medicine Amie Goodin, PhD – University of Florida
Mark Kindy, PhD – University of South Florida
Amie Newins, PhD – University of Central Florida Sari Paikoff, PhD – Florida Gulf Coast University Lea Sacca, PhD – Florida Atlantic University
Mandip Sachdeva, PhD – Florida A&M University Teddy Salan, PhD – University of Miami
Candice Sareli, MD – Nova Southeastern University Barry Setlow, PhD – University of Florida
Rose Stiffin, PhD – Florida Memorial University
Matthew Sutherland, PhD – Florida International University Maria Mejia, MD, MPH – Florida Atlantic University Yiota Kitsanta, PhD – George Mason University
90 - CCORC 2026
Alan Kunz-Lomelin, PhD – Florida Atlantic University
Patricio Viera Perez, PhD – Florida International University
Benjelene Sutherland, PhD – Florida International University Jordan Ortman, MS – University of Central Florida
Madison Maynard, MS – University of Central Florida Rashmi Ghonasgi, BS – University of Central Florida Callie Wang, BA – University of Central Florida
Masoud Rouhizadeh, PhD – University of Florida
Marina Alacoque Rodrigues, MSc, BPharm – University of Florida Shailina A Keshwani, PhD – University of Florida
Chidimma D Azubuike, PharmD, MS – University of Florida Sebastian Jugl, PhD – University of Florida
Catalina Lopez-Quintero, PhD – University of Florida Robert Cook, MD, MPH – University of Florida Nicole Smolinksi, 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 Candice Sareli, MD –Nova Southeastern University Peter Holland, MD – Florida Atlantic University Nicole Ennis, 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
Mandip Sachdeva, PhD – Florida A&M University
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 91
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 - UF College of Pharmacy Lake Nona IT
Brady Budke - UF College of Pharmacy Communications
Brendan Clough - UF College of Pharmacy Office of Events
Gabrielle Gele - UF College of Pharmacy Administrative Assistant Pedro Martinez Giron - UF College of Pharmacy Lake Nona IT
Jonathan Hernandez - UF College of Pharmacy Lake Nona Operations Jonathan Tillett - UF College of Pharmacy Lake Nona IT
92 - CCORC 2026
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 2026, 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 2026, including: keynote speakers, session members, board members, exhibitors, and volunteers. We thank 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 in 2027!
CANNABIS CLINICAL OUTCOMES RESEARCH CONFERENCE - 93
Save the Date: The National Cannabis Research Conference (NCRC 2027) Please join us next year at NCRC 2027 in Orlando, FL! This collaboration represents a combined conference, where we unite the United States’ premiere cannabis-focused scientific organizations into a single, jointly hosted scientific meeting. Joining our Consortium CCORC conference hosts, we welcome: > The Institute of Cannabis Research > The National Interdisciplinary Cannabis Symposium > The Mid-Atlantic Cannabinoid Research Collaborative > The Center for Medicinal Cannabis Research
94 - CCORC 2026
mmjoutcomes.org