While continued cannabis use and misuse in individuals with schizophrenia is associated with a variety of negative outcomes, individuals with a history of use tend to show higher cognitive performance compared to non-users. While this is replicated in the literature, few studies have used task-based functional magnetic resonance imaging (fMRI) to evaluate whether the brain networks underpinning these cognitive features are similarly impacted. Forty-eight first-episode individuals with schizophrenia (FES) with a history of cannabis use (FES + CAN), 28 FES individuals with no history of cannabis use (FES-CAN), and 59 controls (CON) performed the AX-Continuous Performance Task during fMRI. FES+CAN showed higher cognitive control performance (d\'-context) compared to FES-CAN (P < .05, ηp 2 = 0.053), and both FES+CAN (P < .05, ηp 2 = 0.049) and FES-CAN (P < .001, ηp 2 = 0.216) showed lower performance compared to CON. FES+CAN (P < .05, ηp 2 = 0.055) and CON (P < 0.05, ηp 2 = 0.058) showed higher dorsolateral prefrontal cortex (DLPFC) activation during the task compared to FES-CAN, while FES+CAN and CON were not significantly different. Within the FES+CAN group, the younger age of initiation of cannabis use was associated with lower IQ and lower global functioning. More frequent use was also associated with higher reality distortion symptoms at the time of the scan. These data are consistent with previous literature suggesting that individuals with schizophrenia and a history of cannabis use have higher cognitive control performance. For the first time, we also reveal that FES+CAN have higher DLPFC brain activity during cognitive control compared to FES-CAN. Several possible explanations for these findings are discussed.

The purpose of this study was to evaluate Chaldean American perspectives towards legalization and moral acceptability of recreational and medicinal marijuana in the state of Michigan. An online survey was created and distributed through various social media groups, churches, and Chaldean organizations which resulted in a total of 637 respondents following the removal of respondents who did not meet criteria. The survey was open from March 20th, 2022 to April 20th, 2022. The independent variable was level of religiosity. The dependent variables were moral acceptability, opinion towards legalization of recreational and medicinal marijuana, and risk of cannabis use disorder. Logistic regression was used to estimate the strength of the association between the independent and dependent variables. Approximately 64% of the sample was female and 54.6% were between the ages of 21 to 29. Almost 80% of respondents reported high religiosity and 83.4% strongly or somewhat supported the legalization of medicinal marijuana. In addition, 85.8% felt medicinal marijuana was morally acceptable and 58.9% believed recreational marijuana was morally wrong. In the fully adjusted models, individuals who reported high religiosity (compared to low/moderate) were more likely to oppose legalization of recreational marijuana (OR = 2.80; 95% CI = 1.46, 5.39) and believed that marijuana was morally wrong (OR = 2.36; 95% CI = 1.16, 4.78). This trend was not observed with medicinal marijuana. These findings have important implications in better understanding a traditionally conservative ethnic minority group in their attitudes towards marijuana and how religion influences their perspectives. Additional studies are needed to examine any changes in opinion overtime as this is the first study of its kind.

The prevalence and influence of gangs on adolescents and young adults remain a concern in Western Cape, South Africa-particularly as they have one of the largest gang presence. While less attention has been focused on young women, there is a need to elucidate the relationship between gang exposure and health behaviors, such substance use, in addition to understanding whether becoming a caregiver impacts this relationship. This study uses baseline data from 496 participants enrolled in a NIDA-funded R01 trial that recruited young women aged 16 to 19 who were out of school and reported recent alcohol or other drug use and sexual risk behavior. At enrollment, a risk behavior survey was administered, and urine drug screening was conducted. Multivariable logistic regression analyses were conducted to examine baseline associations between childbirth, a gang exposure index based on eight items, and positive drug screens of the most prevalent drugs in the Western Cape (marijuana, methaqualone, and methamphetamine). At enrollment, approximately 39% of the sample had a positive urine screen for marijuana, 17% for methaqualone, and 11% for methamphetamine. Additionally, 28% had ever given birth. While only 6% reported ever being a member of a gang, most reported exposure to gangs through their physical and social environments. For all three drugs, gang exposure was associated with statistically significantly higher odds of a positive screen. Every one-point increase in the gang exposure index was associated with a 31% increase in the odds of a positive marijuana screen (p < .001), a 26% increase for methaqualone (p = 0.005) and a 37% increase in the odds of a positive methamphetamine screen (p < .001). Ever given birth was associated with lower odds of marijuana use (adjusted odds ratio [AOR]: 0.63; 95% CI: 0.42-0.96), but it was not associated with methaqualone or methamphetamine use. The findings suggest that exposure to gangs through young women\'s social and physical environment is positively associated with drug use. Childbirth was also protective for marijuana use, indicating there may be something unique about this type of drug, such as one\'s ability to more easily stop use. Although very few young women reported gang membership, a majority reported some exposure, indicating the need to address how pervasive this exposure is and the potential risk.

BACKGROUND: In December 2018 the Michigan Regulation and Taxation of Marihuana Act legalized the recreational use of cannabis in Michigan. There are now high potency forms of cannabis readily available in the state, which could result in increased emergency department (ED) visit rates due to intoxication in adults and children. Although cannabis related visits account for a small percentage of all adult and pediatric ED visits, they impose a significant burden on the health care system\'s resources. This study aimed to assess the impact of the legalization of recreational marijuana on the rate of ED visits for acute cannabis intoxication.
METHODS: We utilized the legalization of marijuana in the state of Michigan to conduct a natural experiment utilizing a retrospective observational cohort design of ED visits for acute intoxication before and after legalization. The study was conducted at a health system composed of eight hospitals in southeast Michigan, including both academic and community hospitals serving a diverse patient population. We estimated monthly cannabis-related ED visits based on cannabis-related ICD-10 discharge codes and total ED visits using electronic health record data from 2016 to 2022. A negative-binomial (NB) regression model was used to estimate the immediate and cumulative changes in cannabis-related ED visit rate after legalization.
RESULTS: There were a total of 2177 ED visits from 2066 patients for cannabis intoxication in our study cohort. Of the 2177 visits, 671 were before and 1506 were after legalization. In the univariate analysis, recreational cannabis legalization was associated with an increase in the average cannabis-related ED visit rate (Rate Ratio [RR]:1.70, 95% CI: (1.49, 1.94), p-value <0.001). In the multivariate analysis adjusting for age, results remain significant (RR 1.47, 95% CI (1.29, 1.70), p-value <0.001). The increased visit rate occurred in the first month after legalization; however, the slope of the increasing rate of ED visits were similar before and after cannabis legalization (RR, 1.28, 95% CI (1.07, 1.54), p-value <0.001).
CONCLUSIONS: The legalization of recreational cannabis in Michigan was associated with an immediate increase in ED visit rates for acute cannabis intoxications across all ages, especially among middle-aged adults, in the context of an stably increasing ED visit rate.

BACKGROUND: There are no clinical practice guidelines addressing the treatment of tobacco-cannabis co-use and a dearth of studies to inform treatment for co-use. This narrative review aims to (1) summarize promising intervention components used in published co-use treatment studies, (2) describe key gaps and emerging issues in co-use, and (3) provide recommendations and considerations in the development and evaluation of co-use interventions.
METHODS: We conducted a literature search in June 2024 across several databases to update previous reviews on tobacco-cannabis co-use treatment. We found 9 published intervention studies that specifically addressed treatment for both substances. Data from these studies were manually extracted and summarized.
RESULTS: Most of the 9 included studies (1) focused on acceptability and/or feasibility, (2) provided both psychosocial/behavioral and pharmacotherapy intervention components, (3) were conducted in adults, and (4) were delivered in-person, with some having digital asynchronous components, for a 5-to-12-week duration. The most common psychosocial/behavioral strategies used were Cognitive Behavioral Therapy, Motivational Interviewing, and Contingency Management; while the most common pharmacotherapy was Nicotine Replacement Therapy. There was no evidence of compensatory use of tobacco or cannabis when providing simultaneous treatment for both substances.
CONCLUSIONS: The literature to date provides support for well-integrated multi-component interventions of psychosocial/behavioral and pharmacotherapy strategies for co-use treatment. This review reinforces an urgent need for treatments targeting tobacco and cannabis co-use. Future interventions should address key gaps, including co-use of vaporized products among youth and young adults, tailored interventions for priority populations, and digital applications to increase reach and advance health equity.

UNASSIGNED: Cannabis is the most widely used psychoactive drug in the United States. While multiple studies have associated acute cannabis consumption with alterations in cognitive function (e.g., visual and spatial attention), far less is known regarding the effects of chronic consumption on the neural dynamics supporting these cognitive functions.
UNASSIGNED: We used magnetoencephalography (MEG) and an established visuospatial processing task to elicit multi-spectral neuronal responses in 44 regular cannabis users and 53 demographically matched non-user controls. To examine the effects of chronic cannabis use on the oscillatory dynamics underlying visuospatial processing, neural responses were imaged using a time-frequency resolved beamformer and compared across groups.
UNASSIGNED: Neuronal oscillations serving visuospatial processing were identified in the theta (4-8 Hz), alpha (8-14 Hz), and gamma range (56-76 Hz), and these were imaged and examined for group differences. Our key results indicated that users exhibited weaker theta oscillations in occipital and cerebellar regions and weaker gamma responses in the left temporal cortices compared to non-users. Lastly, alpha oscillations did not differ, but alpha connectivity among higher-order attention areas was weaker in cannabis users relative to non-users and correlated with performance.
UNASSIGNED: Overall, these results suggest that chronic cannabis users have alterations in the oscillatory dynamics and neural connectivity serving visuospatial attention. Such alterations were observed across multiple cortical areas critical for higher-order processing and may reflect compensatory activity and/or the initial emergence of aberrant dynamics. Future work is needed to fully understand the implications of altered multispectral oscillations and neural connectivity in cannabis users.

OBJECTIVE: To estimate the strength of association between psychiatric disorders and substance use disorders (SUD), and cannabis use and cannabis use disorder (CUD) during early pregnancy.
METHODS: Observational study.
METHODS: Kaiser Permanente Northern California, USA.
METHODS: 299 496 pregnancies from 227 555 individuals screened for cannabis use by self-report and a urine toxicology test at entrance to prenatal care in Kaiser Permanente Northern California during January 2011-December 2021 (excepting year 2020). The sample was 62.5% non-White, with a mean (standard deviation) age of 31.1 (5.5) years; 6.8% used cannabis; 0.2% had a CUD.
METHODS: Exposure variables included electronic health record-based psychiatric diagnoses of attention deficit hyperactivity, anxiety, bipolar, depressive, personality, posttraumatic stress and psychotic disorders; and alcohol, opioid, stimulant and tobacco use disorders, during the two years prior to pregnancy up to the day before the prenatal substance use screening date. Outcome variables were any cannabis use, frequency of self-reported cannabis use and CUD during early pregnancy.
RESULTS: Psychiatric disorder prevalence ranged from 0.2% (psychotic) to 14.3% (anxiety), and SUD ranged from 0.3% (stimulant/opioid) to 3.8% (tobacco). Psychiatric disorders were associated with cannabis use and CUD, with the strongest association for any use found for bipolar disorder (adjusted odds ratio [aOR] = 2.83; 95% confidence interval [CI] = 2.53-3.17) and the strongest association for CUD found for psychotic disorders (aOR = 10.01, 95% CI = 6.52-15.37). SUDs were associated with cannabis use and CUD, with the strongest association for any use found for tobacco use disorder (aOR = 4.03, 95% CI = 3.82-4.24) and the strongest association for CUD found for stimulant use disorder (aOR = 21.99, 95% CI = 16.53-29.26). Anxiety, bipolar, depressive disorders and tobacco use disorder were associated with greater odds of daily than monthly or less cannabis use.
CONCLUSIONS: Psychiatric disorders and substance use disorders appear to be associated with elevated odds of any and frequent cannabis use as well as cannabis use disorder during early pregnancy. In most cases, the associations with cannabis outcomes were stronger for substance use disorders than other psychiatric disorders.

Lactic acidosis is a common finding in the intensive care unit and is associated with increased mortality. We present the case of a 42-year-old male with alcohol use disorder and cirrhosis who developed sudden onset shortness of breath while smoking marijuana. He was found to have a lactic acid level of 25.6 mmol/L with a significant anion gap metabolic acidosis requiring emergent dialysis. He was hypertensive without evidence of tissue hypoperfusion. His profound type B lactic acidosis was primarily attributed to a rare manifestation of cannabinoid toxicity. At a clinic visit 3 months later, he was doing well and had not smoked marijuana since his discharge.

Over the past two decades, vaping has increased in popularity among young adults. Yet, little is known about the daily activities or contexts associated with vaping behavior. The current study examined whether nicotine vaping, cannabis vaping, and dual-substance vaping (i.e., vaping both nicotine and cannabis) fluctuated in tandem with alcohol use and activities on a given day. Data came from the Monitoring the Future Vaping Supplement, a national sample of U.S. young adults. A subsample of people who vaped (N = 330 people) completed up to 14 daily surveys (N = 3686 days). Multilevel logistic regressions separated within- and between-person characteristics and controlled for combustible nicotine and cannabis use, day of the week, and demographic characteristics. Weights accounted for the complex survey design and attrition. Results demonstrated that nicotine vaping was more common on days when participants drank moderately or binge drank (compared to not drinking), used cigarettes, and spent more time at bars and parties than usual. Cannabis vaping on a given day was more likely on days when young adults drank moderately and spent more time at bars/parties. Likewise, moderate drinking, spending more time at bars/parties than usual, and spending less time on schoolwork than usual was associated with a higher likelihood of dual-substance vaping on a given day. Our findings highlight when young adults vape nicotine and cannabis, while also identifying proximal correlates of these behaviors to inform intervention and cessation efforts.

Mississippi youth are demographically unique compared to those of the nation. The aim of the study was to examine the drug use among adolescents in Mississippi compared to that in the US, which included determining prevalence and trends in drug use as well as drugs on school property and estimating the differences in drug use prevalence by gender and by race. National and Mississippi Youth Risk Behavior Surveillance System (YRBSS) data from 2001 to 2021 were obtained for analysis. Summary statistics, prevalence ratio, and survey Chi-squared tests of independence statistics were generated for the comparison for all students, and by gender and race separately. Trend analysis was conducted using logistic regression combined with joinpoint regression. The six survey questions being studied were the following: have you ever used marijuana, an inhalant, heroin, methamphetamines, or injected drugs, and were you offered, sold, or given an illegal drug on school property during the last 12 months. Survey packages in R were used to account for the complex sampling design of YRBSS data. On the national level, all six drug-related risk behaviors being studied showed a significant decrease from 2001 to 2021. In Mississippi, however, only \"ever used marijuana\" showed a decrease trend, while three remain unchanged, and two increased. The 2021 YRBSS data show that Mississippi adolescents exhibited a significantly higher prevalence of drug use, and are more likely to be offered, sold or given an illegal drug on school property. This research showed detailed findings on drug use-related issues in Mississippi, which is alarming. This poses an important challenge for public health in Mississippi and sounds an urgent call for drug use intervention among Mississippi adolescents. More concerted actions at the community, school and government level are needed for reducing youth drug use and controlling the drug traffic on school property.