New study finds increase in exposures to synthetic tetrahydrocannabinols among young children, teens, and adults
Experts highlight need for increased awareness, safe storage and improved regulation
NATIONWIDE CHILDREN'S HOSPITAL
(COLUMBUS, Ohio) – A sharp rise in exposures to synthetic cannabis products among youth — some leading to hospitalization — highlights the need for increased education around the dangers of exposure and increased focus on safe storage and packaging, according to pediatricians and researchers at Nationwide Children’s Hospital and the Central Ohio Poison Center.
A new study conducted by researchers at the Center for Injury Research and Policy of the Abigail Wexner Research Institute at Nationwide Children’s Hospital and the Central Ohio Poison Center examined trends in calls to poison centers across the country for exposures to different types of tetrahydrocannabinol (THC): delta-8 THC, delta-10 THC and THC-O acetate. These products are often referred to as “diet weed” or “hemp products,” which leads to a misperception that they are safer alternatives to the more regulated and more abundant delta-9 THC.
The study, published in Clinical Toxicology, found increases in the number of exposures in multiple age groups, with unintentional ingestions by young children being especially concerning.
“Many people don’t realize how toxic these products can be, especially to young children. One in four children needed to be hospitalized after exposure,” said Hannah Hays, MD, co-author of the study, medical director of the Central Ohio Poison Center and faculty of the Center for Injury Research and Policy at Nationwide Children’s. “If someone vapes, smokes, eats edibles or drinks infused beverages with delta-8, delta-10 THC or THC-O, all of those products should be stored up, away, and out of sight and reach of children, preferably in a locked container. These products should never be used in front of kids who might mistake them for food or drinks that they are allowed to have.”
Data Highlights
According to the study:
- U.S. poison centers received 1,746 calls related to delta-8 THC, delta-10 THC, and THC-O acetate exposures in 2021. This number increased by 88% to 3,276 in 2022 – an average of one call every 2.6 hours.
- Most cases were single-substance (94%), ingestions (94%) that occurred at a residence (96%) in 20-59-year-olds (40%), <6-year-olds (31%), and 6-19-year-olds (25%). The most common clinical effects were mild central nervous system depression (when signals from the brain and spinal cord decrease) (25%), rapid heartbeat (23%), and agitation (16%). Other clinical effects included moderate central nervous system depression (11%), confusion (7%), hallucinations/delusions (4%) and ataxia (uncoordinated movement) (3%).
- More than one-third (38%) of cases experienced a serious medical outcome and 16% were admitted to a health care facility. Children <6-years-old accounted for roughly half of those admissions (58% of critical care admissions and 49% of non-critical care admissions).
Safe Storage
Pediatricians and other health care providers should continue to counsel patients and their families about the potential dangers of these products and the importance of safe storage practices, experts recommend:
- Talk to children about cannabis-related products. Have age-appropriate conversations with children about cannabis-related products, explaining what these products are and why they can be dangerous.
- If these products are in the home, store them safely. The best way to keep children safe from cannabis-related products is to keep them out of the home. If these products are kept in the home, store them in a safe place away from your children – stored up and out of sight, away from food, and locked if possible.
- Don’t use these products in front of children. It is helpful to never use these products in front of your children, especially if packaged to look like treats.
- Talk to friends, family, and other caregivers. Talk with caregivers around your child about cannabis-related products and how to keep these products away from your children. Save the national Poison Help Line number (1-800-222-1222) in your phone and post it in a visible place in your home. The Poison Help Line provides free, confidential advice from experts, 24 hours per day, seven days per week.
Safe packaging
Study investigators also highlight inconsistent regulations of these products from state to state. Because the United States Food and Drug Administration currently does not regulate manufacturing of these products, contaminants such as heavy metals, solvents or pesticides may be found in them and may not be listed on product packaging. In addition, in many states, these products may not have the packaging or labeling requirements that delta-9 THC products have.
While at least 14 states have banned or regulated the sale of these products, they are still available to the public online and in locations like gas stations and small convenience stores. In many places, there may be little to no regulation, with retailers often setting their own minimum purchasing age.
“The current patchwork of state regulations has led to an environment that allows for easily available products that may have unlisted contaminants, inaccurate labels and packaging that can be appealing to children” said Christopher Gaw, MD, co-author of the study, pediatric emergency medicine physician and faculty member of the Center for Injury Research and Policy at Nationwide Children’s. “We need clearer regulation of these products with better oversight and enforcement.”
Data for this study were obtained from the National Poison Data System (NPDS), which is maintained by America’s Poison Centers, formerly the American Association of Poison Control Centers (AAPCC). Poison centers receive phone calls through the national Poison Help Line (1-800-222-1222) and document information about the product, route of exposure, individual exposed, exposure scenario, and other data, which are reported to the NPDS.
The Center for Injury Research and Policy (CIRP) of the Abigail Wexner Research Institute at Nationwide Children’s Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research at its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment, and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy, and advances in clinical care. For related injury prevention materials or to learn more about CIRP, visit www.injurycenter.org. Follow CIRP on X @CIRPatNCH.
The Central Ohio Poison Center (COPC) provides state-of-the-art poison prevention, assessment and treatment to residents in 64 of Ohio’s 88 counties. The center’s services are available to the public, medical professionals, industry, and human service agencies. COPC handles more than 42,000 poison exposure calls annually, and confidential, free emergency poisoning treatment advice is available 24/7. To learn more about COPC, visit www.bepoisonsmart.org. Follow COPC on X @OHPoisonControl and Facebook https://www.facebook.com/CentralOhioPoisonCenter.
About The Abigail Wexner Research Institute at Nationwide Children's Hospital
Named to the Top 10 Honor Roll on U.S. News & World Report’s 2023-24 list of “Best Children’s Hospitals,” Nationwide Children’s Hospital is one of America’s largest not-for-profit free-standing pediatric health care systems providing unique expertise in pediatric population health, behavioral health, genomics and health equity as the next frontiers in pediatric medicine, leading to best outcomes for the health of the whole child. Integrated clinical and research programs are part of what allows Nationwide Children’s to advance its unique model of care. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children’s faculty train the next generation of pediatricians, scientists and pediatric specialists. The Abigail Wexner Research Institute at Nationwide Children’s Hospital is one of the Top 10 National Institutes of Health-funded free-standing pediatric research facilities in the U.S., supporting basic, clinical, translational, behavioral and population health research. The AWRI is comprised of multidisciplinary Centers of Emphasis paired with advanced infrastructure supporting capabilities such as technology commercialization for discoveries; gene- and cell-based therapies; and genome sequencing and analysis. More information is available at NationwideChildrens.org/Research.
-30-
JOURNAL
Clinical Toxicology
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Delta-8 tetrahydrocannabinol, delta-10 tetrahydrocannabinol, and tetrahydrocannabinol-O acetate exposures reported to America’s Poison Centers
Study highlights key predictors of adolescent substance use; special issue of the American Journal of Psychiatry focuses on substance use disorders
AMERICAN PSYCHIATRIC ASSOCIATION
NEW YORK, May 6, 2024 – New research, published online today in the American Journal of Psychiatry, examined a broad range of potential predictors of substance use among adolescents and found sociodemographic variables were the most robust predictors of substance use initiation.
The study is part of a special issue of the journal highlighting advances in understanding the neurobiology and sociodemographic underpinnings of substance use disorders and how this understanding has advanced recognition and treatment. Several authors discussed this work today at a special briefing during the 2024 Annual Meeting of the American Psychiatric Association (APA).
The study of substance use initiation predictors was led by ReJoyce Green, Ph.D., assistant professor at the Medical University of South Carolina. Green and colleagues examined a multitude of factors using sociodemographic, hormonal, neurocognitive, and neuroimaging data from the Adolescent Brain Cognitive Development Study. They looked at data on 420 variables for more than 6,800 youths (ages 9-10), following them over three years. The analysis used a statistical approach that accounts for the complexity of the data (a penalized logistic regression with elastic net).
By age 12, approximately 14.4% of the youths had initiated substance use and the most commonly reported substances were alcohol, cannabis and nicotine, similar to previous research findings. Among the sociodemographic factors predicting substance use initiation were religion, race and income. Religion was a strong protective factor for Mormon youths, while Jewish youths were more likely than those from other religions to initiate substance use. Black youths were less likely to initiate substance use than white youths, and those from a lower-income background were more likely than others to initiate substance use. Prenatal exposure to substance use was among the top predictors, with prenatal exposure associated with a greater likelihood of initiation. In addition, youth with a history of school detention and suspension were more likely than others to initiate substance use. Several modifiable risk factors also predicted greater likelihood of substance use initiation, including substance availability, peer use of alcohol and nicotine, and sensation seeking (need for varied, novel, and complex sensations and experiences).
The findings suggest that for this age group, resource-intensive data-collection methods (such as collecting hormonal, neurocognitive, and neuroimaging data) do not improve the ability to predict substance use beyond using data obtainable through self-report. Data related to self-, peer-, and familial-related factors was more informative than resource-intensive methods in predicting substance use initiation during late childhood and early adolescence. Children and teens who begin substance use early are at greater risk of developing a substance use disorder and psychosocial problems in adulthood, and results of this study provide data that can be useful in streamlining and tailoring prevention and early intervention efforts.
Other papers from the special issues featured at the APA Annual Meeting include commentaries highlighting cannabis risks and reflecting on 50 years of the National Institute on Drug Abuse (NIDA). The full issue, guest edited by Kathleen T. Brady, M.D., Ph.D., is available online.
Cannabis Use Among Adolescents
A commentary from Jesse D. Hinckley, M.D., Ph.D., Jacqueline-Marie N. Ferland, Ph.D., and Yasmin L. Hurd, Ph.D., examines the changing cannabis use landscape for adolescents, focusing on the increased risks for developing cannabis use disorder and other psychiatric illnesses due to the higher potency and availability of cannabis. They highlight the current research and understanding, such as the key risk factors for cannabis use disorders: early use and frequent use. Adolescents who start using cannabis before age 16 years are at the highest risk of developing the disorder.
“The plasticity of the developing brain offers windows of opportunity for prevention and early intervention to change that trajectory,” the authors write. “Clearly new treatment strategies are needed to address the mounting challenge of [cannabis use disorder] risk in teens and young adults.”
50 Years of the National Institute of Drug Abuse
NIDA Director Nora Volkow, M.D., highlights the agency’s contributions to scientific advancements in the field over the past 50 years. These include the innovation of powerful research tools that have allowed researchers to better understand and investigate the circuitry underpinning drug reward and addiction, the development and testing of evidence-based prevention and treatment strategies, the development of new treatments and products to address the overdose crisis, and more.
“A half-century of NIDA research has shown clearly that SUDs are chronic but treatable brain disorders that emerge from the complex interplay of biological, social, and developmental factors,” writes Volkow. “The continued losses from overdoses are forefront in our minds as we vigilantly seek novel scientific and policy solutions to end the current crisis and support people’s recovery from addictive disorders that we know — because the science shows it — is achievable.”
The special issue of the American Journal of Psychiatry coincided with APA President Petros Levounis, M.D., M.A.’s theme for the year and the meeting: Confronting Addiction: From Prevention to Recovery.
American Psychiatric Association
The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with more than 38,900 physician members specializing in the diagnosis, treatment, prevention and research of mental illnesses. APA’s vision is to ensure access to quality psychiatric diagnosis and treatment. For more information, please visit www.psychiatry.org.
JOURNAL
American Journal of Psychiatry
ARTICLE PUBLICATION DATE
6-May-2024
Parents’ watchful eye may keep young teens from trying alcohol, drugs: Study
IMAGE:
"NO USE OF SUBSTANCES" SIGN
view moreCREDIT: JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
PISCATAWAY, NJ – Teenagers are less likely to drink, smoke or use drugs when their parents keep tabs on their activities--but not necessarily because kids are more likely to be punished for substance use, suggests a new study in the Journal of Studies on Alcohol and Drugs.
Researchers found that, contrary to common belief, parents’ “monitoring” does not seem to boost the odds of catching their kids using substances. However, when kids simply are aware that their parents are monitoring behavior, they avoid trying alcohol or drugs in the first place.
It is the fear of being caught, rather than actually being punished.
Many studies have found that adolescents are less likely to use substances when they have parents who monitor--meaning that parents are aware of their kids’ activities, know their friends and know their whereabouts when they are not at home.
The assumption has been that monitoring works because parents are more likely to catch substance use and make sure there are consequences--grounding their kids or taking away their smartphones, for example, said William Pelham, the lead researcher on the new study. That, in turn, might keep kids from making the same mistake twice.
But it appears that assumption is wrong, said Pelham, an assistant adjunct professor of psychiatry at the University of California, San Diego.
Instead, he explained, the new findings suggest that monitoring teenagers can reduce their chances of using alcohol or drugs simply by making them think twice, whether or not parents succeed in catching them.
The results are based on survey responses from over 4,500 11- to 15-year-olds from 21 communities across the United States. Participants were asked about their substance use in the past month, including whether their parents found out about it. They also completed a standard questionnaire on parental monitoring (how often their parents knew their whereabouts or asked about their plans for the day, for instance).
Overall, 3.6% of kids said they had used alcohol or drugs in the past month, and there was no evidence that parents’ monitoring increased their likelihood of finding out about those instances.
In contrast, some kids said there were times in the past month that they planned or had the chance to drink or use drugs, but they chose not to out of fear that their parents would find out. If not for those second thoughts, Pelham’s team found, substance use would have been 40% higher in the study group as a whole.
Understanding why monitoring works is important, Pelham said, in order to give parents more specific advice on how to do it. These findings suggest that it might not be necessary to catch kids in the act of substance use: If they know their parents are keeping track of them, that might be enough.
However, that may not always apply, Pelham pointed out. This study focused on younger adolescents who were not heavy substance users, he said. When kids have more serious substance use issues, negative consequences might become a more important tool.
More broadly, the findings underscore the point that parents’ actions matter when it comes to kids’ substance use.
“Some parents think drinking or using drugs is something that kids are just going to do, no matter what,” Pelham said. “But that’s not true. Parents can make a difference.”
-----
Pelham III, W. E., Tapert, S. F., Gonzalez, M. R., Ahiarakwe, U., Patel, H., Davis, I. S., Meruelo, A., van Rinsveld, A. M., Marshall, A. T., Dick, A. S., Guillaume, M., Dowling, G. J., Baskin-Sommers, A., & Brown, S. A. (2024). How does parental monitoring reduce adolescent substance use? Preliminary tests of two potential mechanisms. Journal of Studies on Alcohol and Drugs, 85(3), 389–394. https://doi.org/10.15288/jsad.23-00297
-----
To arrange an interview with William E. Pelham III, please contact Annie Pierce, Senior Communications and Media Relations Manager, at arpierce@health.ucsd.edu or 858-249-0423.
-----
The Journal of Studies on Alcohol and Drugs considers this press release to be in the public domain. Editors may publish this press release in print or electronic form without legal restriction. Please include a byline and citation.
-----
To view the public domain, stock-photo database of alcohol, tobacco and other drug-related images compiled by the Journal of Studies on Alcohol and Drugs, please visit www.jsad.com/photos.
JOURNAL
Journal of Studies on Alcohol and Drugs
METHOD OF RESEARCH
Survey
SUBJECT OF RESEARCH
People
ARTICLE TITLE
How does parental monitoring reduce adolescent substance use? Preliminary tests of two potential mechanisms
ARTICLE PUBLICATION DATE
7-May-2024
Clinical trial shows that cytisinicline can help people quit vaping
MASSACHUSETTS GENERAL HOSPITAL
BOSTON–Eleven million U.S. adults use e-cigarettes to vape nicotine, and about half of them say that they want to stop, but many have trouble doing so because nicotine is an addictive drug.
A plant-based medication called cytisinicline may be an effective therapy to help them stop vaping, according to the results of a new clinical trial co-led by an investigator from Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare system. The trial’s findings are published in JAMA Internal Medicine.
In the double-blind randomized clinical trial, 160 adults who vaped nicotine but did not currently smoke cigarettes were assigned to take either oral cytisinicline or placebo tablets for 12 weeks. All participants had weekly behavioral support to stop vaping.
At the end of treatment, participants receiving cytisinicline were more than twice as likely as those receiving placebo to have successfully abstained from vaping for weeks 9 to 12 (31.8% vs 15.1%, p=.04). The drug was well tolerated, with comparable rates of side effects between the groups. The study was conducted at Massachusetts General Hospital and 4 other sites.
“No medication has been approved by the FDA for vaping cessation in the United States,” said lead author Nancy A. Rigotti, MD, director of Massachusetts General Hospital’s Tobacco Research and Treatment Center and a professor of medicine at Harvard Medical School. “Our study indicates that cytisinicline might be an option to fill this gap and help adult vapers to stop using e-cigarettes.”
The team tested cytisinicline for vaping because the drug binds to nicotine receptors on brain cells. In their previous clinical trial, the research team found that cytisinicline helped people to quit smoking traditional cigarettes. They hypothesized that it might also help people to stop vaping nicotine. “The results of our study need to be confirmed in a larger trial with longer follow-up,” said Rigotti, “but they are promising.”
Authorship: Nancy A. Rigotti, MD; Neal L. Benowitz, MD; Judith J. Prochaska, PhD, MPH; Daniel F. Cain, BSc; Juli Ball, MS; Anthony Clarke, PhD; Brent A. Blumenstein, PhD; and Cindy Jacobs, PhD, MD.
Disclosures: Dr. Rigotti has consulted with Achieve Life Sciences and MGH has received research grants for clinical trials of cytisinicline for smoking cessation. Disclosure forms provided by the authors are available with the full text of this article at JAMA Internal Medicine.
Funding: The trial was funded by a grant from the National Institute of Drug Abuse and by Achieve Life Sciences, a pharmaceutical company that is developing cytisinicline as a treatment for nicotine dependence.
Paper cited: Rigotti NA et al. “Cytisinicline for Vaping Cessation in Adults Using Nicotine E-Cigarettes—The ORCA-V1 Randomized Clinical Trial.” JAMA Internal Medicine
DOI: 10.1001/jamainternmed.2024.1313
###
About Massachusetts General Hospital
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. MGH is a founding member of the Mass General Brigham healthcare system.
JOURNAL
JAMA Internal Medicine
ARTICLE TITLE
Clinical trial shows that cytisinicline can help people quit vaping
ARTICLE PUBLICATION DATE
6-May-2024
Contract treatment reduces recidivism and substance-related adverse health events
Substance use disorder treatment in the community is a superior alternative to incarceration for offenders with a substance misuse background, according to a recent study evaluating the effectiveness of the contract treatment sanction in Sweden.
Contract treatment refers to a criminal penalty in which the offender voluntarily consents to treatment in accordance with a specific implementation plan.
“Contract treatment is an alternative to incarceration. It is mainly used when the offence is deemed to have occurred as a result of substance misuse or some other condition requiring treatment,” says Suvi Virtanen, a University Lecturer in Psychology at the University of Eastern Finland.
A rehabilitation period is always planned based on individual needs. In addition to psychosocial treatment, it may include opioid substitution therapy.
In addition to Sweden, a sanction similar to contract treatment is in use in, e.g., Norway and many EU countries; however, not in Finland. The United States, in turn, has adopted a model of specialised drug courts.
Contract treatment carries a smaller risk of recidivism
Although contract treatment has been in use in Sweden since the late 1980s, its effectiveness has not been studied until now. The present study combined data from the Swedish Prison and Probation Service’s client register with other national registries, including data on visits to specialised health care. The study cohort included 11,893 individuals who were serving a contract treatment sanction between 1999 and 2012, and they were followed up for at least two years.
“With the introduction of contract treatment, criminal behaviour and substance-related adverse health events, such as overdoses and hospitalizations due to psychiatric and somatic reasons, decreased significantly compared to the period before contract treatment,” Virtanen says.
A significant proportion of those sentenced to contract treatment had also served community sanctions and prison sentences. In the within-individual research design, an individual’s risk of recidivism and adverse health events during contract treatment was examined compared to periods when the individual was serving a community sanction or was on parole after a prison sentence.
“The risk of recidivism and adverse health events was lower during contract treatment than during a community sanction or probation,” Virtanen notes.
Providing treatment yields better results than punishment
Substance misuse problems and criminality often go hand in hand. The most effective way to prevent recidivism is to address its root causes, which often are, in one way or another, linked to the use of substances.
“Substance use disorders are increasingly understood as a health issue that should primarily be addressed by means of health care. Usually, prison is not the best place for an individual who needs appropriate treatment and support for recovery,” Virtanen says.
The results of the study provide support for the notion that, from the viewpoint of societal security and public health, providing treatment can lead to better outcomes than penalties that emphasise punishment.
In the future, the researchers intend to study the effectiveness of contract treatment in more recent data.
JOURNAL
BMC Psychiatry
ARTICLE TITLE
Effectiveness of substance use disorder treatment as an alternative to imprisonment.
No comments:
Post a Comment